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J Strength Cond Res. 2017 Dec 4. doi: 10.1519/JSC.0000000000002384. [Epub ahead of print]

Mechanisms Behind Blood Flow Restricted Training and its Effect Towards Muscle Growth.

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Department of Health, Human Performance, and Recreation, Exercise and Biochemical Nutrition Laboratory, Baylor University, Waco, TX 76798, USA.


It is widely established throughout the literature that skeletal muscle can induce hypertrophic adaptations following progressive overload of moderate to high-intensity resistance training. However, there has recently been a growing body of research that shows that the combination of blood flow restriction (BFR) with low intensity resistance exercise can induce similar gains in muscular strength and hypertrophic adaptations. The implementation of external pressure cuffs over the most proximal position of the limb extremities with the occlusion of venous outflow of blood distal to the occlusion site defines the BFR methodological protocol. There are various mechanisms through which BFR training may cause the stimulations for skeletal muscle hypertrophy and increases in strength. These may include increases in hormonal concentrations, increases within the components of the intracellular signaling pathways for muscle protein synthesis such as the mTOR pathway, increases within biomarkers denoting satellite cell activity as well as apparent patterns in fiber type recruitment. There have also been scientific findings demonstrating hypertrophic effects within both blood-flow restricted limbs and non-blood flow-restricted muscles during BFR training programs. The purpose behind this critical review will be to provide a comprehensive discussion on relevant literature that can help elucidate the potential underlying mechanisms leading to hypertrophic adaptations following BFR training programs. This review will also explicate the various findings within the literature that focalizes on both blood flow-restricted limb and non-blood flow-restricted muscle hypertrophy following bouts of BFR training. Furthermore, this critical review will also address the various needs for future research in the many components underlying the novel modality of BFR training.

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