Blood flow restriction (BFR) is growing in popularity in physiotherapy, Olympic and professional sports, and weight rooms. Yet, how it works and how it can help people build muscle is still misunderstood.
So how can blood flow restriction training help you gain muscle? By wrapping specially designed cuffs or bands around the top portion of a limb when training, BFR allows blood to enter the working muscle but fully restricts it from leaving the muscle. It also restricts oxygen to the muscles, which increases protein synthesis that contributes to muscle growth and repair.
If done incorrectly or without the proper protocols, individuals may be missing out on the benefits of BFR and can even damage their veins or arteries.
In this article, I'll discuss the proper BFR training protocols for individuals looking to use it for muscle gain, including cuff pressures, the best types of exercises to do with BFR, and recommended set and rep ranges.
Let’s get into it.
Results You Can Expect From BFR Training
There are three key results someone would expect from BFR training:
- Increased hypertrophy
- Increased strength with lighter weight
- Improved injury rehab
One of the primary benefits of BFR training is that you can increase muscle size when training at a very low intensity. BFR training produces a low-oxygen environment that helps it produce hypertrophy results similar to those found in heavy resistance training.
Research has shown that this environment creates metabolic stress in the body, meaning that as you continue to workout, the body responds by pumping more blood to the working muscles.
As the muscles start to fatigue, the cells begin to repair damaged tissue and build new muscle, helping them get bigger.
Increased Strength With Lighter Weights
Lifting at even 20% of your 1RM (one rep max) can help you maintain or increase strength during BFR training.
Research from the University of Tokyo demonstrated that combining high-intensity resistance training with BFR training can enhance increases in muscle strength. Participants combining these forms of training showed a 15% increase in their 1RM on the bench press.
Improved Injury Recovery
This is because BFR supports strength increases in muscles without placing heavy loads on the injured ligaments or joints. As such, BFR can accelerate injury recovery and can be a beneficial tool to use in rehab programs for athletes.
Factors to Consider When Structuring BFR Training
When designing a program that includes BFR training, there are several factors to consider.
- Experience level
- Workout goals
- Type of BFR band
- Type of exercise
A crucial consideration of BFR training is how experienced an individual is with workout programs and using BFR protocols in general.
Safety is a huge concern for beginners attempting BFR. Incorrectly wrapping the band or using the wrong pressure can result in side effects ranging from minor bruises to numbness.
Such symptoms are commonly found at the start of an individual's BFR program, but will likely dissipate as you become more accustomed to the program.
Much like any novel stimulus, BFR training should be implemented at low intensities and gradually progressed to prevent excessive soreness and associated negative side effects.
The contraindications to BFR are centered around those with vascular or cardiac considerations. The increased heart rate from the body trying to get arterial blood to the tissues can cause an increase in cardiac stress.
Contraindications can include:
- Cardiac disease
- High blood pressure
- Varicose veins
You should use common sense to decide if BFR training is suitable for you and consult a doctor before starting a BFR training program.
The BFR program you devise will be highly dependent on your workout goals.
For those looking to accelerate their injury rehab, a typical BFR program will avoid overloading and stressing the associated injury.
For individuals looking to enhance hypertrophy and build muscle strength, the program should focus on working with loads at 20-40% of your 1RM and lifting in rep ranges of 15 or more.
Type of BFR band
Choosing the best BFR band can be one of the most difficult and important decisions when beginning a BFR training program.
There are different kinds of BFR bands available on the market. Most BFR cuffs sold online are thick bands made out of cotton and elastic, and you have to manually tighten them yourself. This can lead to inconsistent pressure from limb to limb or workout to workout, and it’s easy to accidentally tighten them too much.
There are also BFR cuffs like the SAGA BFR cuffs that use your blood pressure to determine the correct amount of occlusion pressure. Cuffs like these are more ideal for BFR training because you can ensure a safe, consistent amount of pressure each time you use them.
Type of exercise
Almost any exercise used to build strength and hypertrophy can be used with BFR. It can also be used for sprint workouts and has been shown to help decrease sprint times in well-trained athletes. However, research has also shown that there are no positive effects of BFR training on jump performance, so there is no benefit to using BFR cuffs for jump training.
Even using BFR without doing any exercises can mitigate a decrease in muscle mass and strength post-surgery or during an injury. It is often used by injured athletes in the initial stages of their rehab.
Keeping the above considerations in mind, we can now look at how to structure a BFR training program for muscle gain. But it’s important to note that for healthy athletes looking to enhance their performance training, BFR should not act as a replacement for heavy lifting.
Heavy lifting is much more than just recruiting type II muscle fibers (the muscle fibers that are activated during activities that require quick bursts of energy). It also requires stabilization, coordination, and multiple muscle groups working together to complete the lift.
BFR training can, however, supplement and enhance a fully rounded workout program.
There are only two places that a BFR device should be placed: the upper arm and the upper thigh. Placing these devices on the upper calf or forearm can compress and damage the superficial nerves that exist in these areas. This can lead to injury and medical conditions such as foot drop, which occurs when you can’t lift the front of your foot and your toes drag on the ground.
It’s also extremely important that you do not wear BFR cuffs on the arms and legs at the same time. You can wear them on both arms or both legs but not all four limbs simultaneously.
When using an actual BFR device, you should be able to precisely measure the blood flow occlusion.
The beauty of the SAGA BFR cuffs is that they automatically inflate and apply pressure to your limbs based on your blood pressure. They’re designed to provide 50% occlusion for the arms and 80% occlusion for the legs, which are shown to be the most optimal percentages for doing BFR safely while still promoting muscle gain.
With that said, it is possible that your cuffs may be too loose or too tight when they’re inflated. If they’re too loose, you won’t gain any benefit from wearing them. If they’re too tight, you may notice tingling in the limb, paleness in your skin, or a lack of pulse in your wrist or ankle.
Sets and Reps
Literature is a little inconclusive when it comes to the number of sets and reps you should do. However, the general consensus is 1 set of 30 reps followed by 3 sets of 15 reps with a 30-second break between each set.
It’s important to remember that BFR causes a low oxygen environment that already produces similar results as lifting at 80-85% of your 1RM. Lifting too heavy when you’re occluding blood flow can cause you to pass out. For optimal results, you shouldn’t lift more than 20-40% of your 1RM.
If you don’t know your 1RM, I recommend starting with a weight that’s about 50-60% lighter than what you normally lift. So if you usually use 35lb dumbbells for lunges, you can start with around 20lbs with BFR bands and adjust the weight higher or lower based on how it feels.
While BFR training doesn’t produce muscle damage the same way traditional strength training does, it’s still important to give yourself enough rest in between each BFR training session. It’s best done 2 to 4 days per week on non-consecutive days.
BFR Training for Lower Body Muscles
Most lower body exercises that you’d see in a typical strength training program can be used with BFR training. These include:
- Leg presses
- Bulgarian split squats
You can also do isolation exercises (movements that train one muscle group at a time) like calf raises, leg extensions, and hamstring curls. You can even use BFR cuffs when doing glute exercises like hip thrusts or glute kickbacks, as research has shown that BFR training can still produce strength and hypertrophy gains even if a muscle group isn’t directly occluded.
BFR Training for Upper Body Muscles
Like lower body exercises, BFR training for the upper body can be done with a combination of compound exercises (ones that work more than one muscle group) and isolation exercises.
Some of the best upper body exercises to use with BFR include:
- Bicep curls
- Tricep extensions
- Bench presses
- Cable flys
- Dumbbell shoulder presses
Done correctly and as part of a rounded workout program, BFR training can be highly effective for building muscle strength and hypertrophy. It’s also an effective training method for individuals who are unable to train with heavy weights or those who are rehabbing an injury.