Blood flow restriction (BFR) training uses BFR cuffs to limit blood flow to specific muscles during exercise. This method has gained popularity for its ability to enhance muscle growth and strength with lighter weights. Originally developed in Japan in the 1960s, BFR training has evolved into a widely used strategy among athletes and fitness enthusiasts looking to maximize their workout results efficiently.
Blood flow restriction training involves partially restricting the blood flow to the working muscles during exercise. This is typically done using specialized BFR cuffs placed around the limbs. By limiting blood flow, it creates a temporary hypoxic (low-oxygen) environment in the muscles, leading to increased metabolic stress and muscle growth.
BFR training generally allows you to achieve muscle and endurance gains at lower intensities and in shorter time frames compared to traditional exercise methods.
To understand how BFR cuffs do their thing it is helpful to understand the difference between arterial versus venous blood flow.
Arterial blood flow refers to the oxygen-rich blood flow from the heart to the rest of the body through the arteries. In contrast, venous blood flow refers to the return of oxygen-depleted blood from the body's tissues back to the heart through the veins.
You are likely familiar with how a tourniquet works.
A tourniquet—by definition—is designed to occlude, or obstruct, arterial flow.
This same function forms the basis for the BFR cuff.
The applied pressure from the cuff partially restricts arterial blood flow, reducing the amount of oxygen-rich blood reaching the targeted muscles. At the same time, the pressure fully occludes venous blood flow, preventing the oxygen-depleted blood from returning to the heart.
This process allows for blood to get into the muscle, but not out and provide the sensation of what many people describe as a pump. The scientific name for this pump feeling is cellular swelling.
Cellular swelling occurs when the muscle becomes engorged with blood and is magnified by moderate to higher repetitions with limited rest intervals.
First, for the upper limbs apply the BFR cuff to the upper arm and for lower limbs on the upper thigh. Then, ensure they are snug but not causing any discomfort.
In general, BFR training is most effective when targeting muscles that are distal, or below, the cuff used to restrict blood flow.
For upper body BFR training, this would be biceps, triceps, and forearms.
For lower body training, targeted muscles would be quads, hamstrings, and calves.
You do this because the blood flow restriction creates a localized hypoxic (low oxygen) environment that stimulates the targeted muscles' metabolic and physiological responses, enhancing the effectiveness of the exercise.
It’s worth mentioning that there is absolutely no issue with training non-distal muscles under BFR; however, the muscles that will likely benefit the most are those that are distal to the cuff.
Maintaining safe pressure levels is crucial for effective blood flow restriction training.
Recommended pressure typically ranges between 40-80% of arterial occlusion pressure (AOP).
AOP, sometimes referred to as LOP (limb occlusion pressure), is the minimum amount of pressure required to completely stop blood flow to a limb.
The desired AOP is often measured by a percentage reading on the BFR cuff device. The device adjusts the pressure based on your desired result.
It is important not to exceed this range as it can lead to adverse effects, while lower pressures may not induce the desired training adaptations.
During blood flow restriction exercises, it's essential to continuously monitor the limb's color, temperature, and sensation. Any changes in color or numbness indicate excessive pressure and require immediate band adjustment or removal.
Regularly check a limb's condition throughout the session to ensure safety and optimal training benefits.
Applications and Benefits of Blood Flow Restriction Training
A BFR workout can be most beneficial for:
Enhanced Muscle Growth: BFR workouts can allow you to put on muscle and strength even while training with significantly less weight. The restricted blood flow causes metabolic byproducts to accumulate in the muscles, triggering a greater response for muscle hypertrophy—the muscle growth that occurs when the body repairs the muscle trauma experienced from exercise.
Time Efficiency: With lower loads, individuals can achieve similar muscle-building effects as heavy lifting in less time.
Injury Recovery: Blood flow restriction training can be beneficial for individuals recovering from injuries as it allows for lighter loads with reduced joint stress.
Enhanced aerobic endurance: More research is needed on this topic to truly determine if there are any benefits to VO2 max. The limited number of studies combined with conflicting results make it difficult to draw conclusions.
Rehabilitation: BFR workouts have the ability to promote muscle growth and strength gains at lower exercise intensities allows individuals to stimulate muscle development without placing excessive stress on the joints, tendons, or healing tissues.
Manage fatigue: build or maintain muscle while minimizing fatigue and joint stress associated with heavy lifting. By stimulating muscle growth and strength gains at lower intensities, BFR training allows individuals to train without the added strain of heavy resistance training. This can be beneficial for athletes during periods of high training volume, as it allows them to continue building strength and muscle without increasing the risk of overuse injuries.
Travel: BFR training an excellent option for individuals who have limited access to equipment, such as during travel or in situations where weights are not available. Low -intensity resistance or even bodyweight exercises with BFR cuffs can still promote muscle growth.
Time constraints: BFR workouts typically require shorter durations and less rest between sets to elicit muscle growth, making them ideal for busy individuals seeking to maximize their training in a limited amount of time.
The following is a recommended framework for achieving maximum results with BFR cuffs
Pressure: 40-80% of AOP depending on exercise and individual tolerance.
Load: Train with loads between 20 - 40% of 1RM (1 repetition maximum). Generally, this should be a weight in which 20-30 reps under BFR leads close to or to failure.
3-4 exercises per session
2-3 weeks preferred
Reps and Rest: BFR training is most effective when performed with high repetitions (e.g., 15-30 reps per set) and short rest intervals (e.g., 30-60 seconds between sets). A common protocol involves performing four sets with reps of 30-15-15-15 and 30-60 seconds of rest between sets.
Training to failure under BFR does not appear to be necessary. Instead, finishing most sets with 1-4 reps in reserve is probably most effective at maximizing stimulus while minimizing fatigue.
Seeking guidance from healthcare professionals or fitness experts can provide valuable insights into tailoring a blood flow restriction training program. Their expertise can help optimize the training regimen based on individual factors such as age, fitness level, and specific goals.
A 2022 extensive literature review pertaining to BFR training and any adverse events related to its usage concluded that BFR training can be utilized safely in the proper patient population when administered by qualified professionals who have undergone the appropriate training.
Of the studies that reported a specific number of individuals noting adverse events, a total of 1672 individuals (n = 25,813) or 6.47% indicated experiencing a Grade 1 adverse outcome. Commonly reported as numbness, dizziness, subcutaneous hemorrhage, and rhabdomyolysis.
Grade 1 adverse outcomes defined as follows: Any deviation from the normal therapeutic course without the need for any pharmacologic, surgical, or radiographic intervention.
Although no absolute contraindications have been established for BFRT as it is a relatively new treatment modality, there have been plausible contraindications noted.
Potential increases in adverse outcomes can be associated with pre-existing hematologic diseases such as sickle cell anemia, Factor V Leiden, past events with venous thromboembolism, liver disease, or any other cause that increases the risk for blood clotting.
All factors that may increase an individual’s risk for adverse events should be noted and discussed before starting BFR training.
Final Thoughts
Incorporate BFR cuffs and blood flow restriction training sensibly into your fitness regimen, following outlined guidelines diligently. Prioritize safety above all else, ensuring a sustainable and effective workout routine. Stay informed, consult professionals when needed, and unlock the full potential of this cutting-edge training method. At Stretch Affect our San Diego physical therapists successfully use Saga Fitness BFR cuffs to promote muscle growth during times of recovery offering a beneficial workout for anyone needing to modify their workout and still realize gains.
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