Where Does Blood Flow Restriction Fit in the Toolbox of Athletic Development? A Narrative Review of the Proposed Mechanisms and Potential Applications

Abstract

Blood flow-restricted exercise is currently used as a low-intensity time-efficient approach to reap many of the benefits of typical high-intensity training. Evidence continues to lend support to the notion that even highly trained individuals, such as athletes, still benefit from this mode of training. Both resistance and endurance exercise may be combined with blood flow restriction to provide a spectrum of adaptations in skeletal muscle, spanning from myofibrillar to mitochondrial adjustments. Such diverse adaptations would benefit both muscular strength and endurance qualities concurrently, which are demanded in athletic performance, most notably in team sports. Moreover, recent work indicates that when traditional high-load resistance training is supplemented with low-load, blood flow-restricted exercise, either in the same session or as a separate training block in a periodised programme, a synergistic and complementary effect on training adaptations may occur. Transient reductions in mechanical loading of tissues afforded by low-load, blood flow-restricted exercise may also serve a purpose during de-loading, tapering or rehabilitation of musculoskeletal injury. This narrative review aims to expand on the current scientific and practical understanding of how blood flow restriction methods may be applied by coaches and practitioners to enhance current athletic development models.

Fig. 1

Three exemplary cases of how blood flow restriction (BFR) may be introduced and progressed for a team sport athlete at various times throughout the season. The example programmes provided a focus on lower body strength and conditioning training as these are most relevant to the case study sport. Other training modes (e.g. upper body strength, sport-specific training) may continue as normal if appropriate. In situations where one repetition maximum (1RM) testing is not possible or practical, it is recommended to use a load that is estimated to be between 30 and 35 RM and to adjust effort using the repetitions in reserve (RIR) and rating of perceived exertion (RPE) values provided. If measurement of repetition velocity is possible, practitioners may also use loads that equate to initial mean concentric velocities of 1.0–1.3 m per second. *Higher cuff pressures are used in the knee pain case study as these appear to elicit a greater hypoalgesic effect [131]. AOP arterial occlusion pressure, BW bodyweight