SAGA Blood Flow Restriction Training Instruction Manual
- June 17, 2024
- SAGA
Table of Contents
SAGA Blood Flow Restriction Training
Specifications
- Product Name: Blood Flow Training System
- Brand: Saga Fitness
- Pages: 5
Product Information
Blood Flow Restriction (BFR) Training is an innovative exercise method
designed to promote muscle growth, strength gains, and endurance adaptations
at lower intensities and in shorter time frames. By partially restricting
arterial blood flow and fully occluding venous blood flow, BFR training
elicits unique adaptations that contribute to its effectiveness.
Product Usage Instructions
Chapter 1: Introduction to BFR Training
BFR Training involves applying pressure from a cuff or band to restrict
arterial blood flow while fully occluding venous blood flow. This leads to
favorable adaptations in muscle growth, strength gains, and endurance.
Arterial vs. Venous Blood Flow
Understanding the difference between arterial and venous blood flow is
crucial in BFR training. Arterial blood flow carries oxygen-rich blood from
the heart to the body, while venous blood flow returns oxygen-depleted blood
to the heart. BFR training impacts both types of blood flow to induce desired
adaptations.
Limb Occlusion Pressure (LOP)
LOP is the pressure required to restrict arterial blood flow during BFR
training. Factors like limb circumference and cuff width influence LOP, with
larger limbs requiring more pressure and wider cuffs needing less pressure to
achieve occlusion.
The Elevator Pitch for BFR Training
BFR Training offers a unique exercise approach for significant muscle
growth, strength gains, and endurance improvements at lower intensities and in
shorter durations compared to traditional methods.
Chapter 2: Origins
The concept of BFR Training originated from Kaatsu training developed by
Dr. Sato. This method, known as Kaatsu in Japanese, demonstrated the ability
to stimulate muscle growth and strength with lower exercise intensities,
making it suitable for various populations.
FAQ
-
What are the benefits of BFR Training?
BFR Training promotes muscle growth, strength gains, and endurance adaptations at lower intensities and in shorter time frames compared to traditional methods. -
How is Limb Occlusion Pressure (LOP) determined?
LOP is determined by factors like limb circumference and cuff width, with larger limbs requiring more pressure and wider cuffs needing less pressure to achieve occlusion.
Introduction to BFR Training
Blood Flow Restriction (BFR) Training is a unique and innovative exercise method that has gained significant attention in recent years for its ability to promote muscle growth, strength gains, and endurance adaptations at lower intensities and in shorter time frames. This chapter will serve as a brief introduction to the concept of BFR training, including key terminology and nomenclature.
Blood Flow Restriction Training:
The Basics
BFR training involves placing an inflated cuff or band on either the upper
arms or upper legs during some form of physical activity – the cuff is
designed to partially restrict arterial blood flow while fully occluding
venous blood flow, creating a localized hypoxic environment that enhances the
metabolic and physiological responses of the targeted muscles. This unique
approach allows individuals to achieve muscle and endurance gains at lower
intensities and generally in shorter time frames compared to traditional
exercise methods.
Arterial vs. Venous Blood Flow
To better understand the principles of BFR training, it is helpful to
differentiate between arterial and venous blood flow. Arterial blood flow
refers to oxygen-rich blood flow from the heart to the rest of the body
through the arteries. In contrast, venous blood flow refers to the return of
oxygen-depleted blood from the body’s tissues back to the heart through the
veins. In BFR training, the applied pressure from the cuff or band is
sufficient to partially restrict arterial blood flow, reducing the amount of
oxygen-rich blood reaching the targeted muscles. At the same time, the
pressure fully occludes venous blood flow, preventing the oxygen-depleted
blood from returning to the heart. Both arterial and venous occlusion play
unique roles in the favorable adaptations elicited from BFR training.
Limb Occlusion Pressure (LOP)
Understanding limb occlusion pressure (LOP) is essential for effectively
implementing Blood Flow Restriction Training. LOP refers to the minimum amount
of pressure required to completely stop blood flow to a limb. This is measured
either via a Doppler ultrasound device or by the use of specialized BFR cuffs
capable of detecting LOP.
In BFR training, it is crucial to apply pressure that is a certain percentage
of an individual’s LOP (discussed in subsequent chapters) to ensure safety and
effectiveness. Applying too much pressure may lead to complete occlusion of
blood flow and potential injury, while applying too little pressure may not
produce the desired hypoxic environment and training adaptations.
Factors that Determine LOP
There are several factors that determine the necessary pressure required to
reach LOP, but the primary factors include:
Limb circumference:
Larger limbs generally require more pressure to occlude due to the “tissue
padding effect”. Limb circumference is likely the biggest determinant of LOP.
LOP = 130 mmHg
LOP = 150 mmHg
Cuff width:
Wider cuffs require less pressure than narrow cuffs to reach limb occlusion.
This is likely because wider cuffs may eliminate blood flow without total
collapse of the arteries possibly due to an accumulation of frictional
resistance to fluid flow along the compressed length. (Crenshaw, 1988)
LOP = 220 mmHg
LOP = 150 mmHg
The Elevator Pitch for BFR Training
Blood Flow Restriction Training offers a unique and effective approach to
exercise, allowing individuals to achieve significant muscle growth, strength
gains, and endurance adaptations at lower intensities and generally in shorter
time frames than traditional training methods.
Origins
Idea Catalyst
The story of BFR training began in Japan in the 1960s, with Dr. Yoshiaki Sato.
While attending a Buddhist ceremony, Sato experienced numbness and discomfort
in his legs due to sitting in a kneeling position for an extended period. He
noticed that his calves were swollen and experienced a pump sensation upon
standing (similar to the pump initiated by resistance training) and was
intrigued by the possible connection between restricted blood flow and
muscular growth. This led him on a journey of experimentation and testing his
hypothesis.
The Development of Kaatsu Training
Over the next few decades, Dr. Sato continued to refine his techniques and
developed what he called Kaatsu (Japanese for “additional pressure”) training.
His extensive research demonstrated that this method could stimulate muscle
growth and strength development with lower exercise intensities, making it an
appealing option for a variety of populations, including athletes, the
elderly, and individuals with physical limitations.
Scientific Validation and Adoption
As Dr. Sato’s work gained recognition, researchers worldwide began
investigating the underlying mechanisms and potential benefits of BFR
training. Early studies primarily focused on its application in bodybuilding
and strength training, but over time, research expanded to include
rehabilitation, injury prevention, and even cardiovascular health. As more
studies validated the safety and effectiveness of BFR training, it garnered
attention from professional athletes, coaches, and trainers, who began
incorporating it into their training regimens.
Physiology
This chapter will discuss the mechanisms that are understood to drive the favorable adaptations from blood flow restriction, beginning with hypoxia.
Hypoxia
Blood carries oxygen. Since BFR cuffs restrict a percentage of arterial blood
flow (the blood flowing from your heart to your muscles), this leads to a
decrease in oxygen availability, creating a hypoxic environment within the
muscle cells. This hypoxic state triggers a cascade of cellular responses that
play a key role in the benefits associated with BFR training.
Explained simply:
Low oxygen delivery to the working muscles kicks off a whole host of responses
in the body that can lead to muscle, strength, and endurance gains.
Metabolite Accumulation and Muscle Fiber Activation
The hypoxic environment created by blood flow restriction leads to an
accumulation of metabolic byproducts, such as lactate and hydrogen ions. This
buildup of metabolites results in an increase in acidity within the muscle
cells, which is understood to be a potent muscle growth stimulus.
Additionally, this hypoxic state likely forces faster twitch muscle fibers
(the fibers most prone to growth) to be recruited earlier and to a greater
degree. As a result, BFR training can promote muscle growth and strength
development even at lower exercise intensities compared to traditional
resistance training.
Explained simply:
Muscles need oxygen to deal with metabolites like lactate (the thing that’s
partially responsible for the burn you feel in your muscles towards the end of
a set). Since oxygen delivery is limited by the cuff, lactate and hydrogen
ions build up faster than normal, which can cause your faster twitch muscle
fibers to fire up sooner. It’s also believed that the presence of these
metabolites are one contributor to muscle growth.
Cellular Swelling and Anabolic Signaling
The blood flow restriction during BFR training results in an increase in fluid
accumulation within the muscle cells, leading to cellular swelling. This
swelling is believed to generate a mechanical stress on the cells, activating
anabolic signaling pathways, such as the mammalian target of rapamycin (mTOR)
pathway. Activation of these
pathways promotes protein synthesis and muscle growth, contributing to the
hypertrophic response observed with BFR training.
Explained simply:
Since the BFR cuffs restrict blood from leaving your limb and going back to
your heart, the limb temporarily swells – this is a result of the actual
muscle cells swelling. There are sensors on the wall of the muscle cells that
detect this stretch, which can trigger muscle growth.
Hormonal and Growth Factor Responses
BFR training has been shown to elicit an acute hormonal response, with
increased levels of anabolic hormones like growth hormone (GH), insulin-like
growth factor-1 (IGF-1), and testosterone. These hormones play a crucial role
in promoting muscle growth and recovery. Additionally, BFR training stimulates
the production of vascular endothelial growth factor (VEGF) and other growth
factors that contribute to angiogenesis, the process of forming new blood
vessels, which can improve oxygen delivery and nutrient exchange within the
muscles. These mechanisms are not unique to BFR training, but have a more
significant effect under BFR versus load-matched training without occlusion.
Explained simply:
Traditional resistance training can cause hormonal responses and growth
factors that lead to muscle growth and the formation of new blood vessels.
Research has demonstrated that those same hormonal responses and growth
factors can occur under BFR, even while training at a lower intensity (20 –
30% 1RM).
Safety
Safety of BFR Training:
A Meta-Analytical Perspective
Several meta-analyses have been conducted to assess the safety and efficacy of
BFR training, providing valuable insights into the potential risks associated
with this method. A meta-analysis by Slysz et al. (2016) examined 28 studies
and surmised that BFR training is safe and effective for promoting muscle
hypertrophy and strength in both healthy and the clinical populations
observed. Similarly, a meta-analysis by Centner et al. (2018) analyzed 17
studies and found BFR training to be safe and effective for increasing muscle
strength and size. These meta-analyses, along with numerous individual
studies, demonstrate that BFR training can be safe when performed correctly,
using appropriate equipment and protocols.
Explained simply:
A meta-analysis is an examination of data from a number of independent studies
of the same subject, in order to determine overall trends. The meta-analyses
referenced above combine data from dozens of studies to gather a broad picture
on BFR safety, ultimately suggesting BFR training is safe and effective for
most people.
Addressing the Concern: Blood Clots
Research has shown that the risk of blood clots associated with BFR training
is exceptionally low when proper protocols are followed. The totality of the
literature reveals minimal adverse events pertaining to VTE and clinically
reported events have not been reported (Patterson, 2019). Furthermore, the
previously mentioned meta-analyses by Slysz et al. (2016) and Centner et al.
(2018) did not report any significant increase in blood clot risk related to
BFR training.
Addressing the Concern: Blood Pressure
The majority of studies on BFR training have reported no significant increase
in blood pressure compared to traditional resistance training. In fact, some
studies have even demonstrated improvements in arterial stiffness and blood
pressure following BFR training (Ozaki et al. (2013). Broadly, BFR training
does not appear to increase blood pressure above intensity-matched exercise.
Some studies even show higher blood pressure response in the control (non BFR
group).
Benefits
Enhanced Muscle Growth and Strength Development
One of the most notable benefits of BFR training is its ability to promote
muscle growth and strength development even at lower exercise intensities. By
restricting blood flow to the working muscles, BFR training triggers a cascade
of physiological responses, including increased muscle fiber activation,
hormonal release, and anabolic signaling. These factors contribute to
hypertrophy and strength gains, making BFR training an effective alternative
or complement to traditional resistance training.
Explained simply:
BFR can allow you to put on muscle and strength even while training with
significantly less weight.
More Effective Rehabilitation
BFR training’s ability to elicit muscle growth and strength gains at lower
exercise intensities makes it particularly well-suited for rehabilitation,
injury recovery, and load management for people regardless of their injury
status. For those recovering from injuries or surgeries, BFR training allows
them to stimulate muscle growth and strength development without placing
excessive stress on the joints, tendons, or healing tissues, accelerating the
recovery process and helping them return to their pre-injury function more
quickly.
Faster Recovery
For those who are not injured, BFR training offers a valuable tool for load
management and mitigating the risk of injury associated with heavy resistance
training. By reducing the loads required to stimulate muscle growth and
strength gains, BFR training can help people avoid excessive joint and
connective tissue stress, potentially decreasing the likelihood of overuse
injuries. This can be particularly beneficial for athletes during periods of
high training volume or for those who may be prone to joint-related issues.
Furthermore, BFR training’s lower intensity nature can help facilitate faster
post-exercise recovery, allowing individuals to maintain or even increase
their training frequency without compromising performance or increasing the
risk of injury. This makes BFR training an attractive option for those looking
to optimize their training programs and overall physical performance.
Explained simply:
Since BFR training can allow muscle and strength gains while training with
less weight, it’s a fantastic solution for those rehabbing from injuries
because it can minimize stress on joints, tendons, and ligaments while
maximizing stimulus to muscles. Further, even for those not injured, BFR
training can allow for faster recovery since lower loads put less stress on
joints and generally cause less fatigue.
Enhanced Endurance Performance
BFR training has also shown promise in improving endurance performance by
replicating many of the effects of higher intensity endurance training while
enabling lower training intensities. The restricted blood flow during BFR
training leads to a decrease in oxygen availability, creating a hypoxic
environment within the muscle cells. This hypoxic state results in an
increased reliance on anaerobic energy systems and a buildup of metabolic
byproducts, simulating the physiological demands experienced during high-
intensity endurance training. Additionally, BFR training has been shown to
promote mitochondrial biogenesis (the process of creating new mitochondria
within the muscle cells) even at a lower output. Mitochondria are the primary
site of energy production in the cells, and an increase in mitochondrial
content can improve the muscles’ capacity to produce energy aerobically. This
enhanced energy production capability can contribute to improved endurance
performance. The increased capillary density and angiogenesis associated with
BFR training, as mentioned earlier, can also play a role in enhancing
endurance performance. Improved vascular function and capillary density can
lead to more efficient oxygen delivery and waste product removal, thereby
increasing the muscles’ ability to sustain prolonged exercise. By offering a
low-intensity alternative that mimics many of the physiological adaptations
associated with high-intensity endurance training, BFR training can be a
valuable tool for endurance athletes or those looking to improve their
cardiovascular fitness without placing undue stress on the joints or
increasing injury risk.
Explained simply:
The restricted blood flow into working muscles mimics some of the responses
seen from higher intensity endurance sessions despite training at a lower
intensity (speed or pace). These responses can lead to enhanced endurance
gains.
Situations & Applications
There are four specific situations where blood flow restriction training can be particularly adventageous – each of these situations are discussed below.
Rehabilitation
BFR training has been shown to be highly effective during rehabilitation and
injury recovery. Its ability to promote muscle growth and strength gains at
lower exercise intensities allows individuals to stimulate muscle development
without placing excessive stress on the joints, tendons, or healing tissues.
This makes BFR training an ideal tool for physical therapists and clinicians
working with patients recovering from injuries or surgeries, helping them
return to or exceed their pre-injury function more quickly.
Travel / Limited Access to Weights
One of the primary benefits of BFR training is its ability to promote muscle
growth and strength gains using low -intensity resistance or even bodyweight
exercises. This makes BFR training an excellent option for individuals who
have limited access to equipment, such as during travel or in situations where
weights are not available. With the portability and ease of use of BFR cuffs,
individuals can easily incorporate BFR training into their workouts regardless
of their location or access to traditional gym equipment.
Time Constraints
BFR training can be particularly beneficial for individuals who face time
constraints and are looking for efficient and effective workouts. BFR workouts
typically require shorter durations and less rest between sets to elicit
muscle growth or endurance adaptations, making them ideal for busy individuals
seeking to maximize their training in a limited amount of time. Additionally,
because BFR training can stimulate adaptations at lower intensities, less time
is generally required in the warm-up phase of the session.
Load Management
BFR training offers a valuable tool for load management, particularly for in-
season athletes or individuals looking to build or maintain muscle while
minimizing systemic fatigue and joint stress associated with heavy lifting. By
stimulating muscle growth and strength gains at lower intensities, BFR
training allows individuals to maintain or even improve their physical
performance without the added strain of heavy resistance training. This can be
particularly beneficial for athletes during periods of high training volume,
as it allows them to continue building strength and muscle without increasing
the risk of overuse injuries. Additionally, non-athletes seeking to optimize
their training programs while preserving joint health can also benefit from
incorporating BFR training into their routines. Blood Flow Restriction (BFR)
Training has gained significant attention for its ability to elicit muscle
growth, strength gains, and endurance adaptations at lower exercise
intensities. However, to fully harness the benefits of BFR training, it is
essential to understand the research-backed protocols for both endurance and
strength/ muscle gain applications. In this chapter, we will examine the best
practices for implementing BFR training into your exercise regimen, focusing
on evidence-based protocols for optimal results.
Protocols
BFR Training for Muscle Growth and Strength Gains
Pressure: When using BFR cuffs, the applied pressure should be sufficient
to partially restrict blood flow without completely occluding it. A general
guideline is to apply pressure at 40-80% of limb occlusion pressure (LOP),
depending on individual tolerance and the specific exercise being performed.
Load: Train with loads between 20 – 40% of 1RM (1 repetition maximum). As
a general rule, this should be a weight in which 20-30 reps under BFR leads
close to or to failure.
Rep & Rest Ranges: Research suggests that BFR training is most effective
when performed with high repetitions (e.g., 15-30 reps per set) and short rest
intervals (e.g., 30-60 seconds between sets). A common protocol involves
performing four sets with a 30-30-15-15 rep scheme and 30-60 seconds of rest
between sets. In other words, a set of 30 reps, followed by three sets of 15
reps with 60 seconds rest between each set. For more information on the
30-15-15-15 protocol, you can find our podcast episode on it here.
Relative Intensity: Research supports the idea that training to failure
under BFR does not appear to be necessary. Instead, finishing most sets with
1-4 reps in reserve is probably most effective at maximizing stimulus while
minimizing fatigue.
BFR Training for Endurance Adaptations
BFR training can also be utilized to improve endurance performance by
replicating many of the physiological adaptations associated with high-
intensity endurance training.
To optimize BFR training for endurance adaptations, consider the below:
Pressure: As with strength training, apply pressure at 40-80% of limb
occlusion pressure (LOP) during BFR endurance training. The specific pressure
may vary depending on the exercise and individual tolerance.
Intensity: In most cases, BFR training should be performed at low to
moderate intensities, typically around 40 -60% of an individual’s maximal
aerobic capacity (VO2max).
Protocol: BFR endurance training can be performed as continuous steady-
state exercise or interval training. For steady-state training, sessions of 10
– 20 minutes are generally optimal. When performing interval training, bout
and rest durations can vary greatly and largely depend on training goals. A
common protocol in the literature is a 2:1 work:rest ratio (I.E. 2 minutes of
activity followed by one minute of rest, repeated ~ 5-10 bouts).
Exercise
Selection
In this chapter, we will discuss three key recommendations for choosing the
most effective exercises for BFR training: targeting distal muscles, selecting
slow velocity movements, and emphasizing a full range of motion.
Focus on Distal Muscles
In general, BFR training is most effective when targeting muscles distal to
the cuff used to restrict blood flow. This is because the blood flow
restriction creates a localized hypoxic environment that stimulates the
targeted muscles’ metabolic and physiological responses, enhancing the
effectiveness of the exercise. When designing your BFR training program, focus
on exercises that target the muscles below the cuff. For upper body BFR
training, this would be biceps, triceps, and forearms. For lower body
training, targeted muscles would be quads, hamstrings, and calves. It’s worth
mentioning that there is absolutely no issue with training non-distal muscles
under BFR, and many movements will involve additional muscles (I.E. the lats
on a pull-up variation). However, the muscles that will likely benefit the
most are those that are distal to the cuff.
Explained simply: focus on training muscles away from the cuffs (biceps,
triceps, forearms for upper body and quads, hamstrings, calves for the lower
body).
Choose Slow Velocity Movements
Max power or velocity movements, such as sprints, power cleans, or jumps, are
generally not well-suited for BFR training. This is because these high-
intensity exercises require significant force production and can be negatively
impacted by the hypoxic conditions created by BFR. Instead, focus on selecting
exercises that naturally involve lower velocity movements, where the load and
movement pattern themselves promote a slower pace. To be clear, this is not to
suggest a need to intentionally move slowly during BFR exercises. Instead,
just choose exercises that naturally encourage a slower velocity, such as
controlled resistance training movements like squats, lunges, or seated rows.
Explained simply:
max power or speed exercises and movements are generally not advisable under
BFR. Instead, favor more traditional bodybuilding-style movements.
Emphasize Range of Motion
Since BFR training involves lighter loads, typically around 20-30% of your
1RM, it is generally advised to select exercises that offer a greater range of
motion (when possible). This will allow you to better detect when you are
approaching muscular failure, which is a critical factor in stimulating muscle
growth. Exercises with limited range of motion at such light loads may not
allow proper perception of true muscular failure versus simply fatigue.
Moreover, greater range of motion has been shown to favorably impact
hypertrophy even outside of BFR training. Therefore, emphasizing range of
motion in your exercise selection aligns with broader principles of effective
resistance training.
Explained simply:
In general, take exercises through the maximum safe range of motion afforded
by the movement.
SAGA produces the world’s most powerful bluetooth-enabled, auto-calibrating
blood flow restriction cuffs. The BFR Cuffs measure your unique LOP with one
tap in less than 15 seconds – you can then select your desired occlusion
percentage and adjust pressure seamlessly.
References
Wide tourniquet cuffs more effective at lower inflation pressures – PubMed.
(1988, August 1). PubMed. https://doi.org/10.3109/17453678809149401
The efficacy of blood flow
restricted exercise: A systematic review & meta-analysis – PubMed. (2016,
August 1). PubMed. https://doi.org/10.1016/j.jsams.2015.09.005
Centner, C., Wiegel, P., Gollhofer, A., & König, D. (2018, October 10).
Effects of Blood Flow Restriction Training on Muscular Strength and
Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis.
PubMed Central (PMC). https://doi.org/10.1007/s40279-018-0994-1
Ozaki, H., Yasuda, T., Ogasawara,
R., Sakamaki-Sunaga, M., Naito, H., & Abe, T. (2012, May 23). Effects of high-
intensity and blood flow-restricted low-intensity resistance training on
carotid arterial compliance: role of blood pressure during training sessions –
European Journal of Applied Physiology. Springer.
https://doi.org/10.1007/s00421-012-2422-9
Patterson, S. D., Hughes, L., Warmington, S., Burr, J., Scott, B. R., Owens,
J., Abe, T., Nielsen, J. L., Libardi, C. A., Laurentino, G., Neto, G. R.,
Brandner, C., Martin-Hernandez, J., & Loenneke, J. (2019, May 15). Blood Flow
Restriction Exercise: Considerations of Methodology, Application, and Safety.
PubMed Central (PMC). https://doi.org/10.3389/fphys.2019.00533
References
- The components of the Wired Spanning Forest are recurrent | Probability Theory and Related Fields
- Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis | Sports Medicine
- Redirecting