February 16, 2022

Wellness Read: Blood Flow Restriction

by Avis Jason

We are constantly researching, testing, and employing innovative technology to support and drive gains in the health and performance of SHIFT Members. Read below to learn more about new equipment we have to offer here at SHIFT.

What is Blood Flow Restriction (BFR)?

Blood flow restriction was discovered in Japan by Dr. Yoshiaki Sato, MD, PHD in 1966 when he coined the term “KATTSU,” a method involving the use of added pressure in training. Subsequent research and technology improvements have led to the development of effective methods and tools to make safe blood flow restriction-based training possible. The BFR apparatus uses compression cuffs, applied to the upper portion of a limb, to partially restrict blood flow during strength-training or cardiovascular exercise. Once the cuff is inflated to a personalized pressure, muscular fatigue occurs more quickly during an exercise regimen and stimulates muscle development. Previous research indicates that strength training programs must focus on high intensity loads of 70-85% of a 1-repeititon max (1-RM) to elicit the desired muscular mass or strength gains.2,4 However, research on the use of BFR has proven similar muscular adaptations of improved muscular strength and muscular mass through low-load resistance training or specific cardiovascular training, making BFR a highly useful alternative.1,2

How does BFR work?

The reduction in blood flow due to BFR decreases oxygen delivery to the exercising muscle. The muscle contracts under an anaerobic (lack of oxygen) pathway, which produces lactic acid and other byproducts to generate the characteristic muscle burn. A systematic review published in 2021 found positive outcomes of BFR on both musculoskeletal and other organ systems.1 BFR has additional benefits, such as:

  • Increasing hormone levels,3
  • Blocking specific protein gene expression that inhibits muscle growth,7
  • Stimulating more rapid bone turnover.9

Through BFR, cellular stress encourages muscle repair and drives adaptation connected with strength gains. From a broader musculoskeletal perspective, studies have shown BFR produces outcomes similar to high-load resistance training6 and has benefits to a limb that did not undergo any BFR training.3,5,6 Overall, research concludes BFR produces neuromuscular adaptations at a systemic level, which means strength gains are found even in muscle groups that did not undergo training.1,2  

Why should BFR be used?

Historically, heavy load was deemed necessary for eliciting muscle growth and strength. The current (and abundant) research concludes that BFR training increases muscular strength and total body neural adaptations through the use of a safe and appropriate exercise prescription. These positive muscular changes have been proven at a prescription as low as 20% load of 1-RM, training 2-3 days per week, at a high volume of 75 repetitions over 4 sets (30/15/15/15) with 30-second rest periods between sets.4,7 This volume method creates metabolite accumulation and drives the physiological adaptations for tissue repair and recovery. This indicates that BFR is an effective alternative modality for individuals who cannot tolerate the stress of high-load exercise. Systematic reviews on BFR found no known adverse effects when dosed properly.1 Furthermore, studies evaluating comorbid populations, such as those with heart and renal disease, suffered no determinantal effects with a BFR training protocol.10

When is BFR used?

BFR can be used clinically during a guided rehabilitation program or in conjunction with a strength training program to off-load the tendon or joint stress associated with heavy weight strength training. BFR has gained popularity within the professional athlete community for post-surgical recovery to minimize muscle loss during the acute stage of tissue healing. Other clinical populations that may benefit from BFR programming are those unable to tolerate high-load resistance training, including the elderly, individuals with joint osteoarthritis, or patients with other medical comorbidities such as heart disease or renal disease.1,10

Is BFR right for me?

The degenerative effects of muscle atrophy can be seen with musculoskeletal injuries such as fractures, ligament injuries and can lead to the development of osteoarthritis. BFR is a progressive clinical rehabilitation tool for safe implementation of strength training through a low-load regimen. Continuous improvement in technology has produced more viable systems for both in-clinic and at-home use. While research is still ongoing to develop a gold-standard exercise prescription for the use of BFR training, tremendously positive research for current dosage of BFR training supports positive outcomes.

When developing your personalized exercise plan, consider using blood flow restriction in your training program to keep the muscle systems in balance. Anyone interested in considering BFR for either clinic or at-home use should first be evaluated by a physical therapist. Please Schedule Physical Therapy Appointment or direct any questions to your SHIFT physical therapist Avis at avis.jason@shiftlife.com.

Here are a few examples of exercises completed with BFR:

Bicep Curl

Bicep curl with blood flow restriction cuffs.

Tricep Pressdown

Tricep pressdown with blood flow restriction cuffs.


Squat with blood flow restriction cuffs


Lunge with blood flow restriction cuffs

In Real Health,

Avis Jason, PT, DPT

SHIFT Physical Therapist

Reference List

  1. Miller BC, Tirko AW, Shipe JM, Sumeriski OR, Moran K. The Systemic Effects of Blood Flow Restriction Training: A Systematic Review. IJSPT. 2021;16(4):978-990. doi:10.26603/001c.25791
  2. Slysz J, Stultz J, Burr JF. The efficacy of blood flow restricted exercise: a systematic review & meta-analysis. J Sci Med Sport. 2016;19(8):669-675. doi:10.1016/j.jsams.2015.09.005
  3. Cook CJ, Kilduff LP, Beaven CM. Improving strength and power in trained athletes with 3 weeks of occlusion training. Int J Sports Physiol Perform. 2014;9(1):166-172. doi:10.1123/ijspp.2013-0018
  4. Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 43(7): 1334-1359, 2011. doi:10.1249/MSS.0b013e318213fefb.
  5. May AK, Russell AP, Warmington SA. Lower body blood flow restriction training may induce remote muscle strength adaptations in an active unrestricted arm. Eur J Appl Physiol. 2018;118(3):617-627. doi:10.1007/s00421-018-3806-2
  6. Bowman EN, Elshaar R, Milligan H, et al. Proximal, distal, and contralateral effects of blood flow restriction training on the lower extremities: a randomized controlled trial. Sports Health. 2019;11(2):149-156. doi:10.1177/19417381188w21929
  7. Laurentino GC, Ugrinowitsch C, Roschel H, et al. Strength training with blood flow restriction diminishes myostatin gene expression. Med Sci Sports Exerc. 2011;44(3):406-412. doi:10.1249/mss.0b013e318233b4bc
  8. Karabulut M, Bemben DA, Sherk VD, Anderson MA, Abe T, Bemben MG. Effects of high-intensity resistance training and low-intensity resistance training with vascular restriction on bone markers in older men. Eur J Appl Physiol. 2011;108(11):1659-1667. doi:10.1007/s00421-010-1796-9
  9. Thiebaud RS, Loenneke JP, Fahs CA, et al. The effects of elastic band resistance training combined with blood flow restriction on strength, total bone-free lean body mass and muscle thickness in postmenopausal women. Clin Physiol Funct Imaging. 2013;33(5):344-352. doi:10.1111/cpf.12033
  10. Yasuda T, Fukumura K, Uchida Y, et al. Effects of low-load, elastic band resistance training combined with blood flow restriction on muscle size and arterial stiffness in older adults. J Gerontol A Biol Sci Med Sci. 2015;70(8):950-958. doi:10.1093/gerona/glu084


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