The Influence of Cuff Width, Sex, and Race on Arterial Occlusion: Implications for Blood Flow Restriction Research

Purpose The main aim of this study was to examine differences in upper arm arterial occlusion pressure (AOP) between three different cuff widths and how individual characteristics influence this. Additional aims of the study were to investigate differences in AOP due to sex and race and to create regression equations that estimate AOP for each cuff width. Methods Two hundred and forty nine participants (males n = 102; females n = 147) visited the laboratory once for measurement of arm length, arm circumference, and resting brachial systolic (bSBP) and diastolic blood pressure (bDBP). Next, each cuff was applied to the upper arm and inflated until a Doppler probe placed at the radial artery no longer detected blood flow. The minimum inflation pressure that caused cessation of blood flow was determined to be the AOP. Results Differences in AOP were observed between cuff widths (p < 0.001). The 5-cm-wide cuff required the greatest inflation pressure [145 (19) mmHg], followed by the 10 cm [123 (13) mmHg], and 12-cm-wide cuff [120 (12) mmHg]. A model encompassing arm circumference, bSBP, arm length, bDBP, and sex explained the most variance in AOP for each cuff (5 cm, R-2 = 0.651; 10 cm, R-2 = 0.570; 12 cm, R-2 = 0.557). However, arm circumference explained the most unique variance for each cuff. When separated by sex, males required greater pressures. Additionally, after controlling for sex, it was found that non-Hispanic Blacks required greater pressures compared with Whites. The regression equations for each cuff width are as follows: 5 cm (mmHg) = 2.926 (arm circumference) + 1.002 (bSBP) - 0.428 (arm length) + 0.213 (bDBP) + 12.668 (sex) 68.493; 10 cm (mmHg) = 1.545 (arm circumference) + 0.722 (bSBP) - 0.235 (arm length) + 0.205 (bDBP) + 6.378 (sex) - 15.918; 12 cm (mmHg) = 1.393 (arm circumference) + 0.710 (bSBP) - 0.294 (armlength) + 0.164 (bDBP) + 6.419 (sex) - 8.752. Conclusions The AOP is dependent upon cuff width, highlighting the need for authors to report cuff width and consider the impact it has on restriction. Participant characteristics, especially arm circumference, should be considered when applying this blood flow restriction pressure. Lastly, both sex and race have an impact on AOP, although it is not presently known how meaningful this difference is.