The aim of this review was to explore the use of various blood flow restriction (BFR) techniques in order to provide meaningful insight and practical outcomes for exercise performance. An electronic literature search was performed, with specific focus on BFR during strength exercise, as well as the use of ischemic preconditioning (IPC) as a strategy to enhance aspects of preparation and recovery when employed directly pre- or post-exercise. These techniques involve the use of non-invasive inflatable cuffs, wraps or tourniquets applied to the upper thigh(s) or arm(s) to apply the desired level of restriction to arterial inflow and venous return to the target muscle group. When combined with low-load (20-40% 1RM) strength training (approximately 75 reps over 3-4 sets), BFR can facilitate significant strength and morphological adaptions when compared to traditional methods (60-80% 1RM). However, practical research suggests that a combination of both low-load BFR (2-3 times per week) and high-load training will result in the best adaptations and sport-specific outcomes over a 6-10-week period. Ischemic preconditioning in BFR applied pre-exercise, with repeating cycles of complete arterial occlusion (ischemia) and intermittent reperfusion providing significant benefit to exercise tolerance during subsequent maximal aerobic and anaerobic exercises bouts, due to the positive influence on hemodynamics and metabolic efficiency. Specifically, the use of three to four 5 min cycles of alternating ischemia and reperfusion applied bilaterally on the lower limbs approximately 45 min pre-exercise, may produce the greatest benefit to the impending exercise bout. Overall, this review showed that BFR techniques could offer a safe and viable ergogenic aid for enhancing aspects of preparation, recovery and adaptation for exercise performance.
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