Restricted Blood Flow Training for bodybuilders



Blood flow restriction is a unique technique that uses tourniquet cuffs to generate vascular occlusion in a limb. Researchers accredit the method for its usefulness in clinics for therapeutic purposes and muscle strength generation among athletes and footballers. This study seeks to investigate the outcome of the BFR technique among male bodybuilders. The research will utilize a small number of professional bodybuilders who have stayed in their profession for at least one year. Some of the equipment the study will use include a squat rack, leg extension machine,  hamstring curls machine, Calf Raise Machine, treadmills, BFR cuffs, and other BFR devices. Measurement of muscle activation patterns will use electromyography (sEMG) with an 8-channel sEMG system. For ethical consideration, the research will ensure that participants sign a consent form that explicitly highlights the benefits, potential outcomes, and risks involved. The study also has some limitations; the research will only involve male bodybuilders who have been in the industry for at least one year. Those who intend to do it for a recreational purpose will get exempted.

Keyword; BFR





Restricted Blood Flow Training


The Blood flow restriction is a trending training technique used for muscle strength development and hypertrophy, primarily in clinical and athletic settings. The process utilizes inflatable cuffs that help generate vascular occlusion in a limb while exercising. Compared to traditional methods such as conventional resistance training, BFR’s effectiveness extends to ageing patients. But how did it come into existence? According to Rolnick et al. (2020), Sato Yoshiaki discovered it in 1966 and called it KAATSU, which implies “added pressure” training. Since its discovery, various studies on the topic have taken place as quantitative researchers sought to find more about the technique.

What the training involves and what it does

Experts describe BFR as a technique involving the use of tourniquets that individuals wrap around a limb’s proximal portion for partial reduction of arterial flow while restricting intravenous return (Rolnick et al., 2020). The blood reduction in arteries subsequently decreases oxygen supply, affecting local metabolism energy; the process also reduces the time required during aerobic training, thus distinguishing this process from those that do not use restriction. BFR and other techniques’ distinguishing factor is that BFR uses loads that are 20% one-repetition maximum. Alternatively, the method alongside the resistance technique provides a consistent muscle mass increase.

The BFR method has proved that muscle growth is achievable with low resistance exercises alongside blood flow restriction. BFR limits intramuscular oxygen supply and restricts metabolites from clearing from the veins, leading to increased metabolic stress. In turn, the metabolic stress stimulates systematic hormone generation, cell swelling, and amplified fibre recruitment that facilitate muscle growth. Generally, the BFR training mimics high-intensity exercise’s effects merely using a cuff, which creates a hypoxic atmosphere. Rolnick et al.. (2020) also note that BFR’s low-intensity outcome increases muscle circumference compared to the regular exercise’s low intensity.

Is there proof of the effectiveness of this method? Certainly. Physiopedia (n.d) notes that a short BFR low-intensity training of around six weeks yields a muscle-strength increase of about 10-20%. Due to its distinctiveness, the BFR technique utilizes particular equipment types, which this section will merely highlight for a more in-depth description in the method’s section. The equipment, therefore, includes a BFR cuff (tourniquet) made of either nylon or elastic with a specific prescribed pressure. BFR is ideal for it ensures that correct pressure during exercising and is safer for exercising takes place at optimal pressure.

BFR training, as mentioned earlier, extends to patients over fifty years. So many clinicians have adopted the method to help athletes and other recreational trainers obtain this muscle hypertrophy. Despite the various instigations on the techniques’ usefulness, the present study seeks to re-affirm the impact the training will have after six weeks of training. The research will evaluate participants preparing for a tournament and later engage them in the BFR training. The one discretion about the study is that it will only accommodate the bodybuilders who have trained for at least one year to tell apart the effectiveness of their traditional methods compared with BFR one. Many athletes are adopting the technique besides those who utilize it as a therapy due to injuries. The literature review section explores the two groups that use the method; footballers and athletes. Therefore, after six weeks training period, this research seeks to answer whether restricted blood flow training offers superior leg size and circumference outcomes for male bodybuilders compared to traditional hypertrophy training?


For many decades, leg strength achievement progressed from the traditional extreme training to modern-day Blood Floor Restriction training (Aka BFR). As stated in the introduction, Rolnick et al. (2020) note that Sato Yoshiaki discovered the technique in 1966 and called it KAATSU, which implies “added pressure.” Sato invented the method to help to strengthen the muscle, antiaging purpose, and general cardiovascular health. BFR training denotes the use of a computerized tourniquet whereby the cuff is wrapped around the proximal portion to reduce arterial flow and restriction of venous return. Studies have reported that the minimized arterial blood flow reduces oxygen delivery that challenges energy metabolism.

According to research reports, to achieve BFR training, it is vital to utilize a load that is less than 20% repetition maximum (Rolnick et al., 2020). The investigation on BFR training on athletes portrays its importance in improving muscle hypertrophy when used with heavy load RT. The strategy modestly increases energy expenditure (EE), metabolic stress, and cell swelling compared to work-matched exercise. These aspects are crucial to physique athletes in maintaining caloric deficit and creating an anabolic environment during muscle growth. Also, they are essential in maximizing hypertrophic potential during the exercise session. Fundamentally, the BFR training proves to be the best aspect of athletes’ training. It was reported that BFR helps in achieving hypertrophy and increases muscle strength. Generally, this kind of training shows a scan helps improve and upgrade the cardio-circulatory parameter function (Baker et al., 2020). However, for this approach, athletes’ implementation of BFR training must be considered an essential aspect of training effectively and healing muscle injuries.

The utilization of this kind of training has been applied as a clinical rehabilitation technique for ageing patients. A combination of BFR training with other exercises has with no doubt shown some positive results on muscle hypertrophy. In research from Hanke et al. (2020, p. 178), this is determined by muscle thickness, mass, circumference, and cross-sectional area. BFR training can enhance muscle hypertrophy. BFR demonstrates the capability to improve rehabilitation efforts for over 50 years to comb muscle atrophy, improve muscle function, increase muscle strength and muscle hypertrophy. Therefore, for an ageing patient, BFR is established to enhance overall muscle performance.

Low-intensity BFR training was investigated to determine the impact of the exercise among the individuals. The population with the same baseline characteristics indicated that the BFR training’s implementation enhanced growth and development. Besides, muscle hypertrophy was enhanced due to the adequate blood supply and protein synthesis (Leonneke et al., 2011). The incorporation of protein synthesis was considered the key reason for improved growth and development due to healthy muscles. There was a significant correlation between weeks of duration and strength for the development but did not show any correlation for muscle hypertrophy. Low-intensity training with BFR training is considered essential to facilitate muscular strength among different populations (The American Educational Research, (2020). A research investigation in Japan showed that BFR training stimulates muscle growth and development. This indicates there exist positive impacts associated with BFR, especially those with orthopaedic conditions.

However, it is worth noting that some research reports indicate that BFR training is found to be controversial. Scientifically, the implementation of BFR training aids in inducing metabolic stress and hypoxia impact and the reduction of proteolysis. Through this training, there is an increase in muscular growth hormone growth, leading to controversy about its effect on neuromuscular functions (Heitkamp, 2015). The particular argument is that even without training, BFR still reduces knee muscle atrophy and a rise in immobilization strength. The BFR training is also essential in non-occluded muscles immediately after the low-intensity blood flow restriction training. During immobilization, the implementation of BFR without required training can result in reduced atrophy in the knee. Research highlights that safety measures need to be considered when making any action or plan to execute BFR training (Luebbers, 2014). For instance, wrapping is done around the limbs on the upper proximal portion, and this makes it essential since it helps prevent blood from leaving through the veins.

BFR Training on Footballers

Research has been done to determine the impact of BFR training among American football clubs. The subjects were found to be physically fit after being involved in BFR training. Therefore, it was an indication that the implementation of the BFR among the football players helped strengthen muscular strength and enhance overall body growth. The study also confirmed that lower intensity resistances combined with the BFR training portrayed a significant impact on muscular stability (Yamanaka et al., 2012). The four-week training results based on the research indicated a positive outcome in muscular development and circumference outcomes. An increase in lower and upper chest girths was investigated to enhance muscular hypertrophy through BFR training.

Interestingly, the research showed that BFR training increased muscular activity to blood-flow restricted muscle. A combination of BFR training and low-load resistance training portrayed the promotion of muscular adaption. The evidence is sparse on determining how BFR training can be used to influence muscle strength and mass, especially for older adults (Center et al., 2018). Therefore, the research’s primary goal was to determine the impacts of BFR training for older adults. The study was, therefore, carried out on the more ageing population involved in the BFR training. Moreover, the impact of walking exercise was also assessed to determine the effect of BFR training

BFR Training on Athletes

BFR training has currently been reported as an athlete training and clinical training tool to strengthen muscles and treat muscle injuries. Therefore it should be executed in a setting that has an individualized approach. As an adjunct, the BFR training is more essential than traditional training for personal fitness (Patterson et al., 2019). Evidence has indicated that continuous muscle hypertrophy and the most potent response are enhanced through being involved in the BFR training. Therefore this aspect of training would be imperative both in clinical rehabilitation and in athlete training.

Current research has established some guidelines for BFR training. Generally, this study focuses on applying BFR in muscle strength gaining, the method’s safety, and methodology regarding BFR training applications in body development training. Therefore, the expertise involved in this research concentrates on BFR training in exercising strength, conditioning, and the Science Kinesiology field. The study concluded that BFR training is not only crucial for muscular development but also in injury recovery. The compression is created, which results in room for more development of muscles, especially among the bodybuilders.

Despite that different research studies have been executed based on the BFR training, the research gap exists in determining whether BFR training results in superior leg size and circumference outcomes than traditional practice among male bodybuilders. Previous research has shown that BFR training has successfully increased strength when used alongside other training forms. Therefore, this future study will investigate if BFR training offers male bodybuilders a superior leg (thigh and calves) size and circumference compared to the traditional training method. The research hypothesis is that BFR training offers men’s physique bodybuilders a superior leg (thigh and calves) size circumference. The overall null hypothesis in the research is that there is no difference between restricted blood flow training and traditional hypertrophy training, and this will be useful in the declaration of the alternate hypothesis if results for the research call for its rejection. After a six-week training period, does restricted blood flow training offer bigger leg size and circumference outcomes for male bodybuilders than traditional hypertrophy training?


This research is seeking authorization by Point Loma Nazarene University’s institutional review board. This study intends to protect human subjects’ rights, welfare, and privacy used for the research. Before participating in the study, subjects will be required to sign an informed consent form. This form will describe the study, its benefits, potential risks and discomfort, extent of confidentiality, and a statement indicating that the participation is voluntary (Biros, 2018).


Participants will be randomly selected to either the restricted blood flow training group or the traditional hypertrophy training group and undergo different bodybuilding programs. Leg size and leg circumference will be measured and assessed at baseline and after six weeks. The randomized trial will be conducted at Point Loma Nazarene University between 2021-2022 (weekends and holidays will be excluded). Participants will be male bodybuilders physique competitors of ages between 18 and 32. They will be recruited from the San Diego area by posting study recruitment posters at the gyms and fitness centres. The Kinesiology community at Point Loma will also receive a notification email concerning the same. Participants will be required to meet the following inclusion criteria: healthy young males between 18 and 32 and professional bodybuilders with no history of cardiovascular diseases. They must have been at least one year of experience as bodybuilders and must be enrolled in some competition to validate the results. Participants with any health complications will be excluded from the study. The G* Power statistical power analysis will calculate that eight subjects would yield a power of 80%. Based on a priori power analysis, it will be established that alpha value will 0.05, actual Power will be 0.88, and effect size will be 1.15. (Baker et al. 2020)


All participants will fill out a health questionnaire highlighting any form of health conditions that might inhibit them from participating in the study. The research assistant will show the participants how numerous equipment such as squat rack, leg extension machine,  hamstring curls machine, Calf Raise Machine, treadmills, BFR cuffs, and other BFR devices; besides, leg measurements will be taken using a measuring tape (a flexible body tape measure, such as the type that a tailor would use). BFR cuffs will be placed on the participants’ limbs belonging to the restricted blood flow training group. These cuffs will be tightened to a particular pressure that blocks venous flow but allows arterial flow when the training is conducted. BFR cuffs between 10 and 12 cm will be used. Also worth noting is that the research assistant will use a mobile ultrasound to measure resting LE arterial blood flow velocity


The training exercise will be conducted at the gym and fitness centre at Point Loma Nazarene University. The participants will be asked to complete ten separate visits throughout the 6-weeks duration. During the first visit, they will be familiarized with the testing protocol and equipment. Each training session will last for two hours. During the second visit, each group will conduct different training exercises, with one group engaging in BFR and the other group in traditional hypertrophy training. During the subsequent visits, the participants will engage in rigorous training under the research assistant’s supervision.

The hypertrophy training group will engage in exercises using low to intermediate repetition series with progressive overload. Four sets of (12,12,10,10) intermediate repetitions will be done, and barbell squat at 80% of the one-repetition maximum (1RM) with a rest period of 2 minutes. Exercises will include a squat rack, leg extension machine, hamstring curls machine, Calf Raise Machine. Other activities will consist of self-myofascial release and dynamic stretching. For BFR training, narrow cuffs will be positioned close to the subjects’ torso anteriorly and medially in the most proximal part of their left and right thighs, but distal to the amount of the gluteal muscles. After the cuffs are placed, and the participants begin to train, the research assistant will use a mobile ultrasound to measure resting LE arterial blood flow velocity (Baker et al. 2020).

Biomechanics Measurements

For each subject, there will be the placement of reflective markers (9mm DIA) [a set of passive] on the skin surface covering particular anatomical landmarks for joint location estimation and adjacent bone segment. These are defined to calculate joint kinematics and kinetics based on previously incorporated model specifications (Aguinaldo, Buttermore, & Chambers, 2007). During each subsequent movement, the markers’ 3D global locations will be captured using a motion analysis system of 8 visible-red cameras (Kestrel, Motion Analysis Corp., Santa Rosa, CA) incorporated with the Cortex motion capture software at a sampling rate of 240 fps. Ground reaction force (GRF) data will be collected using two force platforms (AccuGait, AMTI, Watertown, MA) interfaced with the motion analysis system at a sampling rate of 1800 Hz. Kinematic and kinetic points will be extracted from the time-series data for subsequent statistical analysis.

Muscle activation patterns will be measured using surface electromyography (sEMG) with an 8-channel sEMG system (Bagnoli, Delsys, Natick, MA). Single differential Ag electrodes will be placed on the skin overlying these muscles. Raw sEMG data will be collected at a sampling rate of 1800 Hz through an A/D data acquisition (DAQ) card (USB-6218, National Instruments, Austin, TX) integrated with the motion analysis system. All sEMG data will be processed using a rectification and filtering pipeline that smooths sEMG signals at a cut-off frequency of 20 Hz and ensures sEMG data quality with a signal-to-noise ratio (SNR) of 1.2 or higher (De Luca, Donald Gilmore, Kuznetsov, & Roy, 2010).

Data Analysis

This study’s independent variables are the time (6 weeks training period) and the training types, restricted blood flow training vs traditional hypertrophy training. The dependent variable is leg size and circumference. Furthermore, descriptive statistics (mean, variance, and standard deviation) will be used to calculate the data cross-time (pre and post) and exercise interventions (BFR and traditional hypertrophy training). The data will be analyzed using the R Studio software, and the parametric test that will be used will be a two-way mixed ANOVA. The two-way mixed ANOVA will be utilized to compare the mean differences between two independent variables to determine whether there is a two-way interaction between and within-subject factors. The two-way mixed ANOVA will also assess the within-subjects factor, which is time, and the between-subjects factors, which are the training (BFR and hypertrophy training) (Baker et al. 2020). If there is a significant interaction, it will mean that BFR effectively aids in increasing strength and muscle size.

Ethical considerations

The present study evaluates restricted blood flow training effectiveness in enhancing leg size and circumference outcomes for male bodybuilders. Therefore, the research will recruit participants who will volunteer to participate and ensure that they consent before the onset of the study. Besides, the study will discreetly ensure a smooth process to avoid any harm to the participants. The participants will fill in the forms that the research explicitly describes the benefits, discomforts, and potential risks involved. The study acknowledges the importance of confidentiality and will uphold that by keeping the participants’ records from third parties and only surface at their consent.


Since the research’s interest is to investigate the impact of Blood Flow Restriction in contrast to the traditional methods, the study introduced some bias by selecting only the professional male bodybuilders who have undergone training for at least one year. Those who intend to participate for a recreational purpose will get exempted.


The study will assume that the BFR method does not facilitate muscle strength and then do the survey to either reject if the outcomes turn positive or fail to reject when the results turn negative.


Various studies have investigated the technique’s impact on older patients, their effectiveness in healing muscle injuries as a therapy. This study only limited itself to contrasting the method’s effectiveness compared to traditional hypertrophy training. The study also will only assess a small sample due to the time limitation. If I had 3-years and $1,000, the research would have extended to women and individuals interested in doing recreation training.






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Baker, Breanne S. Stannard, Michael S. MS; Duren, Dana L., Cook, James L. DVM, Stannard, & James P. MD, (2020). Does Blood Flow Restriction Therapy in Patients Older Than Age 50 Result in Muscle Hypertrophy, Increased Strength, or Greater Physical Function? A Systematic Review. Retrieved from:

Biros, M. (2018). Capacity, vulnerability, and informed consent for research. The Journal of Law, Medicine & Ethics, 46(1), 72-78.

Blood Flow Restriction Training. (2020, October 15). Physiopedia. Retrieved 08:21, November 28, 2020, from

Center, C, Weigel, P, Gollhofer, A, &Konig, D (2018). Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis. Retrieved from:

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