What phenomena do occur in blood flow-restricted muscle?

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Oxygen is an essential molecule for all cellular activities including growth. Either excessive or deficient oxygen supply to cells induces the various responses of the cells. In the field of pathophysiology, effects of blood flow restriction on various organs have been studied for the past ∼130 years. Subsequently, the roles of oxygen at subcellular level have been studied in vitro. Although a number of studies show that a low-intensity exercise (20∼50% of one repetition maximum) with a moderate tourniquet restriction of blood flow results in increases in muscular strength and size, the mechanisms for this muscular adaptation remain unclear. In particular, it is uncertain whether the low-intensity exercise with blood flow restriction using a tourniquet causes the hypoxia or hyperoxia in the muscle, and then what signals leading to muscular hypertrophy are activated inside and/ or outside the cells. Also, it is not well understood what side effects occur in addition to conferring the benefits of strength gains. The review summarizes recent studies on the muscular adaptations to oxygen environment and discusses the mechanisms that may be involved in the resistance exercise with restricted blood flow.