Blood Flow Restriction Exercise Position Stand


If you didn’t catch it on our social media yesterday, an impactful piece on blood flow restriction exercise / rehabilitation was published Thursday in Frontiers in Physiology. We’ve been anxiously awaiting this piece as it will hopefully serve as a guidepost for clinicians and researchers alike as they apply BFR. The paper is open access, so you can follow the link within this blog if you’d like to read it; below we’ll summarize a bit, including the importance of individualized pressures for blood flow restriction exercises..

Initially the authors note that practitioners continue to use a wide range of pressures which has...

“resulted in unintended consequences such as a large incidence of numbness following BFR. Therefore, the aim of this position statement is to provide a current, research informed guide to BFR from a group of world leading experts in the field. It is envisaged that this will facilitate practitioners to be more informed and clearer in deciding the reasons why they should apply BFR, how they should apply BFR as well as understanding the safety issues associated with this BFR training.”

If there’s an overall theme to this piece that this statement foreshadows it’s that methods need to be a bit more individualized, particularly the pressure used, in order to allow effective use of BFR across a wide range of populations / conditions.

They note that with regard to strength, heavy lifting remains the ultimate goal of a training regimen, but that BFR with low load performs similarly with regard to hypertrophy. They suggest that blood flow restriction exercises are more effective than low load resistance exercise alone for strength / hypertrophy, and…

“can be used when heavy load resistance exercise (HL-RE) is not advisable (e.g., post-operative rehabilitation, cardiac rehabilitation, inflammatory diseases, and frail elderly). When considering muscle mass growth, both BFR-RE and HL-RE seem equally effective.”

They advocate for individualized pressures from 40-80% of LOP, and point out that higher pressures are associated with greater discomfort and augmented cardiovascular responses.

Regarding exercise programming they affirm that loads of 20-40% seem to be the sweet spot, and that if loads are lighter than that there is at least some preliminary indication that 80% or higher pressures may be indicated.

With low load exercise for strength and hypertrophy, volume remains king…

“Therefore, it is suggested 75 repetitions, across four sets (30, 15, 15, 15) is sufficient volume to lead to adaptations in most people. Working to failure is another possibility to induce adaptations but may not always be required.”

In order to elicit adaptation via exercise considered aerobic in nature, like pedaling a bike or walking on a treadmill, they note it’s difficult to claim a particular intensity, pressure, duration, frequency, or rest / exercise split is superior. It seems this may be the next frontier to be explored.

On that note, the other area of research they advocate for is elucidating the best strategies for combating disuse atrophy. This is great because it will give us a foundation from which to build strong, empirically based recommendations for pre-hab and acute post-op care, allowing us to demonstrate effectiveness and lobby for access for our patients.

They finish off the paper with a really thorough review of the various safety aspects of BFR which having a nice working knowledge of will help our conversations with referral sources who have concern over the modality. Please give the paper a read and shoot us any questions you may have!! 

Thanks for the write up Kyle Kimbrell, MPT.