Bridging Training and Competition: Blood Flow Restriction as a Novel Tapering Approach

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Blood flow restriction (BFR) training, a low-load alternative to traditional resistance exercise, has shown promise; however, its biomechanical effects during tapering are not well defined. This study aimed to compare the acute effects of low-pressure and high-pressure BFR with traditional progressive resistance exercise (PRE) on muscle tone and stiffness during a simulated tapering period. Methods This randomized controlled study included sixty-two healthy participants (mean age 21.03 ± 0.83 years;54.8% female). The participants were randomized into three groups: low-pressure BFR (20% arterial occlusion pressure [AOP]), high-pressure BFR (80% AOP), or PRE. Over four days, participants completed group-specific resistance protocols targeting the biceps brachii. Muscle tone and stiffness were measured using a MyotonPRO device just after each session. Results In intragroup analyses, muscle tone showed significant time effect in the PRE (η²=0.772, p < 0.001) and 80% BFR (η²=0.387, p < 0.001) groups, but not in the 20% BFR group (η²=0.004, p = 0.975). Similarly, muscle stiffness increased over time in the PRE (η²=0.393, p < 0.001) and 80% BFR (η²=0.251, p < 0.001) groups, while no significant changes were observed in 20% BFR group (η²=0.037, p = 0.544). Intergroup comparisons revealed that 80% BFR induced greater changes in both muscle tone and stiffness compared to 20% BFR (p < 0.001). Conclusions Both high-pressure BFR and PRE increase muscle tone and stiffness during tapering, which may elevate injury risk. In contrast, low-pressure BFR preserves neuromuscular properties without exacerbating tissue stiffness, presenting a viable and safer tapering alternative for strength athletes aiming to maintain readiness while minimizing mechanical strain. Clinical trial number: NCT06861699 blood flow restriction therapy BFR resistance training muscle tone Figures Figure 1 Introduction Power athletes often employ tapering strategies, including short-term training cessation, in the final preparation phase before competition to optimize physiological and psychological recovery, enhance performance, and mitigate injury risk. The primary objective of tapering is to alleviate musculoskeletal stresses accumulated during intensive training, ensuring peak readiness on competition day [ 1 ]. Resistance training, a cornerstone of power athletes’ regimens, imposes adaptive stress on skeletal muscle, driving structural remodeling that alters its internal architecture (e.g., fiber alignment) and external orientation (e.g., pennation angle) [ 2 ]. A well-documented consequence is increased muscle tone—defined here as the baseline tension in resting muscle—and stiffness, reflecting resistance to deformation under mechanical loading [ 2 – 5 ]. However, the biomechanical implications of these changes for injury-prone muscles remain contentious. For instance, Freitas et al. [ 3 ] suggest that elevated stiffness may heighten injury risk by reducing muscle compliance, whereas Kawai et al.[ 4 ] found no such association, possibly due to differences in measurement techniques (e.g., shear wave elastography vs. myotonometry) or training status of participants. This discrepancy underscores a critical gap: whether training-induced stiffness exacerbates injury susceptibility or supports performance remains unclear. Similarly, the optimal muscle tone for peak athletic output is undefined, though overuse and overtraining are widely recognized to elevate stiffness, potentially compromising tissue resilience [ 5 , 6 ]. Moreover, resistance training can acutely increase passive muscle stiffness, a determinant of joint range of motion (ROM), possibly due to muscle damage [ 7 ]. The limitation of joint ROM has been suggested to increase the risk of musculoskeletal injuries[ 8 ] and impair athletic performance [ 9 ]. These findings highlight that excessive stiffness and restricted ROM may elevate injury risk and hinder performance in power athletes, necessitating tailored training protocols during tapering to balance neuromuscular adaptations with tissue compliance. To mitigate these training-induced risks, athletes commonly reduce training loads through tapering or cessation strategies. Designing an effective taper is complex, as load can be adjusted via intensity, volume, duration, frequency, or combinations thereof [ 10 , 11 ]. Short-term training cessation-defined as a complete halt of athletic activity for 1 to 7 days [ 12 ]-is a prevalent approach, yet its impact on strength performance is inconsistent. For example, Pritchard et al. [ 11 ] observed no significant changes in peak force during isometric mid-thigh pulls or bench presses after 3.5 or 5.5 days of cessation in trained individuals, suggesting maintenance of strength. Conversely, Kyle Travis et al. [ 13 ] reported potential declines in upper-body isometric maximal strength after similar durations, possibly due to reduced neuromuscular activation in less-trained cohorts. These conflicting outcomes, likely influenced by factors such as athlete experience or testing protocols, indicate that the ideal cessation duration for maximizing upper- and lower-body strength remains elusive [ 12 , 14 ]. In technical sports like weightlifting, even brief interruptions may impair performance by disrupting neuromuscular coordination [ 15 ], highlighting the limitations of cessation alone and the need for alternative tapering methods that preserve performance while reducing mechanical stress. One such method gaining traction is blood flow restriction resistance exercise (BFR-RE), which uses partial vascular occlusion to enhance low-load training outcomes. BFR-RE has been shown to outperform traditional low-load resistance exercise, yielding strength and hypertrophy gains comparable to high-load protocols [ 16 , 17 ]. Current guidelines recommend restriction pressures of 20–80% of arterial occlusion pressure, applied over four sets (30, 15, 15, 15 repetitions) with 30–60 seconds of inter-set rest, to optimize muscle adaptations [ 18 ]. Emerging evidence supports its potential during tapering: Smith et al. [ 18 ] demonstrated significant improvements in bench press performance with BFR-RE in this phase, though their small sample size limits generalizability. Similarly, Harrison et al. [ 19 ] found that “priming exercises” with BFR 48 hours before competition enhance neuromuscular performance, offering a practical boost, albeit in a specific cohort of powerlifters. While promising, these findings raise questions about optimal pressure ranges, long-term safety, and applicability across diverse athletic populations-gaps that warrant further exploration. Nonetheless, BFR-RE’s ability to sustain neuromuscular activation with reduced mechanical load positions it as a candidate to address the dual demands of fatigue prevention and competitive readiness. Building on this foundation, the present study hypothesizes that varying doses of blood flow restriction (BFR) modulate muscle stiffness during the tapering period, enabling athletes to train safely until competition day without compromising performance or recovery. Specifically, this research compares BFR protocols-defined by restriction pressures ranging from 20–80% of arterial occlusion pressure-to traditional progressive resistance exercise (PRE) programs in regulating muscle stiffness following short-term training cessation. By systematically evaluating these parameters, the study aims to identify an optimal BFR configuration that maintains neuromuscular performance, prevents excessive stiffness that could elevate injury risk from prior training, and supports tissue resilience. This approach seeks to contribute a novel, evidence-based tapering protocol to the literature, offering athletes a strategy to bridge reduced training loads with sustained competitive readiness. Such a framework could enhance preparation for competition day, balancing the trade-offs between recovery and performance maintenance. Method Participants The study involved 62 healthy university students aged 18–25 years. Inclusion criteria required participants to have refrained from biceps strength training for at least eight weeks, have no history of musculoskeletal injuries affecting the biceps muscle–tendon complex, and demonstrate right-hand dominance per the Edinburgh Handedness Inventory. Exclusion criteria included diagnosed cardiovascular, pulmonary, or metabolic diseases; sickle cell anemia; recent surgical procedures; a body mass index (BMI) exceeding 35 kg/m²; significant orthopedic pain; use of antihypertensive or cardiac medications; or implanted medical devices. Written informed consent was obtained from all participants, and the study protocol was approved by the Istanbul Okan University’s Institutional Ethics Committee (Approval Date: January 8, 2025; Approval No: 183; Decision No: 34), adhering to the Declaration of Helsinki. Study Design A prospective, double-blind, randomized controlled trial was conducted to compare the effects of strength exercises with 20% BFR, 80% BFR, and PRE without BFR on biceps brachii muscle tone (Myoton-F) and stiffness (Myoton-S) over a four-day simulated tapering period. Interventions were delivered by a single physiotherapist, with assessments conducted by a separate physiotherapist unaware of group assignments to maintain evaluator blinding. The statistician was also blinded to group assignments. This study was carried out in the university's physiotherapy department laboratory. This study was conducted in accordance with the CONSORT guidelines. Sample Size Sample size was calculated using G*Power software (version 3.1.9.7; Heinrich-Heine-Universität Düsseldorf, Germany) with the “ANOVA: Repeated measures, within-between interaction” method. Assuming a moderate effect size (f = 0.25), 95% statistical power, and a 5% significance level, a minimum of 45 participants was required [ 20 ]. To further strengthen the study's robustness, 66 participants were recruited. However, 4 participants discontinued due to personal reasons and scheduling conflicts, and 62 participants completed the study and were included in the final analysis. Randomization and Blinding Participants were randomly assigned to one of three groups (20% BFR, 80% BFR, or PRE) using a numbered sequence (1–62): numbers 1–20 to 80% BFR, 21–40 to 20% BFR, and 41–62 to PRE. Two additional participants were included, though the randomization method for these is unclear. Participants were scheduled at different times and unaware of their group allocation, ensuring participant blinding. The evaluating physiotherapist, blinded to group assignments, conducted all assessments to minimize bias. Exercise Interventions Interventions were conducted over four consecutive days in a controlled environment (ambient temperature 22–24°C) to minimize external influences on muscle performance. On days 1–3, designated as a simulated exercise tapering period, group-specific exercises were conducted, with measurements taken immediately after each session to evaluate acute effects. On day 4, designated as a simulated competition day, biceps brachii measurements were recorded without exercise. Prior to interventions, each participant’s one-repetition maximum (1RM) for the biceps brachii was determined. The exercise protocols were as follows: 20% BFR Group : Performed low-pressure BFR exercise at 20% arterial occlusion pressure (AOP) with 20% 1RM resistance. The protocol included four sets: 30 repetitions in the first set, followed by 15 repetitions in each of the subsequent three sets. 80% BFR Group : Followed the same set and repetition structure as the 20% BFR group but at 80% AOP with 20% 1RM resistance. PRE Group : Performed progressive resistance exercise without BFR, comprising three sets at 75%, 80%, and 85% of 1RM, respectively [ 21 , 22 ]. Myotonometry Muscle tone (Myoton-F) and stiffness (Myoton-S) of the biceps brachii were measured using the MyotonPRO device (Myoton AS, Tallinn, Estonia), a non-invasive, handheld tool that applies brief mechanical impulses to elicit soft tissue responses. Muscle tone is quantified as signal frequency, and stiffness as resistance to external force, measured via an accelerometer [ 23 ]. Participants were positioned supine with the elbow at 45° flexion and the forearm neutral. The midpoint between the coracoid process and radial tuberosity was marked with a wax pencil for consistent measurement. Assessments were conducted by a blinded physiotherapist to ensure objectivity. BFR Application BFR was applied using wireless automated exercise cuffs (Airbands, Vald Health, Brisbane, Australia; 25–45 cm length, 7 cm width) controlled via the Airbands Version 7.0.0 application (VALD, iOS). Cuffs were positioned on the proximal biceps brachii, secured with a two-finger gap between cuff and skin, and paired with the application via Bluetooth. This method is valid and reliable for BFR protocols, with established accuracy [ 24 , 25 ]. Pressures were set at either 20% or 80% of the AOP according to group allocation and applied at the start of the program. Each participant’s AOP was automatically calculated by the device. Statistical Analysis Data analysis was conducted using IBM SPSS Statistics Standard Concurrent User Version 26 (IBM Corp., Armonk, New York, USA). Descriptive statistics were reported as mean ± standard deviation (M ± SD), median (M), minimum (min), and maximum (max) values. The normality of numerical variables was assessed using the Shapiro-Wilk test. One-Way ANOVA was used to compare numerical characteristics between groups, while categorical variables were compared using the Chi-square test (Pearson Chi-square or Fisher’s exact test). Repeated Measures ANOVA was applied to evaluate changes in variables over time within groups. The Bonferroni correction was used for pairwise comparisons of main effects. For repeated measures, the sphericity assumption was tested using Mauchly’s test; as this assumption was met, the Sphericity Assumed test was employed. Two-Way Repeated Measures ANOVA, followed by the Bonferroni-Dunn test for multiple comparisons, was used for overall comparisons between groups and across repeated measures. Effect sizes for significant findings were reported using partial eta squared (η²), with values interpreted as follows: 0.01 = small, 0.06 = medium, and 0.14 = large effect [ 26 ]. A statistical significance level of p < 0.05 was adopted for all analyses. All analyses were performed by an independent statistical expert to minimize researcher bias and ensure the objectivity of statistical interpretations. Results Flow diagram showing patient inclusion and follow-up in Fig. 1 . The demographic characteristics of the 62 participants (PRE group, n = 22; 20% BFR group, n = 20; 80% BFR group, n = 20) included in the study are shown in Table 1 . The mean age of the participants was 21.00 ± 0.76, 21.00 ± 0.97, and 21.10 ± 0.79 years for the PRE, 20% BFR, and 80% BFR groups, respectively. The mean BMI was 22.78 ± 3.44, 22.19 ± 2.74, and 22.51 ± 2.81 kg/m² for the PRE, 20% BFR, and 80% BFR groups, respectively. 1RM values were 11.41 ± 6.54, 10.10 ± 2.61, and 11.25 ± 2.45 kg for the PRE, 20% BFR, and 80% BFR groups, respectively. No significant differences were found among groups in terms of age, gender, BMI, or 1RM values at baseline (p > 0.05) (Table 1 ). Table 1 Demographic features of participants ( N = 62). Groups Test ( p ) PRE %20 BFR %80 BFR n = 22 n = 20 n = 20 Gender , n ( % ) χ 2 = 1.213 p = 0.545 Female 10 (45.5) 12 (60) 12 (60) Male 12 (54.5) 8 (40) 8 (40) Age , ( years ) F = 0.157 p = 0.855 Mean ± SD 21.00 ± 0.76 21.00 ± 0.97 21.10 ± 0.79 M ( min - max ) 21 (20–23) 21 (19–22) 21 (20–22) Body Mass Index , ( kg/m 2 ) F = 0.198 p = 0.821 Mean ± SD 22.78 ± 3.44 22.19 ± 2.74 22.51 ± 2.81 M ( min - max ) 22.7 (16.9–28.4) 21.9 (17.8–26.8) 21.8 (19.5–29.7) One-Repetition Maximum , ( kg ) F = 0.540 p = 0.586 Mean ± SD 11.41 ± 6.54 10.10 ± 2.61 11.25 ± 2.45 M ( min - max ) 9 (5–25) 10 (6–14) 12 (8–16) One way ANOVA ( F ); Chi SquareTest ( χ 2 ); standart deviation ( SD ), Median ( M ), minimum ( min ), maksimum ( max ), number ( n ), percentage ( % ). Table 2 presents the comparison of muscle tone (Myoton-F) and stiffness (Myoton-S) values between the groups across different follow-up days before and after exercise. In intragroup analyses, a significant main time effect was noted in Myoton-F values in the PRE and 80% BFR groups (F [3, 57] = 64.359, p < 0.001, partial η²=0.772 and F [3, 57] = 12.003, p < 0.001, partial η²=0.387, respectively), while the 20% BFR group showed no significant changes over time (F [3, 57] = 0.071, p = 0.975, partial η²=0.004). Similarly, Myoton-S values showed a significant time effect in the PRE and 80% BFR groups (F [3, 56] = 12.061, p < 0.001, partial η = 0.393 and F [3, 56] = 6.268, p < 0.001, partial η²=0.251, respectively), but no significant changes were observed in the 20% BFR group (F [3, 56] = 0.721, p = 0.544, partial η²=0.037). Table 2 Comparison of outcome measurements according to groups at follow-up times (N = 62) Groups Test Statistics † Statistical Model PRE (n = 22) %20 BFR (n = 20) %80 BFR (n = 20) Group X Time Effect Mean ± SD Mean ± SD Mean ± SD Myoton-F p < 0.001 η 2 = 0.315 Day 1 13.50 ± 0.91 aA 12.74 ± 1.16 aA 13.22 ± 1.30 aA p = 0.094 η 2 = 0.077 Day 2 14.77 ± 1.38 bB 12.79 ± 1.22 aA 13.82 ± 1.18 bB p < 0.001 η 2 = 0.303 Day 3 15.28 ± 1.12 bcC 12.75 ± 1.28 aA 13.92 ± 1.53 bB p < 0.001 η 2 = 0.398 Day 4 15.35 ± 1.28 cC 12.72 ± 1.15 aA 14.09 ± 1.36 bB p < 0.001 η 2 = 0.434 Test Statistics ϕ p < 0.001 η 2 = 0.772 p = 0.975 η 2 = 0.004 p < 0.001 η 2 = 0.387 Myoton-S p < 0.001 η 2 = 0.164 Day 1 1.11 ± 0.15 aA 1.03 ± 0.22 aA 1.07 ± 0.18 aA p = 0.349 η 2 = 0.036 Day 2 1.20 ± 0.17 bB 1.01 ± 0.18 aA 1.15 ± 0.14 bB p < 0.001 η 2 = 0.221 Day 3 1.25 ± 0.14 bcB 0.98 ± 0.14 aA 1.18 ± 0.18 bB p < 0.001 η 2 = 0.369 Day 4 1.27 ± 0.14 cB 1.00 ± 0.18 aA 1.19 ± 0.14 bB p < 0.001 η 2 = 0.369 Test Statistics ϕ p < 0.001 η 2 = 0.393 p = 0.544 η 2 = 0.037 p < 0.001 η 2 = 0.251 Repeated Measures ANOVA ( F ), Effect size ( η 2 ), ϕ Comparion of intragroup, † Comparison of intergroups, standart deviation ( SD ), The sections highlighted in bold are statistically significant (p < 0.05). a < b < c: Differences between time points in the same column are significant (p < 0.05), A < B < C: Differences between groups in the same row are significant (p < 0.05). Although significant within-group differences were found over time in muscle tone and stiffness in the PRE and 80% BFR groups, post hoc analyses revealed that the 20% BFR group did not demonstrate significant alterations in either parameter across the three days following exercise. Intergroup comparisons revealed that 80% BFR induced greater changes in both tone and stiffness compared to 20% BFR (p < 0.001) (Table 2 ). Discussion This study experimentally investigated the comparative effects of strength exercises performed with varying BFR ssures (20% and 80% AOP) and PRE on biceps brachii muscle tone (Myoton-F) and stiffness (Myoton-S) during a four-day simulated tapering period in healthy individuals. The results partially support the hypothesis that BFR protocols modulate muscle stiffness, demonstrating that 80% BFR and PRE significantly increase muscle tone and stiffness, whereas 20% BFR induces no significant changes. These findings align with the study’s objective to identify an optimal BFR configuration for tapering in power athletes, offering critical insights into balancing neuromuscular performance maintenance with injury risk mitigation during competition preparation. Significant time effects were observed in the PRE and 80% BFR groups for Myoton-F indicating robust increases in muscle tone and stiffness. The large effect sizes in the PRE group and moderate to large effect sizes in the 80% BFR group suggest substantial alterations in muscle biomechanical properties during simulated tapering. These results are supported by Yanagisawa et al. [ 27 ], who reported increased biceps brachii stiffness immediately after dynamic arm curl exercises (70% 1RM, 5 sets of 8 repetitions). Similarly, Lacourpaille et al. [ 28 ] observed a 46% increase in shear elastic modulus following PRE, aligning closely with the present findings. Regarding 80% BFR, Buckner et al. [ 29 ] showed that high-pressure BFR significantly enhances muscle swelling, elevating muscle tone and stiffness-a phenomenon likely linked to increased intracellular fluid and intramuscular pressure. Jessee et al. [ 30 ] identified fluid accumulation distal to the BFR cuff as a key mechanism altering muscle mechanical properties. Moreover, greater muscle damage was associated with the largest magnitude of change in muscle stiffness, which remained elevated for at least one muscle group three weeks post-exercise, as demonstrated by Agten et al. [ 31 ]. This muscle damage was suggested to acutely increase muscle stiffness, possibly due to rapid perturbations of intramuscular calcium homeostasis followed by an increase in stable cross-bridges [ 28 ]. Taken together, these findings support and extend earlier observations [ 28 – 31 ], reinforcing the role of fluid shifts and muscle damage in stiffness-related adaptations following high-pressure BFR and PRE. In contrast, the 20% BFR group exhibited no significant changes in Myoton-F or Myoton-S, indicating that low-pressure BFR does not alter muscle tone or stiffness during tapering. This absence of effect suggests minimal muscle damage, as supported by Suga et al. [ 32 ], who found that low BFR pressure (100 mmHg, 20% 1RM) induces significantly lower metabolic stress compared to moderate pressures (150 mmHg). Studies by Nielsen et al. [ 33 ] and Neto et al. [ 34 ] corroborate this, reporting no significant changes in serum creatine kinase (CK) or lactate dehydrogenase activity-indirect markers of muscle damage- 24–48 hours after low-load BFR training (20–30% 1RM). However, conflicting findings exist, with studies like Alvarez et al. [ 35 ] and Sieljacks et al. [ 36 ] observing significant muscle damage markers (e.g., delayed onset muscle soreness, increased CK) post-low-load BFR, potentially due to differences in muscle groups or exercise protocols. The lack of stiffness increase with 20% BFR positions it as a safer tapering option, avoiding injury risks associated with heightened stiffness, as noted by Pickering Rodriguez et al. [ 37 ], who linked elevated stiffness to reduced muscle compliance and increased injury risk. Between-group comparisons confirmed that 80% BFR induced significantly greater changes in muscle tone and stiffness compared to 20% BFR, with moderate to large group × time interaction effect sizes. This supports the role of higher BFR pressures in driving biomechanical changes, likely due to increased metabolic stress, as noted by Wilk et al. [ 38 ]. However, the PRE group’s superior effect sizes underscore high-intensity resistance training as the most potent stimulus for altering muscle properties, consistent with Grosset et al. [ 39 ]. While effective for neuromuscular priming, the increased stiffness from 80% BFR and PRE may elevate injury risk in strength sports, where explosive movements demand muscle elasticity, as cautioned by McHugh et al. [ 40 ]. Conversely, 20% BFR’s maintenance of baseline muscle properties suggests it preserves strength without compromising compliance, making it a safer option for tapering. This is supported by Sugiarto et al. [ 41 ], who found that low-intensity BFR (20–30% 1RM) enhances muscle strength and hypertrophy. Additionally, Brandner et al. [ 42 ] demonstrated that low-pressure BFR induces rapid and long-lasting increases in corticomotor excitability during biceps brachii resistance exercise. This effect may contribute to performance improvements in athletes prior to competition, enhancing 20% BFR’s utility in tapering strategies. The findings have significant implications for strength athletes. The increased tone and stiffness with 80% BFR and PRE, while beneficial for neuromuscular activation, may heighten injury risk just before competition, particularly in strength sports [ 37 – 40 ]. In contrast, 20% BFR’s lack of effect on stiffness offers a safer tapering strategy, maintaining strength without increasing injury risk, aligning with the study’s aim to balance performance and recovery. This is supported by Smith et al. [ 18 ], who found that BFR during tapering sustains performance while reducing training volume, potentially enhancing outcomes during competitive seasons. The study’s methodological rigor, including a randomized controlled design, double-blind methodology, and objective MyotonPRO measurements, strengthens these findings. The absence of baseline differences in age, gender, BMI, or 1RM further enhances internal validity. Several limitations must be acknowledged. First, the focus on the biceps brachii limits generalizability to other muscle groups critical for strength sports, such as the quadriceps or hamstrings. Second, the participant cohort of healthy, young adults without recent strength training may not fully represent trained athletes, who may respond differently due to training adaptations. Third, unmeasured variables, such as diet or sleep, could have influenced muscle responses despite environmental controls (e.g., 22–24°C). Finally, the study did not directly measure strength retention or injury incidence, limiting conclusions about 20% BFR’s efficacy in maintaining performance or preventing injuries. Future research should extend intervention durations to assess effects on strength, and injury risk in competition settings. Including diverse muscle groups and trained athletes would enhance ecological validity, as would direct measurements of strength retention and injury outcomes. Exploring intermediate BFR pressures (e.g., 40–60% AOP) could identify an optimal threshold for balancing efficacy and safety. Integrating 20% BFR with other tapering strategies, such as reduced volume, could further refine protocols. In conclusion, this study demonstrates that 80% BFR and PRE significantly increase muscle tone and stiffness, potentially elevating injury risk for strength athletes during tapering, while 20% BFR maintains muscle properties without increasing stiffness, offering a safer alternative for competition preparation. These findings suggest that 20% BFR is a promising tapering strategy that reduces injury risk while maintaining strength and neuromuscular function. Abbreviations 1RM 1 repetition maximum AOP arterial occlusion pressure BMI body mass index BFR blood flow restriction PRE progressive resistance exercise ROM Range of motion BFR-RE blood flow restriction resistance exercise Declarations Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Istanbul Okan University (Approval Date: January 8, 2025; Approval No: 183; Decision No: 34). Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent for publication: Not applicable. Availability of data and materials: The data that support the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy or ethical restrictions. Competing interests : The authors have no competing interests to declare that are relevant to the content of this article. Funding: No funds, grants, or other support was received. Authors' contributions: Authors had made substantial contributions to all of the following: (OS, MD, KK, EA, GA) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (OS MD, KK, GA) drafting the article or revising it critically for important intellectual content, (OS, EA) final approval of the version to be submitted. Acknowledgements: None. References Bosquet L, Berryman N, Dupuy O, Mekary S, Arvisais D, Bherer L, et al. Effect of training cessation on muscular performance: A meta-analysis. Vol. 23, Scandinavian Journal of Medicine and Science in Sports. 2013. Giannesini B, Cozzone PJ, Bendahan D. Non-invasive investigations of muscular fatigue: metabolic and electromyographic components. Biochimie. 2003;85(9):873–83. Freitas SR, Mendes B, Firmino T, Correia JP, Witvrouw EEMC, Oliveira R, et al. 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Han H rim, Yi C hwi, You S hyun, Cynn H seock, Lim O bin, Son J ik. Comparative effects of 4 single-leg squat exercises in subjects with gluteus medius weakness. J Sport Rehabil. 2018;27(6):513–9. Yanagisawa O, Niitsu M, Kurihara T, Fukubayashi T. Evaluation of human muscle hardness after dynamic exercise with ultrasound real-time tissue elastography: a feasibility study. Clin Radiol. 2011;66(9):815–9. Lacourpaille L, Nordez A, Hug F, Couturier A, Dibie C, Guilhem G. Time-course effect of exercise-induced muscle damage on localized muscle mechanical properties assessed using elastography. Acta physiologica. 2014;211(1):135–46. Buckner SL, Jessee MB, Dankel SJ, Mattocks KT, Mouser JG, Bell ZW, et al. Acute skeletal muscle responses to very low-load resistance exercise with and without the application of blood flow restriction in the upper body. Clin Physiol Funct Imaging. 2019;39(3):201–8. Jessee MB, Mattocks KT, Buckner SL, Dankel SJ, Mouser JG, Abe T, et al. Mechanisms of blood flow restriction: the new testament. Techniques in orthopaedics. 2018;33(2):72–9. Agten CA, Buck FM, Dyer L, Flück M, Pfirrmann CWA, Rosskopf AB. Delayed-onset muscle soreness: temporal assessment with quantitative MRI and shear-wave ultrasound elastography. American Journal of Roentgenology. 2017;208(2):402–12. Suga T, Okita K, Morita N, Yokota T, Hirabayashi K, Horiuchi M, et al. Intramuscular metabolism during low-intensity resistance exercise with blood flow restriction. J Appl Physiol. 2009;106(4):1119–24. Nielsen JL, Aagaard P, Prokhorova TA, Nygaard T, Bech RD, Suetta C, et al. Blood flow restricted training leads to myocellular macrophage infiltration and upregulation of heat shock proteins, but no apparent muscle damage. J Physiol. 2017;595(14):4857–73. Neto GR, Novaes JS, Salerno VP, Gonçalves MM, Batista GR, Cirilo-Sousa MS. Does a resistance exercise session with continuous or intermittent blood flow restriction promote muscle damage and increase oxidative stress? J Sports Sci. 2018;36(1):104–10. Alvarez IF, Damas F, Biazon TMP de, Miquelini M, Doma K, Libardi CA. Muscle damage responses to resistance exercise performed with high-load versus low-load associated with partial blood flow restriction in young women. Eur J Sport Sci. 2020;20(1):125–34. Sieljacks P, Matzon A, Wernbom M, Ringgaard S, Vissing K, Overgaard K. Muscle damage and repeated bout effect following blood flow restricted exercise. Eur J Appl Physiol. 2016 Mar 1;116(3):513–25. Pickering Rodriguez EC, Watsford ML, Bower RG, Murphy AJ. The relationship between lower body stiffness and injury incidence in female netballers. Sports Biomech. 2017 Jul 3;16(3):361–73. Wilk M, Krzysztofik M, Gepfert M, Poprzecki S, Golas A, Maszczyk A. Technical and training related aspects of resistance training using blood flow restriction in competitive sport - A review. Vol. 65, Journal of Human Kinetics. Sciendo; 2018. p. 249–60. Grosset JF, Breen L, Stewart CE, Burgess KE, Onambélé GL. Influence of exercise intensity on training-induced tendon mechanical properties changes in older individuals. Age (Omaha). 2014;36(3):1433–42. McHugh MP, J Connolly DA, Eston RG, Kremenic IJ, Nicholas SJ, Gleim GW. The Role of Passive Muscle Stiffness in Symptoms of Exercise-Induced Muscle Damage. 1999. Sugiarto D. CrossMark. Bali Medical Journal (Bali Med J) 2017 [Internet]. 2017;6(2):251–7. Available from: www.balimedicaljournal.organdojs.unud.ac.id/index.php/bmj Brandner CR, Warmington SA, Kidgell DJ. Corticomotor excitability is increased following an acute bout of blood flow restriction resistance exercise. Front Hum Neurosci. 2015 Dec 2;9(DEC). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6796036","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":503837010,"identity":"3570b1e7-0201-4061-bf0b-94302c938fae","order_by":0,"name":"Ozgur SURENKOK","email":"","orcid":"","institution":"Istanbul Okan University","correspondingAuthor":false,"prefix":"","firstName":"Ozgur","middleName":"","lastName":"SURENKOK","suffix":""},{"id":503837011,"identity":"2e18ce39-763e-4e02-8109-9eb6997546e8","order_by":1,"name":"Melis DESTAN","email":"","orcid":"","institution":"Istanbul Okan University","correspondingAuthor":false,"prefix":"","firstName":"Melis","middleName":"","lastName":"DESTAN","suffix":""},{"id":503837012,"identity":"865bd4a5-c7bd-4238-9955-e087df173276","order_by":2,"name":"Kubra KENDAL","email":"","orcid":"","institution":"Istanbul Okan University","correspondingAuthor":false,"prefix":"","firstName":"Kubra","middleName":"","lastName":"KENDAL","suffix":""},{"id":503837015,"identity":"8f8efcab-b367-41fd-a3f0-9e0626048dec","order_by":3,"name":"Emine ATICI","email":"","orcid":"","institution":"Istanbul Okan University","correspondingAuthor":false,"prefix":"","firstName":"Emine","middleName":"","lastName":"ATICI","suffix":""},{"id":503837019,"identity":"cbde9f76-4b40-4a0a-aaa6-86fb0bb2e9fd","order_by":4,"name":"Gamze AYDIN","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYJADxgcMB8AMA2JUgxUxGyC0JBCnhU2CKC3y7qeTP3xg+CMnPyP3WMWHM3Z5DOzN2yQYf9zDqcXwTO4GwxkMBsYGN/LSbs64kVzMwHOsTIIhoRi3lobcDck8DAaJGyRyzG7zfGBObAAygFpwu8yw/+2Gw3+AWubPyDEr5vlQn9gg/wa/FnmJ3I3NQA8nNtzIMWPmuXEYaAsPfi0GEm83M/YYGBsbnHljLDnjzPHENp60YouENDy29Odu/vCjQk5Ovj3H8MOHY9WJ/eyHN974YIPHlgNgEkmEDUTg1gC0pQGP5CgYBaNgFIwCMAAA7PJSh/5Ss8MAAAAASUVORK5CYII=","orcid":"","institution":"Istanbul Okan University","correspondingAuthor":true,"prefix":"","firstName":"Gamze","middleName":"","lastName":"AYDIN","suffix":""}],"badges":[],"createdAt":"2025-06-01 13:53:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6796036/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6796036/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90002225,"identity":"ef3ef3ae-fa93-4ea5-bf2f-4886111aa75b","added_by":"auto","created_at":"2025-08-27 09:05:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33641,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram showing patient inclusion and follow-up.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6796036/v1/26d0639a96afd2c8ecf3be2c.png"},{"id":108601114,"identity":"f7c90e55-3344-463f-904a-514c3e4de002","added_by":"auto","created_at":"2026-05-06 11:28:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":388100,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6796036/v1/56f66051-1c3e-4c29-a583-6efd5d78aa64.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bridging Training and Competition: Blood Flow Restriction as a Novel Tapering Approach","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePower athletes often employ tapering strategies, including short-term training cessation, in the final preparation phase before competition to optimize physiological and psychological recovery, enhance performance, and mitigate injury risk. The primary objective of tapering is to alleviate musculoskeletal stresses accumulated during intensive training, ensuring peak readiness on competition day [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eResistance training, a cornerstone of power athletes\u0026rsquo; regimens, imposes adaptive stress on skeletal muscle, driving structural remodeling that alters its internal architecture (e.g., fiber alignment) and external orientation (e.g., pennation angle) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A well-documented consequence is increased muscle tone\u0026mdash;defined here as the baseline tension in resting muscle\u0026mdash;and stiffness, reflecting resistance to deformation under mechanical loading [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, the biomechanical implications of these changes for injury-prone muscles remain contentious. For instance, Freitas et al. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] suggest that elevated stiffness may heighten injury risk by reducing muscle compliance, whereas Kawai et al.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] found no such association, possibly due to differences in measurement techniques (e.g., shear wave elastography vs. myotonometry) or training status of participants. This discrepancy underscores a critical gap: whether training-induced stiffness exacerbates injury susceptibility or supports performance remains unclear. Similarly, the optimal muscle tone for peak athletic output is undefined, though overuse and overtraining are widely recognized to elevate stiffness, potentially compromising tissue resilience [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Moreover, resistance training can acutely increase passive muscle stiffness, a determinant of joint range of motion (ROM), possibly due to muscle damage [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The limitation of joint ROM has been suggested to increase the risk of musculoskeletal injuries[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and impair athletic performance [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These findings highlight that excessive stiffness and restricted ROM may elevate injury risk and hinder performance in power athletes, necessitating tailored training protocols during tapering to balance neuromuscular adaptations with tissue compliance.\u003c/p\u003e\u003cp\u003eTo mitigate these training-induced risks, athletes commonly reduce training loads through tapering or cessation strategies. Designing an effective taper is complex, as load can be adjusted via intensity, volume, duration, frequency, or combinations thereof [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Short-term training cessation-defined as a complete halt of athletic activity for 1 to 7 days [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]-is a prevalent approach, yet its impact on strength performance is inconsistent. For example, Pritchard et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] observed no significant changes in peak force during isometric mid-thigh pulls or bench presses after 3.5 or 5.5 days of cessation in trained individuals, suggesting maintenance of strength. Conversely, Kyle Travis et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] reported potential declines in upper-body isometric maximal strength after similar durations, possibly due to reduced neuromuscular activation in less-trained cohorts. These conflicting outcomes, likely influenced by factors such as athlete experience or testing protocols, indicate that the ideal cessation duration for maximizing upper- and lower-body strength remains elusive [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In technical sports like weightlifting, even brief interruptions may impair performance by disrupting neuromuscular coordination [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], highlighting the limitations of cessation alone and the need for alternative tapering methods that preserve performance while reducing mechanical stress.\u003c/p\u003e\u003cp\u003eOne such method gaining traction is blood flow restriction resistance exercise (BFR-RE), which uses partial vascular occlusion to enhance low-load training outcomes. BFR-RE has been shown to outperform traditional low-load resistance exercise, yielding strength and hypertrophy gains comparable to high-load protocols [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Current guidelines recommend restriction pressures of 20\u0026ndash;80% of arterial occlusion pressure, applied over four sets (30, 15, 15, 15 repetitions) with 30\u0026ndash;60 seconds of inter-set rest, to optimize muscle adaptations [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Emerging evidence supports its potential during tapering: Smith et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] demonstrated significant improvements in bench press performance with BFR-RE in this phase, though their small sample size limits generalizability. Similarly, Harrison et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] found that \u0026ldquo;priming exercises\u0026rdquo; with BFR 48 hours before competition enhance neuromuscular performance, offering a practical boost, albeit in a specific cohort of powerlifters. While promising, these findings raise questions about optimal pressure ranges, long-term safety, and applicability across diverse athletic populations-gaps that warrant further exploration. Nonetheless, BFR-RE\u0026rsquo;s ability to sustain neuromuscular activation with reduced mechanical load positions it as a candidate to address the dual demands of fatigue prevention and competitive readiness.\u003c/p\u003e\u003cp\u003eBuilding on this foundation, the present study hypothesizes that varying doses of blood flow restriction (BFR) modulate muscle stiffness during the tapering period, enabling athletes to train safely until competition day without compromising performance or recovery. Specifically, this research compares BFR protocols-defined by restriction pressures ranging from 20\u0026ndash;80% of arterial occlusion pressure-to traditional progressive resistance exercise (PRE) programs in regulating muscle stiffness following short-term training cessation.\u003c/p\u003e\u003cp\u003eBy systematically evaluating these parameters, the study aims to identify an optimal BFR configuration that maintains neuromuscular performance, prevents excessive stiffness that could elevate injury risk from prior training, and supports tissue resilience. This approach seeks to contribute a novel, evidence-based tapering protocol to the literature, offering athletes a strategy to bridge reduced training loads with sustained competitive readiness. Such a framework could enhance preparation for competition day, balancing the trade-offs between recovery and performance maintenance.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eThe study involved 62 healthy university students aged 18\u0026ndash;25 years. Inclusion criteria required participants to have refrained from biceps strength training for at least eight weeks, have no history of musculoskeletal injuries affecting the biceps muscle\u0026ndash;tendon complex, and demonstrate right-hand dominance per the Edinburgh Handedness Inventory. Exclusion criteria included diagnosed cardiovascular, pulmonary, or metabolic diseases; sickle cell anemia; recent surgical procedures; a body mass index (BMI) exceeding 35 kg/m\u0026sup2;; significant orthopedic pain; use of antihypertensive or cardiac medications; or implanted medical devices. Written informed consent was obtained from all participants, and the study protocol was approved by the Istanbul Okan University\u0026rsquo;s Institutional Ethics Committee (Approval Date: January 8, 2025; Approval No: 183; Decision No: 34), adhering to the Declaration of Helsinki.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eA prospective, double-blind, randomized controlled trial was conducted to compare the effects of strength exercises with 20% BFR, 80% BFR, and PRE without BFR on biceps brachii muscle tone (Myoton-F) and stiffness (Myoton-S) over a four-day simulated tapering period. Interventions were delivered by a single physiotherapist, with assessments conducted by a separate physiotherapist unaware of group assignments to maintain evaluator blinding. The statistician was also blinded to group assignments. This study was carried out in the university's physiotherapy department laboratory. This study was conducted in accordance with the CONSORT guidelines.\u003c/p\u003e\n\u003ch3\u003eSample Size\u003c/h3\u003e\n\u003cp\u003eSample size was calculated using G*Power software (version 3.1.9.7; Heinrich-Heine-Universit\u0026auml;t D\u0026uuml;sseldorf, Germany) with the \u0026ldquo;ANOVA: Repeated measures, within-between interaction\u0026rdquo; method. Assuming a moderate effect size (f\u0026thinsp;=\u0026thinsp;0.25), 95% statistical power, and a 5% significance level, a minimum of 45 participants was required [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. To further strengthen the study's robustness, 66 participants were recruited. However, 4 participants discontinued due to personal reasons and scheduling conflicts, and 62 participants completed the study and were included in the final analysis.\u003c/p\u003e\n\u003ch3\u003eRandomization and Blinding\u003c/h3\u003e\n\u003cp\u003eParticipants were randomly assigned to one of three groups (20% BFR, 80% BFR, or PRE) using a numbered sequence (1\u0026ndash;62): numbers 1\u0026ndash;20 to 80% BFR, 21\u0026ndash;40 to 20% BFR, and 41\u0026ndash;62 to PRE. Two additional participants were included, though the randomization method for these is unclear. Participants were scheduled at different times and unaware of their group allocation, ensuring participant blinding. The evaluating physiotherapist, blinded to group assignments, conducted all assessments to minimize bias.\u003c/p\u003e\n\u003ch3\u003eExercise Interventions\u003c/h3\u003e\n\u003cp\u003eInterventions were conducted over four consecutive days in a controlled environment (ambient temperature 22\u0026ndash;24\u0026deg;C) to minimize external influences on muscle performance. On days 1\u0026ndash;3, designated as a simulated exercise tapering period, group-specific exercises were conducted, with measurements taken immediately after each session to evaluate acute effects. On day 4, designated as a simulated competition day, biceps brachii measurements were recorded without exercise.\u003c/p\u003e\u003cp\u003ePrior to interventions, each participant\u0026rsquo;s one-repetition maximum (1RM) for the biceps brachii was determined. The exercise protocols were as follows:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003e20% BFR Group\u003c/b\u003e: Performed low-pressure BFR exercise at 20% arterial occlusion pressure (AOP) with 20% 1RM resistance. The protocol included four sets: 30 repetitions in the first set, followed by 15 repetitions in each of the subsequent three sets.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003e80% BFR Group\u003c/b\u003e: Followed the same set and repetition structure as the 20% BFR group but at 80% AOP with 20% 1RM resistance.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePRE Group\u003c/b\u003e: Performed progressive resistance exercise without BFR, comprising three sets at 75%, 80%, and 85% of 1RM, respectively [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eMyotonometry\u003c/h2\u003e\u003cp\u003eMuscle tone (Myoton-F) and stiffness (Myoton-S) of the biceps brachii were measured using the MyotonPRO device (Myoton AS, Tallinn, Estonia), a non-invasive, handheld tool that applies brief mechanical impulses to elicit soft tissue responses. Muscle tone is quantified as signal frequency, and stiffness as resistance to external force, measured via an accelerometer [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Participants were positioned supine with the elbow at 45\u0026deg; flexion and the forearm neutral. The midpoint between the coracoid process and radial tuberosity was marked with a wax pencil for consistent measurement. Assessments were conducted by a blinded physiotherapist to ensure objectivity.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eBFR Application\u003c/h3\u003e\n\u003cp\u003eBFR was applied using wireless automated exercise cuffs (Airbands, Vald Health, Brisbane, Australia; 25\u0026ndash;45 cm length, 7 cm width) controlled via the Airbands Version 7.0.0 application (VALD, iOS). Cuffs were positioned on the proximal biceps brachii, secured with a two-finger gap between cuff and skin, and paired with the application via Bluetooth. This method is valid and reliable for BFR protocols, with established accuracy [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Pressures were set at either 20% or 80% of the AOP according to group allocation and applied at the start of the program. Each participant\u0026rsquo;s AOP was automatically calculated by the device.\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData analysis was conducted using IBM SPSS Statistics Standard Concurrent User Version 26 (IBM Corp., Armonk, New York, USA). Descriptive statistics were reported as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD), median (M), minimum (min), and maximum (max) values. The normality of numerical variables was assessed using the Shapiro-Wilk test. One-Way ANOVA was used to compare numerical characteristics between groups, while categorical variables were compared using the Chi-square test (Pearson Chi-square or Fisher\u0026rsquo;s exact test). Repeated Measures ANOVA was applied to evaluate changes in variables over time within groups. The Bonferroni correction was used for pairwise comparisons of main effects. For repeated measures, the sphericity assumption was tested using Mauchly\u0026rsquo;s test; as this assumption was met, the Sphericity Assumed test was employed. Two-Way Repeated Measures ANOVA, followed by the Bonferroni-Dunn test for multiple comparisons, was used for overall comparisons between groups and across repeated measures. Effect sizes for significant findings were reported using partial eta squared (η\u0026sup2;), with values interpreted as follows: 0.01\u0026thinsp;=\u0026thinsp;small, 0.06\u0026thinsp;=\u0026thinsp;medium, and 0.14\u0026thinsp;=\u0026thinsp;large effect [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. A statistical significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was adopted for all analyses. All analyses were performed by an independent statistical expert to minimize researcher bias and ensure the objectivity of statistical interpretations.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFlow diagram showing patient inclusion and follow-up in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe demographic characteristics of the 62 participants (PRE group, n\u0026thinsp;=\u0026thinsp;22; 20% BFR group, n\u0026thinsp;=\u0026thinsp;20; 80% BFR group, n\u0026thinsp;=\u0026thinsp;20) included in the study are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age of the participants was 21.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76, 21.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97, and 21.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79 years for the PRE, 20% BFR, and 80% BFR groups, respectively. The mean BMI was 22.78\u0026thinsp;\u0026plusmn;\u0026thinsp;3.44, 22.19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74, and 22.51\u0026thinsp;\u0026plusmn;\u0026thinsp;2.81 kg/m\u0026sup2; for the PRE, 20% BFR, and 80% BFR groups, respectively. 1RM values were 11.41\u0026thinsp;\u0026plusmn;\u0026thinsp;6.54, 10.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61, and 11.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45 kg for the PRE, 20% BFR, and 80% BFR groups, respectively. No significant differences were found among groups in terms of age, gender, BMI, or 1RM values at baseline (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic features of participants (\u003cem\u003eN\u0026thinsp;=\u003c/em\u003e\u0026thinsp;62).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eGroups\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTest (\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePRE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%20 BFR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%80 BFR\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;22\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e, \u003cem\u003en\u003c/em\u003e (\u003cem\u003e%\u003c/em\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u003c/em\u003e\u0026thinsp;1.213\u003c/p\u003e\u003cp\u003e\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.545\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (45.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (60)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (54.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (40)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e, (\u003cem\u003eyears\u003c/em\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cem\u003eF\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.157\u003c/p\u003e\u003cp\u003e\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.855\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMean\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e (\u003cem\u003emin\u003c/em\u003e-\u003cem\u003emax\u003c/em\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (20\u0026ndash;23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (19\u0026ndash;22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21 (20\u0026ndash;22)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBody Mass Index\u003c/b\u003e, (\u003cem\u003ekg/m\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cem\u003eF\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.198\u003c/p\u003e\u003cp\u003e\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.821\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMean\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.78\u0026thinsp;\u0026plusmn;\u0026thinsp;3.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.51\u0026thinsp;\u0026plusmn;\u0026thinsp;2.81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e (\u003cem\u003emin\u003c/em\u003e-\u003cem\u003emax\u003c/em\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.7 (16.9\u0026ndash;28.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.9 (17.8\u0026ndash;26.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.8 (19.5\u0026ndash;29.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOne-Repetition Maximum\u003c/b\u003e, (\u003cem\u003ekg\u003c/em\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cem\u003eF\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.540\u003c/p\u003e\u003cp\u003e\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.586\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMean\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.41\u0026thinsp;\u0026plusmn;\u0026thinsp;6.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e (\u003cem\u003emin\u003c/em\u003e-\u003cem\u003emax\u003c/em\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (5\u0026ndash;25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (6\u0026ndash;14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (8\u0026ndash;16)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOne way ANOVA (\u003cem\u003eF\u003c/em\u003e); Chi SquareTest (\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e); \u003cem\u003estandart deviation\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e), \u003cem\u003eMedian\u003c/em\u003e (\u003cem\u003eM\u003c/em\u003e), \u003cem\u003eminimum\u003c/em\u003e (\u003cem\u003emin\u003c/em\u003e), \u003cem\u003emaksimum\u003c/em\u003e (\u003cem\u003emax\u003c/em\u003e), \u003cem\u003enumber\u003c/em\u003e (\u003cem\u003en\u003c/em\u003e), \u003cem\u003epercentage\u003c/em\u003e (\u003cem\u003e%\u003c/em\u003e).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the comparison of muscle tone (Myoton-F) and stiffness (Myoton-S) values between the groups across different follow-up days before and after exercise. In intragroup analyses, a significant main time effect was noted in Myoton-F values in the PRE and 80% BFR groups (F [3, 57]\u0026thinsp;=\u0026thinsp;64.359, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, partial η\u0026sup2;=0.772 and F [3, 57]\u0026thinsp;=\u0026thinsp;12.003, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, partial η\u0026sup2;=0.387, respectively), while the 20% BFR group showed no significant changes over time (F [3, 57]\u0026thinsp;=\u0026thinsp;0.071, p\u0026thinsp;=\u0026thinsp;0.975, partial η\u0026sup2;=0.004). Similarly, Myoton-S values showed a significant time effect in the PRE and 80% BFR groups (F [3, 56]\u0026thinsp;=\u0026thinsp;12.061, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, partial η\u0026thinsp;=\u0026thinsp;0.393 and F [3, 56]\u0026thinsp;=\u0026thinsp;6.268, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, partial η\u0026sup2;=0.251, respectively), but no significant changes were observed in the 20% BFR group (F [3, 56]\u0026thinsp;=\u0026thinsp;0.721, p\u0026thinsp;=\u0026thinsp;0.544, partial η\u0026sup2;=0.037).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of outcome measurements according to groups at follow-up times (N\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eGroups\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTest Statistics \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStatistical Model\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePRE \u003cem\u003e(n\u0026thinsp;=\u003c/em\u003e\u0026thinsp;22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%20 BFR \u003cem\u003e(n\u0026thinsp;=\u003c/em\u003e\u0026thinsp;20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%80 BFR \u003cem\u003e(n\u0026thinsp;=\u003c/em\u003e\u0026thinsp;20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eGroup X Time Effect\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eMean\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eMean\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eMean\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMyoton-F\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e \u003cb\u003eη\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;\u003cb\u003e0.315\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eDay 1\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91 \u003csup\u003eaA\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16 \u003csup\u003eaA\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30 \u003csup\u003eaA\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.094 \u003cem\u003eη\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u003c/em\u003e\u0026thinsp;0.077\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eDay 2\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38 \u003csup\u003ebB\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22 \u003csup\u003eaA\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18 \u003csup\u003ebB\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e \u003cb\u003eη\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;\u003cb\u003e0.303\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eDay 3\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12 \u003csup\u003ebcC\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28 \u003csup\u003eaA\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53 \u003csup\u003ebB\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e \u003cb\u003eη\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;\u003cb\u003e0.398\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eDay 4\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28 \u003csup\u003ecC\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15 \u003csup\u003eaA\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36 \u003csup\u003ebB\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e \u003cb\u003eη\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;\u003cb\u003e0.434\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest Statistics \u003csup\u003eϕ\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e \u003cb\u003eη\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;\u003cb\u003e0.772\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.975 \u003cem\u003eη\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u003c/em\u003e\u0026thinsp;0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e \u003cb\u003eη\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;\u003cb\u003e0.387\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMyoton-S\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e \u003cb\u003eη\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;\u003cb\u003e0.164\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eDay 1\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15 \u003csup\u003eaA\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22 \u003csup\u003eaA\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18 \u003csup\u003eaA\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.349 \u003cem\u003eη\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u003c/em\u003e\u0026thinsp;0.036\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eDay 2\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17 \u003csup\u003ebB\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18 \u003csup\u003eaA\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14 \u003csup\u003ebB\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e \u003cb\u003eη\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;\u003cb\u003e0.221\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eDay 3\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14 \u003csup\u003ebcB\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14 \u003csup\u003eaA\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18 \u003csup\u003ebB\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e \u003cb\u003eη\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;\u003cb\u003e0.369\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eDay 4\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14 \u003csup\u003ecB\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18 \u003csup\u003eaA\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14 \u003csup\u003ebB\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e \u003cb\u003eη\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;\u003cb\u003e0.369\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest Statistics \u003csup\u003eϕ\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e \u003cb\u003eη\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;\u003cb\u003e0.393\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.544 \u003cem\u003eη\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u003c/em\u003e\u0026thinsp;0.037\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e \u003cb\u003eη\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;\u003cb\u003e0.251\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRepeated Measures ANOVA (\u003cem\u003eF\u003c/em\u003e), Effect size (\u003cem\u003eη\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e), \u003csup\u003eϕ\u003c/sup\u003eComparion of intragroup, \u003csup\u003e\u0026dagger;\u003c/sup\u003e Comparison of intergroups, \u003cem\u003estandart deviation\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e), The sections highlighted in bold are statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). a\u0026thinsp;\u0026lt;\u0026thinsp;b\u0026thinsp;\u0026lt;\u0026thinsp;c: Differences between time points in the same column are significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), A\u0026thinsp;\u0026lt;\u0026thinsp;B\u0026thinsp;\u0026lt;\u0026thinsp;C: Differences between groups in the same row are significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eAlthough significant within-group differences were found over time in muscle tone and stiffness in the PRE and 80% BFR groups, post hoc analyses revealed that the 20% BFR group did not demonstrate significant alterations in either parameter across the three days following exercise. Intergroup comparisons revealed that 80% BFR induced greater changes in both tone and stiffness compared to 20% BFR (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study experimentally investigated the comparative effects of strength exercises performed with varying BFR ssures (20% and 80% AOP) and PRE on biceps brachii muscle tone (Myoton-F) and stiffness (Myoton-S) during a four-day simulated tapering period in healthy individuals. The results partially support the hypothesis that BFR protocols modulate muscle stiffness, demonstrating that 80% BFR and PRE significantly increase muscle tone and stiffness, whereas 20% BFR induces no significant changes. These findings align with the study\u0026rsquo;s objective to identify an optimal BFR configuration for tapering in power athletes, offering critical insights into balancing neuromuscular performance maintenance with injury risk mitigation during competition preparation.\u003c/p\u003e\u003cp\u003eSignificant time effects were observed in the PRE and 80% BFR groups for Myoton-F indicating robust increases in muscle tone and stiffness. The large effect sizes in the PRE group and moderate to large effect sizes in the 80% BFR group suggest substantial alterations in muscle biomechanical properties during simulated tapering. These results are supported by Yanagisawa et al. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], who reported increased biceps brachii stiffness immediately after dynamic arm curl exercises (70% 1RM, 5 sets of 8 repetitions). Similarly, Lacourpaille et al. [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] observed a 46% increase in shear elastic modulus following PRE, aligning closely with the present findings. Regarding 80% BFR, Buckner et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] showed that high-pressure BFR significantly enhances muscle swelling, elevating muscle tone and stiffness-a phenomenon likely linked to increased intracellular fluid and intramuscular pressure. Jessee et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] identified fluid accumulation distal to the BFR cuff as a key mechanism altering muscle mechanical properties. Moreover, greater muscle damage was associated with the largest magnitude of change in muscle stiffness, which remained elevated for at least one muscle group three weeks post-exercise, as demonstrated by Agten et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. This muscle damage was suggested to acutely increase muscle stiffness, possibly due to rapid perturbations of intramuscular calcium homeostasis followed by an increase in stable cross-bridges [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Taken together, these findings support and extend earlier observations [\u003cspan additionalcitationids=\"CR29 CR30\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], reinforcing the role of fluid shifts and muscle damage in stiffness-related adaptations following high-pressure BFR and PRE.\u003c/p\u003e\u003cp\u003eIn contrast, the 20% BFR group exhibited no significant changes in Myoton-F or Myoton-S, indicating that low-pressure BFR does not alter muscle tone or stiffness during tapering. This absence of effect suggests minimal muscle damage, as supported by Suga et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], who found that low BFR pressure (100 mmHg, 20% 1RM) induces significantly lower metabolic stress compared to moderate pressures (150 mmHg). Studies by Nielsen et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and Neto et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] corroborate this, reporting no significant changes in serum creatine kinase (CK) or lactate dehydrogenase activity-indirect markers of muscle damage- 24\u0026ndash;48 hours after low-load BFR training (20\u0026ndash;30% 1RM). However, conflicting findings exist, with studies like Alvarez et al. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] and Sieljacks et al. [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] observing significant muscle damage markers (e.g., delayed onset muscle soreness, increased CK) post-low-load BFR, potentially due to differences in muscle groups or exercise protocols. The lack of stiffness increase with 20% BFR positions it as a safer tapering option, avoiding injury risks associated with heightened stiffness, as noted by Pickering Rodriguez et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], who linked elevated stiffness to reduced muscle compliance and increased injury risk.\u003c/p\u003e\u003cp\u003eBetween-group comparisons confirmed that 80% BFR induced significantly greater changes in muscle tone and stiffness compared to 20% BFR, with moderate to large group \u0026times; time interaction effect sizes. This supports the role of higher BFR pressures in driving biomechanical changes, likely due to increased metabolic stress, as noted by Wilk et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. However, the PRE group\u0026rsquo;s superior effect sizes underscore high-intensity resistance training as the most potent stimulus for altering muscle properties, consistent with Grosset et al. [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. While effective for neuromuscular priming, the increased stiffness from 80% BFR and PRE may elevate injury risk in strength sports, where explosive movements demand muscle elasticity, as cautioned by McHugh et al. [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Conversely, 20% BFR\u0026rsquo;s maintenance of baseline muscle properties suggests it preserves strength without compromising compliance, making it a safer option for tapering. This is supported by Sugiarto et al. [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], who found that low-intensity BFR (20\u0026ndash;30% 1RM) enhances muscle strength and hypertrophy. Additionally, Brandner et al. [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] demonstrated that low-pressure BFR induces rapid and long-lasting increases in corticomotor excitability during biceps brachii resistance exercise. This effect may contribute to performance improvements in athletes prior to competition, enhancing 20% BFR\u0026rsquo;s utility in tapering strategies.\u003c/p\u003e\u003cp\u003eThe findings have significant implications for strength athletes. The increased tone and stiffness with 80% BFR and PRE, while beneficial for neuromuscular activation, may heighten injury risk just before competition, particularly in strength sports [\u003cspan additionalcitationids=\"CR38 CR39\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. In contrast, 20% BFR\u0026rsquo;s lack of effect on stiffness offers a safer tapering strategy, maintaining strength without increasing injury risk, aligning with the study\u0026rsquo;s aim to balance performance and recovery. This is supported by Smith et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], who found that BFR during tapering sustains performance while reducing training volume, potentially enhancing outcomes during competitive seasons. The study\u0026rsquo;s methodological rigor, including a randomized controlled design, double-blind methodology, and objective MyotonPRO measurements, strengthens these findings. The absence of baseline differences in age, gender, BMI, or 1RM further enhances internal validity.\u003c/p\u003e\u003cp\u003eSeveral limitations must be acknowledged. First, the focus on the biceps brachii limits generalizability to other muscle groups critical for strength sports, such as the quadriceps or hamstrings. Second, the participant cohort of healthy, young adults without recent strength training may not fully represent trained athletes, who may respond differently due to training adaptations. Third, unmeasured variables, such as diet or sleep, could have influenced muscle responses despite environmental controls (e.g., 22\u0026ndash;24\u0026deg;C). Finally, the study did not directly measure strength retention or injury incidence, limiting conclusions about 20% BFR\u0026rsquo;s efficacy in maintaining performance or preventing injuries.\u003c/p\u003e\u003cp\u003eFuture research should extend intervention durations to assess effects on strength, and injury risk in competition settings. Including diverse muscle groups and trained athletes would enhance ecological validity, as would direct measurements of strength retention and injury outcomes. Exploring intermediate BFR pressures (e.g., 40\u0026ndash;60% AOP) could identify an optimal threshold for balancing efficacy and safety. Integrating 20% BFR with other tapering strategies, such as reduced volume, could further refine protocols.\u003c/p\u003e\u003cp\u003eIn conclusion, this study demonstrates that 80% BFR and PRE significantly increase muscle tone and stiffness, potentially elevating injury risk for strength athletes during tapering, while 20% BFR maintains muscle properties without increasing stiffness, offering a safer alternative for competition preparation. These findings suggest that 20% BFR is a promising tapering strategy that reduces injury risk while maintaining strength and neuromuscular function.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e1RM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e1 repetition maximum\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAOP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003earterial occlusion pressure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ebody mass index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBFR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eblood flow restriction\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePRE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eprogressive resistance exercise\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eROM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRange of motion\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBFR-RE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eblood flow restriction resistance exercise\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Istanbul Okan University (Approval Date: January 8, 2025; Approval No: 183; Decision No: 34).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u003c/strong\u003e Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The data that support the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy or ethical restrictions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors have no competing interests to declare that are relevant to the content of this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo funds, grants, or other support was received.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003eAuthors had made substantial contributions to all of the following: (OS, MD, KK, EA, GA) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (OS MD, KK, GA) drafting the article or revising it critically for important intellectual content, (OS, EA) final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBosquet L, Berryman N, Dupuy O, Mekary S, Arvisais D, Bherer L, et al. 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Quantified biomechanical properties of lower lumbar myofascia in younger adults with chronic idiopathic low back pain and matched healthy controls. Clinical Biomechanics. 2020;73:78\u0026ndash;85. \u003c/li\u003e\n\u003cli\u003eZhang WY, Zhuang SC, Chen YM, Wang HN. Validity and reliability of a wearable blood flow restriction training device for arterial occlusion pressure assessment. Front Physiol. 2024;15:1404247. \u003c/li\u003e\n\u003cli\u003eSurenkok O, Aydin G, Ciftci EA, Kendal K, Atici E. Impact of blood flow restriction intensity on pain perception and muscle recovery post-eccentric exercise. Clin Physiol Funct Imaging. 2025;45(1):e12925. \u003c/li\u003e\n\u003cli\u003eHan H rim, Yi C hwi, You S hyun, Cynn H seock, Lim O bin, Son J ik. Comparative effects of 4 single-leg squat exercises in subjects with gluteus medius weakness. J Sport Rehabil. 2018;27(6):513\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eYanagisawa O, Niitsu M, Kurihara T, Fukubayashi T. Evaluation of human muscle hardness after dynamic exercise with ultrasound real-time tissue elastography: a feasibility study. Clin Radiol. 2011;66(9):815\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eLacourpaille L, Nordez A, Hug F, Couturier A, Dibie C, Guilhem G. Time-course effect of exercise-induced muscle damage on localized muscle mechanical properties assessed using elastography. Acta physiologica. 2014;211(1):135\u0026ndash;46. \u003c/li\u003e\n\u003cli\u003eBuckner SL, Jessee MB, Dankel SJ, Mattocks KT, Mouser JG, Bell ZW, et al. Acute skeletal muscle responses to very low-load resistance exercise with and without the application of blood flow restriction in the upper body. Clin Physiol Funct Imaging. 2019;39(3):201\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eJessee MB, Mattocks KT, Buckner SL, Dankel SJ, Mouser JG, Abe T, et al. Mechanisms of blood flow restriction: the new testament. Techniques in orthopaedics. 2018;33(2):72\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eAgten CA, Buck FM, Dyer L, Fl\u0026uuml;ck M, Pfirrmann CWA, Rosskopf AB. Delayed-onset muscle soreness: temporal assessment with quantitative MRI and shear-wave ultrasound elastography. American Journal of Roentgenology. 2017;208(2):402\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eSuga T, Okita K, Morita N, Yokota T, Hirabayashi K, Horiuchi M, et al. Intramuscular metabolism during low-intensity resistance exercise with blood flow restriction. J Appl Physiol. 2009;106(4):1119\u0026ndash;24. \u003c/li\u003e\n\u003cli\u003eNielsen JL, Aagaard P, Prokhorova TA, Nygaard T, Bech RD, Suetta C, et al. Blood flow restricted training leads to myocellular macrophage infiltration and upregulation of heat shock proteins, but no apparent muscle damage. J Physiol. 2017;595(14):4857\u0026ndash;73. \u003c/li\u003e\n\u003cli\u003eNeto GR, Novaes JS, Salerno VP, Gon\u0026ccedil;alves MM, Batista GR, Cirilo-Sousa MS. Does a resistance exercise session with continuous or intermittent blood flow restriction promote muscle damage and increase oxidative stress? J Sports Sci. 2018;36(1):104\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eAlvarez IF, Damas F, Biazon TMP de, Miquelini M, Doma K, Libardi CA. Muscle damage responses to resistance exercise performed with high-load versus low-load associated with partial blood flow restriction in young women. Eur J Sport Sci. 2020;20(1):125\u0026ndash;34. \u003c/li\u003e\n\u003cli\u003eSieljacks P, Matzon A, Wernbom M, Ringgaard S, Vissing K, Overgaard K. Muscle damage and repeated bout effect following blood flow restricted exercise. Eur J Appl Physiol. 2016 Mar 1;116(3):513\u0026ndash;25. \u003c/li\u003e\n\u003cli\u003ePickering Rodriguez EC, Watsford ML, Bower RG, Murphy AJ. The relationship between lower body stiffness and injury incidence in female netballers. Sports Biomech. 2017 Jul 3;16(3):361\u0026ndash;73. \u003c/li\u003e\n\u003cli\u003eWilk M, Krzysztofik M, Gepfert M, Poprzecki S, Golas A, Maszczyk A. Technical and training related aspects of resistance training using blood flow restriction in competitive sport - A review. Vol. 65, Journal of Human Kinetics. Sciendo; 2018. p. 249\u0026ndash;60. \u003c/li\u003e\n\u003cli\u003eGrosset JF, Breen L, Stewart CE, Burgess KE, Onamb\u0026eacute;l\u0026eacute; GL. Influence of exercise intensity on training-induced tendon mechanical properties changes in older individuals. Age (Omaha). 2014;36(3):1433\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eMcHugh MP, J Connolly DA, Eston RG, Kremenic IJ, Nicholas SJ, Gleim GW. The Role of Passive Muscle Stiffness in Symptoms of Exercise-Induced Muscle Damage. 1999. \u003c/li\u003e\n\u003cli\u003eSugiarto D. CrossMark. Bali Medical Journal (Bali Med J) 2017 [Internet]. 2017;6(2):251\u0026ndash;7. Available from: www.balimedicaljournal.organdojs.unud.ac.id/index.php/bmj\u003c/li\u003e\n\u003cli\u003eBrandner CR, Warmington SA, Kidgell DJ. Corticomotor excitability is increased following an acute bout of blood flow restriction resistance exercise. Front Hum Neurosci. 2015 Dec 2;9(DEC). \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"blood flow restriction therapy, BFR, resistance training, muscle tone","lastPublishedDoi":"10.21203/rs.3.rs-6796036/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6796036/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEffective tapering is essential to maintain peak performance and reduce injury risk prior to competition. Blood flow restriction (BFR) training, a low-load alternative to traditional resistance exercise, has shown promise; however, its biomechanical effects during tapering are not well defined. This study aimed to compare the acute effects of low-pressure and high-pressure BFR with traditional progressive resistance exercise (PRE) on muscle tone and stiffness during a simulated tapering period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis randomized controlled study included sixty-two healthy participants (mean age 21.03 ± 0.83 years;54.8% female). The participants were randomized into three groups: low-pressure BFR (20% arterial occlusion pressure [AOP]), high-pressure BFR (80% AOP), or PRE. Over four days, participants completed group-specific resistance protocols targeting the biceps brachii. Muscle tone and stiffness were measured using a MyotonPRO device just after each session.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn intragroup analyses, muscle tone showed significant time effect in the PRE (η²=0.772, p \u0026lt; 0.001) and 80% BFR (η²=0.387, p \u0026lt; 0.001) groups, but not in the 20% BFR group (η²=0.004, p = 0.975). Similarly, muscle stiffness increased over time in the PRE (η²=0.393, p \u0026lt; 0.001) and 80% BFR (η²=0.251, p \u0026lt; 0.001) groups, while no significant changes were observed in 20% BFR group (η²=0.037, p = 0.544). Intergroup comparisons revealed that 80% BFR induced greater changes in both muscle tone and stiffness compared to 20% BFR (p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth high-pressure BFR and PRE increase muscle tone and stiffness during tapering, which may elevate injury risk. In contrast, low-pressure BFR preserves neuromuscular properties without exacerbating tissue stiffness, presenting a viable and safer tapering alternative for strength athletes aiming to maintain readiness while minimizing mechanical strain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e NCT06861699\u003c/p\u003e","manuscriptTitle":"Bridging Training and Competition: Blood Flow Restriction as a Novel Tapering Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 09:05:24","doi":"10.21203/rs.3.rs-6796036/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1027886a-143d-4b0b-898b-3930039d0bc5","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Withdrawn","date":"2026-05-06T11:16:35+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T11:27:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 09:05:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6796036","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6796036","identity":"rs-6796036","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}