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No this is not the latest ‘shake weight to get ripped’ or ‘Dr. Ho belt for a six pack’ gimmick.  

The use of blood flow restriction (BFR) has become an increasingly well-supported tool in both exercise science and rehabilitation and new research published in 2026 is helping clarify where and how it can be helpful. 

So, what is BFR? 

BFR involves placing a specialized cuff around a limb, usually close to the hip or shoulder, and partially restricting blood flow to that extremity while performing an exercise.  Even using very light loads the exercise can feel extremely difficult. 

Why does a light weight feel so intense, so quickly? Restricting venous blood flow causes metabolites to accumulate in the working muscle and increases the recruitment of muscle fibres as fatigue develops.  The net effect is that using BFL can create a surprisingly large training stimulus without the need for using heavy weights. 

Can light weights really build muscle? 

Increasingly, the answer appears to be yes.   

And if you’ve read our content over the past decade you know that Dr. Brad Schoenfeld and colleagues have shown that muscle hypertrophy can be achieved across a remarkably wide spectrum of rep ranges (from 3+ to 30 reps per set) provided that the effort or tension is high enough to take a set close to failure. 

But with BFR we are talking VERY light weights.  Typically 20-30% of a 1RM max, whereas even 40-60% of a 1RM max would be considered light weight in Schoenfeld and colleagues work. 

A 2026 systematic review and meta-analysis in the British Journal of Sports Medicine examined BFR in people with musculoskeletal conditions. Compared with the same low-load exercise without BFR, low-load BFR produced greater improvements in muscle strength and disability. However, BFR did not clearly outperform conventional high-load resistance training. 

And that’s an important distinction. 

BFR isn’t necessarily better than heavy lifting or likely even moderate lifting at higher reps, it’s simply a way of creating a meaningful training stimulus when typical loading protocols are not practical or possible. 

Where does BFR become particularly interesting? 

Imagine someone recovering from knee, ankle, elbow or wrist surgery.  Or maybe they just got out of a cast or boot being immobilized for an extended period of time.  There may be significant atrophy, pain or other restrictions to safely perform a traditional rehabilitation exercise like a squat, push or pull exercise. 

Simple movements with BFR such as knee extension, elbow flexion or hand gripping can potentially allow a light exercise to provide a much stronger stimulus for maintaining or rebuilding muscle. 

A good example of a clinical application for BFR is early in the ACL rehabilitation (1-12 weeks).  During this early period there is a need to protect the healing graft and knee joint by avoiding heavy loads.  But this is also a period of significant quadriceps atrophy.  Many patients are experiencing high levels of pain and swelling during this period so the notion of any challenging exercises can be a major barrier.  BFR can help combat that quad atrophy and improve early ACL rehabilitation results using simple movements such as a quad squeeze or a partial knee extension. 

Some other clinical applications for BFR include: Total knee arthroplasty (knee replacements), meniscus repairs, knee or ankle osteoarthritis, patellofemoral pain syndrome, achilles tendonopathy or tears, patellar tendinopathy, wrist and elbow surgery and elbow tendon issues. 

Because the blood flow cuff is applied in the upper leg and arm (past the shoulder and hip joints), typically BFR is used less often with hip and shoulder issues.  However, when there is distal muscle loss from a hip replacement or rotator cuff surgery for example BFR might be a reasonable option to help combat that peripheral muscle loss. 

What about for regular fitness or athletic training in subjects that are not injured? 

Here’s where there is some nuance to the BFR story. 

A 2026 meta-analysis involving 859 team-sport athletes found that adding BFR to resistance training produced small improvements in muscle hypertrophy and strength, but did not significantly improve sprint or jumping performance. 

That’s a valuable lesson, but not really a surprising one.  Building more muscle doesn’t automatically make you more athletic.  You still have to train the specific qualities you want to express as an athlete. 

Just like lifting light weights with high reps and high challenge can build muscle, that style of training won’t win you any powerlifting competitions.  

So should everyone start training with BFR? 

Not necessarily. 

For someone who can comfortably perform progressive, heavy resistance training, there is no compelling reason to abandon it. Moderate to heavy resistance remains one of the most effective ways to build muscle and develop maximal strength. 

Where BFR gets particularly interesting is when the amount of weight you can lift is the limiting factor. 

Think of it as a one tool in your strength training toolbox.  

And that’s where exercise science and physiotherapy converge.  BFR can help get a more meaningful muscular stimulus when you can’t lift heavy. 

At The Proactive Athlete, BFR is one of the tools we can use when the goal is to progressively rebuild strength and muscle while respecting an individual’s current capacity. 

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Yes, we love to pit runners against gym bros in a one size fits all health economy where each will claim superiority over the other.

The main point that Dr. Stu Philips continually pounded out during his lecture to our clients this spring was that the best form of exercise is the one that you enjoy the most!

So when yet another giant study comparing aerobic exercise with resistance training just got published to much fanfare, I can admit I started to leaf through it with a bit of a narrow view, expecting to learn nothing.

I was pleasantly surprised at the change in tone of the recommendations made by the researchers.

This was a massive study looking at the effectiveness of both aerobic health and resistance training on many health factors with one catch.

This large meta-analysis only included people with diabesity.

That immediately begs the question…….what the heck is diabesity???

Well the article notes that in 2021 alone, cardiovascular disease and type 2 diabetes combined for over 20 million deaths. This can no longer be called an issue, it is now considered a full blown obesity related epidemic.

Cardiovascular disease and type 2 diabetes share a lot of common features: high blood pressure, dyslipidemia (issues with your fat levels), impaired fasting glucose, insulin resistance and many more.

Researchers are now starting to take a step back and look at what are called ‘network models’ of disease where they acknowledge the complexity of these conditions and grouping them together allows for us to make scalable lifestyle interventions to impact more conditions.

This was the birth of the term ‘diabesity’ which links insulin resistance, impaired glycemic control, fat deposition throughout the body, fatty tissue chronic inflammation and chronic low grade systemic inflammation.

Recommendations for one disease are likely to be very impactful on the other. This makes a ton of sense.

The issue is that all clinicians know that diabesity carries huge risks but they are not sure which to emphasize between aerobic exercise and resistance training.

If someone comes in severely overweights, many doctors will suggest biking a number of times a week, however this may ignore the benefits of resistance training for folks with type 2 diabetes like maintaining skeletal muscle mass which is a key factor in insulin sensitivity.

The other issue is that most prior meta-analysis where they group trials together to draw out conclusions, tend to compare aerobic exercise with non-exercise or ‘usual care’. Same with resistance training. They rarely compare one against the other.

After a ton of exclusion criteria this trial ended up including 1,184 trial participants across 23 studies. The mean BMI in the group was 32.1.

This graphic summarizes the study findings (we will break them down below):

A simple summary:
– Aerobic training was better for fasting blood glucose and cardiorespiratory fitness
– Resistance training for body fat and free fat mass
– There was no difference between the two for an astounding number of factors including body weight, body mass index, HbA1c, lipid markets and many others.

Overall this is yet another study showing that both aerobic training and resistance training should likely be combined. However, researchers are starting to recognize that there should be no one size fits all program for folks struggling with weight.

Let’s say someone was trying to lose weight and had just started a GLP-1. Perhaps the dominant treatment target is to stop muscle loss (sarcopenia) while they lose weight. Then an emphasis on resistance training should likely be at the forefront.

Let’s say that a person’s blood work showed that glucose metabolism issues are the primary goal. Well aerobics may be a better emphasis here.

Overall the concluding sentence does a good job of summarizing the findings:

“When interpreted within lifestyle medicine paradigm, these complementary findings support a goal directed and individualized approach to exercise prescription rather than a one modality fits all model.”

Like Dr. Phillips said……you’re best exercise is the one that you enjoy the most!

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Both the cancer itself and cancer treatment often leaves patients dealing with fatigue, muscle loss, reduced cardiovascular fitness, pain, and decreased independence. These challenges can persist long after chemotherapy or radiation has ended.

A 2025 umbrella review published in the British Journal of Sports Medicine showed that exercise consistently reduces cancer-related fatigue, anxiety, depression, physical deconditioning, treatment complication while improving quality of life, physical function and overall fitness.

And these improved quality of life measures are not limited to early stage and lower grade diagnoses.

The 2024 PREFERABLE-EFFECT trial, published in Nature Medicine, focused on people living with metastatic breast cancer, a group historically underrepresented in exercise research. Participants completed a supervised program combining aerobic exercise, resistance training, balance work, and behavioural coaching over nine months.

The results demonstrated meaningful improvements in cancer-related fatigue, physical fitness, quality of life, pain and overall physical functioning.

Perhaps most importantly, the study showed that appropriately prescribed exercise is both safe and beneficial, even for individuals living with advanced cancer.

Exercise can and should be recommended as supportive care for almost anyone with cancer, however the science has taken a remarkable step forward in the last couple years.

We now know exercise isn’t simply about recovering from cancer treatment, it may actually improve cancer outcomes itself.

A Landmark Study Changes the Conversation

In 2025, researchers published the results of the CHALLENGE trial in the New England Journal of Medicine, the first large randomized controlled trial to demonstrate that a structured exercise program can reduce cancer recurrence and improve survival after treatment for colon cancer.

The study followed 889 patients with Stage II and III colon cancer who had completed surgery and chemotherapy. Participants were randomized to either receive standard health education or a three-year, behaviourally supported exercise program led by exercise professionals.

The results were striking.

Patients who participated in the exercise program experienced:

• 28% lower risk of cancer recurrence, developing a new primary cancer, or death
• 37% lower risk of death
• Higher disease-free survival and overall survival after nearly eight years of follow-up

This is a pivotal finding because randomized controlled trials are considered the highest level of clinical evidence. Previous research had shown that people who exercised tended to live longer after cancer, but it was difficult to know whether exercise itself was responsible (causation versus correlation).

The CHALLENGE trial provides compelling evidence that structured exercise can directly improve long-term outcomes in at least one common cancer.

The exact mechanisms for exercise causing better survival rates will be an area of study for decades to come.

However one recent hypothesis is that exercise may be able to literally starve a tumour.

A fascinating new study published in PNAS found that just 4 weeks of regular exercise dramatically slowed tumour growth in multiple mouse models.  Researchers found that increases in muscle glucose metabolism and reductions in tumour glucose metabolism correlated with slower tumour progression.

Essentially exercising muscle becomes a powerful glucose competitor pulling glucose into skeletal muscle and the heart, leaving less fuel available for tumours to grow.

The authors also found that exercise can reduce mTOR signalling, a major pathway that drives cell growth and is frequently overactive in cancer.

Yes, this is just an animal (mouse) study, so it alone does not prove anything.  However, it’s provides an interesting mechanistic framework supporting this growing body of evidence that exercise interventions may enhance future cancer prevention and treatment strategies.

What Does the Research Suggest Patients Should Do?

So what should you do, if you or a loved one is diagnosed with cancer?  While every individual requires a personalized plan, the strongest evidence supports programs that include:

• 150–300 minutes of moderate aerobic activity per week, such as brisk walking or cycling
• Resistance training two to three times per week to preserve and rebuild muscle
• Progressive increases based on tolerance
• Long-term consistency rather than short bursts of activity

For many people recovering from cancer treatment, simply beginning with regular walking and a supervised strengthening program can provide substantial benefits.  And as a mentor of mine once said, there are many roads to Rome.  How you incorporate exercise into your cancer care strategy will depend on many different factors.

Train for strength.  Train for cardiovascular fitness (both low intensity, longer duration sessions or higher intensity intervals can work).  Mix in some training for power, mobility and recovery if you have time as well.  You have lots of options.  And if you have questions on how to get started safely and effectively, we can help.

The Bottom Line

The message from the latest research is clear: exercise is no longer simply a way to help people recover from cancer treatment, it is becoming an important part of cancer care itself.

If you or someone you know has been diagnosed with cancer, talk to your healthcare team about incorporating exercise into your treatment and recovery plan.  Don’t wait for your oncologist to advise on your exercise strategy.  Your oncologist may not recommend exercise as part of your active treatment plan for various reasons; knowledge translation from academic research to clinical practice takes decades.

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Dr. Christopher Neason, a young Australian, is the athletic research example of this.

He just completed his PhD program and published not one, not two, not three but FOUR ground breaking original research studies (plus some additional bolt on studies) on the same topic to help educate the population and lower fear about what can now be considered a VERY useful intervention in the management of chronic low back pain.

RUNNING.

That’s right running.

If you asked me 5 years ago (heck, even 3 years ago) if high intensity running intervals were good for those with chronic low back pain I would suggest trying just brisk walking instead.

But Dr. Neason’s research has officially made me a believer in running.

Let’s briefly explore the 4 studies he published (including a pair of new ones).

Study 1:  

This was a secondary analysis on a prior 6 month long study that looked at strength and conditioning and low back pain.  Specifically he was looking at variables like training volume, intensity and frequency and how it affected those with low back pain.  This key study showed that shorter session duration and higher perceived exertion was associated with reductions in pain intensity in those with chronic low back pain.  From this, he thought to try this with running……specifically a run-walk interval programme as this allows for shorter duration spurts of higher intensity followed by rest periods.

Study 2:

This was the real ground shaking study.  It was called the ASTEROID study and was such a shock to our respective biases that we wrote a big blog article about it when it came out in 2024.  Essentially this was a 12 week trial comparing a run/walk interval intervention against a control group for those with chronic low back pain using just 3 thirty minute sessions per week.  This study showed that those in the run group had a statistically lower pain intensity and disability when compared to controls.  This was THE FIRST solid piece of literature to definitively show that running at intensity can actually be GOOD for chronic low back pain.

Study 3:

This is the first of his more recent studies that looked at how patients with low back pain actually FEEL about running.  In it, he studied the beliefs about the safety of running in adults with chronic low back pain both prior to his ASTEROID trial and then after.  Folks completed a questionnaire specific to beliefs questions both before and after the running intervention.  Overall 25% of participants in the trial reported that running was unsafe at baseline.  After the running intervention there was a trend towards more positive beliefs about running in those with chronic low back pain however the number of people was not large enough to make it generalizable to the population et large.

Study 4: 

His most recent study from January of this year showed definitively that adults with chronic low back pain had negative beliefs about running.  To do this he compared a group of people with low back pain to a group without.  This showed that adults with chronic low back pain have negative beliefs 69% of the time where they generally felt that running was unsafe.  On top of that, 93% of those with chronic low back pain limited the amount of running they did due to these negative beliefs.

So one obstacle as a therapist (and the purpose of this blog) is to convince folks with chronic low back pain that running is both SAFE and EFFECTIVE.  It will only be by changing these beliefs that people suffering with low back pain will be willing to try intense running as a potential intervention.

Call me a convert.

Running can not only be safe, but also efficacious in the treatment of low back pain.  Counterintuitively, short but intense running can actually amplify these benefits!

Here are two charts that nicely sum up his research finds on running with low back pain and why it is a GREAT, not good intervention.

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Sounds too good to be true.

But there is a training intention gaining attention in the research and rehab world.

The concept is simple:

Train muscles to build capacity at long lengths.

In other words, train muscles to produce force while in a stretched position.

Simple idea. Powerful results.

At our clinic, we commonly see hamstring, groin, calf, pec, rotator cuff, and forearm strains. A common thread? Many of these injuries occur when muscles are loaded while lengthened.

So the question becomes:

Are we adequately preparing muscles for the positions where they are most vulnerable?

I did a Therapy Thursday a couple weeks back emphasizing the same concept but wanted to reinforce the message.

Stretching Versus Stretching Under Load

Most active people already stretch.

Yet despite regular stretching, hamstrings stay tight, hips remain restricted, and muscle strains still happen.

Why?

Conventional stretching involves placing a muscle in a lengthened position and holding it there. This can improve flexibility and reduce stiffness, but research suggests much of that improvement comes from better stretch tolerance rather than major structural changes within the muscle.

Stretching still matters, but it may not be the whole story.

Why Load Changes the Equation

Recent research examining sarcomerogenesis, the addition of sarcomeres within muscle fibres, suggests that mechanical tension at longer muscle lengths may be a key driver of muscle adaptation.

A recent review by Blazevich and colleagues challenges the idea that passive stretching alone creates these changes. Instead, the more meaningful stimulus may be loading muscles while they are lengthened.

That is an important shift in thinking.

Many studies have concluded that eccentric exercise is the key to sarcomerogenesis, however Blazevich has proposed that it may be that muscles adapt best when they are asked to produce force in stretched positions.  Eccentrics are not the magic rehab potion, training at long muscle lengths might be.

What does loaded stretching or training at long-lengths look like?

Long-length training is not new.

Many effective rehab and strength programs already use it such as the use of Romanian deadlifts/lengthened Nordic variations in hamstring rehab or the use of deficit calf raises in calf and achilles rehab or cossacks/copenhagen variations for groin and hip rehab.

These exercises combine mobility and strength rather than treating them separately.

Instead of merely visiting end range, they help you own it.

The bodybuilding world has also embraced the research on hypertrophy from long-length training.  Resistance training performed at longer muscle length has been found to be more effective for promoting overall hypertrophy compared to training at a shorter length.

Bodybuilding programs often includes “lengthened partials”, where you only perform the stretched half of an exercise (partial range of motion), keeping the muscle under maximum tension when it is lengthened.

But a word of caution before you start doing some intense lengthened partials or advanced bodyweight stretch holds.  If you are new to resistance training, start with full-range strength training and progress gradually. Mobility, stability, and movement quality still matter and the challenges for long length muscle training may be too much for a beginner resistance trainer.

The takeaway message is simple:

Think of how you can emphasize muscle length in some of your common resistance training exercises.  Can you emphasize the reach and hold extended portion of a row or can you work your split squat for better control at a lower depth.

Or think outside of the traditional exercise box and create effort in some of your stretched positions.

There appears to be a unique adaptation when muscles are challenged in a fully lengthened state.

Research in this area has certainly changed the way I think about improving mobility, enhancing rehabilitation and preventing injuries for both myself and my patient care and hopefully it will change how you think about your own resistance training plan!

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