Journal of Sports Science and Medicine
Journal of Sports Science and Medicine
ISSN: 1303 - 2968   
Ios-APP Journal of Sports Science and Medicine
Androit-APP Journal of Sports Science and Medicine
©Journal of Sports Science and Medicine (2024) 23, 326 - 341   DOI:

Research article
Low-load Resistance Exercise with Perceptually Primed Practical Blood Flow Restriction Induces Similar Motor Performance Fatigue, Physiological Changes, and Perceptual Responses Compared to Traditional Blood Flow Restriction in Males and Females
Robert Bielitzki1, , Tom Behrendt1, Martin Behrens2, Victoria Malczewski1, Thomas Mittlmeier3, Lutz Schega1
Author Information
1 Department of Sport Science, Institute III, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
2 University of Applied Sciences for Sport and Management Potsdam, Potsdam, Germany
3 Department of Traumatology, Hand- and Reconstructive Surgery, Rostock University Medical Center, Rostock, Germany

Robert Bielitzki
✉ Department of Sport Science, Institute III, Otto-von-Guericke University Magdeburg, 39104 Magdeburg, Germany
Publish Date
Received: 23-09-2023
Accepted: 11-04-2024
Published (online): 01-06-2024

In the recent past, practical blood flow restriction (pBFR) using non-pneumatic, usually elastic cuffs has been established as a cost-effective alternative to traditional blood flow restriction (BFR) using pneumatic cuffs, especially for training in large groups. This study investigated whether low-load resistance exercise with perceptually primed pBFR using an elastic knee wrap is suitable to induce similar motor performance fatigue as well as physiological and perceptual responses compared to traditional BFR using a pneumatic nylon cuff in males and females. In a randomized, counterbalanced cross-over study, 30 healthy subjects performed 4 sets (30-15-15-15 repetitions) of unilateral knee extensions at 20% of their one-repetition-maximum. In the pBFR condition, each individual was perceptually primed to a BFR pressure corresponding to 60% of their arterial occlusion pressure. Before and after exercise, maximal voluntary torque, maximal muscle activity, and cuff pressure-induced discomfort were assessed. Moreover, physiological (i.e., muscle activity, muscle oxygenation) and perceptual responses (i.e., effort and exercise-induced leg muscle pain) were recorded during exercise. Moderate correlations with no differences between pBFR and BFR were found regarding the decline in maximal voluntary torque and maximal muscle activity. Furthermore, no to very strong correlations between conditions, with no differences, were observed for muscle activity, muscle oxygenation, and perceptual responses during exercise sets. However, cuff pressure-induced discomfort was lower in the pBFR compared to the BFR condition. These results indicate that low-load resistance exercise combined with perceptually primed pBFR is a convenient and less discomfort inducing alternative to traditional BFR. This is especially relevant for BFR training with people who have a low cuff-induced discomfort tolerance.

Key words: Vascular occlusion, performance fatigability, muscle oxygenation, exercise-induced muscle pain, discomfort, sex differences

           Key Points
  • Perceptually primed pBFR induces similar changes in motor performance as well as muscle activity, muscle oxygenation, and perceptual responses during sets of low-load resistance exercise compared to traditional BFR
  • Perceptually primed pBFR using elastic wraps induces less discomfort compared to traditional BFR using pneumatic nylon cuffs and therefore, might be more favorable for individuals who have a low cuff-induced discomfort tolerance
  • The application of an elastic wrap relative to the limb circumference might be more accurate compared to a fixed overlap value, when a specific percentage arterial occlusion pressure is required for BFR exercise or training
  • Elastic wraps should be stretched to the maximum before first use to ensure constant material properties thereafter, because initial slackening might be possible when using new elastic wraps
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