Blood Flow Restriction Training: To Adjust or Not Adjust the Cuff Pressure Over an Intervention Period?

Abstract

Blood flow restriction (BFR) training combines exercise and partial reduction of muscular blood flow using a pressured cuff. BFR training has been used to increase strength and muscle mass in healthy and clinical populations. A major methodological concern of BFR training is blood flow restriction pressure (BFRP) delivered during an exercise bout. Although some studies increase BFRP throughout a training intervention, it is unclear whether BFRP adjustments are pivotal to maintain an adequate BFR during a training period. While neuromuscular adaptations induced by BFR are widely studied, cardiovascular changes throughout training intervention with BFR and their possible relationship with BFRP are less understood. This study aimed to discuss the need for BFRP adjustment based on cardiovascular outcomes and provide directions for future researches. We conducted a literature review and analyzed 29 studies investigating cardiovascular adaptations following BFR training. Participants in the studies were healthy, middle-aged adults, older adults and clinical patients. Cuff pressure, when adjusted, was increased during the training period. However, cardiovascular outcomes did not provide a plausible rationale for cuff pressure increase. In contrast, avoiding increments in cuff pressure may minimize discomfort, pain and risks associated with BFR interventions, particularly in clinical populations. Given that cardiovascular adaptations induced by BFR training are conflicting, it is challenging to indicate whether increases or decreases in BFRP are needed. Based on the available evidence, we suggest that future studies investigate if maintaining or decreasing cuff pressure makes BFR training safer and/or more comfortable with similar physiological adaptation.

Blood flow restricted walking in patients suffering from intermittent claudication: a case series feasibility and safety study

“…Additionally, no adverse events related to BFR-W were observed. This may be explained by the relatively low occlusion pressure at 60%, which may minimise the risk of adverse events, as suggested by Cerqueira et al 31 .…”

“…The cuff was inflated to 100 mmHg and then the pressure was gradually increased by 20 mmHg until the arterial pulse was no longer detectable with the Ultrasound Doppler, which was defined as LOP 30 . If the patients experienced pain and discomfort at 60% LOP, the pressure was decreased by 20 mmHg ( n =2) 31 .…”

Effect of blood flow–restricted resistance training on myocardial fibrosis in early spontaneously hypertensive rats

“…In terms of cardiac morphology, function, and blood pressure, studies have shown that BFR exercise has a positive effect on the cardiac function and heart rate variability of healthy people, elderly people, and some patients with coronary artery disease, and improved the cardiac contractility and anti-ischemic ability, reduced heart rate and blood pressure, and increased heart rate variability ( 21 – 24 ). The same results were obtained in a study of elderly rats, in which BFR exercise improved cardiac function and arterial compliance ( 15 , 25 ).…”

Blood Flow Restriction Training for the Intervention of Sarcopenia: Current Stage and Future Perspective

“…Pressure is also an important factor in BFR. The cuff width, limb circumference, ankle-brachial index, fat and muscle thickness, arterial stiffness, endothelial function, and blood pressure all influence the BFR pressure ( 116 ). The optimal limiting pressure value for BFRT should be high enough to allow venous blood flow to the occluded muscle but low enough to maintain arterial blood flow to the muscle.…”