A research proposal for Vascular (blood) Occlusion Training

          It’s been a while since I’ve last posted but some recent discussions have inspired me to share an idea and some old work in hopes that this information may improve knowledge to others unfamiliar and also arouse discussion in the area of performance training. I first came across the topic of blood occlusion training while pursuing a master’s of science in exercise science at Springfield College.   During this period of time, I learned the importance of various hormones and their ability to greatly influence strength. So it was with great interest to learn of a practice that had the potential to impact strength hormones in a positive and appreciable way. In order to appreciate the practice of blood flow occlusion it’s important to first understand the impact of hormones to strength, size and power.
Hormones are responsible for influencing two main factors which have an important role in strength and expression of power. The two factors which are going to be heavily impacted by hormones are cellular metabolic adaptation and cellular remodeling. These factors play a role in hormonal adaptations that increase the capacity to generate force. It is through the process by which muscle cells increase that the body is able to generate greater force.

           It has been widely research and shown that growth hormone represents an important and influential hormone in tissue remodeling and tissue development.  Growth Hormone, a polypeptide hormone, secreted and released by the anterior pituitary gland exerts many of it’s effects directly and through the release of small polypeptides called insulin growth factors.  Through resistance training, growth hormone enhances cellular amino acid uptake and protein synthesis in skeletal muscle, resulting in hypertrophy of both type 1 and type II muscle fibers. These muscle fibers play an integral role in athletic performance from endurance activity to explosive activity.  Growth of these muscle types is important to the improvement of athletic performance.

Researchers have demonstrated that an exercise protocol of 10 repetitions at moderate intensity completed with short (1- min) rest periods produced greater lactate values and higher GH responses ( Kraemer et Al., 1990). In response to this research the American College of Sport medicine recommends resistance training at moderate to high loads (70- 85% of one repetition maximum) using multiple sets of 8 – 12 repetitions with short rest periods ( 1 – 2 min) two to three times per week.  These methods are now commonly accepted within the strength and conditioning community as an effective protocol for increasing the potential for muscle repair and remodeling.

Researchers at Yokohama medical center in Japan have demonstrated effective methods of increasing the presence of growth hormone within the body.  With the use of new methodologies these researchers have reported GH increases of up to 290 times baseline values. Increases in GH levels may lead to increases in tissue repair, amino acid uptake and greater metabolic adaptations. As recovery becomes more important between athletic competitions there is a greater demand to explore ways for effective and efficient repair and remodeling of muscles involved in stressful activity.

As  a strength and conditioning coach, finding efficient and effect methods of improving athletic potential is of great importance; particularly, the methods which lead to muscle recovery and the processes that result in an increase in protein contractile unit and thus improvement in factors that lead to athletic performance.  Researchers have investigated and demonstrated many protocols for improving muscle recovery through increases of growth hormone endogenously. Vascular occlusion resistance training is a widely researched topic and accepted method of eliciting growth hormone responses within the body. It generally involves the use of blood pressure cuffs and a form of light resistance training. Vascular Occlusion Training has been shown to cause the activation of a sufficient number of fast twitch fibers (fibers largely responsible in sprint, power activities) at low intensities.  Vascular occlusion training has also shown an increase in muscular fiber cross sectional area and induced significant GH responses as compared with exercises at the same intensity without occlusion.  It should be noted that recently the Houston Texans athletic training staff presented work detailing their use of blood flow occlusion as a method of recovery for athletes incurring injury.

This particular protocol of blood flow occlusion training  is both comprehensive and feasible to complete with the resources available in most research labs. Further investigation of the effect of resistance training under blood flow restriction can lead to greater understanding of resistance training and growth hormone. This in turn can have a tremendous impact on the way athletes train and recover. Athletes participating in multiple competitions during a short duration or preparing for competition may see greater improvement in performance and a decrease in stress related injuries from this research.

The purpose of this study will help investigate provide greater information on if and how blood flow occlusion techniques can be effectively used in strength and conditioning programs.  Furthermore we will be able to demonstrate whether blood flow occlusion presents any greater effect to improving performance factors when combined with a traditional periodization strength training model.  Researchers have shown in numerous studies that daily activities such as walking and stepping with vascular occlusion to be more effective then performing those activities alone thus improving the effectiveness of exercise in using vascular occlusion methods.

Before we get into this particular research proposal it is important to understand a few key terms.  Vascular occlusion  or Blood flow Restriction is defined as a process which uses blood pressure cuff  pressurized anywhere from 50 – 200 millimeter of mercury to  restrict the venous return of blood flow from the muscle.   It is often used at low intensities (categorized as 10 -30% of 1RM).  The term periodization is define as the systematic planning of athletic or physical training which involves progressive cycling of various aspects of a training program during a specific period.

A study involving eight college males and eleven college female students’ subjects who were not engaged in any regular heavy resistance showed improvements in factors such as muscle strength and endurance. In this study a manual blood pressure cuff was placed around the thigh one inch above the subject’s knee. The cuff was inflated to the midpoint pressure to restrict blood flow to the muscles distal to the cuff. Subjects used a 12 inch bench during the stepping exercise after which, the cuff was deflated and removed.  Subjects complete 15 sessions with three training sessions per week.  Training sessions consisted of two sets of 100 steps at a rate of 20 steps per minute. At the end of 5 week training period, muscle mass, muscular strength and muscular endurance were measured and compared between non-occluded leg and occluded leg for each subject.  Muscular strength of the occluded leg was shown to be significantly increased over the nonoccludded leg. This research clearly shows a benefit for untrained populations but what about untrained individuals?

One of the key features of the blood vascular occlusion is the low level of intensity needed to produce positive effects. This feature can be beneficial for populations who cannot tolerate high levels of intensity as well as individuals who are looking to maximize recovery during periods of low intensity.

During linear periodization programs it is common for athletes to go through a download phase or a period in which athletes significantly lower training intensity and/ or volume in efforts to promote greater recovery, strength and to limit the potential for overtraining.  Introducing the practice of blood occlusion to periods of low intensity training can potentially magnify the recovery response as well as improve potential for increased muscle strength and size. Researchers at the University of Tokyo demonstrated low-intensity resistance exercise can increase muscular size and strength when combined with resistance exercise with blood flow restriction. In addition, a study performed by Takashi Abe , Charles F. Kearns  and Yoshiaki Sato demonstrated that serum growth hormone levels were elevated after a low intensity walk exercise.  While there have been documented cases of improved strength, increased cross sectional area of muscle and improved growth hormone serum levels post exercise, there still remains limited research on the effects of vascular occlusion in a planned periodized program.

Many researchers have demonstrated positive results in the effects of blood flow occlusion, however questions still remain.  In particular, what are the effects of a blood flow occlusion protocol combined with a periodized training program to muscle strength, size and growth hormone response in highly trained athletes ?  How do performance factors (particularly muscle strength, size and growth hormone levels) respond over a 12 week period when using a combined periodized strength training program and blood flow occlusion protocol during a download week.  How does this response compare to the response in performance factors when using a blood flow occlusion protocol alone or a periodized training program alone?

The participants of this study will comprise of 40 collegiate football players between the ages of 18 – 23 selected from a population of 100 collegiate football players of the University at Buffalo football program. It is common for football programs to hold a roster of 100 athletes.  To select individuals I will use a stratified random selection. The various individuals will be selected out of the 100 players and randomly stratified into the following groups. 10 individuals will be randomly selected for each group.

  1. Group 1 – Athletes less than or equal to 225 and pounds and under 6 foot 2
  2. Group 2 – Athletes less than or equal to  225 pounds and above 6 foot 2
  3. Group 3 – Athletes more than or equal to 225 pounds and under 6 foot 2
  4. Group 4 – Athletes more than or equal to 225 pounds and above 6 foot 2

To recruit subjects I will compile the active roster list of the affiliate University at Buffalo football program and arrange individuals on the roster based on weight and size.  From these groups, 10 individuals will be randomly selected to participate in the experimental study.

The study is a randomized pre – test, posttest experimental design with a control group. To assign subjects to groups I will use a stratified random assignment. I will arrange individuals in this study based on factors such as weight and height.

  1. Group 1 will be athletes less than 225 and pounds and under 6 foot 2
    1. 5 athletes will be included in Experimental Group
    2. 5 athlete will be included in the Control Group
  2. Group 2 will be athletes less than 225 pounds and above 6 foot 2
    1. 5 athletes will be included in Experimental Group
    2. 5 athlete will be included in the Control Group
  3. Group 3 will be athletes more than 225 pounds and under 6 foot 2
    1. 5 athletes will be included in Experimental Group
    2. 5 athlete will be included in the Control Group
  4. Group 4 will be athletes less than 225 pounds and above 6 foot 2
    1. 5 athletes will be included in Experimental Group
    2. 5 athlete will be included in the Control Group

It is important to me that the subjects in the control group and experimental groups are similar.

A pre – test, post – test control group will be used in the study.  During the pre – test and posttest individuals will be measured in the following ways

  • Muscle strength
    • Maximum voluntary Isometric leg press to measure leg strength will be determined using a biodex system isometric leg press.
    • Maximum voluntary isokinetic strength of the knee extensors and flexors was determined using a Biodex System 3 dynamometer (Biodex Medical Systems, Shirley, NY)
  • Muscle cross – sectional area.
    • MRI or Magnetic Resonance Imaging Device to determine Cross sectional size designed by General Electric Yokogawa Signa 0.2-T scanner (GE Yokogawa, Tokyo, Japan)
  • Blood Samples were taken
  • All individuals will first participate in a practice test to familiarize themselves with strength equipment a week prior to pre – test.
    • Venous blood samples (20 ml for each point of measurement) will be obtained from the subjects seated in a slightly reclined position through an indwelling cannula in a superficial arm vein.
    • All of the blood sampling will be conducted at the same time of the day to limit the effects of any diurnal variations on the hormonal concentrations. A resting blood sample was obtained after a 20-min equilibration period. The exercise session started 5 min after the resting blood sample was drawn. After the exercise sessions, the occlusion was released and blood samples were obtained at 0 (immediately after exercise), 15, 45, and 90 min, and at 24 h. All blood samples were processed and stored at 220°C until analysis.
    • Prior to all testing subjects will be ask to refrain from ingesting alcohol and caffeine for 24 h and performing any strenuous exercise for 48 h prior to  the experimental exercise session.
  • Within 1 week individuals will then begin treatment or the intervention program.
    • The experimental group will participate in lower body exercises twice a week with a blood occlusion protocol occurring every 4 weeks within a 12 week program in addition to low intensity exercise.
      • Vascular occlusion during low intensity exercise will take place during week 4, 8, 12
    • The control group will continue participate in lower body exercises twice a week with only low intensity exercises ( 20% of 1 RM) taking place during the 4th week
      • Low intensity exercise will take place during week 4, 8, 12

The instruments that will be used for the blood occlusion protocol is explained as follows.

  1. Blood pressure mounted cuff for the upper thigh Participants in the BFR-Walk group wore elastic cuffs (5 cm wide) (Kaatsu-Master system; Sato Sports Plaza, Tokyo, Japan)
  2. Blood sampling will occur during pre – test or week 0, week 4, week 8 and week 13 or Post – Test. Sampling will occur immediately post – exercise session within 15 minutes and within 45 minutes of exercise.  To control for diurnal changes in growth hormone, measurements will take place at the same time on the first day of the week.

In regard to the ethical considerations we must review the purpose of this study. The purpose of this study is to observe the effects of a periodized resistance training program combined with vascular occlusion during periods of low intensity exercise on muscular strength, cross – sectional area and growth hormone levels in collegiate football players. The benefits of this study will be wide ranging from providing greater perspective to training during low intensity exercise for individuals suffering from injury and also providing greater perspective to promoting muscle development  through  neuromuscular changes and hormonal changes thereby maximizing recovery.

Participation within this study is completely voluntary.  The study will be advertised through a presentation offered during a regular scheduled team meeting as well as through advertisements in several hot spot areas along the facility.

During this presentation, all potential participants will be explained  the subject of the study , guidelines for participations and will be explained consent.  All Individuals will be notified  that participation within the study is completely voluntary.  There will be no reward for participation nor will there by any penalty for not participating.

Individuals will be explained that all information received during the study ( including blood work, strength values, muscle size) will be confidential.  Indivdiuals will also be presented the risks as well as benefits to participating within the study.  For instance, subjects may experience mild to moderate pressure along several areas of the lower body as a result of the blood pressure cuff. Individuals may also experience mild discomfort during drawing procedures for venous blood samples.  In addition, individuals will also experience the common risks associated with exercise. These risks can include injury and/or trauma.

All information provided by the subject will be entered into an encrypted database. Participants within this study will not be identified by name but through  the use of a number system to limit risk of breach of confidentiality.

It is important to consider ethical considerations as it relates to justice or the equitable distribution of research costs and benefits.  The benefits and risks of this study will be assessed, clearly delineated for all participants and distributed equally.   It should be noted that the potential risk of the study include but are not limited to

  • Strong mechanical stress associated with high intensity exercise
  • Injury associated with a strength and conditioning program
  • Potential discomfort, infection or a risk of pulmonary embolism with blood drawing.

Benefits include but are not limited to the following

  1. Improvement in physiological factors related to performance such as strength, size.

2. All measures to protect and demonstrate the welfare of the subjects should will clearly delineated and explained.

In regard for respect for persons, our research will respect and protect the right and dignity of participants. Collegiate students who are interested in participating will receive full disclosure of the nature of the study , the risks and benefits as well as an extended opportunity to ask questions prior to being selected for the study.  Any information provided is confidential. Individuals will be notified verbally and in writing that they have a right to leave the study at any time.

In regard for beneficence, our research will provide a positive contribution to those affected by it.  It should be noted that all participants who volunteer for the study will receive a medical screen and clearance prior to participating within the study. Individuals will also participate within a 12 week strength and conditioning program designed to improve strength, power and muscular size under the supervision, care and attention of strength and conditioning and athletic training department.


List of Works Cited

Baechle, T. (2000). Essentials of strength training and conditioning (2nd ed.). Champaign, IL: Human Kinetics.

Cook, S., Clark, B., & Ploutz-Snyder, L. (2007). Effects of Exercise Load and Blood-Flow Restriction on Skeletal Muscle Function. Medicine & Science in Sports & Exercise, 39(10), 1708-1713.

Kearns, C., Abe, T., & Sato, Y. (2006). Muscle Size And Strength Are Increased Following Walktraining Combined With Restriction Of Leg Muscle Blood Flow (kaatsu). Medicine & Science in Sports & Exercise, 100(5), 1460-1466.

Madarame, H., Neya, M., Ochi, E., Nakazato, K., Sato, Y., & Ishii, N. (2008). Cross-Transfer Effects of Resistance Training with Blood Flow Restriction. Medicine & Science in Sports & Exercise, 40(2), 258-263./

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