Clin Physiol Funct Imaging (2014) doi: 10.1111/cpf.

12193

Acute resistance exercise with blood flow restriction effects

on heart rate, double product, oxygen saturation and
perceived exertion
Gabriel R. Neto1,2,3, Maria S. C. Sousa2,3, Gabriel V. Costa e Silva1,4, Ana L. S. Gil1, Belmiro F. Salles1 and
Jefferson S. Novaes1
1
Physical Education Graduate Program, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, 2Kinanthropometry and Human Development Laboratory
– UFPB, 3Associate Graduate Program in Physical Education UPE/UFPB, Jo~ao Pessoa, Paraıba, and 4Laboratory of Physiology and Human Performance –
UFRRJ, Seropedica, RJ, Brazil

Summary

Correspondence
Gabriel Rodrigues Neto, Department of Physical
Education – Graduate Program, Federal University
of Rio de Janeiro, Avenida Pau Brasil, 540 Ilha
do Fund~ao, Rio de Janeiro 21941-590, Brazil
E-mail: gabrielrodrigues_1988@hotmail.com
Accepted for publication
Received 22 April 2014;
accepted 28 August 2014
Key words
acute effects; haemodynamic; ischaemia;
postexercise responses; resistance training; vascular
occlusion
The aim of this study was to compare the acute effect of resistance exercise (RE)
with and without blood flow restriction (BFR) on heart rate (HR), double prod-
uct (DP), oxygen saturation (SpO2) and rating of perceived exertion (RPE).
Twenty-four men (21
79  3
21 years) performed three experimental protocols
in a random order (crossover): (i) high-intensity RE at 80% of 1RM (HI), (ii)
low-intensity RE at 20% of 1RM (LI) and (iii) low-intensity RE at 20% of 1RM
combined with partial blood flow restriction (LI+BFR). HR, blood pressure, SpO2
and RPE were assessed. The data were analysed using repeated measures analysis
of variance and the Wilcoxon test for RPE. The results indicated that all protocols
significantly increased HR, both immediately postexercise and during the subse-
quent 60 min (P<0
05), and postexercise DP (P<0
05), but there were no differ-
ences between protocols. The protocols of LI and LI+BFR reduced postexercise
SpO2 (P = 0
033, P = 0
007), and the LI+BFR protocol presented a perception of
greater exertion in the lower limbs compared with HI (P = 0
022). We conclude
that RE performed at low intensity combined with BFR seems to reduce the SpO2
after exercise and increase HR and DP while maintaining a perception of greater
exertion on the lower limbs.

Several studies have evaluated the acute effects of RE with

Introduction
The American College of Sports Medicine recommends per-
forming resistance exercise (RE) at intensities greater than or
equal to 60% of one repetition maximum (1RM) to promote
significant strength and hypertrophy gains. It is believed that
any activity below this intensity rarely produces substantial
stimulus and consequently strength and muscle hypertrophy
adaptations responses (ACSM, 2009).
On the other hand, low-intensity RE (20–50% 1RM) com-
bined with the blood flow restriction techniques (BFR) or
KAATSU training has been used both for cardiovascular main-
tenance and/or for rehabilitation (Takano et al., 2005) and
also seems to promote significant strength and hypertrophy
gains (Karabulut et al., 2010; Pope et al., 2013). Research has
shown that strength and muscle mass gains with the use of
low-intensity RE with BFR are as effective as higher intensity
training (≥80% of 1RM) (Karabulut et al., 2007; Loenneke &
Pujol, 2009; Sumide et al., 2009).
BFR in isolated arms or legs on physiological variables, such
as heart rate (Takano et al., 2005; Renzi et al., 2010; Kacin &
Strazar, 2011; Okuno et al., 2014; Vieira et al., 2013), double
product (DP) (Renzi et al., 2010; Vieira et al., 2013) and per-
ceived exertion (Wernbom et al., 2009; Loenneke et al.,
2010a,b, 2013; Mendonca et al., 2014; Thiebaud et al., 2013;
Vieira et al., 2014). However, no studies have evaluated these
variables using agonist–antagonist exercises in upper and
lower body RE sessions with BFR. Furthermore, no study has
evaluated the acute effect of RE with BFR on oxygen satura-
tion (SpO2).
Given these facts, the study hypothesis was that low-inten-
sity RE performed with BFR would increase the values of
heart rate (HR), DP and rating of perceived exertion (RPE)
when compared to high-intensity and low-intensity training.
Therefore, the aim of this study was to compare the acute
effects of RE with and without BFR on HR, DP, SpO2 and
RPE.

© 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd 1
2 Blood flow restriction, haemodynamics and perceived exertion, G. R. Neto et al.

All three protocols were performed at the same time of day to

Methods control diurnal variation in BP, HR, SpO2. Immediately before
Subjects (pre), immediately after, and approximately 10 min (post-
10), 20 min (post-20), 30 min (post-30), 40 min (post-40),
Twenty-four normotensive and recreationally trained men par-
50 min (post-50) and 60 min (post-60) after each protocol,
ticipated in the study (Table 1). The sample dimension was
BP, HR and SpO2 flow measurements were taken. This study
performed using the software G*Power 3.1 (Faul et al. 2007).
employed a randomized crossover design. Participants were
On the basis of a priori analysis, we adopted a power of 0
80,
tested >2 h postprandial and were instructed to avoid caffeine,
a = 0
05, correlation coefficient of 0
5, non-sphericity correc-
medications and exercise on testing days. During all resis-
tion of 1 and an effect size (ES) of 0
27; from these values,
tance-training sessions, subjects were asked not to perform the
an n of 24 subjects was calculated. The sample size was calcu-
Valsalva manoeuvre.
lated based on procedures suggested by Beck (2013). This a
priori statistical power analysis was conducted to reduce the
likelihood of committing a type II error and to determine the Anthropometric assessment
minimum number of participants needed for this investiga-
Height and weight were measured to the nearest 0
5 cm and
tion. It was determined that the selected sample size was suffi-
0
1 kg, respectively, using a stadiometer and Filizolaâ scale
cient to provide a statistical power >80
8%.
(Ind
ustria Filizola S/A, Brasil). Body mass index was calcu-
Excluded were the subjects with the following criteria: (i)
lated as kilogram and square metre.
smokers, (ii) those who had some type of musculoskeletal
injury in the upper or lower limbs and (iii) those who
responded positively to any of the Physical Activity Readiness Ques- One repetition maximum testing
tionnaire/PAR-Q items (Shephard, 1988). The procedures were
To obtain reliable 1RM loads, the data were assessed during
carried out in accordance with the guidelines of the Declara-
two non-consecutive days following the bilateral exercise
tion of Helsinki on human experimentation, and this research
sequence: biceps, triceps, knee extension and knee flexion
project was approved by the University Ethics Committee
(agonist and antagonist). The test protocol followed the Amer-
(0476/13) and by the Research Ethics Committee of the State
ican College of Sports Medicine recommendations (ACSM,
University of Para
ıba (Brazil). Subjects provided written
2000), using a standardized 10-min recovery time for the dif-
informed consent after having the risks and benefits explained
ferent exercises in the test. For the warm-up, each individual
to them.
performed two sets of 5–10 repetitions at 40–60% of the
individual’s perceived maximum strength. After a 1-min rest
Experimental design period, a second set was completed consisting of three and
five repetitions at 60–80% of the perceived maximum
During the first and second visits to the laboratory, anthropo-
strength. After another rest period (1 min), the strength
metrics, determination of BFR and muscular strength were
assessments began, during which up to five attempts could be
assessed. Following these visits, participants came to the labo-
performed, adjusting the resistance before each new attempt.
ratory on four occasions, separated by at least 48 h, during
The recovery duration between the attempts was standardized
which they completed one of the three protocols: (i) a high-
at 3–5 min. The test was interrupted once the participant
intensity 80% 1RM resistance exercise (HI), (ii) a low-inten-
could not properly complete the movement, and the maxi-
sity 20% 1RM resistance exercise (LI) or (iii) a low-intensity
mum load was recorded as the load obtained in the last com-
20% 1RM resistance exercise combined with BFR (LI+BFR).
plete execution. The following strategies were adopted to
reduce the margin of error in the data collection procedures:
(i) standardized instructions were given before the tests such
Table 1 Subject characteristics. that the person being tested would be aware of the entire rou-
tine involved in the data collection; (ii) the individual being
Height (m) 1
72  0
06
Weight (kg) 69
49  9
80
tested was instructed on the proper technique of the exercise
BMI (kg/m2) 23
40  3
33 execution; (iii) all subjects were given standardized verbal
Age (years) 21
79  3
21 encouragement throughout the tests; and (iv) all tests were
conducted at the same time of the day for every session. The
1RMs (kg) Test Retest ICC
heaviest load achieved across both days was considered the
Arm Curl 34
46  8
78 35
81  9
07 0
990 1RM.
Triceps extension 27
67  8
05 28
90  8
21 0
988
Knee extension 139
94  32
44 142
80  33
52 0
996
Knee flexion 99
55  20
98 101
24  21
90 0
995 Blood pressure, heart rate and double product

Values are the mean  SD; n = 24; BMI, body mass index; 1RM, one Before and after each session, subjects were fitted with an auto-
repetition maximum; ICC, intraclass correlation coefficient. matic blood pressure monitor (model HEM-705CP 705CP; OM-

© 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd
 Blood flow restriction, haemodynamics and perceived exertion, G. R. Neto et al. 3
ROM) (Vera-Cala et al., 2011). All subjects remained seated for
60 min after each protocol on environmental conditions at
approximately 22°C. The cuff was placed on the right arm and
extended completely around the arm, with the bladder width
covering at least two-thirds of the upper arm. This equipment
was used for all pre- and postsession blood pressure measure-
ments. All measurements were performed according to the
guidelines of the American Heart Association (Pickering et al.,
2005). Heart rate was continuously monitored (Polarâ T31
Coded transmitter (Polar, Kempele, Finland)), and the DP was
obtained by multiplying HR (bpm) 9 systolic blood pressure
(mmHg).
Level of oxygen saturation
The level of oxygen saturation (SpO2) was assessed pre- and
postsession by means of a finger oximeter (Model: CMS50DL;
OXYM2000) (Yamaya et al., 2002).
Rating of perceived exertion
Before starting the study, all subjects participated in two
familiarization sessions with the OMNI-RES scale (Robertson
et al., 2003). RPE was assessed after the upper limbs exercises,
including the biceps and triceps (local perception), the lower
limbs exercises, including knee extension and knee flexion
(local perception) and the general perception after the session.
Determination of blood flow restriction
The point of BFR was performed with a vascular Doppler probe
(MedPegâ DV-2001, Ribeir~ao Preto, SP, Brazil) that was placed
over the radial artery (arms) and tibial artery (legs) to determine
the blood pressure (mmHg) of vascular occlusion. A standard
blood pressure cuff (tourniquet neumatic komprimeter to hae-
mostasis in extremities – Riester) of the biceps and triceps (width
60 mm; length 470 mm) and the knee extensors and knee flex-
ors (width 100 mm; length 540 mm) attached to the thigh
(axillary and inguinal fold region), respectively, was inflated up
to the point at which the auscultatory pulse of the radial and tibial
artery was interrupted. The cuff pressure used during the training
protocol was determined as 80% of the necessary pressure for
complete BFR in a resting condition (Laurentino et al., 2012).
Blood flow restriction was deflated between sets. The average
pressure used throughout the training protocol (arms and legs)
was 93
75  12
09 and 108
75  11
53 mmHg, respectively.
Exercise protocols
Resistance exercise consisted of bilateral biceps (biceps curl)
and triceps (triceps forehead extension), knee extension and
flexion using a conventional machine (agonist and antagonist).
Three protocols were performed: a high-intensity resistance
exercise at 80% 1RM (HI), a low-intensity resistance exercise at
20% 1RM (LI) and a low-intensity resistance exercise at 20%
© 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd
1RM combined with BFR. To complete the REs, biceps curl was
performed first, followed by triceps extension, knee extension
and knee flexion (agonist and antagonist). Participants in the HI
condition completed four sets of eight repetitions using 80%
1RM with 2 min of rest between all sets and 1 min between
exercises. Participants in the LI condition completed one set of
30 repetitions followed by three sets of 15 repetitions using
20% 1RM with 30 s of rest between all sets and 1 min of rest
between exercises. For the BFR resistance exercise, participants
performed the same reps, sets and rest as the LI group while
wearing specially designed elastic cuffs for the arms and legs
attached to the most proximal portion of both arms and legs,
respectively. The cuff pressure was maintained throughout the
exercise bout except for a 30 s deflation performed during the
30-s rest period between the sets. The duration of each repeti-
tion cycle was established at 4 s (2 s for the concentric and 2 s
for the eccentric muscle action) controlled by the metronome
(WMT-30C, Metro-Tuner; Tagimaâ, Tokyo, Japan).
Statistical analysis
The statistical analysis was initially performed using the Shap-
iro–Wilk normality test and homoscedasticity test (Bartlett cri-
terion). To test the reproducibility of the load between 1RM
test and retest, we used the intraclass correlation coefficient
(ICC). The SBP, DBP, HR and SpO2 demonstrated normal dis-
tribution or homoscedasticity (P>0
05). Repeated measures
analysis of variance followed by Bonferroni post hoc tests was
used for the analysis of possible differences in the dependent
variables. For the categorical variable (RPE), the Wilcoxon test
was used. The ES was used to determine the magnitude (triv-
ial <0
35, small = 0
35–0
80, moderate = 0
80–1
50,
large > 1
50) changes between evaluations of the study proto-
cols (Rhea, 2004), and the percentage variation (D%) was
used to express the possible differences between the signifi-
cant changes. The level of significance was set at P<0
05. All
statistical analyses were carried out using SPSS statistical soft-
ware package version 20
0 (SPSS Inc., Chicago, IL, USA).
Results
Heart rate
The comparative analysis of HR revealed no significant differ-
ences between protocols (P>0
05). The analysis of interaction
between time and all protocols indicated that significant
increases in HR were observed between pre- versus postexer-
cise, pre versus 10 min, pre versus 20 min, pre versus
30 min, pre versus 40 min, pre versus 50 min and pre versus
60 min (P<0
05), respectively (Fig. 1).
Double product
The comparative analysis of DP indicated no significant differ-
ences between protocols (P>0
05). An interaction analysis of
4 Blood flow restriction, haemodynamics and perceived exertion, G. R. Neto et al.

Figure 2 Inferential analysis of the double product (DP) between the

Figure 1 Inferential analysis of heart rate (HR) between the study
study protocols. *Significant difference between rest versus immediately
protocols. *Significant difference compared with rest; HI = high-
post exercise; HI = high-intensity protocol; LI = low-intensity proto-
intensity protocol; LI = low-intensity protocol; LI+BFR = low inten-
col; LI+BFR = low intensity with blood flow restriction protocol.
sity with blood flow restriction protocol.

time and protocol factors revealed that there was a significant

increase for HI, LI, LI+BFR protocols between rest and imme-
diately post exercise (P = 0
001, D = 71
8%, ES = 2
86;
P = 0
001, D = 81
9%; ES = 4
79; P = 0
001, D = 75
3%;
ES = 3
60), respectively (Fig. 2).

Oxygen saturation

The comparative analysis of SpO2 revealed no significant dif-

ferences between protocols (P>0
05). The interaction between
time and protocol revealed significant reductions between rest
and immediately postexercise in LI and LI+BFR (P = 0
033,
D = 0
92%, ES = 0
90; P = 0
007, D = 1
13%; ES = 0
91),
respectively, as shown in Fig. 3.
Rating of perceived exertion
Figure 3 Inferential analysis of the level of oxygen saturation (SpO2)
between the study protocols. *Significant difference between rest ver-
sus immediately post exercise; HI = high-intensity protocol;
LI = low-intensity protocol; LI+BFR = low intensity with blood flow
restriction protocol.

In the comparative analysis of RPE by the Wilcoxon test, we

observed a significant difference between HI and LI+BFR
(P = 0
022) in the local perception of the leg (Fig. 4).

Discussion
The present study examined the acute effects of resistance exer-
cise performed with and without BFR on HR, DP, SpO2 and RPE
in normotensive young subjects. The main finding was that the
LI and LI+BFR RE protocols reduced the levels of oxygen satura-
tion, as demonstrated by a postexercise decrease in SpO2. How-
ever, the magnitude of the per cent decrease in SpO2 was Figure 4 Inferential analysis of perceived exertion (RPE) of exercises
greater for the LI+BFR exercise group. Although no study has between the study protocols. †Significant difference between HI versus
verified oxygen saturation using BFR, several studies have found LI+BFR; RPE = perceived exertion; HI = high-intensity protocol;
LI = low-intensity protocol; LI+BFR = low intensity with blood flow
a reduced supply of intramuscular oxygen (Tanimoto et al.,
restriction protocol.
2005) and reactive oxygen species (Takarada et al., 2000; Tan-
imoto et al., 2005; Goldfarb et al., 2008) using RE with BFR.
Thus, it seems that training with BFR generates a blood Tanimoto et al. (2005) compared the resistance exercise effects
occlusion and a SpO2 decrease, reducing the amount of oxy- in four situations on muscle oxygenation levels. The condition
gen carried by the blood. Consequently, there is a reduced that included BFR induced the greatest decrease in average
availability of oxygen for consumption in muscle tissue. muscle oxygenation during exercise (approximately 22%

© 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd
 Blood flow restriction, haemodynamics and perceived exertion, G. R. Neto et al. 5
when compared to pre-assessment). In addition, BFR increased
the average values of postexercise muscle oxygenation to
approximately 143% compared with the value of the pre-
assessment. These results indicate that a greatest degree of
blood reperfusion occurred after the condition that included
the BFR. The significant reduction in oxygen saturation imme-
diately after RE with BFR in our study may suggest an increase
in reperfusion, similar to that observed in the study by Tan-
imoto et al. (2005).
An important finding of this study was that despite signifi-
cant decreases in SpO2 following the LI and LI+BFR protocols,
such response was not observed after the HI protocol. It is
likely that the HI resistance exercise protocol is capable of
promoting greater blood mobilization (Copeland et al., 1996)
and, consequently, higher amounts of postexercise muscle
oxygen in relation to LI training. Consistent with this idea, it
is speculated that the HI protocol may have stimulated the
increased production of nitric oxide, a known potent vasodila-
tor, because it mobilized a larger volume of blood (Brown
et al., 2000). Thus, lower oxygen percentages were observed
in the LI and LI+BFR protocols, suggesting that exercise inten-
sity is an important factor influencing the acute responses of
oxygen saturation.
Goldfarb et al. (2008) analysed the effect of low-intensity
exercise (30% of 1RM), with and without BFR, and traditional
exercise (70% of 1RM) on oxidative stress and plasma protein
carbonyl (one marker of reactive oxygen species). The authors
reported that the levels of protein carbonyl were significantly
lower after training with BFR compared with traditional
resistance training and that both may increase oxidative stress.
Previously, Takarada et al. (2000) investigated the effect of
low-intensity exercise (20% of 1RM) combined with and
without BFR (knee extension) on lipid peroxide levels (one
marker of reactive oxygen species). The authors found that
lipid peroxide concentrations were not significantly different
between the exercise conditions with and without BFR.
The results of the present study, when analysed in the con-
text of these previous studies, suggest that the reduction in
oxygen saturation may change the supply of intramuscular
oxygen, producing a more acidic and anabolic environment
(Loenneke et al., 2010a,b), which could affect the participants’
perceived exertion. In our findings, RPE responses were higher
for the lower limbs in the LI+BFR protocol compared with HI
exercise. In this scenario, a few studies have evaluated the
responses of RPE during exercise conducted with BFR (Wern-
bom et al., 2009; Loenneke et al. 2010a,b, 2013; Mendonca
et al., 2014; Thiebaud et al., 2013; Vieira et al., 2014). How-
ever, no studies have evaluated RPE after a session involving
RE agonists and antagonists for upper and lower limbs.
Regarding RPE, Loenneke et al. (2010a,b, 2013) studies are
in accordance with the present findings. Loenneke et al.
(2010a,b) observed RPE responses (Borg, 6–20) after each set
during BFR, which was applied intermittently with elastic
resistance. Twelve participants performed bilateral leg exten-
sion exercises (30 repetitions in the 1st set with three sets of
© 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd
15 repetitions) with a load of approximately 30% of 1RM,
with and without BFR. It was observed that RPE was greater
for the group that experienced BFR. Additionally, in a recent
study, Loenneke et al. (2013) investigated whether BFR com-
bined with and without exercise (unilateral knee extensions at
30% of 1RM) would result in RPE changes. The authors found
that RPE was higher with BFR (in both groups) compared
with the control condition.
On the other hand, a study by Wernbom et al. (2009) pre-
sented different findings. They investigated RPE (Borg, 6–20)
during dynamic low-intensity (30% of 1RM) bilateral knee
extension with and without BFR. The exercise was performed
with BFR applied to only one leg. The authors concluded that
the RPE was similar for both conditions, suggesting that RPE
changes are not principally based on the effects of BFR but are
also related to the manipulation of exercise intensity.
Additionally, the findings of a study by Vieira et al. (2014)
differ from our present results. In their study, the authors
compared the effects of unilateral elbow flexion RE with high-
intensity versus low-intensity BFR on RPE. They found that
the RPE for the protocol including RE with BFR was signifi-
cantly higher than the high-intensity protocol in the present
study, but no significant differences for the upper limbs were
observed. When comparing this study with our results, it
seems that more intense RPE responses are elicited from the
performance of unilateral exercises with BFR than from bilat-
eral exercises.
Thiebaud et al. (2013) investigated the effect of RE (unilat-
eral elbow flexion with dumbbells at 30–40% of 1RM) with
BFR held in concentric and eccentric phases on RPE (Borg, 6–
20). The authors found a significant increase in RPE in the
concentric phase compared with the eccentric phase. Mendo-
nca et al. (2014) examined possible relationships between
changes in RPE and ventilation during treadmill walking with
and without BFR. The authors found no significant correlation
between RPE changes and ventilation (r = 0
38, P>0
05) and
found that ventilatory responses during the BFR walk can be
independent of changes in RPE and are most likely combined
with the flux of CO2 between the muscles and respiratory
centres. Therefore, it is observed that both the RE and aerobic
exercise performed with BFR may result in a higher RPE
response.
Another important finding was that all exercise protocols
promoted increases in postexercise DP, but no differences
were observed between the protocols. The results of the study
by Vieira et al. (2013) corroborate the present study. The
authors assessed the haemodynamic responses (blood pressure
and heart rate) during RE with and without BFR in young and
older individuals. The authors found that blood pressure and
heart rate were greater during exercise with BFR in both
groups, thus causing a significant increase in the DP during
the exercise protocol with the BFR. The authors concluded
that RE with BFR causes haemodynamic changes in healthy
young and older individuals, with similar magnitudes of
responses for both groups. Such responses in DP, in both
6 Blood flow restriction, haemodynamics and perceived exertion, G. R. Neto et al.

studies, may have been influenced by muscle tension associ-
ated with the constriction of blood vessels induced by BFR.
Thus, the BFR may have stimulated the muscle and tendon
mechanoreceptors (Hayes et al., 2005), which may provide a
possible explanation for the observed increase in SBP (Fisher
et al., 2005). In addition, HR was significantly increased from
the immediate post-training time point to 60 min following
the cessation of exercise, thus ensuring a significant increase
in DP demonstrated by these data.
In this sense, Takano et al. (2005) measured 11 untrained
men to evaluate the haemodynamic responses promoted by
BFR during low-intensity exercise. The authors observed an
increase in heart rate and blood pressure during exercise.
Additionally, the study conducted by Renzi et al. (2010) cor-
roborates, at least in part, the findings of the present study
because the authors observed that the HR and DP values were
higher in the presence of BFR. As previous research has
indicated, it appears that the activation of type III fibres and
metaboreceptors is capable of inhibiting the parasympathetic
branch of the autonomic nervous system and stimulating qui-
mioreflexo, thereby contributing to an increase in cardiovas-
cular responses in general (Coote & Bothams, 2001; Kaufman
& Hayes, 2002). However, these autonomic responses and
central and peripheral neural mechanisms can only be specu-
lated about because they were not directly evaluated in this
experiment.
Regarding the results obtained in the present study, some
limiting factors become relevant and warrant emphasis. The
unverified levels of autonomic activity and cardiac output are
limitations, which, if measured, would provide further insight
into the mechanisms behind these responses. In this regard,
variables such as the level of the endothelium-dependent vaso-
dilators, cardiac output and hormonal levels were not mea-
sured in this study.
Conclusion
The RE carried out with low intensity combined with BFR
appears to reduce oxygen saturation after exercise and raise
the heart rate and DP while maintaining an RPE greater in the
lower limbs, however, within safety standards. It is recom-
mended that protocol for LI+BFR be used as a non-drug inter-
vention for controlling HR and DP in novice, hypertensive
and sedentary subjects. Therefore, it is important to conduct
further studies to examine the chronic per cent of oxygen sat-
uration responses, particularly involving different subjects,
exercises and intensities.
Acknowledgments
No financial assistance was obtained for this study.
Conflict of interest
The authors have no conflict of interest.

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