Blood Flow Restriction and the Elderly?


Demand is coming-Are you ready?

Blood Flow Restriction and the Elderly?
Nicholas M. Licameli, PT,DPT




I know what you’re thinking…Nick Licameli and the BFR Pros have sold out to click bait titles.  There’s no way we can slap some cuffs on grandma and expect things to go well.  Well…as Lumiere says to Cogsworth in Beauty and the Beast, “A broken clock is right two times a day, mon ami, but this is not one of those times.”

Whether we like it or not, or until Elon Musk comes up with an alternative, we will all go through the aging process.  Aging is typically associated with a gradual decline in physical performance and overall functional ability1.  A critical aspect of this gradual decline is the decrement in muscle quantity and quality, which is characterized by a decrease in the cross sectional area of muscle fibers2 and an increase in non-contractile components intertwined with muscle tissue  – for example, adipose and connective tissue3.  

Some studies indicate that the rate of muscle loss accelerates at more advanced ages (e.g., 80+ years old) 4, 5, 6, further compromising the ability to independently perform activities of daily living (ADL) 7,8. The loss of muscle can also contribute to the development of other pathologies associated with aging, such as osteoarthritis (OA) 9

High load resistance training has been shown as a safe and effective way to positively impact the structural and functional muscular changes associated with aging10.  The problem is that although HLRT can have a significant impact on the aging process, using high loads may cause intolerably high mechanical overload and a contraindicated burden for populations of older ages, especially if they suffer from OA, joint stiffness, and other comorbidities11, 12.  

If only there was a way to train with low loads, but reap the same benefits as training with high loads… 

(BFR kicks open the door and enters the room with a Vince McMahon strut)

So the next time you are working with an elderly patient or client and feel like resorting to the yellow resistance band and seated knee extensions, think again!  Just because an elderly patient is unable to tolerate moderate to heavy loads does not mean we have to put them in rehab purgatory.  BFR is a great way to physically and mentally challenge our load compromised elderly patients and, perhaps most importantly, show them just how resilient they are! 




1 Mitchell, W., Atherton, P., Williams, J., Larvin, M., Lund, J., and Narici, M.
(2012). Sarcopenia, dynapenia, and the impact of advancing age on human
skeletal muscle size and strength; a quantitative review. Front. Physiol. 3:260.
doi: 10.3389/fphys.2012.00260


2 Narici, M. V., Maganaris, C. N., Reeves, N. D., and Capodaglio, P. (2003).Effect of aging on human muscle architecture. J. Appl. Physiol. 95, 2229–2234.doi: 10.1152/japplphysiol.00433.2003


3 Visser, M., Kritchevsky, S. B., Goodpaster, B. H., Newman, A. B., Nevitt, M., Stamm, E., et al. (2002). Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: the health, aging and body composition study. J. Am. Geriatr. Soc. 50, 897–904. doi: 10.1046/j.1532-5415.2002.50217.x


4 Baumgartner, R. N., Stauber, P. M., McHugh, D., Koehler, K. M., and Garry,P. J. (1995). Cross-sectional age differences in body composition in persons60+ years of age. J. Gerontol. A Biol. Sci. Med. Sci. 50, M307–M316.doi: 10.1093/gerona/50A.6.M307

5 Janssen, I., Heymsfield, S. B., Wang, Z., and Ross, R. (2000). Skeletal muscle massand distribution in 468 men and women aged 18–88 yr. J. Appl. Physiol. 89,
81–88. doi: 10.1152/jappl.2000.89.1.81


6 Kyle, U. G., Genton, L., Hans, D., Karsegard, L., Slosman, D. O., and Pichard,C. (2001). Age-related differences in fat-free mass, skeletal muscle, body cellmass, and fat mass between 18 and 94 years. Eur. J. Clin. Nutr. 55, 663–672.doi: 10.1038/sj.ejcn.1601198


7 Aagaard, P., Suetta, C., Caserotti, P., Magnusson, S. P., and Kjaer, M. (2010).Role of the nervous system in sarcopenia and muscle atrophy with aging:strength training as a countermeasure. Scand. J. Med. Sci. Sports 20, 49–64.doi: 10.1111/j.1600 0838.2009.01084.x

8 Cruz-Jentoft, A. J., Baeyens, J. P., Bauer, J. M., Boirie, Y., Cederholm, T., Landi,F., et al. (2010). Sarcopenia: European consensus on definition and diagnosis:report of the European working group on sarcopenia in older people. AgeAgeing 39, 412–423. doi: 10.1093/ageing/afq034


9 Shorter, E., Sannicandro, A. J., Poulet, B., and Goljanek-Whysall, K. (2019).Skeletal muscle wasting and its relationship with osteoarthritis: a mini-review of mechanisms and current interventions. Curr. Rheumatol. Rep. 21:40.doi: 10.1007/s11926-019-0839-4


10 Grgic, J., Garofolini, A., Orazem, J., Sabol, F., Schoenfeld, B. J., and Pedisic, Z.(2020). Effects of resistance training on muscle size and strength in very elderlyadults: a systematic review and meta-analysis of randomized controlled trials.Sports Med. 50, 1983–1999. doi: 10.1007/s40279-020-01331-7


11 Loenneke, J. P., Wilson, J. M., Wilson, G. J., Pujol, T. J., and Bemben, M. G (2011).Potential safety issues with blood flow restriction training. Scand. J. Med. Sci.Sports 21, 510–518. doi: 10.1111/j.1600-0838.2010.01290.x

12 Hughes, L., Paton, B., Rosenblatt, B., Gissane, C., and Patterson, S. D. (2017). Blood flow restriction training in clinical musculoskeletal rehabilitation: asystematic review and meta-analysis. Br. J. Sports Med. 51, 1003–1011.doi: 10.1136/bjsports-2016-097071

****Remember, 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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