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One of the most striking adaptations to exercise is the skeletal muscle hypertrophy that occurs in response to resistance exercise. A large body of work shows that a mammalian target of rapamycin complex 1 (mTORC1)-mediated increase of muscle protein synthesis is the key, but not sole, mechanism by which resistance exercise causes muscle hypertrophy. While much of the hypertrophy signaling cascade has been identified, the initiating, resistance exercise-induced and hypertrophy-stimulating stimuli have remained elusive. For the purpose of this review, we define an initiating, resistance exercise-induced and hypert…

BACKGROUND: The regional hypertrophy response of elbow flexor muscles was compared after unilateral elbow flexion training in extended versus flexed shoulder position under vascular occlusion, which can induce muscle hypertrophy in the absence of muscle damage-induced edema/swelling. HYPOTHESIS: Hypertrophy of elbow flexor muscles would be greater in extended compared with flexed shoulder position. STUDY DESIGN: Randomized within-subject trial. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 21 resistance-trained men (age, 25 ± 5 years; height, 1.78 ± 0.07 m; weight, 79.3 ± 13.1 kg) performed unilateral elbow fle…

Aim: Previous reports suggest that low-load muscle exercise performed under blood flow restriction (BFR) may lead to endurance adaptations. However, only few and conflicting results exist on the magnitude and timing of microvascular adaptations, overall indicating a lack of angiogenesis with BFR training. The present study, therefore, aimed to examine the effect of short-term high-frequency BFR training on human skeletal muscle vascularization. Methods: Participants completed 3 weeks of high-frequency (one to two daily sessions) training consisting of either BFR exercise [(BFRE) n = 10, 22.8 ± 2.3 years; 20% one-…

Low-load exercise performed to or near task failure appears to result in similar skeletal muscle adaptations as low-load exercise with the addition of blood flow restriction (BFR). However, there may be a point where the training load becomes too low to stimulate an anabolic response without BFR. This study examined skeletal muscle adaptions to very low-load resistance exercise with and without BFR. Changes in muscle thickness (MTH), strength, and endurance were examined following 8-weeks of training with a traditional high-load [70% 1RM,(7000)], low-load [15% 1RM,(1500)], low-load with moderate BFR [15%1RM + 40%…

We aimed to compare individual hypertrophic responses to high-load resistance training (HL-RT) or high-load with blood flow restriction (HL-BFR). Furthermore, we investigated whether greater responsiveness to one of the protocols could be explained by acute changes in blood deoxyhemoglobin concentration (HHb) and total hemoglobin concentration (tHb) (proxy markers of metabolic stress). Ten untrained participants had their legs randomized into both HL-RT and HL-BFR and underwent 10 weeks of training. Muscle cross-sectional area (mCSA) was measured at baseline and post training, while HHb and tHb during the final s…

Emerging evidence indicates that the use of low-load resistance training in combination with blood flow restriction (LL-BFR) can be an effective method to elicit increases in muscle size, with most research showing similar whole muscle development of the extremities compared to high-load (HL) training. It is conceivable that properties unique to LL-BFR such as greater ischemia, reperfusion, and metabolite accumulation may enhance the stress on type I fibers during training compared to the use of LLs without occlusion. Accordingly, the purpose of this paper was to systematically review the relevant literature on t…

BACKGROUND: Low-load resistance training (< 50% of one-repetition maximum [1RM]) associated with blood-flow restriction (BFR-RT) has been thought to promote increases in muscle strength and mass. However, it remains unclear if the magnitude of these adaptations is similar to conventional high-load resistance training (> 65% 1RM; HL-RT). OBJECTIVE: To compare the effects of HL- versus BFR-RT on muscle adaptations using a systematic review and meta-analysis procedure. METHODS: Studies were identified via electronic databases based on the following inclusion criteria: (a) pre- and post-training assessment of muscula…

Teixeira, EL, Ugrinowitsch, C, de Salles Painelli, V, Silva-Batista, C, Aihara, AY, Cardoso, FN, Roschel, H, and Tricoli, V. Blood flow restriction does not promote additional effects on muscle adaptations when combined with high-load resistance training regardless of blood flow restriction protocol. J Strength Cond Res 35(5): 1194-1200, 2021-The aim of this study was to investigate, during high-load resistance training (HL-RT), the effect of blood flow restriction (BFR) applied during rest intervals (BFR-I) and muscle contractions (BFR-C) compared with HL-RT alone (no BFR), on maximum voluntary isometric contrac…

CONTEXT: The perceived tightness scale is suggested to be an effective method for setting subocclusive pressures with practical blood flow restriction. However, the reliability of this scale is unknown and is important as the reliability will ultimately dictate the usefulness of this method. OBJECTIVE: To determine the reliability of the perceived tightness scale and investigate if the reliability differs by sex. DESIGN: Within-participant, repeated-measures. SETTING: University laboratory. PARTICIPANTS: Twenty-four participants (12 men and 12 women) were tested over 3 days. MAIN OUTCOME MEASURES: Arterial occlus…

BACKGROUND: The combination of low-load resistance training with blood flow restriction (BFR) has recently been shown to promote muscular adaptations in various populations. To date, however, evidence is sparse on how this training regimen influences muscle mass and strength in older adults. PURPOSE: The purpose of this systematic review and meta-analysis was to quantitatively identify the effects of low-load BFR (LL-BFR) training on muscle mass and strength in older individuals in comparison with conventional resistance training programmes. Additionally, the effectiveness of walking with and without BFR was asse…

To test the applicability of postexercise blood flow restriction (PEBFR) in practical training programmes, we investigated whether PEBFR enhances muscle hypertrophy induced by multiple-set high-load resistance exercise (RE). Seven men completed an eight-week RE programme for knee extensor muscles. Employing a within-subject design, one leg was subjected to RE + PEBFR, whereas contralateral leg to RE only. On each exercise session, participants performed three sets of unilateral knee extension exercise at approximately 70% of their one-repetition maximum for RE leg first, and then performed three sets for RE + PEB…

OBJECTIVE: To evaluate if a single blood flow restriction (BFR)-exercise bout would induce hypoalgaesia in patients with anterior knee pain (AKP) and allow painless application of therapeutic exercise. DESIGN: Cross-sectional repeated measures design. SETTING: Institutional out-patients physiotherapy clinic. PATIENTS: Convenience sample of 30 AKP patients. INTERVENTION: BFR was applied at 80% of complete vascular occlusion. Four sets of low-load open kinetic chain knee extensions were implemented using a pain monitoring model. MAIN OUTCOME MEASUREMENTS: Pain (0-10) was assessed immediately after BFR application a…

Blood flow restriction (BFR) training is a technique shown to be safe and effective at increasing muscular strength and endurance in healthy fitness populations and is under study for its use in postinjury rehabilitation. BFR stimulates muscular strength and hypertrophy gains at much lower loads than traditional methods, allowing patients to begin the rehabilitation process much sooner. We report on 2 patients who incorporated BFR training into their traditional rehabilitation program after Achilles tendon ruptures. Patient 1 was a 29-year-old active duty soldier who sustained a left Achilles tendon rupture while…

INTRODUCTION: We investigated differences in metabolic stress (lactate) and muscle activation (electromyography; EMG) when high-load resistance exercise (HL) is compared with a condition in which blood flow restriction (BFR) is applied during the exercise or during the rest interval. METHODS: Twelve participants performed HL with BFR during the intervals (BFR-I), during the set (BFR-S), and without BFR. Each condition consisted of 3 sets of 8 repetitions with knee extension at 70% of 1-repetition maximum. Lactate and root mean square (RMS) from the surface EMG of the vastus lateralis were calculated. RESULTS: Lac…

Metabolic stress is a physiological process that occurs during exercise in response to low energy that leads to metabolite accumulation [lactate, phosphate inorganic (Pi) and ions of hydrogen (H+)] in muscle cells. Traditional exercise protocol (i.e., Resistance training) has an important impact on the increase of metabolite accumulation, which influences hormonal release, hypoxia, reactive oxygen species (ROS) production and cell swelling. Changes in acute exercise routines, such as intensity, volume and rest between sets, are determinants for the magnitude of metabolic stress, furthermore, different types of tr…

BACKGROUND AND OBJECTIVE: Low-load exercise training with blood flow restriction (BFR) can increase muscle strength and may offer an effective clinical musculoskeletal (MSK) rehabilitation tool. The aim of this review was to systematically analyse the evidence regarding the effectiveness of this novel training modality in clinical MSK rehabilitation. DESIGN: This is a systematic review and meta-analysis of peer-reviewed literature examining BFR training in clinical MSK rehabilitation (Research Registry; researchregistry91). DATA SOURCES: A literature search was conducted across SPORTDiscus (EBSCO), PubMed and Sci…

PURPOSE: Applying blood flow restriction during low-load resistance training has been shown to augment muscle hypertrophy which has been attributed to metabolic accumulation. It remains unknown, however, whether metabolites can augment muscle growth when maintained post-exercise. METHODS: Thirteen untrained individuals (6 males and 7 females) performed 24 training sessions. The control arm performed one set of elbow flexion (70 % 1RM) to volitional fatigue, while the experimental arm performed the same protocol immediately followed by 3 min of blood flow restriction (70 % arterial occlusion). Muscle growth (ultra…

INTRODUCTION: The aim of this study was to investigate the acute and chronic skeletal muscle response to differing levels of blood flow restriction (BFR) pressure. METHODS: Fourteen participants completed elbow flexion exercise with pressures from 40% to 90% of arterial occlusion. Pre/post torque measurements and electromyographic (EMG) amplitude of each set were quantified for each condition. This was followed by a separate 8-week training study of the effect of high (90% arterial occlusion) and low (40% arterial occlusion) pressure on muscle size and function. RESULTS: For the acute study, decreases in torque w…

Blood flow restriction (BFR) alone or in combination with exercise has been shown to result in muscle hypertrophy and strength gain across a variety of populations. Although there are numerous studies in the literature showing beneficial muscular effects following the application of BFR, questions have been raised over whether BFR may lead to or even increase the incidence of muscle damage. The purpose of this review is to examine the proposed mechanisms behind muscle damage and critically review the available BFR literature. The available evidence does not support the hypothesis that BFR in combination with low-…

PURPOSE: The objective of this study is to evaluate the effects of blood flow restriction (BFR) on muscle oxygenation during low-intensity resistance exercise as well as postexercise expression of molecules related to physiological angiogenesis. METHODS: Using a randomized cross-over design, six apparently healthy young adults (22 ± 1 yr) performed 120 unilateral knee extensions at 40% of 1 repetition maximum with and without BFR (CNTRL). Near-infrared spectroscopy was used to measure oxygenation of the vastus lateralis during exercise. Serum and muscle expression of Post-Resistance vascular endothelial growth fa…

OBJECTIVE: Resistance exercise (RE) stimulates growth hormone (GH) secretion in a load-dependent manner, with heavier loads producing larger GH responses. However, new research demonstrates that low-load RE performed with blood flow restriction (BFR) produces potent GH responses that are similar to or exceed those produced following high-load RE. We hypothesized that low-load RE with vascular restriction would attenuate the known age-related reduction in GH response to RE. DESIGN: In a randomized crossover design, ten young (28 ± 7.8 years) and ten older (67.4 ± 4.6 years) men performed bilateral knee extension R…

Concurrent improvements in aerobic capacity and muscle hypertrophy in response to a single mode of training have not been reported. We examined the effects of low-intensity cycle exercise training with and without blood flow restriction (BFR) on muscle size and maximum oxygen uptake (VO2max). A group of 19 young men (mean age ± SD: 23.0 ± 1.7 years) were allocated randomly into either a BFR-training group (n=9, BFR-training) or a non-BFR control training group (n=10, CON-training), both of which trained 3 days/wk for 8 wk. Training intensity and duration were 40% of VO2max and 15 min for the BFR-training group an…

The loss of skeletal muscle mass during aging, sarcopenia, increases the risk for falls and dependence. Resistance exercise (RE) is an effective rehabilitation technique that can improve muscle mass and strength; however, older individuals are resistant to the stimulation of muscle protein synthesis (MPS) with traditional high-intensity RE. Recently, a novel rehabilitation exercise method, low-intensity RE, combined with blood flow restriction (BFR), has been shown to stimulate mammalian target of rapamycin complex 1 (mTORC1) signaling and MPS in young men. We hypothesized that low-intensity RE with BFR would be …

For nearly half a century, high mechanical loading and mechanotransduction pathways have guided exercise recommendations for inducing muscle hypertrophy. However, emerging research on low-intensity exercise with blood flow restriction challenges this paradigm. This article will describe the BFR exercise model and discuss its efficacy, potential mechanisms, and clinical viability.

The purpose of the present study was to compare the effects of short-term high-frequency failure vs non-failure blood flow-restricted resistance exercise (BFRRE) on changes in satellite cells (SCs), myonuclei, muscle size, and strength. Seventeen untrained men performed four sets of BFRRE to failure (Failure) with one leg and not to failure (Non-failure; 30-15-15-15 repetitions) with the other leg using knee-extensions at 20% of one repetition maximum (1RM). Fourteen sessions were distributed over two 5-day blocks, separated by a 10-day rest period. Muscle samples obtained before, at mid-training, and 10-day post…

Blood flow restriction (BFR) with low-load resistance exercise (RE) is often used as a surrogate to traditional high-load RE to stimulate muscular adaptations, such as hypertrophy and strength. However, it is not clear whether such adaptations are achieved through similar cellular and molecular processes. We compared changes in muscle function, morphology, and signaling pathways between these differing training protocols. Twenty-one males and females (means ± SD: 24.3 ± 3.1 yr) experienced with resistance training (4.9 ± 2.6 yr) performed 9 wk of resistance training (three times per week) with either high-loads (…

PURPOSE: Combining blood flow restriction (BFR) with exercise can stimulate skeletal muscle hypertrophy. Recent observations in an animal model suggest that BFR performed without exercise can also induce anabolic effects. We assessed the effect of BFR performed both with and without low-load resistance-type exercise (LLRE) on in vivo myofibrillar protein synthesis rates in young men. METHODS: Twenty healthy young men (age = 24 ± 1 yr, body mass index = 22.9 ± 0.6 kg·m) were randomly assigned to remain in resting condition (REST ± BFR; n = 10) or to perform LLRE (LLRE ± BFR at 20% one-repetition maximum; n = 10), …

The purpose of the present study was to investigate muscle hypertrophy, strength, and myonuclear and satellite cell (SC) responses to high-frequency blood flow-restricted resistance exercise (BFRRE). Thirteen individuals [24 ± 2 yr (mean ± SD), 9 men] completed two 5-day blocks of 7 BFRRE sessions, separated by a 10-day rest period. Four sets of unilateral knee extensions to voluntary failure at 20% of one repetition maximum (1RM) were conducted with partial blood flow restriction (90-100 mmHg). Muscle samples obtained before, during, 3 days, and 10 days after training were analyzed for muscle fiber area (MFA), m…

An inability to lift loads great enough to disrupt muscular blood flow may impair the ability to fatigue muscles, compromising the hypertrophic response. It is unknown what level of blood flow restriction (BFR) pressure, if any, is necessary to reach failure at very low-loads [i.e., 15% one-repetition maximum (1RM)]. The purpose of this study was to investigate muscular adaptations following resistance training with a very low-load alone (15/0), with moderate BFR (15/40), or with high BFR (15/80), and compare them to traditional high-load (70/0) resistance training. Using a within/between subject design, healthy …

Single-joint resistance training with blood flow restriction (BFR) results in significant increases in arm or leg muscle size and single-joint strength. However, the effect of multijoint BFR training on both blood flow restricted limb and non-restricted trunk muscles remain poorly understood. To examine the impact of BFR bench press training on hypertrophic response to non-restricted (chest) and restricted (upper-arm) muscles and multi-joint strength, 10 young men were randomly divided into either BFR training (BFR-T) or non-BFR training (CON-T) groups. They performed 30% of one repetition maximal (1-RM) bench pr…