Author: armstrong.wou@gmail.com

“A wise man makes his own decisions. An ignorant man follows public opinion.”—Chinese Proverb

Inspiration often comes from signs that keep repeating themselves. Such is the case today. Truthfully, it is a topic that has been presenting itself well-beyond today and the last eighteen month. The above quote (which has also been attributed to the American journalist, Grantland Rice [1880-1954]) confirmed that this would be today’s subject.

The first thing I saw today was a post from a friend noting a statement by NPR that the US and China are responsible for 38% of the world’s carbon emissions. What was advertently of inadvertently omitted was that China’s responsibility is 27% and the US’s is 11%. With a bit more digging, I found that both countries have reduced carbon emissions from 2014 levels when they contributed 30- and 14%, respectively. I also learned that the US has returned to 1990 levels.

Over the last couple days, I have been seeing the powers-to-be called to question regarding the lack of discussion about natural immunity with regard to COVID-19. I would add that, not only are they willing to discuss immune v. not immune or natural v. artificial immunity, but they are also not willing to discuss risk stratification. Again, the information we receive is distorted by the narrative the source is trying to present.

I can continue with examples, but the point to be made is that we need to be informed, and to be “informed” means that we need to seek out information—even if it challenges our opinion and worldview. Again, often the “facts” we receive are limited to fit the narrative that the source want to support. Sometimes “misinformation” isn’t blatantly false. More often than that it simply omits contrary information, presents distorted information, or shared limited information.

In the last eighteen months, I have sought to inform myself of the literature regarding exercise and COVID-19. (This is just a current example—my intent is not to only shine a light on COVID-19 [mis]information). If I read of a study in a popular press article or hear one referenced in a podcast or YouTube video, I go to the source. (Admittedly, this is a bit easier for me with access to a University library, but with more and more ‘open-access’, it is quite a bit easier to find journal articles via Google search.) It is unfortunate that the urgency of COVID-19 has allowed journals to (pre)publish studies before they are peer-reviewed. Nevertheless, these can be evaluated with a critical eye.

I commented this morning, “If you believe you are informed because you read/listen to a ‘reputable’ news source but don’t confirm the information you receive, check yourself. How much less informed are you getting when you trust the information from social media and popular press? Even ‘scientific’ sources have been sharing studies *before* they are peer-reviewed. Challenge everything! Don’t just accept “data” because they fit your narrative. Science is not intended to confirm our views. Science is intended to shape–to expand–our understanding of the universe.”

Science is intended to shape–to expand–our understanding of the universe. I teach exercise science, and I can attest to the fact that what I teach today is very much different than what I taught 20 years ago. I disagree with quite a bit of what I was taught in the ‘80s and ‘90s and with conclusions drawn by prominent scientists in their time. I am by no means smarter than these, I simply have the benefit of more information—and better means of testing hypotheses. Science expands.

I don’t believe religion and science need to be divisive. Sadly, many study one without the benefit of the other. Personally, allowing myself to be open to both has given me a deeper understanding of both—an ability to see a greater GOD in both.

Years ago, I was challenged by a student based on what he had learned in another class. I welcomed the challenge. For many of the students, however, it was disconcerting. One student suggested that I just tell them what I wanted them to know for the test. This response was precisely the attitude that I did not want my students to take. It was a great opportunity to train them to question what they are being taught and to search out the truth. My confidence in the particular subject was shaken, but it forced me to (re)examine what I was teaching. I searched and (in this case) what I was teaching was affirmed. I share this story often with my students because my goal is to educate and not to indoctrinate. My goal is to grow my field of “expertise,” and the only way to grow knowledge is to put our presumptions and preexisting knowledge to the test. Truth will always win out, and science serves to reveal truth. We cannot say that we “follow the science” if we don’t question our current beliefs. We don’t “follow the science” if we don’t allow ourselves to explore the boundaries of our comfort. We don’t “follow the science” if we don’t question popular opinion.

“When pride comes, then comes disgrace, but with humility comes wisdom.”—Proverbs 11:2, NIV

Be your best today; be better tomorrow.

Carpe momento!

“According to the CDC¹, only 23% of American adults over the age of 18 meet the Physical Activity Guidelines for both aerobic and muscle strengthening activity.”

I shared the above statistic the other day. Yesterday, our veterinary commented on the number of dogs that gained weight during the pandemic. Today, I saw a statistic that Childhood obesity rates (age 5-11) increased from 36.2% to 45.7% during the pandemic. Nevertheless, the “experts” seem to ignore the ever-growing health crisis of hypokinetic disease. All indications point to the central role of inactivity, diet, and obesity (preventable risk factors) in the incidence of COVID-19. Somehow, though, we can’t see it. It must, after all, be the fault of the variants and the vaccine-hesitant (not trying to make a case against vaccination, here—if anything, these statistics should point to the fact that an overwhelming number of Americans who should be vaccinated are refusing to be). Consider these statistics….

“Only 23% of American adults over the age of 18 meet the Physical Activity Guidelines for both aerobic and muscle strengthening activity.” Do we understand how pathetically low these Guidelines are? They are the minimal guidelines for health—not for optimal physical performance. These Guidelines are the level of physical activity that might keep you from dying in the hospital of COVID-19, but are not likely to dramatically affect your risk of symptomatic infection. These Guidelines are 150 minutes of moderate aerobic exercise and 2 days of strengthening exercise (i.e., achieving a minimum effective volume of resistance training—which I would argue is not really present in the Guidelines. Two days a week is, at best, a maintenance volume—a volume that will minimize atrophy and not necessarily promote “strengthening” of the skeletal muscle.) The Guidelines, however, are not being met by 23% of the adult population. That means that 77% of the adult population is not achieving the minimum levels of physical activity necessary for health. Factor in the number of people who are just meeting the minimal levels, and the number who are achieving optimal health shrink. We can also consider those who are doing extreme amounts of physical activity and recognize that this is not optimal either. There are also those who might be getting the optimal amount and type of exercise for good health but are adversely affecting their health by not eating healthy, not getting enough sleep, or by having unhealthy levels of stress (and those who are doing their best with health conditions that are beyond their control). When we look at the numbers, it is clear that very few Americans are “healthy.” It is also clear that these numbers are worsening. (Questioned our vet, “How could dogs be gaining weight when the owners are working from home.” I know our dogs were walked more than usual during the pandemic. Maybe we are feeding them more like we are overfeeding ourselves.)

We have to take our activity levels seriously. By no means am I suggesting that we train for marathons and bodybuilding compositions. Indeed, these put a strain on the immune system and other physiological systems—which is why what little eyebrow I have gets raised when I hear someone say that a “healthy” person got severely ill with COVID-19. There are very few truly healthy Americans, but we have the opportunity to address this and correct this. It simply takes the will to put in the effort—in our communities, in our homes, and in our personal circumstances.

We need the medical community to recognize the central role of inactivity, diet, and body mass (both over-fat and under-muscle) in the demands on our health care system (regardless of COVID-19 infections). We need local, state, and federal representatives (I hesitate to say “leadership” because we need to stop playing the inactive role that has led us to where we are. It dismisses our collective responsibility.) to act accordingly. We have a bigger health issue than a virus.

Be your best today; be better tomorrow.

Carpe momento!

¹https://www.cdc.gov/nchs/fastats/exercise.htm

We are the culmination of every decision we have made in our lives. We might also consider that we are also the culmination of decisions made by and the circumstances of the generations that came before us (consider the growing science of epigenetics). Good or bad. Minor or major. The actions and inactions of past have shaped who we are—Spiritually, Physically, Intellectually, Emotionally, and Socially.

If the past has shaped our present, then, certainly, the present can shape our future. Carpe momento!

Because of COVID-19, I have been more focused on the Physical—perhaps to the detriment of my “well-centered fitness” (some dimensions have gone less attended too, and the Intellectual focus has been quite narrow). Health is, nevertheless, an important issue. I have been frustrated with the discussion because of the lack of discussion. The focus is on the immediate concern—the vaccine—and little attention is paid on the overwhelming effect of modifiable preexisting health. I might argue that we have been in a bit of denial. It highlights the notion that every action/inaction matters. The choice to exercise or not exercise, dietary decisions, smoking, weight control, etc. all have cumulative effects. If we were to look under the surface (and, honestly, I don’t see too many wanting to go there) of any “healthy” individual who has presented with severe COVID-19 infection, I believe, we will see some preexisting health condition. It may be genetic. It may be the lifestyle prior to becoming “healthy” (I teach my students about Jim Fixx—who, of course, they have never heard of—who can be largely credited with ushering the running craze in the ‘70’s and who died of a heart attack). It may be the lifestyle in becoming “healthy” (e.g., steroid use). It may be the lack of proper recovery and nutrition in “healthy” people (e.g., college athletes compound the effects of intense training with the stress of school, lack of sleep, poor nutrition, etc.). Many “healthy” people are under-fat (and some are also under-muscled). In clinical exercise science, the phase “apparently healthy” is more often applied. Few is anyone is completely “healthy”. Health is generally relative and situational. It is also comprehensive.

Likewise, our “well-centered fitness”—our Spiritual, Physical, Intellectual, Emotional, and Social well-being—is the cumulative effect of our past and present decision. It is, however, modifiable. We can’t change the past, but we can affect the result of the past on our future.

Be your best today; be better tomorrow.

Carpe momento!

I love the art of Monet. Quite possible my favorite painter. The thing about Monet’s art, though, is that it has little meaning close up. The detail is in stepping back and seeing the whole painting.

This is the world we are living in. We are far too focused on what separates us and fail to see the contribution of the individual. We compare. We divide. We only see the dots of paint.

We have the choice of standing too close and only seeing what supports our narrative and preconceived vision of the world, or we can step back and see the Purpose of each “dot of paint.”

“It is the harmony of the diverse parts, their symmetry, their happy balance; in a word it is all that introduces order, all that gives unity, that permits us to see clearly and to comprehend at once both the ensemble and the details.”—Henri Poincare

Be your best today; be better tomorrow!

Carpe momento!

It began in 1956 as the President’s Council on Youth Fitness. In 1963, the name was changed to the to the President’s Council on Physical Fitness by President Kennedy to reflect the needs of all Americans to be physically fit. Physical fitness was emphasized in schools as, beginning in 1966, many of us were required to test for the Presidential Physical Fitness Award (later changed to the President’s Challenge Youth Fitness Award). The council quickly morphed (1968) into the President’s Council on Physical Fitness and Sports to emphasize youth participation in sports. In 2010, President Obama renamed the agency the President’s Council on Fitness, Sport and Nutrition (which I would have to say is an apt name and purpose—presumably emphasizing the broader sense of fitness [Spiritual, Intellectual, Emotional, and Social, as well as Physical]). The goal also became a mission to “end the epidemic of childhood obesity in a generation.” Honestly, from this point in time, I recall very sparse activity on the part of the Council.

From the Council’s own website, it is described as consisting of “athletes, physicians, fitness professionals, and entrepreneurs who are appointed by the President and serve in an advisory capacity through the Secretary of Health and Human Services.” A glance at the list of appointees would indicate that there is little strength behind the Council as the members are noted for their accomplishments in sports rather than any background in nutrition, physical education, or exercise science.

For a class, not long ago, I wanted to state the most current guidelines for physical activity. It was a nightmare trying to find them. In writing this, I started with the health.gov website to see how many steps it would take to get there—three to get to a .pdf of the complete second edition of the Physical Activity Guidelines. To read through the guidelines and find clear summary of the guidelines is challenging to say the least. A link to the Executive Summary is the same number of steps and provides more clear and concise guidance, but still such guidance is limited. It also emphasizes minimal guidelines (for example, Figure A-1. Move Your Way Adult Dosage, simply recommends at least 150 minutes of moderate-intensity aerobic activity a week and at least two days of muscle-strengthening activities a week for adults) which are quite likely underestimated by the average American. According to the CDC¹, only 23% of American adults over the age of 18 meet the Physical Activity Guidelines for both aerobic and muscle strengthening activity. Thus, one can imagine how few actually sufficiently exceed the Guidelines to improve their health.

Quite clearly, the federal strategy for improving the fitness of Americans young and old is not working. Why? Because the really isn’t a strategy. If anything should come out of the current coronavirus pandemic, it should be that we are in a physical inactivity crisis in this country—the cost of which is in the tens, if not hundreds, of billions of dollars. We have lived with and (to varying degrees) accepted and complied with masking mandates and restricted behaviors for 18 months. We have come to demand access to health care, but we shy away from demanding access to universal health. Inequities in health care are reluctantly discussed as the impacts of COVID-19 are studied, but there is little talk about inequities in access to health—adequate healthy food, safe access to physical activity, health education, physical education in schools, etc. Discussions of health disparities always goes to access of care. Rarely do we hear discussion of prevention. Why?

It is time for action. We could begin with putting some credibility behind the President’s Council on Fitness, Sport and Nutrition. Let’s take a hard look at how government assistance programs operate to (not) bring healthy foods for Americans in need. Let’s take action at the local level and not depend upon a bloated distant federal government to tend to our local needs. Let’s address the issues in our communities that are contributing to the growth metabolic disease in our nation.

How would we react if the governors of our states were to mandate a closing of fast-food restaurants and restrict the sale of junk foods? Would we be supportive and say we have to all do our part to “flatten the curve” (i.e., the rising tails of the BMI or body composition distributions)?

How would we react to politicians imposing “standardized test” requirements in our schools and school districts higher more physical education teachers and allocating more time to teach to these testing standards? For once, teaching to the test might just make sense.

We have to support action to make Americans healthy. We have to be proactive. We have to focus on preventative health care. Doctors need to be trained to promote health—i.e. require more training in nutrition and exercise physiology—and to rely less on pharmaceuticals. We have to stop just giving lip-services to health.

We have to educate our communities regarding healthy behavior. This begins in K-12. It can begin with stronger standards for health and physical education. It will require addressing obesity and hypokinetic disease with strength and compassion.

So, here’s a thought…let’s start addressing the root of the problems with the health Americans and see how the burden on the health care health care systems improves.

Be your best today; be better tomorrow.

Carpe momento!

¹https://www.cdc.gov/nchs/fastats/exercise.htm

“A ‘No’ uttered from the deepest conviction is better than a ‘Yes’ merely uttered to please, or worse, to avoid trouble.”—Mahatma Gandhi

I have been thinking about the implications of my convictions a lot lately. These thought often bring to mind the following:

You’ve Got to Stand for Something.

Now Daddy didn’t like trouble, but if it came along
Everyone that knew him knew which side that he’d be on
He never was a hero, or this county’s shinin’ light
But you could always find him standing up
For what he thought was right
He’d say you’ve got to stand for something or you’ll fall for anything
You’ve got to be your own man not a puppet on a string
Never compromise what’s right and uphold your family name
You’ve got to stand for something or you’ll fall for anything

Now we might have been better off or owned a bigger house
If Daddy had done more givin’ in or a little more backing down
But we always had plenty just living his advice
Whatever you do today you’ll have to sleep with tonight

He’d say you’ve got to stand for something or you’ll fall for anything
You’ve got to be your own man not a puppet on a string
Never compromise what’s right and uphold your family name
You’ve got to stand for something or you’ll fall for anything

Now I know that things are different than they were in Daddy’s days
But I still believe what makes a man really hasn’t changed

You’ve got to stand for something or you’ll fall for anything
You’ve got to be your own man not a puppet on a string
Never compromise what’s right and uphold your family name
You’ve got to stand for something or you’ll fall for anything

You’ve got to stand for something or you’ll fall for anything.

Songwriters: Aaron Tippin / William Brock / William Calhoun Jr. Brock

Many of us have now heard about ACE2 as the receptor to which the SARS-CoV2 spike protein binds. Thus, it is considered the viral entry point for COVID-19. Other than that, we probably know little more about it.

Angiotensin converting enzyme (ACE) and angiotensin converting enzyme-2 (ACE2) play critical roles in the renin-angiotensin-aldosterone system (RAAS or RAS). To keep it simple, RAAS involves the series of reactions that work to regulate blood pressure. ACE affects vasoconstriction (i.e., tends to increase blood pressure) and ACE2 affects vasodilation (i.e., tends to decrease blood pressure). In a nutshell, a high ACE/ACE2 will promote high blood pressures, and a low ACE/ACE2 will promote low blood pressures. Unfortunately, to fully understand the functions of ACE and ACE2 might require at least one course in microbiology (Samavati and Uhal [2020] and Pagliaro and Penna [2020], however, present pretty good reviews).

A few things of note about ACE2, however, are that it is expressed throughout the body in tissues including liver, intestine, brain, heart, kidneys, and testes, as well as the lungs, and it is affected by age, gender, diet, and physical activity; women tend to have lower ACE/ACE2 ratios than men; and down-regulation of ACE2 (and/or up-regulation of ACE) and ACE/ACE2 imbalances is associated with cigarette smoking, cardiovascular and other pathologies, hypertension, high-sodium and/or high-glucose diets, insulin-resistance, diabetes, and obesity.

While ACE2 provides the coronavirus access to infect the body, it also provides a protective role (anti-inflammatory, anti-oxidant, anti-fibrotic, etc.) in cardiovascular, respiratory, and other tissues. Discussion of these mechanisms are beyond the scope of this blog (and, perhaps, the author’s ability to articulate them), but it is clear that upregulation of ACE2 favors greater protection against symptomatic COVID-19 (and the associated comorbidities). The SARS-CoV2 virus appears to down-regulate ACE2 and exacerbates the “pro-inflammatory milieu of high ACE/ACE2 ratio” (Pagliaro & Penna, 2020).

The interactions are complex, but, suffice it to say, ACE/ACE2 is an important health consideration—not only for COVID-19. There is, of course, a genetic component, but ACE/ACE2 is, above all, an issue of hypokinetic disease and diet. Obesity (albeit avoided in conversation) is a central factor in metabolic syndrome (the co-presence of insulin resistance, hypertension, and elevated triglycerides) and the risk of severe COVID-19 infection and death.

Risk factors for metabolic syndrome include: abdominal obesity (waist circumference >102 cm or 40 for men and >88 cm or 35 for women), high triglycerides (≥150 mg/dl), low HDL cholesterol (<40 mg/dl for men and <50 mg/dl for women), high blood pressure (≥130/85 mm Hg), and high fasting blood glucose (≥110 mg/dl). This would suggest that these are, in turn, risk factors for COVID-19.

Thus, a primary focus on defeating COVID-19—in eliminating severe complications (including long-haul COVID-19) and death—should be on controlling the factors that affect ACE/ACE2. Namely, light must be focused on nutritional and physical activity habits and altering the body composition of Americans. We also need to better understand the genetics behind ACE/ACE2. (Manning and Fink [2020] make an interesting case that will have you looking at your hand [i.e., the ratio of your index finger to your ring finger (2D:4D)]). Regardless of our gender and genetics, we need to become more active, maintain a healthy body composition, and stop eating crappy foods!

Be your best today; be better tomorrow.

Carpe momento!

 

Manning (2020). Understanding COVID-19: Digit ratio (2D:4D) and sex differences in national case fatality rates. Early Human Development, 146:105074. doi: 10.1016/j.earlhumdev.2020.105074

Pagliaro, P. & Penna, C. (2020). ACE/ACE2 Ratio: A Key Also in 2019 Coronavirus Disease (Covid-19)? Frontiers in Medicine, 7:335. doi: 10.3389/fmed.2020.00335

Samavati, L. & Uhal, B.D. (2020). ACE2, Much More Than Just a Receptor for SARS-CoV-2. Frontiers in Cellular and Infection Microbiology, 10:317. doi: 10.3389/fcimb.2020.00317

“Never blame someone else for the road you’re on. That’s your own asphalt”—Anonymous

I saw the above quote this morning. I see some truth to the statement, but I also find it troublesome. First, it is true that one should never blame someone else for the road that they are on. It is what it is. Blaming others is fruitless. I may be that others may have caused our circumstances—and this is true for the good as well as the bad—but it is always a personal choice what we do with our circumstances. The road behind us? That is what it is. Good or bad, it brought us to where we are. It made us who we are and is preparing us for who we will become. So, perhaps, the more we go down the road blaming others the more it becomes our own asphalt. The choice going forward is always ours, and ours alone, to make.

Be your best today; be better tomorrow.

Carpe momento!

“Keep reading books, but remember that a book’s only a book, and you should learn to think for yourself.”—Maxim Gorky

I came across the above quote this morning. The fact that I would be in conflict with many of Maxim Gorky’s social and political views adds strength to the value of the quote. Rarely, in our present society, are we encouraged to read views that conflict with our narrative—our world view. Increasingly, education and society is being sanitized in an effort to not offend and to drive political agendas. Our divide in society is widened by our dismissal of anything that might challenge our narrative. Social media leads us to scroll past anything we might not agree with in favor of that with fits our opinion. We are not challenged to be educated. Instead, “education” is a means to a document that is of rather little value other than to say we “checked the boxes.”

We are the most fortunate in history, because we have history at our fingertips. For the same reason, we are the least fortunate. We have access to much information, but dismiss the opportunity to use it wisely.

I heard a comment recently about how search engines increase our information bias. The algorithms favor our personal narrative. They continue to feed us the informational junk food that we preferably consume. Sadly, the information that might broaden, challenge, or possibly strengthen our view is lost.

I firmly believe in a liberal education. The term “liberal” has lost its meaning and is often associated with the political “left.” A liberal education, however, is not political, nor is it one-sided. “Liberal” refers to a willingness to respect or accept behavior or opinions that are different from one’s own. I means to be open to new ideas.

A liberal education, according to the Association of American Colleges & Universities, refers to “an approach to undergraduate education that promotes integration of learning across the curriculum and cocurriculum, and between academic and experiential learning, in order to develop specific learning outcomes that are essential for work, citizenship, and life.” It is unfortunate that our educational systems have drifted from these ideals. We often give lip services to the ideal of a liberal education; however, it is too often that the instructor seeks only to impart information—information that suits their narrative or the narrative that fits a broader political agenda. Education must, instead, promote individual thought, creativity, and ingenuity. Education must promote access to information and provide the necessary tools to access and interpret this information.

Education must inspire new ideas. Man was created to evolve—Spiritually, Physically, Intellectually, and Socially. We are meant to grow individually and collectively. Books are a path to inspiration and growth. Freedom to think, to challenge, and to process the experiences of others is essential.

Books are, indeed, just books unless we allow open access to them (and take advantage of our access) and allow ourselves and others to read that which creates conflict with our established ideas and opinions. Books in the hands of the uneducated are just books. In the hands of the truly educated—those who have learned to think for themselves—are both tools and weapons.

Be your best today; be better tomorrow.

willing to respect or accept behavior or opinions different from one’s own; open to new ideas.

Carpe momento!!

Blood flow restriction (BFR) training is an interesting “new” practice in fitness and rehabilitation. (I say “new”, but it has actually been around for decades—first introduced in Japan by Dr. Yoshiaki Sato in the ‘70s as what he called “Kaatsu” [a Japanese term meaning “added pressure”].) I have known of it for a while, but dismissed it a bodybuilding technique that favored sarcoplasmic hypertrophy (increased muscle volume) and had little benefit for strength and performance. Recently, however, I was caused to explore BFR after my 16-year-old was a passenger in a car that was broadsided by a pickup truck. All things considered, his injuries were minor, but they were enough to put a damper on his training goals for his next wrestling season. I have been blessed to have a role in the education of a number of physical therapists and athletic trainers. I reached out to some and the overwhelming response was “BFR.” So, I dove into the literature. I ordered a set of cuffs, and I got certified. Moreover, I starting trying it for myself.

BFR training is, in a nutshell, performing common exercises at a much-reduced load which removes the stress on the joints, ligaments, tendons, etc. from high-intensity resistance exercise. It is commonly understood that one must lift weights in excess of 70% of the one-repetition maximum (1-RM). With BFR, these loads are reduced to 20-40% 1-RM (or less—some research has indicated that passive BFR [restricted blood flow with no exercise] can help minimize atrophy from injury or immobilization). A standard protocol for BFR training is four sets for 30+15+15+15. Blood flow is occluded (“restricted” is a better term) at a percentage of arterial occlusion pressure (AOP) using bands or inflatable cuffs. Common limb occlusion pressures (LOP) are 50% of AOP for the upper extremity and 80% AOP for the lower extremity.

While an increasing number of bodybuilders are using BFR, and an increasing number of physical therapists ar seeing its benefits in post-injury rehabilitation, there may be a place for it in the programming of exercise for the aging exerciser. Why? BFR can stimulate muscle hypertrophy and some strength increases while minimizing excessive stress on the spine and joints. One may get the benefits of heavy resistance training without the heavy weights. (Consider it if you have had to give up squatting because of back issues, for example.) Even the serious powerlifter can benefit from decreasing the load stress while maximizing the metabolic stress to the muscle.

While the proposed mechanisms of BFR are beyond the scope of this writing, it can be stated simply that BFR simulated high-intensity resistance exercise without the heavy loads. Partial occlusion of blood flow to the limb decreases arterial blood flow (the muscle still gets some oxygenated blood) while trapping venous blood in the muscle. This results in an increase in metabolites, cellular swelling (“pump”), and increases the recruitment of fast-twitch muscle fibers (the reduced oxygen in the muscle and buildup of metabolites fatigues the slow-twitch fibers and tricks the muscle into using fast-twitch fibers at a much lower intensity). This triggers the many mechanisms for muscle hypertrophy. I would add, however, that heavy-load training is still necessary to increase strength and performance. Thus, for the athlete, BFR should be considered a supplement to regular training.

There are contraindications to BFR training. These include¹:

• Venous thromboembolism
• Impaired circulation or peripheral vascular compromise
• Previous revascularization of the extremity
• Extremities with dialysis access
• Acidosis
• Extremity infection
• Tumor distal to the tourniquet
• Medications and supplements known to increase clotting risk
• Open fracture
• Increased intracranial pressure
• Open soft tissue injuries
• Post-traumatic lengthy hand reconstructions
• Severe crushing injuries
• Severe hypertension
• Elbow surgery (where there is concomitant excess swelling)
• Skin grafts in which all bleeding points must be readily distinguished
• Secondary or delayed procedures after immobilization
• Vascular grafting
• Lymphectomies
• Cancer

The equipment required can vary from elastic tourniquets to inflatable cuff (similar to blood pressure cuffs) that can be manually or automatically inflated to the desired LOP. These can range from $30-40 to hundreds of dollars to thousands of dollars. In general, the tourniquets can be effective, but these may lack the precision of cuff pressure. (In general, the recommended tourniquet pressure is adjusted to a rating of 7/10 [10 being full occlusion].) Cuff AOP can be determined using Doppler, pulse oximeters, and palpation of the pulse (e.g., radial pulse for the upper extremity and dorsalis pedis pulse in the lower extremity). The latter takes some skill and practice; the former require some additional expense (note that is a pulse oximeter is used one the records continuously is needed). The choice of equipment is individualized and depends largely on budget and the level of precision desired. I opted for a moderately priced inflatable cuff from The Edge Mobility Systems². There are more expensive systems (B Strong³ [pictured above] is a nice system, as well, for a couple hundred dollars more; and there are much more expensive systems), but this one has suited my needs this far.

So, what’s it like? Honestly, I have never experienced quite the same pump. Leg day is more fatiguing than any 10×10 squat workout I have ever done. Squatting at 20% of my 1-RM feels pretty darn effective. I just started a three-week program, so time will tell. I am confident I will see positive results (as a hard gainer when it comes to legs). I am also looking forward to using BFR to help my son get back up to his wrestling weight and beyond.

Be your best today; be better tomorrow.

Carpe momento!

¹https://www.gallowaytherapy.com/bfr-contraindications/

²https://edgemobilitysystem.com/collections/the-fitness-collection/products/edge-restriction-system-bfr-cuffs

³https://bstrong.training/pages/product-2