Journals / Turkish Journal of Kinesiology / 2026 / Volume: 12 Issue: 1

Comparing elastic and pneumatic blood flow restriction cuffs on perceptual responses, delayed onset muscle soreness and performance

Necdet Eray Pişkin(Department of Training Education, Faculty of Sports Sciences, Niğde Ömer Halisdemir University, Niğde, Türkiye)0000-0001-7255-078X
Gönül Yavuz(Department of Physical and Sports Education, Faculty of Sports Sciences, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Türkiye)0000-0003-0732-3200
Zait Burak Aktuğ(Department of Physical and Sports Education, Faculty of Sports Sciences, Niğde Ömer Halisdemir University, Niğde, Türkiye)0000-0002-5102-4331
Pages
—
Publication Date
2026-01-16
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Consequently, considering the population and objectives for which the BFR method is applied, it is recommended that both cuff types be used as alternatives.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:The study aimed to compare the acute effects of two different cuff types used in the blood flow restriction (BFR) method on subjective perception of comfort, delayed onset muscle soreness (DOMS), and performance (total repetitions).
📊
Key Findings & Data:The study included 20 male athletes mean aged 20.55 ± 0.60 years, their mean height was 176.10 ± 6.17 cm, and their mean body weight was 76.50 ± 6.96 kg who had been licensed athletes for at least two years.
💡
Conclusion & Impact:Consequently, considering the population and objectives for which the BFR method is applied, it is recommended that both cuff types be used as alternatives.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:Blood flow restriction · delayed onset muscle soreness · elastic

Abstract

The study aimed to compare the acute effects of two different cuff types used in the blood flow restriction (BFR) method on subjective perception of comfort, delayed onset muscle soreness (DOMS), and performance (total repetitions). The study included 20 male athletes mean aged 20.55 ± 0.60 years, their mean height was 176.10 ± 6.17 cm, and their mean body weight was 76.50 ± 6.96 kg who had been licensed athletes for at least two years. Participants performed four sets of a multi-joint and single-joint exercise targeting (30% 1RM, failure reps) the lower extremity, using a pneumatic cuff and an elastic band, at different times. Participants completed a lower extremity muscle soreness scale 48-72 hours after using both cuffs. The number of successful repetitions performed during the exercise was recorded. Finally, a visual analog scale (VAS) was completed to compare the comfort levels of the cuffs. Data were tested for normality using the Shapiro Wilk test, which determined the data were normally distributed. A Paired T-test was used to compare cuff types. When the study findings were examined, significant differences were observed across all parameters. Subjective perception of comfort (p=0.001; d=1.91) and DOMS levels (p=0.001; d=1.94) were found to be higher with pneumatic cuffs compared to elastic bands, while the average repetition rate for squat (p=0.001; d=1.66) and leg extension (p=0.001; d=0.93) exercises was lower with pneumatic cuffs compared to elastic bands. Participants found elastic bands more comfortable in terms of comfort, while pneumatic cuffs were found to be more time-efficient compared to elastic bands in terms of repetition rate. Given that DOMS levels are related to muscle damage and this mechanism's connection to hypertrophy, this suggests that pneumatic cuffs may further stimulate the developmental mechanisms used in the BFR method. Consequently, considering the population and objectives for which the BFR method is applied, it is recommended that both cuff types be used as alternatives. For individuals experiencing significant discomfort, especially regarding comfort, the BFR method with elastic bands can be recommended, taking the necessary precautions.

🔖

Cite This Article

Pişkin, N. E., Yavuz, G., Aktuğ, Z. B. (2026). Comparing elastic and pneumatic blood flow restriction cuffs on perceptual responses, delayed onset muscle soreness and performance. Turkish Journal of Kinesiology, Volume: 12 Issue: 1. https://doi.org/10.31459/turkjkin.1812674

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (63)

  1. Bausewein, C., Farquar, M., Booth, S., Gysels, M., & Higginson, I. J. (2007). Measurement of breathlessness in advanced disease: A systematic review. Respir Med, 101(3), 399-410. doi: 10.1016/j.rmed.2006.07.003.
  2. Bell, Z. W., Dankel, S. J., Spitz, R. W., Chatakondi, R. N., Abe, T., & Loenneke, J. P. (2019). The perceived tightness scale does not provide reliable estimates of blood flow restriction pressure. J Sport Rehabil, 29(4), 516-518. doi: 10.1123/jsr.2018-0439
  3. Bielitzki, R., Behrens, M., Behrendt, T., Malczewski, V., Mittlmeier, T., & Schega, L. (2024). Low-load resistance exercise with perceptually primed practical blood flow restriction ınduces similar motor performance fatigue, physiological changes, and perceptual responses compared to traditional blood flow restriction in males and females. J Sports Sci Med, 23(2), 326-341. doi: 10.52082/jssm.2024.326
  4. Bijur, P. E., Silver, W., & Gallagher, E. J. (2001). Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med, 8(12), 1153-1157. doi: 10.1111/j.1553-2712.2001.tb01132.x.
  5. Brandner, C. R., & Warmington, S. A. (2017). Delayed onset muscle soreness and perceived exertion after blood flow restriction exercise. J Strength Cond Res, 31(11), 3101-3108.
  6. Brzycki, M. (1993). Strength testing-predicting a one-rep max from reps-to-fatigue. J Phys Educat Recreat Danc, 64(1), 88-90. doi: 10.1080/07303084.1993.10606684
  7. Chen, L. S., McLaurin, N., Brosselin, P., Charry, D., Alhalimi, T., & Tanaka, H. (2025). Vascular adaptations to blood flow restriction resistance training with different cuff types: the role of retrograde shear stress. Eur. J. Appl. Physiology, 1-12. doi: 10.1007/s00421-025-05795-1
  8. Cheung, K., Hume., P. A, & Maxwell, L. (2003). Delayed onset muscle soreness: treatment strategies and performance factors. Sports Med, 33(2), 145-164. doi: 10.2165/00007256-200333020-00005
  9. de Queiros, V. S., Dos Santos, Í. K., Almeida-Neto, P. F., Dantas, M., de França, I. M., Vieira, W. H. D. B., Neto, G. R., Dantas, P. M. S., & Cabral, B. G. D. A. T. (2021). Effect of resistance training with blood flow restriction on muscle damage markers in adults: A systematic review. PloS one, 16(6), e0253521. doi: 10.1371/journal.pone.0253521
  10. Early, K. S., Rockhill, M., Bryan, A., Tyo, B., Buuck, D., & McGinty, J. (2020). Effect of blood flow restriction training on muscular performance, pain and vascular function. Int. J. Sports Phys. Ther, 15(6), 892-900. doi: 10.26603/ijspt20200892
  11. Farup, J., De Paoli, F., Bjerg, K., Riis, S., Ringgard, S., & Vissing, K. (2015). Blood flow restricted and traditional resistance training performed to fatigue produce equal muscle hypertrophy. Scand J Med Sci Sports, 25(6), 754-763. doi: 10.1111/sms.12396
  12. Franz, A., Ji, S., Fröschen, F. S., Kerstin, M., Wahl, P., & Behringer, M. (2023). Effects of low-load blood flow restriction on the venous system in comparison to traditional low-load and high-load exercises. Front Physiol, 14, 1285462. doi: 10.3389/fphys.2023.1285462
  13. Haugen, T., Seiler, S., Sandbakk, Ø., & Tønnessen, E. (2019). The training and development of elite sprint performance: an integration of scientific and best practice literature. Sports Med, 5(1), 44. doi: 10.1186/s40798-019-0221-0
  14. Hazar, S., Erol, E., & Gökdemir, K. (2006). Kuvvet antrenmanı sonrası oluşan kas ağrısının kas hasarıyla ilişkisi. Gazi Beden Eğitimi ve Spor Bilimleri Dergisi, 11(3), 49-58.
  15. Held, S., Behringer, M., & Donath, L. (2020). Low intensity rowing with blood flow restriction over 5 weeks increases VO2max in elite rowers: a randomized controlled trial. J Sci Med Sport, 23, 304-348. doi: 10.1016/j.jsams.2019.10.002
  16. Hughes, L., Jeffries, O., Waldron, M., Rosenblatt, B., Gissane, C., Paton, B., & Patterson, S. D. (2018b). Influence and reliability of lower-limb arterial occlusion pressure at different body positions. PeerJ, 6, e4697. doi: 10.7717/peerj.4697
  17. Hughes, L., Paton, B., Rosenblatt, B., Gissane, C., & Patterson S. D. (2017). Blood flow restriction training in clinical musculoskeletal rehabilitation: A systematic review and meta-analysis. Br J Sports Med, 51(13), 1003-1011. doi: 10.1136/bjsports-2016-097071
  18. Hughes, L., Rosenblatt, B., Gissane, C., Paton, B., & Patterson, S. D. (2018a). Interface pressure, perceptual, and mean arterial pressure responses to different blood flow restriction systems. Scand J Med Sci Sports, 28, 1757- 1765. doi: 10.1111/sms.13092
  19. 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. Br J Sports Med, 57(14), 914-920. doi: 10.1136/bjsports-2022-106069
  20. Jessee, M. B., Buckner, S. L., Dankel, S. J., Counts, B. R., Abe, T., & Loenneke, J. P. (2016). The influence of cuff width, sex, and race on arterial occlusion: Implications for blood flow restriction research. Sports Med, 46(6), 913-921. doi: 10.1007/s40279-016-0473-5
  21. Jessee, M. B., Buckner, S. L., Mouser, J. G., Mattocks, K. T., Dankel, S. J., Abe, T., Bell, Z. W., Bentley, J. P., & Loenneke, J. P. (2018). Muscle adaptations to high-load training and very low-load training with and without blood flow restriction. Front Physiol, 16(9), 1448. doi: 10.3389/fphys.2018.01448
  22. Kamiş, O., Keskin, K., Sofuoğlu, C., & Akçay, N. (2025a). No acute differences in anaerobic performance following autoregulated vs non-autoregulated blood flow restricted resistance exercise. Turk J Kinesiol, 11(3), 170-177. doi: 10.31459/turkjkin.1701143
  23. Kamiş, O., Rolnick, N., de Queiros, V. S., Akçay, N., Keskin, K., Yıldız, K. C., Sofuoğlu, C., Werner, T., & Hughes, L. (2025b). Impact of limb occlusion pressure assessment position on performance, cardiovascular, and perceptual responses in blood flow restricted low-load resistance exercise: A randomized crossover trial. J Sports Sci, 43(19), 2256-2264. doi: 10.1080/02640414.2024.2422205
  24. Kanchanathepsak, T., Pukrittayakamee, N. C., Woratanarat, P., Tawonsawatruk, T., & Angsanuntsukh, C. (2023). Limb occlusion pressure versus standard tourniquet inflation pressure in minor hand surgery: a randomized controlled trial. J Orthop Surg Res, 18(1), 539. doi: 10.1186/s13018-023-04000-3
  25. Krentz, J. R., Farthing, J. P. (2010). Neural and morphological changes in response to a 20-day intense eccentric training protocol. Eur J Appl Physiol, 110, 333-340. doi: 10.1007/s00421-010-1513-8
  26. Libardi, C., Chacon-Mikahil, M., Cavaglieri, C., Tricoli, V., Roschel, H., Vechin, F., Conceição, M. S., & Ugrinowitsch, C. (2015). Effect of concurrent training with blood flow restriction in the elderly. Int J Sports Med, 36(5), 395-399. doi: 10.1055/s-0034-1390496
  27. Lixandrão, M. E., Ugrinowitsch, C., Berton, R., Vechin, F. C., Conceição, M. S., Damas, F., Libardi, C. A., & Roschel, H. (2018). Magnitude of muscle strength and mass adaptations between high-load resistance training versus low-load resistance training associated with blood-flow restriction: a systematic review and meta-analysis. Sports Med, 48, 361-378. doi: 10.1007/s40279-017-0795-y
  28. Loenneke, J. P., Fahs, C. A., Rossow, L. M., Abe, T., & Bemben, M. G. (2012). The anabolic benefits of venous blood flow restriction training may be induced by muscle cell swelling. Med Hypotheses, 78(1), 151-154. doi: 10.1016/j.mehy.2011.10.014
  29. Loenneke, J. P., Fahs, C. A., Wilson, J. M., & Bemben, M. G. (2011). Blood flow restriction: the metabolite/volume threshold theory. Med Hypotheses, 77(5), 748-752. doi: 10.1016/j.mehy.2011.07.029
  30. Lorenz, D. S., Bailey, L., Wilk, K. E., Mangine, R. E., Head, P., Grindstaff, T. L., & Morrison, S. (2021). Blood flow restriction training. J Athl Train, 56(9), 937-944. doi: 10.4085/418-20
  31. Luebbers, P. E., Witte, E. V., Oshel, J. Q., & Butler, M. S. (2019). Effects of practical blood flow restriction training on adolescent lower-body strength. J Strength Cond Res, 33, 2674-2683. doi: 10.1519/JSC.0000000000002302
  32. Mattocks, K. T., Jessee, M. B., Counts, B. R., Buckner, S. L., Mouser, J. G., Dankel, S. J., Laurentino, G. C., & Loenneke, J. P. (2017). The effects of upper body exercise across different levels of blood flow restriction on arterial occlusion pressure and perceptual responses. Physiol Behav, 171, 181-186. doi: 10.1016/j.physbeh.2017.01.015
  33. McEwen, J. A., Owens, J. G., & Jeyasurya, J. (2018). Why is it crucial to use personalized occlusion pressures in blood flow restriction (BFR) rehabilitation? J Med Biol Eng, 39, 7-11. doi: 10.1007/s40846-018-0397-7
  34. Nosaka, K., Lavender, A., Newton, M., & Sacco, P. (2003). Muscle damage in resistance training: Is muscle damage necessary for strength gain and muscle hypertrophy?. Int J Sport Health Sci, 1, 1-8. doi: 10.5432/ijshs.1.1
  35. Patterson, S. D., & Brandner, C. R. (2018). The role of blood flow restriction training for applied practitioners: A questionnaire-based survey. J Sports Sci, 36(2), 123-130. doi: 10.1080/02640414.2017.1284341
  36. 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: considerations of methodology, application, and safety. Front Physiol, 10, 533. doi: 10.3389/fphys.2019.00533
  37. Pearson, S. J., & Hussain, S. R. (2015). A review on the mechanisms of blood-flow restriction resistance training-induced muscle hypertrophy. Sports Med, 45(2), 187-200. doi: 10.1007/s40279-014-0264-9
  38. Pignanelli, C., Christiansen, D., & Burr, J. F. (2021). Blood flow restriction training and the high performance athlete: Science to application. J Appl Physiol, 130(4), 1163e1170. doi: 10.1152/japplphysiol.00982.20
  39. Pignanelli, C., Petrick, H. L., Keyvani, F., Heigenhauser, G. J., Quadrilatero, J., Holloway, G. P., & Burr, J. F. (2020). Low-load resistance training to task failure with and without blood flow restriction: muscular functional and structural adaptations. Am J Physiol Regul Integr Comp Physiol, 318(2), 284-295. doi: 10.1152/ajpregu.00243.2019
  40. Pişkin, N. E., Aktuğ, Z. B., Kara, M., Yavuz, G., Özturk, G. T., Ibiş, S., & Aka, H. (2025). The effect of blood flow restriction training on isokinetic strength muscle thickness and athletic performance. J Musculoskelet Neuronal Interact, 25(2), 208. doi: 10.22540/JMNI-25-208
  41. Pişkin, N. E., Yavuz, G., & Aktuğ, Z. B. (2023). A new approach to strength development: Blood flow restriction training method: Traditional review. Gazi Journal of Physical Education and Sports Sciences, 28(4), 276-290. doi: 10.53434/gbesbd.1318723
  42. Pişkin, N. E., Yavuz, G., Aktuğ, Z. B., Aldhahi, M. I., Al-Mhanna, S. B., & Gülü, M. (2024). The effect of combining blood flow restriction with the nordic hamstring exercise on hamstring strength: randomized controlled trial. J Clin Med, 13(7), 2035. doi: 10.3390/jcm13072035
  43. Rodrigues, S., Forte, P., Dewaele, E., Branquinho, L., Teixeira, J. E., Ferraz, R., Barbosa, T. M., & Monteiro, A. M. (2022). Effect of blood flow restriction technique on delayed onset muscle soreness: A systematic review. Medicina, 58(9), 1154. doi: 10.3390/medicina58091154
  44. Rolnick, N., & Schoenfeld, B. J. (2020). Blood flow restriction training and the physique athlete: A practical research-based guide to maximizing muscle size. Strength Cond Res, 42(5), 22-36. doi: 10.1519/SSC.0000000000000553
  45. Rolnick, N., de Queiros, V. S., Fedorko, B., Watson, S., Ruffhead, C., Zupnik, S., Kuriawa, L., Weedon, M., & Werner, T. (2025). Impact of blood flow restriction cuff design on upper body exercise: A randomized crossover trial in resistance‐trained adults. Physiol. Rep, 13(7), e70303. doi: 10.14814/phy2.70303
  46. Rolnick, N., Kimbrell, K., Cerqueira, M. S., Weatherford, B., & Brandner, C. (2021). Perceived barriers to blood flow restriction training. Front Rehabil Sci, 2, 697082. doi: 10.3389/fresc.2021.697082
  47. Rossow, L. M., Fahs, C. A., Loenneke, J. P., Thiebaud, R. S., Sherk, V. D., Abe, T., & Bemben, M. G. (2012). Cardiovascular and perceptual responses to blood-flow-restricted resistance exercise with differing restrictive cuffs. Clin Physiol Funct Imaging, 32, 331-337. doi: 10.1111/j.1475-097X.2012.01131.x
  48. Sands, W. A., Wurth, J. J., & Hewit, J. K. (2012). Basics of strength and conditioning manual. Colorado Springs, CO: National Strength and Conditioning Association’s.
  49. Savino, F., Vagliano, L., Ceratto, S., Viviani, F., Miniero, R., & Ricceri, F. (2013). Pain assessment in children undergoing venipuncture: the Wong–Baker faces scale versus skin conductance fluctuations. PeerJ, 1, e37. doi: 10.7717/peerj.37
  50. Schoenfeld, B. J., Grgic, J., Van Every, D. W., & Plotkin, D. L. (2021). Loading recommendations for muscle strength, hypertrophy, and local endurance: a re-examination of the repetition continuum. Sports, 9(2), 32. doi: 10.3390/sports9020032
  51. Schoenfeld, B. J., Ogborn, D., & Krieger, J. W. (2017). Dose-response relationship between weekly resistance training volume and increases in muscle mass: A systematic review and meta-analysis. J Sports Sci, 35, 1073-1082. doi: 10.1080/02640414.2016.1210197
  52. Schoenfeld, B.J. (2012). Does exercise-induced muscle damage play a role in skeletal muscle hypertrophy? J Strength Cond Res, 26(5), 1441-1453. doi: 10.1519/JSC.0b013e31824f207e
  53. Sieljacks, P., Degn, R., Hollaender, K., Wernbom, M., & Vissing, K. (2019). Non‐failure blood flow restricted exercise induces similar muscle adaptations and less discomfort than failure protocols. Scand J Med Sci Sports, 29(3), 336-347. doi: 10.1111/sms.13346
  54. Slysz, J., Stultz, J., & Burr, J. F. (2016). The efficacy of blood flow restricted exercise: A systematic review and meta-analysis. J Sci Med Sport, 19(8), 669-675. doi: 10.1016/j.jsams.2015.09.005
  55. Smith, L. L., & Miles, M. P. (2000). Exercise-induced muscle injury. Exerc Sport Sci, 163-173.
  56. Spitz, R. W., Chatakondi, R. N., Bell, Z. W., Wong, V., Dankel, S. J., Abe, T., & Loenneke, J. P. (2019). The impact of cuff width and biological sex on cuff preference and the perceived discomfort to blood-flow-restricted arm exercise. Physiol Meas, 40(5), 055001. doi: 10.1088/1361-6579/ab1787
  57. Stray-Gundersen, S., & Stampley, J. (2025). Advances and limitations of semi-elastic pneumatic cuffs in blood flow restriction training: a narrative review. Front Physiol, 16, 1632367. doi: 10.3389/fphys.2025.1632367
  58. Şengür, E., Pişkin, N. E., & Hazar, S. (2022). The effect of modified strength training according to muscle soreness on muscle development. Journal of Sports Education, 6(2), 131-142. doi: 10.55238/seder.1137599
  59. Tomlinson, D., von Baeyer, C. L., Stinson, J. N., & Sung, L. (2010). A systematic review of faces scales for the self-report of pain intensity in children. Ped, 126(5), 1168-1198. doi: 10.1542/peds.2010-1609
  60. Weatherholt, A. M., VanWye, W. R., Lohmann, J., & Owens, J. G. (2019). The effect of cuff width for determining limb occlusion pressure: a comparison of blood flow restriction devices. Int J Exerc Sci, 12(3), 136-143. doi: 10.70252/rwvu7100
  61. Wilson, J. M., Lowery, R. P., Joy, J. M., Loenneke, J. P., & Naimo, M. A. (2013). Practical blood flow restriction training increases acute determinants of hypertrophy without increasing indices of muscle damage. J Strength Cond Res, 27(11), 3068-3075. doi: 10.1519/JSC.0b013e31828a1ffa
  62. Wortman, R. J., Brown, S. M., Savage-Elliott, I., Finley, Z. J., & Mulcahey, M. K. (2021). Blood flow restriction training for athletes: A systematic review. Am J Sports Med, 49(7), 1938-1944. doi: 10.1177/03635465209644
  63. Yasuda, T., Ogasawara, R., Sakamaki, M., Ozaki, H., Sato, Y., & Abe, T. (2011). Combined effects of lowintensity blood flow restriction training and high-intensity resistance training on muscle strength and size. Eur J Appl Physiol, 111(10), 2525-2533. doi: 10.1007/s00421-011-1873-8