BFR Training

Blood Flow Restriction Training (BFRT)

OVERVIEW

Overview of BFRT

Blood Flow Restriction Training (BFRT) is becoming increasingly popular worldwide. It is done by wrapping a tourniquet around the top portion of one’s upper or lower limbs. The wrapping restricts blood flow from the veins of the working muscles to the heart and limits the amount of blood flow to the limbs from the arteries. The restriction results in physiological changes that mimic changes associated with high intensity exercise. The results are gains in muscle size and strength and increases in cardiovascular function at much lower intensities than are usually required for adaptation.

ORIGINS OF BLOOD FLOW RESTRICTION TRAINING

JAPAN

In the 1960’s, Yoshiaki Sato of Japan experimented with different tubes and tourniquets to improve his physical training. While on a ski trip, he fractured his ankle and caused damage to his knee ligaments. The doctors told Sato that it would take six months to heal. With a plaster cast on, Sato rehabilitated himself with bands applied to his upper leg. He repeatedly applied band pressure off and on while doing isometric exercises for 30 seconds on and a few seconds off three times per day. As a result, his muscles did not atrophy and he fully recovered within a six week period. Between 1973 and 1982, Sato continued to develop what is now known as KAATSU training. Blood Flow Restriction Training has been researched and developed based on this early work by Sato.

UNITED STATES

It wasn’t until about 2011 when the United States military started to experiment with BFRT for helping injured soldiers recover from the injuries sustained in Afghanistan and Iraq. Initially, the military was trying to improve endogenous production of growth hormone while rehabilitating soldiers to help skin and tissue grafts heal. With experimentation and research, protocols were developed to aid in strengthening limbs for prosthetics. Strength and conditioning specialists began utilizing BFRT to optimize training for performance. Currently, many professional teams, hospitals, Universities and clinics are helping their patients and athletes prepare for surgery, minimize disuse atrophy, increase aerobic capacity, increase muscle strength and size by using BFRT.

WHO CAN BENEFIT FROM BFRT?

Within the field of rehabilitation, we come across a variety of patient populations. Patients and insurance companies all want a faster return to normal activities with a decrease in time and cost. BFRT allows patients to recover faster and return to a higher quality of life. BFRT is ideal for populations who have limitations to high mechanical load.

EVIDENCE BASED

VALIDATED WITH SCIENTIFIC EVIDENCE

The principles are simple, but the applications are enormous. By utilizing low intensity resistance at sub-maximal levels, BFRT can scale across a continuum from those assigned bedrest with no ability to exercise to supplementing high performance training. Blood flow restriction training effectively tricks the brain and body into thinking one is performing high intensity exercise. The brain and body respond to this training with a myriad of benefits:

KEY FINDINGS REGARDING THE BENEFITS OF BFRT INCLUDE:

Effective in Increasing Strength

Yasuda, T., Loenneke, J. P., Thiebaud, R. S., & Abe, T. (2012). Effects of blood flow restricted lowintensity concentric or eccentric training on muscle size and strength. PLoS One, 7(12), e52843.

Yasuda, T., Ogasawara, R., Sakamaki, M., Ozaki, H., Sato, Y., & Abe, T. (2011). Combined effects of low-intensity blood flow restriction training and high-intensity resistance training on muscle strength and size. Eur J Appl Physiol, 111(10), 2525-2533.

Effective in Attenuating Atrophy

Gorgey, A. S., Timmons, M. K., Dolbow, D. R., Bengel, J., Fugate-Laus, K. C., Michener, L. A., et al. (2016). Electrical stimulation and blood flow restriction increase wrist extensor cross-sectionalarea and flow mediated dilatation following spinal cord injury. Eur J Appl Physiol, 116(6), 1231-1244.

 Effective in Creating Hypertrophy

Sudo, M., Ando, S., & Kano, Y. (2017). Repeated blood flow restriction induces muscle fiber hypertrophy. Muscle Nerve, 55(2), 274-276.

Slysz, J., Stultz, J., & Burr, J. F. (2016). The efficacy of blood flow restricted exercise: A systematic review & meta-analysis. J Sci Med Sport, 19(8), 669-675.

Effective in Rehabilitation/Prehabilitation

Ferraz, R. B., Gualano, B., Rodrigues, R., Kurimori, C. O., Fuller, R., Lima, F. R., et al. (2017). Benefits of Resistance Training with Blood Flow Restriction in Knee Osteoarthritis. Med Sci Sports Exerc.

Franz, A., Queitsch, F. P., Behringer, M., Mayer, C., Krauspe, R., & Zilkens, C. (2018). Blood flow restriction training as a prehabilitation concept in total knee arthroplasty: A narrative review about current preoperative interventions and the potential impact of BFR. Med Hypotheses, 110, 53-59.

Effective in Aiding Recovery

Borne, R., Hausswirth, C., & Bieuzen, F. (2017). Relationship Between Blood Flow and Performance Recovery: A Randomized, Placebo-Controlled Study. Int J Sports Physiol Perform, 12(2), 152-160.

Brandner, C. R., & Warmington, S. A. (2017). Delayed Onset Muscle Soreness and Perceived Exertion After Blood Flow Restriction Exercise. J Strength Cond Res, 31(11), 3101-3108.

Effective in Improving Cardiovascular Function

Abe, T., & Loenneke, J. P. (2017). Walking with blood flow restriction: Could it help the elderly to get more out of every step? J Sci Med Sport, 20(11), 964.

Bunevicius, K., Sujeta, A., Poderiene, K., Zachariene, B., Silinskas, V., Minkevicius, R., et al. (2016). Cardiovascular response to bouts of exercise with blood flow restriction. J Phys Ther Sci, 28(12), 3288-3292.

Paton, C. D., Addis, S. M., & Taylor, L. A. (2017). The effects of muscle blood flow restriction during running training on measures of aerobic capacity and run time to exhaustion. Eur J Appl Physiol, 117(12), 2579-2585.

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