What is Blood Flow Restriction Training?

Pedro Gracia

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Imagine living happy, healthy and fulfilled to 100!

By now all my readers know that I am hell-bent on living to 100, in a happy, healthy and fulfilling way. Needless to say that during this natural ageing process the body is going to undergo some changes. One of them is muscle wastage, also called Sarcopenia. The older you get, the more important your muscle mass becomes. Not only are strong muscles a requirement for mobility, balance and the ability to live independently, but in the long run, having a muscle mass reserve will also increase your chances of survival during illness and hospitalization.

BFR band while swimming
My next challenge is to use the BFR bands while swimming…

Six months ago I came across a Blood Flow Restriction (BFR) training article from Ben Greenfield. I subsequently did more digging and became fascinated by the subject. Multiple studies have shown that BFR training, done properly, can not only maintain but also increase your muscle mass and strength with very little or no risk of injury. 

Warning; It is advisable to check with your doctor before embarking in this type of training.

How does BFR work

I will start by sharing the history of BFR. It was developed by the pioneering professor Yoshiaki Sato of Japan over 50 years ago. In Japan, where it is widely practised, the technique is called KAATSU, meaning “additional pressure” and was generically defined as BFM (blood flow moderation) by Dr Sato. It involves the application of additional pressure via a cuff proximally to the upper or lower limb, with the aim of obtaining partial arterial pressure and complete venous occlusion.  This, in turn, creates a relatively hypoxic environment or low oxygen pressure in the exercising muscle. With very light weights, and in about 15-20 minutes, you get an exhaustive workout that sends a signal to your brain that you have been lifting heavier than you actually did. This activates a wide variety of powerful hormonal responses that cause your muscles and blood vessels to grow. Studies show that after only 12 weeks, you can expect a 40% increase in muscle strength, depending on your load and health.

Choose a weight that is light enough to enable you to do 30 repetitions without rest. Then a short rest interval of 15 to 20 seconds and repeat 2 more times… Simple and effective !! As part of a long term strategy, BFR training 2 to 3 times a week is sufficient.

BFR training at home
During Lockdown it was so handy to train from home with the BFR bands.

I engage in BFR training 3 times a week, for 15 mins, 3 sets of 30 reps for the arms, and then swap the bands to my legs and do the same for 20 mins. On both, I rest no longer than 15 secs between sets. During the 15 mins for the upper limbs I can hit various muscle groups biceps, triceps, shoulders, dorsal, etc, and then switch the bands to my lower limbs for 20 mins and work on the glutes, hamstrings, quads, and calves. This is a very effective way to train and in less than 40 mins I have given my body a complete workout.

BFR can be applied during aerobic exercise, such as during walking, swimming or cycling.

How BFR increases muscle strength and size

In order to increase muscle mass and strength, it is important to activate fast-twitch Type II muscle fibres during training, since these fibres have been shown to be more responsive to increasing muscle size than Type I fibres. This type II muscle fibre activation can be achieved with high-intensity training such as sprints and heavyweight training. Training with low weights and no resistance bands will not create a hypoxic environment and therefore not activate type II fibres.

On the other hand, when using BFR bands, the type I fibres become hypoxic very quickly, exhausting themselves, kick-starting the activation of type II fibre and generating high levels of lactates. BFR is the type of training that will not only add solid muscle mass to your frame but also significantly increase your strength and endurance whilst reducing your body fat.

With age, there is a loss of microcirculation. The magic lies in the fact that BFR increases your microcirculation, involving your capillaries, venules and arterioles because your muscles are working in a hypoxic (low oxygen) environment. This low oxygen tension causes the release of hypoxia-inducible factor-1 alpha (HIF-1 alpha), that then increases the hormone vascular endothelial growth factor (VEGF). Essentially VEGF acts as “fertilizer” for growing new blood vessels and capillaries to your muscle stem cells.

So for an ageing population, BFR training goes beyond what conventional strength training with heavyweights can do. It increases microcirculation and reduces your risk of injury.

But it gets even better as VEGF not only increases microcirculation in your muscle stem cells but also in your brain and heart. 

BFR and lactate production.

BFR also downregulates a hormone called myostatin, which is an inhibitor of muscle growth and mass. This is particularly important as you age because myostatin levels can double those of a young person and it becomes significantly more difficult to increase muscle size and strength.  Amazingly, BFR can decrease your myostatin levels by 50% which has been shown to increase muscle protein synthesis. When you apply the bands and engorge the working muscle, the Type I muscle fibres get quickly fatigued with the lack of oxygen and rapidly switch to Type II fibres. Glycolysis, where lactate is produced, is the pathway that allows the Type II fibres to run on burning glucose without oxygen. In the past, lactate was traditionally viewed as a metabolic waste product, but today it is understood that lactate is an important and beneficial molecule. Once you release the bands, the lactate travels from your muscles and is released into your bloodstream to make its way to your brain, where it is used for fuel. Once the lactate reaches your brain it increases a powerful hormone called brain-derived neurotrophic factor (BDNF). BDNF is a member of brain growth factors that contribute to neuroplasticity, which greatly enhances cognitive performance.

BFR elastic bands
These BFR training bands are very economical and so easy use.

How to use the BFR bands

I have so far only used the elasticated band (5 cm wide) that you apply manually so my knowledge with KAATSU or other inflatable cuffs is only theoretical.

Remember, whatever bands you use, KAATSU or less expensive BFR bands, the pressure that the cuff is inflated or tightened to should not be painful or cause any numbness or tingling. They are not supposed to shut down your arterial supply. If it is too tight you need to lower the pressure or loosen the bands.

  • When manually applying the bands, tighten them so your skin colour becomes more pink or red compared to your normal skin tone.
  • They should not feel uncomfortable and your skin colour must not become whiter or have a bluish or greyish tone; this means that arterial flow is being restricted
  • A simple way to determine good “base pressure” is to have the bands tight enough that you cannot fit two fingers under the band, but loose enough that you CAN squeeze one finger under the band. 
  • Recent studies suggest that the ideal range is about 60% of AOP (Arterial Oxygen Pressure) and below 40% would not qualify as BFR training as it would not occlude your veins.
  • If the bands are too tight you can actually cause damage to your muscle.  When checking proper band pressure on your arm, it is most easily determined by pressing your index finger firmly into the palm of the opposite hand (on the arm that is under restriction) into the area just under your thumb, then quickly releasing and seeing how long the white area takes to turn pink. If it takes longer than three seconds, the bands are too tight.  Release the pressure and try again.
  • You must not conduct simultaneous BFR on both your arms and legs, as this could decrease your blood pressure.
  • Start using weights that are no more than 20% of your 1 Rep max.
  • With this weight, you should be able to do 30 reps x 3, with no more than 15 seconds rest between sets.
  • Just remember to remove the bands after 15 minutes on your arms and 20 minutes on your legs. 
  • Sweating profusely and a noticeable increase in heart and breathing rate is normal.
BFR training with kettelbells
BFR training with kettlebells

I am hooked on BFR training.

BFR training has been a godsend during the 2 and half months hard lockdown we had here in Spain. I was wearing the bands going up and down my staircase, running round and round in circles on the very small terrace rooftop, and exercising all my muscle groups with limited weights and space. I have seen noticeable improvements in muscle size, especially my biceps. My grip strength has also increased and according to recent studies, longevity and grip strength are closely related. Now on phase 2 of the lockdown, we are allowed to go and exercise outdoors, so I shall try the bands during my swimming sessions ( as per Dr Mercola recommendation)

It has tremendously helped my recovery from an old shoulder injury as well as a more recent one on my biceps.

I am 54 and this is one hack I want to carry on using to maintain my muscle size/strength for many years to come, at least until my 100th birthday.

My wife has bought a set as well and she wears them for her daily power walk.

To learn more check the following links

Dr Mercola’s pdf here.

Medical publication here.

More on grip strength study.

Brain-derived neurotrophic factor (BDNF)

DISCLAIMER; The material on this post is for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner, before undertaking the protocols, diet, exercises, techniques, training methods, or otherwise described herein. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained herein.  No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinicians.

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8 Replies to “What is Blood Flow Restriction Training?”

    1. Hi June, I am glad you found some answers to your questions. Thanks for your support and if I can help any further don’t hesitate to contact me. Take care. Best regards. Pedro

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