64 – Blood Flow Restriction (BFR) Training with Dr. Jeremy Loenneke



Blood Flow Restriction (BFR) Training with Dr. Jeremy Loenneke

Blood Flow Restriction (BFR) training… this technique, which hit the scene in the 1990’s, restricts blood flow to our limbs while exercising. It has some interesting and promising applications, particularly for people rehabilitating from certain injuries such as tendonitis.  Dr. Loenneke provides a brief historical overview, the latest findings and insights as to how BFR training can be applied.  Enjoy!

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Arlene [00:00:01] The Inform Fitness podcast with Adam Zickerman and co-host Mike Rogers is a presentation of Inform Fitness Studios, a small family of personal training facilities specializing in safe, efficient, high intensity strength training. On our bi monthly podcast, Adam and Mike discuss the latest findings in the areas of exercise, nutrition and recovery with leading experts and scientists. We aim to debunk the popular misconceptions and the urban myths that are so prevalent in the fields of health and fitness and to replace those sacred cows with scientific based up to the minute information on a variety of subjects. We’ll cover exercise, protocols and techniques, nutrition, sleep recovery, the role of genetics in the response to exercise, and much more. On this episode, Adam welcomes back Dr. Jeremy Loenneke, assistant professor at Ole Miss. They’re going to discuss a most interesting exercise protocol… BFR, Blood Flow Restriction training.

Jeremy [00:01:15] It could be useful for really anyone who can benefit from exercise, which is probably a lot of people. But it comes down to is it something that they want to do? Is it’s something they want to do all the time. Whatever you can think of applying normal exercise, you could do the same thing with blood flow restriction.

Adam [00:01:32] Today we have with us Dr. Jeremy Loenneke. He is the assistant professor at the University of Mississippi, Ole Miss. Dr. Loenneke graduated with a Phd in exercise physiology from the University of Oklahoma. He had previously earned his master’s degree in nutrition and exercise science from Southeast Missouri State University. Dr. Loenneke is a member of the American College of Sports Medicine, and the American physiological society. He also serves as a peer reviewer for several journals, including The Sports Medicine, AJE, Medicine & Science in Sports & Exercise and the Journal of Applied Physiology. Hi Jeremy, welcome back to the show.

Jeremy [00:02:10] Thanks for having me back.

Adam [00:02:11] Another interesting thing that your group works on is blood flow restriction training. And I’ve been hearing a lot about this recently. I’ve had clients come in asking about it and I’ve done some cursory research on blood flow restriction training. And it makes sense to me and I’m so glad that I met you that you’re doing this kind of work. So I’m basically a novice with this technique. And I’m curious whether I should be incorporating it with some of my clients, if any of them, let’s start at the beginning. What is blood flow restriction training?

Jeremy [00:02:44] Yeah. And this is a topic that’s really becoming popular, especially in the clinical setting in the United States. It took a while to get here and the clinical world that now it’s arrived.

Adam [00:02:54] Yeah, didn’t it start in Japan, I think.

Jeremy [00:02:57] Yeah. People have been placing cuffs on limbs for a long time. But how we currently use it with respect to blood flow restriction and muscle seemingly originated in Japan. The first published paper on it was in 1998, at least how we use it. So it’s been around for a good while. But just to answer your question, what it is, we’re essentially applying a cuff or a wrap to the proximal portion of a limb that we’re gonna train and we inflate it to a pressure that reduces blood flow into the limb.

Adam [00:03:29] So when you say cuff, you’re talking a blood pressure type of cuff.

Jeremy [00:03:32] Yeah, something very similar to that. So we inflate it to a pressure that makes sure that blood flow is going in, but it’s not completely cut off. And when we combine that with low load exercise, we’re able to see changes, at least with muscle growth similar to that of high load exercise. We’re also able to see changes in strength and function. A lot of time, that’s a little bit that the strength combines a little bit less than high load exercise. But again, that goes to what we’ve talked about the previous episode of principal specificity. But it does seem like it has some benefits there and the mechanisms behind it are probably very similar to that of traditional high load exercise. It’s just probably way making that muscle work a lot harder than it normally would with that low load.

Adam [00:04:13] But why is this interesting to do? I mean, do you see it having applications once you if you haven’t figured out already? You know, a good application for this or why we should be doing it?

Jeremy [00:04:23] Yeah, I think a lot of the applications, it’s certainly going to be with elderly people or in a clinical setting. And that’s where a lot of the research is starting to move now. It’s not to say that it can’t work for regular people. It certainly does. That’s the population that my lab primarily studies. But I think it has the biggest benefit in those who may not be able to train with a heavyweight and maybe it’s a kind of a form of exercise that can get them back to doing normal activities. So I think that it does have a lot of utility. But I think there’s a lot of training modalities that have a lot of utility. And I think that this may just be another option for individuals and particularly enticing option for those who are in a clinical setting where they maybe they have an injured limb and they just cannot maintain high levels of stress on that limb, because there is some preliminary data in clinical populations that shows that it’s doing some good things.

Adam [00:05:20] So in other words you’re basically mimicking, by cutting off the blood flow partially, of course, it’s like almost like putting a tourniquet out on an arm or a leg. You’re cutting off the blood flow. And because you you’re cutting off blood flow, you can’t do as much work. You can’t lift as heavy weight. You’re not getting enough of the oxidative. You’re not getting oxygen delivered, as much oxygen delivered. So you’re not going to get as much metabolic action going on in the mitochondria. Therefore, you have to use less weight in order to do any kind of exercise because you have less blood. So it’s mimicking what would happen if you had full circulation with heavier weights, that’s the basic idea behind it?

Jeremy [00:06:07] Yeah, I think that when we reduced blood flow into a muscle, one of the things that it does is it’s reducing blood flow, going into the muscle, but it’s also preventing a lot of blood from leaving the muscle. So all of those metabolites that get produced from muscle contraction, a lot of them are being maintained in or around that muscle. And that might be one of the reasons why it makes the muscle work a lot harder. So the activation has to really increase in order to even do the exercise. When we think about making a muscle get bigger. It really seems like it comes down to having high levels of muscle activation for a sufficient amount of time, because every time we activate a fiber, it’s starting those signaling cascades. With blood flow restriction, we’re getting that same thing. When we maintain those metabolites, it’s making that muscle activate more and more and more and more fibers in order to keep completing that exercise. So, yeah, I know. It’s certainly it’s not going to produce greater benefits than traditional exercise. It just produces them at a lower load.

Adam [00:07:13] Lower load, and maybe more efficiently? I mean, why wouldn’t somebody say, listen, let’s just do the BFR? Because why do I have to spend 20 minutes, half hour, twice a week, three times a week when I can maybe do this less time, less often?

Jeremy [00:07:28] I think that’s something that, you know, that would really come down to a person’s preference, because there’s going to be, of course, some level of discomfort when you apply blood flow restriction. So you have to weigh that with how much training with a high load is discomforting to you.

Adam [00:07:44] So, because, you know, we have people coming into the place saying, you know I’m learning about this BFR training. It sounds really interesting as if they’re saying or believing or thinking that maybe it’s better than what we’re doing now. And maybe, and you use the word modality, but maybe it’s another tool in our tool box to constantly improve our strength and our health.

Jeremy [00:08:09] Yeah. And I think that one of the things that to consider is if you’re routinely training, having a lot of people can do that for a long period of time. But sometimes people, depending on what your workout looks like, sometimes lifting heavy requires a little bit more of mental focus than lifting at a very, very light weight. It’s not to say that lifting a lightweight is easy. It’s by no means easy to do blood flow restriction training. It’s a very good workout. But the amount of mental focus you need to have to lift 30 percent of your max isn’t the same as lifting 80 or 85 percent.

Adam [00:08:44] Well, it certainly sounds less risky, right? It’s less likely to get hurt with a weight that’s 30 percent less of your max as opposed to lifting something close to your max.

Jeremy [00:08:53] Yeah. And I think what you said makes a lot of sense. It’s another option for people when we think about blood flow restriction, I traditionally talk about it as kind of three separate phases. The first one and there’s just a little bit of evidence behind this. Not a lot, but some. Enough that I think it might be worthy to consider in patients who have had ACL surgery, but they can’t do any exercise. There’s some suggestion that applying that cuff is able to slow down the loss of muscle mass as well as function. In other words, you don’t see increases, but you can slow down the loss that you’d have. So if you can’t do anything else, it might be something to think about. Now, there’s not a lot of data on that, certainly, but it’s something to think about.

Adam [00:09:36] For recovery, so you just had ACL surgery and you’re sitting pretty much bed rest for a while. You can’t really lose a limb hardly at all. So do some BFR on that without even lifting weights necessarily, just restrict the blood flow a little bit. Which is really counterintuitive, because you know, there’s a healing process going on. You just had surgery. So don’t you want as much blood to that area as possible?

Jeremy [00:09:57] Yeah. And I think that obviously you always want to be careful with that. But I think the key point with blood flow restriction is that we’re talking about restricting blood flow for minutes. So it’s a very acute reduction in blood flow. We’re not restricting blood flow for hours.

Adam [00:10:13] Gotcha. That’s really interesting. So what do I do, if you have any advice? What do I do as a practitioner with hundreds of clients and they’re asking me about BFR. First of all, is that something that can be learned to do in a clinical setting by trainers? Are there courses on it? Number one. Number two, can people do this on their own if they want to get into it? Do you even recommend that or do you say, you know what? Let’s leave it to the researchers right now. We’ll get back to you on this.

Jeremy [00:10:46] Yeah, I think that applying it to yourself. I think it’s there’s plenty of people who do it. Plenty of people who probably do it correctly. But also, you’re gonna run the risk of people doing it incorrectly. I guess the caveat is, when you’re applying it to yourself in a kind of a local gym setting, you probably don’t have the equipment that a lot of the research is done on. So we’ve done some research on a practical means to do this, you know, trying to apply knee wraps, trying to apply cuffs. But the issue is, you don’t know how much pressure is being applied. So there is data that suggests that people can do that effectively. But obviously, you’ve got to have some degree of caution. Now, if we think about a clinical setting or, you know, a course, there are some courses available through different types of blood flow restriction companies. So obviously with that, you’re always going to be dealing with to some degree, businessmen. But I think that I’ve looked at what some of them have put out and a lot of it seems like its pretty good information. And I know that a lot of people are selling their own cuffs now. So that’s always going to be the case. Anytime you have something that’s very effective. So there are courses that people can take and get certified with some of these different cuffs, differing certifications, maybe better or worse. I’m not too familiar with many of them. I would say one of the more common ones is the Delphi Medical. That’s one that is moved into a lot of clinical settings. That’s a cuff that they can apply. It sets the pressure relative to the person which are all important things. And I know the guy behind that is Johnny Owens.

Adam [00:12:24] Yeah, I looked into that, actually. You have to be a medical professional.

Jeremy [00:12:28] OK.

Adam [00:12:28] In order to buy that from them. So even I because I don’t have a medical degree at the end of my name.

Jeremy [00:12:34] Sure.

Adam [00:12:35] I can’t actually do that. I’d have to have a doctor on premises.

Jeremy [00:12:39] OK. Yeah. I mean, there’s a lot of different ways you can apply blood flow restriction. But I think to your point too, is it comes down to just trying to be intelligent about how it’s applied.

Adam [00:12:50] The reason I looked into the Delphi system is because it can control the pressure, all the other techniques, you really don’t know what kind of pressure you can kind of guesstimate it and stuff like that. And it’s relative to the person. You know, 30 pounds of pressure for me might be perfect, but 30 pounds for somebody else might be too much or too little. And the Delphi machine seems to be able to calculate that. So if I was to do it, I’d want to have something that’s specific because, you know, measuring it is important, obviously.

Jeremy [00:13:16] Yeah, one of the things that you could do. I mean, it’s differing one’s gonna cost a little bit different. But what we use our handheld Dopplers. So we just take a Doppler probe and we just take the pulse, essentially. So that’s no different than what that cuff system is using.

Adam [00:13:34] That’s interesting. Yeah. So yeah, I’ll look into that more as a practitioner. Speaking of that, who would I want to use that for? If somebody came in with, you know, they just came back from rehab, they have you know, they’ve sprained the knee. They have a weak knee. Now they may will do anything on it. Maybe some of that might have chronic fatigue syndrome is that something you’ve considered? People that you know seem to really get too wiped out from conventional exercise because of whatever reason. Have you ever tried BFR with people that seemed to just overtrain conventionally and this is a way of preventing those people from overtraining?

Jeremy [00:14:11] I think all the people that you said might be able to benefit from blood flow restriction. It’s important to note that I myself, I am not a clinician, so I’m just a researcher. I research this, but I don’t work with patients. And I think that’s important to note. So the population that I primarily deal with are normal healthy individuals, but I do know that it has been applied to clinical populations quite favorably. But again, I think it’s it could be useful for really anyone who could benefit from exercise, which is probably a lot of people. But it comes down to is it something that they want to do? Is it something they want to do all the time? You know, it really whatever you can think of applying normal exercise, you could do the same thing with blood flow restriction and maybe more so with people who are in a clinical setting, who are coming back from surgery or don’t maybe want those higher lows right away. Maybe you could use it as a tool to get back to training conventionally. If it’s something like that, that they enjoy doing.

Adam [00:15:14] Yeah. Yeah. My head spinning, but different applications and what could potentially be for. But I think before I jump into this from a business point of view, given that it’s just another alternative and not something that adds, it’s not exactly additive to what we’re doing. I’ll probably hold off on this for a while. Now, are there any risks associated with doing it or doing it the wrong way?

Jeremy [00:15:38] Yeah, we’ve been studying the safety of it and the methodology of it for about 10 years. There’s certainly always going to be risk when you’re doing any form of exercise. So the way I always think about it is. If we were to do exercise without blood flow restriction, does the application of blood flow restriction augment risk over that other group? Because there’s always risk. But the question is, does it increase the risk? So two of the kind of variables that are most worried about is blood clotting and muscle damage. And I think if we look at that literature, particularly blood clotting, it doesn’t seem to increase your risk of blood clots. And that’s important. And of course, there needs to be more data always. Some of that’s been done on healthy people. One study has been done on clinical populations, but it doesn’t seem to increase risk over normal exercise. So the other concern I think individuals have is muscle damage. In other words, when we apply blood flow restriction and we have people exercise, are we causing damage to occur at the actual fiber level. Are we gonna make them necrotic? But I think a lot of that reasoning is coming from studies where we cut off blood flow for hours or even days. So I don’t think that it has a big parallel to what we’re actually doing, where we restrict blood flow for short periods of time. So it doesn’t appear that blood flow restriction is going to augment the risk of muscle damage either. Now, a concern that I have that so far appears to be unfounded, which is good is, what happens to the venous side. In other words, are we causing some sort of long term damage when we’re repeatedly backing blood flow up into the veins? And we’ve looked at this, as have other people. And it doesn’t seem like it’s doing anything negative. So that’s good. My concern was, is that we’re damming blood flow up every single time they come into the gym. And I was just concerned what that would do. Following six or eight weeks or 10 weeks of doing that. But it doesn’t appear to, again, respond in a manner different from that of normal exercise.

Adam [00:17:55] Are you concerned, like some kind of vascular issue to the veins themselves, maybe?

Jeremy [00:17:59] Yeah, I guess I was concerned of almost like having some sort of negative impact on the valves, but it doesn’t seem like it’s doing that, thankfully.

Adam [00:18:08] Yeah, I mean, they’re only doing this for like, how long does a BFR set last?

Jeremy [00:18:14] It really depends on what you’re doing. But for the most part, when we have people exercising, doing a resistance exercise, with blood flow restriction, it’s less than 10 minutes. So to your point. It’s a partial restriction of blood flow for a very short amount of time.

Adam [00:18:31] Yeah. So it doesn’t sound like would probably be too contraindicated or too dangerous.

Jeremy [00:18:35] Right.

Adam [00:18:35] So it’s very interesting. And I’m glad you kind of brought some light to what’s going on with it. I think it’s just at this point for my clients anyway. It’s good information. But, you know, it doesn’t seem like there’s something pressing where we should start incorporating at this point until people like you start doing some more research and get some more findings. And maybe we’ll find over time that there’s a very specific population that this is perfect for, especially since they can’t do anything else. But I think it sounds like we should be leaving it into the rehabilitation sector at this point as opposed to normal people at this point. Normal, healthy people in a personal training setting. Anyway, although it is fun and it does add to variation. You know, people get bored during their workouts and are always looking for something different.

Jeremy [00:19:22] Yeah, and it has. I mean, there is data and people who aren’t in the clinical population. That’s where a lot of the data is coming from, at least initially. So it does work and people who aren’t injured. But to your point, I think if you have concerns over maybe you’re not going to apply it necessarily. Correct, or you’re not sure or you don’t want to take that risk. Now, there’s nothing wrong with just doing good old fashioned normal exercise.

Adam [00:19:46] Yeah, I mean, maybe I’ll do it myself, see how it goes. You know, I’ll be my first guinea pig for sure. All right. Thank you so much, Jeremy. I really appreciate you coming back on. And I know we’re going to be talking again.

Jeremy [00:19:59] Yeah, I know. I appreciate you having me on. And it was always great to talk to you and meet you at the RAC as well.

Adam [00:20:05] Thank you very much. I’ll speak to you soon man.

Jeremy [00:20:06] Sounds good.

Arlene [00:20:09] This has been the Inform Fitness podcast with Adam Zickerman. For over 20 years, Inform Fitness has been providing clients of all ages with customized personal training designed to build strength fast. Visit Informfitness.com for testimonials, blogs and videos on the three pillars. Exercise, nutrition & recovery.