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Supplemental Digital Content is Available in the Text.Scott, BR, Marston, KJ, Owens, J, Rolnick, N, and Patterson, SD. Current implementation and barriers to using blood flow restriction training: Insights from a survey of allied health practitioners. J Strength Cond Res38(3): 481–490, 2024—This study investigated the use of blood flow restriction (BFR) exercise by practitioners working specifically with clinical or older populations, and the barriers preventing some practitioners from prescribing BFR. An online survey was disseminated globally to allied health practitioners, with data from 397 responders included in analyses. Responders who had prescribed BFR exercise (n= 308) completed questions about how they implement this technique. Those who had not prescribed BFR exercise (n= 89) provided information on barriers to using this technique, and a subset of these responders (n= 22) completed a follow-up survey to investigate how these barriers could be alleviated. Most practitioners prescribe BFR exercise for musculoskeletal rehabilitation clients (91.6%), with the BFR cuff pressure typically relative to arterial occlusion pressure (81.1%) and implemented with resistance (96.8%) or aerobic exercise (42.9%). Most practitioners screen for contraindications (68.2%), although minor side effects, including muscle soreness (65.8%), are common. The main barriers preventing some practitioners from using BFR are lack of equipment (60.2%), insufficient education (55.7%), and safety concerns (31.8%). Suggestions to alleviate these barriers included developing educational resources about the safe application and benefits of BFR exercise (n= 20) that are affordable (n= 3) and convenient (n= 4). These results indicate that BFR prescription for clinical and older cohorts mainly conforms with current guidelines, which is important considering the potentially increased risk for adverse events in these cohorts. However, barriers still prevent broader utility of BFR training, although some may be alleviated through well-developed educational offerings to train practitioners in using BFR exercise.

Lovegrove, S, Hughes, L, Mansfield, S, Read, P, Price, P, and Patterson, SD. Repetitions in reserve is a reliable tool for prescribing resistance training load. J Strength Cond Res36(10): 2696–2700, 2022—This study investigated the reliability of repetitions in reserve (RIR) as a method for prescribing resistance training load for the deadlift and bench press exercises. Fifteen novice trained men (age: 17.3 ± 0.9 years, height: 176.0 ± 8.8 cm, body mass: 71.3 ± 10.7 kg) were assessed for 1 repetition maximum (1RM) for deadlift (118.1 ± 27.3 kg) and bench press (58.2 ± 18.6 kg). Subsequently, they completed 3 identical sessions (one familiarization session and 2 testing sessions) comprising sets of 3, 5, and 8 repetitions. For each repetition scheme, the load was progressively increased in successive sets until subjects felt they reached 1-RIR at the end of the set. Test-retest reliability of load prescription between the 2 testing sessions was determined using intraclass correlation coefficient (ICC) and coefficient of variation (CV). A 2-way analysis of variance with repeated measures was used for each exercise to assess differences in the load corresponding to 1-RIR within each repetition scheme. All test-retest comparisons demonstrated a high level of reliability (deadlift: ICC = 0.95–0.99, CV = 2.7–5.7% and bench press: ICC = 0.97–0.99, CV = 3.8–6.2%). Although there were no differences between time points, there was a difference for load corresponding to 1-RIR across the 3 repetition schemes (deadlift: 88.2, 84.3, and 79.2% 1RM; bench press: 93.0, 87.3, and 79.6% 1RM for the 3-, 5-, and 8-repetition sets, respectively). These results suggest that RIR is a reliable tool for load prescription in a young novice population. Furthermore, the between-repetition scheme differences highlight that practitioners can effectively manipulate load and volume (repetitions in a set) throughout a training program to target specific resistance training adaptations.

Physical exercise induces acute psychophysiological responses leading to chronic adaptations when the exercise stimulus is applied repeatedly, at sufficient time periods, and with appropriate magnitude. To maximize long-term training adaptations, it is crucial to control and manipulate the external load and the resulting psychophysiological strain. Therefore, scientists have developed a theoretical framework that distinguishes between the physical work performed during exercise (i.e., external load/intensity) and indicators of the body's psychophysiological response (i.e., internal load/intensity). However, the application of blood flow restriction (BFR) during exercise with low external loads/intensities (e.g., ≤ 30% of the one-repetition-maximum, ≤ 50% of maximum oxygen uptake) can induce physiological and perceptual responses, which are commonly associated with high external loads/intensities. This current opinion aimed to emphasize the mismatch between external and internal load/intensity when BFR is applied during exercise. In this regard, there is evidence that BFR can be used to manipulate both external load/intensity (by reducing total work when exercise is performed to exhaustion) and internal load/intensity (by leading to higher physiological and perceptual responses compared to exercise performed with the same external load/intensity without BFR). Furthermore, it is proposed to consider BFR as an additional exercise determinant, given that the amount of BFR pressure can determine not only the internal but also external load/intensity. Finally, terminological recommendations for the use of the proposed terms in the scientific context and for practitioners are given, which should be considered when designing, reporting, discussing, and presenting BFR studies, exercise, and/or training programs.

Waddingham, DP, Millyard, A, Patterson, SD, and Hill, J. Effect of ballistic potentiation protocols on elite sprint swimming: optimizing performance. J Strength Cond Res35(10): 2833–2838, 2021—Warming-up before an athletic event is important for performance; however, in some competition scenarios, there is a long wait between completing the warm-up and the event. Thus, potentiation protocols are becoming increasingly popular in a competition environment. The aim of the study was to determine the effects of practical potentiation protocols on 15-m start performance in national level swimmers. Eleven national level swimmers participated in the study. Using a randomized cross-over design, subjects completed a 15-m swimming start following 4 different experimental conditions (swim-specific control, resisted band squat, weighted countermovement jumps, and drop jumps from a 45-cm box), each separated by at least 48 hours. A repeated-measures analysis of variance showed a significant difference in 15-m swimming start performance following different warm-up protocols (F(1.646, 14.810)= 6.968, p= 0.01). A post hoc Bonferroni test indicated that 15-m start time was significantly quicker with the band squat protocol compared with the swim-specific protocol (6.65 ± 0.43 vs. 6.78 ± 0.43 seconds, respectively, p= 0.04). The results conclude that practical potentiation protocols are able to enhance 15-m swim start performance when combined with a swim-specific warm-up and supports the use of postactivation potentiation during competitive swimming environments.

Jeffries, O, Simmons, R, Patterson, SD, and Waldron, M. Functional threshold power is not equivalent to lactate parameters in trained cyclists. J Strength Cond Res35(10): 2790–2794, 2021—Functional threshold power (FTP) is derived from a maximal self-paced 20-minute cycling time trial whereby the average power output is scaled by 95%. However, the physiological basis of the FTP concept is unclear. Therefore, we evaluated the relationship of FTP with a range of laboratory-based blood lactate parameters derived from a submaximal threshold test. Twenty competitive male cyclists completed a maximal 20-minute time trial and an incremental exercise test to establish a range of blood lactate parameters. Functional threshold power (266 ± 42 W) was strongly correlated (r= 0.88, p< 0.001) with the power output associated with a fixed blood lactate concentration 4.0 mmol·L−1(LT4.0) (268 ± 30 W) and not significantly different (p> 0.05). While mean bias was 2.9 ± 24.6 W, there were large limits of agreement (LOA) between FTP and LT4.0(−45 to 51 W). All other lactate parameters, lactate threshold (LT) (236 ± 32 W), individual anaerobic threshold (244 ± 33 W), and LT thresholds determined using the Dmax method (221 ± 25 W) and modified Dmax method (238 ± 32 W) were significantly different from FTP (p< 0.05). While FTP strongly correlated with LT4.0,the large LOA refutes any equivalence as a measure with physiological basis. Therefore, we would encourage athletes and coaches to use alternative field-based methods to predict cycling performance.