Cuff Type Research Articles

Blood Flow Restriction Training: Physiological Effects, Molecular Mechanisms, and Clinical Applications

Blood flow restriction is a form of training that partially restricts blood flow to the exercising muscles. This mechanism is achieved by placing a tourniquet on the proximal areas of the upper or lower limbs. Given the great popularity that this type of training has had in various parts of the world and in multiple disciplines, the aim of this text is to elucidate the physiological effects, molecular mechanisms, mode of use, clinical applications, contraindications and precautions of blood flow restriction training. This form of training has multiple physiological effects on the endothelial, endocrine, muscular and cognitive systems. These effects are mediated by the dimerization of hypoxia-inducible factors that take place in hypoxic environments. Aspects such as cuff type, occlusion pressure and exercise dosage are of vital importance to achieve beneficial effects and to avoid adverse events. Since this training allows gains in strength and muscle mass using low training loads, it could be an effective tool for those users who, due to health conditions, cannot exercise using high loads.

The Fifth Bioelectronic Medicine Summit Hosted by the Feinstein Institutes for Medical Research (Manhasset, NY) and Columbia Engineering (NY, NY) at The Garden City Hotel, Garden City, NY 11530 on October 11-12th, 2022- Bioelectronic Medicine: Today’s Tools, Tomorrow’s Therapies

The Fifth Bioelectronic Medicine Summit Hosted by the Feinstein Institutes for Medical Research (Manhasset, NY) and Columbia Engineering (NY, NY) at The Garden City Hotel, Garden City, NY 11530 on October 11-12th, 2022- Bioelectronic Medicine: Today’s Tools, Tomorrow’s Therapies

Differences in the limb blood flow between two types of blood flow restriction cuffs: A pilot study.

Introduction: The determination of the optimal occlusion level is a key parameter in blood flow restriction (BFR). This study aimed to compare the effects of elastic (BStrong) vs. nylon (Hokanson) BFR cuffs on blood flow in the lower and upper limbs. Methods: Eleven healthy participants undertook several BFR sessions with 2 different cuffs of similar width on their lower and upper limbs at different pressures [200, 250, 300, 350, and 400 mmHg for BStrong and 0, 40, and 60% of the arterial occlusion pressure (AOP) for Hokanson]. Doppler ultrasound recorded blood flows through the brachial and femoral artery at rest. Results: With BStrong, only 350 and 400 mmHg pressures were significantly different from resting values (0% AOP). With Hokanson, both 40% and 60% of the AOP were significantly different from resting values (p < 0.05). Discussion: While both cuffs elicited BFR, they failed to accurately modulate blood flow. Hokanson is appropriate for research settings while BStrong appears to be a convenient tool for practitioners due to its safety (i.e., the impossibility of completely occluding arteries) and the possibility of exercising freely detached from the pump.

A Practical Application of Blood Flow Restriction Exercise

Exercise with blood flow restriction (BFR) is emerging as an effective training option to increase muscle size and strength, in healthy, clinical, and athletic populations. However, the need for specialized equipment and associated costs present a major barrier to its accessibility. The purpose of this study was to develop a practical method to implement BFR in the lower body using a thigh sphygmomanometer. Specifically, we aimed to 1) explore what factors should be accounted for when setting pressures with this type of restrictive cuff and 2) generate both a lab‐based and field‐based prediction equation to estimate arterial occlusion pressure (AOP). We hypothesized that measures of limb size and blood pressure would constitute significant predictors of lower body AOP. We also hypothesized that a multiple linear regression model including significant predictors would explain approximately 50% of the variance in AOP. Thirty‐eight normotensive healthy adults (age: 24±5 yrs, BMI: 25±4) visited the laboratory for one testing session. Brachial and femoral systolic (SBP) and diastolic (DBP) blood pressures were taken in the seated position. Next, thigh circumference, muscle thickness of the anterior thigh, and maximal isometric knee extension strength was assessed. Lean thigh volume was estimated using anthropometric measures. Lastly, lower body AOP was assessed in the seated position using an 18cm wide thigh sphygmomanometer and Doppler ultrasound (156±12 mmHg). A multiple linear regression analysis including brachial and femoral SBP and DBP, thigh circumference, muscle thickness, lean thigh volume, and maximal isometric knee extension strength was performed to assess which variables constituted significant predictors of AOP. Regression analysis was then repeated with only significant variables to generate both a lab‐based and field‐based prediction equation for AOP. Thigh circumference (β = 0.322, part = 0.876), brachial SBP (β = 0.362, part = 0.463) and isometric knee extension strength (β = 0.421, part = 0.076) constituted significant predictors of AOP. A lab‐based model including thigh circumference (β=0.278, part = 0.754), brachial SBP (β=0.492, part = 0.549), and isometric knee extension strength (β=0.306, part = 0.055) explained 56% of the variance in AOP. A field‐based model including only thigh circumference (β=0.316, part = 0.857) and brachial SBP (β=0.515, part = 0.658) explained 47% of the variance in AOP. Our results indicate that thigh circumference, brachial SBP, and isometric knee extension strength serve as predictors of AOP in the lower body when utilizing an 18cm wide sphygmomanometer as a restrictive cuff. Further, a field‐based prediction equation including thigh circumference and brachial SBP offers a practical way to estimate AOP. Future work will build upon this prediction equation by utilizing subjective measures of cuff tightness, effort, and muscle pain to further adjust exercising cuff pressures to an appropriate level. Results will help to provide researchers and practitioners with a practical way to implement BFR without the need for specialized equipment.

Investigating the inaccuracies of indirect method of blood pressure measurement associated to the cuff constructing fabrics

Numerous cuffs have been manufactured using different materials in which textile fabric is the main constituent. There are no specific guidelines for the selection of the cuff fabric and its design. In this investigation, five different types of cuffs (made of woven and non-woven fabrics) were selected, and their pressure distribution was noted while mimicking the process of blood pressure measurement. It was achieved by measuring pressure at the interface of the selected cuffs and a bare metal cylinder. I-scan, an interface pressure measurement system was employed to record the interface pressure profiles under the cuffs against 140 mmHg to 40 mmHg pressure inside the cuffs. The data obtained from the pressure sensing system was processed in MATLAB to examine pressure distribution at 96 points in detail. The results show that the cuffs registered non-uniform pressure distribution at the interface which is also non-identical among the selected cuffs. The pressure at the interface is found to be lower than the pressure inside the cuff, which shows that pressure attenuates as transfers to the surface of the object underneath it. The range of the pressure difference varies from 10 mmHg to 15 mmHg. This study indicates that the pressure distribution under a cuff depends on the constructing fabric and its properties. It is concluded that there is a need to select appropriate fabric with optimized properties for desired pressure distribution which may lead to accurate estimation of blood pressure.

The Evolution of Blood Flow Restricted Exercise.

The use of blood flow restricted (BFR) exercise has become an accepted alternative approach to improve skeletal muscle mass and function and improve cardiovascular function in individuals that are not able to or do not wish to use traditional exercise protocols that rely on heavy loads and high training volumes. BFR exercise involves the reduction of blood flow to working skeletal muscle by applying a flexible cuff to the most proximal portions of a person’s arms or legs that results in decreased arterial flow to the exercising muscle and occluded venous return back to the central circulation. Safety concerns, especially related to the cardiovascular system, have not been consistently reported with a few exceptions; however, most researchers agree that BFR exercise can be a relatively safe technique for most people that are free from serious cardiovascular disease, as well as those with coronary artery disease, and also for people suffering from chronic conditions, such as multiple sclerosis, Parkinson’s, and osteoarthritis. Potential mechanisms to explain the benefits of BFR exercise are still mostly speculative and may require more invasive studies or the use of animal models to fully explore mechanisms of adaptation. The setting of absolute resistive pressures has evolved, from being based on an individual’s systolic blood pressure to a relative measure that is based on various percentages of the pressures needed to totally occlude blood flow in the exercising limb. However, since several other issues remain unresolved, such as the actual external loads used in combination with BFR, the type of cuff used to induce the blood flow restriction, and whether the restriction is continuous or intermittent, this paper will attempt to address these additional concerns.

A simulation study to assess fluid leakage through the glove-gown interface in isolation settings

Isolation gowns are recommended to protect healthcare personnel, patients, and visitors from transfer of microorganisms and body fluids in patient isolation situations. Standards provide limited information about barrier performance of isolation gowns for possible exposure scenarios. One of the most vulnerable areas of the personal protective equipment ensemble is considered the glove-gown interface. However, current isolation gown classification standards do not consider the interface regions of the personal protective equipment system while assessing the level of protection. The purpose of this study was to quantitatively evaluate the fluid leakage through the glove-gown interface by simulating exposures and healthcare personnel arm movements in patient care for isolation settings. We tested fluid leakage of two examination gloves with different cuff lengths and seven isolation gown models designed with varying levels of barrier resistance and multiple cuff types. Our results demonstrated that leakage through the glove-gown interface depends on multiple factors, including glove cuff length and gown cuff design. Gowns with the thumb loop design provided better protection than the elastic cuff design, and the elastic cuff design provided better protection compared to the knit cuff design for a given AAMI PB70 level. More importantly, a substantial penetration through gown fabrics was observed. This research identifies a need to develop a standardized method to evaluate leakage at the glove-gown interface to improve worker protection.

Prevalence of hypercementosis and frequency of possible etiological factors in a Turkish subpopulation.

The aim of this study was to investigate the prevalence and types of hypercementosis and the frequency of possible etiological factors in a large sample of Turkish central Anatolian population. A cross-sectional study was performed using panoramic radiographs of 1176 randomly selected adult patients with an age range of 18-96 years, who presented to the Department of Oral and Maxillofacial Radiology of the Faculty of Dentistry, Cumhuriyet University (Sivas, Turkey) for dental care. Patients were questioned about the presence of systemic diseases. Panoramic radiographs of the patients were examined for the presence and types of hypercementosis (diffuse, focal and shirt sleeve cuff) and the frequency of local factors that may be associated with hypercementosis. Chi-square and t-tests were used for statistical analysis. Hypercementosis was detected in 128 of 1176 patients. In total, 85.6% of the teeth with hypercementosis had a diffuse, 7.5% had a focal, and 6.8% had a shirt sleeve cuff type. Hypercementosis was observed most frequently in the mandibular (P < 0.05) and the premolar region. Gender-related differences were nonsignificant (P > 0.05). Atherosclerosis, osteoporosis, and multiple diseases were reported more frequently in individuals with hypercementosed teeth (P < 0.05). While idiopathic origin (39.3%), bruxism (30%), and inflammation (24.37%) were the most prevalent local etiological factors, impacted teeth (1.25%) and history of trauma (0.62%) were less common. The prevalence of hypercementosis was 10.8% in the study population. The lesions were more common in the mandibule. Idiopathic origin was the most common factor associated with hypercementosis.

P0411 / #1109: IS TRACHEAL TUBE CUFF ASSOCIATED WITH POST EXTUBATION STRIDOR IN PEDIATRIC SUBJECTS?

Aims & Objectives: to describe association of PES with cuffed tracheal tube use and related factors in pediatric subjects connected to MV more than 12 hours. Methods: Observational prospective study. Eighty-one intubated subjects admitted to PICU at University Hospital were follow after 12 hours of MV until 48 hours after extubation in order to found PES. Cuff volume and pressure inflation values with minimum volume occlusive test (MVOT) were measure two times by day until extubation. Main outcome was PES occurrence after 48 hours post extubation. Association of PES and cuff was estimate by logistic regression. Cuff volume and pressure relationship, ventilator associate pneumonia (VAP) compared with previous years, and extubation failure with PES association were studied. Results: Cuff use was 64.2%, median age 4 (2; 12) months, MV hours 72 (41-118) hours, and PES occurred in 9.8%. There was no association between cuff use and PES (OR 4.36 [95%CI 0.51 to 37.31; p-value= 0.179]). Both types of cuff were no associated with PES. No other clinical values were associated with PES. Moderate relation between volume and pressure was observe in both types of cuff. No significant differences observed in VAP incidence (VAP= 0) compared with previous years. Conclusions: Cuffed tracheal tube is not associated with PES. Cuff use were not associate with extubation failure nor VAP. Other variables derived from cuff use and other recorded clinical variables were not associate with PES.

Arthroscopic removal of arch-shaped rotator cuff calcifying tendinitis without rotator cuff repair and acromioplasty is an excellent treatment regarding pain relief and function

The aim of this study is to evaluate clinical outcome for arthroscopic removal of calcium deposit without acromioplasty and rotator cuff repair for patients with ultrasound-diagnosed arch-shaped calcifying tendinitis of the rotator cuff (type I), homogenic (x-ray) with chronic pain. We retrospectively reviewed 50 patients with homogenous, arch-shaped calcifying tendinitis, suffering from chronic pain and who underwent arthroscopic treatment and 50 patients with the same type of tendinitis treated conservatively. All patients had calcium deposit located in supraspinatus tendon, pre-operatively and post-operatively evaluated by ultrasound. Clinical outcome was assessed by using Quick DASH, UCLA, and VAS score. There were 29 male and 71 female patients; none had bilateral involvement. We divided patients into group A-operatively treated-and group B-conservatively treated-by shock wave therapy. Patients from group A had higher improvement of all used tests, QDash (from 19.3 to 2.7), UCLA (from 10 to 34), and VAS score (from 3 to 0) when compared with group B. Patients with arch-shaped calcium deposits and acoustic shadow have better results after arthroscopic treatment than the conservative one. There was no need for acromioplasty or tendon repair. The lack of performing the same did not have any impact on the post-operative rehabilitation and recovery.

Comparison of the Effectiveness of Ultrasound-Guided Prolotherapy in Supraspinatus Tendon with Ultrasound-Guided Corticosteroid Injection of Subacromial Subdeltoid Bursa in Rotator Cuff-Related Shoulder Pain: A Clinical Trial Study.

Background:Shoulder pain is the third most common type of musculoskeletal disorder and rotator cuff (RC) tendinopathy is the most frequent diagnosis. Ultrasound is the most preferable guidance tool for diagnostic and interventional purposes. The aim of this study is to compare the effectiveness of the prolotherapy injection with corticosteroid injection in patients with RC dysfunction.Materials and Methods:Thirty to sixty-five-year-old patients with chronic RC disease were divided into two groups. Ultrasound-guided dextrose prolotherapy of supraspinatus tendon was done for one group and ultrasound-guided corticosteroid injection in the subacromial bursa was done for the other groups. Visual analog scale (VAS) and Shoulder Pain and Disability Index (SPADI) were evaluated for both groups at baseline, 3 and 12 weeks after injections.Results:Thirty-three patients were included in the result. Both the groups showed significant improvement in VAS and SPADI scores in 3 and 12 weeks after injections compared with preinjection times with no difference between two groups neither in 3 weeks nor in 12 weeks after injections.Conclusion:Both ultrasound-guided dextrose prolotherapy and CS injections are effective in the management of RC-related shoulder pain in both short-term and long-term with neither being superior to the other. Therefore, prolotherapy may be a safe alternative therapy instead of corticosteroid injection due to lack of its side effects.

Techniken zur Bestimmung von Parametern für die elektrische Personenwarnung

Methods for the determination of parameters for the electrical warning of persons Objectives: The aims of this publication are to present the main findings of research into the development of a wearable system for electrical warning, identify the current challenges and introduce the next research objectives. Methods: A basic study (n = 81) with self-adhesive electrodes on the right upper arm was used to investigate the influence of pulse width, electrode size and electrode position on perceived thresholds as well as qualitative and spatial perception. Varying textile cuff types were developed and tested. The suitability of varying support materials and textile electrodes was investigated with regard to adaptability, comfort, electrical conductivity, DC resistance and traction elastic behaviour. The textile and self-adhesive electrodes were compared with regard to thresholds as well as qualitative and spatial perceptions (n = 30). Results: Practical parameter sets of the thresholds (perception, attention, intolerance) were determined for various pulse widths, electrode sizes and positions. The dominant qualitative perceptions were “Knocking” (perception and attention threshold) and “Muscle twitch” (intolerance threshold). The spatial perception was located at the stimulation area. The resulting textile cuff contains a knitted fabric with electrically conductive surfaces and a layer of an electrically conductive silicone compound. The comparison between textile and self-adhesive electrodes showed no differences regarding thresholds and qualitative and spatial perceptions. The impedance of the textile electrodes was (1.5 to 3 times) higher than that of the self-adhesive electrodes. Conclusions: Future studies will investigate the influences of working conditions, climatic conditions, age, gender and skin properties. The further development of the textile cuffs is focused on the improvement of the contact between electrode and skin to optimise the transition impedance. Keywords: electric stimulation – electrode – TENS – smart textile – wearable

Simulation Models Predicting Pressure Distribution and Transmission underneath Blood Pressure Cuffs of Different Types

Inflatable cuffs of different types are used for the measurement of blood pressure using the indirect method. It is crucial to find pressure distribution and transmission underneath different types of blood pressure measurement cuffs for estimating accurate values of blood pressure. In this study, three simulation models are developed mimicking blood pressure measurement through three cuffs constructed using fabrics that have dissimilar geometric and mechanical properties. Finite element analysis (FEA) is carried out to predict pressure distribution and transmission underneath these cuffs. For validation of these models, an arm simulator was developed. The models provide good agreement with the experimental results. The pressure distribution at the interface of the selected cuffs and arm is not identical.

Short-Term Blood Flow Restriction Increases Power Output and Bar Velocity During the Bench Press.

Wilk, M, Krzysztofik, M, Filip, A, Zajac, A, Bogdanis, GC, and Lockie, RG. Short-term blood flow restriction increases power output and bar velocity during the bench press. J Strength Cond Res 36(8): 2082-2088, 2022-This study examined the effect of blood flow restriction (BFR) with 2 different types of cuffs on peak power output (PP), mean power output (MP), peak bar velocity (PV), and mean bar velocity (MV) in the bench press exercise (BP). Fourteen healthy strength-trained male athletes (age = 27.6 ± 3.5 years; body mass = 84.1 ± 8.0 kg; height = 175.8 ± 6.7 cm; BP 1 repetition maximum [RM] = 138.6 ± 17.8 kg) performed 3 different testing protocols as follows: without BFR (NO-BFR), BFR with a narrow cuff (BFR NARROW ), and BFR with a wide cuff (BFR WIDE ) in a randomized crossover design. During all sessions, subjects performed one set of 3 repetitions of the BP exercise using 70% 1RM. Cuff pressure was set to approximately 90% full arterial occlusion pressure of the upper limb at rest. Analyses of variance showed an increase in PP (by 21%, p < 0.01; effect size [ES] = 1.67), MP (by 16%, p < 0.01; ES = 0.93), PV (by 22%, p < 0.01; ES = 1.79), and MV (by 21%, p < 0.01; ES = 1.36) during BFR WIDE compared with NO-BFR and a significant increase in PP (by 15%, p < 0.01; ES = 1.07), MP (by 17%, p < 0.01; ES = 0.78), PV (by 18%, p < 0.01; ES = 1.65), and MV (by 13% p < 0.01; ES = 1.00) during BFR WIDE compared with BFR NARROW . There were no significant differences in any of the variable between NO-BFR and BFR NARROW . The results of the study indicate that short-term BFR training increases power output and bar velocity during the BP exercise. However, only BFR WIDE significantly influenced bar velocity and power output, which indicates that the width of the cuff is a critical factor determining acute exercise adaptation during BFR resistance training.

Blood pressure estimation based on pulse rate variation in a certain period

Availability of daily continuous blood pressure (DCBP) has a strong impact to realization of healthy society. However, existing methods to obtain blood pressure of cuff type and cuff-less types utilizing correlation with pulse waveform, pulse transit time or pulse rate; or computation of circulation model are not suitable to obtain DCBP. Here we implemented a method based on a simple circulatory system model using pulse rate measurement to overcome the limitations, and showed that it provides appropriate estimation of DCBP. The present model consists of a circulatory dynamic system model and an inverse model of a circulatory control system with input of pulse rate and six model parameters representing standard pulse rate, elasticity of systemic arteries, peripheral vascular resistance, and characteristics of resistance and stroke volume control. Validity of the DCBP estimation method was examined by preliminary experiment for one subject in four days and that for four subjects in one day. DCBP estimation was performed with 24-hour pulse rate measurement by a wearable device and sphygmomanometer measurement for parameter determination and verification. Mean absolute errors in systolic/diastolic pressures were appropriate ones for preliminary experiments with 9.4/6.4 mmHg in four days and 7.3/5.9 mmHg in five subjects.

Efficiency of Pneumatic Tourniquet Cuff With Asymmetric Pressure Distribution at Rest and During Isometric Muscle Action

Ipavec, M, Grapar Žargi, T, Jelenc, J, and Kacin, A. Efficiency of pneumatic tourniquet cuff with asymmetric pressure distribution at rest and during isometric muscle action. J Strength Cond Res 33(9): 2570-2578, 2019-The aim of this study was to compare effects of newly designed double-chamber cuff with asymmetric pressure (APC) distribution and standard single-chamber cuff with symmetric pressure (SPC) distribution on muscle perfusion and volitional activation. First, the 2 cuffs were compared bilaterally on resting thigh muscles of 17 healthy volunteers at 4 cuff pressures (120, 160, 200, and 240 mm Hg). Then, the subjects performed the isometric endurance test of knee extensor muscles to volitional failure at 40% of maximal volitional isometric action in both free-flow and blood flow restricted condition. Changes in hemoglobin kinetics in vastus lateralis muscle (near-infrared spectroscopy), surface electromyography of vastus medialis muscle, and pain intensity (visual analogue scale [VAS]) were continuously recorded. At rest, a significant difference (p = 0.009) in velocity of change in total hemoglobin concentration was noted between the cuffs at 160 mm Hg (APC = 0.028 μM·s and SPC = 0.056 μM·s). The VAS scores significantly increased (p = 0.031) at pressures ≥200 mm Hg, with no difference between the cuffs. Duration of isometric action with blood flow restriction was 12% shorter (p = 0.003) than in free-flow condition, with no difference between the cuffs. There were no significant differences in muscle activation or hemoglobin kinetics between the exercise conditions or cuff types. The results show that APC reduces blood flow in quadriceps femoris muscle at rest at lower pressure than SPC, which suggests its enhanced efficiency for blood flow restriction. Given that application of either type of cuff during sustained isometric action had only minor impact on muscle endurance and oxygen kinetics, future research must focus primarily on dynamic muscle actions.

The Exercise Response In Blood Flow Restriction Training Varies As A Function Of Cuff Type

The Exercise Response In Blood Flow Restriction Training Varies As A Function Of Cuff Type

K-Y\u2122 jelly inhibits increase in endotracheal tube cuff pressure during nitrous oxide exposure in vitro

BackgroundThe increase in endotracheal tube cuff pressure due to nitrous oxide diffusion is a well-known risk during general anesthesia using nitrous oxide. We hypothesized that lubricating endotracheal tube cuffs with K-Y™ Jelly might inhibit the increase in cuff pressure that occurs during exposure to nitrous oxide.MethodsWe used two types of endotracheal tube cuffs: one made from ultrathin polyurethane (PU) and another made from conventional polyvinyl chloride (PVC). Using a pediatric trachea model, which consisted of an acrylic cylinder with an internal diameter of 12 mm, we measured changes in the cuff pressure during nitrous oxide exposure in size 5.0-mm internal diameter endotracheal tubes with each type of cuff, with and without lubrication with K-Y™ Jelly.ResultsDuring nitrous oxide exposure, the increase in cuff pressure was significantly lower in the lubricated cuffs than in the non-lubricated cuffs in both types of cuffs (PVC, P < 0.0001; PU, P < 0.0001). However, the cuff compliance in the trachea model was unaffected by lubrication in both types of cuffs.ConclusionsLubrication of endotracheal tube cuffs with K-Y™ Jelly may effectively delay the increase in cuff pressure that occurs during general anesthesia using nitrous oxide.

Mechanisms of Blood Flow Restriction: The New Testament

When restricting blood flow for the purpose of increasing or maintaining muscle fitness, the aim is to reduce the amount of arterial flow into the limb and restrict the venous flow out of the limb. Doing so has been shown to elicit positive adaptations with regards to skeletal muscle size, and strength, while some evidence also eludes to beneficial effects on vascular and bone tissue. Regarding skeletal muscle, the main benefits of blood flow restriction are the ability to stimulate increases in size and strength while avoiding the greater mechanical stress associated with traditional high-load resistance training, and the greater volumes required when exercising with low loads to failure. While the most robust benefits are observed following blood flow restriction during low-load resistance training, evidence suggests positive adaptations occur while restricting blood flow during low-intensity aerobic exercise, and perhaps even during periods of disuse in the absence of exercise. Although the exact mechanisms are unclear, most of the evidence seems to allude to cell swelling and metabolite-induced fatigue during exercise stimulating synthetic pathways that can lead to muscle growth. While the blood flow restriction stimulus has been shown to be relatively safe for participants, the practitioner should be cognizant of the relative pressure being applied to the underlying tissue. This is important as cuff type, cuff width, and limb circumference can all influence the restrictive stimulus. Therefore, to ensure a similar, safe stimulus all variables should be accounted for.

The Application of Blood Flow Restriction: Lessons From the Laboratory.

Blood flow restriction by itself or in combination with exercise has been shown to produce beneficial adaptations to skeletal muscle. These adaptations have been observed across a range of populations, and this technique has become an attractive possibility for use in rehabilitation. Although there are concerns that applying blood flow restriction during exercise makes exercise inherently more dangerous, these concerns appear largely unfounded. Nevertheless, we have advocated that practitioners could minimize many of the risks associated with blood flow-restricted exercise by accounting for methodological factors, such as cuff width, cuff type, and the individual to which blood flow restriction is being applied. The purpose of this article is to provide an overview of these methodological factors and provide evidence-based recommendations for how to apply blood flow restriction. We also provide some discussion on how blood flow restriction may serve as an effective treatment in a clinical setting.