The purpose of this study was to determine the difference in cuff pressure which occludes arterial blood flow for two different types of cuffs which are commonly used in blood flow restriction (BFR) research. Another purpose of the study was to determine what factors (i.e., leg size, blood pressure, and limb composition) should be accounted for when prescribing the restriction cuff pressure for this technique. One hundred and sixteen (53 males, 63 females) subjects visited the laboratory for one session of testing. Mid-thigh muscle (mCSA) and fat (fCSA) cross-sectional area of the right thigh were assessed using peripheral quantitative computed tomography. Following the mid-thigh scan, measurements of leg circumference, ankle brachial index, and brachial blood pressure were obtained. Finally, in a randomized order, arterial occlusion pressure was determined using both narrow and wide restriction cuffs applied to the most proximal portion of each leg. Significant differences were observed between cuff type and arterial occlusion (narrow: 235 (42) mmHg vs. wide: 144 (17) mmHg; p = 0.001, Cohen’s D = 2.52). Thigh circumference or mCSA/fCSA with ankle blood pressure, and diastolic blood pressure, explained the most variance in the cuff pressure required to occlude arterial flow. Wide BFR cuffs restrict arterial blood flow at a lower pressure than narrow BFR cuffs, suggesting that future studies account for the width of the cuff used. In addition, we have outlined models which indicate that restrictive cuff pressures should be largely based on thigh circumference and not on pressures previously used in the literature.

We suggest that higher relative pressures may not be necessary when exercising under BFR.

Our findings indicate that arm circumference and SBP should be taken into account when determining BFR cuff pressures. In addition, we confirmed our previous study that thigh circumference is the greatest predictor of arterial occlusion in the lower body.

Different levels of BFR may alter the acute muscular response to a degree, although higher pressures do not appear to augment these changes.

The purpose of this study was to determine the muscular adaptations to low-load resistance training performed to fatigue with and without blood flow restriction (BFR). Middle-aged (42-62 years) men (n = 12) and women (n = 6) completed 18 sessions of unilateral knee extensor resistance training to volitional fatigue over 6 weeks. One limb trained under BFR, and the contralateral limb trained without BFR [free flow (FF)]. Before and after the training, measures of anterior and lateral quadriceps muscle thickness (MTh), strength, power and endurance were assessed on each limb. The total exercise training volume was significantly greater for the FF limb compared with the BFR limb (P<0·001). Anterior quadriceps thickness and muscle function increased following the training in each limb with no differences between limbs. Lateral quadriceps MTh increased significantly more (P<0·05) in the limb trained under BFR (BFR: 3·50 ± 0·61 to 3·67 ± 0·62 cm; FF: 3·49 ± 0·73 to 3·56 ± 0·70 cm). Low-load resistance training to volitional fatigue both with and without BFR is viable options for improving muscle function in middle-aged individuals. However, BFR enhanced the hypertrophic effect of low-load training and reduced the volume of exercise needed to elicit increases in muscle function.