Blood flow restriction: an evidence based progressive model (Review).

To remain independent and healthy, an important factor to consider is the maintenance of skeletal muscle mass. Inactivity leads to measurable changes in muscle and bone, reduces exercise capacity, impairs the immune system, and decreases the sensitivity to insulin. Therefore, maintaining physical activity is of great importance for skeletal muscle health. One form of structured physical activity is resistance training. Generally speaking, one needs to lift weights at approximately 70% of their one repetition maximum (1RM) to have noticeable increases in muscle size and strength. Although numerous positive effects are observed from heavy resistance training, some at risk populations (e.g. elderly, rehabilitating patients, etc.) might be advised not to perform high-load resistance training and may be limited to performance of low-load resistance exercise. A technique which applies pressure cuffs to the limbs causing blood flow restriction (BFR) has been shown to attenuate atrophy and when combined with low intensity exercise has resulted in an increase in both muscle size and strength across different age groups. We have provided an evidence based model of progression from bed rest to higher load resistance training, based largely on BFR literature concentrating on more at risk populations, to highlight a possible path to recovery.