Occlusion Training: A Role in Bodybuilding

By Dr. Brian Graf PT, DPT, BS

First of all, what is occlusion training? It involves reducing the blood flow to and from a muscle by either decreasing or completely occluding arterial blood flow into the muscle and occluding the venous blood flow out of the muscle. This type of training has been called many things over the last 20 years, including “occlusion training,” “kaatsu method” and “ischemic training.” What if I told you that current research shows significant increases in strength and muscle mass while lifting between 20 and 50 percent of your 1-rep max as opposed to your usual 60 to 85 percent?2, 3, 4

Occlusion training is primarily utilized for the arms and legs as they are easily occluded with wraps or pressure cuffs. Occluding the chest, back or shoulders may be partially done, but there is little research supporting this. Research usually involves pressure cuffs being applied to the upper arms or upper legs ranging from 140 mmHG to 240 mmHG to reduce venous return and or arterial blood flow into the muscle bellies.2, 3, 4, 5 Once the arms or legs are occluded, one performs high repetitions for multiple sets over a 5- to 8-minute period.

Outside of a lab, very few lifters have specialized cuffs for doing this. Thus, most lifters utilize competition-style knee wraps that are approximately three inches wide and wrap their extremities snugly. Wider bands are important as they reduce the sheer forces and overall compressive forces on the muscles while still providing occlusion.6 While this is not a very accurate technique, it seems to be the most economical and useful in attaining at least 140mmHG of circumferential pressure. A word of warning: Occlusion for long periods of time can cause damage; thus I would recommend taking off the wraps following your 2 to 5 sets.

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To assure you this is safe, a survey of 12,600 participants in occlusion training reported that less than 201 people suffered any serious side effects.13 Also, research performed in 2005 involved complete occlusion for 20 minutes to the forearm without any measurable damage or platelet changes.7 That being said, most protocols range from 2 to 8 minutes, which appears well within the safe range. A word of warning: This training is intense and can be as painful as high resistance training, if not more so.

Personally, this type of training had me wondering if occlusion training would be synergistic with normal resistance training. There is some research suggesting this to be true.1 Interestingly, an article from 2008 showed no enhancement in strength or hypertrophy when occlusion training was utilized at a load of 60 to 80 percent 1-rep max.5 Thus, it appears the threshold for occlusion training may be up to 50 percent of your 1RM, without increased benefit after that.

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So how can starving your muscles of blood flow stimulate muscle growth? Currently research has not come to a firm consensus on the exact mechanism in which this unique training manages to stimulate similar strength and hypertrophy as classic strength training. However, a review on the topic has suggested a couple of different mechanisms that appear plausible.12 They range from increased type II muscle fiber recruitment, accumulation of localized growth factors, and increased expression of hormones and systemic growth factors.8, 9, 10 Possibilities that have less supporting research also include increased nitric oxide (NO) and reactive oxygen species playing a role in the muscle hypertrophy.9, 11 Again, the latter two possibilities are just that; they currently lack overall research and are an area of interest for further experiments. The bottom line is that research shows increases in strength ranging from 10 to 30 percent relative to a 1RM and increases in mass ranging from 3 to 10 percent in trained athletes and untrained volunteers who completed this type of training.2, 3

Parameters for this type of training are not yet well defined when compared to classic strength training protocols. A generalized summary of published protocols shows that intensity is generally 20 to 50 percent of 1RM, includes 1 to 5 sets, involves anywhere from 10 to 30 repetitions, includes rest periods between 30 and 90 seconds, and is performed 2 times per week.12 The occlusive straps are utilized during the entire training episode, which generally lasts 5 to 8 minutes.

So where else can occlusion training fit into your bodybuilding regimen? Smart training requires rest periods and decreased training intensities throughout the year—i.e., “active rest”—in order to avoid overtraining. This idea of active rests generally involves training your body parts with significantly decreased resistance and decreased intensity, resulting in decreased mass and strength gains. It appears that occlusion training may be a great adjunct during your active rest periods. This type of training stresses tendons, bones and joints significantly less while still stimulating similar strength and mass gains as heavy resistance training. This also may be a great technique while dieting down and giving yourself breaks from the heavyweight, high-intensity training that can be extremely taxing to a calorie-depleted body. In my personal opinion, this is an easy sell. If you plan on taking active rest periods throughout the year to give your joints a rest, why not try a type of training that reaps more benefits for your physique?

In summary, occlusive training offers similar increases in strength and muscle mass as classic strength training at 60 to 85 percent 1RM. This holds true for trained athletes and untrained participants. The method is relatively safe; however, one must utilize common sense and ease into training as one would with any other resistance program. Occlusion training offers a unique stimulus to the muscles, and I would advise utilizing it intermittently, between or with your classic strength-training program. Further research is being conducted on this topic at a rapid pace and should help elucidate the mechanisms and best protocol for training.

I encourage you as a bodybuilder to keep an open mind to new training protocols, especially those supported by research. If you have doubts, take the time to read the articles cited below and continue with an independent research review of your own. Do not believe anything you hear around the weight room. Rather, challenge yourself to constantly examine your training method so that you can refine your specific techniques. That is the only way you will find the most economical and specific training style to build your physique.

Note from the editor: Brian Graf has a doctorate of physical therapy and a B.S. in exercise science . He is a professional drug-free bodybuilder in the IFPA.


  1. Yasuda T, Ogasawara R, Sakamaki M, Ozaki H, Sato Y, Abe T. Combined effects of low-intensity blood flow restriction training and high-intensity resistance training on muscle strength and size. Eur J Appl Physiol. 2011;111(10):2525-33. doi: 10.1007/s00421-011-1873-8.
  2. Takarada Y, Takazawa H, Sato Y, Takebayashi S, Tanaka Y, Ishii N. Effects of resistance exercise combined with moderate vascular occlusion on muscular function in humans. / Effets d'un exercice musculaire contre une resistance combine avec une occlusion vasculaire partielle sur la fonction musculaire chez l'homme. J Appl Physiol [serial online]. June 2000;88(6):2097-2106. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed July 15, 2012.
  3. Takarada Y, Sato Y, Ishii N. Effects of resistance exercise combined with vascular occlusion on muscle function in athletes. / Effets d'un effort de resistance combine avec une occlusion vasculaire du muscle de l’ athlete. Eur J Appl Physiol [serial online]. February 2002;86(4):308-314. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed July 15, 2012.
  4. Kubo K, Komuro T, Fukunaga T, et al. Effects of low-load resistance training with vascular occlusion on the mechanical properties of muscle and tendon. J Appl Biomech [serial online]. May 2006;22(2):112-119. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed July 15, 2012.
  5. Laurentino G, Ugrinowitsch C, Tricoli V, et al. Effects of strength training and vascular occlusion. Int J Sports Med [serial online]. August 2008;29(8):664-667. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed July 15, 2012.
  6. Crenshaw AG, Hargens AR, Gershuni DH, Rydevik B. Wide tourniquet cuffs more effective at lower inflation pressures. Acta Orthop Scand. 1988, 59:447-451.
  7. Kilian J, Nakhla S, Griffith K, Harmer J, Skilton M, Celermajer D. Reperfusion injury in the human forearm is mild and not attenuated by short-term ischemic preconditioning. Clin Exp Pharmacol Physiol [serial online]. January 2005;32(1/2):86-90. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed July 15, 2012.
  8. Yasuda T, Abe T, Sato Y, Midorikawa T, Kearns CF, Inoue K, Ryushi T, Ishii N. Muscle fiber cross-sectional area is increased after two weeks of twice daily KAATSU-resistance training. Int J Kaatsu Training Res. 2005;1:65-70
  9. Takarada Y, Nakamura Y, Aruga S, Onda T, Miyazaki S, Ishii N. Rapid increase in plasma growth hormone after low-intensity resistance exercise with vascular occlusion. J Appl Physiol [serial online]. January 2000;88(1):61-65. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed July 15, 2012.
  10. Fujita S, Abe T, Rasmussen B, et al. Blood flow restriction during low-intensity resistance exercise increases S6K1 phosphorylation and muscle protein synthesis. J Appl Physiol [serial online]. September 2007;103(3):903-910. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed July 15, 2012.
  11. Kawada S, Ishii N. Skeletal muscle hypertrophy after chronic restriction of venous blood flow in Rats. Med Sci Sports Exerc [serial online]. July 2005;37(7):1144-1150. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed July 15, 2012.
  12. Wernbom M, Augustsson J, Raastad T. Ischemic strength training: a low-load alternative to heavy resistance exercise? Scand J Med Sci Sports [serial online]. August 2008;18(4):401-416. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed July 15, 2012.
  13. Nakajima T, Kurano M, Iida H, Takano H, Oonuma H, Morita T, Meguro K, Sato Y, Nagata T. Use and safety of KAATSU training: results of a national survey. Int J Kaatsu Training Res 2006;2: 5-14.



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