Blood Flow Restriction (BFR) – Blog

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June 22, 2021

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2. Post on BFR Training to improve sports & athletic performance


In this follow up post on the continues series on BFR for performance, we present the findings from the 2. part of the review by Pignanelli et al. (2021).

In display above, You will find the updated pressure gauge (Wireless) with the brand new optional longer hose (2.2 meters 87 Inch). This can be relevant for interval-based exercise, as it allows for instant pressure readings and importantly swift inflation and deflation relative to inter-set rest and work periods.

📍2. Physiological adaptations following BFR Training.

👉 Muscle Redox and Ionic Buffering:

Muscle fatigue is multifactorial and task-dependent encountered from a range of physical parameters. Optimizing the capacity to maintain redox and ionic homeostasis during exercise is important for athletic performance.

BFR augmented interval running in well trained individuals (>57 VO2-max) increases markers associated with ion transport (Christiansen 2018).

Similar BFR protocols has been used for 6 week of bike-interval training in recreationall individuals, which increased the work capacity of the knee extensors 23% vs workmatched control 11%. (Christiansen 2019A, 2019B).

Comparable adaptations seem to improve repeated sprint and general running performance.

👉 Muscle Oxidative Capacity:

High oxidative capacity is imperative for oxygen extraction, to maintain aerobic work and to perform and recover from repeated high-intensity efforts.

Improvements in muscle oxidative capacity has been linked to both mitochondria content and importantly function.

4 week of moderate-intensity bike training (45 min/session) with BFR increased citrate synthase activity +20% compared with the work-matched control (Esbjörnsson 1993).

Favorable effects of BFR-interval training on muscle oxidative capacity have also been explored as 4–6 week of bike-interval training, which improved muscle diffusional O2 conductance (Christiansen 2020) and oxygen kinetics (Corvino 2019).

More to come in this series on the cardiovascular adaptations and future research/perspectives for BFR Training.

Primary Source:
Pignanelli et al (2021) Blood flow restriction training and the high-performance athlete: science to application.

Original papers:

Christiansen et al (2018) Running is related to fibre type-specific AMPK signalling and oxidative stress in human muscle.

Christiansen et al (2019A) Blood flow-restricted training enhances thigh glucose uptake during exercise and muscle antioxidant function in humans.

Christiansen et al (2019B) Cycling with blood flow restriction improves performance and muscle Kþ regulation and alters the effect of anti-oxidant infusion in humans.

Esbjörnsson et al. (1993 )Muscle fibre types and enzyme activities after training with local leg ischaemia in man.

Christiansen et al (2020) Training with blood flow restriction increases femoral artery diameter and thigh oxygen delivery during knee-extensor exercise in recreationally trained men.

Corvino et al (2019) Speeding of oxygen uptake kinetics is not different following low-intensity blood-flow-restricted and high-intensity interval training.


Maj 25, 2021

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Can BFR Training improve sports & athletic performance?


In this 1. blog-post in a continues series we present the findings from a newly published review by Pignanelli et al. (2021) on BFR and the high-performance athlete:

The present paper explores 3 domains for BFR and performance:

📍1. The evidence of BFR for improved training adaptations in well-trained individuals.

📍2. Physiological adaptations following BFR Training.

📍3. Identify gaps in the literature and future research directions for BFR.

Introduction: BFR training can improve strength and different parameters of endurance using loads and intensities traditionally incapable of stimulating change in healthy populations.

📍1.
👉BFR Training Adaptations in Strength-Trained and Team-Sport Athletes:

For this domain the authors mention the study by Bjørnsen et al. (2019)

The protocol simply, 2 x 1-weekly blocks consisting of front squats at either alternating low-load (30% 1RM) continuous BFR or high-load vs conventional high-load only.

The addition of 10 BFR sessions increased quadriceps cross-sectional area by 3%–8% and increased individual muscle fibers by 12%. No overall changes in these variables occurred in the conventional only high-load group.

By contrast, the conventional training group statistically increased their 1RM (4%), vs (3%) with BFR.

👉BFR-Training Adaptations in Endurance-Trained Athletes:

Held et al (2020) showed surprisingly, huge effects after 3 weekly x 5 weeks in well-trained rowers: VO2max (9%) and maximum aerobic power output (15%) with BFR vs no change in the conventional training group.

📍2.
👉Muscle Strength and Structural Adaptations:

Grønfeldt et al. (2020) conducted a meta-analysis indicating that low-load BFR increases muscle strength (grouped across 1RM, isometric, and isokinetic tests) similar to high-load in untrained and recreationally active individuals.

Though, Lixandrãoe et al (2018) find that improvements in strength (grouped across 1RM, isometric, and isokinetic tests) were higher with conventional high-load Training.

Muscle Redox and Ionic Buffering:
Stay tuned for more on repeated sprints and running performance among other stuff!

Source

Primary source:
Pignanelli et al. (2021) Blood flow restriction training and the high-performance athlete science to application.

Original papers:
Bjørnsen et al. (2019) Type 1 Muscle Fiber Hypertrophy after Blood Flow–restricted Training in Powerlifters.
Held et al. (2019) Low intensity rowing with blood flow restriction over 5 weeks increases VO2max in elite rowers: A randomized controlled trial.
Grønfeldt et al. (2020) Effect of blood-flow restricted vs heavy-load strength training on muscle strength: systematic review and meta-analysis.
Lixandrão et al. (2018) Magnitude of muscle strength and mass adaptations between high-load resistance training versus low-load resistance training associated with blood-flow restriction: A systematic review and meta-analysis.


Maj 15, 2021

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Is low➡️moderate load BFR Training superior for grip strength!?


This clinically relevant research question has been investigated by Zanardini et al. (2020).

– FYI, considering the cold spring in Denmark, remember to dress accordingly..🥶

Background: High-load resistance training is recommended to improve muscle mass and strength, but BFR seems to provide similar adaptations.

Purpose – the effects of BFR Training for grip strength & hypertrophy.

Hypothesis: The effect of low-moderate load BFR Training in Maximum Hand Grip Strength (MHGS) and muscular size is similar to Conventional high-load training!?

Methods: 28 women, age 18-25, randomly assigned into two groups: BFR vs Conventional resistance training (No-BFR).

Outcomes – Muscle size measures & MHGS

Intervention – 3/weekly – 4xweeks as dynamic concentric contraction exercises on a dynamometer.

Intensity for the BFR group. MHGS at 30-35% 1RM in the 1. week, 40-45% 1RM in the 2. week and 50-55% 1RM in 3.-4. weeks.

Intensity for the No-BFR group. MHGS at 65-70% 1RM in the 1. week, 70-75% 1RM in the 2. week and 80-85% 1RM in 3.-4. weeks.

3 sets of 15-25 reps were performed until failure with 30 s. inter-set rest for the BFR group and 3 sets of 8-12 reps with 1 min. rest for No-BFR group.

Results – values presented as medians:

% Change in Right MHGS, BFR group vs No-BFR group: (5% vs 5.1%)

% Change in Left MHGS, BFR group vs No-BFR group: (8.7% vs 14.9%)

Arm Muscle Circumference, BFR group vs No-BFR group: (2% vs -0.1%)

Upper Arm Circumference, BFR group vs No-BFR group: (1.8% vs -0.3%)

Lower Arm Circumference, BFR group vs No-BFR group: (0.2% vs 1.5%)

Conclusion:

Despite the authors praising BFR training in their discussion, the results seems to be in line with comparable studies showing similar effects of Conventional high-load training vs low-load BFR Training.

Clinical Take – Thus, we recommend low-moderate load BFR for improving grip strength as an alternative or adjunct to high-load training. Hand therapists can utilise BFR training when the aim of the intervention is to increase muscle strength when high-load resistance training is contraindicated. E.g. this can be relevant for people who experience aggravation associated with conventional resistance training particularly for people suffering from hand osteo arthritis or hand rheumatoid arthritis.

Source:
Zanardini et al (2020) Effects of blood flow restriction training on handgrip strength and muscular volume of young women.

Additional source for BFR and grip strength: Credeur et al. (2010) Effects of handgrip training with venous restriction on brachial artery vasodilation.
Velic & Hornswill (2014) KAATSU Training and Handgrip Strength.

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April 24, 2021

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, Okklusionstraining, ocklusionsträning, bfrcuffs, bfrtool, bfrequipment, bfr cuffs

Is BFR Training for tendon related pains superior vs conventional rehab modalities?


In a recent short article at Dansk Sports Medicine a group of researchers elaborate on their concurrent RCT that explores whether Low-load Blood Flow Restriction (BFR) Training is effective in the treatment for patellar tendon related pains.

Currently, at the Department of Sports Medicine at Bispebjerg hospital Denmark, the researchers are exploring the potential benefit of BFR Training in the rehab for tendon related overuse injuries e.g., tendinopathy vs conventional training.

So far, the body of literature appears with contradictory outcomes for the effect of Low-load BFR training vs Conventional high-load training in the treatment for pain and objective parameters of tendon health whether.

That is why this concurrent RCT is an important contribution to this less explored field BFR research and is pertinent before a general recommendation of low-load BFR should be prescribed as a first line rehab modality for tendon related pains and tendinopathy.

Introduction:

Eccentric and Heavy Slow Resistance (HSR) Training, particularly the later, is currently the recommended rehab modality for tendinopathy.

However, exercise modality and type of muscle work does not appear to be decisive, instead the total training volume and time under tension seem to be of importance. And notably, only about 25% experience relevant effects of HSR, after 12 weeks of progressive exercise.

The rational for BFR is inherently the low-load and fatiguing stimuli, with less strain on the joint and tendons, whereby modulation of the damaged tissue may be augmented compared to conventional training.

As presented in a previous post, this case-series from the corresponding group of researchers tested a 3-week training intervention in which they performed 3/weekly low-load BFR as 30% of 1-RM.

6/7 subjects experienced a clinically significant pain reduction (≥50%) measured in with a single-leg decline squat.

+4% quadriceps maximal isometric contraction strength.

-31% Doppler activity in the patellar tendon as an expression of reduced vascularization, which could indicate healing of the tendon tissue.

Preliminary conclusion from the authors:

Because of the methodological shortcomings, as the lack of a control group (not RCT) and few participants, the results need to be interpreted cautiously. But it seems that BFR may be effective in the treatment of tendinopathy!?

As explained, the current evidence is sparse with contradictory results for the effect of Low-load BFR training vs Conventional High-load training in the treatment and objective parameters of tendon health and importantly, considering the relative low success rate with the current recommended HSR Training. That is why, this RCT is an important contribution to the literature and we find it pertinent before a general recommendation of low-load BFR should be prescribed as a first line rehab modality for tendon related pains and tendinopathy.
So, stay tuned for the results of this RCT.

But wait – what is the rational for BFR in this population, if volume and time under tension is thought to be the decisive factors? And why should low-load No-BFR with inherently higher volume not be a better option!? . Any explanations of this opposition?

Primary Source: https://dansksportsmedicin.dk/ front page.. With Google translate as Your companion..

Selection of original articles:
Aagaard et al. (2020) The effect of low-load resistance training with blood flow restriction on chronic patellar tendinopathy – a case series.
Sata (2005). Kaatsu Training for patella tendinitis patient.
Centner et al. (20219) Low-load blood flow restriction training induces similar morphological and mechanical Achilles tendon adaptations compared to high-load resistance training.
Kubo et al. (2006) Effects of low-load resistance training with vascular occlusion on the mechanical properties of muscle and tendon.
Reeves et al. (2006) Comparison of hormone responses following light resistance exercise with partial vascular occlusion and moderately difficult resistance exercise without occlusion.
Makris et al. (2014) Developing functional musculoskeletal tissues through hypoxia and lysyl oxidase-induced collagen cross-linking.
Xia et al. (2006) Nitric oxide enhances collagen synthesis in cultured human tendon cells.

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April 20, 2021

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Now don’t be frightened by the cheesy Quadzilla roars or the quads on this man.


Thus, as a follow up on the previous post on the pros and cons for curved vs straight cuffs relative to thigh shape, we have the Leg Cuffs V3 in action. It shows how the rather simplistic designed cuff can be used regardless of thigh circumference.

So, if any one doubted the “one size fits all” label for the Leg Cuffs V3 Quadzilla here definitely proves them wrong.

Thanks to @curtis_demont for the original video material!
Walking Lunges + Quadzilla roar
T-bar Front Squat
Barbel Front Squat
Leg Extension

Nuff said, go hit the Gym with BFR for those quad gains whenever possible!

April 07, 2021

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For Effective Safe & Convenient BFR consider which type of cuff that fits You or Your clients the best.


The cuff shape and width is important for comfort, to reduce mechanical shearing during exercise and more efficient transmission of pressure…


Thighs comes in various sizes and shapes. Though, most are conically i.e., tapered, particularly in muscular or plumper individuals which would best match the cone shape of the Leg Cuff V3. On the other hand, slender – less muscular or longer thighs would also have a decent fit with the V2’s.

The V3 can be adjusted to the shape of the limb by an arc-shaped design that, when attached correctly allows for a customizable fit by a an adjustable smaller diameter distally compared to proximally.

This design simply allows the user to adapt the shape of the cuff to a wider range of thigh shapes:

The narrowing triangle velcro-strap allows the proximal and distal circumferences to be adjusted, allowing the cuff to conform to a variety of cones, to accommodate different thigh shapes, as shown in the figure above (2. image).

You can test the fit during attachment before inflation by placing 4 fingers between the cuff and the thigh distally and proximally, aiming for similar tightness.

Final Considerations.

The Leg Cuff V3 is a state-of-the-art designed variable-contour cuff developed to better match different thigh shapes, and thereby provide more efficient pressure distribution, which enables less pressures to be used.

V3 is a single bladder cuff designed to safely restrict blood flow as either full occlusion i.e., 100% Limb Occlusion Pressure (LOP) or to decrease blood flow (40-90% LOP) by applying evenly distributed circumferential pressure around the thigh.

The internal stiffener helps direct the pressure exerted by the bladder inward towards the thigh, and helps maintain the cuff in a stable position during exercise. The nylon stabilizer is used during cuff attachment and helps prevent the cuff from shifting on the thigh during exercise.

As a rule of thumb, the V2 is designed to fit optimally on cylindrically aka. straight thighs. V3 which is contoured in order to form a cone during attachment, would probably be a better fit for approximately >70% of people. And remember, both Cuffs are applicable for thigh sizes 45->85 cm.

Source:
various articles at https://tourniquets.org/tourniquet-cuff-technology/

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Marts 26, 2021

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If you follow the link above You will see a selection of your favorite disco pump exercises augmented by BFR


Military Press – the major general of the shoulder complex, Pull Down – the Lat expander, King Bench Press and Popeyes one and only exercise, the Curl.

In the text below the disco lights are turned off and we run through a relatively new study concerning BFR for the upper-extremity by Bowman et al. (2020).


Background:
Blood flow restriction (BFR) training with low-load has shown to induce similar physiological changes to high-load with the benefit of less tissue stress. For comparison of Low-load training protocols, BFR reduces the workload (number of repetitions) needed to reach the point of fatigue compared with similar training without BFR.

In this study the authors compared One extremity low-load BFR vs No-BFR low-load (control group) on strength and hypertrophy for muscle groups proximal, distal, and contralateral to the cuff.

Methods:
A prospective, RCT, as healthy subjects were randomized into a 6-week low-weight training program with or without BFR on 1 Arm. Outcome measures included limb circumference and strength, between BFR-arm vs No-BFR-arm, BFR group vs control group, and No-BFR-arm vs control group.

Results:
A total of 24 subjects (14 BFR and 10 control subjects) completed the training intervention.

Significantly greater gains were observed in dynamometric strength for proximal musculature in the BFR-arm group:

Shoulder scaption, 30%

Shoulder flexion, 23%

Shoulder abduction, 22%

And distal musculature: grip strength, 13%

Vs both the No-BFR-arm and the control group (P <.05).

Arm and forearm circumferences significantly increased in the BFR-arm vs No-BFR-arm and control group (P = .01).

The non-BFR-arm group demonstrated greater grip strength vs control group (9%, P < .01). No adverse events were reported.

Conclusion:
Low-load BFR training provided a greater increase in strength and hypertrophy in the upper-extremity proximal and distal muscle groups relative to the cuff vs No BFR Low-load training.

As The non-BFR-arm showed a significant increase in grip strength compared vs control group, indicating a potential systemic effect.

Low-load BFR training could significantly benefit patients who are unable to lift heavy with conservative managed conditions such as osteoarthritis, Subacromial impingement syndrome (SIS), muscle strain, and tendinopathy.

Likewise, BFR can probably accelerate return to preoperative strength levels in rotator cuff repairs, labral repairs, shoulder and elbow arthroplasty, and upper-extremity traumatic injuries.

Source:
Bowman et al. (2020) Upper-extremity blood flow restriction- the proximal, distal, and contralateral effects- a randomized controlled trial.

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Marts 10, 2021

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In this post we discus the concept of Low-load BFR training as a potential rehab modality for knee pain


In a recent meta-analysis by Cuyul-Vasquez et al (1), the authors discovered that only low-quality evidence can be identified for Low-load BFR training on pain and function when compared to Conventional resistance exercise. Though, in a response to this meta-analysis as a “Letter to the Editor” Cerqueira et Vieira (2) acknowledge the current lacking evidence, however, the authors would like to contribute to the discussion on the possible benefits of Low-load BFR training for the treatment of general knee pain.

The disputed statements & analysis from the original meta-analysis:

In the original paper the authors compared BFR exercise at 30% of 1RM vs Conventional high-load (70% 1RM) and low-load (30% 1RM) exercise.

Considering, the reported different results when Low-load BFR is compared to Conventional high-load vs low-load exercise, it is reasonable to consider that pooling the results from two distinct exercise intensities may have affected the results. A relevant shortcoming in the original RCT’s, is the fact that few studies match the exercise volume. As you will often find the BFR group has higher exercise volume as defined as load x reps x sets.

From the results in several original RCT’s and other reviews, it seems apparent that Low-load BFR is superior in regards to strength vs conventional Low-load exercise when the reps and volume are matched.

It is also well established that load-low BFR have similar but maybe slightly less effects on strength when compared to conventional high-load exercise.

Conversely, it can be proposed that for individuals who struggles with high load exercises due to aggravation of joint pain, that low-load BFR exercise can outperform conventional high-load training. This hypothesis is both in regards to worsening of joint pain but probably also in terms of strength as pain and not perceived effort can be the limiting factor for this subgroup.

This notion is consistent with Giles et al. (3), as they identified that for subgroups with higher levels of patellofemoral pain had additional strength gain with low-load BFR vs High-load training.

Subsequently, the drop-out rate for such subgroups is considered to be higher, which can be difficult to adjust for during data analysis.

Considering all of this, it seems appropriate to conduct both stratified and subgroup analysis as main outcomes for future RCT’s and if applicable for reviews as well:

1. Comparing functional, strength and pain levels, for individuals who experience pain aggravation associated with High-load training vs Low-load BFR

2. Load-low BFR vs Conventional Low-load training.

3. Load-low BFR vs Conventional High-load training.

Considering the current evidence, we find it reasonable to recommend low-load BFR training in clinical practice for people with knee pain, who currently or previously has experienced that conventional high-load training is an aggravating modality. But more research for low-load BFR for knee pain is still highly pertinent.

Source:

1.Cuyul-Vasquez et al. (2020) The addition of blood flow restriction to resistance exercise in individuals with knee pain- a systematic review and meta-analysis.

2. Cerqueira et Vieira (2020) Letter to the Editor about the article – The addition of blood flow restriction to resistance exercise in individuals with knee pain- a systematic review and meta-analysis.

3. Giles et al. (2017) Quadriceps strengthening with and without blood flow restriction in the treatment of PFP.
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Marts 03, 2021

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A Pair of Leg Cuffs V3 & the New Pressure Gauge “Wireless” is a great match for BFR-cycling especially the endurance-trained athlete as described by Ferguson et al. (2021)


As described in a previous post the new optional direct attachment has some obvious advantages which are displayed in the video.

In the text below you will find some of the relevant considerations of Blood Flow Restriction (BFR) for the endurance-trained athlete. The focal strategies are deprived from the recently published paper by Ferguson et al. (2021).

Key Concepts:

BFR can possibly amplify the adaptive response to training and improve endurance performance in highly-trained individuals, by stimulus for angiogenesis (capillary supply) and mitochondrial biogenesis (more power inside the cell).

Future studies must clarify how BFR is best incorporated for highly-trained endurance athletes as a part of a structured programme!?

Introduction

The main objective for endurance athletes is to optimize the underlying physiological determinants of performance. BFR is one of many strategies to amplify the exercise-induced stressors and subsequent molecular signaling responses to enhance performance.

Many factors must be considered when programming in highly-trained individuals, defined as VO2-max > 65 ml/min/kg.

It is well known that the repeated bout effect is progressively attenuated as training is continued after a few months. It also seems that isolated increase in training volume is deficient to improve endurance performance, being particularly important to avoid “overtraining” or injury.

Key factors for improved endurance performance in the well-trained individual – how to educed plasticity of trained skeletal muscle.

Metabolic stress i.e., hypoxia – oxidative stress, skeletal muscle oxygenation, reactive oxygen species and the shear stress of reperfusion (blood returning to the working muscles)  capillary growth, mitochondrial biogenesis

BFR exercise presents an intensified training stimulus, due to distorted level of blood perfusion and oxygenation that gives rise to shear, hypoxic, metabolic, and oxidative stress signals beyond that of conventional training.

By use of BFR multiple variables can be manipulated, which has a significant impact on the level of physiological responses to exercise:

Continuous vs intermittent restriction and the timing of cuff application in relation to exercise.

As a rule of thumb, low-moderate intensity – continues pressure and very high intensity interval training – deflated prior to sprint.

It seems that absolute cuff pressures (mmHg) have a particularly significant impact on capillary growth and mitochondrial biogenesis.

Conclusion

BFR has the potential to induce enhanced physiological adaptations, including increases in capillary supply and mitochondrial function, which can contribute to improving endurance-exercise performance in highly trained individuals.

To be explored in future research:

Due to the variability in BFR research, no consensus of the optimal BFR program can be established as well as how to optimize BFR applications in a structured training programme needs further exploration!?

Source:

Ferguson et al. (2021) Blood-Flow-Restricted Exercise- Strategies for Enhancing Muscle Adaptation and Performance in the Endurance-Trained Athlete.
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February 20, 2021

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, Okklusionstraining, ocklusionsträning, bfrcuffs, bfrtool, bfrequipment, bfr cuffs

Presently, a progressed selection of rehab exercises as elevated Hip-Thrusts and Body Weight Squats augmented by Blood Flow Restriction (BFR) Training.


Currently 7 weeks after an Anterior Cruciate Ligament Reconstruction (ACL-R) and Sutured Meniscus.

By applying a step platform under the feed, range of motion of the knee can be increased and thereby shifting the muscle work from a primary glute-based exercise into a more hamstring dominant movement pattern.

This biomechanical consideration seems of importance in ACL rehab:

As the hamstrings posterior aspect inserts on the tibia (shin bone) and fibular head, the hamstrings can impart the posterior draw force on the knee. For this reason, the hamstrings are commonly referred to as ACL agonists as it co-contracts with the quadriceps during knee extension e.g. squatting to reduce anterior tibial translation.

Because the hamstring generates considerable antagonistic force, the hamstrings emerge as the principal structure contributing to reduce knee joint laxity after ACL-Reconstruction.

So, by specific hamstrings strength and endurance training you can assist the neuromuscular control of the knee as a likely protective mechanism by functional decreasing the demand for passive-mechanical joint stability.

In the second part of the video we got some body weight squats. This has been applied and progressed cautiously so far, because of the sutured meniscus and its inherently limited healing properties.

As a rule of thumb, when the meniscus has been sutured or resected, it is recommended to have a rather delayed implementation of bodyweight exercises considering the considerable risk of long-term osteoarthritis.

In the last part of the video, you will find the trick to completely deflate the cuff before detachment, which is important for the consecutive training session.

Source:

Bryant et al. (2008) Dynamic Restraint Capacity of the Hamstring Muscles Has Important Functional Implications After Anterior Cruciate Ligament Injury and Anterior Cruciate Ligament Reconstruction.
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February 17, 2021

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, Okklusionstraining, ocklusionsträning, bfrcuffs, bfrtool, bfrequipment, bfr cuffs

Researchers at Aalborg university wants patients faster on their feet after fractures with Blood Flow Restriciton (BFR) Training.


Please mind that the images above contain explicit footage of a dislocated ankle fracture not from the present study.

3 semester students conducted a project in collaboration with Peter Larsen and Rasmus Elsøe at Aalborg University Hospital.

The aim this feasibility study was to explore if low-load BFR Training can help patients who suffer a major bone fracture regain their function faster.

People with major lower limb fractures often have to immobilize the injured leg in a cast for several weeks or months without being able to do specific resistance exercise for the particular limb.

Therefore, many people lose muscle mass, which leads to loss of function, reduced joint stability and strength as well as pain, explains chief physician Rasmus Elsøe from the Department of Orthopedic Surgery.

The specialized training is called “occlusion training” aka BFR Training which is low-load resistance training combined with partial restriction of the blood supply to the working muscles.

In healthy people, this training seems to increase muscle mass and muscle strength about as much as conventional resistance training, but with less impact on bones and joints – so, we hope that this also applies to patients with bone fractures, says physiotherapist Peter Larsen from the Department of Physiotherapy and Occupational Therapy.

Exactly this form of training is interesting to take a closer look at, as it potentially provides the opportunity to initiate rehab sooner compared to standard care, thereby attenuate the loss of muscle mass and strength and reduce functional deficits. Their semester project showed promising results and for the majority of patients, this new form of training was a positive experience.

This study provides exciting new perspectives for future studies that can explore whether this new form of exercise can get our patients back to full function faster after bone fractures.

Stay tuned for a follow-up study comparing the functional effect of early BFR intervention in fracture rehab.
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February 07, 2021

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, Okklusionstraining, ocklusionsträning, bfrcuffs, bfrtool, bfrequipment, bfr cuffs

How do you safely & effectively implement Leg Press & Knee Extensions in the early phase after a combined ACL and meniscus reconstruction?


This is the 3. post, in the continuing series on BFR augmented rehab for ACL-R and sutured meniscus, currently 6 weeks post op.

In the video you will find that the exercise selection has been progressed by single leg press and end-range isotonic knee extension. Additionally, we’re utilizing contralateral high load resistance training for the interset rest periods.

The primary concern for the leg press is the compressive force within the knee, possibly affecting the sutured meniscus. Though, as the meniscus has a rich supply of pain receptors, monitoring any aggravation is most likely sufficient for monitorization of progression e.g., load and ROM.

In the 2. part of the video knee extension has been progressed from end range isometric contraction to limited-range isotonic contraction.

It is commonly described that Open-Kinetic-Chain (OKC) exercises like knee extension creates detrimental anterior forces within the knee.

For this reason many recommend to avoid OKC after ACL-R because of the proposed strain on the graft increasing knee laxity.

Though, when examining the vast amount of research, it seems less of importance beyond 4 weeks post op. On the other hand, it seems appropriate to limit ROM from 90-40° when using moderate or high relative load for OKC exercises at 4-12 weeks post ACL-R.

Secondly, considering the tensile force from the anterior glide of the shin bone relative to femur, it is recommended to place the shin pad more proximally. With the pad positioned mid-shin vs ankle level, the strain on the ACL is approximately 50% less.

But utilizing low-load we can probably exercise the joint in full ROM with less of a concern in regards to graft stress. And by augmenting this low-load condition by BFR we can amplify the muscular recruitment similarly to a high-load condition.

Apparently, BFR can be such a game changer especially for the early-mid phase rehab in ACL-R.

Any thoughts on this exercise prescription or concerns for laxity?

Primary Source:

Perriman et al. (2018) The Effect of Open- Versus Closed-Kinetic-Chain Exercises on Anterior Tibial Laxity, Strength, and Function Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.
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February 04, 2021

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, Okklusionstraining, ocklusionsträning, bfrcuffs, bfrtool, bfrequipment, bfr cuffs

This is a follow-up video on how to measure Limb Occlusion Pressure (LOP) by our Bluetooth Device, with the present post being applicable for lower body assessments.


This time around we have a guide for measurement of lower body LOP, as this can be a bit more tricky compared to upper body assessments.

So, if you’re having problems with lower body LOP assessments, please see the following troubleshooting guide:

✔Make sure that the cuff is completely deflated before attachment on the most proximal part of the thigh.

✔Also mind that you got a tight fit before inflation (pumping up) and please remember to not sit directly on the cuff.

✔Position yourself or your client as displayed above resting the foot on the floor with a slight bend in the knee.

✔Connect the Bluetooth Device directly into the cuff or to the new “Wireless” edition of the pressure gauge as displayed.

If you receive an error message on the app display, then you should manually control the deflation speed as shown in this video:

✔Keep inflating to about 280 mmHg, before you let the Bluetooth Device deflate the Cuff.

✔Turn the screw-cock on the Fit Manometer (pressure gauge) to slightly speed up deflation as shown.

✔The green graph very peaks is only allowed outside the white window for a successful measurement.

✔If this seems troublesome, try to deflate the cuff with the push-button, thus keeping a slightly accelerated deflation speed through the cock-screw and try again..

✔Please mind that even the slightest movement interferes with the measurement and can make it impossible to measure LOP.

✔Please be patient as it can take some time to get it just right – practice makes perfect!

LOP will drop slightly if you do consecutive measurements and there may be a variance of 5-15% of SYS/LOP relative to body positioning, e.g. seated vs. lying.

230 mmHg SYS(LOP) is the maximum measurable pressure, so if you have excessively large thighs it might not be possible to measure.

We recommend the prescription of relative pressure i.e. 40-80% of LOP measured by the Bluetooth Device, Handheld dopplers or the “Calculate Pressure” module at training.fitcuffs.com.

Relevant Source:

El-Zein (2020) (Thesis) the use of a portable Bluetooth Device to measure blood flow restriction training pressure requirements: a validation study.

Berger et al. (2001) How Does It Work? – Oscillatory blood pressure monitoring devices.

Babbs (2012) Oscillometric measurement of systolic and diastolic blood pressures validated in a physiologic mathematical model.

Jordanow et al. (2018) Comparison of oscillometric, Doppler and invasive blood pressure measurement in anesthetized goat.
Read more

January 27, 2021

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, Okklusionstraining, ocklusionsträning, bfrcuffs, bfrtool, bfrequipment, bfr cuffs

In display we have the new Wireless edition of the pressure gauge assessing Limb Occlusion Pressure (LOP) by the Bluetooth Device and app, which can be imperative for safe applications of blood flow restriction (BFR).


Limb Occlusion Pressure or LOP is the minimum pressure needed to fully block both arterial & venous blood flow. In display 160 mmHg is LOP for this particular person, for that limb, in this position with this exact cuff (Arm Cuff V3).

When preparing for BFR training just set the pressure relative to 100% LOP, but without the Bluetooth Device attached, as this will automatically deflate the cuff.

We recommend to measure LOP in a seated position with the following recommendations for setting the pressure during upper body exercise:

Lying exercise: 40-70% of LOP & seated or standing exercise: 40-80% of LOP. For swift conversions of % to mmHg by our app check the LOP module at training.fitcuffs.com.

“Based on the results of our study, we recommend using the Fit Cuffs® portable Bluetooth Device for objective and personalized BFR practice. This device is a valid, reliable and low-cost replacement for other measurement devices, which are substantially more expensive and require considerable usage skills. Thus, using the Bluetooth Device would offer BFR practitioners the ability to provide high-quality services for their clients or patients, ensuring minimal risks and optimal results regardless of location.” El-Zein (2020).

Nerd Alert – The Bluetooth Device works by oscillometrics i.e, analyzing pulse waves and the absence of pulse waves. This is fundamentally the same as ultra sound by handheld dopplers that detects the absence of blood flow.

– The correct terminology is probably “Arterial Occlusion Pressure” (AOP), but LOP and AOP can for practical applications and explanations be used interchangeably. Total Limb Occlusion (TOP) is another term used in BFR research, this method resolves the problem with hemodynamics i.e., blood pressure variability in relation to external stimuli. So please mind, when doing repeated and continues measurements of LOP on the same limb, readings will vary because of the hemodynamic response to BFR.

Source:

El-Zein (2020) (Thesis) the use of a portable Bluetooth Device to measure blood flow restriction training pressure requirements: a validation study.

Morais et al. (2016) Upper limbs total occlusion pressure assessment; Doppler ultrasound reproducibility and determination of predictive variables.

Loenneke et al. (2014) Blood flow restriction in the upper and lower limbs is predicted by limb circumference and systolic blood pressure.

Zachary et al. (2020) Limb Occlusion Pressure: A Method to Assess Changes in Systolic Blood Pressure.

Disclaimer: When assessing conventional blood pressure, you should always use a calibrated cuff, i.e., width of the cuff relative to the circumference of the limb you are assessing. That is why you can not use Fit Cuffs product selection to measure “blood pressure” and this combined unit is only valid for assessment of LOP.
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January 24, 2021

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, Okklusionstraining, ocklusionsträning, bfrcuffs, bfrtool, bfrequipment, bfr cuffs

This is the 2. blog-post on BFR-rehab to attenuate muscle loss in a combined meniscus and ACL-Reconstruction (ACLR). Currently, 5 weeks post op. cycling and end range loaded knee extension.


As resting pain and swelling has continually subsided, this is less of a concern in this particular case. Like the recent post, the primary focus is to attain full i.e., symmetrical knee extension, currently missing about 3 degrees compared to the contralateral knee. Please consider that blood flow restriction (BFR) is only a small part of the exercise scheme, but nevertheless a clinically relevant add-on.

In the first half of the video BFR-cycling is in display, because this is a relevant avenue to attenuate strength and muscle loss, while improving cardio vascular fitness as a subsidiary concern at this early phase.

Though, as mentioned in the latest post, the client just recently progressed his knee flexion to the extent of pedaling not being an aggravator and thereby becoming an important part of his rehab scheme.

Very low intensity cycling, can help with general healing mechanics, but other important rehab parameters such as muscular- and cardio vascular fitness can normally not be improved at this stage. As pedaling places his knee near end range flexion, this bend position is preferable unloaded and BFR is particular of interest for this client. By keeping the bike unloaded we can protect the ACL graft and the sutured meniscus, and BFR is simply just amplifying this otherwise less effectful exercise prescription.

In the 2. part of this video you will find low-load BFR knee extensions progressing from the latest post with isometric resistance at terminal knee extension and slightly higher pressure (mmHg).

In the interset rest period we got contralateral high-load resistance training to regain muscle mass and strength by cortical, subcortical and spinal level transfer.

By combining both training modalities we’re attaining the potential benefit from both a neurological and a peripheral muscle perspective.

Source:

William et al. (2017) Blood Flow Restriction Training- Implementation into Clinical Practice.

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.

Slysz et al. (2015) The efficacy of blood flow restricted exercise: A systematic review & meta-analysis.

Carroll et al. (2006) Contralateral effects of unilateral strength training: evidence and possible mechanisms.
Read more

January 21, 2021

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, Okklusionstraining, ocklusionsträning, bfrcuffs, bfrtool, bfrequipment, bfr cuffs

This is the first blog post in a continuing series on how to use BFR-rehab to attenuate muscle loss for a client with a recent combined ACL and meniscus tear which occurred doing a soccer match.


In the present post and the following, the focal point is how to add blood flow restriction (BRF) for ACL Reconstruction (ACL-R), so please consider that BFR is used in combination to the client-specific and standard care rehab exercises.

Currently, 4 weeks post op. the goal is reaching terminal knee extension asap and secondly, to attenuate muscle loss in the affected limb e.g. quadriceps, as joint effusion and swelling has almost abolished.

As the meniscus was repaired by sutures, limiting weight bearing activities and graduated exposure are imperative for the first weeks. Which is particularly important for his long-term knee mechanics, i.e., to evade knee OA.

In the video we got unloaded knee extension amplified by BFR, as the client is taxing to reach terminal knee extension.

For this client, the new direct connection Fit Manometer is a convenient alternative to the standard attach and detach solution and please notice this updated model is currently included in the Complete V3 versions. With this basic add-on, the pressure (mmHg) is swiftly monitored and adjusted accordingly by the rapid-deflate button or the screw-cock.

The sub-goal for this client is to succeed with the 30x15x15x15 rep protocol, then progressing the pressure to about 80% of Limb Occlusion Pressure (LOP), before using external load. Making sure no additional swelling or pain occurs compared to his conventional rehab exercises.

As a site note, knee flexion just progressed today and just barely enough to pedal on an exercise bike, so this will be implemented properly to his continued rehab.

More BFR applications will soon be implemented and likely also in conjunction with his recent and successful experience on an exercise bike.

Stay tuned to follow this rehab journey and hopefully a successful return-to-play within 2021.

Relevant source on the effect of BFR amplified rehab in ACL-R:

Hughes et al. (2018) Blood Flow Restriction Training in Rehabilitation Following Anterior Cruciate Ligament Reconstructive Surgery: A Review.
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January 17, 2021

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, Okklusionstraining, ocklusionsträning, bfrcuffs, bfrtool, bfrequipment, bfr cuffs

The brand-new wireless edition of the Fit Manometer (pressure gauge) features inflation, deflation and assessment of pressure (mmHg) with or without the hose connected as the perfect match for Blood Flow Restriction (BFR) Training.


The “Fit Manometer Wireless” is available now at fitcuffs.com with a reduced introductory price via this link Fit Manometer Wireless.

This new featured model is durable and developed with the same type of connectors, so it can be used in conjunction with all of Fit Cuffs products and for all sort of passive modalities, resistance exercises and BFR-Cycling. One-Size-Fits-all.

We find this to be a convenient option in many situations for lower body exercise, as this optional wireless edition has some obvious assets:

✔Instant pressure assessments during inter-set rest periods.

✔Quick pressure adjustments during exercise.

✔Swift interset deflation and inflation of the cuffs.

✔Assessment of pressure fluctuations during exercise.

✔Rotating gauge for easy bilateral application.

We find this to be a convenient alternative for passive Blood Flow Restriction modalities such as Ischemic Precondition (IPC), post-exercise recovery or to apply during periods of immobilization to attenuate muscle loss.

Bilateral application is especially relevant for BFR-cycling. As this allows for convenient assessment of pressure without the need for re-attachment and detachment.

Relevant in clinical settings for people with contra indications and comorbidities as instant access to pressure can be preferable.

Maybe some obvious and relevant implications are missing, if so, please mail us at into@fitcuffs.com or if this new edition has any interest for you!?
Read more

January 04, 2021

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, Okklusionstraining, ocklusionsträning, bfrcuffs, bfrtool, bfrequipment

In this video you can see some relevant BFR – running & strength drills on decline and incline surfaces. In the text below you will find the relevant results from (Paton et al. 2017)


INTRODUCTION The effects of treadmill running training performed with or without BFR / Occlusion Training on parameters of running performance.

METHOD 16 subjects assigned to BFR or CON for 8 sessions of training. Before and after the trial, subjects completed an incremental running test to determine:

Peak running velocity + maximal oxygen uptake + running economy. Followed by a time to exhaustion run performed at peak running velocity.

Training for both groups consisted of progressively increasing volumes of 30-seconds (reps) completed at 80% of peak running velocity, 2 times a week:

Repeated bouts (reps) of 30-s running interspersed with 30-s passive rest.

The initial training session consisted of 2 sets of 5 reps.

Between each set, rest for 150-s without BFR.

Thereafter the total volume of training was increased progressively by 2 min (equivalent to 2 reps per session until the final session of 3 sets of 8 reps.

RESULTS The BFR and CON groups reported gains (6.3±3.5 vs 4.0±3.3%) in VO2max following training with small differences between groups.

Similarly, peak running velocity and incremental test time increased in both training groups with a small additional enhancement in favour of the BFR group.

Running economy improved for BFR but not in CON. Time to exhaustion also increased for both (27±9% vs 17±6%) with a small favour of the BFR.

CONCLUSION Running with Blood Flow Restriction during high intensity sessions may provide additional beneficial adaptations, which may lead to practically gains related to running performance. These gains are predominately due to peripheral adaptations mostly occurring at the muscular level, possibly via an increase in muscle strength or an enhanced ability to resist fatigue inducing metabolites!?

What are you thoughts on these adaptations- Improved muscle strength or fatigue resistance?

Source: Paton et al. (2017) The effects of muscle blood flow restriction during running training on measures of aerobic capacity and run time to exhaustion.
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December 10, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, Okklusionstraining, ocklusionsträning, bfrcuffs, bfrtool, bfrequipment

Thanks to @mahdyelzeinpt for his dedication and final accomplishment throughout this study:

“THE USE OF A PORTABLE BLUETOOTH DEVICE TO MEASURE BLOOD FLOW RESTRICTION TRAINING PRESSURE REQUIREMENTS: A VALIDATION STUDY.”


Background – Blood flow restriction (BFR) is a novel strategy that consists of training with the application of an external pressure proximally to the targeted limbs.

In order to optimize results and minimize safety concerns in BFR, the restrictive pressure should be applied in relation to Limb Occlusion Pressure (LOP) in the upper or lower limbs, respectively. However, available LOP measurement tools are expensive and require intensive training, limiting their availability in practical settings.

Objective – To study the validity of a portable, affordable and easy to use Bluetooth Device in providing accurate LOP measurements for BFR application, by comparing it to the already validated Vascular Doppler.

Methods – 20 healthy adults (15 M, 5 F) underwent 2 measurements in their Upper- and Lower Limbs (UL) and (LL), respectively. Using the Doppler and subsequently via the Bluetooth Device.

Outcome measurements – UL and LL LOP obtained via Bluetooth Device and Doppler measurements. The student t-test was performed to compare mean LOP values obtained from Bluetooth Device and Doppler measurements. Pearson’s correlation coefficient (R2) was also calculated.

Results – No significant differences were found between Bluetooth Device and Doppler measurements for UL and LL LOP. There was an almost perfect uphill correlation between Bluetooth Device and Doppler LOP measurement values in the UL and LL.

CONCLUSION – Based on the results of our study, we recommend using the Fit Cuffs® portable Bluetooth Device for objective and personalized BFR practice. This device is a valid, reliable and low-cost replacement for other measurement devices, which are substantially more expensive and require considerable usage skills. Thus, using the Bluetooth Device would offer BFR practitioners the ability to provide high-quality services for their clients or patients, ensuring minimal risks and optimal results regardless of location.

Primary source:

Mahdy EL-ZEIN (2020) THESIS – THE USE OF A PORTABLE BLUETOOTH DEVICE TO MEASURE BLOOD FLOW RESTRICTION TRAINING PRESSURE REQUIREMENTS: A VALIDATION STUDY.

Additional source:

Weatherholt et al. (2019) The Effect of Cuff Width for Determining Limb Occlusion Pressure: A Comparison of BFR Devices.

Berger et al. (2001) How Does It Work? – Oscillatory blood pressure monitoring devices.

Heather et al. (2020) Limb occlusion pressure for blood flow restricted exercise- variability and relations with participant characteristics.

Jordanow et al. (2018) Comparison of oscillometric, Doppler and invasive blood pressure measurement in anesthetized goat.

Zachary et al. (2020) Limb Occlusion Pressure: A Method to Assess Changes in Systolic Blood Pressure.
Read more

December 08, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, Okklusionstraining, ocklusionsträning, bfrcuffs, bfrtool, bfrequipment

In this video and text we propose how to regain strength by Blood Flow Restriction (BFR) / Occlusion Training and conventional resistance training in the early and mid-phase after a conservative managed elbow fracture.


It usually takes approximately 6 weeks for the fracture to heal, during this time, it is imperative that the elbow is not stressed by heavy lifting. On the other hand, it is equally as important to start to exercising as soon as possible, in order to regain normal ROM.

In this case, after the initial examination for potential displacements, dislocations, injury to blood vessels and nerves no surgical intervention was needed and only partial immobilization was prescript by the physician:

By early contralateral resistance training for the uninjured arm, you can attenuate the loss of muscle mass and strength by cortical, subcortical and spinal level transfer. Using machines with adjustable weights are probably most convenient, with the injured limb using Low-load BFR and the opposite arm performing the same exercise with higher load and fewer reps in the resting periods (30-45 s.). By combining both training modalities, we’re achieving the potential benefit from both a central neurological and a peripheral muscle perspective.

The obvious benefit of using BFR is retaining strength and muscle mass with low loads, protecting the fracture. But additionally, it is imperative for fracture that the bone reabsorption (osteoblastic activity – breaking down bone) does not exceed bone formation (osteoclastic activity). Some BFR training studies showing that the cell swelling increases load around the fracture site, creating a measurable increase in bone formation markers and a decrease in bone reabsorption markers.

Though, this potential specific effect of BFR on bone formation is still very preliminary. It is important to gradually increase activity and load as the pain and swelling subside so the bones can achieve their preinjury strength. As a rule of thumb, do the exercises with high frequency, but low volume even though the elbow is often stiff and painful, it is important to continue progressing for a successful rehab.

Source:

Cancio et al. (2019) Blood Flow Restriction Therapy after Closed Treatment of Distal Radius Fractures.

Carroll et al. (2006) Contralateral effects of unilateral strength training: evidence and possible mechanisms.

Bittar et al. (2018) Effects of blood flow restriction exercises on bone metabolism: a systematic review.
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November 18, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, Okklusionstraining, ocklusionsträning, bfrcuffs, bfrtool, bfrequipment

Here we got a late stage rehab program for a conservative managed (non-operative) Posterior Cruciate Ligament (PCL) tear grade 2-3.


The full exercise selection consists of moderate load resistance training, balance and low-load Blood Flow Restriction (BFR) training with Leg Cuffs V3 as displayed.

The PCL is located behind the ACL, comprised of 2 bundles to synergistically create antero-posterior stability within the knee (avoiding the shin bone to glide backwards relative to the thigh).

The main functional goal should be active stability which is essential for active work-life and return to sport when applicable. As the quadriceps is agonistic to the PCL, an important sub-goal should be to strengthen this muscle group for a successful rehab and return to play.

In the early stage (0-10 weeks) the ligament should heal in a neutral position in a brace to regain optimal length of the ligament, additionally, there are some essential restrictions: 1. Limiting combined hamstring contraction with knee flexion, which is essential for the healing of the ligament. 2. Load management, which is important for the health of the impaired cartilage associated with the injury.

Despite the successful return to sports, the development of osteoarthritis is evident following non-operative PCL management: At 5 years following injury, 77% develop degenerative changes in the medial femoral condyle and 47% had degenerative changes in the trochlea. Because of this, it is probably not recommended to speed up the process in regards to high impact activities such as high-speed running and high-load resistance training for the first 5 and 3 months, respectively.

For this particular client, BFR was implemented at the early stages fitting the Leg Cuff above and beneath the knee brace to limit flexion to 90 degrees during knee extension and closed chain exercises like squats etc.

Considering the relative unpleasant long-term prognosis on cartilage and meniscal health i.e. degenerative changes, the rational for using BFR and low-load exercises even at later stages seems apparent.

Source:

Strobel et al. (2003) Arthroscopic evaluation of articular cartilage lesions in posterior cruciate ligament—deficient knees.

Velde et al. (2009) Analysis of tibiofemoral cartilage deformation in the posterior cruciate ligament-deficient knee.

physio-pedia.com/Non-operative_Treatment_of_PCL_Injury.

Blazey (2018) Blog post – Blood flow restriction: miracle return to play adjunct or therapy fad?
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November 09, 2020

This is yet another post about arthritis and Blood Flow Restriction (BFR) with the brand new Leg Cuffs V3 in display!


Arthritis is the swelling and tenderness in one or several joints. The symptoms of arthritis are pain, stiffness, swelling, redness and/or decreased range of motion which typically worsen with age. The most common type of arthritis is osteoarthritis.

Osteoarthritis causes cartilage to break down over time, beginning with the lining of the joints.

The main goals of all arthritis treatments are to reduce these symptoms and improve quality of life. Conventional resistance training is often prescribed for people suffering from arthritis, as it has shown to improve both outcomes. But for some individuals, the usual training regime can be an aggravating factor. That is why BFR Training, which is inherently low-load, has been proposed as a relevant application for people struggling to do conventional training with research also indicating this.

Worldwide estimates are that 9.6% of men and 18.0% of women aged over 60 years have symptomatic osteoarthritis and the prevalence is increasing. That is also why, it has been proposed as the most important implication for BFR on a population scale!?

Though, remember when applying BFR, this is often a novel training stimulus for the client. So, in order to achieve adherence, progression and not at least to avoid adverse advents, it is imperative that the principles of gradual exposure and the repeated-bout-effect are practiced.

In this particular case, Leg Extension and Leg press is implemented with high pressures at about (70-80% LOP) at about 20-30% 1RM. Because these exercises have shown to slightly aggravate symptoms from the knees even at low-load, which can be contraindicated, especially as this exacerbation is prolonged.

Conversely, Leg curls has not been identified as an aggravator, e.g. post exercise joint swelling or pain, when the range of motion is also controlled. Because of this a lower LOP at about 60% and a higher relative load at about 40% 1RM are utilized.

Source:

Harper et al. (2019) Blood-flow restriction resistance exercise for older adults with knee Osteoarthritis: A Pilot Randomized Clinical Trial.

Ferraz et al. (2018) Benefits of resistance training with blood flow restriction in knee osteoarthritis.

Giles et al. (2017 Quadriceps strengthening with and without blood flow restriction in the treatment of PFP.

Bryk et al. (2016) Exercises with partial vascular occlusion in patients with knee osteoarthritis a randomized clinical trial.

Segal et al. (2015) Efficacy of Blood Flow Restricted Low-Load Resistance Training in Women with Risk Factors for Symptomatic Knee Osteoarthritis.

Takarada et al. (2000) Applications of vascular occlusion diminish disuse atrophy of knee extensor muscles.
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November 06, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, Okklusionstraining, ocklusionsträning, bfrcuffs, bfrtool, bfrequipment

Introducing the specifications for the brand new Leg Cuff V3 for blood flow restriction, which is now available for purchase.


The Leg Cuff V3 has a wide velcro attachment area that allows for a custom contoured fit.

This variable-contour cuff can be adjusted to the shape of the thigh, providing a personalized fit for optimized pressure distribution during exercise.

By simply changing the placement of the velcro strap you achieve a personal fit that will accommodate any thigh shape, from cone to more straight thighs and as always with our products, One-Size-Fits-All.

Listed below are just some of the relevant specs for this updated version:

✅Dynamic Cone Fit.

✅Works with the Bluetooth Device as a convenient alternative to handheld dopplers for assessment of Limb Occlusion Pressure (LOP).

✅Same width (10cm / 4Inch) as the standard Leg Cuff and thereby calibrated for “Calculate Pressure” – accessible at training.fitcuffs.com.

✅Developed to fit 99% of all thigh sizes. (thigh circumference: 45-85cm / 17-34Inch).

✅Plugin reinforced for extreme durability.

✅Thin internal stiffener for improved fit during exercise.

✅Solid metal quick-connector for fast inflation & deflation.

✅Heavy duty nylon band for swift attachment.

✅Solid stitching & bonding.

✅Water resistant nylon material.

✅Right & Left versions – only for convenience.
Read more

 

October 13, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, okklusiontraining, ocklusionsträning

Anywhere from Denmark🌫 to Hawaii 🏖 the Arm Cuff V3 is an effective training tool for blood flow restriction (BFR) Training!


Notice, that the standard or original cuffs are still available for purchase!

Listed below are just some of the relevant specs for this updated version:

✅One-Size-Fits-All: (20-50 cm) / (7.9-20 Inch).

✅Full width: 7 cm / 2.75 Inch.

✅No internal stiffener for improved elasticity and pliability.

✅New reverse velcro design for swift attachment.

✅Water resistant nylon material.

✅Extension piece to avoid pinching.

✅Plugin/coupler enforced for extreme durability.

✅Industry-leading solid metal coupler.
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October 06, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, okklusiontraining, ocklusionsträning

Check out YouTube or Instagram TV for the comprehensive review by “Reviews And Random” for the Fit Cuffs – Complete + Bluetooth Device (LOP) developed for blood flow restriction / Occlusion training. Included below are some of the key points from the review


..”They were not given to me. I paid my own money for them and I am not paid to do a review.”
“This is their complete set that comes with the hard case for everything that comes with the cuffs.”

“I came across Dr. Mario Novo, who’s like one of the world’s leading experts on BFR and an awesome guy,” .. “And he told me specifically to look at Fit Cuffs as one of the brands to look at because he really likes the ability to assess LOP, as it’s extraordinarily important..”

“So I spent a few weeks looking at dozens of different brands of bands and comparing them with certain key aspects that I learned from the studies that I read. We’ll talk about some of those. And I finally settled on #fitcuffs and I could talk literally for hours on the information that I’ve compiled..”

“.., I want to explain my process when I was shopping of why I chose Fit Cuffs over all of those other brands after all of my comparison shopping.

“I want the ability to assess LOP and I want the ability to accurately set and maintain that pressure. I need something that’s comfortable, durable and versatile.” “So I want both the safety and the efficacy of BFR bands and that they are one hundred percent dependent on the ability to accurately assess the LOP.” .. “Mostly I’m I’m choosing to just go 50% of my LOP which seems to be where most of the studies recommend.”

“Yeah, that’s it. So this is an extremely, extremely accurate and easy way to control the pressure.” .. “So to do that, the vast majority of the other brands out there require you to buy a Doppler so that you can listen to the Doppler is basically just a microphone you put on your artery.
“So what I liked about Fit Cuffs is that all of these parts are individual and they’re individually replaceable..”

“So the other brands, were more flashy, which I thought was cool, but they ultimately didn’t provide better results and they weren’t as versatile and they were more expensive..”

“So initially when I was looking at before I actually even put another brand in the cart ready to buy, I was going to buy them because they were like one hundred fifty dollars less. Then I started to actually crunch the numbers and I found that it really wasn’t that good of a deal. The reason why is that I would have to add another one hundred dollars plus to buy a Doppler because it didn’t come with any way to assess LOP..” “The Fit Cuffs Training app is free through their website (fitcuffs.web.app). It works great, nice and easy to use.”

Fit and comfort: “So you don’t want to compound just the inherent discomfort of our BFR Training with poor design e.g. poorly designed cuffs. So that’s what I really liked about Fit Cuffs, is it seems like they pay really great attention to the details.”

Durability: “I use plastic couplers every day at work with my blood pressure cuffs, but that’s because they’re designed to be disposable. So you’re going to actually be inflating and deflating these cuffs multiple times per workout, multiple times per week. So you really don’t want to skip out when it comes to these quick-connectiors (couplings)”.. “So these have the metal couplings, which is awesome.” “So all in all, guys, I’m extremely pleased with the design and construction. They’re really well made with attention paid to every detail” .

“No doubt that this thing is built to last and I’m going to have this for years to come. So that being said, let’s move on to the last section, which is versatility:

“That comes that’s even more important if you’re wanting to use this in a professional setting, like a gym or rehab facility, the way that this is designed, the placement of the velcro and the fact that the other side of the velcro actually extends all the way around the cuff means that this can be used on 99% of the arms and legs out there.”

“So overall, the design of these makes them really some of the most versatile cuffs on the market.”
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September 30, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, okklusiontraining,

In display we got another great example of a home gym which is the perfect setup for an effective lower body workout with “okklusionstræning” BFR training


Leg Extension + Leg Curl + Seated Calf Raises.

Noticeably is the possibility for single-joint exercises which can be an important training modality and has been proposed as the optimal way to start off with BFR. So, keep on reading for the rational of doing single-joint exercises:

A common Jargon among the dinosaurs of health care and fitness professional’s is that movement patterns should be trained as opposed to individual muscle groups. Because single-joint exercises are mostly not a part of ADL, sports or other recreational activities, they are often labelled as nonfunctional and therefore excluded from rehab and performance programs. But as you might already know, this bold argument is somehow outdated and unnuanced.

Compared to multi-joint exercises, single-joint exercises like leg extension is unaffected by proximal fatique occurring in the prime movers, e.g. squats favor glute max at the likely expense of quadriceps exertion. Conversely, single-joint exercises, can be a better option to reach the effective rep range unaffected by the exertion experienced in the surrounding and synergistic muscle groups.

By augmenting conventional multi-joint exercises with single-joint BFR exercises it is possible to gain specific muscle strength that is directly transferable to ADL and sports performance, above which can be achieved with multi-joint training alone.

Because low-load exercise and thereby inherently BFR, must be performed with high exertion on the targeted muscles in order to reach the state of near volitional failure, single-leg exercises can in some instances be preferable. This is particularly relevant for people unaccustomed to BFR, as single-leg exercises can be a great way acclimating to the significant stress of BFR.

Additionally, Leg curls improves stretch tolerance because of increased fascicle length through the addition of sarcomeres in series which improves the functional muscle length and has shown to be relevant for injury prevention and performance, e.g. sprint speed etc.

Source:

Schoenfeld et. Contreras (2012) Do Single-Joint Exercises Enhance Functional Fitness?

Gentil et al. (2015) Single vs. Multi-Joint Resistance Exercises: Effects on Muscle Strength and Hypertrophy.

Stien et al. (2020) Training specificity performing single-joint vs. multi-joint resistance exercises among physically active females: A randomized controlled trial.
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September 17, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfr training kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, okklusiontraining,

This is the successor in the series of BFR for BIG arms. This time around we run through the nuts & bolts obtained from the cutting-edge research in Blood Flow Restriction.


By applying Blood Flow Restriction (BFR) muscles are simply stimulated at a lower working rate compared to Free Flow Conditions. Or alternatively, the metabolic stress and low-load exercise let’s your reach the effective rep range faster compared to conventional training.

For most people similar explanations would do the job, if not, then keep reading for a more comprehensive explanation of why BFR has proven its worth for hypertrophy!

As a rule of thumb, muscles adapts to mechanical and/or metabolic stimuli. Mechanical being the external load on the muscle whereas metabolic being the exertion of the muscle during repetitive or static work. The great thing about BFR is that you reach the state of exertion/fatique much faster compared to conventional resistance training – BFR simply reduces the repetitions needed to build muscle by 30-50%.

When blood flow is partially restricted the transportation of oxygen is also reduced which changes the energy demand and increases the speed in which muscle fatigue occurs. This partial hypoxic (no oxygen) state means that the type 2 muscle fibers are being recruited at a rapid rate. When lactate and other metabolites accumulates because of glucose break down even more muscle fibers are being recruited.

BFR + cell swelling + mechanical tension creates metabolic stress leading to swift muscular exertion. – Activation of mTor and downregulation of myostatin, as the most important hormonal responses leading to increased protein synthesis.

Combined with the repeated bout effect e.g. regular training, we have a finale recipe for hypertrophy.

As some of the ingredients are up for debate, like cell swelling (the primary rational for passive BFR) and lactic acid as a direct anabolic pathway for collagen production (tendon health), please do not hesitate to comment!?

Source:

Klein et al. (2001) Flexor tendon wound healing in vitro: the effect of lactate on tendon cell proliferation and collagen production.

Jessee et al. (2018) Mechanisms of Blood Flow Restriction: The New Testament.

Sleboda et al. (2019). Internal fluid pressure influences muscle contractile force.

Dr. Nicholas Rolnick (2020) 13 Module Online Video Course – Blood Flow Restriction.
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September 5, 2020

Fit cuffs, arm wrestler, arm wrestling, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfr training kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise,

In this shortened review from “Monster” Michael Todd, you can see how BFR by means of the newly developed Arm Cuff V3 is used to augment his sports specific training for arm wrestling. The full version can be found on Youtube: “Monster&MrsMonster”


BFR or blood flow restriction is currently showing its efficacy as a performance optimizer in many different sports, both anecdotally but definitely also from a scientific standpoint. (Wilk et al. 2020).

Though, currently lacking any specific data on arm wrestling the potential benefit of BFR is a dead giveaway.

The popularity of arm wrestling has increased enormously in the recent years, probably because of the intense and audience friendly setup. Even though, at first glance it might seem straightforward, the sport is actually very technical e.g. positioning etc!

Thus, a substantial part of success in arm wrestling can bee contributed to raw physical ability, such as maximal strength and not at least muscular endurance.

The two main physical components can for obvious reasons be augmented by adding BFR to the sport’s specific exercises in arm wrestling. We recommend to use the standard principles for low-load BFR training, but as you can see in the video Michael is adapting some arm wrestling-specific positioning and shorter ROM.

As a relevant factor to consider, is the extremely high training volume which is paramount for all professional arm wrestlers. Because of the inherent training adaptations in arm wrestling, the rep scheme, sets and exercises can probably be much higher compared to what is normally recommended for upper body BFR. Though, the optimal way to program BFR for arm wrestling is currently unexplored.

As discussed in the latest post, BFR can be used as the primary modality in short blogs or as a finisher to your conventional workout. But for any of you that have watched arms wrestling, I would like to know your initial thoughts on how to use and program BFR for performance optimization in this population!?

Source:

Wilk et al. (2020) The Acute Effects of External Compression With Blood Flow Restriction on Maximal Strength and Strength-Endurance Performance of the Upper Limbs.
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September 3, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfr training kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise,

In the video we got a great selection of triceps specific exercises, as this blog post is all about BFR for big arms💪. Covering some of the nerd-alerting physiological mechanisms of low-load BFR in an upcoming post🦾.


As you probably already know, low-load BFR is a great way to increase training volume and frequency without loading the joints or impairing your recovery. For the general public, we recommend to start with your conventional heavy training and finish your workout with BFR as it has some obvious advantages of low-load BFR training, especially in situations of joint pain and high-volume training.

Next, because BFR works best with low-load, use 30-50% of the load you’d usually use for a standard set of 10-15 reps but shorter inter-set rest, as the short rest periods will further increase the rate of exertion and increase the subjective feeling of the pump! You can expect large initial effect, e.g. 2-3 weeks of consecutive training.

When utilizing BFR as a finisher we recommend BFR at a low frequency as only 2-3 times a week with 1-3 upper and/or lower body exercises immediately after performing your main workout as a finisher:

As an alternative to BFR-finishers, is the application of BFR in alternating weeks, swapping with your usual workout routine: We recommend BFR in alternating weeks/days with a high frequency as 1 time per day or even 2 times a day but only for short periods (1-3 weeks).

BFR coupled with low-load exercise increases cell swelling and metabolic stress and let’s your reach the effective rep range faster compared to conventional training and with less mechanical tension.

Source:

Lowery et al. (2013) Practical blood flow restriction training increases muscle hypertrophy during a periodized resistance training programme.

Rolnick et Schoenfeld (2020) Blood Flow Restriction Training and the Physique Athlete- A Practical Research-Based Guide to Maximizing Muscle Size.
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August 14, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfr training kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exerciseIntroducing the Brand New Arm Cuff V3 available at fitcuffs.com.

💥This time around the Arm Cuff has been improved on about all relevant parameters, especially attachment is now faster and more convenient than ever.


💥 Full width is 7 cm (2.7 inch) which is the same as the original Arm Cuff.

💥 Fits about 99% of all arm sizes, specified as upper arm circumference between 20-50 cm (7.9-20 Inch).

💥 Works perfectly in conjunction with the Bluetooth Device for assessment of Limb Occlusion Pressure (LOP) and the “Calculate Pressure” module at training.fitcuffs.com.
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July 28, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfr training kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise

For who that has been living under a rock, Blood Flow Restriction (BFR) training is an emerging exercise modality that combines low intensity exercise with partial restriction of blood flow.


Though, while it may seem a little ridiculous at first glance, BFR consistently outperforms conventional training with low loads on about any relevant parameter such as strength and muscle mass.

It is far from a necessity to do advanced and “functional” exercises and often the simplest exercises are the way to start, especially in regards to muscle mass:

0:00 Hack Squat

0:17 Leg Curl

0:33 Leg Extension

If you´re a BFR novice and you do not have any relevant injuries, we recommend to use such or similar exercises as exemplified in the video to increase muscular strength and mass.

But please mind! If this is your or your clients very first time doing BFR, ask for any relevant chronic conditions, e.g. hyper- or hypotension. Then implement the principles of gradual exposure and progressive overload into your programming, as this is key for both adherence, safety and effectiveness:

We recommend doing only one exercise at about 15-30% 1RM for 30x15x15x15 reps without reaching failure. Then in the following weeks progress your exercise selection, intensity/load, and for most people it would be advisable to deflate the cuffs between exercises for a start.

Additionally, we recommended that the pressure is set relative to the individual, that can be controlled by measurement of Limb Occlusion Pressure “LOP” or for Fit Cuffs, by the “Calculate Pressure” as both modules are readily available at ficuffs.web.app. Basically, the amount of pressure needed to stop blood flow is highly dependent cuff width, the size of the limb in regards to circumference and to a less degree body composition. Though, it should also be considered that BFR has shown to be effective and safe across a wide range of relative pressures i.e. 40-80% LOP.

Above and beyond, by utilizing the principles of gradual exposure you can avoid severe DOMS, numbness, bruising, dizziness (see exercise pressor reflex) and not at least, attain adherence for BFR Training.

Source:

Spranger et al. (2016) Blood flow restriction training and the exercise pressor reflex: a call for concern.

Jesse et al. (2016) Letter to the editor: Applying the blood flow restriction pressure: the elephant in the room.

Spranger et al. (2016) Reply to “Letter to the editor: Applying the blood flow restriction pressure: the elephant in the room”.

Presentation by Dr. James P Fisher. The Exercise Pressor Reflex – available at rigshospitalet.dk.
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July 09, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, bfrexercise vascular occlusiontraining bfrtraining kaatsu, bfr, bfre, bfrt

This is the follow-up for the latest blog on the new Aerobic Fitness module, that can be used to set intensity relative to Watt Load or Work Pulse with or without BFR.


Additionally, the Bike Tests can be used to predict VO2 Max, Fitness Level and Watt Max, which is commonly known as “indirect tests” for Aerobic Fitness. A comprehensive protocol for each test can be located directly at training.fitcuffs.com –> “Bike Tests”.

Many clinician and trainers are interested in determining an individual’s Aerobic Fitness but are limited in their use of “direct tests”. The tests can be performed on any type of exercise bike but preferable on a Watt-bike Cycle Ergometer. Subsequently, you can use the build-in slider to set the intensity relative to either Watt Load or Work Pulse Beats Per Minute (BPM) i.e. Heart Rate Reserve (HRR).

The features consist of 3/4 different tests build into the same interface. All tests seem to have less than 10% error associated with them in predicting VO2 Max (1) and a very high ability to detect any relevant change of Aerobic Fitness:

a. By only using Age, the app will estimate your Max Pulse and Resting Pulse. This is sufficient to use the slider-functionality to set the intensity relative to HRR i.e. BBP. For a more precise estimation of your HRR you can add your Max Pulse and Resting pulse.

b. The Submaximal Bike Tests includes a rather simple “one-point-test”, that can be used to estimate your VO2 Max, Fitness Level and Watt Max. To use this feature, you need to find your steady-state-pulse at a corresponding Watt Load, i.e. Load 1 and Pulse 1. Add your Resting Pulse and Max Pulse to obtain a more valid estimation of your actual Aerobic Fitness (2,3,4).

c. For improved estimation of your Aerobic Fitness, you can perform the same test but adding a higher load and higher pulse i.e. Load 2 and Pulse 2, aka. “two-point-test” (2,3,4).

d. But the Golden standard for most individuals is the Watt Max Bike Test. This is performed by a similar progressive protocol, but this test is much harder as you must go all out and reach the point of absolute failure in order to obtain a valid test result. this maximum test, should not be used in at risk populations i.e. heart or respiratory conditions, without approval from a physician. As a rule of thumb for the general public, if you’re not used to do strenuous exercise, perform the test after gradual exposure to near maximal intensity aerobic exercise.

Disclaimer: Always consider the safety of the tests in respect to age, training condition, etc., and the test–retest reliability and validity (1). The formulas from the Bike Test module can be found at (4).

Source:

(1) Grant et al. (1999) The Prediction of Vo2max: A Comparison of 7 Indirect Tests of Aerobic Power.

(2) Astrand et Rodahl. (1986) Textbook of Work Physiology: Physiological Bases of Exercise (3rd ed.). New York.

(3) Astrand et Ryhming. (1954) A nomogram for calculation of aerobic capacity (physical fitness) from pulse rate during submaximal work.

(4) Beyer et al. (2010) Træning – i forebyggelse, behandling og rehabilitering. Munksgaard Danmark.
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July 06, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, bfrexercise vascular occlusiontraining bfrtraining kaatsu, bfr, bfre, bfrt

Check our brand new Aerobic Fitness module and the relevant Bike Tests at fitcuffs.web.app. We find this relevant for everyone into aerobic fitness and performance training or for clinicians working in cardio/respiratory rehab with or without BFR.


You should also stay tuned for a follow-up post with a comprehensive explanation of the different tests and the essential research on the near linear relationship of Watts and Working Pulse. As this is fundamental for these “indirect tests”, i.e. estimation of VO2 Max, Fitness Level and Watt Max.
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June 26, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, bfrexercise vascular occlusiontraining bfrtraining kaatsu, bfr, bfre, bfrt

In the present post we got some running drills and plyometrics hurdle hops augmented by Blood Flow Restriction (BFR) Training, which can be used to improve running speed and other parameters of anaerobic performance.


0:02 Straight Running.

0:08 Bilateral Hurdle Hop.

0:21 Lateral Hurdle Shuffle.

0:32 Backwards Running.

Straight running drills can be done with a steady pace or as intervals at submaximal velocity i.e. 50-90% maximum sprint speed, with or without backwards running which focuses on the glute and hamstrings.

The Bilateral Hurdle Hop is a simple plyometric movement that combines muscle fatigue and coordination. Just remember to land and take off with both feet at the same time with minimal contact time.

Lateral Shuffle: Without crossing feet, shuffle laterally right over each hurdle, leading with one leg so each foot touches once between hurdles.

Training with BFR is a well‐recognized strategy for promoting muscle hypertrophy and strength. However, its potential to enhance muscle function during sustained, anaerobic type exercise has also been explored in several research papers as presented in the latest post (the complete BFR guide). It seems that BFR performance-training, has its relevance in later stage rehab and to improve performance in the uninjured athlete.

The partial restriction of blood flow to the legs during these and similar workouts, raises the oxygen and energy expenditure with a higher rate of fatiques compared to conventional drills. BFR seems to improve several parameters of performance, but the adaptations after BFR-running seems to be primarily muscular (peripheral) rather than cardiovascular (central).

As BFR training is less time consuming and puts less strain on the tendons and joints this can be relevant for athletes during periods of strenuous exercise e.g. in season.

We recommend that this or similar BFR augmented drills, are performed after conventional sports practice/athletic training or as alternating weekly/daily with or without BFR, simply by changing intensity and exercise time.

As a rule of thumb, duo to the novel training stimuli of BFR, remember to use the principles of gradual exposure, in regards to exercise time, intensity and pressure (mmHg) to avoid rhabdomyolysis. In addition, it seems that training intensity and pressure are important factors to progress for optimal aerobic, anaerobic, and muscular development.
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June 17, 2020

Even though gyms around the world are opening again, home-BFR is equally as swift, effectful and convenient. So, In this post we got another selection of classic compound exercises that works most of the lower body:


0:00 Back Squat – 0:20 Cross-behind Lunge. – 0:40 Romanian Deadlift.

Cross-behind lunge focuses on strengthening the glutes, quads, and calves. It has also been proposed that the large range of motion of the hip, augments glute strength and muscle gains.

Though, the glute muscle is obviously upstream relative to the cuff (proximal), it appears that BFR is effective for improving glute size and strength, when neither clinical or practical feasible to use higher loads.

Proximal hypertrophy is a common observation in multi-joint BFR training exercises in both aerobic and resistance training protocols, but the reasons for hypertrophy of the gluteus are unclear and several explanations exist.

If we compare the rational for proximal gain of the glute in the BFR-Squat vs. BFR-Romanian deadlift, it can be speculated that the underlying mechanisms are somehow different:

The accelerated fatigue of the muscles distal to the cuff require a larger contribution of the muscles proximal to the cuff. Because of a higher motor unit recruitment may be required to maintain sufficient force generation as a synergistic action of the knee and hip muscles that increases the demand of the proximal muscles.

This is the most common explanation of why the conventional BFR-squat movements can be effective for proximal gains. – With the glutes being the prime hip extensors in the squat, and hamstrings being secondary, i.e. stabilizers of the knee, the magnitude of proximal effect is probably attenuated by the rapid fatigue of the quads and thereby the limiting factor.

For the hinge pattern e.g. Romanian deadlift, the knees are almost fully extended causing the hamstrings to be a prime mover along with the glutes. But when you pair this movement with BFR, it can be hypothesized that the hamstrings get fatigued faster compared with No-BFR deadlifts, making the glutes the primary hip extensor and reaching it’s full potential for growth.

Source:

Bowman et al. (2019) The Proximal and Distal Effects of Blood Flow Restriction Therapy on Upper and Lower Extremity Strengthening: A Randomized Controlled Trial.

Abe et al. (2005) Skeletal muscle size and circulating IGF-1 are increased after two weeks of twice daily “KAATSU” resistance training.

Luebbers et al. (2014) The Effects of a 7-Week Practical Blood Flow Restriction Program on Well-Trained Collegiate Athletes.
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June 10, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, bfrexercise vascular occlusiontraining bfrtraining kaatsu, bfr, bfre, bfrt

This is a follow-up to the latest post on the framework for a complete practical guide for Blood Flow Restriction (BFR) Training for clinicians, average Joe’s and athletes of all levels.


If you haven’t already spotted the recent post, we advise you to have a quick look. In the present post we describe some additional guidelines for BFR in Rehab, BFR with conventional exercise and BFR in sports performance.

Regarding BFR as a performance modality, it should be acknowledged that the different protocols effects many of the same parameters. It should also be noticed that the science in BFR for performance is a less explored field of research and many different protocols have been proposed. So, as this is still very preliminary and optimized training protocols will undoubtedly be discovered in the nearest future.

It should also be considered, that regular low-load resistance BFR training has proven it worth as a performance enhancer, relative to the athletes baseline form. Another relevant thing to consider, is the expected inter-individual response to different protocols and importantly, personal preferences for different exercise modalities.

Some of the protocols found in the research utilize very high intensity and high relative pressure (% of Limb Occlusion Pressure). That is why we recommend gradual exposure of both volume and intensity, as the key to avoid adverse events and training adherence.

If you have picked up anything not matching the current science or your own practical experience, please let us know in the comments!?

Additionally, if you find we have missed mandatory information especially regarding safety, please also comment below, so we can continue to improve this complete guide!?

Source:

Rolnick et Schoenfeld (2020) Blood Flow Restriction Training and the Physique Athlete- A Practical Research-Based Guide to Maximizing Muscle Size.

Hansen et al. (2020) Effects of alternating blood-flow restricted training and heavy-load resistance training on myofiber morphology and mechanical muscle function.

Loenneke et al. (2012) Blood flow restriction: an evidence based progressive model (review).

Barbalho et al. (2018) Addition of blood flow restriction to passive mobilization reduces the rate of muscle wasting in elderly patients in the intensive care unit: a within-patient randomized trial.

Bennet et al. (2018) Effects of Blood Flow Restriction Training on Aerobic Capacity and Performance: A Systematic Review.

Amani et al. (2019) Blood Flow Restriction During Futsal Training Increases Muscle Activation and Strength.

Behringer et al. (2017) Low-Intensity Sprint Training With Blood Flow Restriction Improves 100-m Dash.

Christiansen et al. (2019) Cycling with blood flow restriction improves performance and muscle K+ handling and blunts the effect of antioxidant infusion in humans.
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June 6, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, bfrexercise vascular occlusiontraining bfrtraining kaatsu, bfr, bfre, bfrt

Check this post for a preliminary framework to create a complete practical guide for Blood Flow Restriction (BFR) Training for clinicians, athletes and all other using BFR.


This is indeed not a finite version, as more research is being published at a rapid rate, better protocols will certainly be discovered in the newest future.
But if you pick up anything not matching the current science or your own practical experience, please let us know at info@fitcuffs.com.

Additionally, if you find we have missed mandatory information, please also comment below so this guide can be improved as soon as possible.

Source: Bond et al. (2019) Blood Flow Restriction Resistance Exercise as a Rehabilitation Modality Following Orthopaedic Surgery- A Review of Venous Thromboembolism Risk.

Patterson et al. (2019) Blood Flow Restriction Exercise, Considerations of Methodology Application, and Safety.
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May 29, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, bfrexercise vascular occlusiontraining bfrtraining kaatsu, bfr, bfre, bfrt

In display are a bunch of low practical BFR exercises for the biceps and triceps and muscles, which is particularly relevant for bodybuilders of any level.


But for your own expense, be aware, as this video is not for the virginals, as some skin and partial nudity may occur.😉 But I can insure you, for the indefinite Viking i.e. Oliver Price, this is definitely not the first time showing off some impressive physique.

Joking aside, this is actually a great way to display the vascularization and decolorization that is associated with muscle contractions combined with appropriate partial restriction of blood flow i.e. 40-80% LOP.That is when arterial inflow is partially restricted and venous outflow is completely restricted.

Though, for some people it may seem to extreme, but this is actually a common phenomenon in people with low body fat.

In the original Kaatsu protocol for what they now label as blood flow moderation, this is actually a part of their direct indicators of a beneficial BFR stimuli. On the other hand, if you or your client turn pale on the restricted limbs, this is a sign of near or complete occlusion, which is of course contra indicated and should be avoided during BFR training.

Regarding this ingenious home training setup, you can see how some water bottles and a broom can be turned into a dumbbell and a barbel, respectively.

For people who are used to conventional resistance training, aim for 30 reps followed by at least 3 sets of 15-20 reps and progress by doing at least the last set to failure and/or shorter inter-set rest periods (30-60 seconds).

So, when the usual dumbbell rack is not an option and the relative load cannot be identified, this is a convenient way to progress you low practical BFR Training.

Considering 12 x 1.5 kg water bottles used in the last exercise and as a general recommendation, exercises with a relative load above 50% 1RM should be applied without BFR for optimal effectiveness.
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May 23, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, bfrexercise vascular occlusiontraining bfrtraining kaatsu, bfr, bfre, bfrt

In this video we got even more great exercises to the repertoire of low-practical BFR upper body exercises, you can do about everywhere and any time of the day.


By augmenting your conventional exercise selection by Fit Cuffs, you got access to an effective, convenient and significantly less time demanding workout:

0:02 Bodyweight Dip.

0:05 Leg Elevated Chest Press.

0:07 Reverse Flyers.

0:13 Dumbbell Chest Pres.

0:20 Seated Dumbbell Curls.

0:26 Added load by stacking a tire with dumbbells.

0:44 Upright Rows.

0:48 Standing Dumbbell Curls.

BFR can be relevant for athletes, gym rats, and not to forget, in musculoskeletal rehab where high-load may initially be contraindicated. Basically, BFR lets you become stronger, with less stress on the tendon and articular structures, which is relevant for periods of deloading or as a finisher after a conventional workout.

Both programming modalities can be equally as effective and during this time, with limited access to the gym, BFR is probably more pertinent than ever. But as presented in the previous two posts, with reference to the newest and relevant data, it seems appropriate, that BFR is primarily used as a finisher, or as a substitute for shorter periods (<4-6 weeks).

We especially recommend BFR as a part of a periodization programming, for individuals with high volumes of resistance training or for athletes with high intensity weightbearing activities. Simply applied as alternating weeks of either high-load training or low-load BFR training followed by weeks as a short finisher to a high-load training session.

source:

Bagley et al. (2015) Is Blood Flow Restriction Training Beneficial for Athletes?

Scott et al. (2015) Blood flow restricted exercise for athletes: a review of available evidence.
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May 15, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, bfrexercise vascular occlusiontraining bfrtraining kaatsu, bfr, bfre, bfrt

In the past, we have presented the effect of BFR vs. conventional high-load training, but for practical applications, BFR is often more applicable as an add-on on.


This has been explored in a recent RCT from University of southern Denmark and in a practical research-based guide from Rolnick & Schoenfeld.

In the RCT, the researchers compared the effect of lower-limb block-structured training, consisting of alternating weeks of BFR training and conventional Heavy-Load resistance training (BFR+HL) vs. only (HL).

Methods: 18 active young participants were randomized to either 6-weeks (22 sessions) of structured training alternating weekly between BFR (20% 1RM) + HL (70-90% 1RM) vs. only HL (70-90% 1RM).

Outcomes: Maximal isometric knee extensor strength (MVC) and muscle biopsies (VL) as myofiber cross-sectional area (CSA), myonuclear (MN) number and satellite cell (SC) content.

Results: MVC increased in both groups (BFR+HL: +12%) vs. (HL: +7%). Type 2 CSA increased similarly in both groups (16%), while gains in type 1 CSA were only observed in HL (12%).

Conclusion: Conventional HL can periodically be replaced by low-load BFR without compromising gains in maximal muscle strength.

In the practical research-based guide, you will find an evidence-based recommendation on how to maximize hypertrophic potential with the implementation of BFR into a conventional program.

From the comprehensive amount of original research on this topic, it seems legit to add 1–2 exercises per target muscle group at the end of a heavy-load training session, to preferentially stress type 1 muscle fibers as a “finisher”.

This perspective on muscle fiber differentiation seems valid as the authors have discovered this from at least 2 original research articles, but this is actually the direct opposite trend that was discovered in the RCT!

Any thoughts or explanation, as why the RCT found that only the conventional High Load group gained type 1 muscle fiber hypertrophy?

Secondly, what should be considered when choosing to either implement BFR as alternatingly weeks/days (the RCT) vs. supplement to conventional training as a finisher?

Source:

Hansen et al. (2020) Effects of alternating blood-flow restricted training and heavy-load resistance training on myofiber morphology and mechanical muscle function.

Rolnick et Schoenfeld (2020) Blood Flow Restriction Training and the Physique Athlete- A Practical Research-Based Guide to Maximizing Muscle Size.
Read more

May 10, 2020

In this video we present yet another set of low practical BFR exercises:


0:00 Step Up. 0:10 Romanian Deadlift. 0:22 Squat. 0:34 Kneeling Squat. 0:44 Reverse Lunge.

During this point of time with many gyms being closed, it becomes inherently more interesting, whether BFR traning can substitute conventional high load traning?

It seems, that for most people it actually can be just as effective in regards to strength and muscle mass, but tendon health is a less explored field of research.

So, in a new pilot study from University of Copenhagen, the researchers have investigated whether BFR can help to improve tendon health in people with chronic Jumper’s knee (JS).

The rational for using BFR on this population, is that O2 deficiency in the muscle causes lactic acid, that seems to stimulate the formation of collagen protein in the tendon.

Protocol: 7 participants with chronic JP trained 6 sets of both single leg-press and single leg-extension at 30% 1RM until volitional failure for only 3 x 3/weekly.

Results: They experienced about as much progress as normally expected after 12 weeks of heavy slow resistance (HSR) training, which is the current recommended treatment for JS. As, significantly less pain (NRS) was reduced by 50% during single-leg decline squat testing, ultrasound scanning of tendon, showed vascularity diminished by 31 %.

Though, considering the small sample size, it’s very preliminary whether BFR training really has this rapid effect on JS.

If we compare these preliminary findings with the results from Centner et al. (2019), it seems valid that BFR training can be used as the primary modality in the rehabilitation of tendon related pains/disorders such as tendinopathy. But reversely, if we compare this to earlier work by Kubo et al. (2006) they did not find any relevant change on the tendon level. As BFR only increased muscle strength and size without the increment of tendon stiffness or force–elongation, but the high-load leg achieved the desirable improvement in tendon stiffness.

Any thoughts on BFR as the primary training modality or treatment of chronic tendon disorders such as tendinopathy?

Skovlund et al. (2020) The effect of low-load resistance training with blood flow restriction on chronic patellar tendinopathy – a case series.

Centner et al. (2019) similar morphological and mechanical Achilles tendon adaptations compared with high-load resistance training.

Kubo et al. (2006) Effects of low-load resistance training with vascular occlusion on the mechanical properties of muscle and tendon.
Read more

May 2, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, bfrexercise vascular occlusiontraining bfrtraining katsu, bfr, bfre, bfrt

In this video we see a great circuit-based training presented by @curtis_demont as a selection of lower body exercises augmented by Fit Cuffs.


Exercises in display:

0:16 Walking Lunge
0:20 Squats Jump
0:27 Push-up
0:42 Inch Worm
0:39 Horizontal Jump Squat
0:49 Lateral shuffle

So, as long as the gym is closed, we advise you to utilize your favored BFR tool and move your exercise routine to urban areas, nature or for some higher restricted regions as home training.

But if you do not supplement your BFR training by any kind of external resistance tool, like elastic bands etc., most people need to consider how to fatigue of both type 1 and type 2 muscle fibers.

As a rule of thumb, to target type 1 muscle fibers, you need to train at lower intensities, but perform higher reps and probably also more sets.

Subsequently, you can also consider the force-velocity relationship like doing force-full movements like sub-maximal Squat Jumps to achieve the fatigue of type 2 fibers at a rapid rate. This is because, if exercises are conducted at higher velocity this leads to greater exhaustion of fatigue sensitive type 2 fibers.

Any thoughts or precautions on BFR in combination with higher velocity based exercises like Jumping?

Spendiff et al. (2002) Effects of fatigue on the torque-velocity relation in muscle.
Read more

April 15, 2020

We have just released the brand-new progressive web app “Fit Cuffs Traning”, with online and offline availability by downloading it to your phone just as a standard app from google store or app store.


You can check the video on how to register a user, calculate pressure, tab in Limb Occlusion Pressure (LOP) and the last 10 s. on how to download it for offline availability. You can access the app from the homescreen just as an any other app on android devices and Iphones.

We have developed the algorithm from the comprehensive science and data on the predictors of Limb Occlusion Pressure (LOP), for you to enjoy Effective, Save and Convenient BFR Training.

We do not recommend to use arbitrary pressures, neither do we recommend a default pressure, though 80 mmHg and 100 mmHg for the upper and lower body, respectively, would be applicable for about 90% of all people.

Our goal pressure extracted from the algorithm is 40-70% LOP and 50-80% LOP, for the upper and lower body, respectively. Currently, the new progressive web app “Fit Cuffs Training” can predict this goal pressure for +95% of all people.

From the comprehensive research articles, it seems that limb circumference can explain about 50-70% of the variance in LOP. But the width of the cuff is actually the most important factor to consider, that is also why this App is only applicable for Fit Cuffs®.

Thigh circumference is undoubtedly the biggest anthropometric predictor of arterial occlusion, but other factors are also of importance:

It seems that both gender, age and body composition influence the percentage of blood flow that is restricted. That is why these predictors are included in the algorithm, along with training condition, as we find this of importance for Ratings of Perceived Exertion (RPE).

So, when LOP is not assessible, we recomend to use calculated pressure. Every time you tab-in LOP and calculate a corresponding pressure for either upper or lower body, you actually help us to improve the algorithm in the future.

“.. cuff pressures should be largely based on thigh circumference and not on pressures previously used in the literature.” (Loenneke et al. 2012)

Source:

Tuncali et al. (2006) A New Method for Estimating Arterial Occlusion Pressure in Optimizing Pneumatic Tourniquet Inflation Pressure.

Tuncali et al. (2018) Tourniquet pressure settings based on limb occlusion pressure determination or arterial occlusion pressure estimation in total knee arthroplasty.

Loenneke et al. (2012) Effects of cuff width on arterial occlusion implications for blood flow restricted exercise.

Loenneke et al. (2014) Blood flow restriction in the upper and lower limbs is predicted by limb circumference and systolic blood pressure.

Brown et al. (2018) Factors affecting occlusion pressure and ischemic preconditioning.

Hunt et al. (2016) The influence of participants characteristics on the relationship between cuff pressure.

Jessee et al (2016) The Influence of Cuff Width, Sex, and Race on Arterial Occlusion Implications for Blood Flow Restriction Research.

Jobbágy & Varga (2014) Digitális Tankönyvtár. Biomedical Instrumentation. Indirect blood pressure measurement methods.

Karabulut (2011) The effects of different initial restrictive pressures used to reduce blood flow and thigh composition on tissue oxygenation of the quadriceps.
Read more

April 15, 2020

We have just released the brand-new progressive web app “Fit Cuffs Traning”, with online and offline availability by downloading it to your phone just as a standard app from google store or app store.


You can check the video on how to register a user, calculate pressure, tab in Limb Occlusion Pressure (LOP) and the last 10 s. on how to download it for offline availability. You can access the app from the homescreen just as an any other app on android devices and Iphones.

We have developed the algorithm from the comprehensive science and data on the predictors of Limb Occlusion Pressure (LOP), for you to enjoy Effective, Save and Convenient BFR Training.

We do not recommend to use arbitrary pressures, neither do we recommend a default pressure, though 80 mmHg and 100 mmHg for the upper and lower body, respectively, would be applicable for about 90% of all people.

Our goal pressure extracted from the algorithm is 40-70% LOP and 50-80% LOP, for the upper and lower body, respectively. Currently, the new progressive web app “Fit Cuffs Training” can predict this goal pressure for +95% of all people.

From the comprehensive research articles, it seems that limb circumference can explain about 50-70% of the variance in LOP. But the width of the cuff is actually the most important factor to consider, that is also why this App is only applicable for Fit Cuffs®.

Thigh circumference is undoubtedly the biggest anthropometric predictor of arterial occlusion, but other factors are also of importance:

It seems that both gender, age and body composition influence the percentage of blood flow that is restricted. That is why these predictors are included in the algorithm, along with training condition, as we find this of importance for Ratings of Perceived Exertion (RPE).

So, when LOP is not assessible, we recomend to use calculated pressure. Every time you tab-in LOP and calculate a corresponding pressure for either upper or lower body, you actually help us to improve the algorithm in the future.

“.. cuff pressures should be largely based on thigh circumference and not on pressures previously used in the literature.” (Loenneke et al. 2012)

Source:

Tuncali et al. (2006) A New Method for Estimating Arterial Occlusion Pressure in Optimizing Pneumatic Tourniquet Inflation Pressure.

Tuncali et al. (2018) Tourniquet pressure settings based on limb occlusion pressure determination or arterial occlusion pressure estimation in total knee arthroplasty.

Loenneke et al. (2012) Effects of cuff width on arterial occlusion implications for blood flow restricted exercise.

Loenneke et al. (2014) Blood flow restriction in the upper and lower limbs is predicted by limb circumference and systolic blood pressure.

Brown et al. (2018) Factors affecting occlusion pressure and ischemic preconditioning.

Hunt et al. (2016) The influence of participants characteristics on the relationship between cuff pressure.

Jessee et al (2016) The Influence of Cuff Width, Sex, and Race on Arterial Occlusion Implications for Blood Flow Restriction Research.

Jobbágy & Varga (2014) Digitális Tankönyvtár. Biomedical Instrumentation. Indirect blood pressure measurement methods.

Karabulut (2011) The effects of different initial restrictive pressures used to reduce blood flow and thigh composition on tissue oxygenation of the quadriceps.
Read more

April 09, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfr training kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise

In a recent video a we propose the use of BFR-interval training as a potential part of rehab, but it seems equal as relevant for performance.


In this summary we present the results from a newly published paper by Christiansen et al. 2020 and two preceding papers with the same exercise protocol:

AIM: The effect of BFR-interval training on different parameters of performance.

PROTOCOL: 10 Well-trained men completed 6 weeks of interval cycling with one (BFR-Leg) vs. (No-BFR-Leg), workload was matched between legs. The participants trained 3/week for 6 weeks. 5-min warm-up at 30% of maximum workload (Wmax) followed by 2 min of rest.

3 periods of 3 x 2-min cycling bouts were performed separated by 1 min and each period by 2 min of active recovery pedaling. Complete exercise time 24 min. Target intensity of the 1., 2. and 3. period was 60%, 70%, and 80% Wmax, respectively, with a personal preferred cadence.

BFR-Leg only: Pressure ~178 mmHg, deflation immediately after every exercise bout (intermittent BFR).

RESULTS: Time to exhaustion during exhaustive exercise, BFR-Leg ~21% vs. NO-BFR-Leg ~10%. Acute arterial blood flow in BFR-Leg ~52% lower during exercise and 308% higher during recovery vs. no change in No-BFR-Leg. Chronic arterial blood flow before, during and after knee-extensor tests did not change in the NO-BFR-Leg, but improved in the BFR-Leg. Resting femoral artery diameter increased only in BFR-Leg ~4%.

Power output during knee-extensor exercise, BFR-Leg vs. No-BFR-Leg improved ~20% and ~9%, respectively. Knee extensor exercise performance: BFR-Leg vs. No-BFR-Leg improved ~23% and ~11%, respectively.

Venous-arterial K+ difference. Simplified as no change in the No-BFR-Leg, but increased in the BFR-Leg. Thigh oxygen delivery for the BFR-Leg (~23% and ~13% in sub-max and near-max tests, respectively). No significant change in the No-BFR-Leg.

Reduced lactate release at both intensities (~34% and ~16% in both conditions, respectively). No change in No-BFR-Leg.

CONCLUSION: Well-trained individuals can increase V̇O2max and time to exhaustion by use BFR-interval training, explained by various physiological mechanisms.

Christiansen et al. (2020) Training with blood flow restriction increases femoral artery diameter and thigh oxygen delivery during knee-extensor exercise in recreationally trained men.

Christiansen et al. (2019) Blood flow-restricted training enhances thigh glucose uptake during exercise and muscle antioxidant function in humans.

Christiansen et al. (2019) Cycling with blood flow restriction improves performance and muscle K+ handling and blunts the effect of antioxidant infusion in humans.
Read more

Marts 29, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfr training kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise,

In this video we present 6 exercise blood flow restriction (BFR) variations for the rotator cuff muscles (RCs).


0:05-Flexion. 0:12-Abduction. 0:20-External rotation (ER) at 0°. 0:30-Internal rotation (IR) at 0°. 0:39-IR at 90°. 0:46-ER at 90°.

We find this interesting as a relatively new paper (only preliminary results presented), discovered that BFR for low-load resistance exercise to be effective for proximal gains i.e. RCs (1).

PURPOSE: If BFR promote greater increases in strength, muscular endurance, and lean mass for the RCs compared to exercise alone (No-BFR). Secondly, if BFR during acute low-load resistance exercise increases activation of RCs.

METHODS: (RCT) Eighteen healthy adults randomized into 2 groups (BFR vs. No-BFR).

Each group: 8 weeks (2/wk) as 4 low-load RCs resistance exercises at 20% of 1RM: Cable – external rotation (ER) & internal rotation (IR). Dumbbell – scaption & side-lying ER.

1 set/30reps followed by 3 sets/15reps (30s inter-set rest, 2min inter-exercise rest). For progression, 1lb (0.45 kg)/week if all repetitions where achieved.

Only BFR: Intermittent BFR stimuli (only during exercises) at 50% LOP.

RESULTS: Lean Mass: Arms BFR vs No-BFR, 8.15% vs. -0.43%, respectively. Shoulders BFR vs No-BFR, 28.10% vs. 11.23%, respectively.

Strength: Assessed in 6 different positions comparing dominant and non-dominant arm separately: For the dominant arm, all positions showed a strong trend for BFR be superior. ≈ 5-20% greater relative improvements for BFR vs. No-BFR.

Exercise Volume: 7/7 follow-up tests in favor of BFR.

Mean EMG activations: Same relative activation pattern for Infraspinatus, but BFR seemed to be superior for Teres Minor.

CONCLUSIONS: BFR augmented RCs exercises seems favorable. Possible due to a greater activation of shoulder musculature.

Discussion: The exercise intervention was designed in favor of BFR. The load was only 20% 1RM with a standardized rep-scheme and only allowed for 1lb (0.45 kg) once/week for progression. – Any thoughts?

An interesting sub-finding was that only the dominant arm for the BFR-group experienced a greater relative improvement in strength. – Any thoughts?

Source: Lambert et al. (2019) B.F.R. For Proximal Benefit: Blood Flow Restriction Therapy For The Shoulder?
Read more

Marts 25, 2020

When everything are closed, we advise you to find the opportunity to move your exercise routine to urban areas, nature or for some restricted regions as home training.


But when your local gym is not an option, you have to consider several factors for you to maintain muscle mass or strength. For most gym rats it should be achievable to maintain muscle mass in this lockdown situation, but it becomes inherently more difficult when your goal is hypertrophy. In regards to absolute strength, it becomes even more difficult to retain and especially increase strength.

The amount of load and volume is obviously highly dependent on your current training status. But for a vast generalization, maintenance of muscle bulk should be obtainable for most people, especially with BFR and in less time!

As a proxy for estimation of 20-40% of 1 RM, these basic simple principles apply:
As rule of thumb, aim for 20-35 reps to voluntary failure for the first set, followed by 3 sets of 10-20 reps with an interset rest period of 30-45 s.

When considering the minimum effective volume, it becomes more difficult to generalize, but in regards to hypertrophy, more IS better! On the other hand, if your goal is to maintain strength, less volume is needed. Aim for at least 30 % 1 RM with every set near failure. Some evidence suggests that BFR can be optimized by exercising the same muscle group 1 or even 2 times a day in periods of 3 weeks.

Considering these principles for BFR, bodyweight squats is insufficient for most people, but can easily be progressed by means of:

External resistance with an elastic band ➡️ Unilateral like Bulgarian split squat ➡️ Higher relative pressure (mmHg).

For regression of push-ups, just elevate the hands relative to the feet as displayed. Please also remember, that all exercise is better than no exercise! And BFR is Better For Results – when load is low!
Read more

Marts 19, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfr training kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise,

When everything is closed, we advise you to find the opportunity to move your exercise routine to urban areas, nature or for some restricted regions as home training.


But when your local gym is not an option, you have to consider several factors for you to maintain muscle mass or strength.

For most gym rats it should be achievable to maintain muscle mass, but it becomes inherently more difficult when your goal is hypertrophy. In regards to absolute strength, it becomes even more difficult to retain and especially increase strength.

The amount of load and volume is obviously highly dependent on your current training status. But for a vast generalization, maintenance of muscle bulk should be obtainable for most people, especially with BFR and in less time!

As a proxy for estimation of 20-40% of 1 RM, these basic simple principles apply:

As rule of thumb, aim for 20-35 reps to voluntary failure for the first set, followed by 3 sets of 10-20 reps with an interset rest period of 30-45 s.

When considering the minimum effective volume, it becomes more difficult to generalize, but in regards to hypertrophy, more IS better! On the other hand, if your goal is to maintain strength, less volume is needed. Aim for at least 30 % 1 RM with every set near failure. Some evidence suggests that BFR can be optimized by exercising the same muscle group 1 or even 2 times a day in periods of 3 weeks.

Considering these principles for BFR, bodyweight squats is insufficient for most people, but can easily be progressed by means of:

External resistance with an elastic band ➡️ Unilateral like Bulgarian split squat ➡️ Higher relative pressure (mmHg).

For regression of push-ups, just elevate the hands relative to the feet as displayed.

Please also remember, that all exercise is better than no exercise! And BFR is Better For Results – when load is low!
Read more

Marts 10, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfr training kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise,

In the video You will find the concurrent research on the reliability and validity of our new Bluetooth Device for assessment of Limb Occlusion Pressure (LOP).


This research is particularly relevant for Blood Flow Restriction (BFR) training and exercise. But the utility of the present research is beyond Fit Cuffs product selection, as this will have universal implications for osciliatory/ oscillometric blood pressure measurements for assessment of LOP, a potential valid alternative to hand-held dopplers.

We find this method to determine LOP highly interesting, as this is more assessable compared to the doppler-method, which is relevant for about everyone into BFR.

We truly appreciate everyone’s efforts and commitments to test our new Bluetooth Device. Without your practical and academic expertise this was not possible. This is greatly appreciated and we look forward to continuing our collaboration.

Especially thanks to Okan KAMİŞ & Mahdy El-Zein for the dedication that goes into this study:

Okan KAMİŞ, MSc, Lecturer, PhD Student, Faculty of Sports Sciences, Gazi University/Ankara,Turkey.
& Mahdy El-Zein, PT, MPT Student, Faculty of Public Health, Lebanese University, Lebanon.

Please stay tuned for upcoming videos on this research.
Read more

Marts 3, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfr training kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise,

In this post we will explain how progress or regress knee rehab with inspiration from the progressive model for BFR proposed by Loenneke et al. (1)


It seems that passive BFR (BFR without exercise), has the potential to attenuate muscle loss during periods of immobilization (2). Though, for obvious reasons this application is inferior to active modalities.

For the initial stage post-surgery or in some chronic cases, joint swelling and symptoms can be triggered by even low load resistance training. This is especially in such cases that BFR cycling can be the key to regain muscle and mass strength (3).

In the BFR literature, it seems that both continues or interval training can be utilized for hypertrophy and muscle strength (4). But as the muscle specific adaptations seems superior for conventional high intensity training (HIIT) vs. continues, it seems coherent that this is also the case for BFR training. Thus, a single study actually discover the opposite trend (4).

The central paradigm of this ladder-principle, is the reverse nature of progression or regression for early stage rehab vs. prehab, respectively:

Conventional high-load resistance training →

⬆️ Low-Load resistance BFR training, moderate pressure (mmHg) →
⬆️ Very low-load resistance BFR training, high pressure (mmHg) →
⬆️ High intensity interval BFR Cycling →
⬆️ Continuous cardiovascular BFR i.e. steady state walking or cycling →
⬆️ Passive BFR

As described above, we propose that this extended progressive model should be reversed for the general population. That is, if you are able to lift heavy without any pain, conventional exercise should be first line healthcare, but if this is not applicable regress one step, etc.

In the video, a woman with a total knee replacement is training with high intensity intervals for late stage rehab, as in her case, even very low-load training is associated with excessive joint swelling.

Source:

(1) Loenneke et al. (2012) Blood flow restriction: An evidence based progressive model (Review).

(2) Barbalho et al. (2019) Addition of blood flow restriction to passive mobilization reduces the rate of muscle wasting in elderly patients in the intensive care unit- a within-patient randomized trial.

(3) Slysz et al. (2016) The efficacy of blood flow restricted exercise: A systematic review & meta-analysis.

(4) Oliveira et al. (2016) Short-term low-intensity blood flow restricted interval training improves both aerobic fitness and muscle strength.
Read more

February 23, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfr training kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise,

This video displays Dumbbell Rows with Fit Cuffs. The descritption below explains how relative loads (% of 1RM) and relative blood flow restriction (% of LOP) works on a continuum, e.g. the potential of a minimum effective pressure for very low loads.


The default recommendation for upper body and lower body BFR exercise is to use at least 40% LOP and 50% LOP, respectively, for non-failure BFR protocols like the standard four sets of 30-15-15-15 reps. But because both BFR Stimuli and load contribute to the fatigue caused by BFR exercise, we must also consider relative load for a final recommendation (1,2):

Because higher blood flow restriction pressures are likely to be beneficial for muscle growth when very low loads are used (1), it turns out that simple bodyweight-based BFR exercises such as squats and lunges are sufficient to increase muscle mass and strength in active adults (3).

For practical applications, if the relative load is very low (10-15% 1RM), then it can be compensated by higher reps and using a higher pressure (1), as about 70% and 80% for upper and lower body, respectively. This is especially relevant for well-trained people who do not have the opportunity to hit the gym, because of travel, lack of time or simply just for convenience.

Reversely, the current data suggest little or no differences in muscle growth, muscle size or endurance in response to 40% vs. 90% LOP when using higher relative load (30% 1RM). But the 90% LOP condition produced higher ratings of perceived discomfort (2), which is counter productive for adherence to about any exercise program.

But as the data also suggests, that the combined effect of higher loads and higher pressures means less exercise volume, this might have some relevance. So, if you can withstand the high discomfort by combining higher pressure and load, aim for about four set of about 30-10-10-10 reps (2).

As displayed in the video, a higher relative load (30-50% 1RM) is being used, but as a tradeoff, use less pressure (40% LOP) and maybe slightly longer inter-set rest (45s -1 min).

Source:

(1) Dankel et al. (2017) Are Higher Blood Flow Restriction Pressures More Beneficial When Lower Loads Are Used?

(2) Counts et al. (2016) Influence of relative blood flow restriction pressure on muscle activation and muscle adaptation.

(3) Kang et al. (2015) The effects of bodyweight-based exercise with blood flow restriction on isokinetic knee muscular function and thigh circumference in college students.
Read more

February 19, 2020

This post is about the width and material properties of BFR cuffs and how this effect different physical parameters and perceived discomfort.


A newly published review on BFR and discomfort concludes that particularly for the upper body, narrower cuffs seems to be favorable as wider cuffs seems to increase discomfort during exercise (1). For the general public and healthcare this is of huge importance as the adherence to exercise or rehabilitation is imperative for effect regardless of goal setting.

Though, there is a range of tradeoffs or pros and cons to consider when choosing the right cuff width:

Narrow cuffs require higher absolute pressures to elicit the same relative pressure which can inhibit estimation of LOP and increase compression into the underlying tissue (2). The relative fluctuation of pressure and mechanical compression during muscle contractions is also larger.

On the other hand, narrow cuffs allow for more freedom of movement and even though the localized pressure is higher, a smaller area of the muscle is affected by this which seems of importance (1).

During the prolonged development of Fit Cuffs into it’s current form, the cuff material has also been discovered as extremely important especially for the upper body, Thus, the research has yet to confirm this point (3).

Since muscle contractions in the upper arm expands the girth relatively more compared to the upper leg, a stiff material is not alone discomfortable, but also hinders muscle contractions and in extreme cases can lead to tissue damage (1,2).

For a visualization of the inherent properties of different cuff material, see the figure from Mcewen & Casey (cuff type B vs C). This is also why Fit Cuffs is designed with differentiated properties with the upper body cuffs being more pliable.

Source:

(1) Spitz et al. (2020) Blood Flow Restricted Exercise and Discomfort A Review.

(2) Mcewen & Casey (2009) Measurement of hazardous pressure levels and gradients produced on human limbs by non-pneumatic tourniquets.

(3) Buckner et al. (2016) Influence of cuff material on blood flow restriction stimulus in the upper body.
Read more

February 4, 2020

This post is about the brand new Bluetooth Unit for measurement of Limb Occlusion Pressure (LOP) by means of Oscillatory Blood Pressure (BP) (1,2).


When assessing BP you should always use a calibrated cuff in terms of the width of the cuff relative to the circumference of the limb you are assessing. The recommended cuff width is 0.4 relative to the circumference of the limb (3).

That is why a standard BP cuff is about 14 cm wide, which is a calibrated cuff size relative to the upper arm for most adults. But if you are assessing BP on obese or bodybuilders, this would not be a valid measurement of BP, as in these cases you would need a wider cuff to avoid overestimating BP (4). The same principles apply for a very small upper arm, as you need to use a narrow cuff (4).

So even though measurement of BP is only valid when using a calibrated cuff, the amount of pressure to completely stop arterial blood flow is both valid and reliable (5).

Practical Application – how to find LOP via Bluetooth:

Connect the Unit with your phone via standard bluetooth tech.

Connect the Bluetooth Unit with the hose of the Fit Manometer, then connect the unit to the cuff.

Completely rest the corresponding limb and follow the displayed guide provided by the app.

After appropriate measurement you will find SYS (SBP) on the top left corner on the phone. This is the Limb Occlusion Pressure (LOP) for that limb in that particular position, just as the standard but prolonged method with a hand held doppler.

When preparing for exercise just detach the Bluetooth Unit and set the pressure relative to SYS (40-80%).

Research has shown that this method (oscillatory blood pressure measurement), is more precise compared to a hand held doppler ultrasound, relative to the golden standard i.e. invasive methods (5).

Our preliminary testing is showing a very good inter-rater reliability, by comparing this bluetooth device vs. LOP by hand held doppler, as a variance of only 3-6%.

Source:

(1) Babbs (2012) Oscillometric measurement of systolic and diastolic blood pressures validated in a physiologic mathematical model.
(2) Berger et al. (2001) How Does It Work? – Oscillatory blood pressure monitoring devices.
(3) Beevers et al. (2001) ABC of hypertension Blood pressure measurement Part I -Sphygmomanometry: factors common to all techniques. Clinical review.
(4) Croft & Cruickshank (1990) Blood pressure measurement in adults: large cuffs for all?
(5) Jordanow et al. (2018) Comparison of oscillometric, Doppler and ivasive blood preussre measurement in anesthetized goat.
(6) Zachary et al. (2020) Limb Occlusion Pressure: A Method to Assess Changes in Systolic Blood Pressure.
Read more

January 23, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfr training kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise,

#thefutureisnow

Janunary 21, 2020

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This Blog post is about some relevant considerations for BFR in knee-rehab.


First of all, there is no such thing as an optimal rehab regime, and secondly, optimal rehab must be individualized. No people are alike, the same goes for any injury, because of this an individual approach is always recommended.

Individual components such as daily activity, type of surgery, pain levels and not at least personal preference of exercises should be considered. But for most people or relevant stakeholders, the expected time to return to sport or daily activity is of high priority.

Especially in cases of load or weight bearing restrictions, the application of BFR is an effective way to attenuate muscle loss as a supplement to other rehab modalities, as this can accelerate muscle strength and function much earlier compared to a conventional rehab protocols. Though, as always consider the healing properties of subsequent tissues.

E.g. post ACL reconstruction, muscle strength and function can conceivably be reestablished at a higher rate than the remodelling properties of the transplanted tendon. But by following the guidelines and time for return to play, the inclusion of BFR can lead to greater functional symmetry (1) and probably higher estimated pre-injury capacity (2), which are both proven to lower the risk of reinjury.

In rare occasions there can be adverse side effects or other contra indications that inhibits the use of BFR, especially for early stage rehab (0-2 weeks post op.). That is why it is recommended to consult the surgeon before implementation of early stage BFR and always be aware of any additional swelling compared to other conventional exercises.

Conclusion: BFR should be used on the basis of an individual preference with consideration of physical components, such as healing properties of surrounding tissues and potential contra indications.

Video material from @cjmcfarland17

Source:

(1) Kilgas et al (2019) -Exercise with Blood Flow Restriction to Improve Quadriceps Function Long After ACL Reconstruction.

(2) Wellsandt et al. (2017) Limb Symmetry Indexes Can Overestimate Knee Function After ACL Injury.
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Janunary 11, 2020

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, bfrexercise vascular occlusiontraining bfrtraining katsu, bfr, bfre, bfrt

This post is about fast-track rehab with Blood Flow Restriction (BFR) Training after a dislocated and plastered ankle fracture.


The incidence of fractures in DK/year is approx. 80,000, of which 3,000-4,000 are ankle-related.

Most often, the fracture is plastered, which can include marrow sewing, osteosynthesis and rarely external fixation. For the first 3 weeks, load is inhibited, at approx. 3 weeks post op. gradually increased weight bearing is recommended.

Therefore, one should be careful about starting exercising, to avoid compromising the healing mechanisms of the bones. As adjacent to the fracture, muscles, arteries and nerves can be injured due to the sharp surfaces of the fracture or during the operation, which potentially complicates the rehab.

Because of the required immobilization following operation, severe muscle atrophy (muscle loss) will occur. As ankle fractures results in longer periods without weight bearing and local immobility, the rehabilitation options are very limited in the early phase.

Though, it has been proven that atrophy can be reduced by a swift implementation of BFR, in respect to fracture type and possible complications. By reducing the associated loss of muscle mass, one could expect a shorter rehab period and therefor a faster return-to-play.

By combining BFR with conventional low-load resisted knee-extension and knee-flexion exercises you got an effective combo to counter act the atrophy of the thighs, hamstrings and the superficial calf muscles.

Considering the recommendation of high frequency training as 1-2 daily for an effective retention of muscle mass for, elastic bands are being used as a low practical setup for 3 consecutive weeks.

Adjacent to this primary effect, BFR may reduce the fracture associated pain (hypoanalgesic effect) and improve overall functioning which may translate to less long-term disability, which is especially relevant for the elderly.

Source:

Cancio et al. (2019) Blood Flow Restriction Therapy after Closed Treatment of Distal Radius Fractures.

Loenneke et al. (2012) Rehabilitation of an osteochondral fracture using blood flow restricted exercise: A case review.

(3) Bittar et al. (2017) Effects of blood flow restriction exercises on bone metabolism: a systematic review.
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December 28, 2019

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This post is about the effect of BFR Resistance Training (BFR-RT) on strength and muscle mass in comparison to Conventional Resistance Training (C-RT) or High Load Resistance Training (HL-RT).


Because of the inherent difficulties of a fair comparison, results are varying of wherever BFR-RT is more or less effective. Though, at least 4 meta-analysis has explored the potential effect of BFR-RT vs (C-RT) / (HL-RT).

But even though this has been explored in several metal-analysis, methodological difficulties make the question hard to answer without further clarification.

If we take a look at short term follow-up it seems that BFR-RT can be more effective, but probably only in regards to hypertrophy. For longer follow-up periods (>10 weeks) it seems that C-RT is more effective on most parameters.

But the largest issue for measuring the effect of BFR-RT, is the different group designs, i.e. type of exercise intervention. Therefore, we have tried to pin-point some relevant comparisons and the results extracted from various meta-analysis:

BFR-RT vs C-RT (repetition matched):
Strength, significant in favor of BFR-RT. Hypertrophy, significant in favor of BFR-RT.
Though much higher Ratings of Perceived Exertion for BFR-RT.

BFR-RT vs C-RT (voluntary/repetition failure):
Similar effects, thus in favor of BFR-RT.
Similar Ratings of Perceived Exertion. But anywhere from 30-50% more repetition needed without BFR.

BFR-RT vs HL-RT (relative RM matched or voluntary failure):
Strength, in favor of HL-RT. Hypertrophy, similar effect. Though, longer exercise duration for HL-RT.
Similar Ratings of Perceived Exertion.

Summarized:
Short-term muscle mass: Probably BFR-RT.
Long-term muscle mass: Approximately same.
Short-term muscle strength: Approximately same.
Long-term muscle strength: HL-RT.

Side note: Muscle endurance and anaerobic performance: BFR-RT.
Maximum power development and training to improve running velocity: HL-RT.
But these comparisons have only limited practical importance as BFR-RT is primarily targeted the impaired e.g. injured or just as an adjunct to HL-RT for the majority of athletes and average Joe´s.

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: a systematic review and meta-analysis.

Centner et al. (2018) Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta‑Analysis.

Lixandrao et al. (2018) Magnitude of Muscle Strength and Mass Adaptations Between High-Load Resistance Training Versus Low-Load Resistance Training Associated with Blood-Flow Restriction: Systematic Review and Meta-Analysis.
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December 17, 2019

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, bfrexercise vascular occlusiontraining bfrtraining katsu, bfr, bfre, bfrt, kaatsu, blood flow restriction, bfrtraining, bfr training

This post is actually a translated repost on the potential benefit of BFR to treat Patella Femoral Pain (PFP), aka. anterior knee pain, which is common among athletes of various levels.


In the video, a sub-elite orientation runner suffering from fluctuating PFP is implementing Fit Cuffs (older version) to augment the back squat and lunges. In his case, BFR has proven to be a gamechanger in regard to less aggravation of pain.

Typically, high-load resistance training focusing on strengthening the quadriceps and hip abductors, subsequently to graduated exposure, has been recommended.

But the results from a RCT comparing BFR training and conventional resistance training, shows that BFR is just as effective to elicit strength, though, superior for people with concurrent knee pain.

Background: BFR may provide low-load quadriceps strengthening method to treat PFP as heavy resistance exercises may aggravate knee pain.

Method: BFR, n=35 vs. conventional resistance training n=34, as 8 weeks of leg press and leg extension, at 70% 1RM vs. BFR group at 30% 1RM. Interventions were compared by Kujala Patellofemoral Score, Visual Analogue Scale and pain with daily activity, isometric knee extensor torque (strength) and quadriceps muscle thickness.

Results: BFR group had a significant 93% greater reduction in pain with activities of daily living. Participants with painful resisted knee extension (n=39) had a significant greater increases in knee strength with BFR. Though, no significant difference was detected at 6 months.

Conclusion: BFR group experienced greater reduction in pain with daily living at 8 weeks. Improvements were similar between groups as worst pain and Kujala score. The subgroup analysis showed that those with pain during knee extension had greater strength gains with BFR.

Therefore, BFR can be recommended to treat PFP, especially for athletes with pain during conventional exercise or in periods of high training load, e.g. in-season.

Source: Giles et al. (2017) Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: a double-blind randomised trial.
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December 10, 2019

Fit cuffs, fitcuffs, okklusionstræning, occlusion training, blood flow restriction exercise, oclusao vascular, bfrexercise vascular occlusiontraining bfrtraining katsu, bfr, bfre, bfrt, kaatsu, blood flow restriction, bfrtraining, bfr training

This post is about BFR and some supplementary pathways to elicit lower body strength.




In the video @noor.reno is applying Bulgarian split squat with an elevated front foot for increased range of motion. Though, the most import aspect of this relatively low-load setup, is the augmentation of BFR for contralateral leg gain.

Maintaining or improving muscle mass and strength is imperative for higher-level sports and athletic performance.

But for some individuals into training and rehab, BFR is primarily seen as a tool for the injured or otherwise impaired individuals. Thus, recently the body of research on BFR has expanded enormously and repeatedly shows to be a game changer for rapid improvement of performance. This is a soundly reason why, BFR is currently being programmed into the training routines of high-level athletes all around the world.

A relevant implication of BFR for the impaired or for the high performing athlete, is the use of single leg exercises to improve strength in both the proximal and contralateral limb relative to the cuff, as recently discovered by Bowman et al:

Methods: RCT, conducted on healthy participants by a standardized 6-week BFR protocol. BFR training on 1 extremity compared to a control group, specified as BFR-Limp vs No-BFR-Limp vs. control.

Results: A statistically 2-3 fold greater increase in strength was seen proximal and distal to the cuff (BFR-Limp vs control).

Additionally, a significant increase occurred in the thigh girth and knee extension strength for the No-BFR -Limp compared with the control group as (2.3% vs 0.8%) and (8% vs 3%) respectively.

Conclusion: BFR training led to a 2-3 fold greater increase in muscle strength. BFR training had similar strengthening effects on both proximal and distal muscle groups relative to the cuff. Gains in the contralateral limb may corroborate a systemic or crossover effect.

Source:
Bowman et al. (2019) Proximal, Distal, and Contralateral Effects of Blood Flow Restriction Training on the Lower Extremities: A Randomized Controlled Trial.
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December 03, 2019

Fit cuffs, fitcuffs, okklusionstræning, occlusion training, blood flow restriction exercise, oclusao vascular, bfrexercise vascular occlusiontraining bfrtraining katsu, bfr, bfre, bfrt, kaatsu, blood flow restriction, bfrtraining, bfr training

This post is about arthritis in the hand and fingers and the use of BFR to improve grip strength.


In the video an Arm Cuff and Fit Manometer is used in a practical setup to monitor the contractions ≈ 50% MVC.

The joints in the hands are some of the most delicate and just the slightest hand arthritis (HA) complicates various parts of daily living.

1 in about 10 adults suffers from visible or invisible symptoms of HA as either spontaneous or chronic with varying symptoms such as pain, swelling, stiffness and in severe cases deformity and grinding in the joints. Subsequently to chronic HA is the loss of grip strength which aggravates symptoms even further.

The primary grip muscles are extrinsic, i.e. muscles localized to the forearms, as the intrinsic muscles localized to the palm and fingers are primarily focused on more subtle occupations. That is why indirect training of the extrinsic muscles can improve grip strength, i.e. palmar flexion of the wrist.

That is why people that suffers from chronic types of HA often are recommended to strengthen their grip and the rational for doing low-load BFR seems apparent. Especially relevant in situations where conventional grip training are exacerbating symptoms. The use of BFR to improve grip strength has actually been explored in at least two RCT’s:

Two groups (BFR vs. No-BFR) exercised 3d/week for 4 weeks as bilateral handgrip training in 20 min with an intensity of 60% of Maximum Voluntary Contraction (MVC),15 reps/min. (1)

The BFR-group experienced superior strength gains compared to No-BFR (16.17% vs. 8.32%). But please consider that both groups exercised at the same moderate load (60 % MVC), and these findings could not be replicated in a later study using only 30-40% MVC. (2)

Conclusion: While applying BFR to improve grip strength, consider using more than 40% MVC.

Source:

(1) Credeur et al. (2010) Effects of handgrip training with venous restriction on brachial artery vasodilation.

(2) Velic & Hornswill (2014) KAATSU Training and Handgrip Strength.
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November 25, 2019

In this post we present the interesting results from a yet another BFR-running Study! It explores the effects of interval running on different parameters of muscle physiology and performance.


Method: Sixteen participants randomized as either BFR or No-BFR for 8 running training sessions. Before and after training, subjects completed an incremental test to determine peak running velocity/maximal running speed maximal oxygen uptake “(VO2max)” and running economy. Followed by a time to exhaustion run performed at peak running velocity.

Running training for both groups consisted of progressively increasing volumes of 30 s. intervals completed at 80% of their peak running velocity.

Results: Running economy only improved in the BFR group.

Peak running velocity improved in both groups with small but significant effect size of 0.31 in favor of BFR.

Incremental test time also increased in both groups with small but significant effect size ~0.3 in the BFR group.

Time to exhaustion run was also observed in both groups (27 ± 9% vs. 17 ± 6%) as a small but significant effect size ~ 0.3 in favor of BFR.

“VO2max” improved in both improved in both groups (6.3 ± 3.5 vs 4.0 ± 3.3%) with a trend for higher gains in the BFR group vs. No-BFR.

Conclusion: Running augmented by BFR seems to improve several parameters of performance. The beneficial adaptations after BFR-running are speculated to be primarily muscular rather than cardiovascular.

In the video @frederiksass has elastic band attached to his thighs for additional activation of the hip muscles, performed at a constant pace i.e. 20-30% of his peak running velocity.

We propose, that elastic band resistance combined with BFR-running to be just as beneficial compared to high velocity running, but evading the rapid fluctuation of pressure under the cuff during forceful strides.

Source: Paton at al. (2017) The effects of muscle blood flow restriction during running training on measures of aerobic capacity and run time to exhaustion.
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