Determining the optimal blood flow restriction protocol for maximising muscle hypertrophy and strength, pressure and cuff width: A mini-review

Abstract

Low load resistance training accompanied by blood flow restriction (BFR) has been established as a training modality to induce hypertrophy and strength adaptations. Throughout the BFR-literature, several protocols have emerged with a vast difference among manipulations regarding limb occlusion pressure and the use of different cuff sizes. The aim of this review is to summarise the research underpinning the stimulus regarding alterations in occlusion pressure and the use of different cuff widths, thus investigate whether an optimal protocol is evident. While the focal point of BFR-literature supports the efficiency of several BFR-protocols, no uniform BFR-protocol are located in the literature to maximise muscle hypertrophy and strength. However, an optimal limb occlusion pressure is crucial to achieve venous blood pooling, thus induce a significant stimulus to the muscle, and should be individualised and likely applied relative to the maximum arterial occlusion pressure. Quantification of the optimal pressure range is currently a disputed topic, with no conclusive evidence leading to the most efficient range of applied pressure. Regarding cuff widths, applying an absolute or relative pressure, and their implications regarding the hemodynamics of blood flow should be considered by the researchers. The author would highlight that future BFR studies should be conducted to shed light on the determinants underpinning the protocol to optimise muscle hypertrophy and strength through BFR resistance training, which could have an important ramification through its increasing use in clinical settings and athletic development.

Physiological and clinical effects of low-intensity blood-flow restricted resistance exercise compared to standard rehabilitation in adults with knee osteoarthritis–Protocol for a randomized controlled trial

“…The occlusion pressure during both exercises will be set at 60% of the individual arterial occlusion pressure (AOP) in the first two training sessions, and increased to 70% AOP in the subsequent two sessions, to reach 80% AOP from the fifth training session, where it will remain during all subsequent training sessions [40,[52][53][54][55]. The stepwise increments in cuffpressure are chosen to habituate participants to the 80% AOP pressure.…”

Respuestas perceptuales a la aplicación de restricción de flujo sanguíneo en diferentes programas de ejercicio. Una revisión sistemática.

“…En general los programas de ejercicio con RFS siguen unas recomendaciones generales que coinciden con las recogidas en la revisión de Patterson et al ( 2019) 66 , en función de si son de ejercicio resistido o aeróbico (Tabla 3). Aun así, no existe mucho consenso acerca del protocolo a seguir y vemos que los programas de ejercicio usados son bastante variados.…”

“…Aun así, no existe mucho consenso acerca del protocolo a seguir y vemos que los programas de ejercicio usados son bastante variados. Al suponer diferente carga fisiológica, los efectos obtenidos podrán variar de unos a otros 66 . A todo esto se le suma la falta de sesiones de familiarización en ciertos estudio 30,42,41,37 .…”

“…En los últimos años ha aumentado mucho el número de estudios sobre RFS que estudian sus beneficios y efectos según diferentes protocolos. Aunque a nivel de fortalecimiento está más estudiado 2-6, 14 , aún no se han establecido unas pautas de aplicación para el completo aprovechamiento de los beneficios que puede aportar mediante sus diferentes aplicaciones en combinación con las numerosas variantes existentes en el ejercicio 1, 15 . De igual manera ocurre con sus efectos sobre aspectos perceptuales del paciente como esfuerzo percibido, dolor o fatiga.…”

Perceived Barriers to Blood Flow Restriction Training

“…Different BFR applications range from the BFR device used (i.e., autoregulated pressures during application or standardized manual devices), the application form of BFR (i.e., continuously applied pressure throughout the exercise bout or intermittent application during exercise/rest periods only) and the use of various non-individualized BFR pressure prescriptions. At least two reviews ( 21 , 22 ) have discussed the challenges of drawing conclusions using a variety of other applied pressure approaches including arbitrary pressure (i.e., 200 mmHg pressure for every participant) ( 23 ), pressures based off brachial systolic blood pressure ( 24 ), and pressures based on thigh circumference ( 25 – 27 ) as well as perceived tightness scale (i.e., “7/10” tightness, where “10” is maximum tightness) ( 28 ). While BFR training literature has utilized such approaches successfully in healthy participants, practitioners working in the clinical setting may benefit from more precise means of choosing and controlling pressure, especially in those with comorbidities.…”