In Exercise, Hormones

What do you think of when I say blood flow restriction exercise?

Without checking Google, most of our Flipping 50 tribe would think this sounded like something terrible. It sounds like something that happens in a lab and not on purpose in a workout session. If you think it sounds like there’s risk involved and it might be bad for blood pressure or increase heart stress, you’re not alone.

But if you Googled (odd how that is now a verb to anyone else?) it you’d find that there’s emerging science around Blood Flow Restriction (BFR) training. And some of it has promise for older adults, and you. In fact, it’s quite exciting.

What Is It?

Originally developed in 1966 by Yoshiaki Sato in Japan where it was known as “kaatsu training,” meaning “training with added pressure.” It’s performed all over the world. So why haven’t you heard of it before? A quick look on Amazon for BFR bands shows images of (big) body builders, 98% of which are male. It doesn’t look like something you or I would naturally gravitate toward. It certainly hasn’t made it to Prevention or Reader’s Digest… yet.

But it might. Very soon.

Essentially, BFR training involves preventing blood flow to working muscles (or those at rest I’ll discuss later). That tricks the body into thinking it’s doing hard work to increase Human Growth Hormone (or GH), which burns fat and builds muscle.

If you don’t like hard work, won’t or can’t do hard work… blood flow restriction exercise may be your next best friend.

It Helps Muscle, Does It Help Bones?

Though some studies have suggested yes, for you and I, no, or very minimally. Only with instances of growth hormone deficiency in young male adults, or with unexplainable osteoporosis in male subjects was there any positive effect on bone density. There’s no evidence of bone support for women with age-related bone density declines. So, heavy weights when possible are still the answer.

Yet, there is some correlation with reduced fracture risk from increased GH. That may be due to increased muscle strength lending to better strength, reaction skills, and balance.

Are There Risk factors?

A review of literature for a position statement with older adults with frailty, Coronary Artery Disease (CAD), and prior existing Venus Thrombeoembolism, conclude there is no additional risk, “though further studies are encouraged,” Always your selection of appropriateness should be made on an individual basis together with your physician and a medical exercise specialist. Blood pressure response can be higher if cuffs are not removed during the recovery interval periods. 

Blood Flow Restriction Exercise Research

In one research study, adults in a large review of literature were between 57 and early 70s. BFR was effective in developing muscle in low load (walking) compared to walking without BFR.

Positive results are reported in both muscular strength and muscle mass from use of BFR exercise.

It’s important to note that most research confirms the BFR results are similar but still lower than that from High Load (HL) strength training. That is, if you can safely, and are motivated to lift heavy weights, it will still provide the most benefit. If however, travel, special conditions, or you’re unwilling BFR opens up alternatives. 

More Study Results

Optimal strength response was found in subjects (without physical limitations) from Heavy Load strength training combined with low load walking with (BFR) restriction.

For older athletes BFR may enhance performance by allowing combination of low load training with restriction and heavy load more typically used (requiring less of heavy load yet more overall training without damage and risk of injury).

Personally, during training for Ironman, I’m usually an advocate of heavy weight training for avoiding lean muscle losses and bone density benefits. [Yes, more exercise can be a risk just as too little exercise can.] However, as training volume increases for an endurance event balancing sport-specific activity with less strength is better for reduced overall physical stress.

So I’m wearing BFR bands walking the dog before a run and then cutting the volume of training runs significantly. I’m able to optimize hormones this way instead of impose constant fatigue so common in endurance athletes.

For older adults who are unable (or unwillingly, untrusting) to do heavy load training BFR provides a viable way to increase strength and maintain lean tissue, specifically Fast Twitch (FT) muscle fiber. Adults can lose Fast Twitch fibers twice as fast as they age. FT fibers are responsible for metabolism and reaction skills – so you can catch yourself and prevent falls.

How Often Should Blood Flow Restriction Training Be Done?

It depends. Don’t you love that? (sarcasm) Yet, truly it depends on you now and why you’re implementing it. Do you need this to allow you to do something while you’re recovering from an injury? Do you need a good substitute for your regular exercise while traveling? Are you looking for a way to supplement a very active life and fitness program to boost progress without burning out or injury? Use your answer to determine how you start:

  • 1-2 times a day if that’s all you’re doing
  • 2-3 times a week in combination with an existing aerobic and strength training program

How Tight Do Blood Flow Restriction Exercise Bands Need to Be?

You’ll see in the video I discuss the 7/10 on a “tightness” scale. You’re doing this at your perception of tightness. You may need to experiment a little. I find it easiest to go to the point I couldn’t stand it and then back off slightly to get to my “7.” If you’re in our Flipping 50 tribe you’re used to rating your effort level on a 0-10 scale for various exercise so this is familiar.

Why Does It Work for Adults Over 50?

Proper use of the bands creates greater metabolic stress that brings about greater release of growth hormone and IGF-1 – key for gains of lean muscle and prevention of muscle loss.

By inducing greater muscle fatigue with lower loads there may be more Type II fiber recruitment for the relative load. (You’ve heard me talk nation-wide about Fast Twitch Muscle loss prevention.)

Enhanced muscle protein synthesis that occurs with resistance training is another huge win. Research shows clearly that resistance training offsets reduced muscle protein synthesis (ability to use protein you consume to benefit muscle) that can otherwise occur with age.

Enhanced Human Growth Hormone (GH) is an important advantage of lifting heavy weights and intense interval training as you age. Nearly comparable results are reported with BFR bands. Heavy lifting seems to still have the positive edge. This is one of your biggest hormone benefits of resistance training. Feel like you can’t get the muscle tone you once had? Decreases in GH are a part of that.

You can overcome reduced production of GH with age by resistance training at proper intensities. If until now you haven’t chosen or haven’t been able to do resistance training, you have a lighter load option.

Each of these aforementioned benefits point to reducing the signs of aging. What has been “accepted” as normal no longer has to happen. You’re in control. You can prevent and reverse aging. 

When high intensity interval training may not be appropriate (due to fatigue or cortisol levels, current injuries, or lack of access while traveling, Restricted Blood Flow exercise (low load) may be a good option to prevent muscle and strength losses.

For an idea of activities and intensity that work with BFR exercise:

Resistance Training:

  • Light loads on machine weights
  • Body weight exercise
  • Tubing and band exercise
  • Light free weights
  • Pilates exercise (reformer or mat work)

Choosing the Load

Loads for resistance training in most studies feature loads of 20-30% of 1-rep max. Now, I’d never suggest you do a 1-rep maximum test. I’ve discussed that many places in books and posts. It is however the language of intensity in resistance training. If you can lift a weight only once and reach fatigue you’ve found the ultimate of “heavy.”

To give you an idea of 20-30% you’ll need an estimated one-rep max. If you can lift something 10 times to fatigue it’s about 80% of your 1-rep max. (This by the way is the best protocol for bone density).  With a little math you can determine your 1 rep max is about 12.5 lbs. So 20-30% is 2.5-3.75 lbs. I’d suggest starting with a 3-lb dumbbell.

As you perform the exercises you can experiment with what truly causes fatigue in the muscle. The biggest take-away? You’re going to use far lighter weights (or resistance) than you would without the bands.

Aerobic Training:

  • Walking
  • Stair climbing
  • Hiking
  • Low resistance biking

These types of exercises performed are performed at about 40% VOx2 max which is about the equivalent of daily activities of living. So in theory you could wear bands while going up and down your stairs to do laundry or clean for 20 minutes. Some aerobic protocols use intermittent exercise. For example, intervals of pedaling for 3 minutes with bands used alternated with 2 minutes of removing or undoing the bands.

What Size are the Blood Flow Restriction Exercise Bands?

Larger cuff size requires less pressure but movement is restricted. Choose based on your frame and size. Typically, recommendations are 1-1 ½ inches for upper body (bicep) and 2 inches lower body.

These are the bands I am using. *

 

 

 

Aerobic Blood Flow Restriction Exercise Intro

 

The Exercise Protocol At-a-Glance

STRENGTH

  • 75 reps = 30 x 15 x 15 x 15 (4 sets)
  • 30-60s between sets
  • 1-2s concentric and eccentric (but under control)
  • 2-3x per week as a compliment to other Resistance exercise
  • 1-2 times a day as the only exercise you do (injured, sedentary, weak or frail)
  • 3-6 weeks to see results (as early as but best results after)

AEROBIC

  • 2-3 times week
  • 40-50% V02 (very comfortable pace like doing activities of daily life – going upstairs with laundry, walking to the mail box)
  • 5-20 minutes
  • Continuous or intervals (intervals of higher intensity)

How Soon Can You Expect Results From Blood Flow Restriction Exercise?

For those more sedentary doing 1-2 times a day, approximately 3 weeks is suggested time to experience benefits. For those already exercising that incorporate BFR training into their program 3-6 weeks is the suggested time frame. (Think about weight loss, the more weight you have to lose the faster you’ll see progress. So it is with BFR, the more fit you are, the less impactful BFR training may be for you, though that slight increase in fitness can be significant when it happens.)

Bed Rest Implications

Studies suggest that even in instances where exercise is extremely limited or not possible, use of the BFR bands can prevent muscle and strength loss. Wearing the BFR bands intermittently 1-2 times a day even while sedentary is beneficial compared to not using BFR.

BFR show promise during times you might be recovering from surgery or plantar fasciitis. Whenever you’ve got weight bearing restrictions for a period of time and are unable to apply pressure to a limb, or you’re on crutches. For someone undergoing treatment with low energy levels deeming a regular exercise plan implausible, this opens up possibilities to prevent a downward spiral that can easily occur. The BFR bands may provide a means for sparing what can be devastating muscle losses, often the beginning of weakness if not frailty, making falls more likely.

Would You Like Support?

Interested in more information? The best next step is to get STRONGER! When I open the doors for enrollment a few times a year you’ll be the first to know. Click here.

I’m including some BFR training in this 12-week resistance training program. Whether you’re more athletic and want to keep your hormones balanced (not stressed) or you have limits about how much you can lift, or find it hard to reach intensity levels you need…. This is for you!

Resources:
https://lifeforceiq.com/kaatsu/
https://journals.lww.com/nsca-jscr/Fulltext/2013/10000/Exercise_and_Blood_Flow_Restriction.37.aspx
https://www.strengthandconditioningresearch.com/blood-flow-restriction-training-bfr/
https://www.ncbi.nlm.nih.gov/pubmed/10993598
https://www.ncbi.nlm.nih.gov/pubmed/12414848
https://www.ncbi.nlm.nih.gov/pubmed/29030774
https://www.frontiersin.org/articles/10.3389/fphys.2019.00533/full
https://www.ncbi.nlm.nih.gov/pubmed/30306467
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6349784/
https://www.ncbi.nlm.nih.gov/pubmed/26118847
*Links to the Flipping 50 Amazon store will result in a small commission for me if you choose to purchase from that link.


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