Blood Flow Restriction training

Blood Flow Restriction training, although relatively new, has shown promising results in enhancing muscle growth and performance.

HealthMax Physiotherapy Clinic

By HealthMax Physiotherapy Clinic
Last updated: October 24th, 2023
8 min read


  1. Introduction
  2. What is Blood Flow Restriction Training?
  3. Does Blood Flow Restriction Training Really Work?
  4. How Does Blood Flow Restriction Training Work?
  5. How is Blood Flow Restriction Training Measured?
  6. What Does Blood Flow Restriction Training Do?
  7. How Do You Perform Blood Flow Restriction Training?
  8. Examples of Blood Flow Restriction Training
  9. Who Should Avoid Doing Blood Flow Restriction Training?
  10. What Are the Side Effects of Blood Flow Restriction Therapy?
  11. Conclusion


When it comes to fitness and strength training, there’s a constantly evolving landscape of techniques and methods to achieve your goals. One such innovation that has captured the attention of fitness enthusiasts and professionals alike is Blood Flow Restriction (BFR) training. This technique, although relatively new, has shown promising results in enhancing muscle growth and performance. In this article, we’ll dive deep into the world of blood flow restriction training and answer some key questions you might have.

What is Blood Flow Restriction training?

Blood Flow Restriction training, often referred to as BFR or occlusion training, is a resistance training technique that involves using specialised cuffs or wraps to partially restrict blood flow to the muscles being worked [1]. By doing so, BFR training allows individuals to achieve muscle-building benefits with lower weight loads compared to traditional high-intensity resistance training [1, 7]. 

Does Blood Flow Restriction training really work?

Research suggests that blood flow restriction training can indeed be effective in promoting muscle growth and strength gains [2]. While the debate on its superiority over traditional high-load training continues, numerous studies have demonstrated the positive impact of BFR training on muscle hypertrophy and strength improvement [2, 13, 16].

How does Blood Flow Restriction training work?

The benefits of BFR training lie in its ability to create metabolic stress and cellular swelling within the muscle [3, 5]. By applying controlled pressure to the limbs, BFR training limits the outflow of blood while maintaining inflow [2, 5]. This results in a pooling of blood within the muscle, triggering the release of growth factors and hormones that facilitate muscle growth and adaptation [3, 5, 9].

How is Blood Flow Restriction training measured?

The measurement of blood flow restriction during training involves determining the individual’s limb occlusion pressure (LOP) [4, 5]. Specialised devices can then be used to apply a percentage of this pressure to the limb [4]. This personalised approach ensures that the pressure is effective yet safe for each individual [5, 8].

Based on current evidence, Table 1 below shows safe and effective pressure and prescription guidelines for BFR training.

Table 1. Blow flow restriction occlusion pressure guidelines

ContextLimb occlusion pressure
BFR with resistance training– 40-80% limb occlusion pressure and 20-40% 1RM
– Exhale during exertion
BFR with aerobic training– 40-80% limb occlusion pressure.
– Exercise at <50% VO2max or 50% HRR (heart rate reserve)
BFR during bed rest for prevention of muscle atrophy– Limit BFR to 5-minute intervals with 3-5 min between sets.
– Up to 70-100% limb occlusion pressure is reported in the literature, however, the research on this type of training is still developing, and it is recommended that practitioners use a conservative approach and avoid full arterial occlusion.
Credit: AIS – Blood flow restriction training guidelines

What does Blood Flow Restriction training do?

BFR training serves as a catalyst for muscle growth by stimulating muscle fibres that might not be activated as effectively during traditional training [11]. The metabolic stress induced by BFR leads to an increase in hormones like growth hormone and insulin-like growth factor-1 (IGF-1), fostering muscle development [12]. Additionally, BFR training enhances endurance and cardiovascular fitness due to the elevated metabolic demands placed on the muscles [10]. 

How do you perform Blood Flow Restriction training?

To perform BFR training, you’ll need specialised cuffs designed for this purpose [15]. These cuffs are typically applied to the upper arms or legs [15]. Once in place, perform low-intensity resistance exercises with weights ranging from 20-30% of your one-repetition maximum [7, 15]. The cuffs should be tight enough to restrict blood flow but not to the point of causing discomfort or pain [15]. 

How often should you perform Blood Flow Restriction training?

For optimal results, incorporating BFR training a few times a week is recommended. Ensure that you allow at least one day of rest between sessions to allow your muscles to recover [12, 14]. The frequency and duration of BFR sessions can be tailored to your fitness level and goals [10, 13]. 

Examples of Blood Flow Restriction training

FR training can be applied to various exercises such as leg extensions, leg curls, bicep curls, and tricep extensions. These exercises, performed with the cuffs on, engage muscles effectively while using lighter weights [7]. For example: 

Squat with BFR

  • Apply BFR bands/cuffs to the upper thighs.
  • Perform squats with a reduced load.
  • BFR can create metabolic stress in the muscles, contributing to muscle growth.

Leg Press with BFR

  • Attach BFR bands/cuffs to the upper thighs.
  • Perform leg press exercises using a lighter load than usual.
  • The restricted blood flow can help promote muscle growth and strength even with the lighter weight.

Hamstring Curl with BFR

  • Attach BFR bands/cuffs to the upper thighs.
  • Use a hamstring curl machine with lower resistance.
  • BFR can help target the muscles effectively despite using lighter weights.

Calf Raise with BFR

  • Apply BFR bands/cuffs to the upper calves.
  • Perform calf raises using body weight or light weights.
  • BFR can create a potent muscle pump in the calves.

Push-Up with BFR

  • Place BFR bands/cuffs around the upper arms.
  • Perform push-ups with your hands on the ground.
  • The limited blood flow can make bodyweight exercises more challenging and effective.

Triceps Extension with BFR

  • Wrap BFR bands/cuffs around the upper arms.
  • Perform triceps extensions using a light dumbbell or cable machine.
  • BFR can enhance muscle activation during exercise.

Bicep Curl with BFR

  • Wrap BFR bands/cuffs around the upper arms.
  • Perform bicep curls using a light dumbbell or resistance band.
  • The restricted blood flow can lead to increased muscle pump and activation.

Note: Before attempting BFR training, it’s important to consult a qualified fitness professional or healthcare provider to ensure it’s safe for your individual situation.

Remember that BFR training should be performed with proper guidance and using appropriate equipment to ensure safety [4]. The level of restriction, duration, and intensity should be determined based on individual fitness levels and goals. If you’re new to BFR training, consider working with a certified fitness professional who has experience with this technique [4, 6].

Who should avoid doing Blood Flow Restriction training?

While BFR training is generally safe, individuals with medical conditions such as deep vein thrombosis, cardiovascular disease, hypertension, nerve impairments, a history of blood clots, or pregnancy should avoid this training method [3, 4]. Consultation with a qualified fitness professional is advisable before attempting BFR training [14, 16]. 

What are the side effects of Blood Flow Restriction training?

When done correctly, BFR training is safe, but improper cuff application or excessive pressure can lead to discomfort, numbness, tingling, or nerve damage [8]. Ensuring proper form and pressure is essential to avoid these potential side effects [10, 16]. 


To wrap up, BFR training offers an intriguing avenue for individuals aiming to enhance muscle gains and elevate performance through an innovative method. While not universally applicable, when executed correctly, BFR training may serve as a valuable complement to your fitness routine. It’s advisable to seek guidance from physiotherapy clinic professionals before modifying your training approach.  

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  1. Wortman RJ, Brown SM, Savage-Elliott I, Finley ZJ, Mulcahey MK. (2021). Blood flow restriction training for athletes: a systematic review. Am J Sports Med. 49(7):1938–1944. [Link]
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  1. Mouser JG, Dankel SJ, Jessee MB, Mattocks KT, Buckner SL, Counts BR, et al. (2017). A tale of three cuffs: the hemodynamics of blood flow restriction. Eur J Appl Physiol. 117(7):1493–1499. [Link]
  1. Brandner CR, May AK, Clarkson MJ, Warmington SA. (2018). Reported side-effects and safety considerations for the use of blood flow restriction during exercise in practice and research. Tech Orthop. 33(2):114–121. [Link]
  1. Gavanda S, Isenmann E, Schlöder Y, Roth R, Freiwald J, Schiffer T, Geisler S, and Behringer M. (2020). Low-intensity blood flow restriction calf muscle training leads to similar functional and structural adaptations than conventional low-load strength training: A randomized controlled trial. PloS one, 15(6), e0235377. [Link]
  1. Castle JP, Tramer JS, Turner EHG, Cotter D, McGee A, Abbas MJ, Gasparro MA, Lynch TS, Moutzouros V.J. (2023) Survey of blood flow restriction therapy for rehabilitation in Sports Medicine patients. Orthop. 38: 47-52. [Link]
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  1. Lixandrão ME, Roschel H, Ugrinowitsch C, Miquelini M, Alvarez IF, Libardi CA. (2019). Blood-flow restriction resistance exercise promotes lower pain and ratings of perceived exertion compared with either high- or low-intensity resistance exercise performed to muscular failure. J Sport Rehabil. 28(7):706-710. [Link] 
  1. da Silva JCG, Aniceto RR, Oliota-Ribeiro LS, Neto GR, Leandro LS, Cirilo-Sousa MS. (2018). Mood effects of blood flow restriction resistance exercises among basketball players. Percept Mot Skills. 125(4):788-801. [Link] 
  1. Clarkson PM, Hubal MJ. (2002). Exercise-induced muscle damage in humans. Am J Phys Med Rehabil. 81(11 Suppl):S52–69. [Link]
  1. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP. (2011). American College of Sports Medicine. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 43(7):1334-59. [Link] 
  1. Loenneke JP, Fahs CA, Rossow LM, Sherk VD, Thiebaud RS, Abe T, Bemben DA, Bemben MG. (2012). Effects of cuff width on arterial occlusion: implications for blood flow restricted exercise. Eur J Appl Physiol. 112(8):2903-12. [Link] 
  1. Ozaki H, Miyachi M, Nakajima T, Abe T. (2011). Effects of 10 weeks walk training with leg blood flow reduction on carotid arterial compliance and muscle size in the elderly adults. ANG. 62(1):81-86. [Link] 

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HealthMax Physiotherapy Clinic

HealthMax Physiotherapy Clinic

HealthMax Physiotherapy Clinic is a leading healthcare provider located in the heart of the Greater Toronto Area. With a dedicated team of experienced physiotherapists and healthcare professionals, our clinic is committed to enhancing the well-being and quality of life for individuals in our community.

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