Determining the Arterial Occlusion Pressure for Blood Flow Restriction

Background and Objectives: Blood flow restriction during low-load exercise stimulates similar muscle adaptations to those normally observed with higher loads. Differences in the arterial occlusion pressure (AOP) between limbs and between sexes are unclear. We compared the AOP of the superficial femoral artery in the dominant and non-dominant legs, and the relationship between blood flow and occlusion pressure in 35 (16 males, 19 females) young adults. Materials and Methods: Using ultrasound, we measured the AOP of the superficial femoral artery in both legs. Blood flow at occlusion pressures ranging from 0% to 100% of the AOP was measured in the dominant leg. Results: There was a significant difference in the AOP between males and females in the dominant (230 ± 41 vs. 191 ± 27 mmHg; p = 0.002) and non-dominant (209 ± 37 vs. 178 ± 21 mmHg; p = 0.004) legs, and between the dominant and non-dominant legs in males (230 ± 41 vs. 209 ± 37 mmHg; p = 0.009) but not females (191 ± 27 vs. 178 ± 21 mmHg; p = 0.053), respectively. Leg circumference was the most influential independent predictor of the AOP. There was a linear relationship between blood flow (expressed as a percentage of unoccluded blood flow) and occlusion pressure (expressed as a percentage of AOP). Conclusions: Arterial occlusion pressure is not always greater in the dominant leg or the larger leg. Practitioners should measure AOP in both limbs to determine if occlusion pressures used during exercise should be limb specific. Occlusion pressures used during blood flow restriction exercise should be chosen carefully.

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Acute Muscular Responses to Practical Low-Load Blood Flow Restriction Exercise Versus Traditional Low-Load Blood Flow Restriction and High-/Low-Load Exercise

Journal of Sport Rehabilitation ◽

10.1123/jsr.2019-0217 ◽

2020 ◽

Vol 29 (7) ◽

pp. 984-992 ◽

Cited By ~ 1

Author(s):

Robert S. Thiebaud ◽

Takashi Abe ◽

Jeremy P. Loenneke ◽

Tyler Garcia ◽

Yohan Shirazi ◽

...

Keyword(s):

Blood Flow ◽

Isometric Contraction ◽

Arterial Occlusion ◽

Muscle Thickness ◽

Blood Flow Restriction ◽

Occlusion Pressure ◽

Maximum Voluntary Isometric Contraction ◽

Flow Restriction ◽

Low Load ◽

Arterial Occlusion Pressure

Context: Blood flow restriction (BFR) increases muscle size and strength when combined with low loads, but various methods are used to produce this stimulus. It is unclear how using elastic knee wraps can impact acute muscular responses compared with using nylon cuffs, where the pressure can be standardized. Objective: Investigate how elastic knee wraps compare with nylon cuffs and high-load (HL)/low-load (LL) resistance exercise. Design: A randomized cross-over experimental design using 6 conditions combined with unilateral knee extension. Setting: Human Performance Laboratory. Participants: A total of 9 healthy participants (males = 7 and females = 2) and had an average age of 22 (4) years. Intervention: LL (30% of 1-repetition maximum [1-RM]), HL (70% 1-RM), BFR at 40% of arterial occlusion pressure (BFR-LOW), BFR at 80% of arterial occlusion pressure (BFR-HIGH), elastic knee wraps stretched by 2 in (PRACTICAL-LOW), and elastic knee wraps stretched to a new length equivalent to 85% of thigh circumference (PRACTICAL-HIGH). BFR and practical conditions used 30% 1-RM. Main Outcome Measures: Muscle thickness, maximum voluntary isometric contraction, and electromyography amplitude. Bayesian statistics evaluated differences in changes between conditions using the Bayes factor (BF10), and median and 95% credible intervals were reported from the posterior distribution. Results: Total repetitions completed were greater for BFR-LOW versus PRACTICAL-HIGH (BF10 = 3.2, 48.6 vs 44 repetitions) and greater for PRACTICAL-LOW versus BFR-HIGH (BF10 = 717, 51.8 vs 36.3 repetitions). Greater decreases in changes in maximum voluntary isometric contraction were found in PRACTICAL-HIGH versus HL (BF10 = 1035, ∼103 N) and LL (BF10 = 45, ∼66 N). No differences in changes in muscle thickness were found between LL versus PRACTICAL-LOW/PRACTICAL-HIGH conditions (BF10 = 0.32). Greater changes in electromyography amplitude were also found for BFR-LOW versus PRACTICAL-HIGH condition (BF10 = 6.13, ∼12%), but no differences were noted between the other BFR conditions. Conclusions: Overall, elastic knee wraps produce a more fatiguing stimulus than LL or HL conditions and might be used as an alternative to pneumatic cuffs that are traditionally used for BFR exercise.

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Hemodynamic Response to Resistance Blood Flow Restriction Exercise at Different Degrees of Arterial Occlusion Pressure

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000517550.89229.68 ◽

2017 ◽

Vol 49 (5S) ◽

pp. 254-255

Author(s):

Eduardo D. S. Freitas ◽

Rodrigo R. Aniceto ◽

Julio C. G. Silva ◽

Patrick S. S. Pfeiffer ◽

Joamira P. Araújo ◽

...

Keyword(s):

Blood Flow ◽

Arterial Occlusion ◽

Hemodynamic Response ◽

Blood Flow Restriction ◽

Occlusion Pressure ◽

Flow Restriction ◽

Arterial Occlusion Pressure

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Blood-Flow-Restriction Training: Validity of Pulse Oximetry to Assess Arterial Occlusion Pressure

International Journal of Sports Physiology and Performance ◽

10.1123/ijspp.2019-0043 ◽

2019 ◽

Vol 14 (10) ◽

pp. 1408-1414 ◽

Cited By ~ 1

Author(s):

Zhen Zeng ◽

Christoph Centner ◽

Albert Gollhofer ◽

Daniel König

Keyword(s):

Blood Flow ◽

Pulse Oximetry ◽

Cuff Pressure ◽

Arterial Occlusion ◽

Blood Flow Restriction ◽

Lower Limbs ◽

Occlusion Pressure ◽

Gold Standard Method ◽

Flow Restriction ◽

Arterial Occlusion Pressure

Purpose: Setting the optimal cuff pressure is a crucial part of prescribing blood-flow-restriction training. It is currently recommended to use percentages of each individual’s arterial occlusion pressure, which is most accurately determined by Doppler ultrasound (DU). However, the practicality of this gold-standard method in daily training routine is limited due to high costs. An alternative solution is pulse oximetry (PO). The main purpose of this study was to evaluate validity between PO and DU measurements and to investigate whether sex has a potential influence on these variables. Methods: A total of 94 subjects were enrolled in the study. Participants were positioned in a supine position, and a 12-cm-wide cuff was applied in a counterbalanced order at the most proximal portion of the right upper and lower limbs. The cuff pressure was successively increased until pulse was no longer detected by DU and PO. Results: There were no significant differences between the DU and PO methods when measuring arterial occlusion pressure at the upper limb (P = .308). However, both methods showed considerable disagreement for the lower limbs (P = .001), which was evident in both men (P = .028) and women (P = .008). No sex differences were detected. Conclusions: PO is reasonably accurate to determine arterial occlusion pressure of the upper limbs. For lower limbs, PO does not seem to be a valid instrument when assessing the optimal cuff pressure for blood-flow-restriction interventions compared with DU.

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The Effect of Body Position and the Reliability of Upper Limb Arterial Occlusion Pressure Using a Handheld Doppler Ultrasound for Blood Flow Restriction Training

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211043877 ◽

2021 ◽

pp. 194173812110438

Author(s):

Stefanos Karanasios ◽

Charikleia Koutri ◽

Maria Moutzouri ◽

Sofia A. Xergia ◽

Vasiliki Sakellari ◽

...

Keyword(s):

Blood Flow ◽

Doppler Ultrasound ◽

Upper Limb ◽

Body Position ◽

Arterial Occlusion ◽

Standing Position ◽

Blood Flow Restriction ◽

Occlusion Pressure ◽

Flow Restriction ◽

Arterial Occlusion Pressure

Background: The precise calculation of arterial occlusive pressure is essential to accurately prescribe individualized pressures during blood flow restriction training. Arterial occlusion pressure in the lower limb varies significantly between different body positions while similar reports for the upper limb are lacking. Hypothesis: Body position has a significant effect in upper limb arterial occlusive pressure. Using cuffs with manual pump and a handheld Doppler ultrasound can be a reliable method to determine upper limb arterial blood flow restriction. Study Design: A randomized repeated measures design. Level of Evidence: Level 3. Methods: Forty-two healthy participants (age mean ± SD = 28.1 ± 7.7 years) completed measurements in supine, seated, and standing position by 3 blinded raters. A cuff with a manual pump and a handheld acoustic ultrasound were used. The Wilcoxon signed-rank test with Bonferroni correction was used to analyze differences between body positions. A within-subject coefficient of variation and an intraclass correlation coefficient (ICC) test were used to calculate reproducibility and reliability, respectively. Results: A significantly higher upper limb arterial occlusive pressure was found in seated compared with supine position ( P < 0.031) and in supine compared with standing position ( P < 0.031) in all raters. An ICC of 0.894 (95% CI = 0.824-0.939, P < 0.001) was found in supine, 0.973 (95% CI = 0.955-0.985, P < 0.001) in seated, and 0.984 (95% CI = 0.973-0.991, P < 0.001) in standing position. ICC for test-retest reliability was found 0.90 (95% CI = 0.814-0.946, P < 0.001), 0.873 (95% CI = 0.762-0.93, P < 0.001), and 0.858 (95% CI = 0.737-0.923, P < 0.001) in the supine, seated, and standing position, respectively. Conclusion: Upper limb arterial occlusive pressure was significantly dependent on body position. The method showed excellent interrater reliability and repeatability between different days. Clinical Relevance: Prescription of individualized pressures during blood flow restriction training requires measurement of upper limb arterial occlusive pressure in the appropriate position. The use of occlusion cuffs with a manual pump and a handheld Doppler ultrasound showed excellent reliability; however, the increased measurement error compared with the differences in arterial occlusive pressure between certain positions should be carefully considered for the clinical application of the method. Strength of Recommendations Taxonomy (SORT): B.

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The acute muscular response to two distinct blood flow restriction protocols

Physiology International ◽

10.1556/2060.104.2017.1.1 ◽

2017 ◽

Vol 104 (1) ◽

pp. 64-76 ◽

Cited By ~ 8

Author(s):

SJ Dankel ◽

SL Buckner ◽

BR Counts ◽

MB Jessee ◽

JG Mouser ◽

...

Keyword(s):

Blood Flow ◽

Muscle Growth ◽

Arterial Occlusion ◽

Muscle Thickness ◽

Elbow Flexion ◽

Blood Flow Restriction ◽

Post Exercise ◽

Flow Restriction ◽

Acute Responses ◽

Arterial Occlusion Pressure

The purpose of this study was to determine acute physiological and perceptual responses to two commonly implemented blood flow restriction protocols. Using a within-subject design, 15 participants (age ∼25) performed four sets of unilateral elbow flexion with each arm. One arm exercised using a 3-cm elastic cuff inflated to 160 mmHg, whereas the other arm exercised using a 5-cm nylon cuff inflated to 40% of the individual’s arterial occlusion pressure. While both protocols elicited increases in acute muscle thickness [pre: 4.5 (0.2) cm, post: 5.0 (0.2) cm; p < 0.001] and electromyography amplitude [first 3 reps: 55 (5) %MVC; last 3 reps: 87 (10) %MVC], there were no differences between conditions. Both protocols produced decreases in post-exercise strength (pre: 70 Nm, post: 51 Nm; p < 0.001) with no difference between conditions. The nylon protocol resulted in more repetitions during sets 2 [13 (2) vs. 9 (4); p = 0.001] and 3 [10 (2) vs. 7 (4); p = 0.05], while producing lower levels of discomfort following each set (average 3 vs. 4; p < 0.05). In conclusion, both protocols produced similar acute responses thought to be important for promoting muscle growth. However, the use of arbitrary pressures may place some individuals under complete arterial occlusion which may increase the potential risk of an adverse event.

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The Effect of Increasing Blood Flow Restriction Pressure When the Contractions Are Already Occlusive

Journal of Sport Rehabilitation ◽

10.1123/jsr.2020-0402 ◽

2021 ◽

pp. 1-6

Author(s):

Vito V. Nucci ◽

David H. Jarrett ◽

Catherine M. Palmo ◽

Brenna M. Razzano ◽

Mehmet Uygur ◽

...

Keyword(s):

Blood Flow ◽

Arterial Occlusion ◽

Bayes Factors ◽

Muscular Endurance ◽

Occlusion Pressure ◽

Task Failure ◽

Force Steadiness ◽

Flow Restriction ◽

Arterial Occlusion Pressure ◽

Blood Flow Restricted Exercise

Context: Blood flow restricted exercise involves the use of external pressure to enhance fatigue and augment exercise adaptations. The mechanisms by which blood flow restricted exercise limits muscular endurance are not well understood. Objective: To determine how increasing blood flow restriction pressure impacts local muscular endurance, discomfort, and force steadiness when the contractions are already occlusive. Design: Within-participant, repeated-measures crossover design. Setting: University laboratory. Patients: A total of 22 individuals (13 males and 9 females). Intervention: Individuals performed a contraction at 30% of maximal isometric elbow flexion force for as long as possible. One arm completed the contraction with 100% of arterial occlusion pressure applied, while the other arm had 150% of arterial occlusion pressure applied. At the end of the protocol, individuals were asked to rate their perceived discomfort. Main Outcome Measures: Time to task failure, discomfort, and force steadiness. Results: Individuals had a longer time to task failure when performing the 100% arterial occlusion condition compared with the 150% arterial occlusion pressure condition (time to task failure = 82.4 vs 70.8 s; Bayes factors = 5.77). There were no differences in discomfort between the 100% and 150% conditions (median discomfort = 5.5 vs 6; Bayes factors = 0.375) nor were there differences in force steadiness (SD of force output 3.16 vs 3.31 N; Bayes factors = 0.282). Conclusion: The results of the present study suggest that, even when contractions are already occlusive, increasing the restriction pressure reduces local muscle endurance but does not impact discomfort or force steadiness. This provides an indication that mechanisms other than the direct alteration of blood flow are contributing to the increased fatigue with added restrictive pressure. Future studies are needed to examine neural mechanisms that may explain this finding.

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PREDICTIVE EQUATION FOR BLOOD FLOW RESTRICTION TRAINING

Revista Brasileira de Medicina do Esporte ◽

10.1590/1517-869220192506186803 ◽

2019 ◽

Vol 25 (6) ◽

pp. 494-497

Author(s):

Maria do Socorro Cirilo-Sousa ◽

Jiddu Bastos Lemos ◽

Rodrigo Poderoso ◽

Ravi Cirilo Targino de Araújo ◽

Rodrigo Ramalho Aniceto ◽

...

Keyword(s):

Blood Flow ◽

Cuff Pressure ◽

Arterial Occlusion ◽

Lower Limbs ◽

Predictive Equation ◽

Occlusion Pressure ◽

Thigh Circumference ◽

Flow Restriction ◽

Arterial Occlusion Pressure ◽

Age And Sex

ABSTRACT Introduction No research has investigated predictive equations for application in blood flow restriction (BFR) training using a cuff with a circumference of 18 cm for the lower limbs, and including age and sex as predictor variables. Objectives To develop an equation to predict cuff pressure levels for use in BFR training for the lower limbs. Methods A total of 51 adults (age 23.23 ± 5.24 years) of both sexes (males, n= 32; females, n= 19) underwent a series of tests and anthropometric (body mass, height, body mass index – BMI, and thigh circumference – TC) and hemodynamic (brachial systolic – SBP – and diastolic – DBP – blood pressure) measurements. The arterial occlusion pressure (AOP) of the lower limbs was measured using a Doppler probe. Results The predictive equation was developed based on a hierarchical linear regression model consisting of six blocks, corresponding to TC (β = 0.380; p = 0.005), SBP (β = 0.091; p = 0.482), age (β = 0.320; p = 0.015), and sex (β = -0.207; p = 0.105), which explained 39.7% of the variation in arterial occlusion pressure. DBP and BMI were not associated with AOP. As a result, the predictive equation is as follows: AOP (mmHg) = 65.290 + 1.110 (TC in cm) + 0.178 (SBP in mmHg) + 1.153 (age in years) – 7.984 (sex, 1 – male and 2 – female), reporting values of r = 0.630, r2 = 0.397 and SEE = 15,289. Conclusion Cuff pressure for BFR training of the lower limbs may be selected based on TC, SBP, age and sex, and thigh circumference is considered the main predictor. Level of Evidence III, Non-consecutive studies, or studies without consistently applied reference standard.

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