What is BFR (Blood Flow Restriction) Occlusion Training?
February 11, 2021 – 9 min read (great advice!)
Home workouts have become part of the new normal this year due to the COVID-19 pandemic. However, none of us were prepared for what was to come next. At least for me, not being equipped with a full home gym or adequate training equipment before the pandemic hit has been interesting. Finding equipment like dumbbells and free weights was like trying to find toilet paper and continues to be challenging. Nevertheless, finding alternative training programs, methods, and approaches that can make your home workouts more effective has never been more imperative. Blood Flow Restriction (BFR) training is an exercise method that has been increasingly growing in popularity over the years. BFR training allows you to make gains in muscle and strength using light/low load intensity that are comparable to the gains achieved using heavy weight, high intensity. BFR training is an exercise approach that should be contemplated regardless of whether you are staying home for your workouts or fortunate enough to be going to your local gym. BFR training is not only for those who are trying to get the most out of their workouts but also personal trainers and sports medicine rehabilitation professionals working with injured athletes or the elderly. In this article I will explain what is BFR training, why is BFR training important, and provide 10 topline reminders. As always, speak with your health care provider prior to starting any dietary supplement, diet, or exercise program.
What is BFR (Blood Flow Restriction) Training?
Blood flow restriction (BFR), occlusion, hypoxic, or kaatsu training is an exercise method or approach used with both low intensity aerobic (walking) or low intensity anaerobic (resistance weight lifting) training that requires a band, cuff, or wrap to the upper portion of a limb (arm or leg) to restrict blood flow out of the exercising muscle.
BFR training originated in Japan and was developed by Dr. Yoshiaki Sato, where it was called “kaatsu training,” meaning “training with added pressure.” Dr. Yoshiaki Sato appears to have spent a lifetime developing kaatsu training dating back to 1966 and perfecting variations of training protocols for different ages and treatments. Dr. Sato applied and was granted patents in 1994 from Japan, U.S., and Europe. He developed instructional training routines, equipment, and certification programs. Kaatsu training is now used globally and typically referred to as BFR training.
The first BFR training study appears to be a paper published by Shinohara in the European Journal of Applied Physiology 1998 . Some of the leading BFR researchers include Dr. Jeremy Loenneke from the University of Mississippi and Dr. Jacob Wilson from the Applied Science and Performance Institute. BFR training research over the years has been examining mechanisms of action, safety, frequency, cuff sizes, cuff material, % intensity, protocols, and amount of cuff pressure. There appears to be three main categories of use for BFR training, which include the absence of exercise or loss of mobility due to surgery in order to slow down muscle and strength loss, low intensity walking or cycling, which can actually produce some muscle growth, and light/low load intensity resistance training, which produces the greatest increases in muscle and strength.
BFR training when done properly allows blood to flow into the muscle (arterial flow) but restricts blood flow out of the muscle (venous flow) allowing the blood to pool in the muscle acutely. Application of the cuff ONLY to the upper portion of the arms or legs NEEDS to be at a perceived pressure of 6 or 7 on a scale of 10 being the tightest to allow for the flow of blood into the muscle while restricting the flow out the exercising muscle. If the cuff is too tight blood will NOT flow properly into the muscle possibly resulting in a negative impact to the muscle via muscle atrophy or muscle loss. The BFR resistance training mechanism of action is thought to be multifactorial and includes increased motor unit recruitment, metabolic stress, and cell swelling (pump). However, the main mechanism appears to be the shift of fluid or blood from plasma into the muscle causing cell swelling and an accumulation of metabolites thus signaling muscle anabolism. Keep in mind BFR resistance training should be performed with light/low load intensity at 20-40% of 1 repetition maximum (RM). BFR resistance training can be performed every other day, 2-3 times per week alone, or in combination with your regular heavy/high load intensity resistance training as an ending or finishing super set.
Why is BFR (Blood Flow Restriction) Training Important?
American College of Sports Medicine (ACSM) recommends 60-80% high intensity of your 1 repetition maximum (RM) for increases in both muscle hypertrophy (growth) and strength, which typically ends up around 8-12 repetitions (reps). Traditional bodybuilders or weight lifters will use ~16-20 total sets with 4 different exercises and 4 to 5 sets per exercise for large body parts like chest, back, or legs. However, for small body parts such as biceps, triceps, shoulders, and trapezoids they will use ~9-12 total sets with 3 different exercises and 3 to 4 sets per exercise. This exercise routine at 60-80% 1 repetition maximum (RM) high intensity is designed to increase motor unit recruitment, metabolic stress, and cell swelling (pump) with the eccentric (downward) motion producing greater responses to type II fast-twitch muscle fiber growth than the concentric (upward) motion.
BFR resistance training, on the other hand, pre-fatigues the type I slow-twitch muscle fibers that require oxygen (aerobic) thus leveraging the type II fast-twitch muscle fibers (anaerobic). This is accomplished inherently by emphasizing the concentric (upward) motion due to the light/low load intensity with continuous high reps (30, 15, 15, 15). BFR training requires low load intensity at 20-40% of 1 repetition maximum (RM) every other day 2-3 times per week and has been shown produce muscle hypertrophy (growth) and strength gains in experienced athletes accustomed to using heavy/high load intensity training protocols. BFR resistance training has also been shown to produce beneficial muscular responses in healthy athletes that combine both heavy/high load intensity resistance training with BFR light/low load intensity training.
BFR resistance training provides an effective training method for healthy, injured / rehab, or eldery individuals looking to gain or maintain muscle size and strength. As always, speak with your health care provider prior to starting any dietary supplement, diet, or exercise program. Healthy individuals working out at home due to the COVID-19 pandemic can benefit by enhancing or maximizing the impact from their current workout by adding BFR resistance training, especially if they are forced to use light/low load intensity due to lack of equipment. Weight lifters that are still going to the gym can also benefit from BFR resistance training by using it alone or adding it to their heavy/high load intensity resistance training to improve a lagging body part, break a strength plateau, or nurse a sore joint.
Reminders for BFR (Blood Flow Restriction) Resistance Training
- Warm up prior to using BFR resistance training alone
- Alternatively use BFR resistance training as an ending super set exercise in combination with heavy/high load intensity resistance training
- BFR resistance training requires low load intensity at 20-40% of 1 repetition maximum (RM)
- Start BFR resistance gradually only once per week building up to 3 times per week
- Use every other day 2-3 times per week
- Start sets gradually with 2 sets (30 & 15 reps) building up to 4 sets (30, 15, 15, 15 reps)
- 30 second rest periods between each set
- Only wrap at the high portion of the arm or leg
- Wrap NEEDS to be at a perceived pressure of 6 or 7 on a scale of 10 being the tightest
- Don’t over train
The key takeaway of this article includes an understanding that BFR training can be used in three main areas including the absence of exercise due to surgery or injury, low intensity aerobic exercise (walking), and light/low load intensity anaerobic resistance exercise (weight lifting). BFR resistance training requires light/low load intensity at 20-40% of 1 repetition maximum (RM). It can be used every other day 2-3 times per week with one exercise of 4 sets (30, 15, 15, 15 reps) and 30 second rest between each set. BFR resistance training has many beneficial muscle and strength building applications and is somewhat counterintuitive due to the light/low load intensity. However, this is what makes it an ideal adjunct to your current home workout especially if you are lacking weights and/or equipment. BFR resistance training allows you to obtain the muscle and strength gains from heavy/high load intensity resistance training by using light/low load intensity resistance training. This is the first installment in a series of BFR training articles so keep an eye out for the next article coming soon!
- Patterson, Stephen D et al. “Blood Flow Restriction Exercise: Considerations of Methodology, Application, and Safety.” Frontiers in physiology vol. 10 533. 15 May. 2019, doi:10.3389/fphys.2019.00533
- Shinohara M, Kouzaki M, Yoshihisa T, Fukunaga T. Efficacy of tourniquet ischemia for strength training with low resistance. Eur J Appl Physiol Occup Physiol. 1998;77(1-2):189-91. doi: 10.1007/s004210050319. PMID: 9459541.
- Vanwye, William R et al. “Blood Flow Restriction Training: Implementation into Clinical Practice.” International journal of exercise science vol. 10,5 649-654. 1 Sep. 2017
- Scott BR, Loenneke JP, Slattery KM, Dascombe BJ. Blood flow restricted exercise for athletes: A review of available evidence. J Sci Med Sport. 2016 May;19(5):360-7. doi: 10.1016/j.jsams.2015.04.014. Epub 2015 May 9. PMID: 26118847.
About the Author
Sal Abraham, PhD MS RDN LDN
Sal has been working and leading in the food, dietary supplement, and health care industry for over 25 years. He holds both undergraduate and graduate degrees in Foods and Human Nutrition with a Doctorate in Health Sciences and a specialization in International Health. He is a Registered & Licensed Dietitian Nutritionist, ex-competitive bodybuilder, and passionate fitness / health and wellness expert.
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