Blood Flow Restriction At Tokyo Olympics 2020: Popular Fitness Trend Among Olympians

Tokyo Olympics 2020 kicked off on 23 July 2021, delayed by a year due to the COVID-19 pandemic. As of now, India finished at 48th with 7 medals. Among the news of wins and failures, another trend that received major attention during the Tokyo Olympics 2020 is the often weird and amusing fitness trends Olympians follow.

In Tokyo Olympics 2020, the latest training or recovery method the athletes have taken up after the 2016 'cupping' is a tourniquet. What is a tourniquet? It is a device used to apply pressure to a limb or extremity to limit but not stop the flow of blood [1].

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The tourniquets got media attention when it was worn by the American swimmer Michael Andrew, Galen Rupp, the defending bronze medallist in the marathon and several other athletes who strapped tourniquet-like bands during practice and training.

What Is Blood Flow Restriction Training?

Blood Flow Restriction (BFR) training is a technique that combines low-intensity exercise with blood flow occlusion (blockage) that produces similar results to high-intensity training [2]. BFR training was initially developed in the 1960s in Japan and is known as Kaatsu training.

BFR training aims to mimic the effects of high-intensity exercise by recreating a hypoxic environment (reduce oxygen environment) using a cuff. A wide cuff is preferred in the correct application of BFR. 10-12cm cuffs are generally used. BFR cuffs can be made from either elastic or nylon.

BFR workouts involve periods of exercise and rest. During the exercise period, the blood is rapidly circulated from the heart to limbs through arteries, and back to the heart through veins. During the periods of rest, the muscle cells can recover, but it is important with elastic BFR that the bands be left on and inflated during these periods of rest to enhance the benefits.

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How Does Blood Flow Restriction Training Work?

BFR training involves the application of a tourniquet to the muscle that is being trained and can be applied to either the upper or lower limb. The cuff is then inflated to a specific pressure, aiming to obtain a partial arterial and complete venous (of the veins) occlusion.

Then, the athlete performs resistance exercises at a low intensity of 20-30 per cent of 1 repetition max, with high repetitions per set (15-30) and short rest intervals between sets (30 seconds) [3][4].

When restricting blood flow to increase or maintain muscle fitness, the aim is to reduce the amount of arterial flow into the limb and restrict the venous flow out of the limb. It has been shown to benefit skeletal muscle size and strength and beneficial effects on vascular and bone tissue [5].

BFR training allows the body to experience periods of rapid blood circulation where oxygen is flowing throughout the entire circulatory system, causing a lack of oxygen in the limbs. The decreased oxygen levels that the body experiences are temporary, safe and essential for BFR to work.

BFR training promotes the brain to respond by releasing growth hormone, which helps with muscle cell reproduction, muscle cell regeneration, and lipolysis (fat breakdown); and stimulates the release of insulin-like growth factor-1, which is important for muscular hypertrophy, muscle and bone growth, and regulation of DNA.

BFR training can also be used in clinical settings, where an individual cannot perform high-intensity exercises because of the stage of their health condition or pathology involved.

How Is Blood Flow Restriction Training Beneficial For Athletes?

BFR training help stimulate size and strength while avoiding the mechanical stress associated with traditional high-load resistance training [6]. Studies show that positive adaptations occur while restricting blood flow during low-intensity aerobic exercise and can be a great fitness technique as it allows the athletes to reap the benefits of an intense heavy weight-lifting session while only requiring to perform low-to moderate-intensity training.

In image: A tourniquet [Wikipedia]

BFR training also reduces stress to tissues that may be healing from a recent injury or surgery [7]. During BFR training, an athlete performs high repetitions of a particular exercise while wearing a band or cuff around their upper arm or upper leg with the use of light resistance.

Below mentioned are the benefits of BFR training, especially for athletes:

1. Improved muscular strength
2. Increased muscular cross-sectional area
3. Prevention of muscular atrophy
4. Development of newer and healthier blood vessels
5. Decreased risk of cardiovascular disease
6. Improved bone mineral density.

Moreover, the exercise prescription for BFR varies; this is dependent on whether it is being applied during resistance training (BFR-RE), aerobic training (BFR-AE) or passively without exercise (P-BFR) [8].

What Are The Side Effects Of Blood Flow Restriction Training?

• Athletes and bodybuilders also use simple equipment such as surgical tubing or elastic straps instead of a cuff. However, fitness experts say warn against these as you are unable to monitor the amount of blood flow occlusion and can cause tissue damage [9].
• People who are the risk of a poor circulatory system, obesity, diabetes, arterial calcification, sickle cell trait, severe hypertension, or renal compromise should avoid BFR training.
• BFR training should be avoided in case of venous thromboembolism, peripheral vascular compromise, sickle cell anaemia, extremity infection, lymphadenectomy, cancer or tumour, extremity with dialysis access, acidosis, open fracture, increased intracranial pressure vascular grafts, or medications known to increase clotting risk [10].
• In some cases, it may contribute to the formation of venous thromboembolism (deep vein thrombosis and pulmonary embolism) and muscle damage.

Along with these side effects or possible risks, the risk of tourniquet complication is also there, though it is low. Some of the common complications are as follows:

• Nerve injury
• Skin injury
• Tourniquet pain
• Chemical burns
• Respiratory, cardiovascular, cerebral circulatory and haematological effects caused by prolonged ischemia
• Temperature changes.

On A Final Note...

Blood Flow Restriction training is becoming an emerging fitness trend among athletes, and the Tokyo Olympics 2020 is a prime example of that. However, experts say that continued research is needed to establish parameters for the safe application of BFR training prior to widespread adoption of the same.

Susan JenniferPhysiotherapist

Masters in Physiotherapy

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