Fit Cuffs BFR Blog
Browse through our blog posts to learn more about evidence-based BFR Training
November 29, 2021
How much pressure is needed for BFR Training? – The Pressure-Load Continuum ⬇️
A recent review by Queiros et al. has explored how different restriction pressures measured as % Limb Occlusion Pressure / Arterial Occlusion Pressure (LOP) effects fatigue.
Considering the association between metabolite induced fatigue with muscle hypertrophy, some authors have investigated how manipulating BFR pressures during exercise can exert an effect on the level of acute fatigue i.g., Maximum Voluntary Contraction (MVC) or electromyography (EMG).
The data from the original studies are divergent, but it seems that very low-load resistance exercise performed with higher pressures evokes higher levels of acute fatigue and overall training effect known as the pressure-load continuum.
Systematically review and pooling of available data on neuromuscular and metabolic responses at Low-Load BFR resistance exercise (LL-BFR) with different pressures (% of LOP/AOP).
The effects of different restriction pressures on neuromuscular responses can assist trainers and physical therapists in more appropriate and safer prescriptions.
1. Maximum Voluntary Contraction (MVC)
2. Surface Electromyography (EMG)
40% vs. 60% LOP – No difference.
30% of 1 RM: 40-50% vs. 80-90% LOP – No difference.
15-20% 1 RM: 40-50% vs. 80-90% LOP – Favor of High Pressure.
40-80% LOP vs. No-BFR (Free Flow) – Favor of BFR.
“Not failure protocols”: 40% vs. 60% or 80% LOP – Favors Higher Pressure.
“Failure protocols”: 40% vs 80% LOP – Favors Less Pressure
Low-load 40-80% LOP vs. Low-Load No-BFR – No difference.
Low-load 40-80% LOP vs. High-Load No-BFR – Favors High-Load.
Not surprisingly, low-load resistance exercise with (40-90% LOP) BFR pressure induces more fatigue than No-BFR low-load.
For very low-load (15–20% 1RM) higher pressure (about 80% LOP) can increase the magnitude of fatigue and are thereby recommended. On the other hand, it seems that higher pressures (≥80%) with loads of 20-40% 1 RM should not be performed to failure but instead use a pre-defined repetition schemes e.g., 30x15x15x15 reps.
Queiros et al. (2021) Myoelectric Activity and Fatigue in Low-Load Resistance Exercise With Different Pressure of Blood Flow Restriction- A Systematic Review and Meta-Analysis
November 10, 2021
BFR Training to improve dynamic stability of the shoulder complex!? ⬇️
As a related topic, the potential of BFR combined with “functional” training has been discussed in an opinion article from Da Silva-Grigoletto et al. (2020).
The authors deliberate on the possible integration of functional resistance training with BFR which may maximize the effects of conventional training.
To our knowledge no articles has yet to explore or discuss the potential use of BFR in combination with typical dynamic stability exercises for the shoulder!?
Though, the rational is perhaps not too farfetched!?
Various sports and simple ADL requires relative amounts of shoulder stability i.e. inter-individual task demand. So, by improving dynamic stability through various exercises, you will likely prevent and treat injuries or pain associated with these.
BFR in combinations with low-load resistance training seems to be both time and load effective with respect to the current body of evidence:
Any conventional shoulder exercise can be combined with BFR training, just mind that training involving dynamic biceps or triceps contractions would probably benefit the most from BFR.
BFR training for the upper body is most effective when conducted with high reps (15-30 or failure), low load (20-40% of 1RM) and short rest periods (30-60 s). It is recommended to only do 2-4 different exercises relative to your experience.
On the other hand, dynamic stability exercises for the shoulder stresses various physical systems, especially coordination and muscle endurance. The rationale underlying multi-system adaptations with dynamic stability exercises, can be explained by the manipulation of exercise complexity (variations in stability, movement velocities etc.), load or simply time under tension.
In the present video, the last 2 exercises can be categorized as “dynamic stability” drills (00:37 →), So these are intrinsically not well-suited for the standard BFR Training protocol. But by matching time under tension for conventional BFR training, it seems appropriate to extrapolate this as 30-90 s. active exercise relative to the difficulty of the task, followed by the standard inter-set rest period.
The rational for doing BFR combined with dynamic stability drills is the same as for low-load BFR resistance training. A tool to increase the internal training load with less extrinsic load while also being time saving.
Any thoughts on using BFR with “functional” resistance training or dynamic stability drills to enhance adaptations, please let us know!? firstname.lastname@example.org or IG at @fitcuffs
Thanks to @kostasrotziokos for the brilliant video material!
Da Silva-Grigoletto et al. (2020) Functional Training and Blood Flow Restriction: A Perspective View on the Integration of Techniques.
FYI – When doing upper Body BFR, keep in mind that the the cuffs are always attached at the top of the upper arm, just below the armpit.❗
October 06, 2021
Should You do Continuous or Intermittent BFR Training!? ⬇️
In a previous blog post from August 05, intermittent BFR (deflating
the pressure in the inter-set rest period) was mentioned to mitigate or at least attenuate perceptual responses to BFR.
The actual effect of intermittent BFR (iBFR) vs Continuous BFR (cBFR) has recently been investigated in a review by Sinclair et al.
The present paper was conducted to decipher whether iBFR improves tolerance, without compromising strength, as iBFR VS cBFR on outcomes of exercise tolerance or strength.
Materials and Methods: Only RCT’s were included in this review. The primary outcomes of interest were those describing tolerance to BFR during exercise:
• Rating of perceived exertion (RPE)
• Delayed onset muscle soreness (DOMS)
• Objective reporting of adherence rates and adverse events, with the appropriate reasons provided.
• Qualitative reporting of experiences and preferences.
Change in muscle strength.
Search strategy: Preferred reporting system for systematic reviews and meta-analyses (PRISMA) statement. Data analysis: Cochrane risk of bias tool for randomized trials e.g., randomization and allocation processes, blinding of participants, investigators and outcome assessors, and reporting of outcomes. Excluded studies whose methodology created a disparity in tourniquet pressure across groups, i.e., confounding variable.
186 studies were selected, but only 9 RCT’s were included published between 2013-2019, 7 were cross-over by design.
The iBFR groups of all studies had their cuffs deflated in the inter-set rest periods. All but one study deflated the cuffs during the rest periods between exercises for both iBFR and cBFR.
There was no significant difference in RPE between BFR training methods, however, the effect estimate shifted towards the use of iBFR.
No significant strength difference between BFR groups.
It seems iBFR may be better tolerated than cBFR. The overall difference in the meta-analysis however did not show significant variance. Additionally, there is limited evidence to suggest that comparable gains in strength can be expected.
Deflating the cuffs risks attenuating the metabolic stress and thus the mechanism by which BFR exerts its effects on hypertrophy and strength. It is recommended that further research in this area focus on other means to improve tolerance to exercise.
Primary Source: Sinclair et al. (2021) Tolerance to Intermittent vs. Continuous Blood Flow Restriction Training: A Meta-Analysis.
November 02, 2021
Improve parameters of football(soccer) performance by means of “functional” BFR Training!? ⬇️
In this blog post we present the results from a BFR-futsal RCT conducted on 12 elite futsal players:
Aim: The effect of 3 weeks of BFR-Futsal on performance, strength and hormone levels.
Method: 12 players, 6 BFR-players vs. 6 No-BFR. 10 sessions as small sided games 3 vs. 3, 3 min futsal followed by 2 min rest for 4-8 intervals. BFR group had cuffs inflated to 110% of leg systolic blood pressure and further increased by 10% after every two completed sessions. Intensity 80–100 % HRmax in both groups.
Results: BFR-group had significantly greater improvements in peak torque knee extension (30.9 ± 8.0% vs. 14.9 ± 7.5%), flexion (23.8 ± 8.4% vs. 8.1 ± 5.7%), favorable serum concentration of myostatin and a trend for a greater improvement in a Futsal Special Performance Test. Though, Ratings of Perceived Exertion were higher in the BFR-group: (13–14 Borg) vs. (15-17 Borg).
Conclusion: The study combined futsal training with BFR and showed that the addition of BFR was superior to normal futsal training. The addition of BFR to futsal practice can enhance muscle activation, strength and hormonal responses. But please consider several limitations, e.g. sample size was fairly small.
Our recommendation regarding augmentation of functional BFR Training to team sports like futsal: Be cautious if you apply BFR in situations with near maximal effort such as jumping, acceleration and change of directions, as these types of movements are associated with peak muscle forces comparable to heavy lifting. And not least, the risk of adverse events in relation to contusions on blood flow restricted limbs, which is obviously not appealing.
The inclusion of BFR in futsal or similar sports is twofold. As shown in the current study the potential performance enhancement is obvious and for rehab and return to play this seems relevant. Regarding the high exercise intensity, olieveira et al. showed that Low-intensity BFR-interval running had similar benefit compared to high-intensity BFR.
Amani et al. (2019) BFR During Futsal Training Increases Muscle Activation and Strength.
Oliveira et al. (2016) Short-term BFR interval training improves both aerobic fitness and Strength.
November 02, 2021
Can “functional” BFR Training augment running performance!? ⬇️
In this post we present the outstanding results from a BFR-running RCT conducted on physically active women.
The study combined interval running with BFR and showed that training intensity and pressure are important for aerobic, anaerobic, and muscular performance!
Purpose: Comparison of different BFR stimuli and exercise intensities on aerobic, anaerobic, and muscle strength in 4 different groups, as a dose response study.
A 4-week intervention period consisted of 3d/week, 10 sets for each session as 2 min running on a treadmill with BFR interspersed by 1 min of recovery without BFR. The pressure was estimated from thigh circumference.
The four groups: (IP-CE): Increasing Pressure with Constant Exercise intensity. (CPP-IE): Constant Partial Pressure with increasing Exercise intensity. (IP-IE) Increasing pressure with increasing exercise intensity. (CCP-IE): Constant Complete occlusion with increasing exercise intensity.
The study demonstrated improvements in all aerobic and anaerobic variables in all 4 groups, with a trend for greater gains for all parameters in response to progressing intensity and high BFR stimuli.
The CCP-IE (complete occlusion) group had a trend for the greatest overall effect (Vo2max Ꙟ 14.8%). – Though, it might be contrary for safety and could hypnotically lead to adverse events. Nevertheless, this is not the first study that shows a higher BFR stimuli is superior and this was also conducted on a young population + a trend for higher Ratings of Perceived Exertion (RPE) in the CCP-IE group.
Conclusion of the study: Interval based BFR-running with higher BFR stimuli and progressive intensity is superior for overall effectiveness.
We do not recommend complete occlusion (100% Limb Occlusion Pressure) / 100% AOP for the general public, but it is common practice that you either progress effective running time or pace.
Another discovery is that circumference seems to be a legit way to set the pressure, while using Fit Cuffs, we recommend that you use Fit Cuffs Training App – training.fitcuffs.com
Source: Amani et al. (2019) Effects of Blood Flow Restriction and Exercise Intensity on Aerobic, Anaerobic, and Muscle Strength Adaptations in Physically.
September 14, 2021
Blood Flow Restriction and modified squats to evade hip pain!? ⬇️
This recreational athlete (true ⚽️) experienced pain with squatting, sumo deadlifts and similar type of exercises, with symptoms originating profound (deep) within the groin.
Subsequently, special tests were positive for both FABER (hip Flexion-ABduction-External Rotation & FADIR (hip Flexion-ADduction-Internal-Rotation).
As both history and tests indicated intra-articular irritation e.g., overuse injury of the labrum of the hip, reminiscent of Internal Hip Impingement aka Femoroacetabular Impingement (FAI). Even though, FAI can further be classified relative to structural characteristics of the hip as either CAM, PINCER or both, a pragmatic approach without further specification by MR is often sufficient for positive rehab outcomes.
For most types of overuse injuries with or without any underlying mechanical morphology, 100% bullet proof diagnostics, isn’t necessary to achieve relief while maintaining or improving physical function. In this case, simply doing too much of specific exercises too soon had initiated the symptoms and if not managed properly would most likely exacerbate.
First line care for this athlete would be working around pain in a progressively manner and other passive modalities as hip mobilization techniques being secondary, to support performing at the upper best. So, whenever appropriate relative to the severity of the injury aiming for non-time-loss management e.g., missing no playing time.
Both general and joint specific warm-ups, wasn’t relieving pain as conventional wide knee squats and similar movements where still tricky, so other strategies were explored.
The immediate objective was to determine the least affected squatting pattern and as often seen with these types of hip problems, limiting hip abduction, deep hip flexion and external rotation of the femur seemed most comfortable.
So, as displayed in the video with the smith-machine squats was selected because the fixed bar paths enable You to place the feed in front of the axial load, mitigating the deep of part of the ROM (hip flexion) without deviating to far from conventional squatting. Secondly, by applying a narrow stance hip abduction and hip external rotation are also limited.
Thirdly, using low-load the compressive forces within the hip is further eased. And by applying Blood Flow Restriction the effective rep range is reached sooner and volume load is simply less compared with conventional low-load training.
Luebbers et al. (2014) The Effects of a 7-Week Practical Blood Flow Restriction Program on Well-Trained Collegiate Athletes.
Abe et al. (2005) Eight days KAATSU-resistance training improved sprint but not jump performance in collegiate male track and field athletes.
Cook et al. (2014) Improving strength and power in trained athletes with 3 weeks of occlusion training.
Neto et al. (2014) Effects of high-intensity blood flow restriction exercise on muscle fatigue
Scott et al. (2017) The effects of supplementary low-load blood flow restriction training on morphological and performance-based adaptations in team sport athletes.
September 07, 2021
BFR from Rehabilitation to Performance – Part 2/2 ⬇️
In this follow-up post we present the findings from a recent editorial concerning Blood Flow Restriction.
Numerous research papers have shown its effectiveness using light loads/intensities in the elderly, impaired to high performance athletes. More recent data shows promising results with novel application such as whole-body vibration techniques and neuromuscular electrical stimulation.
Though, current guideline exits e.g., Patterson et al. 2019, more research is warranted for long term effects consistent use of BFR!?
Though, recent research has explored the safety aspect of longer term (1 month) of consistent low-load BFR resistance training on parameters of cardiovascular health. It seems that general blood pressure, mean arterial pressure and systemic vascular resistance are unaltered at rest during and after the intervention period. The authors also discovered that BFR Training were hypotensive (reduced blood pressure) during handgrip exercise, thereby suggesting a hypotensive effect
The authors also discovered that the metaboreflex following BFR – the proposed effect of low oxygen delivery to muscles and metabolites accumulation stimulating skeletal muscle afferents and thereby increased blood pressure, were not present after the training period.
A recent systematic review with data from 13 original papers investigated whether exercise interventions utilizing BFR were able to improve various objective measures of physical function relevant for active daily living (ADL) in the elderly.
The authors discovered increased performance on tests like:
30 s sit-to-stand
Timed up and go
Balance and Stepping tests
BFR appear safe and effective for muscle hypertrophy, aerobic capacity and strength comparable to conventional exercise, but the precise mechanisms and optimal protocols still require additional exploration!? But considering the current research, it seems that many modes and different protocols can be applied to positively affect health and performance across various populations.
Patterson, Burr, Warmington (2021) Editorial: Blood Flow Restriction: Rehabilitation to Performance
Clarkson et al. (2019) Chronic Blood Flow Restriction Exercise Improves Objective Physical Function: A Systematic Review
August 28, 2021
BFR from Rehabilitation to Performance – Part 1/2 ⬇️
A relatively new editorial from Patterson et al., elaborates on the current utility of BFR for various populations extracted from 18 original research, 1 systematic review, 1 review and 1 opinion papers.
BFR training has demonstrated efficacy when using light-loads/intensities (20–30% 1RM / 40-60% VO2 Max), generating supporting evidence for BFR resistance training and aerobic exercise, but also passively i.e., Ischemic Preconditioning (IPC).
Despite a growing body of evidence in support of beneficial outcomes as well as functional performance benefits, there is no absolute consensus for the application of different BFR modes or protocols.
Acute Responses of BFR:
There seems to exists a progressive response to increasing applied restriction pressure with a minimum “threshold” of ~60% Limb Occlusion Pressure (LOP) when using very low-load BFR resistance training (20% 1RM), for long-term training adaptations.
Compared with both high- and low load resistance training, the vascular stress is greater with BFR relative to the amount of muscle mass used such as multi- vs single joint exercises. That is why caution be exerted when prescribing BFR to certain at-risk populations and more research are needed to explore the long-term hemodynamic and vascular effects of BFR
Adaptations to Training with BFR:
While mechanical tension and metabolic stress seem to share the variance of the muscle hypertrophy response in high-load training, the metabolic stress seems to be the main mechanism responsible for muscle hypertrophy in BFR Training. Though, it seems that BFR training increases long-term muscle protein turnover to a similar degree compared to high-load training. Collectively, the literature support the clinical value of BFR for populations in whom exercise with high loading is untenable.
Performance capacity may be mediated through altering exercise-induced blood flow and/or vascular function. Considering the current literature, future studies should test the clinically relevance of shorter protocols 12min (2 × 2–3min occlusion/reperfusion)!?
Primary source: Patterson et al. (2021) Editorial: Blood Flow Restriction Rehabilitation to Performance
August 05, 2021
How to minimize the perceptual responses to BFR for successfully introduction and familiarization – Part 2/2 ⬇️
Ratings of Perceived Exertion (RPE), general discomfort, or pain likely constitute a barrier to BFR. So, by reducing the magnitude of perceptual demands You will increase the likelihood of long-term compliance to BFR.
Considering cuff width is imperative as wider cuffs are associated with higher (RPE) than narrow cuffs with the same absolute pressure being applied. This will also proportionally influence the occlusion pressure necessary to reduce blood flow.
We advise for initially lower pressure as upper body at least 30% Limb Occlusion Pressure (LOP) and Lower body at least 40% LOP. So, by lowering the pressure relative to the individual You can influence perceptual responses and thereby maximize tolerance and compliance.
Though, it seems that at least 50% LOP is the threshold for any real benefit of applying BFR, so mind that less pressure should only be applied in a brief familiarization period (1-2 week).
Low relative pressure can also be combined with intermittent BFR, which can either be cuff deflation in-between exercises or even more gentle by deflation during the inter-set rest period. This can be a great method to let people have a tempered introduction to BFR for people experiencing unacceptable discomfort when applying continuous pressure.
Though, intermittent BFR can mitigate discomfort, its effectiveness vs continues BFR is currently not well explored.
Avoid failure training initially as it seems not to provide superior benefits for muscle mass and strength when unaccustomed to BFR.
Loads. Initially about 20% of 1RM, but progressed thoroughly.
For some individuals it can be favorable to introduce BFR passively, simply inflating the cuff to sub occlusion pressures for brief intervals letting the person experience BFR in the absence of exercise.
1 Pressure. 30%-80% LOP
2. Avoid failure training.
3. (Passive BFR) or Intermittent BFR progressed to Continues BFR
4. Initially not more than 25 reps for 3-4 sets of 1-2 exercises.
5. Load of not more than 20% of 1RM
6. Communication. Is it acceptable? Simply ask the client during exercise, but also inform about the importance of high RPE during BFR exercise to elicit adaptations long-term.
Primary source: Nicholas Rolnick, Kyle Kimbrell, Mikhail Santos Cerqueira, Ben Weatherford and Christopher Brandner (2021): Perceived Barriers to Blood Flow Restriction Training
Secondary Source: Hughes et al. (2017) Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis
Hughes et al. (2020) Blood flow restriction exercise position stand: considerations of methodology, application, and safety
Hughes et al. (2019) Examination of the comfort and pain experienced with blood flow restriction training during post-surgery rehabilitation of anterior cruciate ligament reconstruction patients
Spitz et al. (2020) Blood flow restricted exercise and discomfort: a review
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