Should We Adjust Cuff Pressure Over the Course of an Intervention? Part 2


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Should We Adjust Cuff Pressure Over the Course of an Intervention? Part 2
Nicholas M. Licameli, PT,DPT



Welcome back ladies and gentlemen!  I know…the wait was almost unbearable!  Reading Part 1 of this two-part blog was just like how they tease the next Marvel movie at the end of the one you just watched.  Well I have good news for you!  The wait is over!  We may not have a thunder god or a smooth talking Robert Downey Jr. (yet), but we do have a bunch of knowledge bombs coming your way!  


Just a quick review of Part 1, in their 2021 paper titled, “Blood Flow Restriction Training: To Adjust or Not Adjust the Cuff Pressure Over an Intervention Period?,”  Cerqueira and colleagues set out to answer an important question about cuff pressure during blood flow restriction training.  It is known that BFR pressure (BFRP) needs to be individualized and adequate to partially limit arterial blood (Patterson et al., 2019), however there are no clear recommendations for BFRP prescription (Clarkson et al., 2020) and no specific recommendation of whether BFRP should be adjusted.  Part 2 is all about results, conclusions, takeaways, and practical applications.


There are a few reasons why adjusting the pressure might be a good idea. As mentioned in Part 1, we can see an exaggerated cardiovascular response with blood flow restriction training via the exercise pressor reflex.  The study showed that cardiovascular outcomes did not provide a plausible rationale for cuff pressure.


We also see higher ratings of discomfort with BFR training.  The current evidence tells us a few things.  First reducing BFRP can decrease the effects of the exercise pressor reflex and ratings of discomfort without compromising efficacy.  The repeated bout effect will naturally decreased discomfort, however if pressure is progressively increased/changed from session to session, this effect may not occur because as BFRP increases, pain perception also increases.  Unnecessary increases in BFRP may contribute to discomfort, impair adherence, and increase the risk of adverse events, such as venous thromboembolism, rhabdomyolysis, and bruising.


Along the same vein (pun intended), higher pressures should be used with lighter loads and lower pressures should be used with higher loads.  So if a patient or athlete is able to tolerate loads on the heavier end of the low load BFR continuum, feel free to use lower pressures within the effective range.  When it comes to measuring pressure, it is best practice to use a percentage of limb occlusion pressure, which should come as no surprise to anyone who is familiar with our work here at the BFR Pros.  Ideally, we need longitudinal studies directly measuring BFRP to establish whether cuff pressure should be altered in clinical populations.


We at the BFR Pros recommend using the minimal amount of pressure needed to achieve physiological adaptation, which is supported by the findings of this study. Higher pressures are associated with higher perceptual demand and a higher exercise pressor response with no added benefit other than possibly analgesia (Hughes and Patterson, 2020). This study is so important because it demonstrates an absence of evidence to support the idea that we must increase pressure during BFR training.  The study provides evidence that we can confidently use pressures at the lower end of the effective range without sacrificing physiological adaptation, which could help lower the barrier of entry to the widespread use of BFR.


So there you have it, folks!  It’s been real, now it’s time to save the world.  AVENGERS…ASSEMBLE!



Clarkson, M. J., May, A. K., and Warmington, S. A. (2020). Is there rationale for the cuff pressures prescribed for blood flow restriction exercise? a systematic review. Scand. J. Med. Sci. Sports 30, 1318–1336. doi: 10.1111/sms.13676 


Hughes, L., & Patterson, S. D. (2020). The effect of blood flow restriction exercise on exercise-induced hypoalgesia and endogenous opioid and endocannabinoid mechanisms of pain modulation. Journal of applied physiology (Bethesda, Md. : 1985), 128(4), 914–924.

****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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