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July 09, 2020
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 fitcuffs.web.app — 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).
(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.
July 06, 2020
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.
June 26, 2020
In the present post we got some running drills and plyometrics hurdle hops augmented by BFR, 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.
June 17, 2020
Even though gyms around the world are opening again, home-BFR is equally as swift, effectful and convenient.
In this video 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.
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.
June 10, 2020
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.
So, 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!?
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
June 6, 2020
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 in the comments.
Additionally, if you find we have missed mandatory information, please also comment below so this guide can be improved as soon as possible.
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.
May 29, 2020
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.
May 23, 2020
By augmenting your conventional exercise selection by Fit Cuffs, you got access to an effective, convenient and significantly less time demanding workout.
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:
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.
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.
May 15, 2020
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?
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.
May 2, 2020
Exercises in display:
0:16 Walking Lunge
0:20 Squats Jump
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.
Marts 23, 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, 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!
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.
(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.
November 25, 2019
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 Active Collegiate Women.
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.
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 advise 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 unweighted 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.
“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 without any pain.”
If this case has any interest or if you would like to know the exact protocol used in Sørens rehab, just ask!
October 16, 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 12, 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
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 21, 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.