No one would argue with any method that would allow you to increase muscle strength and size using less weight and volume of training. It’s called occlusion training, KAATSU training, or blood flow restriction training (BFR).

Antonio Squillante – The Pinnacle of Isolation Training

Occlusion training is probably one of the most effective ways to promote angiogenesis. This noisy, sophisticated word describes nothing but the physiological process of creating new blood vessels from pre-existing capillaries. For lack of better words, it is the process of increasing capillary density within a specific tissue, in this case, muscle.

Without going too much in depth digging through academic papers and peer-reviewed articles, angiogenesis is a process that normally takes place with training. It’s triggered by gene expression and it’s more likely to occur after endurance-based training. Blood flow restriction training, however, seems to trigger this process in a more specific, localized manner by means of resistance training. It’s, in essence, the pinnacle of isolation training for general endurance purposes.

More capillaries available means two things: more oxygen and less waste product during prolonged, aerobic training and/or between bursts of high-intensity anaerobic training. Over the long distance, this means more significant improvements in terms of VO2Max and/or more volume in terms of heavy strength training.

Better VO2Max and higher tonnage ultimately lead to better improvements in strength, power, and endurance. It’s an investment in the body’s physiological resources to create the foundation for a higher level of functional adaptation. As any other process involving tissue re-modeling, occlusion training takes quite a long time to create a long-lasting adaptation. It very well fit in a GPP program for athletes, being the main goal an overall improvement in work capacity. It can, also, be used to improve power endurance later on during the season as it creates a situation of intense acidosis, strategically pre-fatiguing the muscles.

Ted Sloan – BFR is Efficient and Healing

BFR has been proven through many years of trial and error and through recent scholarly studies to be a highly effective means of training the body and muscle. Although BFR can benefit hypertrophy, strength and fibrous tissue repair, a fairly new use has arisen.

Recent studies show BFR can also be highly useful in the ability to positively affect cardiovascular endurance. Through various studies, BFR has been shown to reduce stroke volume and increase heart rate in participants. A significant increase in blood pressure coincides with these previously mentioned factors to help positively affect the cardiovascular system and consequently increase cardiovascular endurance.

However, due to the increase in blood pressure, it is important to be cautious with the subjects exposed to this form of training. Someone with hypertension, would not be a good fit, for example. Obviously, with any form of training, there are many different modalities that can be used.

Studies have been performed on the effects of BFR use through walking and biking. Common protocols are 15 minutes of BFR use on either walking or biking for 2 to 4 times weekly. Just as with lifting weights, it is important to perform submaximal work.

In one study, subjects biked for 15 minute intervals 3 times a week for 8 weeks. This group increased their exercise time to exhaustion by 15.4% and their VO2Max by 6.4% with only a 3.9% increase in time to exhaustion in control groups and a minor decrease in VO2Max by controlled participants.

Muscle hypertrophy and strength gains were extremely minimal or non-existent in the control group, while the BFR group achieved a 5.4% muscle volume increase and a 7.7% increase in leg extension strength. Participants in the walking studies did not experience as much of a strength increase, however, also tended to experience an increase in hypertrophy.

If used properly, BFR can help to reduce the total work required by an athlete when entering the introductory stages of an off-season training program. Often times, the athlete has taken a period of time off from training and requires some basic cardiovascular work in order to return the resting heart rate back to a healthy acceptable level, on top of the oftentimes initial goal of rebuilding some muscle mass.

This simple protocol can be completed by the athlete on their own time with minimal effort. BFR has been proven to help heal the body much more efficiently than traditional strength training, increase hypertrophy more quickly than traditional strength training and also to simultaneously increase cardiovascular endurance when performed under the right conditions and circumstances. There are few protocols that can help to achieve all three of these tasks, especially during 15 minute intervals performed only a few times a week.

Giulio Palau – Adding Volume to Hypertrophy Programs

In an age where there are so many training methods and modalities to choose from, it can be hard to discern fact from fiction or rather, fad from fiction. If recent talk of BFR training has aroused your sense of skepticism I can’t blame you.

At first glance, it seems like another gimmick perpetuated by an industry of seemingly inexhaustible gimmicks and false pretenses. However, after taking a closer look at the literature, I was pleasantly surprised that BFR seems to be quite effective at inducing a variety of favorable training adaptations with low risk and little to no cost.

The basic premise is this: the metabolic stress caused by partially restricting blood flow to the limbs with an external cuff (6 or 7 tightness on a scale of 1-10) during sub-maximal (about 20-30% of 1RM), high volume (around 15-30 reps x 3-5 sets) strength training, can produce similar strength and hypertrophy adaptations as traditional, high-intensity loading.

This is theorized to be a result of the metabolic effect of the accumulation of lactate and the subsequent hypoxic environment created in the working tissues. One of the direct consequences of this type of metabolic stress is a spike in growth hormone or GH, which has been measured as high as 290x baseline after BFR training (as compared to 100x over baseline with traditional strength training).

Much of the hypertrophic effect has been attributed to this hormonal response. However, this doesn’t fully account for measured increases in strength after a period of BFR training (measured in squat and bench strength in one study). This may be explained by the high threshold of motor units recruited as a result of BFR. Typically, the nervous system recruits motor units in proportion to the amount of force required to overcome an external load.

However, the metabolic stress caused by high volume training in general, and BFR in particular training, can “trick” the nervous system into recruiting a high threshold of motor units in the working musculature. These effects have been measured in working tissues both proximal and distal to the external cuff. In other words, BFR training effects both the limbs and the torso.

The end result is a training modality that can produce measurable gains in both strength and size of muscles with low loading and therefore minimal mechanical and neural stress. This can be hugely useful in adding volume to a hypertrophy program without causing inflammation, or in rehabilitating post-op or post injury clients with poor motor recruitment patterns or a low tolerance for mechanical loading. It should be noted, however, that blood flow restriction training is not an alternative to traditional strength training, but rather a supplement to traditional high-intensity loading.

Adaptations of traditional high-intensity training such as neural drive and connective tissue conditioning are important and essential to being strong and healthy. However, BFR training seems to be an effective tool for metabolic and tissue conditioning in addition to strength training or in the special cases where high loads may not be tolerated.

If your sense of skepticism is still tingling consider this, blood flow restriction training has been around at least since 1966 when Yoshiaki Sato first developed a “blood flow moderation exercise” method which later became the Kaatsu Training society. Now that the mechanisms of BFR are well measured and understood we can begin to implement this tool effectively into a training program. I’m happy to say that there’s nothing here that needs to be taken on insufficient evidence… this time.

References:

1. Zachary Pope, et. al., “Exercise and Blood Flow Restriction,” Journal of Strength and Conditioning Research, 27(10), 2013.

2. Moore, Daniel R., Kirsten A. Burgomaster, Lee M. Schofield, Martin J. Gibala, Digby G. Sale, and Stuart M. Phillips. “Neuromuscular Adaptations in Human Muscle Following Low Intensity Resistance Training with Vascular Occlusion.” European Journal of Applied Physiology 92, no. 4–5 (August 2004): 399–406.

3. Takarada, Y., Y. Nakamura, S. Aruga, T. Onda, S. Miyazaki, and N. Ishii. “Rapid Increase in Plasma Growth Hormone after Low-Intensity Resistance Exercise with Vascular Occlusion.” Journal of Applied Physiology (Bethesda, Md.: 1985) 88, no. 1 (January 2000): 61–65.

4. Abe, Takashi, Satoshi Fujita, Toshiaki Nakajima, Mikako Sakamaki, Hayao Ozaki, Riki Ogasawara, Masato Sugaya, et al. “Effects of Low-Intensity Cycle Training with Restricted Leg Blood Flow on Thigh Muscle Volume and VO2MAX in Young Men.” Journal of Sports Science & Medicine 9, no. 3 (September 1, 2010): 452–58.

5. P Renzi, Christopher, Hirofumi Tanaka, and Jun Sugawara. “Effects of Leg Blood Flow Restriction during Walking on Cardiovascular Function.” Medicine and Science in Sports and Exercise 42 (November 1, 2009): 726–32.

6. Bunevicius, Kestutis, Arturas Sujeta, Kristina Poderiene, Birute Zachariene, Viktoras Silinskas, Rimantas Minkevicius, and Jonas Poderys. “Cardiovascular Response to Bouts of Exercise with Blood Flow Restriction.” Journal of Physical Therapy Science 28, no. 12 (December 2016): 3288–92. https://doi.org/10.1589/jpts.28.3288

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However, the question of why occlusion works remains unclear. Researchers published a study this month in the Journal of Strength and Conditioning Research to address that question. The study focuses on practical blood flow restriction, a method of occlusion that employs common and inexpensive means of restricting blood flow, such as knee and hand wraps. This method of occlusion has replaced the use of blood pressure cuffs and other expensive devices that were common in the original studies.

The key to effective blood flow restriction is occluding only the veins and not the arteries. Veins are closer to the surface of your skin, which is why you can see them. They are also not pressurized in the way that arteries are. Because of this, your veins take less pressure to block than your arteries do, making venous occlusion possible without arterial occlusion. You just don’t tie the wrap as tightly.

Amazingly, occlusion seems to allow you to lift lighter weights, say 30% of your max, and get the same results as you would at a heavier weight without restricting your blood flow. The idea that you could use lighter weights than normal but still get the same results opens up the possibility for more training. You would get the same results, but perhaps with less muscle damage.

There are numerous mechanisms that may cause superior muscle building with blood flow restriction. In this study, the researchers focused on three indicators of hypertrophy: muscle activation, muscle swelling, and muscle damage. They examined the acute effects of occlusion on these three mechanisms. In other words, they wanted to know what happening during and immediately after a workout.

The researchers discovered that the muscles received greater activation and were thicker by using blood flow restriction at 30% of max effort. The idea is that both of these effects will yield greater muscle size in the long run. The researchers also found the same levels of lactate, soreness, power performance, and swelling with blood flow restriction as they did without. So, in theory, occlusion is better for muscle size but doesn’t cause any more damage.

However, there were some oddities to this study. For some reason, the researchers noted that post-workout muscle thickness was a good thing, but muscle swelling was bad. And yet, as far as I can tell, there was no distinction between the two other than what they were called in the study. Although there was indeed more swelling immediately after the occlusion training, it had normalized by the following day. The change in acute muscle thickness is sort of a weird mechanism to study, anyway. Hormonal changes may have been more informative. Nevertheless, despite some minor strangeness, this study is just further evidence that blood flow restriction is an effective way of increasing muscular size. 

References:

1. Jacob Wilson, et. al., “Practical Blood Flow Restriction Training Increases Acute Determinants of Hypertrophy Without Increasing Indices of Muscle Damage,” Journal of Strength and Conditioning Research, 27(11), 2013

Photo courtesy of Shutterstock.

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There are a fair number of studies out there regarding the topic of restricted blood flow and its effects on hypertrophy and strength, but they investigate a far-reaching set of circumstances and hypothesize in many ways. This is all a good thing, and a part of a long-term scientific process, but sometimes with so much varied information we need a good review to put it all together for us. That’s exactly what researchers did in a study published recently in the Journal of Strength and Conditioning Research.

The process of occluding a vein is simpler than it might seem. In the studies reviewed the occlusion was created by simple tourniquets or pressurized cuffs. A tourniquet is a tight bandage that squeezes your veins, and a pressurized cuff is the same thing that is controllable by adding air pressure, like the cuff a doctor uses to check your blood pressure.

The amount of pressure used in venous occlusion is important. The blood flow restriction shouldn’t be so great as to cause arterial occlusion, which would be detrimental to the results. Arteries, which are pressurized by the heart, bring oxygenated blood to your muscles, whereas veins bring deoxygenated blood back from your muscles. It takes less pressure to block your veins than it does to block your arteries.

The result of blocking veins and not arteries is that blood pools in the muscles. This has an interesting effect. According to the researchers, there is universal agreement that when we add blood flow restriction to our weight training it yields improved strength and size. Of course, regular strength training does that too. The interesting thing here is that the results we usually get working with 60-100% of our one rep max actually happen with only 20-50% when we add venous occlusion.

The extent of the pressure to be used depends on the size of the person, but when using occlusion, stimuli as little as walking can yield size and strength gains. Pretty crazy. Not only that, but it seems to be effective on muscles on both sides of the occluding device. In other words, if you put a tourniquet around your arm near your armpit and do a bench press, your tricep and your pec may both benefit.

The reason occlusion works is unclear. From hormonal or neurological signaling, to increased muscle damage, it probably works on several levels, but we don’t know all the important details yet. In addition to being effective, the method also seems to be fairly safe. There are some possible deleterious side effects, but they do not seem substantial or common based on the research out there now.

So there you have it. Mild occlusion is safe and effective, and may be a useful adjunct to our progress.

References:

1. Zachary Pope, et. al., “Exercise and Blood Flow Restriction,” Journal of Strength and Conditioning Research, 27(10), 2013.

Photo courtesy of Melody Schoenfeld.

The post Multiple Studies Agree: Occlusion Training Works appeared first on Breaking Muscle.

Okay, stop laughing. I’m being serious. I’m talking about a relatively new technique called occlusion training, or, as it was originally called, KAATSU training. KAATSU training is the brainchild of Yoshiaki Sato, MD, Ph.D, of Japan. Essentially, it’s the act of using a blood pressure cuff or similar light tourniquet to restrict blood flow to an exercising muscle. 

There is a decent amount of research on the efficacy of blood flow-restricted training. Unfortunately, Professor Sato and his KAATSU training university did much of it. Although those studies may be legitimate, in researching the technique I wanted to exclude any obvious possibility of bias, so I discounted any of Sato’s research right off the bat.

With that done, several studies seem to show that low-load vascular occlusion training bears comparable results to conventional high-load training. Madarame et. al. showed that while occlusion training improved muscle strength and size, it did not improve jump performance in previously untrained young men.¹ Kim et. al. demonstrated that while muscle size increased significantly for individuals who trained with and without blood flow restriction, the traditional trainers had a greater increase in muscle size.²

Traditional training also proved to be much more effective for bone turnover than blood flow-restricted training in this study.³ Moore et. al. conducted a study that showed vascular occlusion training increased muscle strength and changed some aspects of neuromuscular function that conventional training did not.⁴ Yamanaka et. al. found that occlusion training increased both hypertrophy and strength of the muscles of Division IA football players.⁵ One Japanese study performed in 1999 even showed a 290-times increase of growth hormone levels in occlusion-users, and those levels remained slightly higher than the control level after 24 hours.⁶

Occlusion training is thought to work through the process of “metabolic accumulation.”  Basically, instead of letting your body flush all the metabolic products of exertion through the system, the tourniquet keeps it all in the area. This stimulates a big release of anabolic growth factors, recruits more fast-twitch fibers, and induces more production of protein.⁷

Occlusion training also seems to stimulate the production of heat shock proteins, which monitor cell proteins and help transport other proteins across cell membranes, aiding in cell repair. Occlusion training appears to affect Nitric oxide synthase-1 (which helps control blood pressure, insulin secretion, blood vessel growth, and peristalsis, and helps catalyze nitric oxide from L-arginine) and reduces myostatin as well (animals lacking myostatin have larger muscles than other animals). More research is needed on the exact mechanisms of occlusion training, but it seems to have many avenues through which it works its magic.

In light of this and other available research on the effectiveness of occlusion training, it would appear there is some benefit to it for both strength and hypertrophy gains for lifters of all kinds. It’s important to note, though, that occlusion training is not meant to replace heavy lifting. It should be seen as an assistance exercise or used as therapy for those who cannot lift heavy weights. It’s great for deloading periods or on lighter training days.

That having been said, let’s talk about how to work occlusion training into your routine. I use TheraBands as my makeshift tourniquets, although you could really use any elastic band you like (including actual tourniquets), or even a blood pressure cuff. You want to tie it at the joint above the muscle group you plan to train. So, for instance, you would tie it off right at the shoulder joint to affect the bicep, or right around the uppermost thigh to affect the quads. Tie it tightly enough that you feel a rather uncomfortable obstruction of blood without cutting off the supply altogether.

I like to combine occlusion training with bodyweight isometric training. For instance, for a set of pushups, I’ll occlude at the shoulders and hold my pushups for five or so seconds at several angles along the movement. For squats or lunges, I do the same with the occlusion at my hips. For weight training with occlusion, go lighter than usual – 50% or less of your max. Perform as many good reps as you are able at that weight with the occlusion point that relates to your targeted muscle group.

Note: Occlusion training is not fun. Like, at all. Occlusion training is extremely difficult and uncomfortable. But it’s quick and dirty, and you should see some impressive enhancements to your muscle size and strength as a result. Let me know how it goes!

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