Blood flow restriction training and the high-performance athlete: science to application

Abstract

The manipulation of blood flow in conjunction with skeletal muscle contraction has greatly informed the physiological understanding of muscle fatigue, blood pressure reflexes, and metabolism in humans. Recent interest in using intentional blood flow restriction (BFR) has focused on elucidating how exercise during periods of reduced blood flow affects typical training adaptations. A large initial appeal for BFR-training was driven by studies demonstrating rapid increases in muscle size, strength, and endurance capacity; even when notably low intensities and resistances, that would typically be incapable of stimulating change in healthy populations, were used. The incorporation of BFR-exercise into the training of strength- and endurance-trained athletes has recently been shown to provide additive training effects that augment skeletal muscle and cardiovascular adaptations. Recent observations suggest BFR-exercise alters acute physiological stressors such as local muscle oxygen availability and vascular shear-stress, which may lead to adaptations that are not easily attained with conventional training. This review explores these concepts and summarizes both the evidence-base and knowledge gaps regarding the application of BFR-training for athletes.

Blood flow restriction during training for improving the aerobic capacity and sport performance of trained athletes: A systematic review and meta-analysis

“…Blood flow restriction (BFR) is one of these new stimuli that coaches are including during training sessions more and more frequently in order to improve sport performance. 2 Although BFR has traditionally been included in sport rehabilitation contexts, 3 beneficial results obtained in muscle characteristics and strength when it is combined with resistance training have increased the interest of coaches. 4 Therefore, BFR is also being combined with running or sport-specific sessions to achieve additional effects on aerobic capacity and sport performance.…”

Effect of Blood Flow Restriction on Functional, Physiological and Structural Variables of Muscle in Patients with Chronic Pathologies: A Systematic Review

“…To perform the BFR technique, a controlled tourniquet is performed, generating a gradual mechanical pressure just below it, affecting blood flow (both arterial and venous) and generating a hypoxia in the restricted area. For the realization of the tourniquet, mechanical cuffs are used, which are inflated and regulate the pressure generated in the compression zone, although nylon or elastic cuffs are also used for the realization of the tourniquet [2][3][4][5]. This zone of compression is usually the proximal region of both the upper and lower limbs.…”

Effects of Blood Flow Restriction on O2 Muscle Extraction and O2 Pulmonary Uptake Kinetics During Heavy Exercise

“…Thus, the occurrence ofVO 2 SC may be explained by a shift between metabolic energy sources in heavy and a loss of Abbreviations: BFR, blood flow restriction; BFR40, 40% occlusion of the total femoral artery pressure; BFR50, 50% occlusion of the total femoral artery pressure; CON, control (i.e., exercise conducted without blood flow restriction); Hb, haemoglobin; HHb, deoxyhaemoglobin; NIRS, near infrared spectrometry; OXPHOS, mitochondrial oxidative phosphorylation system; O 2 Hb, oxyhaemoglobin; Pi, inorganic phosphate; TSI, Tissue saturation index; TSIA1 ′ , amplitude of phase 1 (TSI kinetics); TSIA2 ′ , amplitude of phase 2 (TSI kinetics); TSIA1ss ′ , amplitude of steady state (TSI kinetics); TSIA3 ′ , amplitude of phase 3 (TSI kinetics); TSIAtot, amplitude of total response (TSI kinetics); TSIMRT, mean response time of phase 1 (TSI kinetics); TSITD1, time delay of phase 1 (TSI kinetics); TSITD2, time delay of phase 2 (TSI kinetics); TSITD3, time delay of phase 3 (TSI kinetics); TSIτ 1, time constant of phase 1 (TSI kinetics);VE, ventilation;VO 2 , pulmonary oxygen uptake;VO 2 Ap, amplitude of the primary phase ofVO 2 kinetics;VO 2 Asc, amplitude of theVO 2 slow component;VO 2 Atot, amplitude of the totalVO 2 response;VO 2BL ,VO 2 averaged during the last 30 s of the empty pedalling phase;VO 2 MRT, mean response time of the primary phase ofVO 2 kinetics;VO 2 peak, peak oxygen consumption;VO 2 SC,VO 2 slow component;VO 2 TDp, time delay of the primary phase ofVO 2 kinetics;VO 2 TDsc, time delay of theVO 2 slow component;VO 2 τ p, time constant of primary phase ofVO 2 kinetics;VO 2 τ sc, time constant of slow component ofVO 2 kinetics; VT, ventilatory threshold; P 10, power equivalent at 10% of the difference between the power at VT1 and the maximal aerobic power. muscle efficiency in severe intensity domain (Conde Alonso et al, 2020;Pignanelli et al, 2021;Preobrazenski et al, 2021).…”

“…Aerobic training with blood flow restriction (BFR) was found to be beneficial for enhancing adaptations, including endurance and muscle hypertrophy (Pignanelli et al, 2021 ; Preobrazenski et al, 2021 ). These results are thought to be caused by some acute effects of BFR reducing venous blood flow according to the level of pressure exerted.…”

“…However, recent works have also suggested that SC was mainly due to a metabolic shift corresponding to enhanced , thus compensating a reduction of the anaerobic energy contribution without changes of total energy utilisation during heavy intensity exercises (Colosio et al, 2020 ). Thus, the occurrence of SC may be explained by a shift between metabolic energy sources in heavy and a loss of muscle efficiency in severe intensity domain (Conde Alonso et al, 2020 ; Pignanelli et al, 2021 ; Preobrazenski et al, 2021 ).…”