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Blood Flow Restriction Training (BFR) is becoming an increasingly popular training method among athletes with high training loads e.g swimmers, gymnasts, rugby players, MMA athletes, boxers and powerlifters.

Initially, this training method was adopted by powerlifters and bodybuilders to reduce joint stress whilst increasing muscle mass and strength.

Competitive athletes across an array of sporting disciplines can benefit from BFR training as it represents a potent stimulus for gains in muscle mass and strength whilst limiting exposure to heavy loads and therefore contributing to improved training longevity.

In this article we’ll cover:

  1. The effectiveness of BFR using evidence from the scientific literature.

2. Describe the potential mechanisms that underpin the effectiveness of BFR training.

3. Present the considerations boxers need to make before employing BFR training.

4. How we use BFR at Boxing Science

5. The main factors when incorporating BFR into a boxer’s training regime.

WHAT IS BLOOD FLOW RESTRICTION TRAINING?

BFR training involves compressing the proximal area of a muscle, usually with specialised bands (known as pneumatic restriction cuffs) that can quantify the amount of pressure being applied to the area (1,2,3).

This compression restricts blood flow, mainly venous but some arterial, and in combination with strength training stimulates a cascade of intracellular signals that facilitate gains in muscle mass and strength.

Example of how the pressure bands are applied.

There are two types of BFR training frequently used in the scientific literature:

Low Load/Intensity BFR training: Isolation/single joint exercises using light loads between 20-30% 1RM (1).

High Load/Intensity BFR: Compound/Multi joint lifts using heavier loads >70% 1RM (4,5,6).

The focus of this article will be predominantly on low load/intensity BFR training as this is the method we use most frequently with our boxers.

For more on the high load method see articles by Dankel et al. (2018), Cook et al.( 2014) and Laurentino et al. (2008).

EFFECTIVENESS OF BFR

Low load BFR training has been shown to induce muscle hypertrophy and strength improvements in both general (7) and sporting populations (8).

These interventions are usually programmed as single-joint exercises such as bicep curls and leg extensions.

In combination with conventional, unrestricted high load strength training, low load BFR has been demonstrated as an effective complementary training method for augmenting gains in muscle size and strength (9).

As such BFR is considered a safe and effective alternative to training at higher intensities, particularly for accessory type exercises (10).

This represents a major upside of BFR training for athletes who have high training loads and perform repetitive actions that stress the same joints over and over e.g swimmers, rowers, boxers and endurance runners.

HOW DOES BFR WORK?

There has been much discussion about how BFR stimulates muscle hypertrophy and gains in muscle strength.

It should be noted that gains in muscle strength as a result of BFR are usually a consequence of muscle hypertrophy from this training method (9).

BFR & MUSCLE HYPERTROPHY

Muscle Activity: Light loaded BFR training has been shown to elicit superior magnitudes of muscle activity compared to unrestricted training (11).

Increases in muscle activity enhance tension within the muscle, providing the basis for hypertrophy.

Muscle Protein Synthesis: Using 20% 1RM with blood flow restriction has shown to significantly increase muscle protein synthesis to a magnitude similar to that of heavier loads following a bout of resistance training (12, 13).

Cellular Swelling: This is said to occur as a result of blood pooling, accumulation of metabolites as a result of the restricted blood flow (14) and reactive hyperaemia that occurs on the release of pressure.

Intra-cellular swelling is a key trigger for anabolic-signalling pathways which facilitate muscle growth.

Increased Metabolic Stress: Metabolic stress is a key driver for increases in muscle mass. Metabolic stress may be defined as an exercise-induced accumulation of metabolites, particularly lactate, inorganic phosphate and H+ (18, 19).

Current research suggests that metabolic stress is heightened with BFR training techniques (15).

Increased Muscle Fibre Recruitment: Due to the accumulation of metabolites associated with blood pooling, it is suggested that this may increase the recruitment of fast twitch muscle fibers.

This blood pooling contributes to slow twitch muscle fibre fatigue and as a result greater fast twitch fibre recruitment during the set, according to Heneman’s size principle.

Usually with lighter loads it is difficult to activate and develop type 2, fast-twitch, muscle fibers due to the low force demands.

BFR seems to increase the force demands of a set even with lighter loads, therefore recruiting more type 2 muscle fibers (16, 25)

BENEFITS OF BFR FOR BOXERS

We know boxers are among the hardest training athletes out there in terms of the intensity and volume of training.

When in camp, boxers will throw thousands of punches throughout the training week.

Though high punching volumes are an essential part of a boxer’s training, this can impart significant strain on the joints and muscles that are recruited repetitively.

Punching the bags, pads and even a sparring opponent pre-disposes these athletes to chronic irritation of the hands, wrists, elbows and shoulders. This can often be reported as tenderness and pain on impact in these joints, potentially impairing the athletes capacity to train maximally.

Therefore, as strength and conditioning coaches we aim to avoid placing further, unnecessary stress on these joints wherever possible.

BFR is one method we can use to minimise joint stress whilst providing a potent stimulus for hypertrophy and strength development.

WHEN TO USE?

Though BFR is a well-established training method, it should be used in certain circumstances with boxers.

Gaining muscle in the wrong places at the wrong time is something we should try and avoid.

Here are examples of when BFR can be beneficial for a boxer:

General Preparation: We have employed BFR with success in general prep phases when the athlete is returning to camp after a lengthy layoff, to help restore lost muscle mass and prepare him/her for more intense training phases.

Moving Up: If aiming to move up in weight BFR is something to consider including.

Using BFR during light loaded sets will help maximise muscle fiber recruitment and in combination with contemporary S&C methods will contribute to your explosiveness in the ring.

Rehabilitation from Injury: Losses in muscle mass and a lack of neurological stimulation, as a result of injury can be detrimental to an athletes strength levels.

Maintaining muscle strength is essential for boxers to maximise their potential for high rates of force development (RFD).

As mentioned previously, the mechanisms that influence hypertrophy from the use of BFR can indirectly enhance dynamic muscle strength (9).

A common method of retaining strength qualities if recovering from a joint injury is the use of handcuff and ankle weights.

Adding BFR to these sets enables us to use light loads but recruit additional muscle fibres which promote hypertrophy and improvements in strength.

Moreover, BFR training enables us to do this without having to use high volumes and minimises the risk of causing further injury to the afflicted limb.

World Super Featherweight Champion Terri Harper using BFR as she recovers from her broken hand.

IMPORTANT CONSIDERATIONS

Accuracy: Despite using elastic bands in the past, we would strongly recommend purchasing a set of Airbands if intending to use BFR training.

It is important to monitor the pressure applied to the athlete and with elastic bands this is impossible.

Airband’s moderate the pressure accurately through an app on your smartphone/tablet, so you can perform BFR with precision.

Visit the Airbands website here.

Pressure: It is important to understand that more pressure does not necessarily equate to better training adaptations.

High pressures can impair exercise performance and increase adverse health risks.

A Pressure level equivalent to 50% estimated arterial pressure has been previously recommended (17).

Previous research has applied pressure relative to the individual’s brachial systolic blood pressure or bSBP (20, 21).

120% – 130% bSBP have been employed successfully in previous publications (22, 23)

The lower end of this pressure range is recommended for wider cuffs whereas narrower cuffs can be applied using the higher pressure value (17).

Exercise Selection: At Boxing Science we tend to use BFR with single joint, accessory exercises such as bicep curls, tricep extensions and lateral raises.

This is mainly because compound lifts such as squats with BFR may be too intense for athletes who have a relatively low strength training history such as boxers.

Maintaining technical proficiency during sets of heavy compound movements, is very important, especially with boxers.

Incorporating BFR during these sets may negatively affect the boxers’ ability to maintain solid posture throughout due to the level of discomfort experienced and thereof increase the chances of injury.

Additionally, supporting evidence surrounding the use of BFR with high load, compound movements is lacking.

Volume: Another advantage of BFR training is that less volume is required with lighter loads to stimulate muscle hypertrophy when using BFR compared to unrestricted training.

Loenneke and colleagues (25) suggest that sets to failure may be more beneficial than the commonly used four set protocol (first set of 30 repetitions followed by 3 sets of 15 repetitions) when implementing BFR training.

At Boxing Science, however, we frequently prescribe a four set protocol of 30/15/15/Failure. This high volume is usually matched with a relatively low intensity, usually around 20-30% 1RM.

This is because boxers are usually not accustomed to achieving such high levels of muscular fatigue as associated with repeated sets to failure using BFR.

Additionally, injured boxers or those carrying niggles will struggle to tolerate the mechanical stress needed to repeatedly reach failure during sets of BFR.

Stage Of Training Camp: The use of BFR is most appropriate during general preparation phases where the athlete has a specific goal of gaining muscle mass.

Performing substantial volumes of BFR during periods of high sparring loads may lead to impaired training performance as a result of exposing the muscle cell to high levels of metabolic stress and, subsequently fatigue.

Similarly, BFR too close to competition is likely to have an excessive fatiguing effect.

SUMMARY

Blood Flow restriction is an effective method for developing muscle mass and improving/maintaining muscle strength in combination with traditional resistance training whilst minimising the risk of chronic joint tendinopathies and inflammation due to the use of lighter loads. (9, 24, 26, 27, 28).

The main mechanisms in which BFR promotes hypertrophic adaptations using lighter relative loads than that of traditional hypertrophy training include: Increased cellular swelling, increased metabolic stress and enhanced muscle fiber recruitment.

At Boxing Science, we use BFR training techniques in cases where the athlete is returning from a lengthy layoff, is looking to move up in weight class or is recovering from an injury.

Important considerations to address when implementing BFR with boxers include Accuracy of the device used, the degree of pressure applied and the exercises used with BFR.

Additional consideration needs to be given to the volume implemented with athletes unfamiliar with BFR training (e.g boxers) and the stage of training camp BFR is performed in.

References

  1. Cook, S.B., Clark, B.C. and Ploutz-Snyder, L.L., 2007. Effects of exercise load and blood-flow restriction on skeletal muscle function. Medicine and science in sports and exercise39(10), pp.1708-1713.

2. Fahs, C.A., Rossow, L.M., Seo, D.I., Loenneke, J.P., Sherk, V.D., Kim, E., Bemben, D.A. and Bemben, M.G., 2011. Effect of different types of resistance exercise on arterial compliance and calf blood flow. European journal of applied physiology111(12), pp.2969-2975.

3. Rossow, L.M., Fahs, C.A., Sherk, V.D., Seo, D.I., Bemben, D.A. and Bemben, M.G., 2011. The effect of acute blood‐flow‐restricted resistance exercise on postexercise blood pressure. Clinical physiology and functional imaging31(6), pp.429-434.

4. Dankel, S.J., Buckner, S.L., Jessee, M.B., Mattocks, K.T., Mouser, J.G., Counts, B.R., Laurentino, G.C. and Loenneke, J.P., 2018. Can blood flow restriction augment muscle activation during high‐load training?. Clinical physiology and functional imaging38(2), pp.291-295.

5. Cook, C.J., Kilduff, L.P. and Beaven, C.M., 2014. Improving strength and power in trained athletes with 3 weeks of occlusion training. International journal of sports physiology and performance9(1), pp.166-172.

6. Laurentino, G., Ugrinowitsch, C., Aihara, A.Y., Fernandes, A.R., Parcell, A.C., Ricard, M. and Tricoli, V., 2008. Effects of strength training and vascular occlusion. International journal of sports medicine29(08), pp.664-667.

7. Karabulut M, Abe T, Sato Y, Bemben MG. The effects of low-intensity resistance training with vascular restriction on leg muscle strength in older men. Eur J Appl Physiol 108: 147–155, 2010.

8. Takarada Y, Sato Y, Ishii N. Effects of resistance exercise combined with vascular occlusionon muscle function in athletes. Eur J Appl Physiol 86: 308–314, 2002.

9. Yasuda, T., Ogasawara, R., Sakamaki, M., Ozaki, H., Sato, Y. and Abe, T., 2011. Combined effects of low-intensity blood flow restriction training and high-intensity resistance training on muscle strength and size. European journal of applied physiology111(10), pp.2525-2533.

10. Loenneke, J.P., Thrower, A.D., Balapur, A., Barnes, J.T. and Pujol, T.J., 2012. Blood flow–restricted walking does not result in an accumulation of metabolites. Clinical physiology and functional imaging32(1), pp.80-82.

11. Takarada, Y., Takazawa, H., Sato, Y., Takebayashi, S., Tanaka, Y. and Ishii, N., 2000. Effects of resistance exercise combined with moderate vascular occlusion on muscular function in humans. Journal of applied physiology88(6), pp.2097-2106.

12. Fry, C.S., Glynn, E.L., Drummond, M.J., Timmerman, K.L., Fujita, S., Abe, T., Dhanani, S., Volpi, E. and Rasmussen, B.B., 2010. Blood flow restriction exercise stimulates mTORC1 signaling and muscle protein synthesis in older men. Journal of applied physiology108(5), pp.1199-1209.

13. Fujita, S., Abe, T., Drummond, M.J., Cadenas, J.G., Dreyer, H.C., Sato, Y., Volpi, E. and Rasmussen, B.B., 2007. Blood flow restriction during low-intensity resistance exercise increases S6K1 phosphorylation and muscle protein synthesis. Journal of applied physiology103(3), pp.903-910.

14. Loenneke, J.P., Thrower, A.D., Balapur, A., Barnes, J.T. and Pujol, T.J., 2012. Blood flow–restricted walking does not result in an accumulation of metabolites. Clinical physiology and functional imaging32(1), pp.80-82.

15. Suga, T., Okita, K., Morita, N., Yokota, T., Hirabayashi, K., Horiuchi, M., Takada, S., Omokawa, M., Kinugawa, S. and Tsutsui, H., 2010. Dose effect on intramuscular metabolic stress during low-intensity resistance exercise with blood flow restriction. Journal of applied physiology108(6), pp.1563-1567.

16. Yasuda, T., Abe, T., Brechue, W.F., Iida, H., Takano, H., Meguro, K., Kurano, M., Fujita, S. and Nakajima, T., 2010. Venous blood gas and metabolite response to low-intensity muscle contractions with external limb compression. Metabolism59(10), pp.1510-1519.

17. Loenneke, J.P., Thiebaud, R.S., Abe, T. and Bemben, M.G., 2014. Blood flow restriction pressure recommendations: the hormesis hypothesis. Medical hypotheses82(5), pp.623-626.

18. Suga, T., Okita, K., Morita, N., Yokota, T., Hirabayashi, K., Horiuchi, M., Takada, S., Takahashi, T., Omokawa, M., Kinugawa, S. and Tsutsui, H., 2009. Intramuscular metabolism during low-intensity resistance exercise with blood flow restriction. Journal of Applied Physiology106(4), pp.1119-1124.

19. Tesch, P.A., Colliander, E.B. and Kaiser, P., 1986. Muscle metabolism during intense, heavy-resistance exercise. European journal of applied physiology and occupational physiology55(4), pp.362-366.

20. Manini, T.M., Vincent, K.R., Leeuwenburgh, C.L., Lees, H.A., Kavazis, A.N., Borst, S.E. and Clark, B.C., 2011. Myogenic and proteolytic mRNA expression following blood flow restricted exercise. Acta physiologica201(2), pp.255-263.

21. Rossow, L.M., Fahs, C.A., Loenneke, J.P., Thiebaud, R.S., Sherk, V.D., Abe, T. and Bemben, M.G., 2012. Cardiovascular and perceptual responses to blood‐flow‐restricted resistance exercise with differing restrictive cuffs. Clinical physiology and functional imaging32(5), pp.331-337.

22. Cook, S.B., Clark, B.C. and Ploutz-Snyder, L.L., 2007. Effects of exercise load and blood-flow restriction on skeletal muscle function. Medicine and science in sports and exercise39(10), pp.1708-1713.

23. Yasuda, T., Brechue, W.F., Fujita, T., Sato, Y. and Abe, T., 2008. Muscle activation during low-intensity muscle contractions with varying levels of external limb compression. Journal of sports science & medicine7(4), p.467.

24. Loenneke, J.P., Wilson, J.M., Marín, P.J., Zourdos, M.C. and Bemben, M.G., 2012. Low intensity blood flow restriction training: a meta-analysis. European journal of applied physiology112(5), pp.1849-1859.

25. Loenneke, J.P., Fahs, C.A., Wilson, J.M. and Bemben, M.G., 2011. Blood flow restriction: the metabolite/volume threshold theory. Medical hypotheses77(5), pp.748-752.

26. Madarame, H., Neya, M., Ochi, E., Nakazato, K., Sato, Y. and Ishii, N., 2008. Cross-transfer effects of resistance training with blood flow restriction. Medicine+ Science in Sports+ Exercise40(2), p.258.

27. Takarada, Y., Sato, Y. and Ishii, N., 2002. Effects of resistance exercise combined with vascular occlusion on muscle function in athletes. European journal of applied physiology86(4), pp.308-314.

28. Yasuda, T., Fujita, S., Ogasawara, R., Sato, Y. and Abe, T., 2010. Effects of low‐intensity bench press training with restricted arm muscle blood flow on chest muscle hypertrophy: a pilot study. Clinical physiology and functional imaging30(5), pp.338-343.