Blood Flow Restriction training

Great synopsis of BFR for endurance training by Richard Furguson with tables of every relevant study:

Blood-flow-restricted exercise: Strategies for enhancing muscle adaptation and performance in the endurance-trained athlete
Richard A. Ferguson, Emma A. Mitchell, Conor W. Taylor, David J. Bishop, Danny Christiansen
First published: 24 January 2021

https://physoc.onlinelibrary.wiley.com/doi/10.1113/EP089280

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New youtube channel which started by sharing 3 videos on that subject

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Theres some pretty decent literature on this is Physical Therapy Journals. Seems to have come into vogue lately for them…

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Quick link to the related section from podcast today:

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My brain is too shot to take it fully in but did Chad say you get 0.5% improvement (if you are super fit) by applying it on recovery intervals and no benefits if you keep the restriction on during higher intensity intervals. That sounds like a right faff, apply the restriction during intervals to take it off again etc, etc for a tiny gain if you are super fit. :roll_eyes:

He said the study showed 3-4% maximum aerobic power improvement, so ftp should be roughly 75% of that. So let’s say 2-3% ftp bump in theory. I don’t know where he gets the 0.5% performance, Jonathan mentioned a 40k TT on the fly so maybe he was just roughing it as an example that time difference will be different than power. That’d give you 20 seconds let’s say in a 40k TT on that math if you’re at a high level.

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Great BFR deep dive! I really appreciated the thoughtful comments and questions by @Jonathan and @ambermalika that brought up topics that still need to be addressed.

It was quite obvious that even though the evidence is there, Chad is still skeptical and is having trouble wrapping his head around the whole “something for nothing” theory, which is completely understandable. Because, as a decades-long athlete and coach, he has lived the life of working hard to see benefits and work harder than the other guys to win.

Even though BFR has been around for decades, there is still a lot to be learned and I appreciated everyone’s caution in addressing the topic. I think the aim of this podcast was to present the overwhelming evidence in support of BFR’s benefits while still trying to place emphasis on it’s potential dangers - especially to TR athletes who, as a group, may tend to lean more toward the “start extreme and taper from there if needed” end of the axis :sweat_smile:

Nonetheless, the entire body of evidence @chad presented not only showed BFR’s benefits but also its safety.

Outside of the statements of caution in the last several minutes by Chad, Jonathan and Amber, I thought this was the big takeaway statement from Chad regarding BFR:

“The less trained, the moderately trained, the immobile, that’s what we’re going to talk about right now. Caitlin’s question – can it benefit time-crunched athletes to get better endurance gains or are the effects short-lived?
So, I used this as an opportunity to talk about who’s best served by blood flow restriction training. And it turns out, pretty much everybody. Untrained, trained, elite, immobilized, strength athletes, endurance athletes, it’s across the board. There’s science to support it benefitting everybody in small ways and in bigger ways.”

and later:

“We’ve seen example after example of increased muscle hypertrophy and muscle strength. And I think this might be the best application for supplementing your training. Because athletes may already be pushing up against what their bodies can compensate for, can recover from, so if you add a little low-load training, low muscle damage in the process could be an excellent supplementary avenue.”

At the end, Jonathan was talking about how he tends to lean away from activities that increase RPE these days and I couldn’t help but think - is that possibly because increased RPE tends to equate to increased time to recovery? Is there more appeal to short-lived high RPE if there is not an equal required recovery time compared to the effort?

And final thought, there’s a lot of talk about marginal gains and the alternative things that can be done to find those gains (sorry but I already do a PRD and still want to maximize my other gains.) Until recently, most TR riders would literally put themselves in extreme physical discomfort and maxed out RPE… just to find a number! What was it, if you make it to 19 minutes and 30 seconds then you just have to keep going to record a higher FTP? And, these BFR sessions are recommended for 20 minutes or less. It’s not like we don’t know how to be uncomfortable for that duration already and expect less of an outcome!

Anyway, my initial question almost three years ago was if anyone had heard or read evidence of it relating to cycling and I knew when Chad finally addressed it, that it would be as deep and thorough as possible and this podcast did not disappoint!

Looking forward to seeing what future research brings and how @Nate_Pearson and Jonathan’s BFR journeys go :joy:

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It seems like the research has a long way to go for endurance athletes.

For example, what is BFR a proxy for?

Is having the muscles spend more time in a metabolic soup, so to speak, a proxy for threshold training (mitochrondrial respiration)?

Could BFR be a proxy for the long ride (capiliarization and mitochrondria development)?

Where is the increased VO2max coming from in the studies? It’s obviously not coming from cardiac output.

Most of the BFR studies have been shorter intervals. I’m more interested in the longer intervals in the rowing study.

I’ve done similar 10-15-20 minute intervals at low power (125-150 watts). They are not painful at all. It leaves me wondering about a protocol like 5x10minute with 5 minute rests. You could do that workout in 90 minutes. Could it be a proxy for a 3-5 hour workout?

I also think about someone that is truly time-crunched. What kind of fitness could one maintain with 5-6 days per week doing 30 minutes per day of BFR. Warm-up plus 2x10. 2.5-3 hours per week all in. It’s interesting to think about.

The rower study was only 5 weeks. What about 3 months? Nobody knows the answers to these questions.

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All lot of this makes sense, and the science and intitial trials appear positive. However, I’ve just bought some inflatable BFR cuffs to test and my experience leads me to believe that more knowledge or info is required (normally more knowledge on my side)

I’m using inflatable, wide leg cuffs. The challenge I have is understanding the correct pressure, studies are stating 40-80% LOP which is a huge variance. I’ve used a doppler to find my occlusion point, and therefore can calculate the % LOP points. ps: I tried non-inflatable bands (only once) and that just felt like uneducated gambling with something quite dangerous.

I’ve found for doing squats and walking that I’m OK at 60% LOP, the same for bicep curls on the arms (narrower bands). However, I want to use these on the bike, but 60% LOP on the bike kills me, it’s hard, really hard. Doing ~45% FTP power is almost impossible as the legs swell, and the pain around the bands gets quite bad. I can manage a couple of minutes max. I’m going to test at pressures below 60%, but my feeling is that there isn’t enough info out there about ‘what is correct’. I’m assuming that you should feel the legs swell and the exercise be more intense, but it shouldn’t be too painful and hard. I’d be interested to try auto-inflation cuffs that auto-adjust the pressure in case it’s the increase in pressure under load that is my problem, ie. 60% relaxed may be much higher under cycling load as pressure builds up… again, I’m still reading, but the info leaves a lot for personal assesment, which as a non-medical professional feels abit hit and miss.

i feel this could be a great tool to have in the training toolbox, but more info is required to make it more safely accessible to Joe Blow. I’m progressing on the side of cautiion, but others would push much harder and I’m not sure if that could be dangerous.

What brand cuffs do you have?

I’ve been experimenting with B-Strong cuffs. I use the recommended 250psi for squats and dumbbell work. On the bike I’ve used 200psi. I can easily do 10-15-20 minute intervals without it feeling like I’m going to die.

I have some no name brand inflatable cuffs, ~$80 delivered from Alibaba for arms and legs set. The leg ones are nice and wide.

I find them fine for walking and squats. Hard but OK. I need to play around on the bike in regards to position.

Bstrong I think are a bit different in their design with the elastic, mine are rigid with a continuous inflatable bladder. I’ve seen the guy from Kinetic Coaching on youtube using BStrong at 260mmhg.

I would have liked to get Bstrong, but didn’t have 450 USD to drop on a 4-band set for something I wasn’t sure I would continue to use.

With my bands and a doppler, I reckon my 100% LOP (blood total cutoff) is at 200-220mmhg. I do squats at 160mmhg and can do bike at 140mmhg.

Although there isn’t much resistance/weight used, I’m interested to know how it impacts TSS for training/recovery. Doing three sets of squats, or 15-20 min on the bike is very hard. 40-45% FTP cycling has me around 45% HRR or 66% Max HR, but feels really hard.

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I really like the Bstrong. I didn’t want to pay $400 for a set either so I set up an alert on ebay and snagged a leg for $100 and then snagged an arm set for cheap after it popped up. I had to be patient.

I also have a cheap non-inflatable set from Amazon and I think they work pretty well since they are elastic and not rigid. It helps to have an idea though what they should feel like.

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I was meaning to post this blog link in this topic. It’s an older blog but he references a lot of studies. I also found his other blog posts interesting.

“while occlusion training may (9), or may not (30), result in enhanced hypertrophy on an effort-matched basis, it represents a more efficient training stimulus, producing comparable growth with less total work at a given training intensity.”

It’s easy to see how BFR applies to weight training but I think the jury is still out on endurance sports. Could BFR be the ultimate time crunched accessory? I’ve been wondering if, for example, you design a 60 minute workout with 2x20minute or 3x15 minute low intensity BFR intervals, if you might get the same benefit as a longer 2+ hour workout?

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great BFR presentation. A number of studies summarized in this presentation but basically he sussed out what the mechanism was for improving VO2max using BFR.

It’s not increased blood volume although they did find increased hormone response post-exercise…just no actual measurable difference in blood volume.

It’s not heart adaptation/increased stroke volume.

Turns out it’s rate of blood flow into and out of the muscle that increases.

Especially interesting results with the rowers. Yikes. (In case you missed it, the protocol used to achieve those results were 10 minute bouts at a 2mmol lactate. So very nominal exercise intensity. Some of those athletes were olympians. Amazing.)

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Cool, I will check that out. I’ve been playing around with cuffs off and on for a couple of years but have never stuck with any protocol.

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@AJS914 if it helps I think Thompson modeled the rowing BFR protocol after Held, 2020 paper:

https://www.jsams.org/article/S1440-2440(19)30568-7/abstract

“Training took place three times a week over 5 weeks (accumulated net pBFR: 60 min/week; occlusion per session: 2-times 10 min/session) and was used exclusively at low intensities (<2 mmol/L).”

So, again, not much. Not intense. I’m just very impressed that they got those results with that protocol from some very well trained athletes.

I’ve played around with 10-15-20 minute zone 2 effort intervals. They were fine but I didn’t see them move the FTP needle noticeably.

Well I guess that would be my expectation as well! If you’ve ever done a 2k row, though, you’ll know it’s definitely a VO2max effort. So maybe that’s the difference. But yeah, I would have guessed exactly what your experience was…not a first order improvement.

I was able to capture all the top rowing times in my region in my age group EXCEPT 2000m, though. So now I’m thinking, 'Hey, if I could chop 8 seconds off my 2k maybe I could have a clean sweep.

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