FAQ
Common curiosities of BFR training.
01.
Does BFR really work?

EFFICACY

Multiple research labs in independent studies have reported that BFR training produces strength gains similar to maximal resistance training (weights).  It is important to note that not all BFR techniques and products are created equal.  (B)STRONG proprietary equipment keeps you safe, while make the experience simple, effective, and fast to use.

By using (B)STRONG equipment and the guidance app you should see a marked improvement on the order of 10% strength gains in as little as 10-15 sessions if done 3-5x per week, 1x per day.  Our application is designed to keep you safe and work your way toward the pressures that are appropriate for you as each individual is different.  (B)STRONG is much more than just the equipment, we bring you the expertise in an easy to implement fashion so you can simply Pump up ‘n GoTM.

(B)STRONG BFR Training provides a more robust anabolic stimulation with lighter weights, in a shorter period of time, and in a safer manner, than normal resistance training. Gains in fitness and strength are realized quicker with (B)STRONG BFR Training than with normal resistance training.

02.
Theory and Mechanism

SCIENCE

BFR is a breakthrough in understanding of how the body adapts to training stress and builds muscle, bone, blood vessels and tendons.  The (B)STRONG BFR SystemTM works by slowing down or impeding the flow of blood exiting the limbs through the veins.  As your muscles work, they use up available oxygen and other nutrients and normally the circulation brings more oxygen and removes metabolic waste products.  Because the circulation has been impeded, there is not enough re-supply of oxygen to the muscle, nor enough clearing of metabolic waste products.  The “environment” of the muscle fiber deteriorates to the point where muscle contraction cannot continue and other muscle fibers have to take over to perform the exercise.  Soon all fibers in the muscle go into a state of “failure” and one cannot continue.  You recognize this state as muscle burn or fatigue followed by not being able to do anymore repetitions.  Your brain senses the distress and responds, as it normally does, by initiating autonomic and hormonal responses in an attempt to mitigate the conditions in the muscle and to adapt to the demands of the exercises.  This process is the normal process of adaptation to severe exercise, but usually to get to this state, one must perform severe exercise like maximal weight lifting or many running intervals. This type of severe exercise usually damages the tissues involved.  In the case of BFR Training, the situation was created by a combination of light otherwise easy exercises but with the blood flow to those muscles impeded.  As a result of the distress in the muscle, growth hormone and other anabolic hormones are released into your blood stream.  This hormonal cascade goes throughout the body and facilitates the repair and building of all tissues that have been working or were injured.

Our team is dedicated to pushing the research into understanding all the underlying mechanisms, and establishing optimal application of (B)STRONG BFR TrainingTM.  Get started today!

The pressure to produce the best systemic response is one that creates a robust metabolic crisis in the working muscles for a substantial (minutes) period of time.  So for example, if the pressure and/or load are so high that only a few repetitions of an exercise are possible, there is not enough time for that metabolic crisis to develop in the muscle and the signal is not sent. On the other hand, if the pressure and/or load are so low that the metabolic crisis takes a long time or never happens, the alarm signal to the brain is not sent, (or sent as if there were no BFR), minimizing a systemic response.

03.
Is it Safe for Me?

SAFETY

We are unaware of any contraindications, negative side effects or complications from using the (B)STRONG BFR System when performed following the 5 Safety Rules.

  1. Always place bands in correct locations.
  2. Never occlude arterial inflow.
  3. Never lift heavy weights.
  4. Never exceed 20 minutes of inflation.
  5. Always use the (B)STRONG guidance app.

Of course, if there is an ongoing medical emergency (e.g. heart attack, hypertensive crisis, hypoglycemic reaction, stroke, acute injury, etc.), the individual should postpone the (B)STRONG BFR Training session and seek medical attention.

Acutely, during a BFR training session, heart rate and blood pressure are somewhat higher than they would otherwise be for the given exercise.

Chronically, BFR training has many positive effects on the cardiovascular system, including the heart, similar to the positive effects gained from regular exercise training.

Not if the 5 safety rules are followed.  If blood in deep veins is brought to a standstill for a prolonged period of time, the blood can begin to form clots.  If this happens and the clots move into the lungs, they will cause what is called a pulmonary embolis.  If big enough, pulmonary emboli can be fatal.  Fortunately, the (B)Strong BFR Belts are designed so that when the safety rules are followed, they cannot make the blood stand still long enough to clot, and thus, (B)STRONG BFR Training does not increase the risk of blood clots or pulmonary emboli.  Millions of BFR sessions have been performed world wide over the last 50 years and where it has been studied, the individuals who practice BFR have less blood clots detected than a matched group of individuals who don’t do BFR training.

Some individuals are genetically predisposed to clotting.  By the time these individuals are adults, they know whether they or others in their families have this condition.  Often they are on anticoagulants.  (B)STRONG BFR Training is safe even for these individuals.

Sometimes, after particular types of surgery (e.g. various orthopedic procedures on the lower extremities), one may have formed clots in the veins while anesthetized.  These clots may go unrecognized and cause a pulmonary embolus in the days following the surgery.  Thus, we recommend waiting a week after surgery to resume or start a (B)STRONG BFR training program.

When one uses a blood pressure cuff, or surgical tourniquet, and if it is applied at a pressure higher than systolic blood pressure, occlusion can occur.  So with those systems, there is an important relationship between cuff pressure and blood pressure.

The (B)STRONG BFR Belt, by virtue of the width, construction, and material properties, has been designed so it cannot occlude the circulation.  Therefore, from a safety standpoint, the pressures prescribed in the (B)STRONG BFR System pressure has little or no consideration to a person’s blood pressure.

The pressure in the (B)STRONG BeltTM restricts or impedes venous blood from returning to the central circulation.  The higher the pressure, the more blood is held in the limb and the more the circulation is slowed.  The higher the pressure, the greater the muscle force needed to push blood past the impediment and back to the central circulation.  In contrast to BP cuffs and tourniquets, the pressure prescribed for (B)STRONG BFR Training has little or nothing to do with the individual’s blood pressure.

As with any exercise program, all practioners of (B)STRONG BFR Training should use common sense in deciding if they should proceed with a session.  They should consult their physician if they have any questions about their particular circumstances. There are very few situations where people should not use the (B)STRONG BFR System.

  1. People should wait one week after major surgical proceedures before starting or resuming (B)STRONG BFR Training. This caution is primarily given to give time for asymptomatic, untreated deep venous thromboses to be identified and treated.
  2. People should not put (B)STRONG Belts directly on healing incisions or wounds. If, for example, there is an incision on the outside of the thigh (as in a total hip replacement) where the leg belt would go, the individual should avoid placing a leg belt directly on the incision, but they can enjoy BFR training on the other three extremities.
  3. Women, if they know they are pregnant, should wait until after delivery before starting (B)STRONG BFR Training.  Note: as with any exercise, if they have been BFR training prior to discovering they are pregnant, no need to stop.  They may do BFR training, on the easy side, until they feel uncomfortable doing (B)STRONG BFR Training (usually in the last trimester).  they should consult their obstetrician if they have any questions or are a high risk pregnancy.
  4. If a person’s limb girth in the appropriate belt location is less than 19 cm (7.5”), that limb (usually an arm) is too small for our smallest belts. We have only seen this situation with children weighing less than 60 lbs.  They may enjoy (B)STRONG BFR Training on their legs only.
  5. If a person’s limb girth in the appropriate belt location is greater than 95 cm (37.5”), that limb (usually a leg) is too large for our largest belt. We have not run into this situation yet, but those individuals may enjoy (B)STRONG BFR Training on their arms only.
  6. If someone is having a medical emergency of any sort, he/she should stop BFR training, call 911 and/or go to the emergency room and seek care.
  7. People should not operate a vehicle while doing BFR training.  However, it is fine for passengers to do so, as long as they do not distract the driver.
  8. If a person has a condition that has produced lymphedema, he/she should avoid BFR on that extremity and they should consult their physician before proceeding.
  9. If a person has iatrogenic vascular access on an extremity (e.g. hemodialysis patients), he/she should avoid BFR on that extremity and they should consult their physician.
  10. If a person has untreated deep venous thromboses, he/she should not do BFR training until they are treated.
  11. If a person is in hypertensive crisis or has untreated hypertension, he/she should seek medical attention and then when their hypertension is controlled, proceed with BFR training, after they have consulted their physician.

As long as the safety rules and cautions are followed, and (B)STRONG equipment and guidance app are used and followed, there are no risks associated with (B)STRONG BFR Training beyond those associated with any exercise.  Please consult your with your physician before starting any exercise routine, including (B)STRONG BFR Training.

No, (B)STRONG Belts and protocols do not increase the risk of varicosities, if anything, (B)STRONG works toward reducing varicosities.
Varicose veins are the result of incompetent valves in the veins linking the deep to superficial venous systems.  They can occur for a variety of reasons, but one cause is pregnancy where the growing uterus and baby put 24/7 pressure on the iliac veins as they carry blood back to the heart.  This fills up the deep veins, the interconnecting veins and the superficial veins.  Because this is a passive, constant situation, the valves are stretched resulting in them becoming incompetent.

In contrast, during (B)STRONG training, venous outflow is restricted leading to distension in the veins and capillaries distal to the (B)STRONG Belt, but then with exercise, the veins are repeatedly emptied and filled.  This has been associated with a up-regulation of markers associated with vascular growth (VEGF, HIF-1a, etc.).  The result of this temporary (~20 minutes) distending and emptying of the veins and capillaries is to improve their smooth muscle, which if anything works to reinforce the valves in between the deep and superficial venous systems.  (B)STRONG may actually result in making barely incompetent valves, competent again, which, in turn, may reduce the amount of varicosities.  We have numerous anecdotal reports of reduced varicosities when regularly using the (B)STRONG training system.

04.
Not all systems are created equal

DIFFERENT METHODS

Occlusion training involves completely stopping blood flow into an extremity for substantial periods of time. It can damage tissue distal (below) to the occlusion. Completely occluding a limb for a substantial period of time increases the risk of blood clots in veins. Deep venous thromboses (DVT’s) can lead to pulmonary emboli, which can be fatal. Occlusion training can also lead to rhabdomyolysis (severe breakdown of muscle fibers), which can lead to kidney failure and possibly death.

See the safety video where we compare occlusion training with a blood pressure cuff and (B)STRONG BFR Training.  The difference between occlusion training and BFR Training is that in the former case, the limb’s blood flow is occluded and in the later, some blood flow is always maintained.

No, (B)STRONG BFR Training does not, if safety rules are followed, totally occlude blood flow in a limb (safety rule #2), while that is what occlusion training seeks.

Because the (B)STRONG BFR System is designed to be both safe and effective.  Surgical tubing or elastic wraps vary tremendously in how they influence the circulation.  With surgical tubing or elastic wraps, one has little knowledge of whether they are safe or effective.  In addition, (B)STRONG Belts are likely to be much more comfortable than surgical tubing or blood pressure cuffs.

(B)STRONG BFR Training emphasizes safety and pays great attention to getting the pressures right. When too much pressure is used, dangerous blood vessel occlusion can result.  The application of too little pressure is not effective in producing the benefits of (B)STRONG BFR Training. The patented (B)STRONG BFR Belts are specifically designed to provide a safe, comfortable and effective (B)STRONG experience.

The only important safety point is that B Strong BFR belts can not occlude arterial inflow in an extremity up to the limit of the hand pump (500 mmHg).  All complications, or negative side effects with BFR occur as a result of occluding the arterial inflow into a limb.  Since B Strong BFR belts are incapable of occluding (up to the limit of the pump), they are eminently safe.

The effectiveness of B Strong BFR Training Systems is not about what % of arterial flow is restricted, but rather the robustness of the metabolic crisis signal occurring in the working muscle and being sent to the brain.  The “robustness” of the metabolic crisis signal is a function of the amount of venous outflow restriction that prevents recovery in the working muscle, the duration of that metabolic crisis signal and the percentage of the body’s muscle mass sending that signal.

05.
Putting it to Practice

APPLICATIONS & TECHNIQUE

The (B)STRONG BFR System can be safely and effectively used by injured and non-injured athletes, as well as normal people of every age, ability and background. In our experience, we have used the (B)STRONG BFR System on both genders from 10 to 93 years of age.

The best way to start (B)STRONG BFR Training is to measure your limb girths, order a system, fill out the requiste information and download the app.  The guidance app will take you from there, track your progress, and prescribe appropriate pressures to keep your sessions safe and effective!

You can do any exercise you can imagine with your (B)STRONG BFR System.  The most important point is to follow the guidance of the app.  In the app, you should follow the (B)STRONG regimen for sets and repetitions to achieve muscle failure.

Any light weight or partial body weight exercises can be performed with (B)STRONG BFR Training. We recommended that the basic exercises described in the app are used first, but gradually, the individual can incorporate exercises most specific to the activities relevant to his/her lifestyle. Examples include cyclists “B-ing” STRONG on a stationary bike with leg bands on or baseball players throwing with the arm bands on.

The proper (B)STRONG BFR System pressure varies between individuals depending on a variety of biometric factors. The (B)STRONG guidance app has an algorithm that takes these factors into account.  That is why the regular use of the app is very important.  The appropriate level of pressure is set by the app and updated based on feedback given after each session.

Yes, essentially substitute a 3 second isometric contraction for each repetition of an exercise movement.  Once you have the belts inflated, and instead of doing the usual exercises, perform 3 sets of 30 isometric contractions of the interested muscle.  When contracting, hold the contraction for 3 seconds and then relax for 1 second and repeat 29 times before resting for 30-60 seconds.  Perform 3 sets of these 30, 3 second isometric contractions for a given muscle group before moving to the next exercise.  These isometric contractions are particularly useful if you have a joint injury that is aggravated and painful if moved during exercise.  You can combine isometric exercises with movement exercises in other areas of the body.  One thing many find that are interested in big hypertrophic muscle gains is that isometric contractions and very slow moving contractions are particularly effective in building muscle.  One can also combine isometric and normal contractions in a given exercise.  For example, when doing 5 lbs arm curls, one can hold an isometric contraction at the end of the range of motion, both with the arm fully flexed and the arm fully extended.