BFR & The Aerobic Athlete


Demand is coming-Are you ready?

BFR & The Aerobic Athlete
Nicholas M. Licameli, PT,DPT




I know what you’re thinking… “But wait, not everyone wants to get jacked and strong.  Some of us have other goals, like distance running, rowing, and cycling!”  Point well-taken…

Along with its potential benefits for resistance training, BFR has shown some promising results for aerobic training, as well.  Most commonly studied are walking and cycling, however there is research to support its use with jogging, sprinting, and even rowing with collegiate and professional athletes with high levels of VO2max (> 60 ml/kg/min).  Gaining and maintaining muscle mass during training can be extremely beneficial for an aerobic athlete.  While the improvements in muscle hypertrophy and strength tend to be small and occur in deconditioned and untrained individuals, there may be some potential for well-trained individuals to improve hypertrophy with higher intensities and higher frequencies of BFR endurance training.  We also see increases in aerobic capacity (VO2max) and even anaerobic power in both untrained and well-trained individuals when BFR is used with aerobic training.  Finally, there is evidence to support improvements in functional clinical outcomes in the elderly, which are predictors of fall risk, functional mobility, and overall quality of life.

Here’s the best part…those potential benefits can be achieved at lower intensities and durations than endurance training without BFR!  With traditional aerobic training, we typically need to train at more than 50% heart rate reserve (HRR) multiple times per week for greater than 10 min, however with BFR we see positive adaptations at intensities as low as 30% HRR!  Similar to load in resistance training with BFR, there seems to be no benefit to high intensity cardio with BFR (at least with the cuffs on during exercise…), so be sure to keep the intensity low to moderate with a restriction time of 5-30 min per exercise bout.  It is recommended to start with a minimum of 50% LOP in the legs and a minimum of 40% LOP in the arms.

Similar to strength and physique athletes, endurance athletes can also use BFR to deload or train around injury without sacrificing a training effect.  As is the case with BFR and resistance training, BFR and aerobic training allows an endurance athlete to achieve a minimum effective dosage at intensities lower than what would typically be required.

How should BFR be integrated into an already existing endurance athlete’s training?  Let’s use a cyclist as an example.  As with any novel training stimulus, dosage should start low and gradually increase with time and adaptation as the repeated bout effect takes place.  There are two ways to program aerobic training for the triathlete/cyclist. The first would be to add it onto the last minutes of a regular training program. Heart rate reserve values can be higher to accommodate for increased specificity while LOP can be lower (due to higher exercise intensities). This can serve two purposes. The first – to accommodate to the unique stresses of BFR exercise and the second – for providing a “BFR base” for other programming in the future.

Program 1 Sample BFR Endurance Training Program for Cyclist

Goal: Facilitate increases in VO2max via upregulation of hypoxic tissue responses from increasing duration of ischemic exercise; possible augmentation of muscle hypertrophy and/or strength due to increased local muscular fatigue.  Ideal Frequency 3x/week

In Weeks 1-2, we suggest using BFR in the last 10 minutes of traditional endurance training (TET) at 30% HRR with 50% LOP.  In Weeks 3-4, the duration would increase to 15 min and the intensity would increase to 40% HRR.  In Weeks 5-6, the duration would increase to 20 minutes and the intensity would increase to 50% HRR.  In Weeks 7-8, intensity increases further to 45% HRR at a longer duration of time (25-30 minutes). Week 9 consists of traditional endurance training with a possible deload depending on the athlete’s goals and timeframe.

Aerobic Training Program 1
Weeks 1-2 Weeks 3-4 Weeks 5-6 Weeks 7-8 Week 9
Last 10 min of TET Last 15 min of TET Last 20 min of TET Last 25-30 min of TET Deload and/or use of TET
30% HRR 40% HRR 40% HRR 45% HRR
50% LOP 50% LOP 50% LOP 50% LOP

Program 2:  Sample BFR Interval Endurance Training Program for Cyclist (Off Days)

Goal: Facilitate increases in angiogenesis via reperfusion to augment VO2max; possible augmentation of muscle hypertrophy and/or strength due to increased local muscular fatigue.  Ideal Frequency 3-4x/wee

Contrary to Program 1, Program 2 could be integrated as its own separate training day apart from the traditional aerobic volume work. This program will rely on working at slightly higher intensities to take advantage of the ischemia-reperfusion properties of BFR training and increase the stress to the peripheral vasculature. The increased blood flow post-deflation will help provide the stimulus needed to produce new capillary supplies to the working muscles improving local tissue aerobic capacity. Program 2 progresses similarly to Program 1 by gradually increasing the number of intervals of exercise, pressure, and HRR values to maximize intensity (although 55% HRR is still relatively low in the grand scheme of aerobic training intensities). Pressure is increased here as a means to induce further hypoxia and create a greater ischemia-reperfusion response. 

Aerobic Training Program 2
Weeks 1 Weeks 3-4 Weeks 3-4 Weeks 5-6 Weeks 7-8 Week 9
OFF Days from TET OFF Days from TET OFF Days from TET OFF Days from TET OFF Days from TET Deload and/or use of TET
3x 5 min on, 1 min off; deflate rest periods 3x 5 min on, 1 min off; deflate rest periods 4x 5 min on, 1 min off; deflate rest periods 5x 5 min on, 1 min off; deflate rest periods 5x 5 min on, 1 min off; deflate rest periods
35% HRR 40% HRR 45% HRR 50% HRR 55% HRR
60-70% LOP 80% LOP 80% LOP 80% LOP 80% LOP


****Remember, the use of BFR training should not be based solely on a success story.  The decision to use BFR, or any treatment for that matter, should be based on the pillars of evidence-based practice.

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