Effects of cuff width on arterial occlusion: implications for blood flow restricted exercise

Abstract

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.

Exercise with Blood Flow Restriction: An Updated Evidence-Based Approach for Enhanced Muscular Development

“…Indeed, some individuals did not reach complete arterial occlusion using narrow cuffs on the legs, even at pressures of up to 300 mmHg [41]. These results suggest that it may be easier to reach the desired level of occlusive pressure using wider cuffs in the lower body.…”

“…An interesting finding from Loenneke et al [41] was that limbs with a larger circumference require higher occlusive pressures to reach the same level of arterial occlusion. Furthermore, limb circumference was as effective, if not more so, than laboratory-based measures of limb composition in predicting the pressure required to restrict arterial blood flow [41].…”

“…Wider cuffs transmit pressure through soft tissue differently to narrow cuffs, which has obvious implications for subsequent training adaptations. To illustrate, Loenneke et al [41] recently reported wide cuffs (13.5 cm) to restrict arterial blood flow at lower pressures than narrow cuffs (5.0 cm).…”

“…Furthermore, limb circumference was as effective, if not more so, than laboratory-based measures of limb composition in predicting the pressure required to restrict arterial blood flow [41]. It is therefore important when implementing BFR to consider the width of the cuff to be used, and to assess the circumference of the individual limbs to be trained.…”

“…Logic therefore dictates that BFR should not be universally applied at an absolute pressure, but should vary relative to each individual [43]. The pressure applied should be dependent on both the cuff width and the size of the limb to which BFR is being applied [41]. This theory is also relevant when considering BFR of the lower and upper limbs; if equivalent restrictive pressures (and cuff widths) are used for both the arms and legs, it is likely that either arterial inflow in the arms will be limited, or that insufficient venous occlusion for venous pooling will occur in the legs.…”