Reported side-effects and safety considerations for the use of blood flow restriction during exercise in practice and research

Blood flow restriction (BFR) exercise is seen as a potential alternative to traditional training methods, and evidence suggests this is being used with both healthy and clinical populations worldwide. Although the efficacy of the technique regarding muscular adaptations is well known, the safety of its use has been questioned. The purpose of this review was: (i) provide an overview of the known reported sideeffects while using BFR exercise; (ii) highlight risks associated with the cardiovascular system, and; (iii) suggest recommendations to minimize risk of complications in both healthy and clinical populations. Overall, reported side-effects include perceptual type responses (ie, fainting, numbness, pain, and discomfort), delayed onset muscle soreness, and muscle damage. There may be heightened risk to the cardiovascular system, in particular increased blood pressure responses, thrombolytic events, and damage to the vasculature. However, while these may be of some concern there is no evidence to suggest that BFR exercise elevates the risk of complications any more than traditional exercise modes. Several modifiable extrinsic factors for risk minimization include selecting the appropriate BFR pressure and cuff width, as well as completion of a preexercise safety standard questionnaire to determine any contraindications to BFR or indeed the prescribed exercise. On the basis of the available evidence, we are confident that the side-effects of using BFR are minimal, and further minimized by the use of an appropriate method of application in the hands of a trained practitioner.