Blood Flow Restriction (BFR) training is pretty analogous to relationships- everyone wants to get in on the action, but few actually know just what the heck they’re supposed to do once it’ time to shine. As a training technique that shows a lot of promise for physique athletes, for those outside of the research field, a lot of questions float around on how to actually apply BFR to a training program. When should it be used, how to apply the cuffs, what to expect when starting BFR- all valid questions that are often unclear for BFR beginners, until now that is. Below are the ins and outs of BFR training to make the technique as easy and productive as possible to apply to your own routine. After this, you may not be any better at cuffing wifey, but you’ll be a pro at cuffing BFR.
The FYI on BFR
Just as you’ll be adding BFR cuffs as an accessory in your gym bag, the technique itself is a relatively new, but very promising “tool” to add to your training tool belt. In short, performing BFR training supports muscle retention and growth through the restriction of venous blood return out of working muscles during exercise. By allowing deeper, arterial blood to enter muscles unhindered, but greatly reducing more superficial, venous blood return from the muscle, a greater total volume of blood & metabolites are then accumulated within the muscle tissue as the set progresses.
As this blood accumulates, the muscle tissue is forced to expand, and type II muscle fibers are left to perform a greater portion of the work as the aerobic, type I fibers are quickly fatigued due to reduced levels of oxygen within the tissue. These effects lead to muscular hypertrophy through much lower training loads as would otherwise be necessary during exercises not using BFR.  This is turn allows athletes to stimulate hypertrophy through lighter training loads (roughly 20-30% of maximum strength in a given exercise), and continue progressing during situations where training at a normal intensities may be hindered.
When BFR comes up in discussion, I find athletes have a lot of questions about whether or not it’s worth incorporating, but even more common- asking what they should expect or if there are any concerns with using the technique. In terms of concerns related to BFR, the available research suggest that for otherwise healthy individuals, incorporating BFR training doesn’t seem to add any additional health risks in muscle damage, blood pressure or coagulation. 
In terms of what to expect in the actual training sessions with BFR, one of the more key points of emphasis is finding the correct tightness to produce the intended benefits without hindering arterial blood flow into the muscle, or creating undue discomfort that could detract from the exercise. A 2014 interview with Dr. Jeremy Loenneke, a leading researcher in BFR training, provides the following guidelines for athletes beginning BFR Training:
- If the cuffs are tight enough to produce pain before even starting the exercise, they are too tight and need to be loosened slightly.
- Cuffs should be a “7” on a 1-10 scale in terms of tightness when applied.
- A general rule of thumb in training protocol is to perform one set of ~30 repetitions, followed by 3 sets of ~15 repetitions with 30-60 seconds between all BFR sets. Aiming for a training load of 20-30% of typical, maximum load for given exercise is a good reference point when determining exercise load. 
If you love getting a great muscle pump you can admire in the mirror, or slinging the phrase, “feel the burn”, to your buddies, you’re in luck. BFR training produces rather intense muscle pumps much more intense than that of normal high-rep training. Expect a totally safe, but intense muscle pump when performing BFR due to the increased blood accumulation and type II muscle fiber utilization.
When to Use BFR
After hearing of the many benefits BFR training can offer, it’s common to see many athletes immediately jump to using it as much and as often as possible. I mean, lifting lighter weights, getting great pumps, and still getting bigger without having to lift heavy- what’s not to like? Sorry to harsh your mellow, but it’s important to remind athletes that BFR is a great training tool, not a long-term training strategy.
BFR stimulates muscle retention and growth through significant, specific mechanisms, but not through the only necessary mechanisms. Continuing to train in a variety or rep ranges, adjusting intensity and training loads, and periodically adjusting exercise selection are all factors that need to be accounted for in a long-term training strategy. That being said, there are certain circumstances that make BFR a very good option for athletes, including:
- Late stages of a contest preparation or general, long-term diet. As dieting progresses, energy levels can get rather low for many athletes. Since maintaining sufficient training intensity and volume is important for muscle retention when dixeting, incorporating BFR into a training program can help continue promoting muscle retention when energy may not always be ideal to perform additional heavy-load sets.
- Deload weeks. One benefit of periodic deloads is to give the central nervous system a break from continued, heavy-load training but allowing for maintenance of optimal motor patterns in training movements. By including BFR training, an athlete can ensure continued progress toward muscle retention and growth while still getting a mental and physical break from their typical training intensities.
- Injuries. As most BFR training examples lend to- injury rehab can be a good time to incorporate BFR techniques to help with muscle retention while an injury has time to heal and normal, heavy training may not be possible.
- Volume accumulation phases can be transitioned into through the addition of BFR sets. As an athletes transitions from a relatively low volume to a higher volume training cycle, it can be useful to begin adding additional sets through BFR first, achieving benefits from that, then transitioning from BFR sets to standard training sets rather than jumping to a large number of additional heavy-load sets. This can allow the athlete to acclimate to a greater total training volume & session duration while minimizing nervous & muscular system stress.
- Rainy Days. Even for the most determined athlete, we all have days where we just can’t seem to get anything going. Hectic week at work, terrible sleep after a string of nights with a newborn, cramming for exams- sometimes circumstances aren’t ideal and we go into a workout feeling less than stellar. Knowing when to push through, and when to take your food off the gas a bit can make a huge difference in maximizing long-term success. Incorporating some BFR work on days you’re not quite up to your normal training can be a great way to make progress on those rainy days you might have otherwise pushed through and risked injury, or skipped them gym altogether.
For a lot of athletes, after learning about BFR training they’re very eager to apply it to their own programming, but purchasing adequate cuffs without paying an arm and a leg (which would make BFR training pretty difficult) is the one of the first concerns that comes to mind.
Although there are some BFR specific cuffs upwards of few hundred bucks, luckily for you if you haven’t purchased any yet- there are much more affordable pricing options available which are just as effective. With a few web searches, you can find a quality pair of cuffs for under $50.
For those looking to reduce costs further, knee wraps can often be used as make-shift BFR cuffs. However knee wraps are most ideal for lower body training, while thinner cuffs are better for upper body training. So it may be worth the investment to still purchase BFR cuffs, of which many brands can work for both upper and lower body training, and allow for quicker set up times than using knee wraps.
Common Mistakes to Avoid
Using BFR as a crutch
BFR training may help when you’re injured, but it’s never intended to serve as a crutch. It may seem reasonable to use BFR on an ongoing basis instead of training heavy, however the normal principles of long-term muscular adaptions from resistance training don’t go out the window once your BFR cuffs arrive.
Factors like low rep, heavy load compound lifts, training in various rep ranges, and adjusting total training volume can’t be ignored simply to perform more BFR training. Just as you wouldn’t only train in one rep range your entire career, or wouldn’t rely solely on isolation movements for gaining strength and size- so to is it important not to make BFR training your sole focus from week to week.
Loosening Cuffs Between Sets
Releasing the cuffs between each set is pretty common for newcomers to BFR. For each exercise, be sure to leave the cuffs at a “7” tightness during the working sets as well as the 30-60 second rest periods. Doing so allows for sufficient blood pooling and metabolite accumulation. At the completion of each exercise, then release the cuffs and allow for normal blood flow to resume before the next exercise.
Mistaking High Rep Training for BFR Training
I get the question a lot on whether high rep, standard sets without cuffs are any different than BFR sets. In short, performing standard resistance training sets in low, medium and high repetition ranges are still very beneficial in their own right for a physique athlete. Although you can and should perform high rep, standard sets; they support muscle growth and retention differently than BFR training.
Performing sets of 15 or 30 reps in a standard fashion can support muscle growth, but would require a heavier load than the same rep scheme using BFR; or simply entail an even higher amount of reps to even reach close to muscular fatigue without the use of cuffs. BFR training requires a relatively lighter, less taxing load, and aids in greater than normal blood & metabolite accumulation than standard, high rep sets- providing a different stimulus. Rather than thinking of high rep, standard sets and BFR sets as synonymous, I would encourage athletes to think of them as entirely different rep schemes.
Jumping into BFR
Another issue to consider is that of simply getting used to the different style and feel of BFR training. It can be tempting to become over eager and jump into dozens of sets per week as soon as your cuffs arrive in the mail. However, just like any other training technique or exercise- it’s best to ease into it to ensure correct execution and prevent frustration from creeping into your training. From my own experience applying BFR training for the first time, I would suggest something like the below transition period.
BFR Acclimation Strategy
Week 1: Perform your current training program completely as you have been. Then perform 1-2 exercises at the end of a few sessions to begin getting accustomed to how the BFR sets feel, the correct tightness of the cuffs, and just getting comfortable with the training technique in general. This will help gain experience applying and using the cuffs without distracting from your current training progress.
Week 2: Choose 1 isolation exercise for each ideal body part (Bicep, Tricep, Quads, Hamstrings) at the end of each body part’s training session and devote it to the BFR technique. At this point you are more comfortable with applying and using the cuffs, and can begin seeing success in its use.
Week 3: After having a couple weeks to become very comfortable with BFR training, you can now apply it to training if the situation (like those mentioned above) calls for it. If not, set them aside and continue with your current training program, now having had experience with BFR training and the confidence to use it in the future when necessary.
Lastly, although more advanced BFR training may help to benefit other muscle groups indirectly, for most athletes, thinking of BFR training as benefiting limb musculature as the main use is your best bet. Below is a brief, but not all inclusive list of exercises ideal for BFR training.
BFR Exercise List
- Bicep Curl Variations
- Tricep Extension Variations
- Leg Press
- Leg Extensions
- Leg Curls
- Close Grip Bench Press
- Machine Dips
- Seated Calf Raises
It’s important to note that BFR cuffs are to be placed at the proximal end of the limbs being trained, regardless of the exercise selected. This means that arm exercises require the cuffs to be placed as high on the arm as possible, just under the shoulder. For lower body movements, even when performing calf exercises, the cuffs should be placed as high on the legs as possible above the quad.
Example BFR Training Session
To give a better idea of how BFR training would be applied in a training program, let’s use an example of a male athlete transitioning from a lower training volume to a higher volume block. As a way of adding additional volume without overtaxing the nervous system, and to eek out more progress during the transition before beginning a full-on higher training volume- he decides to first add in BFR sets at the end of his sessions as the additional volume, then eventually transitioning once more into the actual, higher training volume cycle.
If one training session each week was focused on arms and calves, and previously contained 12 total sets for arms and 4 sets of calves, the transition phase could look something like the following:
|Exercise||Sets||Reps||Rest Period (minutes)|
|DB Hammer Curls||3||8-10||1:30-2:00|
|Close Grip Bench||3||8-10||1:30-2:00|
|EZ Bar Preacher Curls||3||8-10||1:30-2:00|
|EZ Bar Skull Crushers||3||8-10||1:30-2:00|
|BFR Spider Curls||1||30||0:30-1:00|
|BFR Spider Curls||3||15||0:30-1:00|
|BFR Tricep Rope Pushdowns||1||30||0:30-1:00|
|BFR Tricep Rope Pushdowns||3||15||0:30-1:00|
|Standing Machine Calf Raise||4||10-12||0:30-1:00|
|BFR Seated Calf Raise||1||30||0:30-1:00|
|BFR Seated Calf Raise||3||15||0:30-1:00|
Break out the Cuffs
Getting started with BFR training can seem daunting at first, but with the information in this article and a little practice, it can become as easy to incorporate as training with knee wraps or using drop sets during workouts is. It may not be the answer to your relationship problems, but when it comes to maintaining progress when injuries or fatigue arise, consider the question on what training technique to apply solved.
Want to learn more?
Check out Layne’s webinar: Blood Flow Restriction Techniques
- Loenneke, J., Thiebaud, R., & Abe, T. (n.d.). Practical Blood Flow Restriction. NSCA Personal Training Quarterly. Retrieved from https://www.nsca.com/uploadedFiles/NSCA/Resources/PDF/Publications/PTQ/PTQ%201.2.pdf
- Loenneke, J., Fahs, C., Rossow, L., Abe, T., & Bemben, M. (2012). The anabolic benefits of venous blood flow restriction training may be induced by muscle cell swelling. Medical Hypotheses, 78(1), 151-154. doi:10.1016/j.mehy.2011.10.014
- Loenneke, J. P., Wilson, J. M., Wilson, G. J., Pujol, T. J., & Bemben, M. G. (2011). Potential safety issues with blood flow restriction training. Scandinavian Journal of Medicine & Science in Sports, 21(4), 510-518. doi:10.1111/j.1600-0838.2010.01290.
- Madarame, H., Kurano, M., Fukumura, K., Fukuda, T., & Nakajima, T. (2012). Haemostatic and inflammatory responses to blood flow-restricted exercise in patients with ischaemic heart disease: a pilot study. Clinical Physiology and Functional Imaging, 33(1), 11-17. doi:10.1111/j.1475-097x.2012.01158.
- Wilson, J. M., Lowery, R. P., Joy, J. M., Loenneke, J. P., & Naimo, M. A. (2013). Practical Blood Flow Restriction Training Increases Acute Determinants of Hypertrophy Without Increasing Indices of Muscle Damage. Journal of Strength and Conditioning Research, 27(11), 3068-3075. doi:10.1519/jsc.0b013e31828a1ffa