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  • Writer's pictureRipon Physio Co.

Have you done Blood Training ?!


What is Blood training for muscles?

Blood Restriction Training (BRT) decreases blood flow to a muscle by a constricting device to promote blood pooling in the capillary bed of the muscle. Blood restriction training can improve muscle strength and hypertrophy (Patterson, 2019).

Blood restriction training can cause an improvement in strength for Knee Osteoarthritis, in turn causing a reduction in pain and enhancement of daily mobility by increasing functional strength in the quadriceps (Aguilar, 2018).

History Lesson!!

Who developed Blood Restricted Training?

It was developed in 1970 in Japan by a man called Sato. At the time, it was also known as KAATSU. (They even have a website dedicated to KAATSU!) Link below

It is also known as occlusion training, cluster training, blood restriction training and partial vascular occlusion training. It involves a tourniquet device (cuff) placed proximal to the muscle.

How does it work?

The occlusion rate of the muscle is 40% to 80%. It is recommended to have a load of 20%-30% one rep max (1RPM) with high repetitions of 15 to 30 repetitions per session with a 30 to 60 seconds rest. It can build muscle mass and strength with minimal muscle loading.


The mechanism of blood restriction training includes the reduction of oxygen to the muscle. The anaerobic environment that is created (hypoxic) has been found to promote muscle hyper Trophy through micro-mechanisms, including the initiation of cell signalling and hormone changes that stimulate protein synthesis, proliferation of myogenic satellite cells, and preferential activation and mobilisation of type two muscle fibres (Miranda,2019).

Pearson and Hussein 2014 stated that exercise Induced mechanical tension and metabolic stress authorised to signal a number of mechanisms for the induction of muscle growth, including increased fast-twitch fibres, Mecanico transduction and muscle damage.

With the hypoxic environment through mechanical stress, myogenic stem cells are activated, an increase of anabolic hormone levels, especially the human growth hormone. It has been stated by Schonfield, 2013, that HGH increased up to 300% from baseline. HGH has various physiological benefits such as muscle strength, endurance and induce anabolic processes, i.e. hypertrophy. Along with the HGH, there is an increase in protons, lactic acid and cell swelling. Myogenic cells are responsible for the growth of fivers.

HGH doesn’t directly cause hypertrophy, but it aids recovery and facilitate the strengthening process. The combination of lactic and hydrogen ions also increases the HGH release. Due to the hypoxic environment, the hypoxia-inducible factor (HIF-IAlpha) Activates, leading to an increase in lactate and lactate metabolism.



The cough should be 40 to 80% with standard pressure of 180mmHg. The pressure should be relative to the patient’s systolic blood pressure. A Doppler ultrasound can also be used to determine the blood flow.

Clinical Application:

For clinical application, Hughes et al., 2017, States that be Blood restriction training could be used for patients that are unable to tolerate heavy load training. Low Load (LL) with Blood restriction training is effective whilst being more tolerable and therefore easy clinical rehabilitation for the specific populations. It is also recommended to do it 1 to 2 times per week. Takarado, 2000, Found current research that lactate production after blood restriction training is similar to that of high-intensity training.

Oohhhhhhhh so.....

Supporting literature for BRT:

Ferraz, 2018.

The aim was the benefits of resistance training with BRT on knee osteoarthritis. This included 48 females with osteoarthritis randomly placed into three groups. The first group with Low load resistance with blood restriction training, the second group include low load resistance without blood restriction training and the third included high-intensity resistance. They found that blood restriction training and high-intensity resistance had a similar effect of increasing muscle strength, Quadriceps mass and functionality of knee Osteoarthritis patients. Blood restriction training had the ability to improve their pain levels while inducing less joint stress; it is merging as a feasible and effective therapeutic adjunct for osteoarthritis management. Blood restriction training improved by 17% compared to classic training of 9%.


Investigated the effects of low load resistance to blood restriction training and need osteoarthritis. They included 40 females between 45 to 60 years old with mild, moderate unilateral tibiofemoral osteoarthritis. There were two groups. The first group was 20 females, a conventional high load at 60% one rep max. The second group was 20 females with low Load with blood restriction training at 30% one rep max. The groups completed three sessions each week for four weeks. Both groups were an effective treatment option for improving functional mobility. The results were similar.

According to Harper, a Pilot RCT 2019

Training with blood restriction training in Older adults with me osteoarthritis found indicated that bloody restriction training is a safe and feasible alternative for a patient with knee osteoarthritis.

Bryk in 2016

Found the blood restriction training improve the mass by 42% compared to classic physiotherapy of 30%.


The safety precautions of blood restriction training: All patients should be assessed for risks and contraindications before blood restriction training application. Potential contraindications are; poor circulatory systems, including DVT and uncontrolled diabetes, obesity, arterial calcification, sickle-cell trait, severe hypertension, renal compromise (Dephillipo et al., 2018). The most concerning areas while implementing blood restriction training, according to Patterson, 2019 is 1) cardiovascular, 2) muscle 3) nerve. The cardiovascular includes the concerns with Venus thromboembolism. Acute research did not show a significant increase in blood coagulation through the D dimer. D-dimer is the most utilised clinical test to rule out the presence of DVT, according to Clark in 2011.




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