The Influence of Exercise Load With and Without Different Levels of Blood Flow Restriction On Acute Changes in Muscle Thickness and Lactate

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Clin Physiol Funct Imaging (2016) doi: 10.1111/cpf.

12367

The influence of exercise load with and without different


levels of blood flow restriction on acute changes in muscle
thickness and lactate
Jeremy P. Loenneke1, Daeyeol Kim2, Christopher A. Fahs3, Robert S. Thiebaud4, Takashi Abe5,
Rebecca D. Larson2, Debra A. Bemben2 and Michael G. Bemben2
1
Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, University, MS,
2
Department of Health and Exercise Science, University of Oklahoma, Norman, OK, 3Division of Education and Counseling, Lindenwood University-Belleville, IL,
4
Department of Kinesiology, Texas Wesleyan University, Fort Worth, TX, USA and 5National institute of Fitness and Sports in Kanoya, Kanoya, Kagoshima,
Japan

Summary

Correspondence The aim of this study was to compare exercise with and without different degrees
Jeremy Paul Loenneke, Kevser Ermin Applied Phys-
of blood flow restriction (BFR) on acute changes in muscle thickness (MTH) and
iology Laboratory, Department of Health, Exercise
Science, and Recreation Management, The Univer-
whole blood lactate (WBL). Forty participants were assigned to Experiment 1, 2
sity of Mississippi, PO Box 1848, University, MS or 3. Each experiment completed protocols differing by pressure, load and/or
38677, USA volume. MTH and WBL were measured pre and postexercise. The acute changes
E-mail: jploenne@olemiss.edu in MTH appear be maximized at 30% one repetition maximum (1RM) with BFR,
Accepted for publication although the difference between 20% 1RM and 30% 1RM at the lateral site was
Received 14 October 2015; small (01 versus 02 cm, P = 009). Increasing the exercise load from 20% to
accepted 10 March 2016 30% 1RM with BFR produces clear changes in WBL (37 versus 55 mmol l 1,
P<0001). The acute changes in MTH and WBL for 30% 1RM in combination
Key words
KAATSU; muscle hypertrophy; muscle strength;
with BFR were similar to that observed with 70% 1RM and 20 and 30% to fail-
occlusion training; vascular resistance ure, albeit at a lower exercise volume. These findings may have implications for
designing future studies as it suggest that exercise load (to a point) may have a
greater influence on acute changes in MTH and metabolic accumulation than the
applied relative pressure.

anism is the accumulation of metabolites (e.g. lactate) around


Introduction
the working muscle (Sugaya et al., 2011). This accumulation
Blood flow restriction (BFR) in combination with resistance of metabolites may provide some explanation for why differ-
exercise has been shown to result in muscular benefits across ences in muscle mass are observed even when the volume of
a variety of populations, including the elderly (Takarada et al., work is similar (Laurentino et al., 2012).
2000), highly trained athletes (Takarada et al., 2002), those Given that both acute MTH and the accumulation of
recovering from injuries (e.g. ACL, osteochondral fracture) metabolites have been hypothesized as mechanisms of muscle
(Lejkowski & Pajaczkowski, 2011; Loenneke et al., 2013b), as growth, an investigation into which combination of exercise
well as a patient diagnosed with an idiopathic inflammatory load and pressure elicits the largest increase in those variables
myopathy (Gualano et al., 2010). These muscular benefits have may be important from a methodological perspective. In addi-
been observed independent of a high load (~20–30% concen- tion, comparing those responses observed with low-load resis-
tric 1RM) and the stimulus appears to be relatively safe (Loen- tance exercise combined with BFR to those observed with
neke et al., 2014, 2011b). The reported mechanisms behind low-load resistance exercise to failure without BFR is impor-
these effects are likely incomplete but one mechanism may be tant as both protocols have been shown to result in favourable
the acute increase in muscle thickness. This acute increase has skeletal muscle adaptations (Fahs et al., 2015; Loenneke et al.,
been observed following the application of BFR alone (Loen- 2012e; Mitchell et al., 2012). Understanding the differences in
neke et al., 2012c) or in combination with resistance exercise the acute muscular response between protocols may help with
(Fahs et al., 2015; Martin-Hernandez et al., 2013; Yasuda et al., designing more optimal studies in the future. A review of the
2012). To this point, Yasuda et al. (2012) provided data that literature found that these acute differences have never been
acute changes in MTH may be important for increases in mus- examined across protocols of different loads and pressures
cle mass following training with BFR. Another potential mech- (Ingram & Loenneke, 2015). Thus, the purpose of this study

© 2016 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd 1
2 Muscle thickness and lactate response, J. P. Loenneke et al.

was to compare the effects of resistance exercise with and proper form was assessed and recorded as the concentric
without different degrees of BFR on acute changes in MTH 1RM. After recording a successful 1RM attempt, participants
and lactate accumulation, since both have been hypothesized were familiarized with the cadence of the exercise using a
as potential mechanisms behind the beneficial effects of low- metronome and completed two submaximal (30% 1RM, two
load resistance training. To investigate this across several dif- sets of 10) sets under BFR to familiarize them with the stimu-
ferent conditions, we ran three experiments with three sepa- lus. The methods for the conditions requiring BFR have been
rate groups of physically active men. described previously.(Loenneke et al., 2015a) Participants were
then scheduled for their first four visits (three exercise condi-
tions, one control, Table 1) with a minimum of five and a
Methods
maximum of 10 days between visits. The final pressure for
Forty-five physically active men aged 18–35 years were the BFR conditions was set to a percentage of arterial occlu-
recruited to participate (Experiment 1: n = 15, Experiment 2: sion estimated from thigh circumference (Table 2) (Loenneke
n = 15, Experiment 3: n = 15). Physically active was defined et al., 2012b). The individual conditions within each of the
as being active three or more days per week with a whole experiments will be abbreviated in the results and discussion
body resistance training component two or more days per as follows:
week for at least the last 3 months. Physically active partici- Experiment 1 (n = 14): High Load (HL) = 70% 1RM (non-
pants were used to better reflect the actual acute responses to BFR); 20%/40 BFR = 20% 1RM, 40% estimated arterial
different exercises. The use of this population decreases the occlusion pressure; and 30%/40 BFR = 30% 1RM, 40% esti-
chance of erroneously quantifying acute changes more reflec- mated arterial occlusion pressure.
tive of muscle damage/stress from an unaccustomed bout of Experiment 2 (n = 14): 30% = 30% 1RM to failure (non-
exercise (Murton et al., 2014). In addition, three separate BFR); 20%/50 BFR = 20% 1RM, 50% estimated arterial
experiments were used with three separate groups of partici- occlusion pressure; and 30%/50 BFR = 30% 1RM, 50% esti-
pants to lessen the chance of producing and quantifying a mated arterial occlusion pressure.
training effect. Participants who were hypertensive (>140/
90 mmHg), those who used tobacco regularly within the past
6 months, and those who had more than one risk factor for Table 1 Exercise protocols.
thromboembolisms (Motykie et al., 2000) were excluded from
participating. Of those initial 45, only 40 completed all of the Protocol % 1RM % Arterial occ. Rest (s)
testing sessions. Two participants were excluded following the Experiment 1
initial visit because they had resting supine blood pressures Condition 1 4 9 10 70 0 60
≥140/90 mmHg. One participant sustained a knee injury Condition 2 30-15-15-15 20 40 30
prior to Visits 2–5 and was excluded from further participa- Condition 3 30-15-15-15 30 40 30
Condition 4 0 0 0 –
tion. One participant sustained a hamstring injury following
Experiment 2
Visit 2 and withdrew from further participation. Both of these Condition 1 4 9 Failure 30 0 30
injuries occurred outside of the laboratory and were not Condition 2 30-15-15-15 20 50 30
related to this research study. One participant completed the Condition 3 30-15-15-15 30 50 30
first three visits but was unable to schedule the fourth within Condition 4 0 0 0 –
Experiment 3
the 5–10 day window required. Thus, he was excluded from
Condition 1 4 9 Failure 20 0 30
further all analyses. The study received approval from the Condition 2 30-15-15-15 20 60 30
University’s institutional review board, and each participant Condition 3 30-15-15-15 30 60 30
gave written informed consent before participation. Condition 4 0 0 0 –
During the initial screening visit, participants had their
height (to the nearest 05 cm) and body mass (to the nearest %1RM, percentage of one repetition maximum; %Arterial Occ., per-
centage of estimated arterial occlusion; Rest, rest between sets.
0. 1 kg) measured to calculate body mass index (BMI). Next,
blood pressure and ankle brachial index were measured in the
supine position to exclude those who may be hypertensive or
Table 2 Blood flow restriction pressures.
those who had indications of peripheral vascular disease. Fol-
lowing this, thigh circumference was measured with a tape Pressure used Pressure used Pressure used
measure at the 33% site between the top of the patella (knee Thigh circ. (40% AO) (50% AO) (60% AO)
cap) and the inguinal crease to determine the pressure that
<45–509 cm 80 mmHg 100 mmHg 120 mmHg
would be used during the resistance exercise bouts with BFR.
51–559 cm 100 mmHg 130 mmHg 150 mmHg
Participants were then tested for their bilateral concentric one 56–599 cm 120 mmHg 150 mmHg 180 mmHg
repetition maximum (1RM) on the knee extension machine ≥60 cm 140 mmHg 180 mmHg 210 mmHg
(NT 1220; Nautilus, Louisville, CO, USA). The maximum load
that could be lifted through a full range of motion with Circ, circumference; AO, estimated arterial occlusion.

© 2016 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd
Muscle thickness and lactate response, J. P. Loenneke et al. 3

Experiment 3 (n = 12): 20% = 20% 1RM to failure (non- thigh: the lateral and anterior surface of the thigh at a distance
BFR); 20%/60 BFR = 20% 1RM, 60% estimated arterial of 50% between the lateral condyle of the femur and the
occlusion pressure; and 30%/60 BFR = 30% 1RM, 60% esti- greater trochanter. Details on measuring MTH have been
mated arterial occlusion pressure. described previously (Abe et al., 1994). In addition, the inves-
tigator was blinded to the condition and time point for the
analysis of each one of the MTH images. The minimal differ-
Resistance exercise protocols
ence (reliability) needed to be considered real was 4 mm for
Participants were randomly assigned to one of three experi- the anterior site and 2 mm for the lateral site.
ments. Once assigned, participants completed all of the proto-
cols in random order within that experiment. The protocols
Thigh circumference (33%)
were comparing exercise load, differing degrees of BFR and
exercise volume. The differing degrees of BFR were chosen to The circumference of the non-dominant thigh was measured
determine if differences could be observed across restrictive with a tape measure at the 33% site between the top of the
pressures. The maximum was set at 60% of estimated arterial patella (knee cap) and the inguinal crease. The 33% site was
occlusion as this has been previously shown to result in high measured on the initial visit in the supine position to deter-
levels of fatigue postexercise, with many of the participants mine the inflation pressure.
unable to complete the goal amount of repetitions (Loenneke
et al., 2013a). The HL protocol was completed with 1 min rest
One repetition maximum
between sets. All other protocols were separated by 30 s rest
periods between sets. A metronome was used to ensure that The maximum load that could be lifted through a full range
the participants held the cadence of 1-second for the concen- of motion with proper form was assessed and recorded as the
tric muscle action and 1-second for the eccentric muscle concentric 1RM. The bilateral knee extension 1RM was
action during the bilateral knee extension exercises. During assessed using standard 1RM procedures described previously
the control conditions, participants rested in the knee exten- (Loenneke et al., 2013a).
sion device but did not exercise. The protocols within each
experiment are found in Table 1. Prior to each condition
Blood flow restriction
MTH, whole blood lactate (WBL), haematocrit and torque
were measured in that order. In addition, immediately follow- With the participants in a seated position, the BFR cuffs
ing each exercise bout torque, WBL, haematocrit and MTH (5 cm, Hokanson Inc. Bellevue, WA, USA) were applied to
were measured again in that order. Torque, muscle activation the most proximal portion of each thigh. The cuffs were
and the perceptual responses were also measured and that data inflated to 50 mmHg for 30 s and then deflated for 10 s. The
have been published separately (Loenneke et al., 2015a,b) in cuff was then inflated to 100 mmHg for 30 s and then
response to previous reviewer comments and to allow for deflated for 10 s (unless 100 mmHg was the target pressure).
focused discussion. Both of the pre and postmeasurements The cycle of cuff inflation/deflation was repeated with the
were made in the absence of BFR. cuff pressure increasing in increments of 40 mmHg until the
target inflation pressure was reached. The cuff was inflated to
the target inflation pressure prior to the first set of exercise
Whole blood lactate
and then deflated and removed immediately following the
Fingertip blood samples were collected before and after final set of exercise. The final pressure was set to a percentage
(~3 min post) resistance exercise by the same investigator. of arterial occlusion estimated from thigh circumference
Details on measuring WBL have been described previously (Table 2). To determine estimated arterial occlusion, we used
(Loenneke et al., 2012c). a previous data set (Loenneke et al., 2012b), n = 116) and
plotted thigh circumference with arterial occlusion.
Haematocrit
Statistical analyses
Prior to and following the exercise bouts (~3 min post), a
drop of blood was also drawn up into a capillary tube follow- All data were analysed using the SPSS 18.0 statistical software
ing the finger sticks for whole blood lactate. Details on esti- package (SPSS Inc., Chicago, IL, USA) with variability repre-
mating plasma volume from haematocrit have been described sented as standard deviation (SD). The group characteristics
previously (Loenneke et al., 2012c). for each have been published elsewhere,(Loenneke et al.,
2015a) however, there were no significant between group
differences in age, height, body mass, 1RM or supine mea-
Muscle thickness
sured thigh circumference at the 33% site. The mean change
B-mode ultrasound measurements of MTH were made by the from baseline for MTH and WBL was used for analysis, to
same investigator at two anatomical sites on the non-dominant increase statistical power for comparing across experiments. A

© 2016 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd
4 Muscle thickness and lactate response, J. P. Loenneke et al.

(a) (b)

(c) (d)

Figure 1 Mean changes in for anterior thigh muscle thickness (MTH) (a), lateral thigh MTH (b), whole blood lactate (c) and plasma volume
(d). Conditions with different letters represent significant differences between conditions (P≤005). Variability represented as standard deviations.

one-way Repeated Measures ANOVA with the between-subject With respect to WBL (Fig. 1C), there was no condition 9
factor of experiment (Experiment 1, 2 or 3) was completed experiment (P = 0975) or experiment effect (P = 0271), but
for all outcome variables. All posthoc comparisons were com- there was a condition main effect (P<0001). Follow-up tests
pleted using the least significant difference test. Statistical sig- revealed that the combined average of Condition 1 (HL, 30%
nificance was set at an alpha level of 005. Reliability (i.e. to failure and 20% to failure) and Condition 3 (30%/40 BFR,
minimal difference) for MTH and WBL was determined from 30%/50 BFR and 30%/60 BFR) was significantly greater than
the pre and postdata from the control visit within each experi- the combined average of Condition 2 (20%/40 BFR, 20%/50
ment (Weir, 2005). This calculation allowed us to know what BFR or 20%/60 BFR) (P<0001).
effect the exercise condition was having over that which could For changes in plasma volume (Fig. 1D), there was no con-
be expected from repeated testing (pre/post). The minimal dition 9 experiment (P = 0695) or experiment effect
difference needed to be considered real for MTH was 04 cm (P = 0163), but there was a condition main effect
for the anterior site and 02 cm for the lateral site and (P = 0038). Follow-up tests revealed that the combined aver-
05 mmol l 1 for WBL. age change in plasma volume of Condition 1 (HL, 30% to
failure and 20% to failure) and Condition 2 (20%/40 BFR,
20%/50 BFR or 20%/60 BFR) was significantly less than the
Results
combined average of Condition 3 (30%/40 BFR, 30%/50 BFR
There was no significant condition 9 experiment (P = 0998), and 30%/60 BFR) (P <0031).
condition (P = 0627), or experiment (P = 0139) effect for The exercise volume completed within each experiment has
the mean change in MTH at the anterior site suggesting that all been published previously. We extend the results in that manu-
exercise conditions changed similarly (Fig. 1A). In addition, script by calculating differences between experiments. There
there was no condition 9 experiment (P = 0574) or experi- was a significant condition 9 experiment (P = 0004) effect for
ment effect (P = 0352) for MTH at the lateral site (Fig. 1B), total exercise volume. Follow-up tests found significant between
but there was a condition main effect (P = 0018). Follow-up experiment differences for Condition 1 (P = 0022) but not for
tests revealed that the combined average of Condition 1 (HL, Condition 2 (P = 0788) or Condition 3 (P = 0931). Within
30% to failure, and 20% to failure) and Condition 3 (30%/40 Condition 1, the HL and 30% to failure condition completed
BFR, 30%/50 BFR, and 30%/60 BFR) was significantly greater significantly less work than the 20% to failure. The within-
than the combined average of Condition 2 (20%/40 BFR, 20%/ experiment differences in exercise volume have been published
50 BFR, or 20%/60 BFR) (P<002). previously (Loenneke et al., 2015a).

© 2016 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd
Muscle thickness and lactate response, J. P. Loenneke et al. 5

similar changes across conditions in the present investigation


Discussion
suggest that given an adequate stimulus, skeletal muscle can
To our knowledge, this is the first study investigating the only swell a finite amount before its maximal volume capacity
acute changes in MTH and WBL with different exercise proto- is reached.
cols with and without BFR. These two acute variables are The increase in WBL occurs due to fast glycolysis and the
important as they have both been previously hypothesized to accumulation of this lactate along with other metabolites has
play a role in chronic muscle adaptation to low-load resistance been hypothesized to play an important role in skeletal muscle
training. The results of this series of experiments suggest that adaptation through increased muscle fibre recruitment (Loen-
increasing the exercise load from 20% to 30% 1RM with BFR neke et al., 2011a; Ozaki et al., 2016). There is also some sug-
produces clear changes in WBL. Further, acute changes in gestion that lactate, itself, may be anabolic for skeletal muscle.
MTH (i.e. muscle swelling) appear be increased at 30% 1RM For example, Oishi et al. (2015) found that lactate significantly
with BFR, although the difference between 20% 1RM and increased myogenin and follistatin protein levels and phospho-
30% 1RM is small. The changes in MTH and WBL for 30% rylation of P70S6K while decreasing the levels of myostatin
1RM in combination with BFR were similar to that observed relative to a control. A number of studies have observed
with HL, 30% to failure, and 20% to failure, albeit at a lower increases in WBL following low-load resistance exercise in
exercise volume. These data provide a better understanding of combination with BFR (Loenneke et al., 2012d; Yasuda et al.,
the differences in the acute response which may be important 2010, 2015). Of those studies investigating the acute increases
when designing future studies investigating the chronic adap- in lactate following BFR in combination with resistance exer-
tation to BFR. cise, only one has investigated those changes across different
Acute changes in MTH have previously been hypothesized pressures (100 mmHg versus 160 mmHg) and it was com-
to play a role in the beneficial adaptations observed with BFR, pleted in the upper body. To illustrate, Yasuda et al. (2010)
however, to date no study had compared the acute changes in investigated unilateral elbow flexion muscle contractions com-
MTH in response to different pressures and exercise loads pleted at 20% 1RM (30 repetitions, followed by three sets of
(Loenneke et al., 2012a). The hypothesized relationship 15) and 70% 1RM (three sets to failure). The 160 mmHg
between muscle growth and the acute change in MTH (cell condition had a greater increase in lactate than the
swelling) is based largely on Haussinger’s hypothetical model 100 mmHg condition, but the non-BFR 70% 1RM condition
for hepatocyte cell swelling (Haussinger, 1996), which sug- had the greatest increase in lactate. This is in contrast to the
gests that muscle cell swelling is detected by an intrinsic vol- current set of experiments which found that increasing the
ume sensor. The activation of this volume sensor may lead to load from 20% to 30% 1RM produced significant increases in
an activation of the mechanistic target of rapamycin (mTOR) WBL, however, increasing pressure did not augment this
pathway (Loenneke et al., 2012a). A recent animal study pro- response. This discrepancy between studies is unknown but
vides support for this as they found that repetitive cycles of may be due to the method of applied pressure as the previous
restriction, in the absence of exercise, increased both cell study used the same pressure for everyone, independent of
swelling and signalling through the mTOR pathway (Nakajima limb size. This may be an important point as it has been
et al., 2016). An interesting finding is that the acute changes shown that a larger limb requires a greater pressure. The cur-
in MTH appeared fairly similar across all exercise conditions rent set of experiments does support the Yasuda et al. (2010)
within each experimental group. This finding, in combination finding that 70% 1RM leads to a greater change in lactate than
with the similar drop in plasma volume across conditions, 20% 1RM with BFR. The authors suggested that this difference
suggests that a similar fluid shift into the muscle cells is unlikely due to differences in tissue oxygenation levels since
occurred across conditions. It is acknowledged that there were venous oxygen partial pressure and venous oxygen saturation
slight differences between conditions at the lateral site, how- were similar between all exercise conditions. Instead, it seems
ever, these were small and unlikely to be meaningful. This is more likely that 70% 1RM requires a greater dependence on
similar to recent study completed in the upper body which anaerobic metabolism than muscle contractions performed at
found that the acute change in MTH was similar between two 20% 1RM, indicating a greater energetic demand with higher
different conditions despite drastic differences in exercise vol- loads. Interestingly, when the load was increased from 20% to
ume (Yasuda et al., 2015). Although speculative, this may sug- 30% 1RM, the change in lactate was similar to that observed
gest that acute changes in MTH are a requisite for skeletal with the HL condition, suggesting that this intensity/pressure
muscle growth, but in itself is not sufficient since it is not combination may produce an intramuscular stress similar to
augmented to a large degree by different exercise loads and HL exercise. The acute increase in lactate from the non-BFR
pressures. This is supported from a number of studies that conditions also reflects an increased energetic demand. The
have observed acute increases in MTH following the applica- 20% and 30% to failure conditions produced similar increases
tion of BFR in combination with low-load resistance exercise in lactate as the HL condition. This is not surprising as these
(Fahs et al., 2015; Yasuda et al., 2015, 2012) and regular resis- low-load conditions should result in similar metabolic
tance exercise in the absence of BFR (Martin-Hernandez et al., responses if exercise is continued to true muscular failure. To
2013; Ploutz-Snyder et al., 1995; Yasuda et al., 2015). The illustrate, postexercise lactate levels are similar between BFR

© 2016 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd
6 Muscle thickness and lactate response, J. P. Loenneke et al.

and non-BFR conditions despite significant differences in exer- BFR exercise, with 50 and 60% estimated arterial occlusion
cise volume (Loenneke et al., 2012d). providing no further augmentation in WBL or acute changes
In view of the results presented herein, the set of experi- in muscle thickness. These acute findings may have implica-
ments does possess some limitations. First, the amount of BFR tions for designing future studies as it suggest that exercise
was estimated for each participant from previous data col- load (30% versus 20% 1RM) may have a greater influence on
lected during supine rest but was not directly measured. This adaptation than the applied relative pressure (40 versus 50
was not done due to the complexities involved with measur- versus 60% estimated arterial occlusion pressure); when low-
ing changes in blood flow during exercise of the lower body. load exercise is not taken to volitional fatigue. This acute find-
Regardless, each participant did receive graded amounts of ing should be further tested through long-term training stud-
BFR which allowed for the central question of ‘does applied ies.
pressure matter?’ to be answered. Second, the WBL levels
were estimated from fingertip blood drops. Although changes
Acknowledgments
exceeded the error of the measurement (05 mmol l 1), this
measurement only allowed us to quantify systemic lactate The authors are not aware of any affiliations, memberships,
accumulation, it did not allow us to differentiate differences funding or financial holdings that might be perceived as
in lactate accumulation in or around the active muscle tissue. affecting the objectivity of this manuscript. This study was not
Third, although increases in MTH and decreases in plasma supported by any external funding. The authors thank Dr.
volume were observed which indicates a fluid shift did occur, Rosemary Knapp and Dr. Travis W. Beck for their helpful dis-
we are unable to definitively determine from this study cussion on study design.
whether or not the fluid was shifted into the actual muscle
cell. Lastly, it is noted that these acute load- and pressure-
Conflict of interest
dependent changes should be investigated further with long-
term training studies to determine if acute changes predict or The authors declare no conflict of interest.
correlate to chronic adaptation.
Author contribution
Conclusions
JPL, TA, RDL, DAB, and MGB: designed the study. JPL, DK,
In conclusion, this set of experiments suggests that manipulat- CAF, and RST: collected the data. JPL, DK, CAF, RST, TA,
ing the exercise load can produce changes in the acute WBL RDL, DA, and MGB: analysed and interpreted the data. JPL,
response to resistance exercise. Additionally, it appears that DK, CAF, RST, TA, RDL, DA, and MGB: wrote and edited the
moderate (40% estimated arterial occlusion) relative pressures manuscript.
may be all that is needed to maximize the acute response to

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