Key Takeaways & Executive Findings
- •• Blood flow restriction combined with low-intensity aerobic exercise significantly increases total energy expenditure compared to low-intensity aerobic exercise alone. • The combination does not significantly alter the proportional contribution of aerobic, anaerobic lactic, and anaerobic alactic energy systems. • Blood flow restriction training significantly increases excess post-exercise oxygen consumption during the 40-minute recovery period. • The intervention does not increase subjective ratings of perceived exertion, but heart rate is elevated at 1 minute post-exercise, warranting caution.
Abstract
BACKGROUND: In recent years, high-intensity interval exercise has been widely used and gained attention due to its short duration. However, its safety has been seriously questioned because of its high intensity and the controversial effects on the heart. Therefore, exploring time-efficient, intensity-controllable exercise interventions with good compliance has become a research hotspot in the field of exercise science. OBJECTIVE: To investigate the effects of blood flow restriction combined with aerobic exercise on energy expenditure. METHODS: Fifteen male college students were recruited. A repeated-measures crossover design was used to design two exercise protocols: low-intensity aerobic exercise (non-blood flow restriction group) and blood flow restriction training combined with low-intensity aerobic exercise (blood flow restriction group). Both protocols were performed at 40% maximal oxygen uptake, with 10 minutes of running per session, 1 minute rest between sessions, for a total of five sessions and an exercise duration of 54 minutes. In the blood flow restriction group, a cuff was placed at the most proximal end of both lower limbs and pressurized to 50% of the arterial occlusion pressure before exercise, and the pressure was released during each exercise interval. The interval between the two protocols was at least 72 hours. Blood lactate, energy expenditure during exercise, excess post-exercise oxygen consumption, ratings of perceived exertion, heart rate, and blood pressure were measured. RESULTS AND CONCLUSION: (1) Total energy expenditure in the blood flow restriction group was significantly greater than that in the non-blood flow restriction group (P < 0.05). (2) There was no significant difference in the proportional contribution of the three energy systems (aerobic, anaerobic lactic, and anaerobic alactic) between the two exercise modes (P > 0.05). (3) The total excess post-exercise oxygen consumption within 40 minutes of recovery was significantly greater in the blood flow restriction group than in the non-blood flow restriction group (P < 0.05). At 1 minute of recovery, heart rate was significantly higher in the blood flow restriction group than in the non-blood flow restriction group (P < 0.05). At other time points, there were no significant differences in ratings of perceived exertion, heart rate, or blood pressure between the two groups. (4) These findings suggest that blood flow restriction training combined with low-intensity aerobic exercise can increase energy expenditure and excess post-exercise oxygen consumption without additional increases in ratings of perceived exertion, providing an additional training option for individuals seeking to increase physical activity levels, but attention should be paid to the elevated heart rate during recovery.
1. Introduction
With the significant increase in the number of overweight and obese individuals [1-6], the lack of physical activity among the general population is reflected. Moreover, the latest research from the European Association for the Study of Obesity indicates that under a new clinical diagnostic framework, the global proportion of people classified as obese will be higher than that currently indicated by body mass index alone [7]. The sports medicine industry association recommends that moderate-intensity exercise (40%-60% of maximal oxygen uptake) should be performed for a cumulative 250-300 minutes per week, or vigorous-intensity exercise (>60% of maximal oxygen uptake) for a cumulative 150 minutes per week, to prevent significant weight gain, improve physical function, and reduce the risk of related chronic diseases [8]. However, due to lack of time, most people find it difficult to adhere to such exercise regimens [4]. The World Health Organization recommends that adults engage in at least 150-300 minutes of moderate-intensity aerobic activity, or at least 75-150 minutes of vigorous-intensity aerobic activity, or an equivalent combination of moderate- and vigorous-intensity activity per week to obtain substantial health benefits [9]. Yet, most people currently fail to meet the minimum exercise time standards, and lack of exercise time leads to reduced daily energy expenditure, thereby increasing the risk of chronic diseases.
In recent years, high-intensity interval exercise has been widely used and gained attention due to its short duration [10]. However, its safety has been seriously questioned because of its high intensity and the controversial effects on the heart [11]. Therefore, exploring time-efficient, intensity-controllable exercise interventions with good compliance has become a research hotspot in the field of exercise science. Aerobic exercise combined with blood flow restriction training has been proposed as a potential alternative to high-intensity interval aerobic exercise. Blood flow restriction training, also known as KAATSU training, involves applying external pressure to the proximal portion of a limb (upper or lower extremity) using a special pressurization device (typically a pneumatic cuff or elastic band) during exercise, occluding venous blood flow while partially restricting arterial blood flow to enhance training effects [12-13]. This method reduces arterial blood flow while increasing venous blood pooling in the working muscles [14]. The pressure applied during training is expressed as a percentage of arterial occlusion pressure. Compared with high-intensity interval exercise, low-intensity blood flow restriction training results in lower ratings of perceived exertion and may be more acceptable [15]. Compared with traditional aerobic training, blood flow restriction combined with aerobic training increases energy expenditure during exercise [16].
In recent years, blood flow restriction training combined with low-intensity resistance exercise has been widely applied in neurological rehabilitation, musculoskeletal rehabilitation, and postoperative rehabilitation. It has been shown to improve autonomic nervous function and vascular endothelial function [17], improve muscle strength and motor function [18-19], enhance proprioception [20], improve physical function [21], and prevent muscle atrophy [22]. However, the effects of blood flow restriction combined with aerobic exercise on energy expenditure and excess post-exercise oxygen consumption have not been fully elucidated. Therefore, this study aimed to investigate the effects of blood flow restriction combined with aerobic exercise on energy expenditure in young men, using a repeated-measures crossover design.
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LIU Meng, HOU Shilun (2026). Effects of blood flow restriction training and aerobic exercise on energy expenditure in young men. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21538
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Frequently Asked Questions
What is blood flow restriction training?
Blood flow restriction training, also known as KAATSU training, involves applying external pressure to the proximal part of a limb using a pneumatic cuff or elastic band during exercise. This occludes venous blood flow while partially restricting arterial blood flow, enhancing training effects. The pressure is typically set as a percentage of arterial occlusion pressure.
How does blood flow restriction combined with aerobic exercise affect energy expenditure?
According to the study, blood flow restriction combined with low-intensity aerobic exercise significantly increases total energy expenditure compared to low-intensity aerobic exercise alone. It also increases excess post-exercise oxygen consumption during the recovery period, without significantly altering the proportional contribution of energy systems.
Is blood flow restriction training safe?
Blood flow restriction training is generally considered safe when performed under appropriate supervision and with proper pressure settings. However, it may cause elevated heart rate during recovery, as noted in the study. Individuals with cardiovascular conditions should consult a healthcare professional before engaging in this type of training.
Who can benefit from blood flow restriction training combined with aerobic exercise?
This training modality may benefit individuals seeking to increase energy expenditure and improve body weight control, especially those who cannot tolerate high-intensity exercise. However, the study was conducted on healthy young men, so results may not be generalizable to other populations such as women, older adults, or individuals with obesity without further research.
What are the limitations of this study?
The study included only healthy male college students, so results may not apply to other populations. It assessed only a single exercise session, lacking long-term training effects. Additionally, arterial occlusion pressure may have time-dependent effects, and inconsistent testing times could influence results.
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