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1. Patients or post-operative clients, high load and high intensity exercises may not be medically appropriate. Blood Circulation Limitation (BFR) training is a technique that combines low strength exercise with blood circulation occlusion that produces comparable outcomes to high strength training. It has been utilized in the health club setting for a long time however it is getting popularity in scientific settings. Blood Circulation Constraint (BFR) Training [edit modify source] BFR training was at first established in the 1960's in Japan and known as KAATSU training. It can be used to either the upper or lower limb. The cuff is then pumped up to a specific pressure with the objective of acquiring partial arterial and total venous occlusion. The client is then asked to perform resistance exercises at a low strength of 20-30% of 1 repeating max (1RM), with high repeatings per set (15-30) and short rest periods between sets (30 seconds) Understanding the Physiology of Muscle Hypertrophy. [edit edit source] Muscle hypertrophy is the increase in size of the muscle in addition to an increase of the protein content within the fibers. Muscle stress and metabolic stress are the 2 primary factors responsible for muscle hypertrophy. Mechanical Stress & Metabolic Stress [edit modify source] When a muscle is put under mechanical stress, the concentration of anabolic hormonal agent levels increase. The activation of myogenic stem cells and the raised anabolic hormonal agents result in protein metabolic process and as such muscle hypertrophy can occur. Insulin-like development factor and growth hormonal agent are accountable for increased collagen synthesis after workout and aids muscle recovery. Development hormone itself does not directly cause muscle hypertrophy but it helps muscle recovery and consequently possibly assists in the muscle enhancing process. The accumulation of lactate and hydrogen ions (eg in hypoxic training) more increases the release of growth hormone. Myostatin controls and prevents cell growth in muscle tissue. Resistance training results in the compression of blood vessels within the muscles being trained. When there is blood pooling and a build-up of metabolites cell swelling takes place. This swelling within the cells triggers an anabolic reaction and results in muscle hypertrophy. The cuff is placed proximally to the muscle being exercise and low intensity exercises can then be carried out. Because the outflow of blood is limited using the cuff capillary blood that has a low oxygen material collects and there is an increase in protons and lactic acid. The exact same physiological adjustments to the muscle (eg release of hormones, hypoxia and cell swelling) will occur during the BFR training and low intensity exercise as would accompany high strength workout. ( 1) Low strength BFR (LI-BFR) leads to a boost in the water content of the muscle cells (cell swelling). It also speeds up the recruitment of fast-twitch muscle fibers. It is also hypothesized that as soon as the cuff is eliminated a hyperemia (excess of blood in the blood vessels) will form and this will trigger more cell swelling. These boosts were comparable to gains obtained as a result of high-intensity workout without BFR A research study comparing (1) high intensity, (2) low strength, (3) high and low intensity with BFR and (4) low strength with

2. BFR. While all 4 workout programs produced boosts in torque, muscle activations and muscle endurance over a 6 week duration - the high strength (group 1) and BFR (groups 3 and 4) produced the greatest effect size and were equivalent to each other.