Blood Flow Restriction Training: Science and Application

Stephen Patterson, PhD is an Associate Professor in Applied Exercise Physiology & Performance and the director of the Centre for Applied Performance Sciences at St. Mary’s University in London. Stephen has published more than 60 scientific research papers investigating strategies to improve performance in clinical groups and elite athletes, with a focus on the adaptation and response to exercise. He is currently investigating the use of blood flow restriction and ischemic preconditioning before and during exercise.

On this podcast, Stephen discusses blood flow restriction (BFR) training, including what it is, how it works, and who can benefit from it.  He shares the importance of using cuffs and properly measuring the pressure they apply, as well as things to look for when purchasing a set. He also shares some conclusions drawn from recent BFR research, including the optimal number of reps, effects of BFR on bone and tendons, and the most important factor when aiming for muscle hypertrophy.

Here’s the outline of this interview with Stephen Patterson:

[00:00:24] Stephen's background and interest in exercise physiology.

[00:01:45] Blood flow restriction (BFR) training.

[00:02:45] Questions from Eric Helms, Mike T Nelson, and Greg Potter.

[00:03:16] Effects of BFR on athletic performance.

[00:05:32] BFR with aerobic exercise (cycling); Study: Christiansen, Danny, et al. "Cycling with blood flow restriction improves performance and muscle K+ regulation and alters the effect of anti‐oxidant infusion in humans." The Journal of physiology 597.9 (2019): 2421-2444.

[00:06:32] Why use BFR.

[00:07:54] The value of using cuffs.

[00:08:44] Use of BFR by practitioners; Study: Patterson, Stephen D., and Christopher R. Brandner. "The role of blood flow restriction training for applied practitioners: A questionnaire-based survey." Journal of sports sciences 36.2 (2018): 123-130.

[00:09:37] Jeremy Loenneke; Studies using elastic knee wraps: Loenneke, Jeremy P., et al. "The acute response of practical occlusion in the knee extensors." The Journal of Strength & Conditioning Research 24.10 (2010): 2831-2834, Loenneke, Jeremy P., et al. "Blood flow–restricted walking does not result in an accumulation of metabolites." Clinical physiology and functional imaging 32.1 (2012): 80-82.

[00:11:58] Delfi's Personalized Tourniquet System for Blood Flow Restriction.

[00:12:56] What to look for when purchasing a BFR system.

[00:13:03] B Strong; Podcast with Jim Stray-Gundersen MD: Blood Flow Restriction Training for Improved Strength, Performance, and Healthspan.

[00:20:58] Aerobic exercise and BFR; Study: Ferguson, Richard A., et al. "Blood‐flow‐restricted exercise: Strategies for enhancing muscle adaptation and performance in the endurance‐trained athlete." Experimental Physiology (2021).

[00:23:08] Protocol for hypertrophy.

[00:23:55] 75 reps is often a recommended volume; more is not better.

[00:28:17] Releasing the cuffs between exercises.

[00:28:42] Potential effects on endothelium; Study: Credeur, Daniel P., Brandon C. Hollis, and Michael A. Welsch. "Effects of handgrip training with venous restriction on brachial artery vasodilation." Medicine and science in sports and exercise 42.7 (2010): 1296.

[00:30:19] BFR compared to other forms of training.

[00:30:47] Lifting to failure more important that amount of weight lifted; Study: Burd, Nicholas A., et al. "Bigger weights may not beget bigger muscles: evidence from acute muscle protein synthetic responses after resistance exercise." Applied physiology, nutrition, and metabolism 37.3 (2012): 551-554.

[00:32:55] Effects on bone density.

[00:34:49] Japanese study in 2006 found no effect on tendon thickness: Abe, T., et al. "Muscle, tendon, and somatotropin responses to the restriction of muscle blood flow induced by KAATSU‐walk training." Equine Veterinary Journal 38.S36 (2006): 345-348.

[00:34:58] Recent German study showed positive effects on tendon stiffness: Centner, Christoph, et al. "Low-load blood flow restriction training induces similar morphological and mechanical Achilles tendon adaptations compared with high-load resistance training." Journal of Applied Physiology 127.6 (2019): 1660-1667.

[00:35:16] Case studies demonstrating structural tendon improvements: Skovlund, Sebastian V., et al. "The effect of low‐load resistance training with blood flow restriction on chronic patellar tendinopathy—A case series." Translational Sports Medicine 3.4 (2020): 342-352.

[00:36:09] Combining BFR with ischemic preconditioning.

[00:41:36] Motor unit recruitment.

[00:42:53] Further research coming up.

[00:44:50] Effects on cognitive function.

[00:45:45] David Raichlen podcast: Wired to Run: Why Your Brain Needs Exercise.

[00:46:18] St. Mary’s University MSc program in Strength and Conditioning.

[00:47:13] Stephen's recent review: Patterson, Stephen D., et al. "Blood flow restriction exercise: considerations of methodology, application, and safety." Frontiers in physiology 10 (2019): 533.

[00:47:22] Find Stephen on Twitter.