How to Do Blood Flow Restriction Training

Posted on by Jesse Santiano, M.D.

Blood flow restriction training or BFR is known initially as KAATSU. Yoshiaki Sato discovered it in Japan in the 1970s.

BFR is the application of a tight band around the upper arms or the thighs. The right application of a BFR band prevents the outflow of blood from the veins but should not limit the arterial blood’s inflow.

The application of the BFR, especially with physical activity, increases the lactic acid levels and growth hormone. These results in the growth of muscles.

BFR has several applications in sports and medicine. BFR is effectively used in physical rehabilitation after injuries and surgeries.

The elderly, in particular,  can benefit from BFR because they can achieve muscle growth can be obtained without the use of heavyweights.

What should I use for BFR?

The least expensive pneumatic KAATSU band is the KAATSU cycle that is $899.95 on their website. The advantage of using pneumatic bands is that the precise amount of time and pressure is calculated to prevent over-constriction.

Fortunately, studies have been done with elastic bands, which showed the same effect as the more expensive pneumatic ones.

Guidelines for Blood Flow Restriction Training

How often?  2-3 times weekly (>3 weeks) or 1-2 times per day (1-3 weeks)

How heavy?  – 20-40% 1 RM. 1 RM is the maximum weight that can be lifted with only one repetition. If the weight of a dumbbell that can be lifted only once is 20 lbs, then the 1 RM is 20. 20% of 20 if 4 lbs.

How long should the restriction bands stay?  – 5-10 minutes per exercise. It is recommended that the band is loosed between the sets to allow for reperfusion.

What extremities can be used? – Arms and legs/ unilateral or bilateral. The restriction bands should be applied to the nearest torso to maximize the muscle groups involved.

How wide is the cuff?  – 5 cm (small), 10 or 12 cm (medium), 17 or 18 cm (large)

Repetitions during BFR – (75 reps) divided into 30 x 15 x 15 x 15 or sets to failure. Failure, in this sense, means the inability to do another repetition due to muscle fatigue.

Rests between sets – 30-60 seconds

How fast should each repetition be? – 1-2 seconds (concentric and eccentric). Concentric is when the muscles contract. Eccentric is when the muscles elongate. In a biceps curl, the concentric is when the elbow are bent, and the eccentric is when the arms are straightened.

How tight should the bands be? Pneumatic bands come with instructions, and the pressure depends on the systolic blood pressure.

For elastic bands, one way is by using the level of pain. The tightness should be around seven out of ten pain scales, with 0 as no pain and ten being the most painful.

Another way is to measure the circumference of the band. This will be determined with bands that have numerical markings like below.

When purchasing elastic bands, spend the extra money to get the one with a buckle that flips like the one shown above. Other models are more challenging to apply. Some models require the band to be inserted twice in the buckle and require two hands to apply the right tightness. That may not be easy to do for some people.

Lastly, read the Precautions in KAATSU or Blood Flow Restriction Training. Certain population groups should not do BFR.

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References:

  • Patterson SD, Hughes L, Warmington S, et al. Blood Flow Restriction Exercise: Considerations of Methodology, Application, and Safety [published correction appears in Front Physiol. 2019 Oct 22;10:1332]. Front Physiol. 2019;10:533. Published 2019 May 15. doi:10.3389/fphys.2019.00533
  • Loenneke JP, Pujol TJ. The use of occlusion training to produce muscle hypertrophy. J Strength Cond. 2009;31:77–84. []
  • Loenneke JP, Balapur A, Thrower AD, Barnes J, Pujol TJ. Blood flow restriction reduces time to muscular failure. Eur J Sports Sci. 2012a;12:238–243. []
  • Wilk M, Krzysztofik M, Gepfert M, Poprzecki S, Gołaś A, Maszczyk A. Technical and Training Related Aspects of Resistance Training Using Blood Flow Restriction in Competitive Sport – A Review. J Hum Kinet. 2018;65:249-260. Published 2018 Dec 31. doi:10.2478/hukin-2018-0101

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