Blood Flow Restriction article


(PJ) #1

Recently when I was looking for more research on blood flow restriction training, I found one I really wanted to read, but it was not available online. But there was an option to request it be made available, so I requested it.

Been awhile, forgot all about it. But today I got the notice that it had been made available as a PDF for download. So, fwiw, here it is.

Potential safety issues with blood flow restriction training
Article· Literature Review
Scandinavian Journal of Medicine and Science in Sports 21(4):510-8 · March 2011
DOI: 10.1111/j.1600-0838.2010.01290.x · Source: PubMed

Safetyreview.pdf (246.3 KB)

(Windmill Tilter) #2

This was an interesting article. Thanks for posting a copy.

I’m really fascinated by BFR training myself. I’m kind of amazed how much research there is out there. I wasn’t even aware it existed but there are hundreds of journal articles about it. Unless you’re an physiotherapist, recovering from joint surgery, or a professional athlete, pretty much nobody has heard of it.

Here is an position stand from the journal “Frontiers in Physiology” that was published in May 2019 so it encompasses all of the recent research. It’s published from a clinicians viewpoint, with respect to implementing BFR into clinical practice so there is a heavy emphasis on safety and medical conditions that present risk factors.

(Windmill Tilter) #3

The whole “blood flow restriction” thing sounds pretty nuts, but it’s not as bad as it sounds. I’ve really been enjoying it. It’s the perfect complement to Body by Science, because it causes muscle growth primarily through metabolic stress, and doesn’t impair recovery.

Dr. Mercola has really gotten into BFR training over the past couple of months. He’s put out a few articles and videos. He actually just published a pretty good e-book about it if anyone is interested.

Here is his video overview:

(Eric - The patient needs to be patient!) #4


I asked my physical therapist if they were considering it in her practice and she just acknowledged that she had heard about it and that it has value in rehabilitation therapy. She did not know much about it.

I search google for BFR in richmond va and got this right down the street from me:

I can’t go and I expect it is $$$$.

And they are doing research at the local VA hospital:

But Richmond is in some things behind the times.

(Bob M) #5

It seems kinda limited in use to me. For instance, I do pushups until I can’t do them anymore. I did 15 this morning. Then I put my feet on an incline and do more, then use a low incline and put my hands there and do more, then use a higher incline and do more. How do I restrict blood when doing these?

Also, the original article said you can’t make gains unless you lift at least 70% of your 1-rep maximum. If that’s the case, how do you explain all the people like say Ted Naiman who increased their muscle mass while doing body weight exercises? I assume when Ted does pushups, he’s not anywhere near his 1-rep maximum (if I can do 15 pushups and I’m still overweight, I’m sure Ted can do many more).

(PJ) #6

The research I skimmed indicated that what % of 1RPM is required depends on the degree of blood flow restriction.

(Windmill Tilter) #7

It is very limited use.

The use case is in circumstances where hypertrophy is desired, but muscle damage and heavy weights are not. It’s primarily used in physical therapy.

Consider an NFL lineman who typically does 1200lbs on the leg press. He gets ACL surgery mid-season. If he doesn’t lift weights, his muscle will rapidly atrophy, but his knee can’t take 1200lbs of mechanical tension. With BFR training, he can get the same hypertrophy lifting 240lbs, which his knee can handle.

The other place where it’s useful is when you want hypertrophy but you want to minimize muscle damage and central nervous system stress for recovery reasons. I’m not capable of doing two Body by Science sessions in a week, but I can easily do a BBS and a BFR session. I’ve tried doing conventional lifting in conjunction with BBS and that was a non-starter. I can’t even do a HIIT session midweek in conjuction with BBS without over-training/regressing. BFR works just fine though.

It’s not for everyone. Apart from physical therapy, it’s really only useful in conjunction with high intensity training . If your doing something relatively low intensity like Crossfit, Stronglifts 5x5, or p90-x, then it really isn’t useful.

(Windmill Tilter) #8

Come to think of it, another place where BFR training has value is for things like bodyweight training or dumbbell training at home. You can use very light weights and still get big hypertrophy like you do when training heavy at the gym.

Doing four sets of ~100 pushups to failure is not the same as doing four sets of ~12 pushups to failure from a hypertrophy perspective. BFR makes that possible.

(Eric - The patient needs to be patient!) #9

I’m doing BFR not for hypertrophy (muscle bulking) but for:

  • benefits from collateral metabolic pathway stimulation (beyond the arms)
  • vascularity improvements
  • BP reduction due to rto vascularity improvements
  • and hopefully heart remodeling through the vascularity improvements

My last angiogram (2012) showed some small artery blockage and remodeling around the blockage (as in new arteries). That was pre keto and pre-exercise as a near-daily modality. I’m hopeful that BBS and now BFR training will accelerate arterial remodeling.

I’m only doing arms 1/week and I am relying on the body by science (BBS) training for strength and bulk. Currently, I’m not doing legs for BFR because there is some indication that if you have varicose veins (I do, one leg) that is a contraindicated condition.

I’m using BFR restriction as an adjunct so if I can’t fit it in one week, no big deal. Worry-free BFR.

Note, I can see visible vascular improvements on my arms after 4 time doing BFR training. That is downright crazy.

(Justin Jordan) #10

As near as can be told, that’s not true.

The less complex version is that as long as you go to about failure, weight more or less doesn’t matter in regards to hypertrophy. Well, the bottom threshold is about 30% of your one rep max. Although going to failure with 30% of your one rep max is going to suuuuuck.

The higher end stuff, like 70% or 80%, is about whether you get full muscle fiber activation from the first rep. If you’re not training to failure, it becomes relevant.

In the case of Naiman, he both works to failure and he also increases the difficulty by making the leverages worse, so he’s kind of covering both ends.

(Bob M) #11

True, but how can you restrict blood to your chest? Seems a bit dangerous to me.

I personally see no value in this for my workouts, which are a mixture of body weight and machine training to failure. That is, I lift until I cannot lift anymore. I have a completely torn supraspinatus in my left shoulder and a completely torn but repaired supraspinatus in my right shoulder. I have a limited set of exercises I can do in the shoulder region. I cannot do overhead pressing, side laterals, even dips seem to negatively affect me.

This also causes an upper back issue, and weakness in my shoulders. So, squatting is out. Even dead lifts are sketchy.

Unlike most people, I don’t really want to gain that much muscle mass. Since I was a former pseudo-body builder, at one time I had tons more muscle mass than I have now. So, the issue is that I gain muscle too quickly and it outpaces the ability of my tendons and various injuries to compensate. My goal is to enjoy “lifting” while at the same time not reinjuring any of my many injuries. In short, I want to be healthy.

This type of BFR training really has no place for me, if I’m already exercising to failure. For young athletes who are recovering from injuries, maybe so. But for me, it’s not worth the time.

(Windmill Tilter) #12

You can’t, and you definitely shouldn’t try! It does appear that there is some carry-over effect to muscles not under restriction, in much the same way that doing only squats will still build your biceps.

I’m in my 40’s now, so looking like a body-builder isn’t my goal either. My main priority is maintaining strength as I age. I’m also still losing weight, and pretty much all weight loss entails lean mass loss. I want to minimize muscle loss in that process. Also, I do a lot of extended fasting, and resistance exercise is a simple way of minimizing muscle loss from this as well.

It’s definitely not for everybody, or even most people. It has it’s virtues and use cases though. Like @daddyoh mentioned, it apparently has some pretty positive side effects for blood pressure.

Same here. Apparently BFR promotes the growth of blood veins in the affected muscles. I believe it. I’m on my 4th week/session too and what I’m seeing hardly seems possible. :grinning:

(PJ) #13

I’m so fascinated, I want to make you all guinea pigs. :smiley:

My fat % is waaaaay too high to see muscle development, so even if I were to do this myself, I wouldn’t SEE it. But you guys apparently can.

Definitely this is only for the limbs, though I read that the shoulders seem to benefit even though they are ‘behind’ the BFR point.

The ref above to BFR of the chest made me laugh. It reminded me of the time when for medical reasons I had massive problems with my limbs abruptly falling asleep at different places. One day I had this terrifying idea: what happens if my HEAD falls asleep? ! :laughing: Not possible… well, you’d die. Somehow the idea had never crossed my mind before though.

Seems like just after BFR would be a great time to take some flush niacin. And whatever other supps you want in your blood since it’ll push them there.

(Justin Jordan) #14

I keep fighting back the urge to make a joke along the lines of “I keep trying to use BFR to build my neck and keep waking up at the hospital”


:joy: I’m sure that guy/gal exists :wink:

I dove right in and bought me a x-mas present - Body by Science and BFR bands. :slight_smile:

I will try the bands over the weekend and BBS stars sometime in February :slight_smile:

(Eric - The patient needs to be patient!) #16

I will have some advice for you BBS and BFR. at work now so I will send it later.

Also, @Don_Q (Nick) will likely as well.


Thanks, I can use all the advice :slight_smile:

(Eric - The patient needs to be patient!) #18

First I’m not an expert, just someone that is using BFR (just 4 times) and BBS (for many months).

I would perfect one approach before moving to the next. I don’t have BFR recommendations because I have just started other than read as much as you can and watch videos.

Note that with BFR your connective tissue does not get stronger. Only muscles. For both, there are metabolic improvements other than strength. So eventually you want to do BBS.

For BBS - read the Body by Science book. Act like your own trainer. In other words talk to yourself that you can do i more rep, and then 1 more.

If you are using a gym pick a time for BBS that you should usually not have to wait to circuit the eqpt. If a piece of eqpt is busy, move to your next exercise and then come back.

Use a stopwatch and get a note pad and pen. For each exercise track

  • date
  • weight
  • reps
  • time under tension (TUT)
  • notes (I sometimes shake like crazy when I’m on the last rep or two)
    There are videos with Dr McGuff on youtube that show technique and form. Watch them.

Go slow on the reps and don’t use momentum and speed. You want to enlist your muscle bundles in order with type I first and then to type IIa and then type IIb.

You can inroad and hold the last rep to add time under tension. I try to inroad up to 10 seconds. The last rep or two do not need to be 100% extended. In fact the reps should never be 100% but more like 80% so that you don’t lock your joints. Locking joints fails to use the muscles.

If I can only get 50% on the last rep I’m good.

recovery - with the date of each exercise you know how many days since the last. That is called the recovery period. Track your progress and see what recovery period works for you. I have found that 7 days is needed for my maximum recovery and gains.

Don’t do other resistance training in the recovery period. Apparently it will stop your progress. Also BFR does not appear to be a problem. But I’m waiting 3 days after BBS to do BFR so that my muscle protein synthesis is near complete.

I eat a protein meal post BBS workout. Typically 3 eggs or some ground beef 8oz. I also add collagen (15g) to my diet daily but I started that to help speed a tendon that needed to heal.

There are several of us doing BBS on this forum and at least to of us trying out BFR. So let us know how it progresses. I hope this helps.

(Joey) #19

Fascinating stuff. Thanks for sharing. Have downloaded and saved these sources for full digestion. And yes, BFR certainly sounds weird (at first) … but then again, so does keto :wink:

About 6 months ago I’d switched from my long-standing habit (25+ yrs) of running 2 miles daily (treadmill) to instead simply doing 10 minutes of elliptical machine on alternate days (i.e., 3x) weekly that included HIIT cardio (included within that 10 min window: three 20 second full-out bursts, which increases my heart rate to about 90-95% of my supposed max).

It saves me so much time with seemingly same results (unclear if this is objective or subjective?). All I know is that, as a geezer in my early 60s, I’ve never felt more strength and energy, so it’s clearly all working well together.

But more on point of this thread: Along with this switchover to HIIT cardio, I’d also embarked on a regular bodyweight regimen. Alternating each day: upper, lower, core (rinse/repeat). Saw meaningful change in muscle tone, all the while losing 20 lbs (which also had a lot to do with keto).

And now - most recently - I’ve stumbled across BBS and related books. I’ve also geeked out on the supporting journal article sources. Based on this info, I’ve begun transforming my daily bodyweight cycle into a more “fatigue-oriented” approach - cognizant of the benefits of muscle inroading - while still applying a separate day for each upper, lower and core routine for different days…

… But now I’m beginning to wonder how important it really is to allow for several days of NO exercise (whatsoever) to promote a whole-body system recovery.

For example, having exhausted the leg muscles to meaningful fatigue, does working on the arms (or core) the following day, or even 2 days later, really get in the way of full repair/recovery of those legs from yesterday or the day before? If so, is this the case when starting out on BBS-style workouts, or does the risk of over-training creep in after the newbie stage has been completed?

A lot to learn here - especially being new to much of this stuff. I was just a runner for decades. Did occasional lifting at home, but never with a serious focus before. So I’m experimenting as I go.

And so, BFR sounds fascinating - but more like something to stash away on the back burner until I get some of the basics figured out :man_shrugging:


I used the BFR bands for the first time the other day for biceps. Got a three day pump and “nice soreness” I hadn’t felt in many years. It definitely hit a different muscle fiber than my previous workouts did. I used to go heavy back in the day and it was a similar soreness that I used to get from intense heavy workouts. I’m always looking for “working out smarter” instead of longer techniques. My T levels are on the downfall due to age and I can’t mentally or physically take the daily workouts of years past.