The current manuscript sets out a position stand for blood flow restriction (BFR) exercise, focusing on the methodology, application and safety of this mode of training. With the emergence of this technique and the wide variety of applications within the literature, the aim of this position stand is to set out a current research informed guide to BFR training to practitioners. This covers the use of BFR to enhance muscular strength and hypertrophy via training with resistance and aerobic exercise and preventing muscle atrophy using the technique passively. The authorship team for this article was selected from the researchers focused in BFR training research with expertise in exercise science, strength and conditioning and sports medicine.

High-intensity resistance training (HRT) has been recommended to offset age-related loss in muscle strength and mass. However, part of the elderly population is often unable to exercise at high intensities. Alternatively, low-intensity resistance training with blood flow restriction (LRT-BFR) has emerged. The purpose of this study was to compare the effects of LRT-BFR and HRT on quadriceps muscle strength and mass in elderly. Twenty-three elderly individuals, 14 men and 9 women (age, 64.04 ± 3.81 years; weight, 72.55 ± 16.52 kg; height, 163 ± 11 cm), undertook 12 weeks of training. Subjects were ranked according to their pretraining quadriceps cross-sectional area (CSA) values and then randomly allocated into one of the following groups: (a) control group, (b) HRT: 4 × 10 repetitions, 70-80% one repetition maximum (1RM), and (c) LRT-BFR: 4 sets (1 × 30 and 3 × 15 repetitions), 20-30% 1RM. The occlusion pressure was set at 50% of maximum tibial arterial pressure and sustained during the whole training session. Leg press 1RM and quadriceps CSA were evaluated at before and after training. A mixed-model analysis was performed, and the significance level was set at p ≤ 0.05. Both training regimes were effective in increasing pre- to post-training leg press 1RM (HRT: ∼54%, p < 0.001; LRT-BFR: ∼17%, p = 0.067) and quadriceps CSA (HRT: 7.9%, p < 0.001; LRT-BFR: 6.6%, p < 0.001); however, HRT seems to induce greater strength gains. In summary, LRT-BFR constitutes an important surrogate approach to HRT as an effective training method to induce gains in muscle strength and mass in elderly.

Mechanisms underlying mechanical overload-induced skeletal muscle hypertrophy have been extensively researched since the landmark report by Morpurgo (1897) of “work-induced hypertrophy” in dogs that were treadmill trained. Much of the preclinical rodent and human resistance training research to date supports that involved mechanisms include enhanced mammalian/mechanistic target of rapamycin complex 1 (mTORC1) signaling, an expansion in translational capacity through ribosome biogenesis, increased satellite cell abundance and myonuclear accretion, and postexercise elevations in muscle protein synthesis rates. However, several lines of past and emerging evidence suggest that additional mechanisms that feed into or are independent of these processes are also involved. This review first provides a historical account of how mechanistic research into skeletal muscle hypertrophy has progressed. A comprehensive list of mechanisms associated with skeletal muscle hypertrophy is then outlined, and areas of disagreement involving these mechanisms are presented. Finally, future research directions involving many of the discussed mechanisms are proposed.

The aim of the present study was to evaluate the effects of 16 wk of resistance training (RT), endurance training (ET), and concurrent training (CT) on inflammatory markers, C-reactive protein (CRP), and functional capacity in sedentary middle-age men. Healthy subjects were randomized into RT (n = 11), ET (n = 12), CT (n = 11), and a control group (n = 13). The subjects performed three weekly sessions lasting about 60 min for 16 wk. Maximal strength was tested in bench press and leg press. The peak oxygen uptake (VO2peak) was measured in an incremental exercise test. Plasma tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and CRP levels were determined by an enzyme-linked immunosorbent assay. Maximal strength was increased after 16 wk, with no differences between RT and CT. VO2peak increased in ET and CT comparing before and after training. There were no significant differences in TNF-α, IL-6, and CRP comparing before and after training. Sixteen weeks of RT, ET, or CT in middle-age healthy men has not affected low and moderate IL-6, TNF-α, and CRP levels. CT performed in the same weekly frequency and session duration of ET and RT was effective in increasing both maximal strength and VO2peak, in addition to improvements in lipid profile.