A comparison of variability between absolute and relative blood flow restriction pressures

Introduction: Recommendations are that blood flow restriction (BFR) be applied relative to arterial occlusion pressure (AOP) to provide a similar stimulus. Purpose: Compare variability of the change in blood flow, shear rate and discomfort between recommended relative pressures and an absolute pressure. Methods: During one visit, brachial arterial blood flow was measured in 91 participants using pulse-wave Doppler ultrasonography. After 5-min seated rest, AOP was measured. Following another 5-min rest, blood flow and discomfort were assessed twice before cuff inflation as controls (C1 and C2), then again with a cuff inflated to each BFR pressure (all measures separated by 1-min). Change scores from C1 to all subsequent measures were calculated (i.e., C2-C1; 40% AOP-C1; 80% AOP-C1; 100 mmHg-C1). Variability of the changes were compared via pairwise modified Pitman–Morgan tests (α = 0.008). Results: Variance (95% CI) of the change for blood flow (ml/min), shear rate (1/s), and discomfort (AU) had similar trends. C2-C1 differed from all conditions (all p < 0.001), 40% AOP-C1 differed from 80% AOP-C1 and 100 mmHg-C1 (all p < 0.001), which did not differ (both p ≥ 0.117). Blood flow: C2-C1 = 469.79 (357.90, 644.07), 40% AOP-C1 = 1263.18 (962.34, 1731.80), 80% AOP-C1 = 1752.90 (1335.42, 2403.18), 100 mmHg-C1 = 1603.18 (1221.36, 2197.92); shear rate: C2-C1 = 6248.24 (4760.10, 8566.15), 40% AOP-C1 = 14 625.30 (11 142.06, 20 050.95), 80% AOP-C1 = 22 064.02 (16 809.13, 30 249.27), 100 mmHg-C1 = 20 778.76 (15 829.98, 28 487.21); discomfort: C2-C1 = 0.07 (0.05, 0.08), 40% AOP-C1 = 2.03 (1.55, 2.78), 80% AOP-C1 = 4.26 (3.25, 5.84), 100 mmHg-C1 = 4.50 (3.43, 6.17). Conclusion: Contrary to previous suggestions, applying relative pressures does not necessarily guarantee a similar stimulus. It seems that higher pressures produce more variable changes even if the external pressure applied is made relative to each individual.