Blood Flow Restriction Training

Here's what you need to know...

Blood flow restriction training involves wrapping a restrictive implement around

the limbs while lifting. Studies show increases in muscle growth when low-load
lifting is combined with flow restriction.

You don't need costly implements to perform BFR. Elastic knee wraps will do.

The best approach is to use this as a "finishing" technique. Perform a moderate to

heavy-load hypertrophy protocol first in a session and then finish up with several
sets of BFR training using single-joint movements.

Resistance training articles often explore variations on the same old theme. That's
because there just aren't many new techniques to report on... at least few that actually
work. Occasionally, though, there are exceptions. If you've been searching for a novel
way to ramp up muscle growth, here's a strategy that you might not have considered
blood flow restriction (BFR) training.
BFR isn't really a new technique. It's been used for years in Japan and research on the
topic dates back to the 90's. Despite emerging evidence of its effectiveness, most lifters
have only a vague idea of what BFR involves and how it can be applied within a
resistance-training program to enhance results.

BFR Basics
BFR entails occluding circulation of the working muscle. This is accomplished by
wrapping a restrictive implement around the limb(s) while carrying out dynamic exercise.
The objective of BFR is to occlude venous flow without significantly affecting arterial
circulation. In this way, blood goes into the muscle but can't escape.
Research on the hypertrophic effects of BFR is compelling. Studies show that simply
occluding blood flow to bedridden patients can prevent atrophy and weakness, without
performing any training at all (1)!
Moreover, walking with blood flow restricted to the legs not exactly your classic
muscle-building activity has been found to significantly increase muscle strength and
size (2). But the real hypertrophic benefits of BFR occur when it's applied in concert with
resistance exercise.
Numerous studies show substantial increases in muscle growth when low-load lifting
(~20-30% 1RM) is combined with flow restriction (3). Gains are often on par with
traditional heavy-load training during early-stage training, sometimes even greater.

How Does BFR Increase Hypertrophy

What is the "magic" behind BFR? The exact hypertrophic mechanisms aren't entirely
clear but it's believed that metabolic stress plays an important role in the process. Simply
stated, metabolic stress is the buildup of training byproducts called metabolites, and is
particularly prevalent when training is carried out in an oxygen-limited state, as is seen
when circulation is restricted. Metabolites implicated in promoting a hypertrophic
response include lactate, inorganic phosphate, and hydrogen ions.

These byproducts are theorized to enhance anabolism by a variety of mechanisms,

including mediating the release of growth factors, reactive oxygen species, and cell
swelling, and/or systemic agents. Alone or in combination, the production of metabolites
drive cellular signaling in a manner that enhances protein synthesis and satellite cell
activation key elements needed for muscle growth (4).

What Should You Use to Wrap?

Well-controlled BFR studies use a variety of pneumatic cuffs and belts to occlude flow.
These devices are usually inflatable to a given pressure so that researchers can
standardize the amount of occlusion applied to the limb (usually based on systolic blood
pressure and set at anywhere from 160-200 mm/Hg). The problem is the cuffs used in
research are quite expensive, in some cases costing thousands of dollars.
Fortunately you don't need costly implements to perform BFR good old elastic knee
wraps do the trick very nicely (5). The wraps must be long enough to circle your limb
several times. However, that's the only requirement; the brand or type of material really
doesn't matter.
Placement of the wraps is crucial. You must position them as high as possible on the
limbs being trained. For the upper arms, they should be wrapped as high on the biceps as
you can get. For the thighs, they should be wrapped just beneath the gluteal fold.
If the wraps are positioned too low, you won't achieve optimal venous occlusion and the
beneficial effects of the strategy will be compromised.

How Tight Should You Wrap?

The goal should be to secure the wraps so that they're snug on the limb but not to the
point where there's excessive discomfort at rest. On a scale from 1-10, pressure should be
about a 7 or so. It generally takes some practice to accurately quantify the pain-pressure
connection, but after a few sessions you should have a clear sense of just how tightly to
wrap.
It's important to remember that the purpose of BFR is to impede venous return, not
arterial flow into the muscle. Wrap too tightly and all local circulation becomes occluded.
This increases the perceived exertion of the exercise with a corresponding reduction in
total training volume. And if there's one thing that's clear in the literature, higher exercise
volumes are positively associated with increases in hypertrophy.
Cuff width also is an important consideration. Research shows that a wide cuff cuts off
arterial circulation at a lower pressure than narrower cuffs (6), thereby impairing your
ability to resist fatigue. It should therefore come as no surprise that the use of a wide cuff
during BFR has been found to reduce the extent of hypertrophy (7).
The best solution is to aim for a width of a couple of inches or so, which is approximately
the size of most knee wraps. From a practical standpoint, this means you should bind the
wraps as closely over one another as possible so there's maximum overlap.

Integrating BFR into Your Routine

In the vast majority of studies, BFR has been carried out in isolation so that it's the sole
training stimulus used over the course of a given research protocol. Training in this

fashion may be okay for elderly individuals or those rehabbing from an injury, but if
you're an experienced lifter, doing just BFR training alone isn't going to cut it. Your best
results are achieved by integrating the technique into a traditional hypertrophy training
program.
There are a number of different ways to go about incorporating BFR into your workout
regimen. After much experimentation, the best approach I've found is to use it as a
"finishing" technique. This involves performing a moderate to heavy load hypertrophy
protocol first in a session and then finishing up with several sets of BFR training.
Here are the specifics. Although BFR can be employed with pretty much any exercise, it
seems to work best with single-joint movements. Biceps curls, triceps pressdowns, leg
extensions, etc., are all excellent choices here. Perform multi-joint exercises such as
squats, rows, and pressing movements in the traditional fashion.
The weights used during BFR should be light. As a rule, keep the loads at ~20-30% of
1RM for a given exercise. Combined with occlusion, you should get about ~20-25 reps
on the first set.
Thereafter, perform a few additional sets of the chosen exercise while keeping rest
periods at about 30 seconds or so. The short rest interval helps to heighten metabolic
stress and pooling of blood in the working muscle. It also necessarily reduces the number
of reps you're able to perform on successive sets.
By the final set, assuming you maintain the same load, you'll probably only get around 810 reps. That's okay. As long as you follow the protocol as described, you'll achieve
optimal anabolic benefits.
It's also important to keep the limbs continually restricted for the duration of the exercise.
Research shows that untying the wraps between sets significantly reduces metabolic
stress, thereby inhibiting the growth stimulus (8). Remove the wraps only after you've
finished the final BFR set. Do it right and you'll get a skin-splitting pump like you've
never experienced in your life.
At least some of your sets should be taken to the point of muscular failure. Understand,
however, that going to failure in BFR requires a different mindset than during traditional
resistance exercise.
With BFR your limbs get heavier with each successive rep. After a point, you'll feel as
though they simply can't move. This is where mental fortitude comes into play. Because
the loads are so light, you can will yourself to push through the sensation and pump out a
few additional reps. Dig deep and squeeze out every last rep possible. Ultimately this is
how you maximize metabolite accumulation and its associated anabolic response.

Final Thoughts
Integrating BFR into your training can really ramp up your muscular gains. With
continued implementation into a well-designed resistance training program, it may well
be the strategy that takes your muscular development to new heights.