Effects of acute piano performance with blood flow restriction on upper limb muscle and perceptual response in pianists

We investigated the physiological and perceptual responses related to piano performance with or without moderate blood flow restriction (BFR) based on acute responses of neuromuscular mechanisms. Student or professional pianists ( n  = 7) performed the "Revolutionary Etude" on the piano with (Piano-BFR) and without (Piano-Ctrl) BFR. During the Piano-BFR performance, 150–180 mmHg of cuff pressure was applied around the most proximal region of both arms as a moderate BFR. Changes in upper limb girth, muscle thickness, and hand grip strength were measured before and immediately after the performance. After the performance, perceptual and other responses were recorded. Immediately after the performance, the Piano-BFR condition induced greater changes in girth (forearm and upper arm), muscle thickness (forearm), and handgrip strength than the Piano-Ctrl condition. Piano-BFR was ( p  < 0.01) higher than Piano-Ctrl on eight questions regarding perceptual response (upper arm fatigue and difficulty playing the piano). Piano performance with BFR was revealed to increase upper extremity muscle size and fatigue in pianists after playing. The effect of BFR on neuromuscular mechanisms on piano performance was greater in the forearm than in the upper arm.