Original Investigations

Effects of Exercise Load and Blood-Flow

Restriction on Skeletal Muscle Function
SUMMER B. COOK, BRIAN C. CLARK, and LORI L. PLOUTZ-SNYDER
Musculoskeletal Research Laboratory, Department of Exercise Science, Syracuse University, Syracuse, NY

ABSTRACT
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COOK, S. B., B. C. CLARK, and L. L. PLOUTZ-SNYDER. Effects of Exercise Load and Blood-Flow Restriction on Skeletal Muscle
Function. Med. Sci. Sports Exerc., Vol. 39, No. 10, pp. 1708–1713, 2007. Resistance training at low loads with blood flow restriction
(BFR) (also known as Kaatsu) has been shown to stimulate increases in muscle size and strength. It is unclear how occlusion pressure,
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exercise intensity, and occlusion duration interact, or which combination of these factors results in the most potent muscle stimulus.
Purpose: To determine the effect of eight BFR protocols on muscle fatigue (decrement in maximal voluntary contraction (MVC) after
the performance of exercise), and to compare the decrement in MVC with the currently recommended resistance exercise intensity
(~80% MVC). Methods: During five test sessions, 21 subjects (14 males and 7 females, 27.7 T 4.9 yr) completed nine protocols, each
consisting of three sets of knee extensions (KE) to failure. One protocol was high-load (HL) exercise (80% MVC) with no BFR, and
the other eight were BFR at varying levels of contraction intensity (20 or 40% MVC), occlusion pressure (partial (~160 mm Hg) or
complete (~300 mm Hg)), and occlusion duration (off during the rest between sets or continuously applied). To evaluate each protocol,
MVC were performed before and after exercise, and the decrement in force was calculated. Results: Three sets of KE at 20% MVC
with continuous partial occlusion (20%ConPar) resulted in a greater decrement in MVC compared with HL (31 vs 19%, P = 0.001).
None of the other BFR protocols were different from the HL protocol, nor were they different from 20%ConPar (P > 0.05). Conclusion:
All BFR protocols elicited at least as much fatigue as HL, even though lower loads were used. The 20%ConPar protocol was the only one
that elicited significantly more fatigue than HL. Future research should evaluate protocol training effectiveness and overall safety of
BFR exercise. Key Words: ISCHEMIA, KAATSU, QUADRICEPS, FATIGUE, EXERCISE PROTOCOLS

T
he American College of Sports Medicine (ACSM)
recommends resistance training at moderate to high
loads (70–85% of one-repetition maximum (RM))
using multiple sets of 8–12 repetitions with short rest
periods (1–2 min) two to three times per week (3).
Resistance training regimens that use the principles of
progressive overload are likely to result in increased muscle
size and, consequently, strength (3). Skeletal muscle
responds to overload with enhanced rates of protein
synthesis leading to increases in the size and amount of
contractile proteins within each muscle fiber (20). Although
the exact mechanisms that trigger protein synthesis remain
elusive, muscle hypertrophy and increased strength as a
result of high-load (HL) resistance training is generally
thought to be associated with the recruitment of higher
threshold motor units (14) resulting in increases in
Address for correspondence: Summer B. Cook, M.S., Syracuse University
Department of Exercise Science, 820 Comstock Avenue, Room 201,
Syracuse, NY 13244-5040; E-mail: slbaldwi@syr.edu.
Submitted for publication March 2007.
Accepted for publication May 2007.
0195-9131/07/3910-1708/0
MEDICINE & SCIENCE IN SPORTS & EXERCISEÒ
Copyright Ó 2007 by the American College of Sports Medicine
DOI: 10.1249/mss.0b013e31812383d6
mechanical stress (10), endocrine responses (12), and
metabolite accumulation (10). For example, large, acute
increases in growth hormone (GH) immediately after HL
exercise is theorized to stimulate the secretion of insulin-
like growth factors (IGFs) leading to increased protein
synthesis and ultimately muscle hypertrophy (3,12).
During periods of reduced muscle use, such as space-
flight and post-injury/surgery, substantial losses in muscle
mass and strength are observed (18,24). Because perform-
ing HL resistance training during these times are not always
feasible and at times actually contraindicated, it is plausible
that the benefits of HL exercise can be achieved using
considerably lower loads and blood flow restriction (BFR)
(also known as vascular occlusion or ischemia). Exercising
with BFR is routinely performed in Japan where it is
referred to as Kaatsu. Researchers have reported similar
muscular adaptations in Kaatsu as seen in HL exercise, and
sometimes in a more rapid time course (1,25,27). For
example, Takarada et al. (25) report similar gains in
strength and muscle cross-sectional area (CSA) after 16
wk of either BFR or HL resistance training of the elbow
flexors, and Abe et al. (1) describe an almost 9% increase in
CSA accompanied by a 17% rise in squat strength after only
2 wk of training twice per day with a vascular occlusion at
20% 1RM. They also found 20% higher serum insulin-like

1708

Copyright @ 2007 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
growth factor-1 (IGF-1) at the end of the 2 wk of training,
attributing the rise in CSA and strength to increased protein
synthesis through the GH–IGF–1 axis (1). Comparable
improvements in strength and IGF-1 levels have been
shown after 13 wk of HL training at 70% 1RM (5). In
addition to these chronic positive effects, our laboratory has
reported an acute ninefold increase in serum GH from
baseline to the cessation of an exercise bout consisting of
knee extensions at 20% maximum voluntary contraction
(MVC) with BFR (17), and others have reported GH
increases of up to 290 times baseline values (21,23,26,28),
with the GH responses following BFR exercise being
similar to, or even high than those reported during HL
exercise of intensities at about 70% 1RM (11,19).
When the long- and short-term effects of BFR exercise on
muscle and endocrine function are considered collectively, the
data suggest that BFR exercise may indeed be a potent
stimulator of muscle growth. However, since training with a
blood flow restriction is rather novel (since about 2000), little is
known about the most effective BFR protocol regarding
exercise intensity and occlusion pressure and occlusion
duration. Currently, studies using BFR vary greatly in terms
of the protocol employed. For instance, exercise loads have
ranged from 20 to 50% of 1RM or MVC (1,6,16,17,21–
23,25–29), occlusion pressures have been moderate (about
30% above systolic blood pressure, or about 160 mm Hg)
(1,6,19,21,22,25) or high enough to completely restrict blood
flow (~300 mm Hg) (8,16,17,26,27,30), and the occlusion
duration is not often specified, thus making it unclear whether
the pressure was constantly applied throughout rest periods or
released at the completion of each exercise set (25,27). If
BFR exercise is to be developed as a viable intervention to
enhance muscle mass and strength, understanding the inter-
play among these factors is critical in the development of the
most effective BFR exercise protocol. Therefore, the purpose
of this study was to determine the acute effect of eight
different BFR protocols on skeletal muscle fatigue (decrement
in MVC immediately following the performance of exercise)
and compare these changes with the currently recommended
resistance exercise intensity (~80% MVC) by the ACSM (3).
On the basis of our previous finding that subjects who
experienced the greatest decrement in force after a bout of
BFR exercise concomitantly experienced the highest plasma
GH concentrations exercise (Spearman r = j0.69) (17), and
on the basis of the findings of Häkkinen and Pakarinen (9),
who report that the more fatiguing the exercise, the greater the
GH response, we suggest that in the present study, the most
fatiguing exercise protocol could reasonably be the most
potent stimulator for muscle growth and should be further
tested in training studies.
METHODS
Subjects
Twenty-one healthy, normotensive males and females
were recruited from the university community for partici-
MUSCLE FUNCTION CHANGES WITH OCCLUSION
Copyright @ 2007 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
pation in this study. All subjects signed an informed consent
approved by the Syracuse University Institutional Review
Board. Subjects completed a health questionnaire and
anyone with a family history (including themselves) of
blood clotting disorders and individuals with orthopedic
injuries or limitations associated with the legs were
excluded from the study. Additionally, subjects who
reported using drugs that are known to increase the risk of
circulatory problems (hormonal contraceptive medicine)
were excluded. The subjects were 27 T 4.9 yr, had a mean
height of 1.73 T 0.07 m, and weighed 74.4 T 14.4 kg. All
subjects participated in some form of regular physical
activity (i.e., running, cycling, resistance training), but were
asked to refrain from strenuous bouts of exercise for 2 d
before each testing session.
Experimental Design
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The study required subjects to visit the laboratory on five
separate occasions, with at least 5 d between visits. Subjects
completed nine different exercise protocols, and the order of
the protocols was counterbalanced. Each testing session
involved the completion of two exercise protocols and
lasted approximately 1.5 h. Before testing, blood pressure
was taken and used to determine occlusion pressure.
Strength testing. Isometric muscle strength was
assessed before and immediately upon completion of each
exercise protocol. To measure exerted force, subjects were
seated in a knee extension dynamometer (MedX, Ocala,
FL). The back rest was adjusted to create a hip joint angle
of 100- from flexion, and a seat belt was secured across the
subject_s hips to reduce any movements of the hip joint, and
to minimize assistance from other muscle groups. For MVC
testing, the knee joint angle was set at 60- from extension.
During testing the contralateral limb was extended and
rested on a pad. To obtain an MVC, subjects were instructed
to push as hard as possible against an immovable arm
attached to a force transducer. Isometric force was measured
by a force transducer (model U1T, HBM Inc., Marlborough,
MA; sensitivity of 0.002 VIN-1), amplified and recorded at
1000 Hz using a 16-bit data acquisition card (MP150,
BioPac Systems Inc., CA). The force exerted by the subject
was displayed on a 43-cm computer monitor located 1 m
directly in front of the subject. Subjects performed MVC
before the exercise protocols until two consecutive trials
were within 5% of each other, and the highest MVC
obtained was used in the analysis. The day-to-day reliability
of the MVC using coefficient of variation was less than 8%.
Subjects performed one MVC at the completion of the
exercise protocol, and this post strength was measured
within 30 s after volitional fatigue. During all MVC, strong
verbal encouragement was given.
Exercise protocols. At each testing session subjects
performed two different exercise protocols (one with each
leg) that involved three sets of dynamic knee extensions to
volitional task failure. Before each protocol, the subject
performed a brief warm-up of 10–15 repetitions at a very
Medicine & Science in Sports & Exercised 1709
 light (less than 20% MVC) workload. Each set of knee
extensions was separated by a 90-s rest period, and
completion of the two protocols was separated by
approximately 30 min of rest. The range of motion of the
exercise was between 12 and 108- of knee extension
(0- = full extension), and the subjects performed the leg
extensions at a fixed cadence (approximately a 2-s
concentric contraction and a 2-s eccentric contraction).
The BFR protocols included two different exercise
intensities (20 or 40% MVC), two occlusion pressures
(partial (~160 mm Hg) or complete (~300 mm Hg)) and
two occlusion durations (no pressure during the rest
between sets or continuously applied). Each of these
variables was independently manipulated resulting in a
total of eight different protocols with an occlusion stimulus.
An additional protocol was performed at 80% MVC with no
BFR. The order of testing was counterbalanced and the leg
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P G 0.05. Statistics were computed using SPSS version 15.0
(Chicago, IL).
RESULTS
MVC. Although males had higher initial MVC than
females (868.8 T 168.3 vs 550.8 T 61.0 N, P G 0.01, power =
1.0, G2 = 0.55), the amount of fatigue (percent decrement
in force) was similar across all protocols (P = 0.31, power =
0.54, G2 = 0.06). Further gender comparisons were not
made because the fewer number of female subjects in the
sample substantially decreased the power of this analysis.
When the subjects repeated their first protocol on their
last visit, there were no differences in MVC (P = 0.89),
force decrement (P = 0.82) and number of repetitions
performed (P = 0.17). Furthermore, there were no signifi-
cant differences between the subjects_ MVC over the nine

tested on each protocol was randomly selected. On the fifth protocols (P = 0.91). This provides evidence that there was
testing session after all nine protocols were completed, each no training effect of the repeated testing.
subject repeated the first protocol they performed at the first Exercise loads. The average exercise load in the HL
testing session to ensure there was no training effect. was 609.3 T 170.8 N, whereas the LLO protocols at 20 and
The occlusion pressure was applied via a 6  83-cm 40% MVC exhibited loads of 161.1 T 50.4 and 304.2 T 85.0
tourniquet cuff (D.E. Hokanson, Inc., Bellevue, WA), N, respectively. All three exercise loads were significantly
placed at the most proximal position on the subject_s different from one another (P G 0.01).
thigh, and inflated (E20 Rapid Cuff Inflator, D.E. Hokanson, Repetitions. Subjects performed more repetitions
Inc., Bellevue, WA) to the designated pressure. In the during all BFR protocols when compared with HL (Table 1;
partial occlusion, the cuff was inflated to a pressure 30% P G 0.01, power = 1.0, G2 = 0.44). The number of
higher than the subject_s resting systolic blood pressure, and repetitions completed in the protocols at 20% MVC were
during the complete occlusion, pressure was set at 300 mm not different, regardless of occlusion pressure and duration
Hg. It has been suggested that a pressure 1.3 times systolic (mean = 165.0 T 108.9; P > 0.05). The number of
blood pressure (partial occlusion) impedes venous blood repetitions performed in the protocols at 40% MVC were
flow causing blood to pool in the capacitance vessels distal similar (mean = 83.8 T 43.4; P > 0.05) but were
to the cuff while restricting some arterial blood flow (25). significantly less than the 20% MVC protocols (P G 0.05).
Using Doppler ultrasound technology, our laboratory has Volume. Protocol volume (load  repetitions) was
previously confirmed that a pressure of 300 mm Hg results lowest in the HL protocol, and this was significantly lower
in blood flow cessation to the limb (7). in comparison with the 40% continuous partial occlusion
(40% ConPar ) and 40% intermittent venous occlusion
(40%IntPar) only.
Statistical Analysis
Fatigue. On the average, subjects experienced the least
Statistics are reported as means T standard deviations. amount of fatigue during the HL protocol (~19 T 12%)
Boxplots were used to display specific percentile points and and the highest during the 20% continuous complete
the overall shape of the data distribution. The central
horizontal line within each box is the median (50th
TABLE 1. Total repetitions completed during three sets of each protocol.
percentile) of the data. The top and bottom of each box
Protocol
displays the 25th and 75th percentiles while the ends of the
% MVC Pressure Duration Pressure Intensity Repetitions
whiskers are the 10th and 90th percentiles (29). One-way
HL 80 — — 33 T 10*
repeated-measures analysis of variance were used (within- 20%IntPar 20 Intermittent Partial 194 T 100
subject main effect: protocol) on the following variables: 20%IntCom 20 Intermittent Complete 143 T 75
20%ConPar 20 Continuous Partial 182 T 153
exercise load, repetitions, protocol volume (load  repeti- 20%ConCom 20 Continuous Complete 140 T 102
tions), force decrements, and force decrements per protocol 40%IntPar 40 Intermittent Partial 90 T 47†
volume. Post hoc comparisons were performed using the 40%IntCom 40 Intermittent Complete 84 T 37†
40%ConPar 40 Continuous Partial 83 T 32†
Bonferroni adjustment for multiple comparisons. Paired 40%ConCom 40 Continuous Complete 73 T 53†
t-tests comparing MVC, force decrement, and number of Data are displayed as means T SD.
repetitions on the protocol that each subject repeated were HL, high-load exercise; MVC, maximal voluntary contraction; int, intermittent; con,
continuous; par, partial; com, complete.
also done. Power and eta squared (G2) were reported as * Significant difference from all occlusion protocols (P G 0.05); † significant
appropriate, and significance was set at an alpha level of difference from all occlusion protocols at 20% MVC (P G 0.05).

1710 Official Journal of the American College of Sports Medicine http://www.acsm-msse.org

Copyright @ 2007 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
FIGURE 1—Boxplot of percent force decrement (from MVC before and immediately after exercise) for each protocol. Protocol abbreviations are
listed in Table 1. The central horizontal line within each box is the median (50th percentile). The top and bottom of each box displays the 25th and
75th percentiles, and the ends of the whiskers are the 10th and 90th percentiles. Open circles represent individual outliers of 90th percentiles, and

BASIC SCIENCES
asterisks denote ‘‘far-out’’ outliers. A repeated-measures analysis of variance and Bonferroni adjustment for multiple comparisons post hoc test
reveal that 20%ConPar is significantly different from HL (P G 0.01).

(20%ConCom) and 20% continuous partial (20%ConPar)
occlusion protocols (33 T 18 and 32 T 12%, respectively).
However, the only significant difference in fatigue among
the nine protocols was between HL and 20% ConPar
(P = 0.01, power = 0.91, G2 = 0.15). Although there was
a slightly greater decrement in force observed during
20%ConCom, this was not significantly different from HL
(P = 0.29), because of the greater variability associated with
the protocol. The boxplot (Fig. 1) reveals the data
distribution associated with muscle fatigue. The 20%ConPar
protocol has the largest minimum fatigue value of all the
protocols, indicating that subjects exhibited at least a 12%
decrement in force, whereas other protocols resulted in
small force decrements (20%IntPar = 2%, HL = 3%, and
20%ConCom = 4%). Also, the 20%ConPar protocol has a small
spread (low variability) of values among the 25th and 75th
percentiles. The boxplots with the widest spread (most
variability) are the 20%IntPar, 20%ConCom, 40%ConCom, and
40%IntPar protocols, respectively.
Protocol efficiency. To evaluate the efficiency
(whether more fatigue was induced using lower volumes
of exercise) of the protocols, fatigue was normalized to each
protocol volume (decrement in force/[load  repetitions]).
Although significant differences between protocols were
found (P = 0.01), no significant pairwise comparisons were
evident using the Bonferroni adjustment for multiple
comparisons. The boxplot (not shown) exhibits similar
median values for force decrement per load in all protocols,
and all have similar spreads of values.
DISCUSSION
In this study, we sought to determine the most effective
combination of exercise load, occlusion intensity, and
occlusion duration to produce muscle fatigue. Our data
show that all acute bouts of exercise with BFR are as
fatiguing or more fatiguing than a bout of HL exercise.
Whereas HL exercise resulted in a 19% decrement in
isometric force after a bout of exercise, BFR exercise showed
strength reductions of 24–33%. Häkkinen and Parkarinen (9)
report similar amounts of fatigue in that muscle force was
reduced by 10.3 T 4.7 and 24.6 T 18.9% after two different
high-load protocols (20  1RM and 10 sets of 10 repetitions
at 70% 1RM, respectively). Using a BFR protocol similar to
20%ConCom but with a higher volume of exercise (five vs
three sets) being performed, Pierce et al. (17) have reported
a 55.8% strength decrement. The magnitude of muscle
fatigue after resistance exercise is known to be associated
with the intensity of the exercise load, type of load (concen-
tric or eccentric muscle contractions), the rest intervals
between sets, and individual characteristics such as muscle
morphology and training status (9,13). In the present study, the
intensity of the load was the only factor that was manipulated,
and we have demonstrated that a bout of BFR exercise can be
as effective as HL in generating muscle fatigue.
Large increases in serum GH levels have been correlated
with fatigue after single bouts of HL exercise (2,9), and GH
is well-known to influence protein regulation and muscle
growth during HL resistance training (11,12). We recently
reported a relationship between acute fatigue and GH
secretion after nine subjects were observed under both
BFR with resistance exercise and BFR without exercise
(muscle ischemia without contraction) (17). Here, the
ischemic condition alone resulted in a 16% decrement in
muscle force independent of a significant rise in GH, and
low-load exercise coupled with BFR resulted in a 55.8%
reduction in muscle force accompanied by a ninefold
increase in GH levels. When the relationship between
fatigue and GH response was evaluated using these data, a
significant correlation of j0.69 was evident, indicating that

MUSCLE FUNCTION CHANGES WITH OCCLUSION Medicine & Science in Sports & Exercised 1711

Copyright @ 2007 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 subjects who experienced the largest acute muscle fatigue
also had the highest plasma GH secretion (17). Therefore,
on the basis of these findings (17), we speculate that the
most fatiguing BRF exercise protocol in this study is the
most potent stimulator for muscle growth, as it would likely
elicit the greatest GH response. Although current studies
reveal that BFR exercise results in muscle hypertrophy and
increased strength in as little as 2 wk (1,25,27,28), the
muscular adaptations leading to hypertrophy remain
unknown. Additional training studies are warranted to
further establish the role of GH as a hypertrophic factor in
response to BFR exercise.
Although there were no differences in the amounts of
fatigue exhibited among the BFR protocols, it is important
to determine which protocol would be best suited for a
resistance training regimen. We evaluated several factors in
the BFR protocols, including degree of muscle fatigue, the
BASIC SCIENCES
range of fatigue within each protocol, fatigue variability,
and protocol efficiency (force decrement per protocol
volume). On the basis of these criteria, at the present time
we recommend using the 20%ConPar protocol for several
reasons. First, this protocol was the only one that resulted in
a significantly greater decrement in force than HL (a
decrease of 240 vs 140 N, or a 32% decrease in MVC vs
a 19% decrease in MVC). Although 20%ConCom resulted in
similar decrements as 20%ConPar, the subject variability in
fatigue was much higher, making the impact of this protocol
less predictable. Second, all subjects tended to respond to
20%ConPar. For example, the minimum force decrement in
the 20%ConPar protocol was 64 N (or 12% MVC), whereas
the minimum force decrements in the HL and 20%ConCom
protocols were 10 N (or 2% MVC) and 15 N (or 2.5%
MVC), respectively. Therefore, we expect that individuals
would exhibit fatigue after 20%ConPar. Third, the variability
(as displayed by the spread of the boxes and the ends of the
whiskers in Fig. 1) is considerably uniform in 20%ConPar
when compared with the other protocols. HL exercise is
rather consistent, but, as stated previously, it exhibits much
lower force decrements than 20%ConPar. Fourth, although
more repetitions are performed during BFR, the exercise
volume (load  repetitions) is consistent in the 20%ConPar,
20%ConCom, and HL protocols. Furthermore, the amount of
force decrement per exercise volume is the same in all
protocols, indicating that although one may perform fewer
repetitions with HL, it is not more efficient in creating
fatigue than an occlusion protocol.
We also believe that 20%ConPar is more conservative (and
possibly safer) than several of the other BFR protocols,
because the occlusion pressure used is lower. Although
severe and often irreversible damage to skeletal muscle is
believed to occur after a prolonged exposure to ischemia
(> 3 h) (4), each BFR protocol in this study was completed
in less than 20 min, and no adverse effects of the exercise
occurred. The protocols using a partial occlusion likely do
not completely restrict arterial flow, so the exercising
muscle is still receiving some blood flow. In surgical
1712 Official Journal of the American College of Sports Medicine
Copyright @ 2007 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
situations in which a bloodless (via complete occlusion)
operating field is needed, McEwen et al. (15) recommend
using the minimum occlusion pressure possible to prevent
nerve, muscle, and skin injury. Although the long-term
effects of BFR resistance training are unknown, other
authors have suggested that muscle and microvascular
damage may result from ischemia, including thrombus and
pulmonary embolism formation (4,25). However, Takarada
et al. (26) found no evidence of muscle damage or oxidative
stress when assessed by creatine phosphokinase and lipid
peroxide, respectively, after a bout of exercise. Because
there were no differences in fatigue among any of the BFR
protocols tested in this study, we recommend using at most
a partial occlusion of 1.3 times systolic blood pressure
around the quadriceps femoris. With more research, it is
possible that occlusion pressures less than that can
effectively elicit muscle fatigue.
Although we did not take measurements of pain or
discomfort associated with the exercise protocols, we
anecdotally observed that 20%ConPar protocol was more
comfortable and tolerable than protocols with higher
exercise loads and occlusion pressures. Wernbom et al.
(30) have reported pain ratings to be higher with BFR
exercise compared with a nonoccluded exercise at loads
higher than 20% 1RM. They used a pressure of about 200
mm Hg, which is greater than the pressure used on
20%ConPar. Therefore, although there were no differences
between the eight BFR protocols in the amount of fatigue
exhibited, 20%ConPar seems to be a suitable protocol in
terms of comfort and effectiveness to induce muscle fatigue.
In conclusion, all BFR protocols elicited at least as much
fatigue as HL, despite the fact that much lower loads were
used. The 20%ConPar protocol was the only one that elicited
significantly more fatigue than HL exercise and, therefore,
could have the potential to stimulate muscle growth. Future
studies should include a comprehensive analysis of the
acute and long-term training adaptations and mechanisms
for hypertrophy from BFR resistance training and compare
them to HL exercise training. The overall safety of BFR
exercise needs to be evaluated as the effect of repeated,
regular bouts is unknown. Health risks associated with
long-term BFR training should be determined, and pop-
ulations in which this type of training is contraindicated
should be established. Finally, the effectiveness of BFR
training for individuals who cannot engage in HL resistance
training (frail elderly, individuals postsurgery) should be
further evaluated.
This investigation was supported by the National Aeronautics
and Space Administration (NASA) (NNX06AG26H).
Present address of B.C. Clark as of August 2006: Dept. of
Biomedical Sciences, College of Osteopathic Medicine, Ohio Univ.,
211 Irvine Hall, Athens, OH 45701.
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