Landmark study on “practical” BFR training that helped establish the perceived pressure tightness scale

Key Takeaways

This study helped establish a few key elements in how many of us use blood flow restriction training today.

  • It was the first study that really looked at the efficacy of “practical” BFR training – using common and affordable wraps we all have access to rather than expensive pneumatic systems that were previously used in research on this topic. This study helped establish that practical BFR training was just as effective as using a high end KAATSU system – the principles were the same. 
  • This study helped establish the “perceived tightness scale” because before this cuff tightness had been computer monitored with expensive equipment – they used a 0-10 scale and found 7 to be the most effective tightness. 
  • The 30 -15 -15 -15 rep scheme used here has sort of become the standard protocol in occlusion training


This 2013 study conducted by Jeremy Loenneke and colleagues was sort of a landmark study because it looked at “practical” blood flow restriction training like most of us in the United States use today. 12 college-aged males between the ages of 18-24 (or as they say in the scientific literature, 21 ± 3 years) volunteered to participate in a blood flow restriction experiment. These men had at least 1 year of resistance training experience.

There were 5 total training sessions that were conducted over a 3 week period, with 72 hours of rest between each session. The experiment required the participants to perform the leg press exercise with a very low load; 30% of their 1-repetition maximum (1RM) for 4 sets of 30, 15, 15, and 15 reps respectively for each set. The subjects were allowed 30 seconds of rest between sets, which is quite a short rest period. 

Before the subjects began the exercise program, ultrasound (commonly used to determine an infant’s sex during pregnancy, but used in the exercise science field to measure muscle thickness and blood flow) was used to assess blood flow before the study began. When wrapping the tourniquet around the thighs, subjects were instructed to give a “tightness rating” from 1-10. 3 groups were created from these levels of tightness, tightness levels of 1, 7, and 10 were used, being practically referred to as control, moderate, and complete blood flow restriction respectively.

Muscle thickness of the outer thigh (vastus lateralis) and blood lactate were measured after the removal of the wrap, while muscle thickness, vertical power, and soreness were measured 24 hours later.

No changes in any variables were shown in the control (1 out of 10 pressure) condition. It was shown that a tightness of 7 out of 10 produced the best results. Greater changes in muscle thickness and muscle activation were seen in this group. This was the optimal group as it completely cut off blood flow to the veins, but not the arteries, which is the goal when performing this type of training. The 10 out of 10 tightness group completely cut off arterial blood flow, increasing the risk of injury and vascular issues. 


What we can take away from this study is that a moderate level of tightness, with the level being subjectively determined by the trainee, is the best way to perform this kind of training. It gives us some empirical data behind a recommended perceived tightness of 7 out of 10 which was valuable in practical blood flow restriction training where we can’t rely on pulse oximeters or computer aided tightness gauges like those used in KAATSU training systems.

Wilson, J. M., Lowery, R. P., Joy, J. M., Loenneke, J. P., & Naimo, M. A. (2013). Practical Blood Flow Restriction Training Increases Acute Determinants of Hypertrophy Without Increasing Indices of Muscle Damage. Journal of Strength and Conditioning Research, 27(11), 3068-3075. doi:10.1519/jsc.0b013e31828a1ffa

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