Acute cellular and molecular responses and chronic adaptations to low-load blood flow restriction and high-load resistance exercise in trained individuals

J Appl Physiol (1985). 2021 Dec 1;131(6):1731-1749. doi: 10.1152/japplphysiol.00464.2021. Epub 2021 Sep 23.


Blood flow restriction (BFR) with low-load resistance exercise (RE) is often used as a surrogate to traditional high-load RE to stimulate muscular adaptations, such as hypertrophy and strength. However, it is not clear whether such adaptations are achieved through similar cellular and molecular processes. We compared changes in muscle function, morphology, and signaling pathways between these differing training protocols. Twenty-one males and females (means ± SD: 24.3 ± 3.1 yr) experienced with resistance training (4.9 ± 2.6 yr) performed 9 wk of resistance training (three times per week) with either high-loads (75%-80% 1RM; HL-RT), or low-loads with BFR (30%-40% 1RM; LL-BFR). Before and after the training intervention, resting muscle biopsies were collected, and quadricep cross-sectional area (CSA), muscular strength, and power were measured. Approximately 5 days following the intervention, the same individuals performed an additional "acute" exercise session under the same conditions, and serial muscle biopsies were collected to assess hypertrophic- and ribosomal-based signaling stimuli. Quadricep CSA increased with both LL-BFR (7.4 ± 4.3%) and HL-RT (4.6 ± 2.9%), with no significant differences between training groups (P = 0.37). Muscular strength also increased in both training groups, but with superior gains in squat 1RM occurring with HL-RT (P < 0.01). Acute phosphorylation of several key proteins involved in hypertrophy signaling pathways, and expression of ribosomal RNA transcription factors occurred to a similar degree with LL-BFR and HL-RT (all P > 0.05 for between-group comparisons). Together, these findings validate low-load resistance training with continuous BFR as an effective alternative to traditional high-load resistance training for increasing muscle hypertrophy in trained individuals.NEW & NOTEWORTHY Low-load resistance exercise with blood flow restriction (LL-BFR) is an effective method for stimulating muscular adaptations, but phenotypical and mechanistic comparisons with traditional high-load training (HL-RT) in trained populations are scarce. The findings indicate that hypertrophy, but not strength, is comparable between LL-BFR and HL-RT, and the acute cellular and molecular processes for hypertrophy were similar, but not identical, between protocols. Thus, LL-BFR is an effective alternative to HL-RT for obtaining hypertrophy in trained populations.

Keywords: Kaatsu; hypertrophy; hypoxia; ischemia; occlusion.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Physiological
  • Exercise
  • Female
  • Humans
  • Male
  • Muscle Strength
  • Muscle, Skeletal
  • Regional Blood Flow
  • Resistance Training*