Blood Flow Restriction Training: To Adjust or Not Adjust the Cuff Pressure Over an Intervention Period?

Mikhail Santos Cerqueira,Rafael Pereira,Eduardo Caldas Costa,Ricardo Santos Oliveira,Wouber Hérickson Brito Vieira

doi:10.3389/fphys.2021.678407

Abstract

Blood flow restriction (BFR) training combines exercise and partial reduction of muscular blood flow using a pressured cuff. BFR training has been used to increase strength and muscle mass in healthy and clinical populations. A major methodological concern of BFR training is blood flow restriction pressure (BFRP) delivered during an exercise bout. Although some studies increase BFRP throughout a training intervention, it is unclear whether BFRP adjustments are pivotal to maintain an adequate BFR during a training period. While neuromuscular adaptations induced by BFR are widely studied, cardiovascular changes throughout training intervention with BFR and their possible relationship with BFRP are less understood. This study aimed to discuss the need for BFRP adjustment based on cardiovascular outcomes and provide directions for future researches. We conducted a literature review and analyzed 29 studies investigating cardiovascular adaptations following BFR training. Participants in the studies were healthy, middle-aged adults, older adults and clinical patients. Cuff pressure, when adjusted, was increased during the training period. However, cardiovascular outcomes did not provide a plausible rationale for cuff pressure increase. In contrast, avoiding increments in cuff pressure may minimize discomfort, pain and risks associated with BFR interventions, particularly in clinical populations. Given that cardiovascular adaptations induced by BFR training are conflicting, it is challenging to indicate whether increases or decreases in BFRP are needed. Based on the available evidence, we suggest that future studies investigate if maintaining or decreasing cuff pressure makes BFR training safer and/or more comfortable with similar physiological adaptation.

Highlights

Exercise with blood flow restriction (BFR) has been widely implemented in recent years (Patterson et al, 2019) due to increases in strength and muscle mass following low-load resistance training
Considering the well-established effects of BFR training on neuromuscular adaptations (Hughes et al, 2017; Centner et al, 2019), we focused on possible association between Blood flow restriction pressure (BFRP) and cardiovascular adaptations induced by BFR training
An electronic search was conducted from inception to May 2021 on PubMed and Scopus databases to retrieve studies investigating the effects of BFR training on cardiovascular outcomes

Summary

Introduction

Exercise with blood flow restriction (BFR) has been widely implemented in recent years (Patterson et al, 2019) due to increases in strength and muscle mass following low-load resistance training. BFR is applied using a pneumatic cuff on the proximal aspect of the exercising limb This cuff blocks venous return and partially occludes arterial blood flow, inducing increased metabolic stress (Suga et al, 2009). It is known that BFRP needs to be individualized and adequate to limit muscle arterial blood flow partially with a recommended 40–80% of total restriction pressure (Patterson et al, 2019). Variables such as cuff width, limb circumference, ankle-brachial index, fat and muscle thickness, arterial stiffness, endothelial function, and blood pressure may influence BFRP (Loenneke et al, 2012, 2015; Hunt et al, 2016; Jessee et al, 2016; Bezerra de Morais et al, 2017). Doppler ultrasound (Bezerra de Morais et al, 2017), handheld Doppler (Laurentino et al, 2018), pulse oximetry (Zeng et al, 2019), and predictive equations (Hunt et al, 2016) have been proposed to adequately obtain and individually prescribe BFRP to maximize benefits and minimize discomfort/risks during BFR exercise (Singer et al, 2020; Spitz et al, 2020)

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