By Dr Charles Bellah PT, DPT, OCS, NCS, CHC
Or maybe you need to be much more moderate in your exercise routine due to a medical condition and you are frustrated that you can’t benefit as much from the usual type of workouts.
Blood flow restriction training exercises have the potential to be of tremendous value to those that are recovering from surgery/illness, have decreased endurance, weakness AND want to enhance their functional abilities or recreational/competitive athleticism.
The following paragraphs will provide more detail into the initial development of this unique exercise approach and some of the science supporting its effective and safe use.
But ...... What Is Blood Flow Restriction Training?
Blood flow restriction training begins with the use of blood flow restriction exercise bands or cuffs that are placed high up on the upper arms or legs. The effect of these bands is to limit the amount of blood escaping the arm/leg from the veins while maintaining blood entering the arm/leg from the arteries.
The result, simply stated, is to create an environment around and within the muscle that quickly fatigues the muscle (partly due to the decreased oxygen availability) and enhances the responses of that muscle to increased size, strength and endurance.
What Were the Origins of Blood Flow Restriction Training?
The origins of this increasingly research-supported modality (and what is now referred to as “blood flow restriction training”) lie with Dr. Yoshiaki Sato. His journey began in 1966 when, as an active young man of 18 years old and exercise enthusiast, he was kneeling on the floor and sitting on his calves (a traditional Japanese sitting position known as “seiza”) during a Buddhist ceremony for 40 minutes.
Subsequently, he noticed a notable tightness and swelling in his calves that seemed similar to when he performed strenuous and heavyworkouts of calf raises as part of his usual exercise routine. He made the initial fortunate assumption that the common component of the experiences was the decrease in blood flow. Having a naturally inquisitive mind, he began a 7-year self-experimentation to discover the benefits of blood flow restriction training (which he termed “kaatsu”).
Just prior to the conclusion of his self-experimentation, Dr. Sato experienced an accident while snow skiing resulting in fractures in bothankles and damage to the cartilage and ligaments to his right knee. Surgery was recommended but Dr. Sato chose, instead, to take a risk and be casted and begin a blood flow restriction training experiment on himself.
Interestingly, after 2 months of cast use and blood flow restriction training, his physicians were struck by not only the absence of any muscle loss but, in fact, some degree of muscle size increase. In addition, there appeared to be accelerated/complete bone healing and good ligament healing, as well.
At the end of this 7-year self-experimentation, Dr. Sato felt prepared to begin sharing the results of what he learned with and for the benefit of his patients. He spent the next 27 years treating his patients and learning how to customize the blood flow restriction training concepts to each patient’s unique needs.
His many observations during those years include:
- Notably decreased or no muscle loss after bone fracture or orthopedic surgeries with the use of BFRT with much less weight.
- Notable increases in strength with very low weights with the use of BFRT.
- Notable and quick improvements in aerobic capacity at much lower intensities of work.
- A variety of other benefits, as well.
Interestingly, the knowledge explosion regarding this bio-hack of BFRT had been limited to Japan as Dr. Sato is unwilling to leave the island of Japan and he speaks only Japanese thus limiting a global exposure of his ideas.
Enter Steven Munatones. He was an engineer by training and an elite level swim coach for the U.S. national swim team who was in Japan in 2001 for the world championships in Japan where he then met Dr. Sato. They immediately connected and Dr. Sato began sharing his life’s work with Mr. Munatones (who spoke fluent Japanese) over the next 13 years.
Subsequently, Dr. Sato and Mr. Munatones began the process of sharing Dr. Sato’s work on BFRT with the world.
What Does the Research Say About Blood Flow Restriction Training?
As previously noted, BFRT has been reported to provide a number of benefits but increases in muscle size, muscle strength and aerobic endurance are the primary motivations that users of BFRT are attracted to this exercise approach.
But what is the current research saying about these reported benefits? Let’s take a look.
Increased muscle size
According to the American College of Sports Medicine, in order to increase muscle size, one needs to lift, push or pull an amount of weight that is equal to or greater than seventy percent of his/her maximal effort in accomplishing the task with one repetition (often termed the one repetition maximum, or 1RM).
Exercising with a weight of at least 70% of a person’s all-out maximal effort for one repetition is either too difficult, off-putting, or inappropriate for a large number of otherwise motivated individuals who want to build muscle to improve their lives.
Individuals who have suffered an injury/illness, received a recent surgery, or have become severely deconditioned (think, perhaps, as in the elderly) may not be appropriate for or capable of safely lifting 70% or more of their 1RM.
However, they may be able to safely and appropriately lift 20% to 30% of their 1RM. The bad news is that exercising with weights of 20 to 30 percent of 1RM (even at repetitions leading to total exhaustion or failure) does not promote muscle building of any amount as many research studies have shown. Enter the blood flow restriction training approach.
It has been demonstrated in peer-reviewed research that using the same weight (equal to 20 to 30 percent of 1RM) in combination with blood flow restriction provides the same muscle building effect as performing the high intensity training efforts of 70% of 1RM.
An added critical bonus for those that have had orthopedic surgeries is that simply using BFRT, while the limb is under restrictions of being immobilized, can greatly reduce or eliminate any loss of muscle due to arm/leg inactivity. This puts their rehab on the fast track since this decreases the time needed to build their muscle tissue back.
Increased strength
In terms of improving strength, increased muscle size does increase strength in and of itself, however, increases in muscle size is not completely proportional to increases in muscle strength.
Again, as in the need to use 70% of 1RM weight to increase muscle size, this need is required to increase muscle strength, as well. In fact, exercising with weights of 20 to 30% of 1RM is ineffective in increasing strength.
However, the research evidence is showing that the combination of 20 to 30% of 1RM along with blood flow restriction results in notable improvements in strength that can approach, but not attain, the same level of strength increase as utilizing the higher loads of 70% or more of 1 RM.
Therefore, in terms of strength benefits alone, eventually using heavier loads, when able, will provide additional strength gains, but, until then, using low loads with BFRT will provide an effective bridge to greater strength improvements.
Increased aerobic capacity
In addition to increasing muscle size and strength, BFRT is being used to improve the aerobic capacities of all levels of conditioning, including competitive athletes, at low to moderate intensities (think walking, bicycling at 10 mph, gardening, recreational swimming, etc.). The scientific research shows that this can be accomplished at these low to moderate intensities in as little as 10 to 15 minutes per session for 2 to 3 days per week.
Of notable importance, one study found that a low-intensity walking/cycling program with blood flow restriction training led to a 5 to 12 percent improvement in aerobic conditioning compared to those that did not use blood flow restriction training, even in well-conditioned recreational/competitive athletes.
But Is Blood Flow Restriction Training Safe?
Though the benefits of blood flow restriction training are valuable and proven, one should be mindful of any potential unwanted side effects or potential for injury. There have been documented unwanted side effects or events but these are rare and include the following:
- Blood clots:
- Deep vein blood clots: 0.055% (55 in 100,000 people)
- Pulmonary blood clots: 0.008% (8 in 100,000)
- Blood pressure/stroke: 0.008% (8 in 100,000)
- Muscle damage: 0.008% (8 in 100,000)
- Heart problems: 0.016% (16 in 100,000)
- Death: 0.000%
Certainly, we would like to see no risk but view the following risks for real-life relative comparisons:
- Risk of serious injury or disability from a motor vehicle accident (MVA): 0.01%, death 0.02%
- Risk of serious injury from fall in bathroom: 0.1%
- Reported food poisoning when eating out: 16%; hospitalized, 0.04%; death, 0.001%
Any risks of blood flow restriction training, as low as they are, are further reduced with the guidance of a knowledgeable health care provider (physical therapist, athletic trainer, physician, etc.) who is certified in the use of BFRT and who will survey your unique risk factors and determine if you are an appropriate candidate for blood flow restriction training. Very few are not.
In summary, blood flow restriction training is another well-tolerated tool to provide positive health benefits and results in the form of increased strength, conditioning and performance in those that are recovering from surgery/illness, have decreased endurance and weakness, AND want to enhance their functional abilities and recreational/competitive athleticism.
Additionally, the resulting improvements in strength, muscle size and conditioning will go far to improve the overall health of the individual and further enhance an individual’s immune system to protect against a variety of infections which would include the COVID-19 virus.
For more information on Blood Flow Restriction Training or to sign up today CALL 951-344-6141 or CLICK HERE to schedule a FREE PHONE CONSULTATION to see if this is a GOOD FIT FOR YOU!
Where We Make your Healthspan Equal Your Lifespan
