Everything You Need To Know About “KAATSU Training”: An All-In-One Exercise, Rehabilitation, & Recovery Blood-Flow Restriction Modality From Japan.

(A COVID "Shelter in Place" Article I wrote for Ben Greenfield after our PodCast)

How I Got Involved With KAATSU

My name is John Doolittle. Three years ago, as I was preparing to end a career in the military, I had to decide what was next, what was to be my “next chapter.” I was proud of what I had accomplished during my career in Naval Special Warfare (NSW, aka the SEAL Teams), and my family surprisingly enjoyed military life. 

We often moved across America and we were stationed overseas several times, which was great for our kids; Sean was born in Germany, Ryan in Monterey, and Meg in Guam. Given the chance, I would change very little in my military career, which started at the U.S. Air Force Academy (long story for another time).

So after finishing 25 years in the Navy, for my next chapter I wanted to continue helping people in a different way, I just wasn’t sure how. Enter Steven Munatones, who, three years ago, asked me to help his small company grow into a global movement.

Almost three years after joining the KAATSU Team and pursuing our mission, I can say with confidence that there is much more going on with KAATSU than just “building muscle” or “improving performance.”

News flash for the Ben Greenfield audience: I am not an exercise physiology Ph.D., I am not a doctor of physical therapy, and I am not a researcher in any way. But, I’ve had a dozen orthopedic procedures after getting beat up over my career, and I appreciate the value of rapid rehabilitation. Prior to my retirement from the SEAL teams, I had experienced KAATSU several times in rehab and had lifted and worked out with the devices. I liked KAATSU, but I really didn’t understand “why” it was good. I just used KAATSU because smart physical therapists and trainers suggested it would be good for me and would help me rehab faster; a good thing in the world of Special Operations. Over time, I learned about KAATSU’s mission to make this new approach available to everyone, from elite athletes to 104-year-old ladies struggling with dementia, and anyone in between. I saw there was something exciting going on with KAATSU besides just making big biceps.

I jumped on the opportunity, and have never looked back.

What the Heck is “KAATSU” Anyway?

KAATSU is a very safe and effective form of exercise, rehabilitation, and recovery. It was invented in Japan in 1966 by Professor Yoshiaki Sato, M.D., Ph.D.

Professor Sato first conceived what's now known as KAATSU in 1966 while sitting on the floor in the traditional Japanese posture known as “seiza.”

After realizing that his blood circulation was blocked in his lower legs, he envisioned a training method that focused on blood flow moderation. Professor Sato began experimenting on himself with bicycle tubes, ropes, judo belts, and bands at various pressures all over his body, methodically keeping track of which type of bands and pressures were safest and most effective. Over the next two decades, he applied KAATSU to thousands of clients and learned what worked best for people of all ages and backgrounds with various kinds of afflictions.

Take a look at Professor Sato below as a young buck and, believe it or not, today at age 72!

By the way, in this podcast, we discuss Dr. Sato's exact training protocol!

So, yes, KAATSU is a strange word that few recognize, but it is the culmination of Professor Sato’s life’s work, so we don’t want to lose track of its origin by compromising the name; that’s very important to our team. KAATSU is a Japanese word and trademarked term where KA (加) means “additional” and ATSU (圧) means “pressure.”

This patented pneumatic equipment enables your arms and legs to modify venous blood flow, which leads to a subsequent cascade of positive physiological effects. KAATSU is supported by decades of extensive research at top academic institutions and is currently leveraged at universities, schools, rehab facilities, and fitness centers in 47 countries.

If you don’t read any further, at least take a look at these key research studies which help explain why it’s so valuable for rehabilitation and immune response:

• Rapid Increase in Plasma Growth Hormone After Low-Intensity Resistance Exercise With Vascular Occlusion
• Effects of low-intensity “KAATSU” resistance exercise on hemodynamic and growth hormone responses
• Muscle Size and Arterial Stiffness After Blood Flow-Restricted Low-Intensity Resistance Training in Older Adults
• Effects of Resistance Exercise Combined With Vascular Occlusion on Muscle Function in Athletes

Pay particular attention to how KAATSU use affects some of the key biomarkers associated with healthy living and exercise: Growth Hormone, Insulin Growth Factor, Vascular Endothelial Growth Factor, and Nitric Oxide.

Just this month, The Journal of Physiology published a great article entitled “BFR-training improves oxygen transport and utilization.” In this paper, researchers demonstrated that when you engorge the legs with blood and engage in “light intensity” exercise, you increase VO2 max, as well as femoral artery diameter and thigh oxygen delivery during exercise—a game-changer in the world of aerobic activities.

How KAATSU Works

Think of your capillaries as a vast, miniature superhighway system. If all the capillary vessels in your body were laid out in a straight line, they would measure about 60,000 miles. Yep, that’s around the world… twice! KAATSU’s key function is the “Cycle,” which is an automated function that creates repeated and intermittent compression on the most proximal part of the arms or legs. 

It’s a way to gradually “stretch” open a portion of that superhighway. Each time the two KAATSU elastic pneumatic bands inflate, a portion of your vascular system (downstream of the bands) is engorged and stretched open—holding that pressure for 30 seconds before a rapid/complete deflation, which allows all the vascular tissue to contract/relax. 

That is what a “KAATSU Cycle” does, it provides automated, repetitive, and precise expansion/contraction of all the tissue distal to the bands. The KAATSU Cycle is a safe form of physiological stress, a form of exercising from the inside out. If you combine some light-intensity functional movement with those Cycles—that’s when the cascade of biochemical reactions in your body begins. Your body responds with a massive secretion of hormones and metabolites, which is the natural response to metabolic stress associated with intense exercise.

In other words, you can mimic the benefits of a vigorous workout by washing the dishes, folding laundry, or walking your dog during KAATSU Cycles. That’s right, with the leg bands on and in the Cycle Mode, you can simply walk your dog at a leisurely pace, and your body will have a systemic response similar to the hormonal and metabolic outcomes of heavy exercise. I know, it sounds bizarre. Yet, after decades of research around the world, the science backs up these claims.

KAATSU's Effect On Aerobic Capacity

There is exciting research being conducted from Texas A&M to the International Olympic Committee on how KAATSU might affect aerobic capacity. 

One of my favorite pilot studies from a few years ago was conducted with “tactical athletes” from Air Force Special Operations Command. 

Put together by researcher William Ursprung at Texas A&M University, the goal of this study was to see if simple “KAATSU Walking” could improve run times, VO2 max, hypertrophy, and strength/power. While this first study was small, the findings were significant and have been the catalyst for follow-up Ph.D. research around the world. Many are interested to see if KAATSU truly is a non-drug and non-invasive way to improve aerobic capacity.

Ursprung took ten fit tactical athletes and kept their routines the same, no change to sleep, diet, existing workouts, etc. Then, he baselined their 1.5 mile run time, VO2 max, muscle girth measurements, and strength/power measurements. All of the run times decreased, all of the hypertrophy measurements increased, and all of the VO2 max/VO2 reserve measurements improved.

He concluded that KAATSU showed impressive changes in aerobic capacity: “…the hypothesis is retained, as results suggest low-intensity BFR walk training does significantly improve aerobic capacity, running endurance performance, and skeletal muscle hypertrophy.”

Using KAATSU For Recovery

What’s truly exciting right now is ongoing research on how KAATSU affects recovery.

The professionals in the sports science world have done a phenomenal job on perfecting approaches to warm-ups and overall performance, yet exercise recovery seems to be a frontier with room to grow. 

I was an NCAA Division I swimmer, so that’s sort of the world I grew up in. In swimming, the established way to “flush” lactate immediately after an event, and before your next event, has always been in the warm-down pool. KAATSU changes that. In order to enhance standard recovery protocols between races, KAATSU Cycles are an efficient way to leverage limited time and resources for a full functional movement (or passive) recovery after heavy work. During an automated KAATSU Cycle, your body will effectively flush lactate out of muscle tissue during the “release” phase when all the capillaries distal of the band are temporarily stretched wide open.

When the KAATSU Cycle aspect is running in its automated mode, the blood is always moving in the limbs since there is never any arterial occlusion. Remember, these are not tourniquets or occlusion bands despite their appearance. The bands inflate to a predetermined and precise level and hold the pressure for 30 seconds. During that half-minute, all the vascular tissue distal to the KAATSU band expands, and then there is a rapid and complete deflation of the bands followed by 5 seconds of no pressure.

Think about that for a minute. You just finished a race and the muscles in your legs are full of lactate. During the inflation phase, all of those blood vessels—a large portion of that 60,000-mile capillary superhighway—are enlarged or “stretched” wide open. At the same time, your cardiac output must adjust in order to keep blood flow always moving past the pneumatic elastic bands.

And then, just as your body has adjusted to this new (pneumatic) stress, you experience a total release of the pressure and an immediate flushing sensation. The device repeats those automated Cycles over and over with gradual and precise increases to the pressure each time. You can feel your limbs recovering while you just sit or lie still. Ultramarathon runners use it, Everest climbers use it, powerlifters use it, team sports athletes use it. It works.

Michael Andrew is a world-class swimmer and one of the fastest humans in water. While doing KAATSU Recovery Cycles in his room between preliminaries and finals, Michael explains, “My body will send extra white blood cells and growth hormone to repair muscles my body thinks are being broken down, but actually are not being broken down, speeding up recovery.” (See the 9:54 mark in Michael's recovery VLOG.)

Who Can Benefit From KAATSU Training?

The short answer: Just about everybody. It doesn’t matter how old you are, you can benefit from KAATSU even if you're well into your 80s. In the study, “Muscle size and arterial stiffness after blood flow-restricted low-intensity resistance training in older adults,” significant gains were shown in a group of healthy adults 61-84 years old.

Researchers observed an 8% increase in MRI cross-sectional area, a 34% increase in leg press one-rep maximum (1-RM), a 26% increase in leg extension 1-RM, and an 18% improvement in a standard chair standing exercise (up and down as many times as possible in 30 seconds).

In another study from 2000, Professor Sato and colleagues began to dig deep into what was happening as a result of KAATSU and found that muscle cross-sectional area and isokinetic strength increased with the experimental group while doing KAATSU and working only with light weights. But, what really got the attention of researchers was how plasma lactate concentrations were higher in the KAATSU group working with light weights (higher than the KAATSU group working with heavier weights at 80% 1-RM.) Take a look at figure-4 from the study:

This implies that not only can you increase hormonal responses to metabolic stress with KAATSU, but you may see more of an effect using very light weights versus the heavier weights/resistance. This study really kick-started the global KAATSU movement.

Changing Lives With KAATSU

As a retired Navy guy who spent a career working among this nation’s heroes, I’ll take this opportunity to give a shout-out to my teammates throughout the US Special Operations Command (USSOCOM). This 73,000-person organization represents the “tip of the spear,” encompassing the entire global USSOCOM force from all the services: Army, Navy, Air Force, and Marines. 

At any given time, USSOCOM forces are working in over 80 countries—from an entire combat Task Force in Afghanistan to a single “operator” embedded with a partner-nation force in an undisclosed location. It was my greatest honor to share blood, sweat, and tears with these very special men and women. 

Like elite athletes, much of the USSOCOM active-duty force is dealing with chronic pain and nagging injuries from an unforgiving choice of employment. Some of our veterans paid a steep physical price with the loss of limbs, spinal cord injuries (SCI), traumatic brain injury (TBI), etc., while other veterans (like myself) are simply struggling with a body that’s been beaten up by decades of this lifestyle.

It’s been a top priority for the Department of Defense and the Department of Veterans Affairs to pursue emerging technologies that can help struggling service members and veterans.

As an example of what KAATSU can do, let’s look at a wounded USSOCOM Veteran and good friend of mine, Sergeant First Class (retired) Joe Lowrey, a decorated Purple Heart recipient. In 2014, Joe was shot in the head in Afghanistan and suffered massive cranial trauma to his right hemisphere. He was given his last rights in Afghanistan with his team present. Yet, somehow this stud pulled through. Despite coming out of his coma completely paralyzed on his left side, Joe's neuromuscular pathways from his brain throughout his body were essentially intact.

In other words, this was not an SCI, but rather a significant TBI. After a year-plus of intense rehab, Joe was still paralyzed on his left side. Then, after some cutting edge treatment with targeted magnetic stimulation at the Brain Treatment Center in Newport Beach, he gained back minor movements on his left side.

This is where KAATSU comes in—to exercise his weakened muscle tissue, from the inside out. 

Initially, it was all passive KAATSU Cycles that Joe did since he couldn’t manage anything else. Eventually, he was able to combine the KAATSU Cycles with very minor movements, essentially crude large muscle groups firing while KAATSU created vascular engorgement in his limbs.

Joe now uses KAATSU 2-3 times a day, and every day he is making improvements. It’s incredible when you see a guy go from essentially paralyzed to walking over 3,000 steps per day. The dude is going to walk a marathon someday soon. I dare you to try to tell this Green Beret it’s impossible.

Yes, KAATSU can make incremental changes for athletes, but it can make exponential positive LIFE changes for someone like Joe Lowrey. You can read more about his motivating story here: I Want To Complete A Marathon.

Another KAATSU user, Robert Griswold, has cerebral palsy and won a bronze medal in swimming at the 2016 Rio Summer Paralympic Games. Yes, a total stud. 

Yet, when he exercises he needs an approach that is easy on his body that will not create a large inflammatory response. People with cerebral palsy deal with all sorts of muscle tightness and spasticity over the course of their lives. Not this guy. He’s reversed that with the help of KAATSU. So, unlike his Paralympian competitors, Robert continues to get stronger and faster. He won his three events at the last Paralympic IPC World Championships and was looking forward to crushing it in Tokyo.

In this current COVID-19 shelter-in-place environment, Robert continues to get better with twice daily KAATSU. He refuses to get depressed or frustrated by the fact that the Paralympics have been postponed. He still works out hard on his Vasa Swim Ergometer and wants to further separate himself from his competition. People talk about how inspirational athletes like Michael Phelps are, but I think guys like Robert are true heroes—humble, but heroic. Here’s Robert gettin’ some with KAATSU: Robert Griswold Shelter-in-Place workout.

Is KAATSU Safe?

Our biggest emphasis on KAATSU is its near-perfect safety record. Now that I’ve been on this team for a few years, I fully understand that if you use KAATSU as designed (this is thoroughly explained in the user’s manual), then you will not get hurt. 

In fact, there are over 30 research studies that were conducted over a span of ten years at the University of Tokyo Hospital and Medical School:

1. Kaatsu Training: Application to Metabolic Syndrome
2. Effects of Exercise and Anti-Aging
3. Effect of KAATSU training on a patient with benign fasciculation syndrome
4. A case of dementia presenting remarkable improvement in activities of daily living through KAATSU training
5. Effects of low-intensity, elastic band resistance exercise combined with blood flow restriction on muscle activation
6. Muscle hypertrophy following blood flow-restricted low force isometric electrical stimulation in rat tibialis anterior: Role for muscle hypoxia
7. Hemodynamic and autonomic nervous responses to the restriction of femoral blood flow by KAATSU
8. Can KAATSU be used for an orthostatic stress in astronauts?: A case study
9. Repetitive Restriction of Muscle Blood Flow Enhances mTOR Signaling Pathways in a Rat Model
10. Resistance exercise combined with KAATSU during simulated weightlessness
11. Effects of Low-Load, Elastic Band Resistance Training Combined With Blood Flow Restriction on Muscle Size and Arterial Stiffness in Older Adults
12. Key considerations when conducting KAATSU training
13. Pentraxin3 and high-sensitive C-reactive protein are independent inflammatory markers released during high-intensity exercise
14. KAATSU training as a new effective exercise therapy in a case of femoral medial condyle osteonecrosis
15. Ischemic Circulatory Physiology, Kaatsu Training
16. Use and safety of KAATSU training: Results of a national survey in 2016
17. Effects of Low-Intensity KAATSU Resistance Training on Skeletal Muscle Size and Muscle Strength/Endurance Capacity in Patients with Ischemic Heart Diseases
18. Low-intensity KAATSU resistance exercises using an elastic band enhance muscle activation in patients with cardiovascular diseases
19. Increases in Thigh Muscle Volume and Strength by Walk Training With Leg Blood Flow Reduction in Older Participants
20. Effect of knee extension exercise with KAATSU on forehead cutaneous blood flow in healthy young and middle-aged women
21. Electromyographic responses of arm and chest muscle during bench press exercise with and without KAATSU
22. Effects of KAATSU training on homeostasis in healthy subjects
23. Effects of Walking With Blood Flow Restriction on Limb Venous Compliance in Elderly Subjects
24. KAATSU training? in a case of patients with periventricular leukomalacia(PVL)
25. Hemodynamic responses to simulated weightlessness of 24-h head-down bed rest and KAATSU blood flow restriction
26. Effect of Low-Load Resistance Exercise With and Without Blood Flow Restriction to Volitional Fatigue on Muscle Swelling
27. Hemodynamic and Hormonal Responses to a Short-Term Low-Intensity Resistance Exercise With the Reduction of Muscle Blood Flow
28. Effect of KAATSU training on thigh muscle size and safety for a patient with knee meniscectomy over 3 years
29. The effects of low-intensity KAATSU resistance exercise on intracellular neutrophil PTX3 and MPO
30. Hemodynamic and neurohumoral responses to the restriction of femoral blood flow by KAATSU in healthy subjects
31. Combination of KAATSU training? and BCAA intake for a patient after aortic valve replacement surgery: A case study
32. Electromyographic responses of arm and chest muscle during bench press exercise with and without KAATSU

Unlike other KAATSU studies, these were done in the cardiac rehab section of the hospital. That’s right, these were arguably some of the most vulnerable patients in the hospital, yet these research studies involved KAATSU being done on this patient population that had suffered heart attacks and strokes. Here’s a great study on how KAATSU can help with Hypertension and Metabolic Syndrome: Kaatsu Application to Metabolic Syndrome. (Note the improved HbA1c markers and improved blood pressure, both systolic and diastolic.)

To be clear: Here in America, KAATSU is not considered a medical device—not yet at least. For obvious reasons, one of our near-term goals at KAATSU is to pursue FDA clearance for use in medical centers and to use this modality on American patients, especially those dealing with various levels of type-II diabetes and pre-diabetes.

Additional Research

There have been a lot of cutting-edge researchers looking at what’s going on with KAATSU. In the same vein, the World Olympians Association and the National Foundation for Integrative Medicine are also developing KAATSU clinical research to help older demographics around the world.

To get an idea of the research that has already been conducted, just take a look at these 100+ peer-reviewed articles.

The measurable and objective benefits from KAATSU training include increased amounts of nitric oxide, growth hormone, insulin growth factor, vascular endothelial growth factor, brain-derived neurotrophic factor, mTOR, muscular protein synthesis, and more. The research also points to improvements in strength, power, agility, and better cardiovascular health.

Honestly, to a non-science guy like me, it’s a little overwhelming how many different ways KAATSU is being researched. There are so many things at play here: There’s a warm-up aspect (stretching open blood vessels just prior to intense activity with the automated KAATSU Cycle), a recovery piece (flushing lactate with the automated KAATSU Cycle), and a performance aspect (the body responding to increased metabolic stress while wearing KAATSU during functional movement). Click here to view a PDF magazine with several videos of Dr. Cory Keirn explaining mechanisms and giving example home-based workouts.

Going forward, we are encouraging future KAATSU researchers to look even deeper into the systemic responses, cross-over effects, effects on BDNF and TBI, and how KAATSU might improve neuromuscular pathways.

Summary

Thanks for reading. Ultimately, KAATSU is a safe and effective way for anyone to pursue exercise and wellness—anytime and anywhere. 

It’s made a significant and positive impact for myself, my parents, my wife and teenage children, my friends, and my SEAL teammates. 

During this difficult time of COVID-19, sheltering in place, and most (if not all) gyms being closed, many of you only have minimal exercise equipment immediately accessible. KAATSU is a great way to exercise in the privacy (and safety) of your home with minimal equipment. While it's not the only way to get in a workout at home (see Ben's Body Weight Hotel Room Workout or his Simple 5-Step, 30 Minute Workout For Mind, Body & Spirit), KAATSU is a phenomenal way to get a more effective and efficient workout, in a shorter time frame, with little-to-no strain on your skeletal system.

So if you're ready to…

• Recover faster,
• Avoid muscle atrophy,
• Maintain muscle balance and strength during rehabilitation,
• Improve your speed, strength, stamina, and size,
• Increase your range of motion, tactile feel, and technical skills,
• Increase your vascular elasticity,
• Avoid muscle degeneration,
• Maintain balance and range of motion, 
• And much more…

…you can just click here to get your own KAATSU device and bands, and be sure to use code BEN at checkout to save 5%! (Pro tip from Ben if you're outside the US: You may want to consider purchasing from a friend in the states as I've been hearing prices in other countries can be considerably higher.)

Ben himself has been getting tons of benefit from his KAATSU devices over the past several months, as you've no doubt heard about on several recent podcasts of his and seen on his social media, and he's definitely a fan of combining science and hard work for better results. This isn't an “easy fitness gimmick,” but is simply a way to seriously upgrade any workout modality.

In closing, I’ll take this opportunity to thank the first responders and medical members of our collective communities as they help beat back the ugliness of COVID-19. You all are doing God’s work—keep going!

Leave your thoughts, questions, or comments below, and I'll be happy to respond! John Doolittle

The original article: https://bengreenfieldfitness.com/article/fitness-articles/workouts-exercise-articles/kaatsu-training/

The PodCast: https://bengreenfieldfitness.com/article/fitness-articles/workouts-exercise-articles/kaatsu/