Preprint / Version 1

Why BFR cuff features are an important methodological consideration

A short commentary on “Cerebral cortex activation and functional connectivity during low-load resistance training with blood flow restriction: An fNIRS study”


  • Nicholas Rolnick The Human Performance Mechanic
  • Matthew Clarkson 3- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
  • Luke Hughes Department of Sport, Exercise and Rehabilitation, Northumbria University, UK
  • Vasileios Korakakis Department of Health Sciences, PhD in Physiotherapy Program, University of Nicosia, Cyprus
  • Victor De Queiros Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil
  • Stephen D Patterson Centre for Applied Performance Sciences, St. Mary’s University Twickenham, London, UK
  • Samuel Buckner USF Muscle Laboratory, Exercise Science Program, University of South Florida, Tampa, Florida
  • Timothy Werner Department of Exercise Science, Salisbury University, Salisbury, MD, United States
  • Dahan Da Cunha Nascimento Department of Physical Education, Catholic University of Brasilia (UCB), Brasilia, Brazil
  • Sten Stray-Gundersen Department of Exercise Science, University of South Carolina, Columbia, SC, United States
  • Okan Kamis Department of Sports and Health, Aksaray University, Aksaray, Türkiye
  • Mathias Thoelen Department of Physical Therapy, Anna TopSupport, Eindhoven, Netherlands
  • Kyle Kimbrell Owens Recovery Science, San Antonio, TX, United States
  • Ewoud Jacobs Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium



blood flow restricted, blood flow restriction, bfr training, bstrong



Before reading the article, we want to reiterate our desire to have an open and honest dialogue with Jia et al. (2024) regarding the content of their manuscript. We wrote this letter to the editor and Dr. Jeremy Loenneke, PhD – the editor for this publication -  felt that this commentary was worthy of publication to begin the discussion surrounding the article. However, he was denied of proceeding forward to publication by the PLOSOne policy of not publishing letters to the editor/commentaries. Moreover, the only place where we could leave a commentary on the article is in the “Public comments” section. Unfortunately, it is not working due to undisclosed circumstances and there is no timeline for when it will be back online. Nonetheless, we are extremely disappointed in PLOSOne’s policy to not allow for open and honest academic discourse on their publications. We hope that in the future PLOSOne allows for more open discussions on the articles they publish.


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Citherlet, T., Willis, S. J., Chaperon, A., & Millet, G. P. (2022). Differences in the limb blood flow between two types of blood flow restriction cuffs: A pilot study. Frontiers in Physiology, 13.

Dancy, M. E., Alexander, A. S., Abbas, M. J., Rolnick, N., Alder, K. D., Lu, Y., & Okoroha, K. R. (2023). No differences in exercise performance, perceptual response, or safety were observed among 3 blood flow restriction devices. Arthroscopy, Sports Medicine, and Rehabilitation, 5(6), 100822.

Graham, B., Breault, M. J., McEwen, J. A., & McGraw, R. W. (1993). Occlusion of arterial flow in the extremities at subsystolic pressures through the use of wide tourniquet cuffs. Clinical Orthopaedics and Related Research, 286(286), 257–261.

Hughes, L., Swain, P. M., Lai, T., & McEwen, J. A. (2024). It’s time to regulate - The importance of accurate surgical-grade tourniquet autoregulation in blood flow restriction exercise applications. Physical Therapy in Sport: Official Journal of the Association of Chartered Physiotherapists in Sports Medicine, 67, 41–46.

Hughes, Luke, Jeffries, O., Waldron, M., Rosenblatt, B., Gissane, C., Paton, B., & Patterson, S. D. (2018). Influence and reliability of lower-limb arterial occlusion pressure at different body positions. PeerJ, 2018(5).

Jacobs, E., Rolnick, N., Wezenbeek, E., Stroobant, L., Capelleman, R., Arnout, N., Witvrouw, E., & Schuermans, J. (2023). Investigating the autoregulation of applied blood flow restriction training pressures in healthy, physically active adults: an intervention study evaluating acute training responses and safety. British Journal of Sports Medicine.

Jia, B., Lv, C., Li, D., & Lv, W. (2024). Cerebral cortex activation and functional connectivity during low-load resistance training with blood flow restriction: An fNIRS study. PloS One, 19(5), e0303983.

Loenneke, J. P., Fahs, C. A., Rossow, L. M., Sherk, V. D., Thiebaud, R. S., Abe, T., Bemben, D. A., & Bemben, M. G. (2012). Effects of cuff width on arterial occlusion: Implications for blood flow restricted exercise. European Journal of Applied Physiology, 112(8), 2903–2912.

Loenneke, J. P., Fahs, C. A., Rossow, L. M., Thiebaud, R. S., Mattocks, K. T., Abe, T., & Bemben, M. G. (2013). Blood flow restriction pressure recommendations: a tale of two cuffs. Frontiers in Physiology, 4, 249.

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Patterson, S. D., Hughes, L., Warmington, S., Burr, J., Scott, B. R., Owens, J., Abe, T., Nielsen, J. L., Libardi, C. A., Laurentino, G., Neto, G. R., Brandner, C., Martin-Hernandez, J., & Loenneke, J. (2019). Blood flow restriction exercise position stand: Considerations of methodology, application, and safety. In Frontiers in Physiology (Vol. 10, Issue MAY, p. 533). Frontiers Media S.A.

Rolnick, N., & Cerqueira, M. S. (2021). Comparison of Blood Flow Restriction Devices and Their Effect on Quadriceps Muscle Activation: Letter to the Editor. Physical Therapy in Sport: Official Journal of the Association of Chartered Physiotherapists in Sports Medicine.

Rolnick, N., Kimbrell, K., & de Queiros, V. (2023). Beneath the cuff: Often overlooked and under-reported blood flow restriction device features and their potential impact on practice. Frontiers in Physiology, 14.

Scott, B. R., Marston, K. J., Owens, J., Rolnick, N., & Patterson, S. D. (2023). Current implementation and barriers to using blood flow restriction training: Insights from a survey of allied health practitioners. Journal of Strength and Conditioning Research.

Sieljacks, P., Knudsen, L., Wernbom, M., & Vissing, K. (2018). Body position influences arterial occlusion pressure: implications for the standardization of pressure during blood flow restricted exercise. European Journal of Applied Physiology, 118(2), 303–312.