Research Digest

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COLUMN EDITOR: Perry Koziris, PhD, CSCS*D,
NSCA-CPT*D, FNSCA
Blood Flow Restriction
Resistance Training:
Potential Benets of
Choking the Muscles
Lymperis (Perry) Koziris, PhD, CSCS*D, NSCA-CPT*D, FNSCA
Institut National du Sport du Que bec, Montreal, Quebec, Canada
A B S T R A C T
BLOOD FLOW RESTRICTION CAN
BE USED IN RESISTANCE EXER-
CISE TO AUGMENT PHYSIOLOGI-
CAL CHALLENGES AND
STIMULATE ADAPTATIONS WHEN
HEAVY LOADS ARE CONTRAINDI-
CATED. FEMALE ATHLETES USING
ONLY 20% 1 REPETITION MAXI-
MUM SUBSTANTIALLY IMPROVED
THEIR MUSCULAR ENDURANCE,
STRENGTH, HYPERTROPHY, AND
MOTONEURON RECRUITMENT
EFFICIENCY, WHEN TRAINING
WAS COUPLED WITH LOCAL
OCCLUSION OR EVEN WITH
BREATHING HYPOXIC AIR.
I
nterest is rising in various ap-
proaches that increase local muscle
ischemia during resistance exercise
(1). This blood ow restriction (BFR)
may be partial or may involve complete
occlusion. The more common methods
include the application of external devices
such as elastic straps or bands, or inat-
able cuffs, to reduce muscle blood ow
during lower-load resistance exercise;
one systematic version of BFR training
with a specic cuff apparatus is known as
Kaatsu. Other possible methods include
the use of slower movements with lower
loads than those of typical heavy resis-
tance training and without pause
between repetitions nor between pha-
ses (concentric or eccentric). This
helps maintain an elevated intramus-
cular pressure, thereby interfering
with local blood ow.
BFR is appealing for situations where
there is a desire to avoid heavy loads
while creating a high degree of meta-
bolic challenge in the muscle. This
may stimulate adaptations in strength
and particularly in muscle hypertrophy,
and the hypoxia resulting from BFR is
one of the physiological mechanisms
being considered (2). A recent study
examined the role of this reduced oxygen
availability during low-load resistance
exercise in female athletes (3).
Two methods were used to create a hyp-
oxic condition in the leg muscles while
resistance training with a low load; one
was the breathing of a low-oxygen gas
mixture (HT) and the other was thigh
blood ow occlusion using Kaatsu cuffs
(KT). Female netballers were assigned to
one of 3 groups, HT, KT, and control
training (CT), all involving a 5-week
standardized program of 3 sessions per
week. The participants performed train-
ing sessions consisting of 3 sets of knee
extension followed, after a 2-minute rest
period, by 3 of knee exion, all with
a resistance of 20% 1 repetition maxi-
mum (RM). Repetitions lasted approxi-
mately 1 second per phase, and the rest
intervals between sets lasted 30 seconds.
All sets were taken to failure by the KT
group and the other 2 groups were asked
to match that number of repetitions per
set to control for training load. The
groups respective intervention was main-
tained throughout each 1213-minute
training session. In the HT, the percent-
age of oxygen in the inspired air was
VOLUME 36 | NUMBER 3 | JUNE 2014 Copyright National Strength and Conditioning Association
62
automatically adjusted to maintain arte-
rial oxygen saturation at 80%. In the KT,
cuff pressure was progressed from 160
mm Hg on the rst training day to 230
mm Hg on the eighth training day and
was kept at 230 mm Hg for the remain-
der of the training sessions.
Strength and muscular endurance tests
for leg extension, which were performed
in a separate session under normal con-
ditions without any intervention, showed
a much higher benet of the 2 experi-
mental modes relative to the control
condition. Similarly, training with vascu-
lar occlusion (KT) and with systemic
hypoxia (HT), compared with training
with an unimpeded muscle oxygen bal-
ance, resulted in changes in voluntary
neural activation of the leg extensors
and substantial thigh muscle growth.
With regard to the strength and mus-
cular endurance testing, CT resulted
in an improvement in the maximal
number of repetitions that could be
completed with a 20% 1RM load
(Reps20) but both KT and HT
showed a larger improvement in this
variable. KTand HTalso showed sub-
stantial increases in peak isometric
force (maximal voluntary contracting;
MVC) and in 30-second isometric
muscular endurance, whereas CT
showed little change in these varia-
bles. Any differences between KT
and HT in these 3 performance vari-
ables were essentially trivial. Even
with the lower training load (20%
1RM) in this study, the KT and HT
adaptations were comparable to those
expected from BFR training with
higher loads (50% 1RM) or from tra-
ditional heavy resistance training.
Total quadriceps electromyography
intensity was also calculated from the
muscle electrical activity as an index of
muscle recruitment during these
performance tests. During the MVC,
it increased in all 3 groups but substan-
tially more as a result of KT. Higher
neural activation during maximal
efforts indicates that at least some of
the strength increase is based on
altered neuromuscular functioning,
which may include increased motor
unit recruitment and synchronization,
as well as increased motor unit ring
frequency. Furthermore, electromyog-
raphy intensity during the Reps20
decreased more after KTand HT. This
lowered motoneuron activity during
the performance of the same task
post-training points to a training-
induced augmentation in the efciency
of force generation. This makes sense
because the same absolute load was
used for this test before and after train-
ing; the load became, in effect, lighter
for the athletes post-training because
of their increased 1RM.
The cross-sectional area of the knee
exors and extensors was calculated at
the mid-thigh level and was shown to
increase substantially in KT and HT
compared with CT. This apparent mus-
cular hypertrophy was of a similar
magnitude shown by previous studies
examining similar protocols. This is
the rst study, though, showing such
an effect in young trained female
athletes.
The ndings of this study do not amount
to a recommendation for these types of
protocols in lieu of typical strength train-
ing programs in an athletic population.
The higher the training status of athletes,
the more likely they are to benet instead
from resistance training that adheres
more closely to the specicity principle
in regard to the sports demands for
strength, this being particularly true for
power needs. However, the results of this
study do provide additional support for
the utilization of these protocols by the
strength and conditioning coach who
needs to maximize the physiological
stimulus and optimize adaptations, espe-
cially through the maintenance of muscle
mass, during suboptimal circumstances
where higher loading is contraindicated
due to injury or other factors. This study
reinforces this rationale particularly for
female athletes.
Conicts of Interest and Source of Funding:
The author reports no conicts of interest
and no source of funding.
Lymperis (Perry) Koziris is an exer-
cise physiologist at the Institut National
du Sport du Quebec.
REFERENCES
1. Alberti G, Cavaggioni L, Silvaggi N,
Caumo A, and Garu M. Resistance
training with blood ow restriction using the
modulation of the muscles contraction
velocity. Strength Cond J 35: 4247,
2013.
2. Loenneke JPand Pujol TJ. The use of occlusion
training to produce muscle hypertrophy.
Strength Cond J 31: 7784, 2009.
3. Manimmanakorn A, Manimmanakorn N,
Taylor R, Draper N, Billaut F, Shearman JP,
and Hamlin MJ. Effect of resistance training
combined with vascular occlusion or
hypoxia on neuromuscular function in
athletes. Eur J Appl Physiol 113:
17671774, 2013.
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