BFR & Effects

BFR – Effect Size & Versus Conventional Exercise Modalities


Aerobic Capacity <strong>⬇</strong>
Forest plot of the overall (Total) and subgroup effects of blood flow restricted exercise on aerobic capacity

Formiga et al. (2020) effect of aerobic exercise training with and without blood flow restriction on aerobic capacity in healthy young adults- a systematic review with meta-analysis
Muscle Strength (High-load vs BFR) <strong>⬇</strong>
Forest Plot (Random effects) as the distribution of studies calculated from post-intervention scores on gains in maximal muscle strength

Grønfeldt et al. 2020 – Effect of blood-flow restricted vs. heavy-load strength training on muscle strength- Systematic review and meta-analysis
Forest plot demonstrating the effects of LL-BFR versus HL
training on muscular strength. Random effects model

Centner et al. (2019) Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis
Muscle Strength (Low-load vs BFR) <strong>⬇</strong>
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Fig. 4 Forest plot demonstrating the effects of LL-BFR vs. LL resistance training on muscular strength. Random effects model

Centner et al. (2019) Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis
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Fig. 2 Forrest plot displaying the difference in muscle strength between the LL-BFR and LL resistance training

Slysz et al. (2016) The efficacy of blood flow restricted exercise: A systematic review &
meta-analysis
Muscle Mass (High-load vs BFR) <strong>⬇</strong>
Fig. 3 Forest plot demonstrating the effects of LL-BFR versus HL training on muscle mass. Random effects model

Centner et al. (2019) Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis
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Fig. 7 Forest plot displaying the overall ESdiff for muscle hypertrophy between high-load resistance training (HL-RT) vs. low-load resistance training

Lixandrao et al. (2018) Magnitude of Muscle Strength and Mass Adaptations Between High-Load Resistance Training Versus Low-Load Resistance Training Associated: Review and Meta-Analysis
Muscle Strength & Mass (Walking vs BFR-Walking) <strong>⬇</strong>
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Fig. 5 Forest plot demonstrating the effects of walking + BFR versus normal walking on muscular strength. Random effects model

Centner et al. (2019) Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis
Fig. 6 Forest plot demonstrating the effects of walking + BFR versus normal walking on muscle mass. Random effects model

Centner et al. (2019) Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis


Effect Size – A Nuanced Perspective <strong>⬇</strong>

There are many ways to compare the effect of Low-load resistance occlusion training (BFR) (20-50% of 1RM) vs. conventional Resistance Training (RT) / No-BFR, this results in varying conclusions of wherever BFR is more or less effective.


Low-load BFR (20-50% of 1RM) vs High-load No-BFR (60-90% of 1RM) – Repetitions to failure

Short-term muscle mass: Probably BFR
Long-term muscle mass: Similar
Short-term muscle strength: Similar
Long-term muscle strength: Probably High-Load
Muscle endurance: BFR
Rate of Force Development (RFD) / explosive strength– e.g. fall prevention, vertical jump, etc: High-load RT

Low-load BFR (20-50% of 1RM) vs Low-load No-BFR (20-50% of 1RM) – Volume matched (equal load and repetitions)

Short-term muscle mass: BFR
Long-term muscle mass: BFR
Short-term muscle strength: BFR
Long-term muscle strength: BFR
Muscle endurance: BFR
Rate of Force Development (RFD) / explosive strength e.g. fall prevention, vertical jump, etc: Probably BFR

Low-load BFR (20-50% of 1RM) vs Low-load No-BFR (20-50% of 1RM) – Load matched but repetitions to failure

Short-term muscle mass: Similar
Long-term muscle mass: Similar
Short-term muscle strength: Similar
Long-term muscle strength: Similar
Muscle endurance: Similar

Rate of Force Development (RFD) / explosive strength e.g. fall prevention, vertical jump, etc: Similar


Source:
Slysz et al. (2016) – The efficacy of blood flow restricted exercise A systematic review & meta-analysis
Hughes et al. (2017) – Blood flow restriction training in clinical musculoskeletal rehabilitation in systematic review and meta-analysis
Grønfeldt et al. (2020) effect of blood-flow restricted vs. heavy-load strength training on muscle strength: systematic review and meta-analysis


Copyright @pheasyque

When comparing (LL-BFR) vs (LL-No-BFR) as load matched and taken to failure, the number of repetitions needed to elicit muscular adaptions is significantly less. The most recent literature shows 10-60% fewer repetitions are needed to reach the same state of muscular fatigue. But the time-benefit of doing BFR is relative to the amount of relative pressure, being that higher pressure 70-90% of Limb Occlusion Pressure (LOP) seems to be favorable for most circumstances. This is particularly relevant when using very low-load (<25% 1RM), as there seems to be a threshold of at least 60% LOP when using very low load. From the literature, it seems that relative load and relative pressure exist on a mutually affected continuum. When using moderate-loads (40-50% of 1RM) use less pressure (40-60% LOP). On the other hand, when utilizing very low-load (<25% of 1 RM) It is strongly recommended to use higher relative pressures (70-90% LOP).



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The Pressure-Load Continuum in Blood Flow Restriction Training

The load-pressure continuum appears important, especially in situations of early post-operation rehab with absolute load restrictions. Conversely, using BFR for the general public without any strict load restriction, it is probably favorable to utilize lower pressure (40-60% LOP) but higher relative load (30-50% 1RM).



Source:
Cerqueira et al. (2021) Repetition Failure Occurs Earlier During Low-Load Resistance Exercise With High But Not Low Blood Flow Restriction Pressures: A Systematic Review and Meta-analysis
Pignanelli et al. (2019) Low-load resistance training to task failure with and without blood flow restriction- Muscular functional and structural adaptations


Nerd Alert – The Adaptive Muscle Response <strong>⬇</strong>

The partial restriction of blood flow in combination with muscles contractions creates short-term edema (cell swelling) around the muscle cells, which limits the supply of oxygen and nutrients so that metabolites accumulate (Cayot et al., 2014). This initiates a cascade of physiologic processes, like the increase of growth hormone secretion, as approximately 2-3 fold greater compared to conventional resistance training. But also the increased activation of muscle satellite cells, about two-fold larger than conventional resistance training. This upregulates the net protein synthesis.(Yasuda et al., 2014; Segal et al., 2010; Roos and Lohmander, 2003). Check also the Blog post from September 17, 2020.


↑ Muscle oxygenation – hypoxia leading to short term ischemia
↑ Metabolite accumulation – accumulation of waste products
↑ Recruiting fast twice muscle fibers
↑ Cell Swelling
↑ Growth hormone 200-300% compared to conventional resistance training – relevant for bone and tendon health
↑ Satellite cell proliferation

↓ Secretion of muscle growth inhibitors (myostatin) – especially important for building muscle tissue
↑ Netto protein synthesis = Hypertrophy (muscle growth)
↑ Muscle strength and endurance
↓ Metabolic resistance – relevant for metabolic syndrome and diabetes
↑ Anaerobic threshold
↑ Mitochondrial content


These processes are further described in the scientific literature, by especially the leading researcher and Associate Professor of Exercise Science Jeremy P. Loenneke. He has contributed to the body of evidence and accumulated knowledge concerning BFR. For the past 12-14 years, he has co-authored several mechanistic and effect studies concerning Blood Flow Restriction.


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Copyright @chrisabeardsley
Other Effects Associated with BFR

  • Treatment of sarcopenia by increasing muscle mass (protective for a wide range of age-related issues and chronic conditions (101 BFR Research Papers)
  • Greater muscle strength – directly transferable to everyday activities (ADL) Fall prevention
  • Improved circulatory system
  • Better self-reported health
  • Improved bone, cartilage & tendon properties
  • Increased aerobic & anaerobic fitness
  • Enhanced body composition

Currently, a quick search on BFR via Pubmed shows >500 published scientific papers across all continents, which manifests the effects of BFR Training

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Copyright @thehpm

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