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PII: S0031-9384(16)30821-6
DOI: doi: 10.1016/j.physbeh.2017.01.015
Reference: PHB 11634
To appear in: Physiology & Behavior
Received date: 16 September 2016
Revised date: 28 October 2016
Accepted date: 9 January 2017
Please cite this article as: Kevin T. Mattocks, Matthew B. Jessee, Brittany R. Counts,
Samuel L. Buckner, J. Grant Mouser, Scott J. Dankel, Gilberto C. Laurentino, Jeremy
P. Loenneke , The effects of upper body exercise across different levels of blood flow
restriction on arterial occlusion pressure and perceptual responses. The address for the
corresponding author was captured as affiliation for all authors. Please check if
appropriate. Phb(2017), doi: 10.1016/j.physbeh.2017.01.015
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The Effects of Upper Body Exercise across Different Levels of Blood Flow Restriction on
Arterial Occlusion Pressure and Perceptual Responses
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Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied
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Physiology Laboratory, The University of Mississippi, University, MS.
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Corresponding Author
Jeremy P. Loenneke, PhD
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Phone: 662-915-5567
Fax: 662-915-5525
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Abstract
Recent studies have investigated relative pressures that are applied during blood flow restriction
exercise ranging from 40% – 90% of resting arterial occlusion pressure; however, no studies
have investigated relative pressures below 40% arterial occlusion pressure. The purpose of this
study was to characterize the cardiovascular and perceptual responses to different levels of
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pressures. Twenty-six resistance trained participants performed four sets of unilateral elbow
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flexion exercise using 30% of their 1RM in combination with blood flow restriction inflated to
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one of six relative applied pressures (0%, 10%, 20%, 30%, 50%, 90% arterial occlusion
pressure). Arterial occlusion pressure was measured before (pre) and immediately after the last
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set of exercise at the radial artery. RPE and discomfort were taken prior to (pre) and following
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each set of exercise. Data presented as mean (95% CI) except for perceptual responses
represented as the median (25th, 75th percentile). Arterial occlusion pressure increased from pre
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to post (p < 0.001) in all conditions but was augmented further with higher pressures [e.g. 0%:
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36 (30 - 42) mmHg vs. 10%: 39 (34 - 44) mmHg vs. 90% 46 (41 - 52) mmHg]. For RPE and
discomfort, there were significant differences across conditions for all sets of exercise (p < 0.01)
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with the ratings of RPE [e.g. 0%: 14.5 (13, 17) vs. 10%: 13.5 (12, 17) vs. 90%: 17 (14.75, 19)
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during last set] and discomfort [e.g. 0%: 3.5 (1.5, 6.25) vs. 10%: 3 (1, 6) vs. 90%: 7 (4.5, 9)
during last set] generally being greater at the higher restriction pressures. All of these differences
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at the higher restriction pressures occurred despite completing a lower total volume of exercise.
Applying higher relative pressures results in the greatest cardiovascular response, higher
perceptual ratings, and greater decrease in exercise volume compared to lower restriction
pressures. Therefore, the perceptual responses from lower relative pressures may be more
appealing and provide a safer and more tolerable stimulus for individuals.
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Introduction
Blood flow restriction training has been shown to increase muscle size and strength similar to
high-load resistance training [1,2] with loads as low as 20% of the one repetition maximum
(1RM). Throughout the blood flow restriction literature, a variety of pressures have been applied
ranging from relative pressures that are based on brachial systolic pressure (130% brachial
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systolic blood pressure) to applying an arbitrary pressure to all individuals [3]. This may be a
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concern because applying an arbitrary pressure may restrict blood flow to a greater extent than
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what was intended, leading to an exaggerated cardiovascular response [4]. Therefore, it is
suggested that when applying pressure to the cuff, the pressure should account for the
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individual’s limb circumference the and width of the cuff [5–7]. One method to do this is to
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apply a percentage of the resting arterial occlusion pressure which ensures that all participants
will receive a similar stimulus and may also reduce the risk of a negative cardiovascular event
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[4,8].
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Recent studies have investigated relative pressures ranging from 40% – 90% of resting arterial
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occlusion pressure during blood flow restriction exercise [9–11]. However, there seems to be
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little augmentation in muscle adaptation beyond a relative pressure of 40% arterial occlusion
pressure [9]. To our knowledge, no studies have investigated relative pressures below 40%
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arterial occlusion pressure during blood flow restriction exercise. We hypothesize that there is
likely a point at which the relative pressure is too low to be efficacious. It is conceivable that a
pressure of 20% arterial occlusion may be high enough at rest but during exercise drops outside
of the hypothetical pressure range needed for muscle adaptation due to the elevated
cardiovascular response [12, 13]. Thus, the purpose of this study was to characterize the
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cardiovascular response to pressures below 40% arterial occlusion pressure (0%, 10%, 20%,
30% arterial occlusion) and compare them to a moderate (50% arterial occlusion pressure) and
higher (90% arterial occlusion pressure) relative pressure. We also sought to investigate the
perceptual response across these pressures to determine whether or not they differ from simply
completing the exercise protocol in the absence of blood flow restriction. This is important
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because higher perceptual responses, despite the effectiveness of blood flow restriction, may
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deter its use in practice.
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Methods
Participants
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Twenty-six resistance trained participants (20 men, 6 women) completed all of the testing
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sessions. Individuals were classified as ‘resistance trained” if they performed resistance training
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two or more days per week for at least the past 6 months in the upper body. All participants were
instructed to refrain from: 1) eating two hours prior in all visits; 2) consuming caffeine eight
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hours prior to all visits; 3) consuming alcohol 24 hours prior to all visits; and 4) upper body
exercise 24 hours before all visits. Participants were excluded if they had more than one risk
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factor for thromboembolism [14] which included the following: obesity (BMI 30 kg/m2);
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diagnosed Crohn’s disease; a past fracture of the hip, pelvis or femur; major surgery within the
last 6 months; varicose veins; a family or personal history of deep vein thrombosis or pulmonary
embolism. Also, participants who were currently using tobacco products were excluded. The
study received approval from the University’s institutional review board and each participant
Study Design
During visit 1, the participants filled out an informed consent form, adult health history
questionnaire and physical activity readiness questionnaire (PAR-Q). After confirming that they
did not meet any exclusion criteria, height and body mass were measured using a standard
stadiometer and an electronic scale. Next, the participants were seated in a quiet room for 10
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minutes. Following the rest period, participants had their standing arterial occlusion pressure
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determined in both arms at the radial artery in a randomized fashion. The participants then tested
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their unilateral concentric elbow flexion one-repetition maximum (1RM) for each arm and were
then familiarized with isometric testing. Following this, participants were familiarized with the
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blood flow restriction stimulus. After visit 1, participants were scheduled for their testing visits
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with a minimum of five and a maximum of 10 days between visits at the same time of day.
During visits 2, 3, and 4, participants performed two exercise conditions of unilateral elbow
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flexion in combination with blood flow restriction at 30% of their concentric 1RM in a random
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order (one condition per arm). The participants exercised at 0%, 10%, 20%, 30%, 50%, or 90%
of their standing resting arterial occlusion pressure. The goal repetitions for the exercise protocol
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consisted of one set of 30 repetitions followed by three sets of 15 repetitions with 30 s rest
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periods between sets. Upon completion of the final set, arterial occlusion pressure was
determined again. A metronome was used to ensure that the participants held the cadence of one
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second for the concentric muscle action and one second for the eccentric muscle action during
the unilateral elbow flexion exercise. Ratings of perceived exertion (RPE) and discomfort were
Following 10 minutes of seated rest, arterial occlusion was measured on both arms. The arm
randomly assigned to exercise first, was measured first. The cuff was then removed and placed
on the other arm to determine resting arterial occlusion for that limb. The cuff used was a 5cm
wide nylon cuff applied to the most proximal portion of the arm. The lowest pressure at which
blood flow at the radial artery was no longer present was determined in the standing position
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using a Doppler hand-held probe (MD6 Doppler Probe, Hokanson, Bellevue, WA, USA).
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Pressure was regulated by the E20 Rapid Cuff Inflator (Hokanson, Bellevue, WA) and was
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inflated to 50 mmHg before being progressively increased by 1 mmHg increments until a pulse
was no longer detected. The participants exercised with the cuff in place and upon completion of
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the exercise, the applied pressure was increased until blood flow was no longer present and the
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cuff was deflated immediately. Thirty minutes after the first condition, the participants were
seated in a quiet room for five minutes. Following the rest period, participants had their standing
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arterial occlusion pressure determined on the arm that was not trained first and then that arm
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completed an additional exercise protocol. Although the arterial occlusion pressure was
determined in this arm after the first 10 minute rest, the arterial occlusion pressure used for
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exercise was based on the assessment obtained immediately prior to exercise in that arm. This
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was done to ensure that if there was an augmented cardiovascular response from the first
exercise condition, it would be accounted for by the “new baseline”. It should be noted that there
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were only minor differences between the first and second measurements [mean difference (95%
CI); 5 (4 – 6) mmHg].
A one-repetition maximum (1RM) for the unilateral elbow flexion exercise was obtained on both
arms for each individual on visit 1. Briefly, participants warmed up with a relatively low load
corresponding to an estimated 30% 1RM. Following the brief warm-up, the load was increased
to approximately 90% of the individuals 1RM and participants performed one repetition.
Thereafter, the load was adjusted to an estimated 1RM and the load was either increased or
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decreased in 0.5 kg increments until a 1RM was obtained. The dumbbell was handed to each
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individual at full elbow extension and participants were instructed to keep their back and heels
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against the wall during all 1RM attempts to ensure strict form. Only those attempts that
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Ratings of Perceived Exertion (RPE)
RPE was taken before the start of exercise and immediately following each set using the standard
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Borg 6-20 scale as previously described [15]. Participants were explained in depth how to rate
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their RPE and to ensure they understood the scale being used. Participants were told, “We want
you to rate your perception of exertion, that is, how heavy and strenuous the exercise feels to
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you. The perception of exertion depends mainly on the strain and fatigue in your muscles. We
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want you to use this scale from 6-20, where 6 means ‘no exertion at all’ and 20 means ‘maximal
exertion’; any questions?” Participants confirmed that they fully understood how to rate RPE
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prior to actual testing. RPE was taken immediately after sets 1, 2, 3 and 4.
Ratings of Discomfort
A rating of discomfort was taken prior to the start of exercise and following each set using the
Borg Discomfort scale (CR-10+) as described previously [15]. For example, participants were
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asked, “What was your worst experiences of discomfort? ‘Maximum discomfort (rating of 10)’
is your main point of reference; it is anchored by your previously experienced worst discomfort.
The worst discomfort that you have ever experienced, the ‘Maximum discomfort’ may not be the
highest possible level of discomfort. There may be a level of discomfort that is still stronger than
your 10; if this is the case, you will say 11 or 12. If the discomfort is much stronger, for example,
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1.5 times ‘Maximum Discomfort’ you will say 15; any questions?” Participants confirmed that
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they fully understood how to rate discomfort prior to actual testing. Ratings of discomfort were
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taken before exercise, as well as 20 seconds after sets 1, 2, 3, and immediately after set 4.
Discomfort was taken 20 seconds after each set because participants in previous blood flow
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restriction studies anecdotally noted greater discomfort later in the rest periods.
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Statistical Analysis
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All data were analyzed using the SPSS 22 statistical software package (SPSS Inc., Chicago, IL).
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variance (ANOVA) was conducted. If there was a significant interaction, paired sample t-tests
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determined differences from pre-to-post exercise within each condition and one-way repeated
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measures ANOVAs determined differences across conditions within each time point. To
compare differences in the perceptual responses (RPE and discomfort), a Friedman non-
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parametric test was used to determine if differences existed between conditions at different time
points (Pre, 1st set, 2nd set, 3rd set, 4th set). If there were significant differences, Wilcoxon
related samples nonparametric tests were used to determine where the difference occurred. For
volume across conditions. All data are presented as means and 95% confidence intervals except
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for the perceptual responses which are represented as 50th (25th, 75th) percentiles. Statistical
Results
Participants
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A total of 26 resistance trained males (n=20) and females (n=6) [mean (95% CI); Age: 22 (21-
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23) yrs; Height: 175.3 (171.2 - 179.4) cm: Body mass: 78.7 (73.4 - 84.1) kg; Left arm 1RM: 22.6
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(19.9 - 25.4) kg; Right arm 1RM: 22.9 (20.1 - 24.6) kg] completed the study protocol.
= 0.014). Follow up tests found that all conditions increased arterial occlusion pressure from pre
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to post (p < 0.001). No significant differences were noted between conditions at pre (F= 0.461, p
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= 0.805), however, differences between conditions were found at post (Figure 1, F= 4.128 p
=0.002). Supplementary Figure 1 displays the pre-post change score (95% CI) in arterial
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occlusion pressure across relative pressures. Given the increase in arterial occlusion pressure
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with exercise, there were noted decreases in the relative applied pressure which is displayed in
Figure 2.
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There were no differences in RPE at pre (Table 1, χ2=3.5, p = 0.623); however, there were
significant differences across conditions for sets 1 (χ2 =18.893, p < 0.05), 2 (χ2 = 30.364, p <
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0.001), 3 (χ2 = 24.616, p < 0.001), and 4 (χ2 = 29.334, p < 0.001) of exercise with the RPE
Ratings of Discomfort
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however, there were significant differences across conditions for sets 1 (χ2 =48.820, p < 0.001), 2
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(χ2 = 58.885, p < 0.001), 3 (χ2 = 58.724, p < 0.001), and 4 (χ2 = 55.748, p < 0.001) with the
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ratings of discomfort generally being greater at the higher applied pressures.
Exercise Volume
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There was a significant difference between conditions (F=22.526, p < 0.001) in exercise volume,
with the higher restriction pressures completing less volume compared to lower restriction
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pressures (Figure 3). When displayed as total repetitions completed across arterial occlusion
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pressures [mean (95% CI)], the majority of individuals were unable to complete the goal number
of repetitions [0%: 65 (62 - 69); 10%: 65 (61 - 69); 20%: 65 (61 - 69); 30%: 64 (60 - 68); 50%:
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Discussion
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The current study uncovered three findings: 1) the application of a relative restriction pressure
perceptual responses were significantly different across conditions and for all sets with the
higher relative pressure coinciding with the greatest ratings of RPE and discomfort, and 3)
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exercise volume was different between conditions with the higher relative pressure completing
The current study sought to further investigate the change in the cardiovascular response to six
different relative restriction pressures following 4 sets of blood flow restriction exercise. It has
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recently been observed by Brandner et al. [16] that blood flow restricted exercise (10.5 cm wide
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cuff used for exercise) with intermittent high-pressure (130% systolic blood pressure measured
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with an 8 cm wide cuff) caused a similar hemodynamic (i.e. heart rate, blood pressure, cardiac
output, rate pressure product) response compared to traditional high load exercise. Further, they
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observed that exercise in combination with low-continuous pressure (80% systolic blood
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pressure measured with an 8 cm wide cuff) produced a response in between that observed with
high load and low load exercise. This suggests that when performing blood flow restriction
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exercise, greater levels of blood flow restriction will augment the cardiovascular response but not
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necessarily augment the muscle adaptation [9,11]. Additionally, low-intensity aerobic exercise in
combination with blood flow restriction has demonstrated a greater increase in the cardiovascular
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response compared to exercise without blood flow restriction [17]. However, the restriction
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pressure applied to the participants in the aforementioned studies were not made relative to the
participant or the cuff used during the exercise which may have had some individuals under
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complete arterial occlusion. This augmented cardiovascular response could be due to the
mechanical compression of the vascular tree which may augment the exercise-induce pressor
response [18]. Although the magnitude of change in pressure may not be of concern to a healthy
participant, this may be more concerning for aging individuals and/or individuals with a
lower relative pressure may maximize muscle adaptation while causing less mechanical
compression. Less mechanical compression may minimize the exercise-induced pressor response
which may lessen the chances of an adverse event [4,8]. However, it is also important to
understand that the relative restriction pressure will decrease with exercise. Thus, a pressure
sufficient at the beginning of exercise may no longer restrict the same amount of blood flow
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following exercise. A previous study found that the relative restriction pressure of 40% arterial
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occlusion pressure decreased ~8% immediately after a bout of blood flow restriction exercise in
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the upper body indicating an increase in the cardiovascular response during exercise [12]. In
agreement with the previous study, we also observed a decrease in the relative restriction
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pressure following a bout of upper body exercise with the addition of incorporating multiple
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levels of blood flow restriction pressures. Examining the cardiovascular response to this type of
exercise can help determine an appropriate restriction pressure to minimize the exaggerated
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In regards to perceptual responses (RPE and discomfort), there is limited information on RPE
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throughout different levels of restriction pressures [10,19,20]. Yasuda et al. [19] applied two
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different pressures to the participants when performing unilateral bicep curls and observed that a
restriction pressure of 160 mmHg induced a higher RPE compared to 100 mmHg; however,
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these pressures were not individualized to the cuff or participant. Therefore, some individuals
may have been fully occluded with 160 mmHg which may have augmented their RPE.
Conversely, when applying a relative restriction pressure based on the participant’s arterial
occlusion pressure [10,20], there were no differences in RPE. While applying a relative
restriction pressure to the participants in the current study, however, there were differences in
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RPE. A possible reason for the discrepancy between Loenneke et al. [10,20] and the current
study is that the authors in that study applied moderate to high restriction pressures while we
applied low to high restriction pressures. Although the pressures applied were randomized,
compared to 1 condition) before exercising at a higher restriction pressure. For example, the
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participant may have received a relative restriction pressure of <40% in the first condition and
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used the ratings from this condition as their anchor for subsequent pressures; thus, when
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receiving a relative restriction pressure of 90% their ratings were altered due to the large
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The results from the current study display that discomfort ratings were greatest when a higher
relative pressure (90% arterial occlusion pressure) was applied which agrees with a previous
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study conducted by Counts et al. [9]. The authors of that study examined discomfort in the upper
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body at 40% and 90% arterial occlusion pressure and found that 90% arterial occlusion pressure
resulted in a greater rating of discomfort. Interestingly, however, the results from our study and
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Counts et al. [9] differ from Loenneke et al. [10] where there were little differences in discomfort
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with pressures ranging 40% - 90% arterial occlusion pressure. There are a few possible reasons
for the divergences between the studies. Counts et al. [9] examined untrained participants while
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Loenneke et al. [10] examined resistance trained individuals which suggests training status may
be playing some role. There were also differences in baseline 1RM between the two studies
which may suggest that the pressure applied may have less of an impact on the ratings of
discomfort in those who are training with an overall higher absolute load (Baseline 1RM: Counts
et al. – 11.2 kg; Loenneke et al. ~19 kg). We examined resistance trained individuals with similar
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strength levels (Baseline 1RM: 22.9 kg) as Loenneke et al. [10] but observed an increased
discomfort at the higher relative pressures. Possible reasons for the discrepancy between the
current study and the aforementioned study could be that they examined relative pressures
ranging from moderate to high while the current study examined relative pressures ranging from
low to high. It may be that participants could not notice a big difference between moderate to
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high relative pressures applied (40%, 50%, 60%, 70%, 80%, and 90% arterial occlusion) due to
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the small increased increments of pressures applied which resulted in little differences in ratings
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of discomfort between pressures. Thus, similar to RPE, part of the discrepancy may be due to the
probability that lower pressures were experienced first altering the subsequent ratings of the
In view of the results presented herein, our study has some limitations. We measured the
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pressure required for resting arterial occlusion but did not quantify the change in blood flow.
Future studies should quantify the change in blood flow through different levels of relative
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restriction pressures in-between sets and/or arterial occlusion pressure to determine where the
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change is occurring. Additionally, we used a 5 cm nylon cuff and it is possible that these results
could differ with cuffs of different widths. It may be that a wide cuff, inflated to a relative
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pressure, may still induce a greater cardiovascular or perceptual response since it covers up both
more area of the muscle as well as more of the vascular structures. Regardless, the results of the
Conclusion
Applying a relative restriction pressure based on arterial occlusion pressure during blood flow
restriction exercise has been shown to produce favorable adaptations while also ensuring a
common stimulus. It appears for muscular adaptations, 40% arterial occlusion [9] is all that is
required at 30% 1RM; however, the cardiovascular response is different depending on the
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relative restricted pressure applied. Currently it is unknown whether pressures <40% arterial
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occlusion pressure with a load of 30% 1RM induces similar muscular and vascular adaptations
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compared to moderate and high pressures. The current investigation sought to characterize the
cardiovascular and perceptual responses to blood flow restriction exercise through different
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levels of restriction pressures. Applying a lower relative restriction pressure resulted in lower
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perceptual responses which may be more appealing to individuals and result in better adherence
to blood flow restriction exercise. Future research could investigate if a lower load (20% 1RM)
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and different levels of pressures produce different or similar cardiovascular and perceptual
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responses. Overall, these results provide additional information to the blood flow restriction
literature by categorizing the cardiovascular and perceptual response to pressures < 40% arterial
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occlusion. In addition, these findings may guide future studies to provide a safer and more
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tolerable stimulus for the individual who still wants to increase muscle size while concomitantly
Acknowledgements
This study was supported in part by the Biolayne foundation (SJD and JPL).
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References:
2. Laurentino GC, Ugrinowitsch C, Roschel H, Aoki MS, Soares AG, Neves M, et al. Strength
training with blood flow restriction diminishes myostatin gene expression. Med. Sci. Sports
Exerc. 2012;44:406–12.
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3. Ingram J, Loenneke JP. The Current State of Blood Flow Restriction [Internet]. 2015.
IP
Available from:
https://www.dropbox.com/s/qmkxwzncpjrr0q2/OleMiss_BloodFlowRestriction.pdf?dl=0.
CR
4. Spranger MD, Krishnan AC, Levy PD, O’Leary DS, Smith SA. Blood flow restriction training
and the exercise pressor reflex: a call for concern. Am. J. Physiol. Heart Circ. Physiol.
2015;309:H1440–52.
US
5. Loenneke JP, Fahs CA, Rossow LM, Sherk VD, Thiebaud RS, Abe T, et al. Effects of cuff
width on arterial occlusion: implications for blood flow restricted exercise. Eur. J. Appl. Physiol.
AN
2012;112:2903–12.
6. Loenneke JP, Fahs CA, Rossow LM, Thiebaud RS, Mattocks KT, Abe T, et al. Blood flow
restriction pressure recommendations: a tale of two cuffs. Front. Physiol. 2013;4:249.
M
7. Buckner SL, Dankel SJ, Counts BR, Jessee MB, Mouser JG, Mattocks KT, et al. Influence of
ED
cuff material on blood flow restriction stimulus in the upper body. J. Physiol. Sci. JPS. 2016;
8. Jessee MB, Buckner SL, Mouser JG, Mattocks KT, Loenneke JP. Letter to the editor:
Applying the blood flow restriction pressure: the elephant in the room. Am. J. Physiol. Heart
PT
9. Counts BR, Dankel SJ, Barnett BE, Kim D, Mouser JG, Allen KM, et al. Influence of relative
CE
blood flow restriction pressure on muscle activation and muscle adaptation. Muscle Nerve.
2016;53:438–45.
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10. Loenneke JP, Kim D, Mouser JG, Allen KM, Thiebaud RS, Abe T, et al. Are there
perceptual differences to varying levels of blood flow restriction? Physiol. Behav.
2016;157:277–80.
11. Lixandrão ME, Ugrinowitsch C, Laurentino G, Libardi CA, Aihara AY, Cardoso FN, et al.
Effects of exercise intensity and occlusion pressure after 12 weeks of resistance training with
blood-flow restriction. Eur. J. Appl. Physiol. 2015;115:2471–80.
12. Barnett BE, Dankel SJ, Counts BR, Nooe AL, Abe T, Loenneke JP. Blood flow occlusion
pressure at rest and immediately after a bout of low load exercise. Clin. Physiol. Funct. Imaging.
2015; 10.1111/cpf.12246.
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13. Loenneke JP, Thiebaud RS, Abe T, Bemben MG. Blood flow restriction pressure
recommendations: the hormesis hypothesis. Med. Hypotheses. 2014;82:623–6.
14. Motykie GD, Zebala LP, Caprini JA, Lee CE, Arcelus JI, Reyna JJ, et al. A guide to venous
thromboembolism risk factor assessment. J. Thromb. Thrombolysis. 2000;9:253–62.
15. Loenneke JP, Fahs CA, Thiebaud RS, Rossow LM, Abe T, Ye X, et al. The acute muscle
swelling effects of blood flow restriction. Acta Physiol. Hung. 2012;99:400–10.
16. Brandner CR, Kidgell DJ, Warmington SA. Unilateral bicep curl hemodynamics: Low-
T
pressure continuous vs high-pressure intermittent blood flow restriction. Scand. J. Med. Sci.
IP
Sports. 2015;25:770–7.
17. Renzi CP, Tanaka H, Sugawara J. Effects of Leg Blood Flow Restriction during Walking on
CR
Cardiovascular Function. Med. Sci. Sports Exerc. 2010;42:726–32.
18. Rossow LM, Fahs CA, Loenneke JP, Thiebaud RS, Sherk VD, Abe T, et al. Cardiovascular
US
and perceptual responses to blood-flow-restricted resistance exercise with differing restrictive
cuffs. Clin. Physiol. Funct. Imaging. 2012;32:331–7.
AN
19. Yasuda T, Abe T, Brechue WF, Iida H, Takano H, Meguro K, et al. Venous blood gas and
metabolite response to low-intensity muscle contractions with external limb compression.
Metabolism. 2010;59:1510–9.
M
20. Loenneke JP, Kim D, Fahs CA, Thiebaud RS, Abe T, Larson RD, et al. The effects of
resistance exercise with and without different degrees of blood-flow restriction on perceptual
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Table 1. Perceptual Responses to differing levels of arterial occlusion pressure. Sets with different letters represent significant
differences between pressures (p 0.05). If conditions contain at least one of the same letter, they are not significantly different from each
other. Values are represented as median (25th, 75th percentile).
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b
10% 6 (6, 6) 10 (9, 13) 12 (9, 15) b 14 (11, 16) c 13.5 (12, 17) a
20% 6 (6, 6) 11 (9, 13.5) ab 13 (11, 15.5) abcdef 14 (11, 16) c 15 (12, 16.25) a
30%
50%
6 (6, 6)
6 (6, 6)
13 (9.75, 14)
12.5 (11, 14)
abc
c
14, (12, 15.5) af
14 (12.5 16) cdef
C R
15 (13, 16.25) b
15 (13.75, 17) b
15 (13, 16.25) a
15 (13, 17) a
S
c
90% 6 (6, 6) 13 (9.75, 15) 15 (13, 16.5) g 16 (14.5 17.5) d 17 (14.75, 19) b
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2 (0.925, 3) b
2.75 (1.5, 4.25) a
2.5 (1.25, 4) a
3 (2, 5) a
3 (1.375, 4) b
3.5 (2.375, 6) ac
50%
90%
0 (0, 0)
0 (0, 0) D
2.25 (0.925, 3)
E
4.5, (2.75, 6) c
b
3.5 (1.875, 5) c
5 (3.75, 7) d
4 (2, 6.5) b
7 (5, 9) c
4.5 (3, 7) c
7 (4.5, 9) d
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C E
A C
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Figure Legends
Figure 1. Mean arterial occlusion pressure before (pre) and immediately after exercise (post). An asterisk
indicates a significant difference from pre-to-post (p .05). Conditions with different letters represent
significant differences between conditions for post values (p .05). If two conditions contain at least one
of the same letter, they are not significantly different from each other. Data represented as mean (95%
CI).
Figure 2. Relative applied arterial occlusion pressure differences from pre to post. Data represented as
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mean (95% CI).
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Figure 3. Average total exercise volume completed across conditions. Conditions with different letters
represent significant differences between conditions (p .05). If two conditions contain at least one of the
same letter, they are not significantly different from each other. Data represented as mean (95% CI).
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Supplementary Figure 1. The mean pre-post change in arterial occlusion pressure across
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conditions. The mean change in arterial occlusion pressure from pre with variability in change
represented by 95% confidence intervals.
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Figure 2 US
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Figure 3 US
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Highlights
Due to the cardiovascular response, the relative restriction pressure decreases during
exercise.
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