Commentary: Can Blood Flow Restricted Exercise Cause Muscle Damage? Commentary on Blood Flow Restriction Exercise: Considerations of Methodology, Application, and Safety
Mathias Wernbom, Brad J. Schöenfeld, Gøran Paulsen, Thomas Bjørnsen, Kristoffer Toldnes Cumming, Per Aagaard, Brian C. Clark, Truls Raastad
Abstract
Low-load exercise combined with blood flow restriction (BFR) is known to induce significant gains in muscle strength and size, and this mode of training is increasingly used in both healthy and clinical populations, as documented in the recent review of Patterson et al. (2019). However, since the first training studies on BFR exercise appeared about 20 years ago, there have been some concerns about its safety, in particular with regard to the potential risk for muscle damage (Wernbom et al., 2019). In a recent editorial, Wernbom et al. (2019) briefly discussed the accumulating evidence for muscle damage and rhabdomyolysis with very strenuous and unaccustomed BFR resistance exercise (BFR-RE). In contrast, Patterson et al. (2019) stated that “analysis of the incidence rate from the published literature suggests the risk remains very low (0.07–0.2%),” referring to the editorial of Thompson K. M. A. et al. (2018). Patterson et al. (2019) went on to conclude: “In summary, the available evidence suggests that the application of BFR does not appear to induce a muscle damage response to low-load resistance exercise using single exercise protocols of up to five sets to volitional failure.” In our view, these statements do not recognize the nuances and complexities of the topic, and we argue that the available evidence does suggest that BFR-RE may induce muscle damage under some circumstances (Wernbom et al., 2019). Given the obvious importance of the issue, in this commentary we will elaborate on the points discussed in the recent editorial of Wernbom et al. (2019).