• Blood Flow Restriction Training: The Next Generation of Anabolic Exercise

    Posted In: Training  /  Posted On: 06.23.12

    “God gave men both a penis and a brain, but unfortunately not enough blood supply to run both at the same time.”

    -Robin Wiliams

    We all know that blood is vital to support life and various other ‘systems’ as so eloquently stated by Mr. Williams.  Blood is responsible for the transport of oxygen, nutrients, and many other molecules crucial for sustained life.  Most bodybuilders will also tell you that blood is important for gaining muscle, blood flow to be more specific.  Not surprisingly, an entire category of supplements has emerged in the past decade, focused on increasing blood flow and thus purporting to enhance anabolism.  But what if I told you that the opposite may be true?  What would you say if I told you that occluding blood flow to muscles can have an anabolic effect?  You would probably tell me I’m not getting enough blood flow to my brain but you would be wrong.  Blood Flow Restriction (BFR) training has years of research to support its effectiveness and in this article I will explain what it is and how to use it to augment your training.

    What is Blood Flow Restriction Training?

    Quite simply, BFR training involved restricting the venous return of blood flow from the muscle.  The goal is not to restrict blood flow to the muscle, but instead prevent blood flow return from the muscle, i.e. you do NOT want to restrict the arterial blood flow to the muscle, only the venous return from the muscle, causing the blood to pool in the muscle.  This is accomplished by use of a blood pressure cuff or perhaps more practically using knee wraps tightly secured around the limb(s).   For example, to use BFR on arm muscles you would tightly secure a cuff or cloth knee wraps as close to the shoulder as possible.  This will restrict blood flow return from the arms and cause the blood to pool.

    What is so great about it?

    Blood Flow Restriction training when performed properly allows one to use much lower weights than normal training protocols and still achieve sizable anabolic training responses.  In fact, occlusion training can increase muscle size and strength using training loads as light as 20% of a 1 rep max (1)!  This is especially useful for individuals who individuals who are injured and can only use very light weights or for trainers who are undergoing a deload phase in their training cycle.  BFR training allows you to still make gains using light weights while giving your joints, ligaments, and tendons a break from heavy lifting.

    How does it work?

    BFR training induces an anabolic response through various pathways perhaps the most important of which is by preferentially targeting the large fast twitch muscle fibers.  Fast twitch fibers are the biggest muscle fibers and have the most potential for growth.  These fibers are recruited last during contractions and are mostly anaerobic (don’t use oxygen) whereas the smaller slow twitch fibers are recruited first during contractions and are aerobic (use oxygen).  Slow twitch fibers have a much smaller potential for growth compared to fast twitch fibers.  BFR training restricts blood flow to muscles, pre-fatiguing the slow twitch fibers and forcing the anaerobic fast twitch fibers to handle the load even at low intensities (2)!  Metabolically, your muscle is getting a similar effect to lifting heavy loads but using much lighter weights.  Not only does occlusion training preferentially activate fast twitch muscle fibers, it has been shown to cause a fiber type shift from slow to fast, thus increasing the potential for muscular growth and size (3)!

    Metabolic by-product accumulation is primary mechanism by which occlusion training produces hypertrophy.  These metabolic by-products would normally be ‘washed out’ by normal blood flow, but occlusion allows them to accumulate near the muscle.  Lactate accumulation in particular seems to have an effect, presumably by increasing growth hormone (GH) concentrations (4-5).  In fact, one study found that BFR training caused a GH increase 290 times above baseline (4)!    This is a twofold greater increase in GH than what is produced by normal heavy resistance training (6).

    If those reasons weren’t convincing enough to try occlusion training, consider that it has also been shown to increase muscle protein synthesis, mTOR signaling, and the expression of NOS-1 which has been shown to increase muscle growth through increased satellite cell activation (7-9).  Perhaps even more impressive, BFR training has been demonstrated to reduce myostatin concentrations (9)!    For those of you who have been living under a rock for the better part of the last decade, myostatin is a big time inhibitor of muscle growth and is thought to limit the muscle potential of muscle gain.  Perhaps occlusion training may be able to increase the overall potential of muscle gain through slow to fast fiber shifts and reductions in myostatin!

    So are you saying we should use Blood Flow Restriction Training instead of normal heavy training?

    BFR isn’t a replacement for heavy training, it is a supplement.  It is also very useful for people who can’t train heavy due to injury or deloading.  However, occlusion provides several long term benefits that regular heavy training doesn’t including slow to fast fiber transitions and a greater hormonal response.

    Practical application?

    Before proceeding further, please keep in mind that BFR training is very difficult even though the loads are very light.  It is easily the most painful form of training I have ever performed.  As always, before starting any kind of new training protocol, you should talk with a medical professional.  BFR can be performed for the thighs, calves, upper arms, and forearms using a blood pressure cuff or tightly wrapped knee wraps (more practical).  To occlude the thighs and upper arms, wrap at approximately 70% of maximum tightness around the uppermost part of the muscles.  To occlude the calves or forearms wrap at approximately 70% of maximum tightness just below the knee or elbow.

    Perform 3-5 sets to muscular failure with 20-50% of your 1 rep max on a given exercise with the muscle occluded the entire time.  Rest periods should be 30-60 seconds between sets.  After the final set remove the wraps and restore blood flow to the muscle.  A word of advice, be prepared for a lot of pain and if you do not find yourself in excruciating pain, the odds are the wraps are not tight enough.  Try blood flow restriction training and take your training to another hypertrophic dimension!

    References

    1)      Loenneke JP and Pujol TJ.  The Use of Occlusion Training to Produce Muscle Hypertrophy.  Strength & Conditioning Journal. 31(3): 77-84, June 2009.

    2)      Takarada Y, Takazawa H, Sato Y, Takebayashi S, Tanaka Y, and Ishii N.  Effects of resistance exercise combined with moderate vascular occlusion on muscle function in humans. J Appl Physiol 88: 2097–2106, 2000.

    3)      Kawada S and Ishii N.  Changes in skeletal muscle size, fiber-type composition and capillary supply after chronic venous occlusion in rats. Acta Physiol 192: 541–549, 2008.

    4)      Takarada Y, Nakamura Y, Aruga S, Onda T,Miyazaki S, and Ishii N.  Rapid increase in plasma growth hormone after low-intensity resistance exercise with vascular occlusion. J Appl Physiol 88: 61–65, 2000.

    5)      Takano H, Morita T, Iida H, Asada K, Kato M, Uno K, Hirose K, Matsumoto A, Takenaka K, Hirata Y, Eto F, Nagai R, Sato Y, and Nakaajima T. Hemodynamic and hormonal responses to a short-term low-intensity resistance exercise with the reduction of muscle blood flow.  Eur J Appl Physiol 95: 65–73, 2005.

    6)      Kraemer W, Marchitelli L, Gordon S, Harman E, Dziados J, Mello R, Frykman P, McCurry D, and Fleck S.  Hormonal and growth factor responses to heavy resistance exercise protocols. J Appl Physiol 69: 1442–1450, 1990.

    7)      Fujita S, Abe T, Drummond M, Cadenas J, Dreyer H, Sato Y, Volpi E, and Rasmussen B.  Blood flow restriction during low-intensity resistance exercise increases S6K1 phosphorylation and muscle protein synthesis. J Appl Physiol 103: 903–910, 2007.

    8)      Anderson J.  A role for nitric oxide in muscle repair: nitric oxide-mediated activation of muscle satellite cells. Mol Biol Cell 11: 1859–1874, 2000.

    9)      Kawada S and Ishii N.  Skeletal muscle hypertrophy after chronic restriction of venous blood flow in rats. Med Sci Sports Exerc 37: 1144–1150, 2005.

    • Kenny

      Hey Dr, Great article.. this is the first i am hearing about this concept and i am very interested. WHat types of wraps would you normally use .. do you use it for the whole workout , when deloading ?

      • http://www.biolayne.com Layne Norton

        i use it anytime including when deloading. Just regular knee wraps will work. Wrap at a 7/10 level of tightness

        • Kenny Croxdale

          Hi Layne,

          Personally, I’ve found Xertubes (rubber tubing) much easier to work with than knee wraps.

          Kenny Croxdale

    • http://YourWebsite... justin venes

      Hi Layne, great article. Would i do Occlusion training for my Biceps and or calves seperate to my normal training for those muscle groups, so on a seperate day and just hit them with the occlussion training and no other stimulation? Hope that makes sence, great new site too:) thanx for all your work and knowledge:))

      • http://www.biolayne.com Layne Norton

        you can put it with your normal training

    • jim wood

      Dara Torres made mention of using this recently in an interview I saw.

    • Steve

      Hi Layne, loving the new website. Curious as to what knee wraps you’re using for your occlusion training? Thanks.

      • http://www.biolayne.com Layne Norton

        just basic Sheik red line wraps you can get for like $12 at bodybuilding.com

    • http://www.facebook.com/profile.php?id=654105017 Jacob Allen

      Hey Layne, I’m curious if you’ve heard of blood-starving training? Essentially, you would train in a similar fashion to the video (excluding the wraps), but holding your arms above your head for 30 sec rest between sets. This seems like it would have the opposite effect of occlusion training; increasing venous return and inhibiting arterial blood flow. I’ve tried this a few times and it’s the fullest my arms have ever been. Does the body just over-compensate when the arms are brought back down? Just interested in hearing the physiology behind this if you happen to know.

      • http://www.biolayne.com Layne Norton

        that is not anything close to what blood flow restriction training is.

        • http://www.facebook.com/profile.php?id=654105017 Jacob Allen

          I wasn’t suggesting it is. When I said similar fashion I just meant you could do everything the same, but replace occlusion with blood-starving.

        • http://www.biolayne.com Layne Norton

          i’m saying the outcomes aren’t even close. BFR does not prevent delivery to muscle, the blood still goes to the muscle, what you are restricting is the venous return. So the blood pools in the muscle. What you are describing would be the exact opposite of BFR

        • http://www.facebook.com/profile.php?id=654105017 Jacob Allen

          I guess that’s what I was confused about, but I just did a terrible job in asking. Considering it’s the exact opposite, where does the idea come from that this would be potentially beneficial (not that it necessarily is). Anyway, it’s not that important. It’s just fun to do sometimes for the fullness =).

          This is where I got it from: http://www.gasparinutrition.com/TeamGaspari/ViewAthleteBlog.aspx?id=4791&postid=9868

        • http://www.biolayne.com Layne Norton

          I have no idea how the concept developed that it would be helpful

    • Stanzi

      Hello Layne. First day on the site. Really like it.
      I have a question on the BFR training. You said in your article that it restricts blood flow to aerobic muscles and makes the type 2 fibers do more of the work. That being said would this be a good thing to incorporate in a speed day (dynamic) because it will increase power? As an example on my squat day would it be good to wrap my legs and do a dynamic squat workout?
      And on another note I’m assuming the hypertrophy principles are the same with this as with FST type training. I gues that BFR is FST’s bigger meaner cousin?

      • http://www.biolayne.com Layne Norton

        no it’s not going to increase power, you are misinterpreting. It won’t make you more powerful, it just means that type II has to take over and since you have more pre-fatigued fibers you will be less powerful

    • http://www.exerciseequipmentfanatic.com michael h

      yikes, this sounds painful as all hell!

    • StanziBl

      Ok. Another question, when wrapping is a good way to judge tightness to wrap it really tight to obliterate the arterial pulse then loosen it enough to restore the pulse? Or would that be to loose still?

    • ChrisM

      Hi Layne,
      Was just doing some research on BFR and it simply amazes me how many positive studies are out there. The numbers the studies are coming up with are nothing to scoff at. It actually is astonishing that this type of training is not more prevalent in the BB community.

      It got me thinking about the best way to do this into a normal routine?

      I figured it would be best suited at the end of a workout as supplementary work given that after a standard workout I would already be fairly fatigued and trying to get any good rep/sets at a higher weight is easier said then done.
      This did raise another question though. Since we are in a sense trying to ‘trap’ all the nutrients and deprive oxygen to activate fast twitch muscle.

      Would it be more prudent to do this at the beginning of a workout to perhaps increase GH early in the workout and flush the muscles with blood?

      Not sure if any studies have been done in regards to using BFR before/after a normal workout rather then apart from and in comparison to and if it would be more favorable for hypertrophy.

      • http://www.biolayne.com Layne Norton

        GH release during a workout means nothing for anabolism. I would use it at the end of a workout so you still get maximal performance during your heavy compounds

    • ChrisM

      Thanks for the reply Layne it is much appreciated.

      Follow up question: Most of the studies are either short term or BFR is done apart from normal training. I cannot find any studies that compare high intensity training followed by BFR to high intensity alone. (adjusting for working load)

      Have you or anyone you know tried using this for longer durations in addition to normal intensity resistance training and was there any notable changes during that time or are there any studies I may have missed that address this?

    • Kyle

      Hey layne, just wondering if you think it’s practical to do rest pause sets with BFR? What I mean is to occlude both legs then do the 1st set with one leg then whilst you rest that leg do the 1st set with the other leg.

      Just because if you do one leg at a time you may not occlude them exactly the same and with both legs at once the stronger side can dominate an lead to imbalances.

      • http://www.biolayne.com Layne Norton

        and what makes you think occluding one at a time will automatically make them evenly occluded?

        • Kyle

          Not that it will evenly occlude them, you can go by feel. for example if you occlude both legs at once, you can feel if the wraps are the same on both but during the exercises the dominant leg may take more of the load. So still occlude them at the same time but just perform unilateral lifting, with something like rest pause. 

          Where as if you occlude one leg perform the sets and then occlude the other, it’s harder to feel if that wraps are equal because they are wrapped at different times. 

          Hope that makes sense…

    • dada

      hello layne! Can I use BFR protocol for leg press?

      • http://www.biolayne.com Layne Norton

        certainly

    • Kenny Croxdale

      Hi Layne,

      I have a question in regard to an LSU research study publised in the NSCA Research Journal by Travis Godawa.

      For those interested, this is the “Cliff Note” version of the NSCA research article. http://www.ergo-log.com/clothesmaketh.html

      Maximum Strength Occlusion Training

      LSU research revolved around using Powerlifting gear. The research demonstrated that FULL Arterial Blood Flow Restriction occured with the Squat Suit on and knees wrapped. (As a powerlifter, I know that feeling).

      NO Occlusion Training effect was produced with the Bench Press Shirt nor the Deadlift Suit. Neither restricted blood flow. I agree with that assessment.

      All the other research with Occlusion Training has revolved around Venous Blood Flow Restriction. As you noted in one of your articles 100-140 mm/hg is enough to restrict venous blood flow.

      It appear from information that I have gathered that approximate 180 mm/hg or higher restricts arterial blood flow.

      Powerlifting Training Protocol

      The LSU research stated that the standard Powerlfting sets, repetitions, and load percentages were utilized in their Occlusion Strength Training research.

      Question

      Would (in your opinion) Arterial Blood Flow Restriction elicit a greater increase in maximum strength?

      Thanks,

      Kenny Croxdale, CSCS

      • http://www.biolayne.com Layne Norton

        Kenny, I answered your email as well, but I’ll answer here for the benefit of others. I really have no idea. I think arterial occlusion might be dangerous over a long period of time but I’m certainly not an expert on the matter

    • Kenny Croxdale

      Hi Layne,

      I got your email. I really appreciate the rely.

      Leonneke

      As per your directions, I emailed Jeremy Leonneke.

      Here’s his response. “I personally do not feel that the benefit of wearing a powerlifting suit has anything to do with “blood flow restriction” and was more to do with the mechanical advantage the powerlifting suit gives you. I found the study interesting but I do not feel it is applying a stimulus similar to “blood flow restriction”.

      Godawa/LSU Research on “Powerlfting Aterial Blood Flow Occlusion Training”

      In my initial contact with Godawa, here’s part of his reply.

      “The lab at LSU (Louisiana State University) has done several studies and found that it does indeed produce greater gains in strength and muscle mass when compared to non-occluded training.”

      Tom Morris, MS, C.S.C.S.

      When ask, Tom (a friend of mine who applying moderate occlusion training) speculated the following.

      “I personally would venture to guess that the same mechanisms active in venous restriction/occlusion training are the same as with arterial restriction. In fact, I would guess that the anabolic environment created by cutting off arterial blood flow would multiply the effects of occlusion training in general and would be considered a higher intensity form of training than cutting off venous flow only.”

      My Perspective

      From using moderate Occlusion Training, I am a believer.

      In regard to LSU “Powerlifting Arterial Blood Flow Occlusion Training”, I’m still undecided on it. I continue to experiement with it.

      Long Term Arterial Blood Flow Occlusion Training

      LSU’s demonstrated that almost complete arterial blood flow restriction occured with the Squat Suit and Knees Wrapped.

      As a powerlifter who’s trained with the Suit/Wraps prior to a meet for decades, I never experience an side effects (other than minor brusing).

      None of the lifter I have been associated with have, either.

      Extrapolated Information

      Nothing was mentioned in the LSU article on long Arterial Blood Flow was restricted with a Suit/Wraps. (How many minutes complete occlusion occured).

      However, anecdotal information shows that arterial blood flow is restricted for perhaps two minutes during a powerlifting meet condition. Perhaps a little less in the gym.

      The two minute mark (my estimation) is about how long it takes from the time your “Suited up”, perform the lift and then drop the shoulder straps and take the knee wraps off.

      I don’t see much danger with health individuals with this form of “Aggressive Occlusion Training”. Powelifter who train with Suit/Wraps have trained this way for decades.

      Danger Zone

      As my former wife (Registered Nurse) told me in my discussion with her, complete arterial occlusion is akin to giving your muscles a heart attack. Not a great idea.

      Pain Threshold

      Due to the pain when squatting with a Suit/Wraps on, as you know, it is impossible to sustain that for more an about two minutes.

      The very first thing you do after your set of squats with the Suit/Wraps is get the wraps off and drop the shoulder straps.

      Doing so, allows arterial blood flow and takes you out of the unbearable pain zone.

      With that said, I am still not sure if the “Powerlifting Arterial Blood Flow Occlusion Method” produces an increase in maximum strength.

      Kenny Croxdale, C.S.C.S.

    • adrian danchez

      i got a question . if i want to do this for arms or legs how would i do it for both the bicep and tricep or quad and hamstring. would i do my 3 set for biceps then take off the wraps wait for a while and rewrap them and do 3 more for tris or would i do them back to back.

    • Timothy

      I was wondering when using BFR do you use it for each exercise of the training day or just 1?

    • http://www.facebook.com/profile.php?id=509782765 Nic Ellerby

      Are their risks to this technique?
      In particular it is known via Virchow’s triad that increasing stasis and turbulence which is effectively what you are doing with cutting off venous drainage by applying the band would this not increase the likelihood of Deep Vein Thrombosis formation and subsequently Pulmonary embolism?
      In addition to this is their not a risk of compartment syndrome?

    • Alan Fox

      Hi Layne, You are studding this with a light weight. what would be the diffrence if someone did it with a heaver weight?

    • Pamela

      Hi Layne,
      I have been following a lot of your articles & video logs & feel like they’ve gotten me on the right track.
      I really found this topic to be interesting. I was wondering if it could help to correct imbalances. My weak side has always been slightly lacking & I was wondering if by only wrapping the weak side & using 50% weight, 3 sets to failure (like you mention), I could see some increases?
      Thank you for your continued posts & videos, spreading your knowledge & debunking the countless myths out there.
      Pamela

    • Jake

      As someone previously mentioned in the comments, what are the chances of causing compartment syndrome with this?

    • http://www.facebook.com/profile.php?id=1218281960 Billy Perez

      Hi I would just like to say that a few things are missing from this article. Let me introduce myself first. My name is Guillermo Perez and I am a researcher at the University of Texas at Brownsville. Our Exercise Physiology department specializes in BFR with the use of the KAATSU master cuffs. The KAATSU master is able to inflate the restrictive cuffs to precise pressures. First off I wouldn’t really recommend going out and just getting wraps to perform this type of training. Why? Well there are very specific pressures, relative to each individual, that need to be applied in order to achieve results. Two pressure levels that need to be mentioned are the Initial Restrictive Pressure (IRP) and the Final Restrictive Pressure (FRP). IRP is the pressure applied to the circulatory path way when the cuffs are first placed on the individual. It has been found that if the IRP is less than 40 mmHg the desired results will not be obtained, also when IRP is too high (>65 mmHg) There may be to much restriction. FRP is now being set by measuring the circumference of your thigh and setting the pressure to <45–50 cm = 120 mmHg; 51–55 cm = 150 mmHg; 56–59 cm = 180 mmHg; and ≥60 cm = 210 mmHg. As you can see, it is impossible to get these values using simple wraps or even blood pressure cuffs. When using wraps, the individual might apply it too tightly and restrict arterial blood flow to the limb. On the other hand the individual may not set the wraps tight enough and fail to achieve results.

      I invite you to read the following article that will further highlight my discussion:

      Karabulut, Murat, and Guillermo E. Perez. "Neuromuscular Response to Varying Pressures Created by Tightness of Restriction Cuff." Journal of Electromyography and Kinesiology (2013)

      Loenneke, Jeremy P., Monica L. Kearney, Austin D. Thrower, Sean Collins, and Thomas J. Pujol. "The Acute Response of Practical Occlusion in the Knee Extensors." Journal of Strength and Conditioning Research 24.10 (2010): 2831-834.

    • http://www.bonytobombshell.com Shane

      Heard about this from Brad Schoenfeld and then Scott Tousignant. This article pretty much answered all of my question. I’m pretty stoked to give this a shot and see how it goes.

      Thank you Layne.

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    • Matthew Hulk Smash Eubanks

      I understand the BFR is great for those, like me, suffering from tendentious. But can the BFR technique be used for pecs? Ive seen web sites saying you can but i wanted to ask you Layne.My elbows hurt so bad during chest n tricep exercises. I’ve even had cortizone shots and even though they helped a little it isnt enough. Your thoughts?