The Rings have always been my favourite home-fitness equipment but lately I’ve been experimenting with Blood Flow Restriction (BFR) or Kaatsu Training.
What is BFR?
Seen here as the blue straps on my arms, basically they reduce venous blood flow back to the heart but are only partially restrict arterial blood flow from the heart to the muscles.
This accumulates metabolic by-products like lactic acid and carbon dioxide while depriving your muscles of oxygen, creating a hypoxic environment. 
This causes your slow-twitch (Type I) muscles to fatigue quickly (because they depend primarily on oxygen) and forces the engagement of your Fast Twitch (Type II) muscles.
Meaning … ?
You stimulate and fatigue both FAST and SLOW twitch muscles at the same time!
Something that ordinarily requires intense physical effort such as a high-intensity sprinting or very heavy weight-lifting.
This significantly enhance STRENGTH and builds MUSCLE MASS using lighter weights, less repetitions and in less time!
For example, you only need 20-40% of your 1-Repetition Maximum weight (1 RM) to achieve the same muscular fatigue as conventional strength training using 70-85% of your 1 RM.
1. TIME: You get a tougher workout in a shorter time.
2. LIGHTER WEIGHTS = LESS RISK: Because you only need 20-40% of your maximum weight, this means it is safe for at risk individuals like the ELDERLY or debilitated patients with medical conditions (KAATSU training is used widely in hospitals in Japan)
Lighter weights also mean lower risk for INJURY and faster RECOVERY.
3. INCREASED TRAINING FREQUENCY: Because only light weights are needed, people recover faster and so can train more often which then gives more stimulus for growth!
Compared to traditional heavy weight strength training which requires 24-72 hours of rest between trainings, BFR training using light weights can be done daily.
This allows people to stay active more and see results in shorter times.
4. HORMONES: The buildup of metabolic by-products stimulates more endogenous hormone production like…
- Human Growth hormone & IGF-1 (locally, within the muscles) are like natural steroids you produce for MUSCULAR GROWTH  – especially important for the ELDERLY to prevent Sarcopenia (loss of muscle mass)
- Vascular Endothelial Growth Factor (VEGF) is increased in response to the hypoxic (low oxygen) environment. This improves microcirculation by growing new blood vessels and capillaries. 
The microcirculation benefits are not just restricted to the muscles, they even benefit the brain and heart – which is why BFR training is also used in Japan for patients recovering from cardiovascular incidences like stroke and heart attacks.
BFR also increases Nitric Oxide production, which together with VEGF, spurs muscular growth through increasing the numbers of muscle stem cells by up to 300%! 
- Brain-derived Neurotrophic Factor (BDNF) in your brains which is like a fertilizer for brain cells, improving long-term memory and stimulating neurogenesis (growth of new brain cells).
5. AEROBIC EXERCISE: Increased strength and hypertrophy have been noted for BFR training with aerobic exercise too!  This is not common as aerobic training tends to reduce muscle mass as it primarily targets Type I slow-twitch muscle fibres which are smaller in size than Type II fast-twitch ones.
The required intensity for aerobic exercise with BFR is also very low (45% heart rate reserve or 40% VO2 max), meaning it is safer for at risk individuals like those with cardiovascular disease.
6. PREVENTING STRENGTH LOSS & ATROPHY: BFR has been used to prevent strength and muscle loss/wasting after surgery and periods of bed rest or immobilisation.
7. LESS OXIDATIVE STRESS: because of lesser loads compared to conventional resistance training, there is significantly LESS oxidative stress on the body 
8. SYSTEMIC EFFECTS: the increased hormone production benefits almost every major system in your body, including your BONES! 
9. PERFECT FOR THE ELDERLY: the use of light weights and the upregulated hormonal response makes this perfect for the elderly who often have difficulty maintaining or increasing muscle mass. Muscle is the organ of longevity and mortality is very closely related to the amino acid pool which comes primarily from your muscles. 
At first, I thought all these benefits are too good to be true but after 4 months of experimenting, I am convinced of the ingenuity of this biohack!
I even convinced my parents (who are in their 60s) to try BFR training with resistance bands!
Do note that there are many common mistakes people make when starting BFR training.
How do you do BFR?
Many people have dabbled with BFR training but may not be doing it right and therefore having mixed results or worse, injuring themselves.
Common mistakes include:
- Bands that are too tight, causing numbness, nerve pain or more serious pathologies such as a blood clot in your arteries and fainting
- Exercise loads that are too heavy or light, therefore not achieving fatigue in the recommended repetitions
- Not allowing reperfusion (releasing the bands’ pressure) between exercises and going BEYOND the recommended restriction time of 5-10 min per exercise
- Using bands on the arms and legs at the same time which might lower blood pressure too drastically. Hence it is only recommended to use bands on EITHER the arms OR the legs and focus on one exercise at a time.
Here is a model of exercise prescription with BFR for Resistance Exercise (RE) taken from the latest methodological research paper published in 2019 by a team of exercise physiologists specialising in BFR training. 
For resistance training, the sets and repetitions (reps) are slightly different than conventional training. The total volume of reps is about 75 with the 1st set being the highest – 30 repetitions.
Subsequently, you do 3 more sets of 15 repetitions, resting about 20-60 seconds in between sets.
So each exercise lasts 4 sets (30 + 15 + 15 + 15) with 20-60 secs between sets.
This is a better image describing this.
And this is the recommended exercise prescription for BFR training with Aerobic Exercise (AE) such as running or swimming. 
Of course to begin with you will need the BFR bands.
However, there are many BFR bands on the market that are much cheaper because they don’t come with the machine. These are not as safe as you can injure yourself if you tie them too tight.
The next thing you need is some resistance. This can come in the form of weights, resistance bands or simply use your own body weight.
When putting on the bands, a general gauge of tightness of 6/10 is enough. Note that your muscles will expand as they fill with blood once you start your training too.
One way to measure if your bands are too tight is to check your capillary refill times.
- Simply use your thumb and put pressure on the centre of the palm of your hands for several seconds. THis will produce a ‘white’ thumb-size area on your skin.
- Release and observe how long it takes for the redness/pinkness to return
- It should return in < 1 second. This is ideal.
- If it takes more than that, your bands are too tight!
Other safety pointers:
- If you get any NUMBNESS or TINGLING in your extremities (fingers or toes), RELEASE THE PRESSURE immediately to allow reperfusion and avoid damage!
- Always release the pressure after each exercise！
- NEVER wear the bands for more than 15 minutes on the ARMS and 20 minutes on the LEGS
MY PERSONAL FITNESS ROUTINE
I personally use them almost everyday now. But I rotate with different types of exercise so I don’t injure myself. This is my current fitness routine.
DAY 1: Saturdays & Tuesdays
AM (AEROBIC) – BFR bands on thighs: easy morning run up some slopes followed by some WIM HOF breath hold burpees / calisthenics like push-ups, pull-ups or squats without BFR bands.  (never more than 20 minutes and I will release pressure after each slope run or if I feel numbness)
PM (UPPER BODY STRENGTH) – I start with some Rings training without the bands to test my skill and strength progress.
After sufficient warmup, I put the BFR bands on my ARMS and do 1-2 exercises for the upper body using the Rings or resistance bands. I do both pushing and pulling exercises. Again, releasing pressure after each exercise.
Pushing: assisted push-ups, dips, shoulder press (light weights/resistance bands)
Pulling: assisted pull-ups, incline rows, bicep curls (light weights/resistance bands)
End with some core work on the Rings: front/back levers
DAY 2: Sundays & Wednesdays
AM (AEROBIC) – Same as Day 1 but less intense upper body exercises if I am aching (or none at all).
PM (LOWER BODY STRENGTH) – I start with testing my 1-Repetition Maximum deadlift and squats without the bands.
Then with BFR bands on LEGS: 1-2 exercises for the legs such as Squat jumps to failure followed by normal squats to failure, 1-leg pistol squats and lunges using my bodyweight. Again, releasing pressure after each exercise.
DAY 3.1: Mondays & Thursdays – active rest
PM (ACTIVE RECOVERY) – No strength training today as I will normally be aching all over.
BFR bands on ARMS: I watch and follow a YouTube shadow boxing session like this, releasing the pressure after 15 minutes.
I head down to the garden and work on some more shadow boxing or handstands without the BFR bands.
DAY 3.2: Fridays – active rest
PM (ACTIVE RECOVERY) – no BFRs. Might do some stretching/yoga and housework.
Blood Flow Restriction training is a novel method of training that produces amazing results with much less weights and time. This is due to the systemic effects of upregulated hormone production. Anyone can use this method to gain muscle and strength efficiently but it is especially beneficial for the elderly or anyone with an injury requiring immobilization/bedrest.
There are many dangers to be aware of, so it is advised to thoroughly research and understand how to do BFR training properly. The original KAATSU bands are the safest but very costly. Thankfully, there are BFR bands and exercise equipment like resistance bands readily available and affordable online for purchase.
Thank you for taking time to read this.
I hope this post has been educational and if you found it useful, please share it with someone who might benefit.
Leave a comment for any questions, opinions, tips or advice! They will all be appreciated.
Love, Peace and Health
- Patterson, S. D., Hughes, L., Warmington, S., Burr, J., Scott, B. R., Owens, J., Abe, T., Nielsen, J. L., Libardi, C. A., Laurentino, G., Neto, G. R., Brandner, C., Martin-Hernandez, J., & Loenneke, J. (2019). Blood Flow Restriction Exercise: Considerations of Methodology, Application, and Safety. Frontiers in physiology, 10, 533. https://doi.org/10.3389/fphys.2019.00533
- Wernbom, M., Augustsson, J., & Raastad, T. (2008). Ischemic strength training: a low‐load alternative to heavy resistance exercise?. Scandinavian journal of medicine & science in sports, 18(4), 401-416. Retrieved from https://nih.brage.unit.no/nih-xmlui/bitstream/handle/11250/170821/Raastad%20ScanJMedSciSport%202008.pdf?sequence=1
- Nielsen, J. L., Aagaard, P., Bech, R. D., Nygaard, T., Hvid, L. G., Wernbom, M., Suetta, C., & Frandsen, U. (2012). Proliferation of myogenic stem cells in human skeletal muscle in response to low-load resistance training with blood flow restriction. The Journal of physiology, 590(17), 4351–4361. https://doi.org/10.1113/jphysiol.2012.237008
- Bittar, S. T., Pfeiffer, P. S., Santos, H. H., & Cirilo‐Sousa, M. S. (2018). Effects of blood flow restriction exercises on bone metabolism: a systematic review. Clinical physiology and functional imaging, 38(6), 930-935. Retrieved from https://b3sciences.com/wp-content/uploads/2019/01/BFR-BONEMETABOLISM.pdf
- McLeod, M., Breen, L., Hamilton, D. L., & Philp, A. (2016). Live strong and prosper: the importance of skeletal muscle strength for healthy ageing. Biogerontology, 17(3), 497–510. https://doi.org/10.1007/s10522-015-9631-7
- Mercola, J. (2020). What You Need To Know About Blood Flow Restriction Training. Retrieved from https://fitness.mercola.com/sites/fitness/archive/2020/01/03/kaatsu-blood-flow-restriction-training.aspx
- KAATSU Bands link: https://www.kaatsu-global.com/index.cfm?Action=Store.Details&pid=11
- BFR Bands I recommend: https://www.lazada.sg/products/bfr-occlusion-wraps-pro-resistance-bands-fitness-arm-leg-blaster-elastic-exercise-bands-for-blood-flow-restriction-training-i656432669-s1988330501.html?spm=a2o42.searchlist.list.1.69466837ARiUfA&search=1
- Resistance bands for training: https://www.lazada.sg/products/13pcs-resistance-bands-set-workout-fintess-exercise-tube-bands-jump-rope-door-anchor-ankle-straps-cushioned-handles-8-shaped-resistance-band-with-carry-bags-for-home-gym-travel-i658364104-s1995324596.html?spm=a2o42.searchlist.list.42.4b3637d9WMmv4A&search=1
- Wim Hof Breath Hold exercises: https://www.youtube.com/watch?v=3Y8Jk1FUv_o
- MMAShredded, 15 Minute MMA Shadowboxing Workout: https://www.youtube.com/watch?v=MrzGlecbLxU