Muscle Adaptations to High-Load Training and Very Low-Load Training With and Without Blood Flow Restriction
Open accessAbstract
An inability to lift loads great enough to disrupt muscular blood flow may impair the ability to fatigue muscles, compromising the hypertrophic response. It remains unknown what level of blood flow restriction (BFR) pressure, if any, is necessary to reach failure at very low-loads (i.e., 15%1RM). The purpose of this study was to investigate muscular adaptations following resistance training with a very low-load alone (15/0), with moderate BFR (15/40), or with high BFR (15/80), and compare them to traditional high-load (70/0) resistance training. Using a within/between subject design, healthy young participants (n=40) performed four sets of unilateral knee extension to failure (up to 90 repetitions/set), twice per week for eight weeks. Data presented as mean change (95% CI). There was a condition by time interaction for 1RM (p<.001), which increased for 70/0 [3.15 (2.04,4.25) kg] only. A condition by time interaction (p=.028) revealed greater changes in endurance for 15/80 [6 (4,8) repetitions] compared to 15/0 [4 (2,6) repetitions] and 70/0 [4 (2,5) repetitions]. There was a main effect of time for isometric MVC [change = 10.51 (3.87,17.16) Nm, p=.002] and isokinetic MVC at 180/second [change = 8.61 (5.54,11.68) Nm, p<.001], however there was no change in isokinetic MVC at 60/second [2.45 (-1.84,6.74) Nm, p=.261]. Anterior and lateral muscle thickness was assessed at 30, 40, 50, and 60% of the upper leg. There was no condition by time interaction for muscle thickness sites (all p≥.313). There was a main effect of time for all sites, with increases over time (all p<.001). With the exception of the 30% lateral site (p=.059) there was also a main effect of condition (all p<.001). Generally, 70/0 was greater. Average weekly volume increased for all conditions across the eight weeks, and was greatest for 70/0 followed by 15/0, 15/40, then 15/80. With the exception of 1RM, changes in strength and muscle size are similar regardless of load or restriction. The workload required to elicit these changes lowered with increased BFR pressure. These findings may be pertinent to rehabilitative settings, future research, and program design.
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Studies in which local muscular endurance testing is based on pre-study 1RM tend to refute the benefit of low-load training for this outcome.
“studies in which local muscular endurance testing is based on pre-study 1RM tend to refute the benefit of low-load training for this outcome.”
From Loading recommendations for muscle strength, hypertrophy, and local endurance: a re-examination of the repetition continuum. (2021) · cites this paper as [31]
The Methods (Endurance; page not provided) confirm that endurance was tested at 42.5% of pre-training 1RM. But the Results (Endurance; page not provided) report significant increases in endurance in every low-load condition, with the high-BFR low-load condition improving more than high-load training. This study therefore does not refute a benefit of low-load training for endurance. (LLM, conf=0.86)
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Experimental — accuracy not yet measuredFindings on isokinetic strength are conflicting; some studies show a benefit of heavy load training, others show a benefit to low-load training, and yet others show no differences between conditions.
“the findings from available evidence are conflicting; some studies show a benefit of heavy load training [27,28], others show a benefit to low-load training [29] and yet others show no differences between conditions on this metric [30,31].”
From Loading recommendations for muscle strength, hypertrophy, and local endurance: a re-examination of the repetition continuum. (2021) · cites this paper as [31]
Some studies evaluating the effects of different loading schemes on muscular endurance used pre-intervention (baseline) 1RM values to determine load for endurance tests, whereas others used post-intervention values.
“some studies that evaluated the effects of training with different loading schemes on muscular endurance used the pre-intervention (baseline) 1RM values to determine load for the endurance tests, whereas others used post-intervention values [20,31].”
From Loading recommendations for muscle strength, hypertrophy, and local endurance: a re-examination of the repetition continuum. (2021) · cites this paper as [31]
Jessee et al. [31] showed similar increases in relative muscular endurance assessed at 42.5% of the pre-test 1RM in the unilateral knee extension following an 8-week training program using loads of either 15% or 70% 1RM.
“Jessee et al. [31] showed similar increases in relative muscular endurance assessed at 42.5% of the pre-test 1RM in the unilateral knee extension following performance of an 8-week training program using loads of either 15% or 70% 1RM.”
From Loading recommendations for muscle strength, hypertrophy, and local endurance: a re-examination of the repetition continuum. (2021) · cites this paper as [31]
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Cites
Resistance exercise load does not determine training-mediated hypertrophic gains in young men
Mitchell, C. J., Churchward-Venne, T. A., West, D. W. D., Burd, N. A., Breen, L., Baker, S. K., & Phillips, S. M. (2012) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00307.2012 · Cited by 627 · see citing works
Morton, R. W., Oikawa, S. Y., Wavell, C. G., Mazara, N., McGlory, C., Quadrilatero, J., Baechler, B. L., Baker, S. K., & Phillips, S. M. (2016) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00154.2016 · Cited by 404 · cited 3× · see citing works
“, 30% 1RM) to volitional failure elicits increases in muscle size and strength similar to high-load resistance training (Mitchell et al., 2012; Morton et al., 2016).”
BackgroundDamas, F., Phillips, S. M., Lixandrão, M. E., Vechin, F. C., Libardi, C. A., Roschel, H., Tricoli, V., & Ugrinowitsch, C. (2016) · European Journal of Applied Physiology · doi:10.1007/s00421-015-3243-4 · Cited by 202 · see citing works
Flagged first, then by citations
Research works printed but not linked: 23
- Buckner S. L. Dankel S. J. Mattocks K. T. Jessee M. B. Mouser J. G. Counts B. R. (2017a). Differentiating swelling and hypertrophy through indirect assessment of muscle damage in untrained men following repeated bouts of resistance exercise. Eur. J. Appl. Physiol. 117 213– 224. 10.1007/s00421-016-3521-9 28012037 · DOI
- Buckner S. L. Jessee M. B. Mattocks K. T. Mouser J. G. Counts B. R. Dankel S. J. (2017b). Determining strength: a case for multiple methods of measurement. Sports Med. 47 193– 195. 10.1007/s40279-016-0580-3 27380100 · DOI · Paper page
- Burd N. A. Andrews R. J. West D. W. Little J. P. Cochran A. J. Hector A. J. (2012). Muscle time under tension during resistance exercise stimulates differential muscle protein sub-fractional synthetic responses in men. J. Physiol. 590 351– 362. 10.1113/jphysiol.2011.221200 22106173 PMC3285070 · DOI
- Counts B. R. Dankel S. J. Barnett B. E. Kim D. Mouser J. G. Allen K. M. (2016). Influence of relative blood flow restriction pressure on muscle activation and muscle adaptation. Muscle Nerve 53 438– 445. 10.1002/mus.24756 26137897 · DOI
- Dankel S. J. Jessee M. B. Mattocks K. T. Buckner S. L. Mouser J. G. Bell Z. W. (2018). Perceptual and arterial occlusion responses to very low load blood flow restricted exercise performed to volitional failure. Clin. Physiol. Funct. Imaging 10.1111/cpf.12535 [Epub ahead of print]. 29938892 · DOI
- Dankel S. J. Jessee M. B. Mattocks K. T. Mouser J. G. Counts B. R. Buckner S. L. (2016). Training to fatigue: the answer for standardization when assessing muscle hypertrophy? Sports Med. 47 1021– 1027. 10.1007/s40279-016-0633-7 27677915 · DOI · Paper page
- Fahs C. A. Loenneke J. P. Thiebaud R. S. Rossow L. M. Kim D. Abe T. (2015). Muscular adaptations to fatiguing exercise with and without blood flow restriction. Clin. Physiol. Funct. Imaging 35 167– 176. 10.1111/cpf.12141 24612120 · DOI
- Farup J. de Paoli F. Bjerg K. Riis S. Ringgard S. Vissing K. (2015). Blood flow restricted and traditional resistance training performed to fatigue produce equal muscle hypertrophy. Scand. J. Med. Sci. Sports 25 754– 763. 10.1111/sms.12396 25603897 · DOI · Paper page
- Ferguson R. A. Hunt J. E. A. Lewis M. P. Martin N. R. W. Player D. J. Stangier C. (2018). The acute angiogenic signalling response to low-load resistance exercise with blood flow restriction. Eur. J. Sport Sci. 18 397– 406. 10.1080/17461391.2017.1422281 29343183 · DOI
- Ganesan G. Cotter J. A. Reuland W. Cerussi A. E. Tromberg B. J. Galassetti P. (2015). Effect of blood flow restriction on tissue oxygenation during knee extension. Med. Sci. Sports Exerc. 47 185– 193. 10.1249/mss.0000000000000393 24870580 PMC4246015 · DOI
- Holm L. Reitelseder S. Pedersen T. G. Doessing S. Petersen S. G. Flyvbjerg A. (2008). Changes in muscle size and MHC composition in response to resistance exercise with heavy and light loading intensity. J. Appl. Physiol. 105 1454– 1461. 10.1152/japplphysiol.90538.2008 18787090 · DOI · Paper page
- Hunter S. K. Enoka R. M. (2001). Sex differences in the fatigability of arm muscles depends on absolute force during isometric contractions. J. Appl. Physiol. 91 2686– 2694. 11717235
- Jessee M. B. Dankel S. J. Buckner S. L. Mouser J. G. Mattocks K. T. Loenneke J. P. (2017). The cardiovascular and perceptual response to very low load blood flow restricted exercise. Int. J. Sports Med. 38 597– 603. 10.1055/s-0043-109555 28651256 · DOI
- Kacin A. Strazar K. (2011). Frequent low-load ischemic resistance exercise to failure enhances muscle oxygen delivery and endurance capacity. Scand. J. Med. Sci. Sports 21 e231– e241. 10.1111/j.1600-0838.2010.01260.x 21385216 · DOI
- Larkin K. A. Macneil R. G. Dirain M. Sandesara B. Manini T. M. Buford T. W. (2012). Blood flow restriction enhances post-resistance exercise angiogenic gene expression. Med. Sci. Sports Exerc. 44 2077– 2083. 10.1249/MSS.0b013e3182625928 22677927 PMC3633075 · DOI
- Lasevicius T. Ugrinowitsch C. Schoenfeld B. J. Roschel H. Tavares L. D. De Souza E. O. (2018). Effects of different intensities of resistance training with equated volume load on muscle strength and hypertrophy. Eur. J. Sport Sci. 18 772– 780. 10.1080/17461391.2018.1450898 29564973 · DOI · Paper page
- Laurentino G. C. Ugrinowitsch C. Roschel H. Aoki M. S. Soares A. G. Neves M. (2012). Strength training with blood flow restriction diminishes myostatin gene expression. Med. Sci. Sports Exerc. 44 406– 412. 10.1249/MSS.0b013e318233b4bc 21900845 · DOI
- Lixandrão M. E. Ugrinowitsch C. Berton R. Vechin F. C. Conceição M. S. Damas F. (2018). Magnitude of muscle strength and mass adaptations between high-load resistance training versus low-load resistance training associated with blood-flow restriction: a systematic review and meta-analysis. Sports Med. 48 361– 378. 10.1007/s40279-017-0795-y 29043659 · DOI · Paper page
- Lixandrao M. E. Ugrinowitsch C. Laurentino G. Libardi C. A. Aihara A. Y. Cardoso F. N. (2015). Effects of exercise intensity and occlusion pressure after 12 weeks of resistance training with blood-flow restriction. Eur. J. Appl. Physiol. 115 2471– 2480. 10.1007/s00421-015-3253-2 26323350 · DOI
- MacInnis M. J. McGlory C. Gibala M. J. Phillips S. M. (2017). Investigating human skeletal muscle physiology with unilateral exercise models: when one limb is more powerful than two. Appl. Physiol. Nutr. Metab. 42 563– 570. 10.1139/apnm-2016-0645 28177712 · DOI
- Motykie G. D. Zebala L. P. Caprini J. A. Lee C. E. Arcelus J. I. Reyna J. J. (2000). A guide to venous thromboembolism risk factor assessment. J. Thromb. Thrombolysis 9 253– 262. 10728025
- Shinohara M. Kouzaki M. Yoshihisa T. Fukunaga T. (1998). Efficacy of tourniquet ischemia for strength training with low resistance. Eur. J. Appl. Physiol. Occup. Physiol. 77 189– 191. 9459541
- Sugaya M. Yasuda T. Suga T. Okita K. Abe T. (2011). Change in intramuscular inorganic phosphate during multiple sets of blood flow-restricted low-intensity exercise. Clin. Physiol. Funct. Imaging 31 411– 413. 10.1111/j.1475-097X.2011.01033.x 21771263 · DOI
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Carvalho, L., Junior, R. M., Barreira, J., Schoenfeld, B. J., Orazem, J., & Barroso, R. (2022) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2021-0515 · Cited by 116 · see citing works
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LIM, C., KIM, H. J., MORTON, R. W., HARRIS, R., PHILLIPS, S. M., JEONG, T. S., & KIM, C. K. (2019) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002088 · Cited by 81 · see citing works
Nuzzo, J. L., Pinto, M. D., Nosaka, K., & Steele, J. (2024) · Sports Medicine · doi:10.1007/s40279-023-01937-7 · Cited by 85 · see citing works
Refalo, M. C., Hamilton, D. L., Paval, D. R., Gallagher, I. J., Feros, S. A., & Fyfe, J. J. (2021) · Journal of Sports Sciences · doi:10.1080/02640414.2021.1898094 · Cited by 45 · see citing works
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Spitz, R. W., Bell, Z. W., Wong, V., Yamada, Y., Song, J. S., Buckner, S. L., Abe, T., & Loenneke, J. P. (2020) · Physiological Measurement · doi:10.1088/1361-6579/abb1fa · Cited by 31 · see citing works
Self-citationWarneke, K., Keiner, M., Hillebrecht, M., & Schiemann, S. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191811621 · Cited by 20 · see citing works
- Authors
- Jessee, M. B., Buckner, S. L., Mouser, J. G., Mattocks, K. T., Dankel, S. J., Abe, T., Bell, Z. W., Bentley, J. P., & Loenneke, J. P.
- Affiliations
- University of Southern Mississippi (US)
- University of South Florida (US)
- Troy University (US)
- Lindenwood University (US)
- University of Mississippi (US)
- Corresponding author
- Loenneke, Jeremy P.
- ORCID
- Venue
- Frontiers in Physiology
- Publisher
- Frontiers Media SA
- Published
- 2018-10-16
- Volume
- 9
- Pages
- 1448-1448
- ISSN
- 1664-042X (ISSN-L)
- PMC
- PMC6198179
- OpenAlex
- W2893001864
- Cited by
- 164
- References
- 3
- Citations by year
- 2026: 12 · 2025: 18 · 2024: 30 · 2023: 19 · 2022: 33 · 2021: 21 · 2020: 16 · 2019: 15
- FWCI
- 17.15
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Frontiers in Physiology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Aquila Digital Community (University of Southern Mississippi) (submittedVersion)
- Digital Commons - University of South Florida (University of South Florida) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Keywords
- blood flow restriction training, high-load resistance training, muscle hypertrophy, muscular endurance, knee extension, muscle thickness, isokinetic strength, one-repetition maximum, muscle fatigue, muscle blood flow, muscle fiber cross-sectional area, muscle fiber diameter, muscle fiber length
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