Blood Flow Restricted Exercise

Grace’s latest blog post about vibration plates as a current popular topic got me thinking about other trending workouts, such as blood flow restricted exercise. While its hype may have peaked a couple of years ago, the literature is still working on catching up to determine the actual safety, effectiveness, and usefulness of this modality of exercise.

So, here is a brief low-down on all things blood flow restriction.

First off, what is blood flow restricted exercise?

Blood flow restricted (BFR) exercise is a form of exercise that involves using cuffs that partially restrict blood flow to the muscles. The cuffs restrict blood from leaving the muscles, but should not restrict blood from entering.

Why would you do BFR exercise?

• BFR exercise became popular because of its claims of increasing muscle growth and strength quicker when compared to traditional strength training. It involves using much lighter weights, so it's a good option for populations in which heavy lifting is not appropriate.

• Injury rehab is another reason to use BFR, with claims of expedited recovery.

  
  

Is any of this true?

• Studies have shown that BFR exercise improves muscle mass and strength with a lighter load than traditional strength training, though it's unknown if the gains are as great as with high-load training¹ ² ⁴.

• Cognetti et al.⁵ (2022) reported that BFR therapy and exercise stimulates muscle hypertrophy and also has benefits on cardiovascular fitness and pain. These benefits come from synergistic effects of the metabolic stress and tension from the blood flow restriction.

How do you do BFR exercise?

• BFR exercise is commonly performed with high repetitions and lower weight. Sets of 15 to 30 repetitions are common at 20-40% of 1RM. Cuff pressure is commonly 40-80% of total occlusion³.

• Having a certified trainer set your cuffs is important, pressure needs to be dosed to your individual limb rather than applied with a generic setting, and doing it wrong carries real risk.

Who should or shouldn't use BFR?

• Populations that cannot lift heavy weight or high load for a variety of reasons could benefit from BFR. This can include elderly and clinical populations, as well as healthy adults.

• BFR increases strain on the heart and the risk of blood clots. Populations at risk for blood clots may want to avoid or carefully monitor use of BFR exercise.

Bottom line

There is a lot to learn about BFR exercise, how to do it safely, and how to see maximum benefits. Hopefully this gives a bit of insight into this exercise modality!

- Coach Morgan

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Sources

¹ Chang, H., Zhang, J., Yan, J., Yang, X., Chen, B., & Zhang, J. (2024). Effects of Blood Flow Restriction Training on Muscle Strength and Hypertrophy in Untrained Males: A Systematic Review and Meta-Analysis Based on a Comparison with High-Load Resistance Training. Life (Basel, Switzerland), 14(11), 1442. https://doi.org/10.3390/life14111442

² Cook, S. B., & Cleary, C. J. (2019). Progression of Blood Flow Restricted Resistance Training in Older Adults at Risk of Mobility Limitations. Frontiers in physiology, 10, 738. https://doi.org/10.3389/fphys.2019.00738

³ Matthews, Evan L., et al. Blood Flow Restriction (BFR) Resistance Exercise 101 | Infographic. May 2026. acsm.org, https://acsm.org/blood-flow-restriction-bfr-resistance-exercise-101-infographic/.

⁴ Pope, Z. K., Willardson, J. M., & Schoenfeld, B. J. (2013). Exercise and blood flow restriction. Journal of strength and conditioning research, 27(10), 2914–2926. https://doi.org/10.1519/JSC.0b013e3182874721

⁵ Cognetti, D. J., Sheean, A. J., & Owens, J. G. (2022). Blood Flow Restriction Therapy and Its Use for Rehabilitation and Return to Sport: Physiology, Application, and Guidelines for Implementation. Arthroscopy, Sports Medicine, and Rehabilitation, 4, e71–e76. https://doi.org/10.1016/j.asmr.2021.09.025