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The efficacy of blood flow restricted exercise: A
systematic review & meta-analysis

Article · September 2015
DOI: 10.1016/j.jsams.2015.09.005

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A total of 916 hits were screened in order Keywords: based on title.4 cm2 . No.3 Adequate skeletal muscle is crucial to main. Exercise was separated into aerobic and resistance exer- Muscular hypertrophy cise. Disuse of skeletal muscle leads the blood flow to a muscle or muscle group is restricted or fully to relatively rapid and progressive atrophy.09. fiber shortening and reduced muscle compliance.F. occluded. with chronic disease. was pioneered by Yoshiaki Sato. Accepted 17 September 2015 Design: A systematic review.G Model JSAMS-1230. mal capacity) to stimulate significant muscular adaptations when strength. while BFR resistance exercise resulted in a mean improvement of 0. all a non-occluded exercising control group.e.jsams.005 . Please cite this article in press as: Slysz J. impaired immune strated a 14% increase in knee extensor strength of young subjects engaging in strength training at an intensity of 50% of 1 RM. persons taining the ability to undertake activities of daily living. The magnitude of observed changes are noteworthy. and fall avoidance. such as the elderly. decreases in oxida. there was a mean strength improvement of 0. Takarada et al. it is intriguing that several studies in recent years have trum.jsams. ing. A total of 377 participants were included in 19 studies measuring muscle size increase (cross sectional area) when exercise was combined with BFR.7 demon- of which result in a reduced exercise capacity. longevity. resulting in 47 articles that fit the review criteria.com/locate/jsams Review The efficacy of blood flow restricted exercise: A systematic review & meta-analysis Joshua Slysz.1016/j.doi. or rehabilitating and recovering athletes. power. J Sci Med Sport (2015).5 As such. As such.4 basal metabolic rate. Canada a r t i c l e i n f o a b s t r a c t Article history: Objectives: To systematically search and assess studies that have combined blood flow restriction (BFR) Received 19 March 2015 with exercise.3 kg. for health. Crown Copyright © 2015 Published by Elsevier Ltd on behalf of Sports Medicine Australia.09. Jack Stultz. Occlusion Ischemia Results: A total of 400 participants were included from 19 different studies measuring muscle strength Kaatsu increases when exercise is combined with BFR. although the effect sizes varied. et al. Available online xxx Methods: A computer assisted database search was conducted for articles investigating the effect of exer- cise combined with BFR on muscle hypertrophy and strength. Blood flow restricted (BFR) training. Jamie F. For example. caloric expenditure.doi. All rights reserved.4 N m between the Muscular strength experimental group and control group. particularly considering the relatively short duration of the average intervention. At the other end of the physical activity spec. abstract. and quality of life.2015.6 However. which accounts for approximately 80% of non-insulin etition maximum (1-RM) are typically recommended. high-intensity contributor to glycemic control acting as the body’s largest glucose resistance exercise with loads approximating 70–85% of one rep- sink by mass. of Japan in the 1970s and http://dx. skeletal muscle quantity and quality have a direct bearing suggested the potential for low load exercise (i. 1. and full article. The mean difference in muscle size between the experimental group and control group was 0. traindicated for certain individuals. of Pages 7 ARTICLE IN PRESS Journal of Science and Medicine in Sport xxx (2015) xxx–xxx Contents lists available at ScienceDirect Journal of Science and Medicine in Sport journal homepage: www. ∗ Corresponding author. All rights reserved.1016/j. Burr ∗ Human Performance and Health Research Laboratory. Burr).org/10. also known as Kaatsu train- E-mail address: burrj@uoguelph. The efficacy of blood flow restricted exercise: A systematic review & meta-analysis. Introduction system and decreased sensitivity to insulin. and somatotype.ca (J.1 Skeletal muscle is a major To enhance both muscle mass and strength. http://dx. and to perform meta-analysis of the reported results to quantify the effectiveness of BFR Received in revised form 27 August 2015 exercise on muscle strength and hypertrophy. while no change occurred using resistance training alone.005 1440-2440/Crown Copyright © 2015 Published by Elsevier Ltd on behalf of Sports Medicine Australia. ambulation. stimulated glucose uptake2 and also plays an important role in heavy-load resistance exercise is often challenging or even con- oxidizing fatty acids. This effect was consistent for both resistance training and aerobically-based exercise. Resulting from BFR aerobic exercise. <25% maxi- on sport performance.elsevier. comparing blood flow restricted exercise to tive capacity.org/10. University of Guelph.2015. Conclusion: Current evidence suggests that the addition of BFR to dynamic exercise training is effective for augmenting changes in both muscle strength and size. muscle strength and mass has important implications for both health and The maintenance of skeletal muscle mass is an important factor fitness.

Englewood. All other dynamic exercise training with high loads. Articles that reported their results as a percentage change BFR training methodologies are being employed and study designs or only in graphical form could not be included in the meta-analysis have differed. Methods calculated using Comprehensive Meta-Analysis software (V. introduced from the physiologic adaptation happening via the lung opment. methods of assess- ment. sample size. due to an inability to accurately calculate an effect size. commentaries. and ScienceDirect. to provide mechanical compres. sion of the underlying vasculature. hyperbaric chamber. of Pages 7 ARTICLE IN PRESS 2 J. hypoxic environment) were BFR alone has been shown to attenuate the disuse of atro. and (2) not greater and more current understanding of the effects of blood fully meeting our inclusion criteria (see above). (frequency. of effect size magnitude. Two of the authors aerobic training may become a method of training for the wider (JS and JS) independently screened articles based on the title and population. whereas studies that used resistance used are included as a supplemental file to this article (Table 1. the muscle by application of an external constricting device. ES were analyzed and appropriately A computer assisted database search was used. abstracts. The search was con. This resulted in 47 flow restriction on training outcomes such as muscle strength and articles that fit the inclusion criteria for the systematic review. intensity.005 . exercise quantified increases in strength using a measure of perfor- plemental material). time and type of exercise). Please cite this article in press as: Slysz J.doi. however..G Model JSAMS-1230. CAB abstracts.0. BFR must be reduced partial pressure of O2 were excluded due to variability combined with an exercise stimulus for enhanced muscular devel. Exercise was represented by both aer- Search words included variations on words that were related to obic and resistance modalities. magazine articles. post data included means. however there relevance was unclear from this information.10 however.e. research design. intervention. studies that the restriction of blood flow to skeletal muscle. This in turn will lead to the formulation remaining articles were assessed for methodological quality using of novel research questions and advance training methods for per. SD. the evidence has not been systematically third authour’s judgment was used as the sway vote. Databases and Tweedie. Articles retrieved were examined for further mance (i. No modality of exercise was excluded but were classi. year exercise on muscle strength and hypertrophy (3) identify which of publication. Medline.11 The development of muscle size and strength using BFR. Furthermore. The efficacy of blood flow restricted exercise: A systematic review & meta-analysis. groups and post data only. CINAHL. At present. and the data is thus presented below BFR intervention combined with an exercise stimulus and com. The ies that have combined blood flow restriction with exercise (2) process of article retrieval is outlined in Fig. / Journal of Science and Medicine in Sport xxx (2015) xxx–xxx 1980s.09. There were 26 male only studies. Sup.e. J Sci Med Sport (2015). Arti- blood pressure cuff or tourniquet.1016/j. BFR is applied with the intent reports. abstract of each and the full article was retrieved for review when There is a previous review12 concerning BFR. the Downs and Black checklist (1998)13 (Table 2. The authors believe that the specificity and BFR. For these reasons. rele- culature distal the tourniquet. a mean difference for mixed modality training proto- language scientific journals. not related provide the most substantial muscular gains when combined with to a localized stimulus.2. even though strength A total of 916 hits across all databases were saved in a ref- and hypertrophy do not typically occur from aerobic mode of erence management software program wherein exact duplicates exercise. The search terms using Newton meters (N m).14 ES calculations were performed using unmatched searched included: PubMed. cle exclusion criteria included published supplements. A total of our objectives were: (1) to systematically identify and assess stud. http://dx. and physiological results. objectives. Therefore. were removed. book chapters. 1. considered separately for both practical and theoretical reasons. A level of significance of p = 0. improvements in muscular size and strength. Inc.9 mechanisms (e. excluded. such as a authors believe this is a necessary division for interpretation. The 47 studies identified that fit the inclusion criteria for the fied as either an aerobic or resistance modality. which were captured then culled were (1) meta-analysis of the BFR exercise training literature is needed for improper controls or randomization to assess efficacy. Only studies using mechanical blood flow restriction exercise). As such. Supplemental sons in both health and disease. At least one of two outcomes must have been consid- ered: muscle strength or muscle size.6 Although there have been isolated vant peripheral literature was collected and reference lists were reports of adverse events (as would be expected with any form of searched.g. reviews.05 was selected a pri- ducted to find studies investigating the effect of exercise combined ori and the scale proposed by Rhea15 was used for interpretation with BFR training on muscle hypertrophy and muscular strength. Any investigation that focused on a cols could not be calculated. Slysz et al. Descriptive statistics for each study and effect sizes (ES) were 2.jsams.8 This training method involves decreasing blood flow to a modalities (from both a clinical and performance standpoint). on the whole there is little published evidence to suggest through external applied pressure on the proximal point of a limb that this type of training offers any greater health risk than typical (i. sample size. several investigations have reported that utility of the results for assessing BFR training are improved by the low-intensity aerobic exercise combined with BFR can facilitate exclusion of such studies. Results adult (>18 yr) human participants in ostensibly good health were included. NJ). blood pressure cuff or tourniquet) were included. separately. In the event of a dis- has since been a fast growing evidence-base for BFR exercise agreement as to article’s relevance by the primary reviewers the training. targeting all adjusted for potential sample bias using the methodology of Duval articles published prior to the last week in June 2015. and possible effects caused by BFR.org/10. No. PSYCHinfo. making direct comparison challenging. Almost uniformly. exercise modalities were relevant references. health status). and SPORT Discus. Mechanisms employing altered atmospheric pressure or phy during periods of immobilization. FITT hypertrophy outcomes. The reason reviewed. case studies and presentations. an up to date systematic review and for removal of studies. types of exercise tested aerobic exercise quantified BFR related increases in strength used with BFR. a variety of different material). sex.2015. The exercise stimulus of resistance exercise appears to or other components of the cardiorespiratory system. including the frail and elderly. participant character- BFR training methods result in the greatest strength and muscle istics (age. leaving a total of 820 articles. All included articles were published in peer-reviewed English Similarly. et al. pared to a matched exercise exposure without BFR was eligible for inclusion. opinion articles. weight lifted in kg). 28 studies met the full inclusion criteria for the meta-analysis. Yet interestingly. to promote blood pooling in the capillary beds of the limb mus. Only studies using human 3. Given the evidence systematic review included all healthy participants that had a relating to the differing physiological effects elicited by these two mean age of 34 ± 18 yrs (18–70). to perform a meta-analysis to quantify the effectiveness of BFR The extracted data included study identifying information. Biostat. All hypertrophic adaptations.

training variables within aerobic-BFR training. 2.2 kg versus 0. 0.3 kg [95% CI: 0. Only a minor variation was apparent in the mean dif- Amongst the total of 72 subjects representing 4 independent ference in gains comparing the experimental and control group studies (14 cases) that considered strength changes resulting from considering 2 day versus 3 day/week training.jsams.04] (Fig.2 [95% CI: −0. sure of ≥150 mmHg caused an increase in strength comparing the Please cite this article in press as: Slysz J. 0.doi. Flowchart demonstrating the step-by-step process of article elimination to find the final articles to be included in the systematic review.4]. Typically. Training pro- control group more than training less than 6 week. 0.G Model JSAMS-1230. and 14 studies that included both male and respectively (p < 0. when aer.4 N m [95% CI: 0. Gains the experimental group above changes in the control group was in muscle strength were significantly greater when the intensity 0.4 kg [95% CI: −0. http://dx.6 N m [95% CI: grams of greater than 8 wk were approximately 60% as effective as 0. et al. 0. p = 0.1. Muscular strength jects.2].1016/j. training at 30% 1 RM resulted in a much ference in muscle strength between the experimental group and greater improvement in muscle strength (p < 0. / Journal of Science and Medicine in Sport xxx (2015) xxx–xxx 3 916 total database results Duplicates Removed 820 total database results Titles and Abstracts Read 42 relevant tles and abstracts 21 relevant tles and abstracts from manual reference searches 67 arcles examined full text Full Arcles Read 47 arcles included in review 19 arcles culled due to inability to be included in Meta-Analysis 28 studies included in Meta-Analysis Fig. was greater than 70 m/min compared to an intensity of less then practical significance may be of more questionable value.01] considering exercise combined with blood flow restriction. but it should be The mean increase in muscle strength between the experimental noted that the mean difference between the experimental and con- group and the control group was larger when walking intensity trol group were relatively small and despite statistical significance. 0.9] versus 0. Impor- obic training was combined with BFR. at 20% 1 RM and 30% 1 RM. −0.3 kg. respectively (p = 0.5. No. 1.9 N m [95% CI: 1. 0.org/10.3] versus −0.4. the mean improvement in strength gains of 1. (Fig. The efficacy of blood flow restricted exercise: A systematic review & meta-analysis. 1.01. p < 0. of the workout was >20% 1 RM versus < 20% 1 RM or lower.3 kg [95% CI: 0. There was inadequate data to analyze other female.2]. of Pages 7 ARTICLE IN PRESS J.2.5.2 N m [95% CI: −0.05). 2A).1. J Sci Med Sport (2015).05).001).6. 2B). when comparing gains in muscle strength between training 5–8 N m. 7 female only studies.2015.001). 0. There were 15 studies (27 cases) with a total of 328 sub- 3.1.4. p = 0.5.03). those less than 8 wk (0.09. Slysz et al. and these revealed a mean augmentation A total of 400 participants were included from 19 different of muscle strength gains between the experimental group and studies (41 cases) measuring muscular strength increases and control group of an additional 0. respectively (p > 0.005 . that considered strength changes resulting from BFR resistance exercise. muscle strength increased tantly. Training more than 6 weeks increased the mean dif. BFR aerobic exercise.0] versus 0. Cuff pres- 70 m/min.

005 .00 -2. This highlights training muscle size between the experimental group and control the need for further work in this area to clarify the dose–response group of 0. how- insufficient studies to analyze further dose–response training vari.11. frequency.2. 3. 0.1. baseline strength and muscular size that lack a suffi- blood flow restriction.34. Slysz et al.2 cm2 (95% CI: −0. cient evidence base to be included in meta-analysis. mental group and the control group was 0.00 Favours A Favours B Meta Analysis A B Fig.1 kg measuring CSA increase when resistance exercise was combined [95% CI: −0.1016/j.G Model JSAMS-1230. ever.12.00 Abe 2005 a Abe 2005 b Favours A Favours B Yusada 2011 Patterson 2011 Fahs 2014 Luebbers 2014 Meta Analysis Luebbers 2014a Vechin 2015 -4.03.org/10.36 cm2 [95% CI: 0. 3B) greater than that seen in the control groups.5] versus 0. 0. when combined with BFR pro- ence (p < 0. Aerobic training had a mean increase of post. sex.34 cm2 [95% CI: 0.05). / Journal of Science and Medicine in Sport xxx (2015) xxx–xxx Study name Std diff in means and 95% CI Study name Std diff in means and 95% CI Madarame 2008 a Takashi 2010 a Madarame 2008 b Takashi 2010 b Laurentino 2001 a Hernendez 2013 b Takashi 2010 c Weatherholt 2013 a Takashi 2010 d Weatherholt 2013 b Takashi 2010 e Yamanaka 2012 a Takashi 2010 f Yamanaka 2012 b Ozaki 2010 a Moore 2004 Ozaki 2010 b Yusada 2005 Thiebaud 2013 a Ozaki 2010 c Thiebaud 2013 b Ozaki 2010 d Thiebaud 2013 c Ozaki 2011 a Thiebaud 2013 d Ozaki 2011 b Thiebaud 2013 e Abe 2009 a Thiebaud 2013 f Thiebaud 2013 g Abe 2009 b Thiebaud 2013 h Fujita 2008 -4. compared to training programs 8 weeks expected to cause considerable increases in muscular quantity or or less that only caused a 0. when undergoing aerobic exercise (A) and resistance exercise (B).2 kg [95% CI: −0. p = 0. the results of this analysis give insight into variables and ables within aerobic-BFR training. aerobic exercise (<70 m/min walk training).4].031 0. which would not be imental and control group.32 cm2 p = 0.doi. respectively (p > 0.964] size increase between exper. No.09. 0. fitness level. strength increase produced by various training variables including 56] versus 0.00 2. methodological considerations that could be important to consider Please cite this article in press as: Slysz J. At present.jsams. 0.001). 2. 0. This analysis offers a quantified description of the week compared to a training 2 days a week. 0. experimental group and control group than when the cuff pressure A total of 246 participants were included in 12 studies (29 cases) was lower than 150 mmHg.41 cm2 . Forrest plot displaying the difference in muscle strength between the experimental group and control group for each individual case. There were relationship of this perturbation of typical exercise training.2015. et al. volume. and cuff pressure.05).16. Muscular hypertrophy A total of 377 participants were included in 19 studies (40 cases) 4. The in both muscle strength and size.001 [95% CI: 0.61] (Fig. 0. Importantly.46.29 cm2 [95% CI: 0. both resistance-training exercises and aerobically based exercise. p < 0. intensity. Muscle size differences between the experimental duced an exaggerated response for maximizing muscle strength group and control group did vary when training took place 3 days a and hypertrophy. of Pages 7 ARTICLE IN PRESS 4 J. http://dx. This effect was true for mean increase in post-training muscle size between the experi. Training programs that were 8 weeks or longer gests that low load resistance exercise (20–30% 1 RM) and low load caused a 0. quality under normal circumstances. respectively (p > 0.37) size differ. there A total of 131 participants were included in 7 studies (11 cases) remain a number of further variables such as age.00 -2.00 4. the change in muscle size ranged from an dynamic exercise training is effective for augmenting changes increase of 2–5 cm2 when exercise was combined with BFR.7 cm2 [95% CI: 0.00 2.10.001]. although the degree of increase varied. research sug- 0. The efficacy of blood flow restricted exercise: A systematic review & meta-analysis. The mean increase in muscle size as a result of BFR training was 0.55].03 [95% CI: 0. J Sci Med Sport (2015).2.58] (Fig.00 0. measuring CSA increase when aerobic exercise is combined with training status. Most often. Discussion measuring muscle size increase (cross sectional area (CSA)) consid- ering both modalities of exercise when combined with blood flow Current research suggests that the addition of BFR to low load restriction. with blood flow restriction.00 4. 0.00 0. 3A).

No. The efficacy of blood flow restricted exercise: A systematic review & meta-analysis. It is entirely the identification and analysis of these variables is based on limited possible that efficacy may change further using higher intensities.00 -2. Nonetheless. and were unable to calculate an “overall” effect for exercise irrespective different types of cuffs and limb circumferences occlude arterial of the stimulus. it seems acceptable to conclude that.16 Therefore. blood flow at much different inflation pressures.00 0. 3. Furthermore. in future research design. http://dx. muscle strength does not significantly increase 4.00 O'Halloran 2014 O'Halloran 2014a Favours A Favours B Luebbers 2014 Luebbers 2014a Luebbers 2014b Vechin 2015 Yauda 2014 Meta Analysis Yasuda 2014a Yasuda 2014b Yasuda 2014c -4.G Model JSAMS-1230. training durations >6 weeks produced greater strength resent important information when selecting application methods increases compared to training <6 weeks. of Pages 7 ARTICLE IN PRESS J. who have suggested that with BFR training. resistance training. From our analysis. there ities revealed a positive mean difference between the experimental is a need for more investigation into a model that will result in equal and control group. it is important to highlight that Overall. We do not believe the above cut-points to of the unit of measure. BFR training trended toward greater efficacy for increasing muscle strength when cuff pressure >150 mmHg. but 4.00 0. et al. It has been found that there is strength between aerobic and resistance modalities of exercise. Within the literature there are many different Owing to a methodological difference in the reporting of units of cuff pressures used for BFR training. the evidence suggests that resistance resistance training. which would not be sure >150 mmHg appeared more effective at increasing muscle size Please cite this article in press as: Slysz J. greater strength gains may be expected when training causes greater increases in muscle size than aerobic train- employing intensities ≥20% 1 RM. since both aerobic and resistance modal. using specific equipment. we no single pressure that produces equal BFR between subjects. the authors highlight that expected to illicit adaptation in the absence of BFR.1.1016/j. regardless occlusion for all subjects. but at present this remains caution. albeit at a increased muscular work performed by a given muscle group in greatly reduced percentage of 1 RM. but rather these apparent divides in mean increase.2015. However. Such an effect mirrors what ing. a cuff pres- training employed these very low intensities. This difference is likely related to the purposeful isolation and would be expected for traditional resistance training. cacy with higher loads. could be performed between variables. The current evidence base suggests that as a result of BFR Perhaps not surprisingly.00 4. when undergoing aerobic exercise (A) resistance exercise (B). This is in agreement with to use with BFR training. and the work of Loenneke et al. research. this may rep- cise.09. however. the generally accepted adaptation period for standard resistance training. Muscular strength the 95% confidence interval crosses zero thus this should be inter- preted cautiously.00 2. J Sci Med Sport (2015). In agreement with muscle strength.12 .00 2. common methodologies were the only points at which an analysis Our analysis suggests that when performing BFR aerobic exer.2.jsams.org/10. Forrest plot displaying the difference in muscle size between the experimental group and control group for each individual case.doi. Despite a greater overall effi. speculation.00 Favours A Favours B Meta Analysis A B Fig. overall muscle strength would also have a represent hard-fast thresholds. Slysz et al. Muscular hypertrophy until the 10th week.00 -2. / Journal of Science and Medicine in Sport xxx (2015) xxx–xxx 5 Study name Std diff in means and 95% CI Study name Std diff in means and 95% CI Madarame 2008 Madarame 2008a Takashi 2010 Laurentino 2008 Takashi 2010 a Laurentino 2008a Weather 2013 Takashi 2005 Thiebaud 2012 Takashi 2005 a Thiebaud 2012a Ozaki 2010 Thiebaud 2012b Thiebaud 2012c Ozaki 2010 a Thiebaud 2012d Nygren 1999 Thiebaud 2012e Thiebaud 2012f Nygren 1999 a Thiebaud 2012g Sakamaki 2011 Thiebaud 2012h Ozaki 2011 Fujita 2008 Abe 2005 Abe 2009 Yusada 2011 Yusada 2011a Fahs 2014 -4. and should be interpreted with or that risk may appreciably increase.00 4.005 . ≥8 wk of training has a greater effect on muscle size measurable effects were still consistently observed even when than training <8 wk.

Abe T. from clinical to human performance applications. Effects of strength training and vascular occlusion. / Journal of Science and Medicine in Sport xxx (2015) xxx–xxx than pressures <150 mmHg. Guillet C. the ing with blood flow restriction in the elderly. resistance and aerobic exercise. There were insufficient Supplementary data associated with this article can be found. This systematic review provides meta-analytic evidence of 2.G Model JSAMS-1230. Int J Sports Med 2008. Fatty acid oxidation in human skeletal muscle. Conclusion 1. Burr is supported by an NSERC Discovery Grant (03974). Given that 3. Costa PB et al. muscular adaptation regardless of vascular occlusion. Effects of resistance exercise combined ing may offer benefit to those recovering from orthopaedic or other with moderate vascular occlusion on muscular function in humans. Skeletal muscle size and circulating IGF-1 are increased after two weeks of twice daily “KAATSU” resistance training. Ishii N. between variables. Mattocks KT.2015. Thiebaud RS et al. Acknowledgments 26.1016/j. Int J KAATSU Train Res 2005. Front believe these cut-points represent hard-fast thresholds. Improving strength and power in trained ath- letes with 3 weeks of occlusion training. 395–399. Fahs CA. Please cite this article in press as: Slysz J. Ugrinowitsch C. http://dx. Boirie Y. thus. of Pages 7 ARTICLE IN PRESS 6 J. regarding optimal training methods should be interpreted with the 11. Eur J Appl Physiol 2012. training at 20% 1 RM). Loenneke JP. 4(1):1–8. Sakamaki M. Low load train. Duval S. tendinous. Am J Prev Med 2003. compared with low load exercise alone. ing loads on the associated tissues including muscular.org/10. Abe T. at 20. in studies to further breakdown and analyze the training variables of the online version. Prevention of disuse muscular weakness and bony. Muscle performance. Jeong J et al. this investigation has established a path for future research and highlights important areas of concentration. tissues including muscular. but 23. Clin Physiol Funct Imaging 2015. Fahs CA. Midorikawa T et al. adaptation may still be associated with intensity (i. 52(6):377. Determining the magnitude of treatment effects in strength train- apparent divides in common methodologies of the literature and ing research through the use of the effect size. Sakuraba K. 15. We do not 16. Progression models in resis- training offers potential benefits to various practitioners ranging tance training for healthy adults. American College of Sports Medicine Position Stand. The history and future of KAATSU training. Eur J Appl • Current evidence suggests that within the range of low load stim. The benefits of strength training for older adults. tendinous 10.1016/j. training is contraindicated. Supplementary data mization of cuff pressure and the relationship with other training variables (and safety) is again suggested.doi. connective. Trim and fill: a simple funnel-plot-based method of testing optimization can be made. • These results suggest lighter load BFR training to stimulate 18. 6. Blood flow restriction pressure recommendations: a tale of two cuffs. Sawaki K et al. ulus. Sato Y. 100(5):1460–1466. J Strength Cond Res 2004. more targeted studies health care interventions. Barcelos LC. Yasuda T. No. 1(1):24–28. at doi:10. Potential safety issues with blood flow restriction training. is convincing verification that BFR con. a meta-analysis. the practitioner working with 1(1):1–5. restricted leg blood flow on muscle strength and aerobic capacity in older adults. Laurentino G. J Strength Cond Res 2013. 36(5): authors have no other funding or conflict of interest to declare. Effect of concurrent train- J. Abe T. 117:1–10. Med Sci Sports Exerc 2008. Circuit training without external load induces hypertrophy in lower-limb muscles when combined with moderate venous occlusion. evidence showing alterations in strength and hypertrophy with 27(11):3091. 34(5):356–363. 56(2):455. Brechue WF. Wilson GJ et al. Physiol 2015. Wilson J. Int J KAATSU Train Res 2005. 4:1–3. 88(6):2097–2106 (1985). Wilson JM. Fujita S et al. Sato Y et al. Marín P et al. Thiebaud D. the accumulated ized. athletes may find application in progressing strength while reduc. Clin Physiol Funct Imaging for whom training with higher loads is contraindicated. were the only cut-points at which an analysis could be performed 18(4):918–920. Sato Y. Loenneke J. Takazawa H.e. strength and hypertrophy ranges from 45 to 60% 1 RM in untrained 4. placebo-controlled clinical trial. Herda AA. and glucose storage in man. Perceptual effects and efficacy of intermittent or continuous blood flow restriction resistance training. Blood flow restricted and traditional resistance strength adaptation. orthopaedic or other conditions requiring rehabilitative care. Kearns CF. Aihara AY et al. Scand J Med • BFR training has a potential benefit to those recovering from Sci Sports 2015. 13.doi. J Clin Invest 2002.09. Jensen MD. Low intensity blood flow restriction training: systematic reviewing process is the ability to highlight knowl. 33(1):34–40. 9. the training intensity typically required to maximize increases in 110(11):1607–1609. 27. training durations >6 weeks seem to offer greater returns in 22. size. de Souza et al. 41(3):687–708. 5S20-5S26. DeFronzo RA et al. Tweedie R. The effect of graded doses of insulin on greater increases in muscle size and strength when exercise is com. 1(0)). Abe T. 25. Int J KAATSU Train Res 2005. Med Sci Sports Exerc 2009. glucose oxidation. which we offer as a starting point. et al.09.2015. 35(3):167–176. Increased muscle volume and strength fol- seek to progress strength while reducing loads on the associated lowing six days of low-intensity resistance training with restricted muscle blood flow. Rossow LM. Similarly. Low-load resistance training promotes may be inappropriate or unattainable. Kubota A. 25(3):141–149. safety responses after eight weeks of resistance training and protein supplementation: a random- individuals. Loenneke JP. Libardi CA. Effects of low-intensity walk training with increases in muscle size and strength effects may be effective. Scand J Med Sci Sports 2011. Cook CJ. J Appl Physiol 2000. Downs SH. Odagiri K et al. however. kaatsu-walk understanding that few studies have specifically sought to deter- training. the above cut-points chosen were and adjusting for publication bias in meta-analysis. but further investigation into the opti. Fujita T. A strength of the 12. Practical implications 17. Bemben MG. Muscle size and strength are increased following walk training with restricted venous blood flow from the leg muscle. Int J Sports Physiol Perform 2014. Bjerg K et al. Nelson ME. Muscular adaptations to fatiguing exer- • Quantifiable muscular adaptations present quickly. however. Kurita K et al. Seguin R. 1(1):6–12. and could potentially be used when traditional high-load training J Geriatr Phys Ther 2010. 31(11):957. or 80–85% 1 RM in trained athletes. at present. 112(5):1849–1859. Takarada Y. 30% 1 RM could offer much more strength gaining benefit than 9(1):166–172. double-blinded. Appendix A. References 5. 40(3):529–534. mine these factors as targeted study outcomes. 31(Suppl. Chacon-Mikahil MP. Rhea MR. The efficacy of blood flow restricted exercise: A systematic review & meta-analysis. low loads (20–50% 1 RM). Black N. Madarame H. Nunes PRP. Finally. Kistler B. 2014. J Sci Med Sport (2015). This type of mass loss? Diabetes Metab 2005. Thiebaud RS. • BFR training has applicability to a range of populations who may 24. 5. Further reading 6. Farup J. J Epidemiol Community Health 1998. Jacot E. cise with and without blood flow restriction. and bony. or volume.12396 [Epub ahead of print]. Int J KAATSU Train Res 2008. Biometrics 2000.005 . Again. 29(8):664–667. The feasibility of creating a checklist for the assessment of edge gaps and this has revealed that. there is a relative the methodological quality both of randomised and non-randomised studies of dearth of specific research in this area. Beaven CM. training performed to fatigue produce equal muscle hypertrophy. Cavaglieri CR et al. 7. Paoli F. conditions requiring rehabilitative care. Kilduff LP. 21. Diabetes 1982. Slysz et al. are required before concrete statements regarding methodological 14.1111/sms. total glucose uptake. but for which higher load 8. load.org/10. bined with BFR. it is worth stressing that the current findings by restriction of blood flow. Herda TJ. Loenneke JP.005.jsams. Physiol 2013. http://dx. J Appl Physiol 2006. 21(4):510–518. Int J Sports Med 2015.jsams. Insulin resistance: a contributing factor to age-related muscle tributes substantially to these adaptive processes. 19. Fitschen P.

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