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Supercharging Muscle Strength & Mass With Blood Flow Restriction Training

Welcome to the Peak Performance Podcast

 I’m your host Dr. Marc Dupuis on this show we discuss tips, tools and strategies for optimizing athletic performance, overall health & wellness!

Today’s topic: BFR training: If you have not heard of it, get ready as this could really shake up your training by literally turbo charging your strength & conditioning plan!  In a nutshell, BFR training is one of the best, if not the #1 way to increase muscle hypertrophy and strength without the risk of joint injury or excessive muscle damage!  

Of course: Please NOTE: There are certain risks associated with this type of training, be SURE to consult with your health care provider prior to beginning any BFR training

Before we dive into the specifics of BFR training, we need to take some time and review the basics of muscle building  and strength building so that you will be able to understand just how BFR training works and Why NOW Is the time to add it to your training plan.

Let’s call this muscle hypertrophy 101

There are TWO basic Ways to increase muscle size or technically muscle hypertrophy
1. BY Applying Mechanic stress (which ultimately creates muscle damage): traditional strength training: lifting increasingly heavy weights to create damage.  Then when the body is at rest, if given enough time and adequate nutrition,it will rebuild the muscles bigger and stronger than they were before, this is known as the principle of super compensation.
2. By creating Metabolic stress accumulation (this involves building up lactate, while simultaneously failing to clear it from the muscles as well as the accumulation of hydrogen ions in the working muscles which are the by-products of ATP hydrolysis). Most people that exercise regularly are aware this happens, as this is what you feel when your muscles are burning at the end of a set or sprint  etc, but not that many people know this accumulation of metabolites is also a direct trigger of muscle hypertrophy.  

Now let’s move on the some basic Principles of Exercise Physiology
We will start with Muscle fiber.  There are 2 primary types of muscle fibers:
Type 1: slow twitch /more aerobic and
Type 2: fast twitch  /  more anaerobic
This is important because there is a Size Principle of Motor Unit Recruitment
Type 1 fibers are recruited first, these fibers as I said are more aerobic, meaning they primarily utilize oxygen, now as demand increases during a particular exercise the body will then recruit Type 2 fibers which as I noted are more anaerobic. 

here is a Key Point: Hypertrophy does NOT always = greater strength.  A bigger muscle is not always a stronger muscle.
Hypertrophy plays a role in building strength, but it is the Central Nervous System’s involvement in learning to recruit more motor units and also synchronize these additional motor units, which allows them  to fire together> that COMBINED with a larger or hypertrophied muscle, equals greater strength.  

Now for muscle hypertrophy 202: There are Hormones needed for muscle hypertrophy; such as:
Growth Hormone is the major player here, keep in mind GH is only optimized with adequate: sleep, nutrition, exercise)

mTOR major pathway activating muscle protein synthesis and skeletal muscle hypertrophy; Think of mTOR as the Body’s on/off switch for muscle growth
Then there is IGF-1, which is an upstream trigger via the Akt pathway which activates mTOR.
    You may have heard of mTOR, it’s been a suddenly hot topic of discussion especially from many so called online health experts and by many in the biohacking space, often it is seen as the enemy because excessive mTOR activation has been linked with degenerative changes and CA, however, like most things in life, it is all about BALANCE.  we MUST have mTOR activated for certain portions of time if we want muscle hypertrophy and increased strength!!

Now, mTOR > yes stimulates protein synthesis, AND it also stimulates VEGF (Vascular Endothelial Growth Factor) > this promotes Angiogenesis which is the formation of new blood vessels. Why is this important?

Simple: While Building muscle is good, you need more than just that to be stronger, since the more muscle you have, the more blood vessels are needed in order to deliver greater amounts of  nutrition into the muscle and also meet the greater demand for waste products removal! – in other words, increasing muscle mass requires an increased vascular network in order to get the most work out of that muscle!

Up until now, MECHANICAL STRESS VIA lifting heavy has been the main method for increasing muscle mass and stimulating CNS involvement in building strength, simply because no other methods were shown to be as effective.  theoretically we’ve known about METABOLIC STRESS ACCUMULATION but did not have any practical methods to achieve it that did NOT also involve MECHANICAL STRESS OR LIFTING HEAVY

Here are some of the Leading Authorities on Muscle Hypertrophy:
ACSM (American College of Sports Medicine) Guidelines for Muscular Hypertrophy
To build muscle you need a Load or amount of weight to lift that equals:
    70-85% 1RM for novice to intermediate athletes
    70 – 100% 1RM for advanced athletes

    1-3 sets of 8-12 reps for novice to intermediate
    3-6 sets of 1-12 reps for advanced

Rest period
    2-3 min for higher intense exercises that use heavier loads
    1-2 min between lower intense exercises with light loads

NSCA (National Strength and Conditioning Association)Guidelines for muscular hypertrophy is similar

This is THE Challenge: Science says we need to push the athlete or patient to lift heavy enough to achieve some degree of muscle breakdown, but for many they cannot do the amount of work that the science says is needed due to a number of different factors such as fear of injury, fear of re-injury in the athlete or patient that is trying to come back from an injury or surgery, lack of experience with this type of training, or fear due to being in pain, etc

The Solution:  Enter BFR training!

Basically, BFR Training: tricks the body into thinking it is doing 70-100% of 1RM type work while using much lighter loads that do not carry nearly the same risk for injury!
How it works:
Constrictive Bands are placed onto the arms or legs that limit the venous return.  This allows metabolites to be “trapped” into the muscle and local tissues.  The bands while tight enough to limit or occlude venous return, they DO allow some arterial blood flow into the muscle/limb.  BFR training utilizes much lower weights, but allows one to do much higher reps, often until failure.  As the reps continue the trapped blood begins running out of nutrients, this stimulates the CNS to require more muscle fibers to lift the same small weight, this achieves the same type of fiber requirement that would have been needed to move a much higher weight say 85% of a 1 RM!  

Not only does this type of workout create a build up of exercise metabolites or by-products such as lactate and Hydrogen ions that cause more muscle fibers to be recruited, it also triggers a cascade of events!

This cascade of events triggers an anabolic or muscle building environment similar to doing high percentage 1RM work without any of the joint stress or actual muscle damage that typically accompanies that type of workout!   BFR training takes advantage of the 2nd method of increasing muscle hypertrophy: metabolic stress accumulation!

BFR training, Really is a Game Changer for patients that are at risk of injury, have pain or other limitations and for high performing athletes that want the benefits of high intensity training without the RISK of injury that could force them OUT of competition!

SIDE note: This is NOT Occlusion training, BFR training uses bands that reduce but not block all blood flow!!

Results of BFR training in the literature:
increased muscle hypertrophy and increased strength
Training to fatigue with BFR has shown Non-traditional recruitment patters, (Type 2 fibers before type 1)
Increased hormone changes enhancing protein synthesis, involving GH and IGF-1
Increased cell signaling for mTOR
Building of non-contractile tissue (may lead to increased strength over time while decreasing future injury risk by improving  the individual’s connective tissue, talk about a win-win)
Less fatigue compared to traditional strength training; this can allow for more training sessions per week with less accumulating soreness & fatigue!

BFR Systems:

They utilized Pneumatic Cuff Systems: Two basic types
Automatic systems: very effective, very expensive!! often only makes sense for health care providers and trainers
Manual Systems: more portable, ease of use, much more cost effective: better for the individual athlete or patient, if properly trained.

**(Doppler Ultrasound: allows one to find min occlusion pressure (mop): min amount of pressure needed to fully occlude limb:  We want to be BELOW that!  (certain % based off of literature)
Helpful with patients with comorbidities
    needs 8 mHz probe
    Audio output/headphone jack**

There are Only TWO places to put bands: (Remember: Many effects are SYSTEMIC! Therefore, there is no need to put them anywhere else! (See Results slide)
    1. Proximal UE, as high into axilla fold as possible
    2. Proximal LE, as close to gluteal fold as possible

The Radial artery pulse is assessed when using UE bands (occluding cephalic & basilic veins)
The Posterior Tibial artery pulse is assessed when using LE bands (occluding Deep and Femoral veins)

Exercise Prescription with BFR training IS Different
You will fatigue sooner!!
Heed the modifications!!
In most cases body weight exercises are MORE Than adequate!!
Cuffs stay inflated through the entire workout, do not inflate/deflate between sets/exercises
Begin around 8 min per total workout
Building  to 15 minutes,
    longer if the person using them is a more trained athlete
Load: Most Bodyweight
    IF you add weight: no more than 20% of 1-RM
3-5 min of rest post BFR training for recovery and perfusion
  ***   Higher the pressure you trained at, more time needed for perfusion
Instead of adding weight, alter tempo: Longer eccentric 4 sec, 2 sec hold, 2 sec concentric**
Basically utilize 2-4 Total Exercises Per Arms and 2-4 exercises per Legs
Max 4 sets (3 most common)
For reps, you target a Max 30 reps during the 1st set
30-60 sec between sets***  STICK to this NO PHONE USE etc
Maintain pressure throughout
Remaining sets should be reps until failure, rarely should you be able to get to another 30 reps, as fatigue should be setting in if cuffs are set appropriately.
**Common reps per sets 1-3
    20-10-10 or 15-8-8 common early
    30-15-15 later rehab**

Safety of BFR Training??
Compared to High Intensity Resistance Training
Decreased Stroke Volume
Less Muscle Damage (none!)
Decreased Oxidative Stress
Not as severe BP systolic spike
Many people ask about clot risks?  Research shows, No change in coagulation activity.  In fact, when using bands increasing pressure on limbs, the body actually increases its production TPA, which is the body’s own clot busting chemical!

Signs and Symptoms to STOP: If these occur, the cuffs often need to be adjusted
Sensation of numbness
Pins and needles
Uncomfortable tingling
Severe discomfort

Contraindications: Conditions where one should NOT do BFR training
Acute Deep Vein Thrombosis (DVT)
Acute Sickness or Fever
Blood Pressure Greater than 180/100 mmHg
Early Postoperative period: check with your surgeon, this can vary greatly
Higher class arrhythmia or coronary ischemia
Varicose Veins
A-Fib or Heart Failure
BP: Systolic >160 mmHg; Diastolic 95 mmHg

Athletes: There is still value in lifting heavy!  So BFR is not to permanently replace high intensity resistance training, rather ADD this INTO your current training plan to be a more well-rounded, strong athlete! And especially during peak season so you can still improve your strength yet minimize the risk of injury during competition season!

So there you have it, BFR training is a groundbreaking method of increasing muscle hypertrophy and strength with minimal risks and faster recovery times! 

Case Study: Early Post-Op ACL
Body wt.
tempo 2020
30s rest between sets
45s rest between exercises
3-5 min post BFR

1. Supine isometric quad sets with NMES
2. Supine Isometric HS curls
3. Side Lying hip abd
4. Standing calf raises

Mid Post-Op ACL Late
15-8-8-8 20-10-10-10
tempo 2020 4120
30s 45
45s 60
3-5 3-5

1. Stationary bike 1. SL squat
2. Mini (partial) squats 2. Lateral lunges
3. Step-ups 3. Bridging with roll in
4. Bridging 4. RDL

This concludes today’s episode of The Peak Performance Podcast, where we discuss tips, tools and strategies for optimizing athletic performance, overall health & wellness! Please SUBSCRIBE to this podcast so that you never miss a future episode, also PLEASE take a moment to Rate & Review us on Apple Podcasts, Thank you very much for listening & Have a Great Day!


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