Why is it Crucial to Use Personalized Occlusion Pressures in Blood Flow Restriction (BFR) Rehabilitation?

Abstract

An increasing amount of evidence has been shown to support the use of blood flow restriction (BFR) in combination with low-load resistance exercise to enhance morphological and strength responses. The BFR technique involves applying a tourniquet cuff to a limb and pressurizing it with a tourniquet instrument to restrict, but not fully occlude, arterial blood flow into the limb during rehabilitative exercise. A review of BFR rehabilitation literature shows that inconsistencies exist in methodology, equipment and in levels of restriction pressure used. Current non-personalized methodologies of setting BFR pressure may occlude rather than restrict blood flow, increasing the risk of injury during rehabilitation. Furthermore, these non-personalized methods of setting pressure do not provide a consistent stimulus within and across patients, reducing the efficacy of the BFR rehabilitation and inhibiting the meaningful comparison of a full range of BFR studies. A restriction pressure level set for each individual patient, based on a percentage of limb occlusion pressure (LOP) measured at rest, and applied using a surgical-grade tourniquet cuff, enables those individual patients to receive a safe and consistent BFR stimulus compared to other methods of setting the restriction pressure level. In view of the above, it is crucial to use surgical-grade tourniquet technology with automatic LOP measurement capability, adapted to incorporate and deliver optimal protocols, for safe and effective application of BFR to consistently achieve optimal patient outcomes in rehabilitation.

Strengthening the Brain—Is Resistance Training with Blood Flow Restriction an Effective Strategy for Cognitive Improvement?

“…Since those mentioned moderator variables are crucial for an effective BFR-stimulus and the physiological response, as well as the psychological response, it is likely that those also alter neurocognitive adaptations, which, in turn, influence the changes in cognitive functions. To evoke the above mentioned cognition-related neurobiological adaptations through a resistance training with BFR, it is strongly recommended to determine a personalized cuff pressure be chosen [ 217 , 240 ] which takes the above mentioned relationships of the moderator variables and the cuff pressure into account. From a practitioner’s view, the optimal solution(s) to determine the cuff pressure ensuring an appropriate stimulus would be using a pressure that is relative to the used cuffs and individual’s characteristics [ 117 , 241 ] or to use a BFR system that automatically adjust the cuff pressure [ 239 , 240 ].…”

“…To evoke the above mentioned cognition-related neurobiological adaptations through a resistance training with BFR, it is strongly recommended to determine a personalized cuff pressure be chosen [ 217 , 240 ] which takes the above mentioned relationships of the moderator variables and the cuff pressure into account. From a practitioner’s view, the optimal solution(s) to determine the cuff pressure ensuring an appropriate stimulus would be using a pressure that is relative to the used cuffs and individual’s characteristics [ 117 , 241 ] or to use a BFR system that automatically adjust the cuff pressure [ 239 , 240 ]. Furthermore, even moderate cuff pressures induce adaptions comparable to high cuff pressures [ 227 , 242 ].…”

The Acute Impact of External Compression on Back Squat Performance in Competitive Athletes

“…The value of 100% AOP is the point where blood flow is completely cut off. Furthermore, the effect of external compression on blood flow restriction (BFR) is also related to a range of individual characteristics (limb circumference, body composition) as well to the type of cuff (tourniquet shape, width, and length) [5][6][7].…”

Is there rationale for the cuff pressures prescribed for blood flow restriction exercise? A systematic review

“…The present review highlights a clear lack of consistency among the individualized cuff pressures used in the BFR exercise literature, and even more concerning is the absence of a clear justification for the pressure selection by the vast majority of studies. The purpose of utilizing individualized cuff pressures is to overcome the variability in magnitude of limb blood flow that is restricted when using arbitrary pressures or a percentage of measured systolic blood pressure due to individual participant differences in body composition and hemodynamics 1,15,76 . These individualized cuff pressures are attained through direct measurement of the pressure required to completely occlude limb blood flow (ie, AOP/LOP), and then using a percentage of AOP/LOP that is expected to allow arterial inflow, but restrict venous outflow at rest 1 .…”

“…This is also relevant for the broader consistency of BFR application across all populations, particularly in research settings, to reduce the heterogeneity that makes comparisons between studies problematic 3 . For example, individualized applied pressures during BFR exercise can be derived from measures of limb occlusion pressure (LOP) or arterial occlusion pressure (AOP), usually as a percentage of this value 15 . These individualized pressures are favorable when applying cuff pressure during BFR exercise, as they help address some of the variability in restriction caused by differences in the equipment used, such as differing cuff widths, when set at the same absolute pressure 16 .…”