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Zac Dunkle Prezi Part 2

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johnny owens

on 8 December 2018

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Transcript of Zac Dunkle Prezi Part 2

Absolute and relative VO2max increased in the BFR-training group by 6.4% (p < 0.05) but did not change in the CON-training group.

Additionally, an increase in exercise time until exhaustion was observed in the BFR- training group (15.4%, p < 0.01) but not in the CON- training group.
BFR vs Non-BFR

10 minutes at 30% (Peak) 2 weeks

16 minutes last 2 weeks

Recently a study reported increases in VO2max after 2 weeks of 2x/day walking. (Park 2010)

The study involved highly trained athletes, college basketball players, who walked for 3 minutes with both legs under BFR for 5 sets with a 1 minute rest between sets.

The overall improvement in VO2max was 11.6% for the BFR group, controls did not exhibit a statistically significant improvement.

The authors concluded that BFR walk training may be used as a low intensity alternative for athletes to maintain or improve endurance.
Ozaki et al demonstrated that elderly adults who walked for 20 minutes 4 days a week
for 10 weeks at a low intensity (45% heart rate reserve) increased their maximum knee joint strength (15%) and thigh muscle CSA (3%) under BFR conditions.

The control group did not demonstrate significant changes.

Similarly, in the Journal of Geriatric Physical Therapy Abe et al demonstrated in older adults that walking 5 days a week for 20 minutes at a normal walking pace over 6 weeks.

At the conclusion of the study only the BFR group demonstrated improvements in knee strength 7% and 16% (extension and flexion) and muscle cross sectional area increased 5.8% for the thigh and 5.1% for the lower leg.

This confirmed previous work by this group published in the Journal of Physiology that demonstrated a significant increase in knee strength, thigh CSA and growth hormone response after walking with BFR.

Similarly to the previous studies the control group did not demonstrate changes. (Abe 2006)
It should be pointed out that although growth hormone increased in the walking with BFR group it peaked out at
13 ng/ml
this is well below previous reported levels reported with BFR after exercise which reach
40 ng/ml and higher
. (Takarada 2000)
BFR increases O2 demand (Ozaki 2010, Takano 2005)
Pre and post testing:
Incremental test (2 minutes)
110% (Ppeak)

BFR cycling group improved their time to exhaustion by 53% (Pre: 227 ± 44s vs. Post: 338 ± 76s)

Control did not (Pre: 236 ± 24s vs. Post: 212 ± 26s).
40% VO2 3x wk 8 wks
Abe et al 2010
15 minutes
45 minutes
The magnitude of change in VO2max increases as exercise intensity increases from 50-100% of VO2max. (Gaesser 1984, Wenger 1986)
The minimum stimulus thought to be needed for change is
50% VO2max
and the
lower the
stimulus the longer the duration of exercise needed (>35 minutes)
and longer duration may be more effective than short duration at higher intensities. (Wenger 1986)
From the maximum HR the authors were able to average the intensity of the BFR group
to be 59% VO2max which is within the effective training window for aerobic adaptations.
Sundberg et al 1994
Knee Strength
Abe et al investigated the effects of low load (20% 1RM) squat and leg curl exercises with and without BFR on thigh and gluteus muscle volume and strength. (Abe 2005)


Yasuda et al investigated the effects of low load (30% 1RM) bench press training with and without BFR on strength and muscle CSA.

The muscles measured using MRI for volume size were the pectorals and triceps.

They utilized the standard 30/15/15/15 protocol and performed exercises 2x day (separated by 4 hours) for 6 days over 2 weeks (12 sessions).
More evidence to support the systemic response to proximal strength was provided by Cook et al. (Cook 2014)

In their study semi-professional rugby players exercised for 3 weeks performing squats, bench press, and weighted pull-ups at 70 % 1 RM.

The players were divided into 2 groups, 1 group wore tourniquets on bilateral lower extremities during the entire session while the control group exercised at free flow.

At the conclusion of the training block the BFR subjects demonstrated significant improvements in squat and bench 1RM as well as sprint time and counter-jump movement.
20% squat
20% squat
No Curl
No Curl

3xwk x 4wks 25%1RM
Increased iEMG in pecs vs controls Yasuda 2006
Our data demonstrate that
bilateral lower-limb BFR
training was more beneficial than traditional resistance
training in terms of increasing strength, power, and speed
measures in trained male athletes over a relatively
3-week training block. These results are suggestive of an
advantage of combining occlusion with moderate resistance
loads (70% 1-RM) in eliciting strength and power
gains during an intense training phase or potentially
within a competitive season.
Testosterone ES BFR=large to very large (ES 1,50-2,19) in comparison with moderate increases in response to nonoccluded training (ES 0,73-1,19),
Lower Extremity

Walking, Cycling, Isometrics, Leg Extension, Hamstring Curl, Straight Leg Raises, Short Arc Quad, Terminal Knee Extension, Hip Abd/Clam, Hip Extension, Hip Adduction, Hip External/Internal Rotation, Bridge, Hip Thruster, Leg Press, Hack Squat, Squat, Split Squat, Lunge, Ankle Dorsiflexion, Plantarflexion, Inversion, Eversion and all Foot Exercises
Upper Body

Upper Body Ergometer, UBE, Isometrics, Scapular Rows, Serratus Punches, Shoulder Abduction, Shoulder Scaption, Shoulder Extension, Shoulder Adduction, Shoulder External Rotation, Shoulder Internal Rotation, Prone T, Prone Y, Prone I, PNF Patterns, Bench Press, Push-up, Elbow Flexion, Elbow Extension, Elbow Supination, Elbow Pronation, Wrist Flexion, Wrist Extension, Flexion, Abduction, Adduction and all Hand Gripping Exercises.
No Hypertrophy Gains
The Problem With Endurance
Blood Flow Restriction Rehabilitation
Downstream Fatigue
Systemic Response
Distal or Proximal muscles may be able to handle more load. Less fatigue under the cuff.
Back Flow Effect
Endurance Protocols

Primarily Bilateral
Total of 15-20 minutes either steady state or intervals
2-5x week
Increase frequency if decreasing number of weeks
UE and LE
Can incorporate other endurance modalities (StairMaster, Recumbent, Elliptical)

Cell Swelling
Metabolite Build-Up
Back in the Game/Fight
Min to no load
Increased frequency (Daily)
Can add NMES
Low intensity
15-20 min either constant or interval
Increase frequency based on total duration
2-3x week
20-30% 1RM
1) Blood Flow Restriction and exercise has demonstrated improved strength, endurance and hypertrophy changes?
A) True
B) False

2) BFR exercise at low loads can significantly increase lactate production within the muscle?
A) True
B) False

3) As lactate accumulates muscle activity (iEMG) goes down?
A) True
B) False

4) Growth hormones main role is most likely?
A) Performance improvement
B) Increased endurance capacity
C) Mitochondrial synthesis
D) Collagen synthesis

4B) And how would you maximize the GH response with BFR?
5) The way to maximize muscle hypertrophy and potentially heal damaged muscle is through up-regulation of IGF-1.
A. True
B. False

6) In order to allow for muscle growth to occur, Myostatin has to be down-regulated.
A. True
B. False

6B) What else does Myostatin play a role in?
7) The pathway associated with muscle protein synthesis is?
A) Muscle protein alpha 1 (MPA1)
B) Mammalian target of rapamycin complex 1 (MTORC1)
C) Muscle tension of rapid protein 1 (MTORP1)
D) Krebs

7B) Muscle atrophy and loss of strength after injury is most likely due to ___________.
A. Decreased protein synthesis
B. Loss of cross sectional area
C. Decreased activity
D. All of the above (Anabolic Resistance)
8) The best source of net amino acids post workout is?
A) Soy
B) Rice
C) Dairy (Whey)
D) Hemp
9) The prevailing hypothesis behind BFR without exercise is?
A) Cell rupture
B) Mechanical tension
C) Metabolite build up
D) Cell swelling
9B) In what phase of rehab would this be applied and how would you maximize the response?
10) The pressure exerted on the bone through BFR is known as interstitial fluid flow (IFF), this increased pressure can?
A) Reduce bone density
B) Increase bone density
C) Result in osteoporosis
D) Is the same as Wolf’s law
11) What other factors can potentially help with bone healing?
12) BFR and exercise corresponds to muscle damage greater than you would see with traditional high load training?
A) True
B) False
13) Stroke volume is decreased with the application of BFR. What will be increased to maintain cardiac output?
A) Increase heart rate
B) Decrease heart rate
C) Reduce blood pressure
D) Vasoconstriction
14) BFR training has demonstrated positive changes after knee arthroscopy, anterior cruciate reconstruction surgery, inflammatory myopathies and subjects at risk for knee OA.
A) True
B) False

15) The rest period shown to have the greatest effect size is?
A) 30 seconds
B) 60 seconds
C) 10 seconds
D) 2 Minutes

16) The recommended pressure to begin with for the lower extremities is?
A) 80%
B) 50%
C) 25%
D) 100%

17) The recommended pressure to begin with for the upper extremities is?
A) 80%
B) 50%
C) 25%
D) 100%

18) The recommended training load for BFR is 20-30% of 1RM?
A) True
B) False

19) If the patient does not get to the last set of 15 reps you should decrease the volume of work at the next session?
A) True
B) False

20) If the patient reports that the pressure from the cuff is painful you should?
A) Decrease the pressure
B) Increase the pressure
C) Move the cuff lower
D) Decrease the volume

21) The standard repetition scheme for BFR and exercise is?
A) 3x10
B) 4 sets of 80% 1RM
C) 30/15/15/15

22) When measuring LOP the patient should be?
A) Supine
B) Sitting
C) Standing
D) Prone

23) LOP accounts for variables such as:
A) Cuff Application Method, Limb Circumference and Shape and Systolic Blood Pressure
B) Cuff Application Method, Limb Circumference and Shape and Height and Weight
C) Heart Rate and Blood Pressure
D) Bone Density

24) Target active work time with BFR and endurance should be ___________?
A. 5-10 minutes
B. 15-20 minutes
C. 30-45 minutes
D. 1 hour

20 min walk
3x week x 5 weeks
Start 1% grade increased 1% every 4 minutes up to 5%

VO2 (p=.034)

1.5 mile run time (p=.024)

CSA thigh (p=.016)
BFR for Performance
In addition to regular off-season workouts, 32 football players were randomized to BFR (16) or LI free flow and performed 4 sets of squats and bench press at 20% 1RM 3 days/week for 4 weeks
Yamanaka et al, 2012
72 Div II football players were assigned to 1 of 4 resistance training protocols for 7 weeks. All groups performed same ancillary lifts.

Squat and bench 65-90% 1RM

HIT supplemental: same as HIT with 4 additional sets (1x30, 3x20) of squats and bench press

HIT with supplemental with BFR:
Supplemental lifts performed with BFR

Modified supplemental with BFR:
No HIT squats or bench press performed, performed supplemental with BFR

Luebbers et al, 2014
20 male semi professional rugby players participated in a 3 week cross over training protocol

HIT: Squat, bench press and weighted pull up for 5x5 at 70%

BFR: Same protocol as HIT but with bilateral tourniquets worn on the LE. Cuff was only inflated during the exercise
Cook et al, 2014
15 male collegiate athletes were divided into just sprint training or sprint training with BFR resistance exercises for 8 consecutive days

Exercises consisted of 3x15 squats and leg curl at 20% 1RM
Strength significantly improved 9.6% in the BFR group and non significantly (4.8%) in the traditional group while CSA significantly increased (4.5%) in the BFR group while decreasing 1% in the traditional group
Abe et al, 2005
20 year old with 5 years of sprint training and 1 year of traditional resistance training

Training consisted of 12 visits (3x/week for 4 weeks) performing 4 bouts of 5 minutes at 40% max aerobic speed (5.2 km/hr) with 1 min rest for reperfusion between bouts
Adding BFR to Paralympic Training
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