Wednesday, March 20, 2019

Hard Questions To Face Regarding KAATSU

For who? Baby Boomers, retirees, student-athletes
For what? Strength, stamina, functional movement, mobility, flexibility, recovery

In the emerging world of blood flow restriction (BFR), there are many hard questions, false allegations and mistruths disseminated by BFR manufacturers, sellers and users, especially vis-a-vis KAATSU.

Each of these questions, allegations and mistruths are addressed below:

Question: What is the difference between BFR and KAATSU as a modality?

Answer: KAATSU, in fact, is the original BFR. This was a term required by the editors of scientific journals who had reviewed the initial KAATSU studies that were submitted. But strictly speaking, BFR is based on the principle of occluding - or cutting off temporarily - the arterial flow from the torso to the limbs. That is, arterial blood flow is literally restricted or occluded when applying a tourniquet or occlusion bands in blood flow restriction equipment.

Most often, tourniquets are used that are the same or very similar to blood pressure cuffs that are used in the medical world. These tourniquets and blood pressure cuffs - used to take blood pressure readings - are specifically designed and engineered to occlude arterial flow. Due to their width, structure and inelastic material, the tourniquets are very effective at cutting off arterial flow.

That is, if you keep the tourniquets on long enough, the arterial blood flow is at first limited and then cut off. The palms of our hands go white and there is no pulse felt at your wrist. These tourniquets function exactly as they are designed and engineered and promoted.

In contrast, the KAATSU Air Bands are specifically designed and engineered to allow arterial blood flow to continue and to reduce the venous blood flow back from the limb to the torso. These pneumatic bands are flexible, much more narrow and are elastic that enable the arterial flow to continue and the venous flow to be slightly and safely reduced.

The KAATSU Air Bands were tested and used for 10 years at the University of Tokyo Hospital under the supervision and research conducted by cardiologists Dr. Nakajima and Dr. Morita and other exercise physiologists in collaboration with KAATSU inventor Dr. Sato. Many of the patients who used the KAATSU Air Bands were individuals undergoing cardiac rehabilitation.

These physicians in Japan coined the description BFM or blood flow moderation to describe KAATSU long before the current BFR equipment was conceived or marketed in the United States and Europe. But in the literature, KAATSU is understood to be BFR, and vice versa.

Question: What is the difference between BFR and KAATSU equipment?

Answer: BFR focuses on arterial flow because its core equipment is a tourniquet that is specifically designed and engineered to occlude arterial flow. KAATSU focuses on venous flow because its core equipment are pneumatic bands that are specifically designed and engineered to moderate venous flow and not occlude arterial flow.

Not only are the tourniquet materials, size (width), and structure are significantly different than KAATSU pneumatic bands, but also BFR and BFM protocols are dramatically different.

Question: What is the difference between BFR and BFM?

Answer: While the definitions of Blood Flow Restriction versus Blood Flow Moderation may first appear nuanced and vague, the actual protocols and applications are significantly different and important.

In concept and in application, BFR starts at the point of full occlusion and then held at a specific percentage (between 50-80%). Arterial flow is first occluded and then the limb occlusion pressure is reduced so allow a certain amount of natural arterial flow.

In contrast, BFM starts at a gentle pressure that is gradually increased in duration increments of 20 seconds and only very slight pressure increase so capillary, vein and artery distention and pressure are safely managed.

In concept and in application, BFM starts with normal arterial flow. The arterial flow continues as the venous flow is gradually and slowly reduced. This results in safe blood pooling in the limbs as the vascular walls gradually and slowly expand to accommodate the increased amount of blood in the limbs.

For this reason, KAATSU equipment is often used with the Masimo MightySat Finger Pulse Oximeter. The data from the Bluetooth-enabled pulse oximeter ranges from Pulse Rate to Perfusion Index and is stored on the KAATSU Performance cloud database. Users can measure, store and analyze a variety of their own circulatory information while doing KAATSU.

Allegation: Thin bands like KAATSU cause nerve damage and are dangerous.

Truth: While this rumor has long been promoted by BFR advocates about KAATSU, there has been no documented cases of nerve damage occurring after following standard KAATSU protocols after over 20 years in the marketplace. KAATSU users as old as 104 years have safely and repeatedly used KAATSU over the past few decades (see here). This allegation and false rumor may be the result from some users feel a tingling in their fingertips when using KAATSU equipment. This tingling is caused by a few different phenomena:

1. An engorgement of blood in the small capillaries of the fingertips leads to a tingling sensation. If the sensation is uncomfortable, the easiest action is to either remove the KAATSU Air Bands. However, the best recommendation is to reduce the KAATSU Optimal SKU pressure and the tingling goes away.

2. A user is not well-hydrated before or during KAATSU. Standard KAATSU protocols always calls for all KAATSU users to be very well-hydrated before and during KAATSU use.

3. A user applies a too-high Base SKU pressure and places the KAATSU Air Bands too high up on their arms when first starting KAATSU. It is important to apply the KAATSU Air Bands snugly - but not overly tight. The standard recommendation is to apply the bands tight enough so no more than one finger can be placed under the bands between the skin and the band. If a finger cannot be placed under the bands, it is likely the bands are on too tightly. Also, the bands should be placed above the biceps muscle, but below the deltoids.

There are two major players in the market created by KAATSU inventor Dr. Yoshiaki Sato in Tokyo: the devices designed and manufactured by KAATSU Global, Inc. (e.g., KAATSU Nano, KAATSU Master 2.0, KAATSU Air Bands) and the Delfi Portable Tourniquet System for Blood Flow Restriction.

There are misunderstandings in the marketplace about these two products and approaches.

The Delfi product identifies total occlusion pressure and then applies a specific percentage of that pressure during its applications. In contrast, the KAATSU products are not designed to even remotely approach occlusion pressure or do Blood Flow Restriction.

This fact was identified by Professor Alyssa Weatherholt of the University of Southern Indiana, Professor William VanWye of Western Kentucky University, and Johnny Owens of Owens Recovery Science (the exclusive distributor of the Delfi Portable Tourniquet System for Blood Flow Restriction equipment) who recently presented a study called Pressure Needed to Achieve Complete Arterial Occlusion: A Comparison of Two Devices Used for Blood Flow Restriction Training [see above].

The researchers concluded a wider cuff of the Delfi Portable Tourniquet System for Blood Flow Restriction is able to restrict arterial blood flow at significantly lower pressures compared to the narrow cuff [KAATSU Air Bands] using the KAATSU Master. The key finding of this study is as follows:

We were unable to achieve complete arterial occlusion in any participant with the KAATSU cuff.”

The KAATSU equipment was designed and is specifically manufactured to avoid arterial occlusion in the limbs. This fact is precisely why KAATSU was originally defined by Dr. Yoshiaki Sato, the KAATSU inventor, and leading Japanese cardiologists at the University of Tokyo Hospital as a Blood Flow Moderation (BFM) device. KAATSU equipment is specifically not a BFR (Blood Flow Restriction) device.

While the vernacular nuance between BFM and BFR may be overlooked by many (venous flow modification versus arterial flow restriction), the modification of venous flow is critical to understanding the safety and goal of KAATSU as certified KAATSU Specialists understand.

"There is no part of the KAATSU protocols that includes as part of its protocols - or tries to achieve - arterial occlusion. This is why KAATSU is definitely not BFR, occlusion training, tourniquet training, O-training, or any kind of blood flow restriction modality," explains Steven Munatones. "This is why KAATSU equipment does not use cuffs or bands that are specifically designed to occlude or manufactured to restrict arterial flow. KAATSU Air Bands are not tourniquets or blood pressure cuffs. Rather, the stretchable bands are designed with flexible, elastic air bladders that inflate inwards towards the limb at very moderate pressures to minimally modify venous flow.

This pressure is gentle on the body and uniform because the limb is evenly and safely compressed by a bed of air. This principle and practical engineered solution leads to blood pooling in the limb - not arterial occlusion. This fact was independently determined by researchers and the leading Delfi proponent of BFR

Furthermore, the patented KAATSU Cycle allows normal arterial and venous flow every 20 seconds which means it is safe, effective and gentle for people of all ages (including up to 104 years - see here).

In summary:

1. The purpose of KAATSU equipment and its protocols is a reduction in venous flow via blood flow moderation, a term first coined in the 1990s by Dr. Sato and Doctors Nakajima and Morita, cardiologists at the University of Tokyo Hospital. But the initial definition of KAATSU as BFR stuck and continues to this day.

2. The pneumatically controlled KAATSU Air Bands is designed to achieve a reduction in venous flow is a very different approach from BFR and its widely-promoted use of blood pressure cuffs that are specifically designed to achieve limb occlusion.

3. When the KAATSU equipment is used, its users agree to follow the specific protocols as defined by its inventor, Dr. Sato. Specifically, KAATSU protocols and equipment are designed not to occlude.

4. The stretchable, pneumatically controlled KAATSU Air Bands are not (blood pressure) cuffs. A cuff is a term that refers to devices specifically engineered for limb occlusion.

5. KAATSU Specialists understand the importance of users to know both their Base SKU pressure and their Optimal SKU pressure while using in the KAATSU Cycle and KAATSU Training modes. To refer to KAATSU pressure without reference to both Base SKU and Optimal SKU pressures is misleading.

There is another paper written by Jeremy P. Loenneke, Christopher Fahs, Lindy Rossow, Robert Thiebaud, Kevin T. Mattocks, Takashi Abe, and Michael G. Bemben (Blood flow restriction pressure recommendations: a tale of two cuffs) that addresses this subject from another perspective.

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