Perceived Barriers to Blood Flow Restriction Training

Abstract

Blood flow restriction (BFR) training is increasing in popularity in the fitness and rehabilitation settings due to its role in optimizing muscle mass and strength as well as cardiovascular capacity, function, and a host of other benefits. However, despite the interest in this area of research, there are likely some perceived barriers that practitioners must overcome to effectively implement this modality into practice. These barriers include determining BFR training pressures, access to appropriate BFR training technologies for relevant demographics based on the current evidence, a comprehensive and systematic approach to medical screening for safe practice and strategies to mitigate excessive perceptual demands of BFR training to foster long-term compliance. This manuscript attempts to discuss each of these barriers and provides evidence-based strategies and direction to guide clinical practice and future research.

A Useful Blood Flow Restriction Training Risk Stratification for Exercise and Rehabilitation

“…Unlike leisure time physical activity, BFRT likely needs some degree of supervision to minimize risk. Supervision by knowledgeable clinicians should theoretically reduce the occurrence of adverse events (e.g., numbness, nausea, hypertension, headache, venous thrombus, deterioration of ischemic heart disease, fainting, tingling, excessive pain, central retinal vein occlusion, and rhabdomyolysis) ( Nakajima et al, 2006 ; Ozawa et al, 2015 ; Yasuda et al, 2017 ; Patterson and Brandner, 2018 ; de Queiros et al, 2021 ) especially when performed under those who adequately screen out high risk patients and use recommended guidelines ( Patterson et al, 2019 ; Rolnick and Schoenfeld, 2020a , b ; Rolnick et al, 2021 ) to structure exercise programming.…”

“…Something important to address is that BFRT practitioners (e.g., physiotherapy, physical education teacher, or strength and conditioning coaches) are required to have a necessary physiological and pathoanatomical background knowledge on these conditions to apply the proposed risk stratification. Due to the judgment required and lack of any formal credentialing processes for those engaging in disseminating BFRT knowledge to clinicians and other providers, physician consultation may be necessary to clarify complex medical problems or their severity ( Rolnick et al, 2021 ).…”

“…As DM is associated with a prothrombotic state ( Paneni et al, 2013 ; Kaur et al, 2018 ), risk stratification for DVT ( Tables 2 , 3 ) in conjunction with the previous risk factors must be included ( Table 4 ). However, clinicians should use clinical judgment, knowledge of risk factors, and experience to provide protection to the patient along with consulting other clinician experts/physicians when unsure of risk ( Rolnick et al, 2021 ).…”

“…To avoid untoward outcomes and ensure that BFR exercise is properly used according to current best practice guidelines, efficacy endpoints such as a questionnaire for risk stratification involving a review of the patient’s medical history, signs, and symptoms indicative of underlying pathology is strongly advised. A recent review paper reported that a significant barrier to successful BFRT implementation includes difficulty with integrating a comprehensive and systematic medical screening process, and determining when it is best to include BFRT into a plan of care while considering relevant participant characteristics like pain, loading intolerances, clotting issues, hemodynamics, and recent physical activity history ( Rolnick et al, 2021 ). The proposed model aimed to improve the provision of best practice BFRT prescription for people across the health spectrum by utilizing a thorough screening process.…”

“…Evaluation of the individual patient for BFRT represents a potentially complex medical screening problem. A list of individual risk factors that are associated with adverse responses to BFRT has already been discussed and proposed elsewhere to aid in the screening process ( Nakajima et al, 2011 ; Kacin et al, 2015 ; Brandner et al, 2018 ; Bond et al, 2019 ; Rolnick et al, 2021 ). However, a considerable amount of information regarding their impact on health is scattered throughout the literature and not compiled in a BFR-specific resource.…”