Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition: Summary 4
Exercise pressures are then set as a percentage of LOP, typically: • 30-50% of LOP for upper body exercises • 60-80% of LOP for lower body exercises • Generally, higher pressures are used with lower resistance levels Tips for Taking LOP: • Have patients relax the muscle • Do not talk • Take in the same position in which the exercise will be performed (or least intense if in multiple positions) • A pulse ox can be used for the upper body but not the lower • This should not change much over an 8 week period of time, so there is no need to reassess every session unless there is swelling How to take LOP: • Place the cuff as proximal as possible. Find the pulse with the doppler, listening for 20 seconds. Inflate the tourniquet in 10-15 mmHg increments. Stop once the pulse cannot be located. Slowly deflate the cuff. When the pulse is heard again, this is the LOP: ○ For the upper extremity, use the radial artery ○ For the lower extremity, use the posterior tibial or dorsalis pedis Resistance training with BFRT typically uses loads of 20-40% of one repetition maximum (1RM), much lower than traditional strength training. Aerobic exercise with BFRT is usually performed at low intensities, around 40% of VO2 max or 45% of the heart rate reserve. ACSM suggests using the heart rate to estimate the percent of VO2 max as follows: • 40% VO2 max = 55% HR max • 60% VO2 max= 70% HR max • 80% VO2 max= 85% HR max • 85% VO2 max= 90% HR max Proper Intensity of BFRT Resistance Training: • Use 3-4 sets of an exercise, starting with lower reps (10) and progressing to high reps (75) • Initially use longer rest periods (90 seconds) and progress to less rest (30 seconds) • Use a total session duration of 10-20 minutes • This can be used several times per week, up to 2 times per day • Progressions:
GUIDELINE: NO BFRT IF MORE THAN 4 POINTS • History of DVT • Acute sickness or fever • Blood pressure >180/100mmHg • Early postoperative period • High class arrhythmia or coronary ischemia 5 points • Pregnancy 4 points • Varicose veins 3 points
• Prolonged inactivity • A-Fib or heart failure • Blood pressure: 160-179/95-99mmHg
• Age >60 years • BMI >30 kg/m 2 • Malignancy • Hyperlipidemia • Estrogen therapy • Age 40-58 years • Women • BMI 25-30 kg/m 2
2 points
1 point
Rhabdomyolysis Rhabdomyolysis is very rare after exercise with BFRT, but it is important to be aware of the signs and symptoms. Symptoms start 48-72 hours after exercise, reporting muscle pain, weakness, and myoglobinuria (tea colored urine) due to muscle breakdown releasing high amounts of myoglobin in the blood. Application and Programming LEARNING TIP!
Determining the appropriate cuff pressure is crucial for safe and effective BFRT. It is important to note that brands of cuffs will vary in width, number of bladders, and availability of the cuff to optimize pressure. The cuff width is a significant factor for determining safe pressure.
The pressure should be moderate in order to reduce arterial blood flow, but not occlude the vessels. This is typically done by measuring the limb occlusion pressure (LOP) - the minimum pressure required to completely occlude blood flow to a limb. This is done using a doppler.
○ Start with passive BFRT for cell swelling ○ Progress to aerobic exercises/return to sport/HIIT with BFRT
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