Blood flow restricted exercise and discomfort: a review

Review written by Dr Nicholas Rolnick info

Key Points

  1. Blood flow restriction (BFR) training produces higher levels of perceptual demand (discomfort, exertion and muscle pain) than the same exercise performed in free-flow.
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BACKGROUND & OBJECTIVE

Blood flow restriction (BFR) training involves low-load exercise (20-50% 1RM) with an application of a cuff or strap to the proximal limb to reduce blood flow to the limb. In doing so, greater muscle hypertrophy and strength gains can be achieved during resistance training in comparison to the same exercise performed in free-flow (given the exercise isn’t performed to volitional fatigue). It also provides a host of other benefits (e.g. cardiovascular capacity, muscular endurance, etc) depending on the exercise modality performed.

However, the tradeoff for these benefits is a consistently observed increase in perceptual demands (i.e. rate of perceived exertion, discomfort and muscle pain). A complicating factor in the BFR literature is the variety of ways that BFR training has been performed. For example, some studies utilize arbitrary pressures (i.e. 200mm Hg per person regardless of limb size), whereas others apply an individualized pressure.

Understanding how to mitigate excessive increases in perceptual demands can help with increasing patient adherence to a chronic training program. This review article synthesized the current body of evidence on what factors have been shown to influence perceptual demands, in order to guide rehab professionals on ways to minimize exercise-induced BFR training discomfort.

Blood flow restriction training involves low-load exercise (20-50% 1RM) with an application of a cuff or strap to the proximal limb.
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This paper supports the use of personalized pressures to help reduce excessive perceptual demands during BFR training, increasing the potential for long-term adherence.

METHODS

  • Authors searched “discomfort and blood flow restriction”, “pain and blood flow restriction”, “ischemic pain and blood flow restriction”, “perception and occlusion”, and “perception and blood flow restriction” on Google and PubMed.
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