Protocols for BFR: importance and outcomes

Blood flow restriction (BFR) training has emerged as a valuable tool for performance and recovery. Therefore, selecting the most beneficial protocols for BFR to target your training goals is important. Traditionally for muscle mass and strength gains, resistance training must be done with heavy loads. However, the application of BFR promotes improvements with low/light loads. Therefore, you are able to train at lower intensities but still benefit! For that reason, being able to select the most beneficial and appropriate protocols for BFR is important.

Outcomes of BFR:

Reduce fatigue
Maintenance of strength and power
Enhance recovery

Once the cuff is set up and in place (correct positioning is important!) you're ready to train. Then - lots of different protocols can be implemented into your training session or programme. In order to compliment your training goals, these protocols should be specific and tailored. For example: performance or recovery, active or passive, endurance or strength? Almost any exercise used to build muscle mass and strength can be used in combination with BFR. Same goes for exercise used to improve endurance capacity. Amazingly, research also shows that BFR can be used passively. So not just during exercise but sitting at home on your sofa. The adaptations revolve around:

Promoting blood flow to muscles
Reducing inflammation
Inducing protein synthesis

Therefore, BFR can aid recovery after a heavy training day - reducing Delayed Onset of Muscle Soreness (DOMS). Everyone hates DOMS!

Protocols for BFR:

BFR is typically a single joint exercise modality for strength training or low-level cardio exercise. And so the protocol must fit with the exercise modality AND intensity. From a clinical/research and a practical application there are common protocols that appear over and over. The majority are strength/resistance training based. Such as the '30/15/15/15' protocol. However, there are more protocols emerging for aerobic based exercise. So let's break them down...

Strength

'30/15/15/15' protocol (Abe, 2005)

30 reps with a 2 second concentric and 2-second eccentric contraction 30 seconds rest 15 reps 30 seconds rest 15 reps 30 seconds rest 15 reps 30 seconds rest

Aerobic

'work:rest ratio' protocols

20-30 minute steady state bout at 40% VO2max or 30% HRR (Kim et al. 2016)

5 sets: 2 minutes work, 1 minute rest (Park et al. 2010)

What cuff pressure should I use?

Firstly, the cuff is inflated to a specific pressure where the arterial blood flow is completely occluded. This known as limb occlusion pressure (LOP). Then the cuff pressure is calculated as a percentage of the LOP. This is normally between 40%-80%. This is because the cuff pressure depends on numerous factors. Such as: the exercise type, the number of sets and reps, and the desired outcome. For example, if you're doing strength training and following the '30/15/15/15' protocol, you may only want to apply 70-80% pressure. Although, if you are doing a 30 minute aerobic bout, you may want to apply 40-50% pressure. Remember, training should always specific and so should BFR!