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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 in the comments. . Disclaimer: Please contact us for the current app availability in your country.
January 22, 2020
January 21, 2020
This post is about some relevant considerations for BFR in 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.
January 11, 2020
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, 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.
December 28, 2019
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 in the comments.
December 17, 2019
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.
December 10, 2019
This post is about BFR and some supplementary pathways to elicit 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.
December 3, 2019
This post is about arthritis in the hand and fingers and the use of BFR to improve grip strength. . 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 if 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. . In the video an Arm Cuff and Fit Manometer is used in a practical setup to monitor the contractions ≈ 50% MVC. . (1) Source: Credeur et al. (2010) Effects of handgrip training with venous restriction on brachial artery vasodilation. . (2) Velic & Hornswill (2014) KAATSU Training and Handgrip Strength.
November 25, 2019
In this post we present the interesting results from a yet another BFR-running RCT. . The present study explored the effects of interval running performed with or without BFR 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.
November 17, 2019
In this post we present the results from a BFR-futsal RCT conducted on 12 elite futsal players. . The study combined futsal training with BFR and showed that the addition of BFR was superior to normal futsal training. . Aim: The effect of 3 weeks of BFR-Futsal on performance, strength and hormone levels. . Method: 12 players, 6 BFR-players vs. 6 No-BFR. 10 sessions as small sided games 3 vs. 3, 3 min futsal followed by 2 min rest for 4-8 intervals. BFR group had cuffs inflated to 110% of leg systolic blood pressure and further increased by 10% after every two completed sessions. Intensity 80–100 % HRmax in both groups. . Results: BFR-group had significantly greater improvements in peak torque knee extension (30.9 ± 8.0% vs. 14.9 ± 7.5%), flexion (23.8 ± 8.4% vs. 8.1 ± 5.7%), favorable serum concentration of myostatin and a trend for a greater improvement in a Futsal Special Performance Test. Though, Ratings of Perceived Exertion were higher in the BFR-group: (13–14 Borg) vs. (15-17 Borg). . Conclusion: The addition of BFR to futsal practice can enhance muscle activation, strength and hormonal responses. But please consider several limitations, e.g. sample size was fairly small. . Our recommendation regarding augmentation of BFR to team sports like futsal: Be cautious if you apply BFR in situations with near maximal effort such as jumping, acceleration and change of directions, as these types of movements are associated with peak muscle forces comparable to heavy lifting. And not least, the risk of adverse events in relation to contusions on blood flow restricted limbs, which is obviously not appealing. . The inclusion of BFR in futsal or similar sports is twofold. As shown in the current study the potential performance enhancement is obvious and for rehab and return to play this seems relevant. Regarding the high exercise intensity, olieveira et al. showed that Low-intensity BFR-interval running had similar benefit compared to high-intensity BFR. . Source: Amani et al. (2019) BFR During Futsal Training Increases Muscle Activation and Strength. . Oliveira et al. (2016) Short-term BFR interval training improves both aerobic fitness and Strength.
November 11, 2019
In this post we present the outstanding results from a BFR-running RCT conducted on physically active women. . The study combined interval running with BFR and showed that training intensity and pressure are important for aerobic, anaerobic, and muscular performance! . Purpose: Comparison of different BFR stimuli and exercise intensities on aerobic, anaerobic, and muscle strength in 4 different groups, as a dose response study. . A 4-week intervention period consisted of 3d/week, 10 sets for each session as 2 min running on a treadmill with BFR interspersed by 1 min of recovery without BFR. The pressure was estimated from thigh circumference. . The four groups: (IP-CE): Increasing Pressure with Constant Exercise intensity. (CPP-IE): Constant Partial Pressure with increasing Exercise intensity. (IP-IE) Increasing pressure with increasing exercise intensity. (CCP-IE): Constant Complete occlusion with increasing exercise intensity. . The study demonstrated improvements in all aerobic and anaerobic variables in all 4 groups, with a trend for greater gains for all parameters in response to progressing intensity and high BFR stimuli. . The CCP-IE (complete occlusion) group had a trend for the greatest overall effect (Vo2max Ꙟ 14.8%). - Though, it might be contrary for safety and could hypnotically lead to adverse events. Nevertheless, this is not the first study that shows a higher BFR stimuli is superior and this was also conducted on a young population + a trend for higher Ratings of Perceived Exertion (RPE) in the CCP-IE group. . Conclusion of the study: Interval based BFR-running with higher BFR stimuli and progressive intensity is superior for overall effectiveness. . We do not recommend complete occlusion for the general public, but it is common practice that you either progress effective running time or pace. . Another discovery is that circumference seems to be a legit way to set the pressure, while using Fit Cuffs, we recommend that you use the "App". . 1st. pic- copyright @elitestlab. . Source: Amani et al. (2019) Effects of Blood Flow Restriction and Exercise Intensity on Aerobic, Anaerobic, and Muscle Strength Adaptations in Physically..
October 31, 2019
This post is about a pragmatic research project at Odder Fitness Center. . A group of Physical Therapy Students from Copenhagen University of Applied Sciences are currently exploring the potential benefit of Low Load - Blood Flow Restriction Training (BFR) for people suffering from varying degrees of knee osteoarthritis (OA). (1,2) . Freely translated as: The effect of BFR for pain, quality of life (QOL) and functioning in knee OA - a case series . Background for their study: OA is the most common joint disease in Denmark (5%), most of those people have symptoms that negatively impact QOL. Currently, the treatment for these patients is exercise based, particularly popular is the initiative “Good Life with osteoArthritis in Denmark (GLA:D®)” . Purpose of the study: To explore the importance of BFR for patients with knee OA in terms of pain level, functioning and QOL in clinical practice. . Study design: A series of patients undergo PT supervised BFR twice weekly for one month. . As this is only a pragmatic trial designed to assess the outcome of BFR for knee OA in a clinical real-life practice, the sample size is too small for the results to be generalized and applied directly. But this is interesting from other perspectives, as it evaluates the potential effectiveness of BFR for this population in a direct setting. The next step for researchers would be a larger feasibility study on BFR for OA in direct clinical practice, which involves more factors to also measure cost-effectiveness. . If you have any questions related to this pragmatic study or how to utilize BFR for all types of arthritis (3), please comment below. Stay tuned for the upcoming results from this project. . Please mind that the video footage is not from this trial. . SOURCE: (1) Vanwye et al. (2017) – Blood Flow Restriction Training: Implementation into Clinical Practice. . (2) Segal et al. 2015 – Efficacy of Blood Flow Restricted Low-Load Resistance Training in Women with Risk Factors for Symptomatic Knee OA. . (3) Rodrigues et al. (2019) - Low-load resistance training with blood flow restriction increases muscle function, mass and function in RA.
October 29, 2019
This is second post in a miniseries about the less known effects of BFR training. . Conventional high intensity exercise as both aerobic and resistance training have proven to reduce pain, known as exercise-induced hypoalgesia. . In the recent years, BFR research has also shown to reduce pain both acutely and long lasting, with huge implications for both accelerated rehab and performance. For the modulation of acute pain, at least 3 interacting pathways have been proposed (1): . (A) Changing the feedback of the central nervous system via the working muscle and hypoxia which produces pain inhibiting hormones. (B) The short increases of blood pressure simply leads to hypoalgesia. (C) The training induced discomfort creates a reduction in perception of other painful stimuli. . Regarding the potential chronic pain relief from BFR, research shows that in people with pain underneath the kneecap (PFP) and osteoarthritis this effect long lasting effect seems legit. As BFR has been compared to conventional resistance training to treat PFP and osteoarthritis in at least two separate RCT's. It seems that BFR is superior in regards to both pain relief and improvement of strength of whom with symptoms reproduces during conventional resistance exercise (2,3). . A potential explanation of the augmented hypoalgesic effect of BFR vs conventional resistance exercise, is probably an interaction of acute pain modulation and less stress on the joints during exercise. . We recommend that future BFR research explores the potential comparable benefit for shoulder and elbow pain. But if you already know of any relevant research for the upper body, please let us know in a comment. . Thanks to @Sinisa_Entrenador for the videos. . SOURCE: (1) Hughes & Patterson (2019) Low intensity blood flow restriction exercise: Rationale for a hypoalgesia effect. . (2) Giles et al. (2017) Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: a double-blind RCT. . (3) Ferraz et al. (2018) Benefits of Resistance Training with Blood Flow Restriction in Knee Osteoarthritis.
October 23, 2019
This post is a case story on how BFR can make a huge difference for post surgery knee-rehab. . @SorenRotne 51, has always been active as a committed runner, swimmer and cyclist, but for years he had suffered from severe pain in his left knee because of damage to his meniscus and cartilage, as early signs of osteoarthritis. . After several doctor visits and numerous attempts with different terapedic modalities, such as acupuncture, massage etc., he was eventually referred for surgery. Subsequently he got the judgment from the surgeon: I adwise you not attempt to run again. . Søren inaugurated her wife Runa, in this sad message. She immediately contacted her personal trainer at Odder Fitness Center, @AlexOdfit and asked if he could help Søren. . Alex was of a completely different view of the prognosis of Søren knee and the potential for a succesfull return to run. So Alex went to see Søren the day after the operation, explaining about BFR training with the use of a Leg Cuff for an immediate start of rehab. . Søren started by unweigted BFR exercises for the first 10 days, before he was joined by Lars Pårup (PT & MSc) who progressed the BFR training for an intense rehab at Odder Fitness Center. The progressive rehab continued for the next 10 weeks, after which Søren moved on to conventional resistance training. . Just 3 months after the operation, he performed a 1/4 ironman in just under 3 hours. . Søren states: "A great commitment and a big thanks you to Lars and Alex at Odder Fitness Center, for a targeted and effective rehabilitation that was tough, but well worth it. Today, I can run and exercise 4-5 times a week with out any pain." . If this case has any interest or if you would like to know the exact protocol used in Sørens rehab, please make a comment below.
October 15, 2019
This is the first post in a miniseries about the less known effects of BFR training. . It has been proven that complete occlusion over long periods, e.g. hours can be detrimental. Some even fear that blood clots or even venous thromboembolism (VTE) could be formed during BFR, which is known as a hypercoagulable effect. But please remember that BFR is a brief stimuly with a sub-occlusion pressure, that can be calculated by Web App or Android App (40-80 % LOP). The actual effect of BFR on the vascular system are probably the opposite i.e. hypocoagulational! . It has been proven that both BFR and regular resistance training results in optimized working conditions for the enzymes that degrade microscopic blood clots i.e. a fibrinolytic effect. It seems plausible that BFR promotes fibrinolysis and that blood thickening will be dissolved in connection with BFR as a long-term effect.(1) . Thus, for some patients there is additional considerations prior initiating BFR, as relevant contraindications should be screened for in the acute postsurgical patient by a general VTE risk questionnaire.(2) There is also need for additional research to completely understand the risks of BFR on the acutely post orthopaedic surgery patients, as the potential benefit for this population is enormous! . Conclusion: For the general population, BFR is likely beneficial in terms of the effects on vascular health , similarly to conventional resistance training. When the amount of research in BFR on vascular health increases, BFR might become a standard therapedic modality for various circulatory disorders and acutely after orthopaedic surgery.(3) . Disclaimer: The Content is not intended to be a substitute for professional medical advice. . SOURCES: (1) Nascimento et al. (2019) Effects of blood flow restriction exercise on hemostasis: a systematic review of randomized and non-randomized trials. . (2) Bond et al. (2019) Blood Flow Restriction Resistance Exercise as a Rehabilitation Modality Following Orthopaedic Surgery: A Review of Venous Thromboembolism Risk. . (3) Yasuda et al. (2016) Use and safety of KAATSU training: Results of a national survey.
October 6, 2019
Exercise bands are the perfect supplementation to BFR-walking, as presented in this video with the collab of @Kipeconcept (KE:PE) and @Fitcuffs. . So far all of the walking-BFR studies have yet to explore the potential of elastic band resistance. Thus, at this point of time several studies have demonstrated impressive results of BFR-Walking! . It might not seem of much and for this particular athlete i.e. @frederiksass, this is probably not a sufficient stimuly. But we find the potential synergistic benefit of combining walking-BFR with elastic bands to be obvious, especially for the load compromised individuals. As the compression of relevant joints is kept to a minimum, the injured and the elderly can improve on numerous parameters of performance: . Park et al. explored the potential benefit of only 2-weeks BFR-Walking in an semi-athletic population, they found significant increases in VO2max, thigh muscles and improvements in 1.5-mile runs! . Regarding the elderly, Letieri et al. found that BFR-Walking improves functional tests, as the 30 s sit to stand, 6‐minute walk, timed up‐and‐go, and stept-test, by 10-20 min walking at 4 km/t for 5d/week. Also, Ozaki et al 2011 found improved arterial compliance after 10 weeks of BFR-walking in a similar population. . In another study on younger individuals, Sakamaki et al. found hypertrophy of the thigh (3.8%) and lower leg (3.2%) after only 3 weeks of BFR-walk as 6 d/week, 2 times/day. Thus, hypertrophy only occurred in muscles downstream relative to the cuff, as the non-restricted muscles did not. . We propose that proximal gains can be achieved by adding elastic bands to BFR-walks, as they predominantly increase the demand of the hip flexors, extensors and abductors. . (SOURCE) Park et al. (2010) Increase in VO2max following 2-week walk training with BFR. . Letieri et al. (2019) Effect of 16-Week Blood Flow Restriction Exercise on Functional Fitness in Sarcopenic Women. . Ozaki et al (2011) Increases in thigh muscle volume and strength by BFR-walk . . Sakamaki et al. (2011) Legs and Trunk Muscle Hypertrophy Following BFR-Walk with Restricted Leg muscle.
September 25, 2019
This is the 4. post in a mini-series about BFR training as a supplement or substitute to traditional resistance training. . In the video you see #JustLiftArmBlaster and #FitCuffs in synergi to isolate the Biceps Muscles- the unmistakable hallmark of gym training for bodybuilders of all levels. . The Arm Blaster is a harness with a metal plate, that locks the arms into the grooved padded sections on each side. It provides greater isolation of the biceps, which means greater tension and stress on the muscles, equals more potential growth of the biceps. Besides, it is easier to keep a neutral spine giving the lower back less of a workout. The Arm Blaster works perfect with a conventional curl bar as it works both heads of the biceps. . Just grab the barbell with an underhand grip and let it hang with arms fully extended and palms facing forward. Press your upper arm back into to the Arm Blaster, bend your elbows and curl the barbell as close to your shoulders as you can, then lower the barbell back to the starting position. . With the supplementation of BFR you put a ton of work through the bicep muscle, sculpting serious mass and shape. That is why this combination of gadgets is so potent to stress the biceps, as the external fixation by the Arm Blaster makes it easier to use a heavier weight than a standard BFR biceps curl. This symbiotic effect seems of substantial importance as discovered by Buckner et al. as they discovered that loads equal or less than 15% 1 RM should be avoided if clinical applicable even with BFR. . SOURCE: Marcolin et al.(2018) Differences in electromyographic activity of biceps brachii and brachioradialis while performing three variants of curl. . Buckner et al. (2019) Blood flow restriction does not augment low force contractions taken to or near task failure.
September 17, 2019
Exercise bands are the perfect supplementation to just about any BFR workout, as presented in this video with the collab of @Kipeconcept (KE:PE) and @Fitcuffs. . We find it obvious why this is such a great combo, as you can augment your rehab or performance training anywhere and anytime by both external and internal resistance by simple means of KI:PE Lite and Fit Cuffs - Performance Lower Body. . This is especially relevant for rehab scenarios and load compromised individuals, as both modalities add resistance to the exercise without compression of the spine and comparatively adds minimal load on other relevant joints. . Walking lunges are effective as they engage nearly the entire lower body musculature and the stabilizers of the core and hip, in order to maintain balance. With the addition of elastic resistance you particularly increase the demand of the abductors and hip flexors. All of this is extremely beneficial for challenging the movement and increasing the effect of your workout . Begin your lunges so that your back knee almost touches the ground with a vertical thigh, then push yourself back up to starting position while keeping the back straight throughout. Perform the reps controlled to target both the quads, glutes, hamstrings and calves. Aim for a controlled pace with about 30 steps for each set x 4, with 30-45 s. interest rest. . About KI:PE Lite: Designed to ensure the maximum power of each workout by 3D attachment clips that ensures all-direction resistance, with the possibility to switch bands for optimal resistance. . SOURCE: Jönhagen et al. (2009) Forward lunge: a training study of eccentric exercises of the lower limbs. . Otha et al. (2003) Low-load resistance muscular training with moderate restriction of blood flow after anterior cruciate ligament reconstruction. . Yasuda et al. (2016) Thigh muscle size and vascular function after blood flow-restricted elastic band training in older women. . Kang et al. (2015) The effects of bodyweight-based exercise with blood flow restriction on isokinetic.
September 11, 2019
This is the third post in a mini-series about BFR training as a supplement or substitute to traditional resistance training. . Below we will present a simple field-method to calculate the load needed for effective BFR stimulus. . In most BFR literature you will find that heavy lifting is to be avoided, especially as a novice to BFR. That is also why we recommend a load approx. 25% of the maximum load that can be lifted once, also known as 25% 1 RM. . But most people do not know their actual 100% 1 RM, and in a rehab setting, this is often not applicable to test by direct methods. That is also why we recommend to use a more simple, thus indirect method. . For general exercises you might recognize the load that you are able to lift for a maximum of 10 reps. This load should be multiplied by 1.3 or 1.4 if you are slightly more optimistic regarding your 1 RM. . Example: Estimated maximum load in a traditional leg press for a single set of 10 reps (10 RM) = 140 kg. . 140 kg x 1.3 = 182 kg multiply this by 0.25 ≈ 45 kg. Which is actually pretty close to 1/3 of the estimated 10 RM, to use as a rule of thumb. . But please remember for the estimation of 1 RM, this field method should be modified for bodyweight exercises i.e. squats, by including the weight of the person. Besides, this is primarily recommended to be used with the generic 30x15x15x15 rep protocol. . SOURCE: Reynolds et al. (2006) Prediction of one repetition maximum strength from multiple repetition maximum testing and anthropometry.
September 7, 2019
Occlusion training (BFR) is not just for people with injuries, pain or aches as the potential for performance optimization is huge for all athletes of any level! . Especially the king of upper body compound exercise, the bench press, has been explored in at least 3 studies with the augmentation of BFR. . In a study by Zachary et al., the BFR group underwent the common 30x15x15x15 protocol, but with progressive loads from 20 to 32 % 1RM for 3/week in the 4 weeks training period. The BFR group demonstrated significantly greater increases in bench press performance (6 kg) compared to a conventional high load training group (1.5 kg). . Yasuda et al. (2010) looked at how non-restricted trunk muscles are affected by compound exercise with the supplementation of BFR. The BFR group trained twice daily, 6d/week for 2 weeks, performing bench press at 30% 1RM with the common 30x15x15x15 protocol. The results were significant, as an increase in 1RM bench press in the BFR group of 6% with no improvements in the non BFR group. Muscle thickness in the triceps and pectoralis major increased by 8% and 16% respectively in the BFR group, with just about no change in the non BFR group. . Yamanaka et al. (2012) studied BFR on National Collegiate Athletic IA football players, but with a lighter load of 20% 1RM, thus higher rep protocol as 30x20x20x20. The results concluded that the average 1RM bench press increased by 7.0% in the BFR group, which was significantly greater than the 3.2% increase in the non BFR group. . Conclusion: The data from the 3 studies suggests that BFR is effective for improving bench press strength and muscle size both upstream and downstream relative to the cuff. Probably most potent with loads above 20 % 1 RM, thus obviously, only when clinical feasible to use higher loads. . SOURCE: Zachary et al. (2017) The Effect of Practical Blood Flow Restriction Training on Body Composition and Muscular Strength in College-Aged Individuals. . Yasuda et al. (2010) Effects of low-intensity bench press training with restricted arm muscle blood flow on chest muscle. . Yamanaka et al. (2012) Occlusion training increases muscular strength in division IA football players.
September 5, 2019
Occlusion training (BFR) is not just for people with injuries, pain or aches as the potential for performance optimization is huge for all athletes of any level! . Just take a look below, as we present the original training protocol and results from the famous study on elite rugby players. As this is particularly interesting for everyone interested in performance optimization. . The inclusion criteria for this study was a history of at least 5 consecutive years of conventional resistance training prior enrollment. . The actual training protocol for the group of interest (BFR) was very simple: Only 4 sets of resisted knee extensions to voluntary failure, with an inter-set rest period of 30 s. Though, importantly augmented by BFR, but only done twice a week for 8 weeks as a supplement to their normal training regime. . However, the relative load where slightly heavier than commonly used in BFR studies, as the load intensity was 50 % of 1 RM. But nevertheless, the researchers found tremendous progress in regards to strength and cross-sectional area of knee extensors ≈ 14 % and 15 %, respectively, besides the functional markers of muscle endurance. . Individuals with many years of resistance training normally reach a plateau in their progress of either strength or hypertrophy. Particularly, such individuals can achieve great improvements by augmenting their training with Fit Cuffs, as this is an ideal supplement to virtually any workout routine. . Conclusion: Resistance exercise augmented by BFR causes, in almost fully developed athletes, relevant increases in muscle size, strength and endurance. . SOURCE: Takarada et al (2002) Effects of resistance exercise combined with vascular occlusion on muscle function in athletes.
August 26, 2019
This is the second post in a mini-series about BFR training as a supplement or substitute to traditional resistance training. . Here we present the relevant parameters to consider for appropriate intensity in BFR. . The primary parameters are common: Relative load (% of 1 RM), reps and percentage of voluntary failure. Secondary parameters: Tempo (time under tension) and rest between sets. As slow tempo, isometric holds and shorter rest periods between sets equals relative higher intensity. Additionally, consider the overall volume (load x reps). . BFR should be interpreted as an additional parameter. For simplicity, this is like adding more resistance and as consequence the load must be less than normal. If you do higher relative pressures the internal load is higher and you should use less weight, to obtain the same relative intensity. This is why BFR is very potent directly after surgery, as high external load is contraindicated but higher pressures can be implemented safely in most cases. . As a rule of thumb, if you use the typical protocol of 30x15x15x15 reps with 30 s. inter-set rest, use a load about 25-35 % of 1 RM, with a pressure of 40-80 % LOP. If for any reason contraindicated to use a load of 20 % of 1 RM, use a higher relative pressure. For more advanced users, try higher loads but less pressure, longer inter-set rest period and fewer reps pr. set. . The combined intensity is sufficient when reaching voluntary failure within the 30x15x15x15 protocol. Then for the concecutive session, re-think either your load, pressure or inter-set rest period. . SOURCE: Patterson et al. (2019) Blood Flow Restriction Exercise Position Stand: Considerations of Methodology, Application, and Safety. . Counts et al. (2016) influence of relative blood flow restriction pressure on muscle activation and muscle adaptation. . Jessee et al. (2017) The Acute Muscular Responses to Blood Flow Restricted Exercise Using Low and High Relative Pressures. . Loenneke et al. (2017) Are Higher Blood Flow Restriction Pressures More Beneficial When Lower Loads Are Used?
August 20, 2019
This is the first post in a mini-series about BFR training as a supplement or substitute to traditional resistance training. . In this post about exercise selection we argument for doing compound exercises that works multiple muscle groups, as this is preferable for most people in regards to overall effect. We recommend a load that is 20-50 % of 1 RM, which is trivial for most people doing BFR. . Squat or lunges is compound exercises that works the quadriceps, glutes, calves, etc. This can be paired with romanian deadlifts that primarily works the glutes and hamstrings. . The same principals are extrapolatable for upper body workouts. If you do chest press that works the pectoralis deltoideus, triceps, etc. then try to pair with a pulling motion which works primarily the opposite muscles . Of course, this is only a generic recommendation as individuals might have different preferences, injuries or minor pain and aches contraindicating multi joint exercises to be used. Another aspect to consider is the overall training volume, which is relevant for people undergoing high volume training. In these cases, single joint exercises might be a better option. . The 30/15/15/15 protocol with 30 s. interset rest period is what appears the most in the literature which also seems convenient from a clinical perspective. . If the total of 75 reps can be completed ad load for the next workout. If less than 60 reps were completed, we recommend to lower the load, or just prolong the rest period with 10-15 seconds. . SOURCE: Dankel et al. (2016) The Effects of Blood Flow Restriction on Upper-Body Musculature Located Distal and Proximal to Applied Pressure. . Luebbers et al. (2017) The Effects Of Practical Blood Flow Restriction Training On Adolescent Lower Body Strength. . Luebbers et al. (2014) The Effects of a 7-Week Practical Blood Flow Restriction Program on Well-Trained Collegiate Athletes. . Yasuda et al. (2010) Effects of low-intensity bench press training with restricted arm muscle blood flow on chest muscle hypertrophy: a pilot study.
August 14, 2019
As explained in a previous post BFR can successfully be used to augment the effect of cardiovascular exercise. These effects are presented in a review by H. Bennett and F. Slattery as they discover that BFR can improve aerobic capacity (VO2 max). . Increased muscle capillarization and central adaptations after a training period results in improvements in VO2 max! But also on running endurance performance even at low intensities and low volumes of BFR training! . This is beneficial for individuals in prehab or rehab or just for everyone undertaking concurrent high intensity strength or endurance training, as the effects are archived with much less mechanical stress on the body. . Please check below for two easy to follow protocols to try on yourself to improve VO2 max with Fit Cuffs®: . Pressure calculated by the Fit Cuffs App “fitcuffs.dk/web-app” or about 50-80 % of resting state LOP. . 4 to 6 consecutive weeks. Complete 6 training sessions each week. A maximum of 2 training sessions each day equals 3 days of exercise with at least 5 min complete rest between sessions. . Interval or intermittent based protocol: 5 intervals at an intensity about 50 % VO2 max then progressed by 1 interval and 5 % intensity for each week. The intervals consisting of 2 minutes of effort followed by 1 min passive rest. Cuffs deflated during the rest period. . Continuous protocol: 8 min with constant pressure and constant intensity at about 40 %. Progressed by 2 min and 5 % intensity each week. . Disclaimer: Expect huge variance in effect size relative to baseline fitness level and a widespread responder continuum. . /Pictures are subject to copyright of @elitestlab. https://elitetestlab.dk/artikler/saadan-forbedrer-okklusion-traening-fysisk-udholdenhed.html. . SOURCE: H. Bennett and F. Slattery (2019) Effects of Blood Flow Restriction Training on Aerobic Capacity and Performance: A Systematic Review.
August 9, 2019
This is the second post in a miniseries about BFR cuffs used for pneumatic devices such as Fit Cuffs® and the impact of different parameters which are relevant for in vivo applications. . As explained in the recent post the most important factors are the width and the elastic properties or pliability of the cuff. . Different materials are used for BFR cuffs as some are made of elastic textiles whereas other cuffs are made of less pliability materials i.e. nylon. . The research shows that the acute muscular responses are similar and that elastic vs. less-elastic cuffs set at the same pressure restrict blood flow similarly at rest. During exercise the research data finds no differences in markers of blood flow or Ratings of Perceived Effort (RPE), even considering the different elastic properties suggesting that cuffs of different elasticity but same width causes similar BFR stimulus. . Though, the research data shows preliminary evidence for pliability not being an important factor. The nature of the cuff material will influence the fluctuation of pressure that occurs during muscle contraction e.g. expansion underneath the cuff which is relevant for comfort and mechanical tension. . Conclusion: Both the width and to a less degrees the pliability of the cuff has meaning full implications for BFR Training. . Fit Cuffs® is designed with a Upper Body Cuff that is more pliable then the Lower Body Cuff because the expansion of the upper arm muscles are greater than of the thigh muscles. But be aware when applying BFR with Fit Cuffs® that you must completely deflate the cuffs before attachment as this will impact blood flow at the same pressure and not at least the fit during training. . SOURCE: Bruckner et al. (2017) Inﬂuence of cuff material on blood ﬂow restriction stimulus in the upper body. . Loenneke et al. (2013) Effect of cuff type on arterial occlusion. . Loenneke et al. (2014) Blood flow restriction: effects of cuff type on fatigue and perceptual responses to resistance exercise.
August 4, 2019
This is the first post in a miniseries about BFR cuffs used for pneumatic devices such as Fit Cuffs® and the impact of different parameters which are relevant for in vivo applications. . The two most important factors to consider are the width and the elastic properties or pliability of the cuff. . As for the width of the cuff the research data has proven this as the second most important factor for the pressure needed to elicit arterial occlusion pressure (AOP), just after limb circumference. . The data from several studies validates that the width has an inverse correlation for the pressure needed to elicit AOP during passive BFR protocols such as pre-ischemic conditioning. . It has been speculated, that less pressure and thereby less mechanical tension associated with wider cuffs is less harmful for the tissue underneath the cuff. However, the research data actually propose that the ischemic crisis e.g. shortage of oxygen + time and not the mechanical tension, to be the important risk factors for tissue damage and prolonged inhibited nerve conductivity. . However, in BFR training wider cuffs (not considering elasticity), are associated with less fluctuation of pressures when muscles expands, which is relevant for the brief discomfort when muscles contracts. Though, this is a trade-off, as wider cuffs can be detrimental for range of motion and perceived effort. . Fit Cuffs® is actually designed to be a compromise considering those factors to accomplish One-Size-Fit-All! . But be aware when applying Fit Cuffs that you must completely deflate the cuffs before attachment, as this will impact the distribution of pressure into the tissue and not at least the actual fit. . SOURCE: Mittal et al. (2008) Effect of different cuff widths on the motor nerve conduction of the median nerve: an experimental study. . Rossov et al. (2012) - Cardiovascular and perceptual responses to blood-flow-restricted resistance exercise with differing restrictive cuffs. . Loenneke et al. (2011) Effects of cuff width on arterial occlusion: implications for blood flow restricted exercise. . Mouser et al. (2017) A tale of three cuffs: the hemodynamics of blood flow restriction.
July 30, 2019
This is a #repost from @elitetestlab as they are testing the benefits of Blood Flow Restriction (BFR) with #fitcuffs on the track. . On the second picture, you can see the athlete doing 6 intervals of 2 min at 12 km/h (7.5 mph) with a pressure of 120-220 mmHg – which is actually very intense but described as tolerable. . He is also testing them in the lab, where oxygen uptake and blood lactate are measured to see how energy turnover changes at different cuff pressures. It can be used to find out how occlusion training (BFR) can enhance endurance in running and cycling which can be extrapolated to other sports with high petition on endurance. . You can read more about the vast applications of BFR to improve sports performance on fitcuffs.dk/com and elitetestlab.dk. . Please see the relevant research on endurance training augmented by BFR on the muscular adaptations (muscle glucose uptake, ion regulation, improved fatigue time, and greater blood flow). . Actually, the portraited athlete is the first author of the two uppermost research articles. . /Pictures are subject to copyright of @elitestlab. . SOURCE: Christiansen et al. (2018). Increased FXYD1 and PGC-1α mRNA after blood flow-restricted running is related to fibre type-specific AMPK signalling and oxidative stress in human muscle. . Christiansen et al. (2019). Blood flow-restricted training enhances thigh glucose uptake during exercise and muscle antioxidant function in humans. . Brusamolino et al. (1986). Acute leukemia occurring in a primary neoplasia (secondary leukemia). A Review of biological, epidemiological and clinical aspects.
July 13, 2019
This is the 3rd post in a mini-series on the different ways to utilize Blood Flow Restriction (BFR). This is still relevant as false dichotomies in BFR still thrives, i.e. safe vs. unsafe or effectful vs ineffectfual. . When measuring Limp Occlusion Pressure (LOP) with a cuff like Fit Cuffs in the Lower body, of 100 randomly picked people 90 % will be in the range of 150-250 mmhg. Then just add limb circumference, which alone explains about 70 % of the variance in LOP (1), we get into the sweet spot of 40-80 % LOP using a simple algorithm. As our app includes other factors such as accustomization and gender the utility is just about complete: www.fitcuffs.dk/web-app or Google Store "Fit Cuffs". . Pros: Effective, Convenient and Safe as the pressure is 40-80 % resting LOP measured by doppler or standard blood pressure monitor. . Cons: For Ischemic Pre Conditioning you need a small margin to sustain 100 % LOP. . Conclusion: Algorithm based methods are simple, fast and effective. This is probably the most feasible and convenient way to personalize pressures and utilizes Fit Cuffs® pneumatic system about perfect. . Disclaimer: The algorithm/app is developed exclusively to be used with Fit Cuffs Training system. . SOURCE: (1) Loenneke et al. 2011 - Effects of cuff width on arterial occlusion: Implications for blood flow restricted exercise.
June 20, 2019
June 16, 2019
This is the 2. post in a mini-series on the different ways to BFR in clinical practice or supplement for the general public. . As explained in the last post beware of the incentives when people preach about how to do BFR. Some go as far as claiming that if clinicians use it in the wrong way and experience adverse events BFR could possibly be banned. . Though, this post is about practical BFR (pBFR) – The to go method when using elastic bands: . The literature suggests a subjective scale from 0-10 with a prefered perceived tightness anywhere from 4-8 (1). Some preliminary studies have explored the validity of measuring the band length as a way to standardize the pressure, but this is probably to early to be operationalized (2). . But is this method is actually safe? Yes, even considering the arbitrary and subjective nature, as even with a tightness of 100 % restriction, blood flow is not completely occluded when muscles contract (3,4). But pBFR is hard to standardize and thereby not optimal for muscle strength and hypertrophy especially relevant in clinical settings (5). . Pros: Convenient in every sense and cheap. Cons: You should take every set close to voluntarily failure and difficult to standardize. . pBFR do not utilize Fit Cuffs® precise pre- and post-exercise pressure readings and a submaximal method from our perspective. . SOURCE: (1) Lowery et al. 2018 - Practical blood flow restriction training increases muscle hypertrophy. . (2) Abe et al. 2019 - A method to standardize the blood flow restriction. . (3) Disclaimer - considered safe. Please see elsewhere for contraindications. . (4) Singer et al. 2018 - Various Cuff Pressures During Blood Flow Restriction Exercise on Blood Flow. . (5) Jessee et al. 2018 - The acute muscular response to blood ﬂow-restricted exercise.
June 10, 2019
This is this first post in an upcoming miniseries on the different ways to standardize/personalize the pressure in "BFRE" with reference to clinical experience, research articles and it is potential utility with Fit Cuffs®. . Recently, different methods have been proposed and debated, especially the use of Limp Occlusion Pressure (LOP) has been proposed as the “only” way to do it right. Some individuals even go as far as claiming that autoregulated systems e.g. hospital standard equipment is the only safe way to do BFR, when in reality many different methods, if used appropriately is completely safe. Thus, obviously different methods come with pros and cons. . So when people claim that some methods and equipments are unsafe and in effective, beware of the potential incentives that lies behind these false dichotomies. . So follow us and look out for the upcoming post on practical BFR (pBFR)! . In the mean time go check the available Web App on Fitcuffs.dk. And for all of you who already purchased a Fit Cuffs product, please DM us for instant access to the android app! Ps. Algorithm based pressures will also be discussed in an upcoming post.
June 6, 2019
#repost #missfitxox #fitcuffs @odderfitnesscenter #occlusiontraining #bloodflowrestriction #evidencebased #musclegrowth #strongbyscience #physio #personligtræning #personaltraining #bikinifitness #bodybuilding #bfrtraining #okklusionstræning #muscle #exercisephysiology #sportsperformance #trainsmart #fysioterapi #performance #bicepsworkout #maintenance #smartdesign #tricepsworkout
June 1, 2019
#repost #part3 @simonthorlarsen #fitcuffs #biceps #muscletear #rehab #muskelskade #okklusionstræning #occlusiontraining #kaatsu #moderntraining #bfrtraining #intensitymatters #strongbyscience #physio #personligtræning #fisio #oclusaovascular #okklusjonstrening #exercisephysiology #sportsperformance #trainsmart #personaltrainer #bicepstear #bloodflowrestriction #evidencebased #musclegrowth #hypertrophy #rehab #bfrexercise #innovativedesign