Training with blood flow restriction increases femoral artery diameter and thigh oxygen delivery during knee‐extensor exercise in recreationally trained men
Authors: Christiansen Danny , Eibye Kasper , Hostrup Morten , Bangsbo Jens 
Published: April 2020

Key points
Endurance‐type training with blood flow restriction (BFR) increases maximum oxygen uptake () and exercise endurance of humans. However, the physiological mechanisms behind this phenomenon remain uncertain.
In the present study, we show that BFR‐interval training reduces the peripheral resistance to oxygen transport during dynamic, submaximal exercise in recreationally‐trained men, mainly by increasing convective oxygen delivery to contracting muscles.
Accordingly, BFR‐training increased oxygen uptake by, and concomitantly reduced net lactate release from, the contracting muscles during relative‐intensity‐matched exercise, at the same time as invoking a similar increase in diffusional oxygen conductance compared to the training control.
Only BFR‐training increased resting femoral artery diameter, whereas increases in oxygen transport and uptake were dissociated from changes in the skeletal muscle content of mitochondrial electron‐transport proteins.
Thus, physically trained men benefit from BFR‐interval training by increasing leg convective oxygen transport and reducing lactate release, thereby improving the potential for increasing the percentage of that can be sustained throughout exercise.
AbstractIn the present study, we investigated the effect of training with blood flow restriction (BFR) on thigh oxygen transport and uptake, and lactate release, during exercise. Ten recreationally‐trained men (50 ± 5 mL kg−1 min−1) completed 6 weeks of interval cycling with one leg under BFR (BFR‐leg; pressure: ∼180 mmHg) and the other leg without BFR (CON‐leg). Before and after the training intervention (INT), thigh oxygen delivery, extraction, uptake, diffusion capacity and lactate release were determined during knee‐extensor exercise at 25% incremental peak power output (iPPO) (Ex1), followed by exercise to exhaustion at 90% pre‐training iPPO (Ex2), by measurement of femoral‐artery blood flow and femoral‐arterial and ‐venous blood sampling. A muscle biopsy was obtained from legs before and after INT to determine mitochondrial electron‐transport protein content. Femoral‐artery diameter was also measured. In the BFR‐leg, after INT, oxygen delivery and uptake were higher, and net lactate release was lower, during Ex1 (vs. CON‐leg; P < 0.05), with an 11% larger increase in workload (vs. CON‐leg; P < 0.05). During Ex2, after INT, oxygen delivery was higher, and oxygen extraction was lower, in the BFR‐leg compared to the CON‐leg (P < 0.05), resulting in an unaltered oxygen uptake (vs. CON‐leg; P > 0.05). In the CON‐leg, at both intensities, oxygen delivery, extraction, uptake and lactate release remained unchanged (P > 0.05). Resting femoral artery diameter increased with INT only in the BFR‐leg (∼4%; P < 0.05). Oxygen diffusion capacity was similarly raised in legs (P < 0.05). Mitochondrial protein content remained unchanged in legs (P > 0.05). Thus, BFR‐interval training enhances oxygen utilization by, and lowers lactate release from, submaximally‐exercising muscles of recreationally‐trained men mainly by increasing leg convective oxygen transport.