In this interview, Mario Novo, doctor of physical therapy, discusses the many health benefits of blood flow restriction (BFR) training. It’s a phenomenally easy way to take control of your health, especially if you’re elderly. I don’t know of any intervention that will improve your health as dramatically. BFR training was developed by Dr. Yoshiaki Sato in Japan over 50 years ago. In Japan, BFR training is known as KAATSU, which translates into “additional pressure.” It’s a perfectly descriptive name, as the KAATSU device consists of inflatable bands that provide additional pressure on your limbs. Sato is now 73 years old and in fantastic shape for any age. He’s a really strong testament to the fact that it works. But it’s not just for strength building. Metabolically, BFR will radically improve your health and decrease your risk for sarcopenia and most other age-related diseases. BFR in Physical Therapy and Limb SalvageBFR didn’t arrive in the U.S. until 2010. In the years since, it’s become increasingly popular, not only among fitness experts but also among physical therapists such as Novo. Novo is also the owner of the Lifters Clinic,1 which specializes in strength and conditioning.
Owen’s experimentation with patients at CFI confirmed BFR training helped inhibit scar tissue formation and salvage more muscle. Aside from boosting strength, BFR also helped reduce pain associated with arthritis and nerve injuries. BFR for Post-Fracture RecoveryAround 2012 or 2013, BFR was adopted by the National Football League (NFL), where it was applied for post-anterior cruciate ligament (ACL) injury, reconstruction and repair. A couple of years after that, BFR’s benefits for bone breaks also became more widely appreciated.
BFR Is Now a Standard Rehab ModalityIn 2018, the American Physical Therapy Association approved BFR as an indication for rehab, making it part of physical therapists’ scope of practice. So, it’s not an alternative medicine or an alternative modality. It’s indicated for knee pain, for example, including knee pain associated with osteoarthritis (OA). It’s also a tool used to address osteopenia, sarcopenia, high blood pressure and diabetes. It may also be useful in the treatment of traumatic brain injury (TBI) and post-stroke. Unfortunately, it still does not have a reimbursable current procedural terminology (CPT) code (a medical code used for billing), but eventually, there will be. How BFR Affects Your PhysiologyThere are two primary types of muscle fibers: Type 1, the slow, endurance-type fibers; and Type 2, the fast-twitch fibers, which are primarily anaerobic and use glucose, not oxygen. Type 2 fibers are larger than Type 1 and tend to kick in when the oxygen supply runs out and the Type 1 fibers are exhausted. The activation of Type 2 fibers generates lactate as a metabolic byproduct. The lactate builds up because the BFR bands don’t allow the lactate to diffuse systemically. This buildup of lactate provides many of the metabolic benefits of BFR. With age, or when you’re injured, exercising intensely enough to maintain health can be a challenge. This is where BFR shines, as the light load required doesn’t overstrain you, while still providing benefits you’d normally only see with heavier exercise loads. Novo explains:
Benefits of Lactic AcidAs mentioned, BFR significantly increases lactic acid, which can cross the blood-brain barrier. Once you release the bands, the lactate travels in your blood to your brain, where a monocarboxylate transporter shuttles it into your brain to use it for fuel.2,3 It also increases brain derived neurotropic factor (BDNF),4 a brain growth factor that contributes to neuroplasticity and enhances cognitive performance.5,6 BFR also downregulates a hormone called myostatin, which is a negative regulator of muscle growth and mass.7,8,9 In other words, when your myostatin levels are high you cannot grow muscle. This is important because the elderly have levels twice as high as the young.10 In the past, lactate was traditionally viewed as a metabolic waste product, but today it is understood that lactate is an important molecule that is responsible for many metabolic processes and results in many structural adaptations. It is even referred to as a pseudo-hormone.11 The lactate that your Type 2 muscle fibers generate during BFR actually down-regulates the production of myostatin and helps improve skeletal muscle loss. Amazingly, BFR can decrease your myostatin levels by 45%,12,13 which has been shown to increase muscle protein synthesis.14,15,16 Novo explains:
KAATSU Versus Other BFR DevicesOne of the greatest areas of controversy when it comes to BFR centers around the equipment used. KAATSU uses a special inflatable cuff device that can provide pulsed and continuous pressure. When KAATSU was initially introduced into the U.S. in 2010, the device had a price tag of $16,000. Most physical therapists could not afford it so they used surgical tourniquets that already had FDA approval for surgery to substitute for KAATSU. Novo uses these wider tourniquet-type bands or devices. KAATSU uses thinner inflatable elastic bands, so they stretch as you exercise. As a result, your blood flow, including your venous return, is not completely obstructed. The Delfi surgical tourniquet system Novo uses, which involves a static, nonelastic, wider band, is controversial in that it causes a near-complete obstruction of blood flow. KAATSU leaders are quite opposed to it for this reason. One major concern is that the wider bands may increase the risk of blood clots. Another is that it could potentially create a hypertensive crisis in susceptible individuals. The KAATSU bands, because they’re elastic, doesn’t seem to cause that. Novo addresses these objections, saying:
To be clear, it’s important to not use a regular tourniquet, such as what you’d find in an emergency room, for BFR. Applied hard enough, the lack of elasticity could make it very dangerous, potentially causing a blood clot or nerve damage. “Elastic BFR cuffs are safe to use. Tourniquets, austere tourniquets, that’s not at all to be used with this. Don’t apply it to yourself. Don’t apply it to anybody if you’re training them,” Novo warns. BFR for Cardiac RehabAnother magnificent benefit of BFR is its ability to promote the growth of new capillaries, thus improving your microcirculation, which is important for cardiovascular, heart and brain health. Your microcirculation tends to diminish with age, and BFR can go a long way toward maintaining healthy circulation. In Japan, BFR is actually used for cardiac rehab, and in the U.S., Novo says there are some cases in which it’s been used to rehab after a heart attack. Like your brain, your heart can also use lactate as a form of fuel during ischemia or reperfusion injury. Novo explains:
Sample Protocol for Strength BuildingWhile BFR is certainly ideal for the elderly, even competitive athletes stand to gain from it. According to the American College of Sports Medicine (ACSM), you need to use a weight that is 70% to 85% of your one rep max (1RM) if you want to build muscle and strength. With BFR, you’re using only 20% to 40% of your 1RM.
Now, if you’re elderly, it would be wise for you to revise this 80-20 rule to something like 60-40, where BFR makes up at least 40% of your fitness routine. The reason for this is because as you get older, your microcirculation diminishes. By the time you’re in your 80s, you’re bound to have a fairly significant decrease is your w. For the elderly, having BFR make up just 20% of your exercise is likely to be too little, as conventional strength training has not been shown to increase microcirculation. My BFR RecommendationsAfter careful review, it is clear to me that the KAATSU equipment is the best BFR equipment on the market, as it is the only one that allows you to do cycling or automatically cycling pressure on for 30 seconds and off for five seconds. You can review my comprehensive review on BFR from January 3, 2020. The equipment used to be $16,000 when first introduced in the U.S. and even last year when I purchased mine it was $2,300. However, the new Cycle 2.0, which is the one I use every day, is now only $899. >>>>> Click Here <<<<< More InformationNovo teaches formal courses on BFR around the country. At present, all live workshops are done through Novo’s company, The BFR Pros, which offers workshops for both performance and rehab. You can find more information about each class and register on theBFRpros.com.
from http://articles.mercola.com/sites/articles/archive/2020/03/22/mario-novo-blood-flow-restriction.aspx
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