by Dr. Mario G. Novo, PT, DPT

Blood flow restriction (BFR) is an evidence based exercise training method for the widespread population that combines tourniquet technology and lite intensity resistance training to build muscle mass, strength, cardiovascular capacity and bone density that is similar to higher intensity training.

BFR training is performed by applying an inflatable tourniquet to the upper arms or upper legs (never all 4 at once), that is calibrated to the individual user by technology from a certified BFR specialist.

Reducing blood flow to a limb while performing lite intensity cardiovascular exercise or resistance training has shown to increase muscle oxygen demands in muscle, which encourage larger and greater force producing bundles of muscle fibers to become active.

These higher thresholds, fast twitch muscle fibers are quite particular and during normal conditions require heavier weight or near absolute muscle fatigue to be recruited; which is often difficult or not advised pre competition, during in-season competition, post injury/surgery, or within the aging community. In each of these cases, maintaining or increasing in muscle mass is critical for health and injury reduction, as per the American college of sports medicine. BFR has shown to positively influence similar high-intensity benefits while lifting loads as lite as 20% to 40% or a single repetition max, which commonly are not enough resistance or intensity.

Similarly, BFR has shown to be beneficial to cardiovascular capacity or VO2max adaptations in young, elderly and professional sports players who are unable to use high-intensity training like running due to cardiovascular restrictions, bone density, joint health, or are just limited in time. Typically, higher intensity exercises are needed to encourage positive cardiovascular changes, such as running within the 60% to 80% of heart rate reserve (HRR), with required durations of 30 to 45 minutes.

Findings with BFR have shown to increase cardiovascular capacity, circulatory fitness, and increase in muscle mass and strength while at intensities as low as 45% HRR. These outcomes appear to be explained by studies that have shown reductions in blood flow to the heart via tourniquet use, can be used to safely increase heart rate and arterial adaptations while using treadmill walking, riding a bike or even walking in a pool that can be beneficial for lower bone density/post injury/post-surgical patients.

BFR research began nearly 50 years ago, by Dr. Yoshiaki Sato, who was curious to explore why muscles burned when they became fatigued. His early curiosity led him to use an innertube from a bike tire to reduce blood flow to a limb. Since then, the US military, NASA, Sports Orthopedic surgeons, Biologist, Cardiovascular specialist and Neurologist from around the world have participated in over 1000 peer reviewed studies to peer further into the safety, benefits, and population specifics for applying BFR training in hospital settings, outpatient, and in the training room. What the studies have demonstrated so far, is that BFR training can be a game changer for many people wanting to get back to what they love to do and perform better.

As of 2018, BFR training became part of the American Physical Therapy association practice act, and since 2014 has been adopted into nearly all US professional sports rehab teams, Olympics, special forces rehab units, top orthopedic groups and with the help of other fellow researchers and educators such as myself, is now growing abroad in Europe, Australia, Ireland, and South America.

As a sports medicine/exercise physiologist lead Physical Therapist at Lifters Clinic here in Mount Juliet TN, a researcher in BFR here at our very own Belmont University, and co-founder of The BFR Pro’s, an unbiased BFR continuing education company; BFR has made up my life for the better of the last 5 years.

The amazing anecdotal stories that I have seen, in cases where fractures finally closed, muscles bounced back after an ACL surgery, reduced knee pain for osteoarthritis/rheumatoid arthritis patients, faster recovery periods post sport-related injuries; and elderly patients making leap and bounds to positive muscle mass, strength, and cardiovascular changes have all been a humbling life-changing experience.

For many of my patients, BFR directly helped lower the threshold and barrier of entry to experience positive change and a path forward.

BFR training is easy to use, hard to misuse, safe, effective, and becoming mainstream. We in the field say that BFR is better for results, backed by science, and changing people’s lives.