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Blood Flow Restriction Training

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Other Names

  • BFRT
  • Low-load Resistance Training With Blood Flow Restriction (LL-BFR)
  • Resistance Training with Vascular Occlusion
  • Kaatsu or KAATSU
  • Kaatsu resistance training


  • This page covers Blood Flow Restriction Training (BFRT)


  • Originated in the 1970s with Dr Yoshiaki Soto’s Kaatsu resistance training
  • First publication was in 1998[1]



  • General description
    • Occlude venous outflow while maintaining arterial flow leads to anaerobic environment
    • Hypothesised that an ischaemic and hypoxic muscular environment is generated during BFRT
    • Can generate cell signaling, hormonal changes similar to what is seen higher-intensity resistance training
  • Clinical value
    • Clinically relevant MSK rehabilitation tool
    • Does not require the high joint forces associated with heavy-load exercise
    • Individuals can achieve an increased degree of muscle burden and physiologic change at a lower level of resistance training
  • Proposed or theoretical mechanisms of muscle hypertrophy
    • Primarily related to metabolic stress, mechanical tension[2]
    • Elevated systemic hormone production[3]
    • Cell swelling[4]
    • Production of reactive oxygen species (ROS)[5]
    • Intramuscular anabolic/anticatabolic signaling[6]
    • Increased fast-twitch fiber recruitment[7]


  • Product
    • Pneumatic cuffs
    • Hand-pumped blood pressure cuffs
    • Elastic wraps (3 to 18 cm wide)
    • Kaatsu bands
    • Hook-and loop resistance bands
  • Occlusion pressure
    • Based on previous studies, ranges from 60 to 270 mm Hg[1]
  • Exercise load for resistance exercise
    • Can range from 10% to 50% depending on protocol
  • Duration
    • Long enough to perform the prescribed exercise
    • Subsequently, the occlusive pressure should be removed until the next set
  • Upper extremity
    • Tourniquet is placed on the upper arm
  • Lower extremity
    • Tourniquet is placed on the upper thigh



  • Ozaki et al: BFRT improved carotid arterial compliance[8]
  • Ozaki et al: increased VO2peak during a bicycle graded exercise after 10 weeks of BFRT[9]
  • Loenneke et al: Different levels of BFR may alter the acute muscular response to a degree, although higher pressures do not appear to augment these changes[10]
  • Loenneke meta-analysis (2012)[11]
    • BFRT resulted in greater gains in strength, hypertrophy compared to walking
    • It also resulted in greatest effect size at 2-3 days compared to 4-5 days
    • Correlation was found for strength development and weeks of duration, but not for hypertophy
  • Biomechanical
    • Burgomaster et al: BFRT increased glycogen, decreased ATP but did not augment increase in strength[12]
  • Biometrics/ Anthropometry
    • Takarada et al (2004): BFRT increased quadriceps muscle strength and cross sectional area[13]


  • A 2020 meta-analysis concluded that BFRT lead to improvements in strength, muscle size, and markers of sports performance in healthy athletes lead to improvements in strength, muscle size, and markers of sports performance in healthy athletes[14]
  • Abe et al: BFRT over 8 days improved sprint but not jump performance in male track and field athletes[15]
    • Significantly 1RM leg press, thigh muscle thickness, muscle bone CSA
  • Takarada et al (2000): found vascular occlusion increased strength, hypertrophy[16]
  • Abe et al: low-intensity, short-duration cycling exercise +BFRT improved muscle hypertrophy, aerobic capacity[17]
  • Cook et al: improved strength, fatigue resistance, maximum sprint time in Rugby athletes[18]
    • These athletes also had improvements in salivary testosterone, cortisol response
  • Lowery et al: BFRT stimulated muscle hypertrophy to the same degree as high-intensity resistance training[19]
  • Luebbers et al: BFRT increased 1RM squat among collegiate American football players[20]
  • Manimmanakorn: BFRT improved strength, muscle endurance, sprint and jump performance among female netball athletes[21]
  • Neto et al: among male jiu-jitsu fighters, BFRT performed similarly to heavy squat training[22]


Knee Osteoarthritis

  • BFRT was effective in increasing leg press and knee extensor strength in women at risk for knee OA[23]
  • Addition of BFRT to 30% 1RM resistance training for 4 weeks did not confer significantly greater increases in leg press or quadriceps strength in older men with risk factors for symptomatic knee OA[24]
  • Combination of BFRT to low-load exercise resulted no difference in pain, function, and quadriceps strength compared to control[25]
    • BFRT combined with low-load exercise resulted in less anterior knee pain during the training session

ACL Rehabilitation

  • Low-load resistance training with BFRT was effective for early muscular training after reconstruction ACL[26]
  • BFRT attenuates postoperative atrophy due to disuse following ACL reconstruction[27]
  • BFRT after ACL reconstruction (14 days) did not reduce quadriceps muscle atrophy measured by MR in athletes[28]

Other Uses


  • None are common
  • Potential
    • If occlusive device left on for too long, it could lead to prolonged ischemia and permanent damage
    • Venous Thromboembolism, the risk is poorly understood and defined[29]
    • Lymphedema
    • Swelling
    • Delayed Onset Muscle Soreness (DOMS) should subside within 72 hours
    • Nerve injury
    • Skin injury
    • Chemical Burn
  • Reported side effects[30]
    • Fainting and dizziness
    • Numbness
    • Pain and discomfort
    • Delayed Onset Muscle Soreness


See Also


  1. 1.0 1.1 Shinohara M, Kouzaki M, Yoshihisa T, Fukunaga T. Efficacy of tourniquet ischemia for strength training with low resistance. Eur J Appl Physiol Occup Physiol. 1998;77(1-2):189-191.
  2. Pearson SJ , Hussain SR . A review on the mechanisms of blood-flow restriction resistance training-induced muscle hypertrophy. Sports Med 2015;45:187–200.
  3. Takarada Y , Nakamura Y , Aruga S , et al . Rapid increase in plasma growth hormone after low-intensity resistance exercise with vascular occlusion. J Appl Physiol 2000b;88:61–5.
  4. Loenneke JP , Fahs CA , Rossow LM , et al . The anabolic benefits of venous blood flow restriction training may be induced by muscle cell swelling. Med Hypotheses 2012b;78:151–4.
  5. Kawada S , Ishii N . Skeletal muscle hypertrophy after chronic restriction of venous blood flow in rats. Med Sci Sports Exerc 2005;37:1144–50.
  6. Fujita S , Abe T , Drummond MJ , et al . Blood flow restriction during low-intensity resistance exercise increases S6K1 phosphorylation and muscle protein synthesis. J Appl Physiol 2007;103:903–10.
  7. Takarada Y , Sato Y , Ishii N . Effects of resistance exercise combined with vascular occlusion on muscle function in athletes. Eur J Appl Physiol 2002;86:308–14.
  8. Ozaki, Hayao, et al. "Effects of 10 weeks walk training with leg blood flow reduction on carotid arterial compliance and muscle size in the elderly adults." Angiology 62.1 (2011): 81-86.
  9. Ozaki, Hayao, et al. "Increases in thigh muscle volume and strength by walk training with leg blood flow reduction in older participants." Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences 66.3 (2011): 257-263.
  10. Loenneke, Jeremy P., et al. "Effects of exercise with and without different degrees of blood flow restriction on torque and muscle activation." Muscle & nerve 51.5 (2015): 713-721.
  11. Loenneke, Jeremy P., et al. "Low intensity blood flow restriction training: a meta-analysis." European journal of applied physiology 112.5 (2012): 1849-1859.
  12. Burgomaster, KIRSTEN A., et al. "Resistance training with vascular occlusion: metabolic adaptations in human muscle." Medicine and science in sports and exercise 35.7 (2003): 1203-1208.
  13. Takarada, Yudai, Tomomi Tsuruta, and Naokata Ishii. "Cooperative effects of exercise and occlusive stimuli on muscular function in low-intensity resistance exercise with moderate vascular occlusion." The Japanese journal of physiology 54.6 (2004): 585-592.
  14. Wortman, Ryan J., et al. "Blood Flow Restriction Training for Athletes: A Systematic Review." The American Journal of Sports Medicine (2020): 0363546520964454.
  15. Abe, T., et al. "Eight days KAATSU-resistance training improved sprint but not jump performance in collegiate male track and field athletes." International Journal of KAATSU Training Research 1.1 (2005): 19-23.
  16. Takarada, Yudai, et al. "Effects of resistance exercise combined with moderate vascular occlusion on muscular function in humans." Journal of applied physiology 88.6 (2000): 2097-2106.
  17. Abe, Takashi, 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 9.3 (2010): 452.
  18. Cook CJ, Kilduff LP, Beaven CM. Improving strength and power in trained athletes with 3 weeks of occlusion training. Int J Sports Physiol Perform. 2014;9(1):166-172.
  19. Lowery RP, Joy JM, Loenneke JP, et al. Practical blood flow restriction training increases muscle hypertrophy during a periodized resistance training programme. Clin Physiol Funct Imaging. 2014;34(4): 317-321.
  20. Luebbers PE, Fry AC, Kriley LM, Butler MS. The effects of a 7-week practical blood flow restriction program on well-trained collegiate athletes. J Strength Cond Res. 2014;28(8):2270-2280.
  21. Manimmanakorn A, Hamlin MJ, Ross JJ, Taylor R, Manimmanakorn N. Effects of low-load resistance training combined with blood flow restriction or hypoxia on muscle function and performance in netball athletes. J Sci Med Sport. 2013;16(4):337-342.
  22. Neto GR, Santos HH, Sousa JB, et al. Effects of high-intensity blood flow restriction exercise on muscle fatigue. J Hum Kinet. 2014;41:163-172.
  23. Segal, Neil A., et al. "Efficacy of blood flow–restricted, low-load resistance training in women with risk factors for symptomatic knee osteoarthritis." PM&R 7.4 (2015): 376-384.
  24. Segal, Neil, Maria D. Davis, and Alan E. Mikesky. "Efficacy of blood flow-restricted low-load resistance training for quadriceps strengthening in men at risk of symptomatic knee osteoarthritis." Geriatric Orthopaedic Surgery & Rehabilitation 6.3 (2015): 160-167.
  25. Bryk, Flavio Fernandes, et al. "Exercises with partial vascular occlusion in patients with knee osteoarthritis: a randomized clinical trial." Knee Surgery, Sports Traumatology, Arthroscopy 24.5 (2016): 1580-1586.
  26. Ohta, Haruyasu, et al. "Low-load resistance muscular training with moderate restriction of blood flow after anterior cruciate ligament reconstruction." Acta Orthopaedica Scandinavica 74.1 (2003): 62-68.
  27. Takarada, Yudai, Haruo Takazawa, and Naokata Ishii. "Applications of vascular occlusions diminish disuse atrophy of knee extensor muscles." Medicine and science in sports and exercise 32.12 (2000): 2035-2039.
  28. Iversen, Erik, Vibeke Røstad, and Arne Larmo. "Intermittent blood flow restriction does not reduce atrophy following anterior cruciate ligament reconstruction." Journal of Sport and Health Science 5.1 (2016): 115-118.
  29. da Cunha Nascimento D, Petriz B, da Cunha Oliveira S, Vieira DC, Funghetto SS, Silva AO, Prestes J. Effects of blood flow restriction exercise on hemostasis: a systematic review of randomized and non-randomized trials. International Journal of General Medicine. 2019;12:91.
  30. Brandner, Christopher & May, Anthony & Clarkson, Matthew & Warmington, Stuart. (2018). Reported Side-effects and Safety Considerations for the Use of Blood Flow Restriction During Exercise in Practice and Research. Techniques in Orthopaedics. 33. 1
Created by:
John Kiel on 10 December 2020 15:19:20
Last edited:
13 December 2020 16:25:51