As a general rule, there are no restrictions as long as you are healthy, have the proper equipment, and a certified KAATSU instructor to guide you in performing KAATSU correctly.

Like any exercise program, all KAATSU practitioners should use common sense to determine whether to proceed with a session. For example, you should definitely not engage in KAATSU if you are dehydrated.

You should consult with your doctor if you have questions about your specific health conditions. However, there are very few situations where KAATSU should be avoided. Below are the exceptions and precautions:

• After Major Surgical Procedures: It is recommended to wait one week after major surgical procedures before starting or resuming KAATSU training. This precaution is advised primarily to allow time for any undetected asymptomatic, untreated deep vein thromboses to be identified and treated.

• On Healing Wounds or Incisions: KAATSU belts should not be placed directly on healing cuts or wounds. For instance, if there is an incision on the outer thigh (such as from a total hip replacement) where the belt will sit, the belt should not be placed directly on the incision but can be placed on the other three extremities.

• Pregnancy: Women who know they are pregnant should wait until after delivery before starting KAATSU training. Note: If they have been training KAATSU before discovering their pregnancy, they do not need to stop. They can continue with mild KAATSU training until they feel uncomfortable (usually in the third trimester). They should consult an obstetrician if they have any questions or are considered a high-risk pregnancy.

• Lymphectomy: Individuals who have had lymph nodes removed may be at potential risk for lymphedema in the affected extremity. This is subjectively determined and depends on factors such as how long ago the lymph nodes were removed, their location, and how many were removed. They should consult their doctor before continuing.

• Vascular Access: If a person has iatrogenic vascular access on an extremity (e.g., dialysis patients), they should avoid KAATSU on that extremity and consult their doctor.

• Untreated Deep Vein Thromboses: Individuals with untreated deep vein thromboses should not engage in KAATSU training until they are treated.

• Hypertension: If a person is in a hypertensive crisis or has untreated hypertension, they should seek medical help and only resume KAATSU training once the hypertension is under control and after consulting their doctor.

• Sickle Cell Anemia: Individuals with sickle cell anemia should avoid KAATSU training.

To perform KAATSU safely and effectively, you must use the correct, patented equipment and work with a certified KAATSU instructor. Proper KAATSU training places a strong emphasis on determining the optimal pressure accurately. Therefore, training with homemade belts or unauthorized KAATSU equipment is potentially dangerous and could, in the worst case, lead to permanent injury.

When KAATSU is performed correctly with proper equipment by a certified KAATSU instructor, it is both safe and appropriate.

Not if KAATSU Fitness safety guidelines are followed. When blood in the deep veins is restricted for extended periods, there is a risk of clot formation. If these clots move into the lungs, they can cause what is known as a pulmonary embolism. If large enough, a pulmonary embolism can be fatal. Fortunately, KAATSU belts are designed to ensure that, when safety protocols are followed, they do not restrict blood flow long enough to form clots, and thus do not increase the risk of blood clots or pulmonary embolism. Research has shown that tissue plasminogen activator (TPA) levels, which activate plasmin to dissolve clots, are elevated after KAATSU training, while fibrin levels (involved in the blood clotting process) remain unchanged. Thus, there is likely a reduced risk of blood clots after KAATSU training.

Millions of KAATSU sessions performed worldwide over the past 50 years have proven to be risk-free, and where studies have been conducted, individuals practicing BFR have fewer blood clots compared to matched groups not using KAATSU.

Some individuals are genetically predisposed to blood clots. By the time these individuals reach adulthood, they are usually aware if they or their family members have this condition. Often, they are on anticoagulants. KAATSU training is safe even for these individuals.

Sometimes, after certain types of surgery (e.g., various orthopedic procedures on the lower extremities), blood clots may form in the veins while under anesthesia. These clots may go undetected and cause a pulmonary embolism in the days following surgery. Therefore, we recommend waiting one week after surgery before resuming or starting a KAATSU training program.

During a KAATSU training session, your heart rate and blood pressure may be temporarily elevated compared to typical exercise for that intensity. However, KAATSU training generally has beneficial effects on the cardiovascular system, including the heart, similar to the benefits seen with regular fitness training. Notably, KAATSU is integrated into cardiac rehabilitation programs at Tokyo University Hospital in Japan, highlighting its acceptance in clinical settings for heart patients.

While the immediate effects might involve higher cardiovascular strain, long-term studies and clinical use suggest that KAATSU can positively influence cardiovascular health, potentially offering similar benefits to conventional exercise. As with any exercise regimen, especially one that involves restricted blood flow, it’s important to monitor individual responses and consult with healthcare professionals if you have pre-existing heart conditions or other concerns.

Yes, as with any intense or exhausting workout, part of the systemic response from the brain is the release of beta-endorphins from the pituitary gland. This natural opiate produces a euphoric effect and enhances the healing/anabolic response.

No, original KAATSU belts and protocols do not increase the risk of varicose veins; if anything, KAATSU may help reduce them.

Varicose veins result from defective valves in the veins that connect the deep venous system with the superficial venous system. They can arise from various causes, one of which is pregnancy, where the growing uterus and baby exert constant pressure on the pelvic veins, which return blood to the heart. This pressure fills the deep veins, interconnected veins, and superficial veins. Because this is a passive, constant situation, the venous valves stretch and become defective.

In contrast, during KAATSU training, venous outflow is restricted, leading to distension in the veins and capillaries distal to the KAATSU belt. However, during exercise, the veins are repeatedly emptied and refilled. Research has shown an upregulation of markers associated with vascular growth (VEGF, HIF-1a, etc.) as a result of this temporary (~20 minutes) distension and emptying of the veins and capillaries. This improves the smooth muscle of the veins and appears to reinforce the valves between the deep and superficial venous systems. KAATSU can actually result in less defective valves becoming healthy again, potentially reducing the number of varicose veins. We have several anecdotal reports of reduced varicose veins with regular use of KAATSU.

There is a very low risk of rhabdomyolysis. Rhabdomyolysis does not occur when following the safety guidelines of KAATSU Fitness.

Rhabdomyolysis is defined as extensive destruction of muscle fibers. As muscle fibers are torn and damaged, their intracellular contents are released into the bloodstream, and the kidneys attempt to filter them out. If the burden of cellular waste is too great for the kidneys, kidney failure can occur. If untreated, it can be fatal.

A “perfect storm” of factors must occur simultaneously to cause significant muscle fiber damage leading to rhabdomyolysis. Rhabdomyolysis is associated with several factors, including:

• First-time exercise with a new activity
• Exercise while dehydrated
• Excessive eccentric exercise
• Exercise with restricted blood flow
• Heavy weight training
• Prolonged exercise duration

It requires a combination of many of these factors to produce significant muscle damage. When following KAATSU Fitness guidelines, it is not possible for all of these factors to occur simultaneously.

Common causes of rhabdomyolysis include:

• Use of alcohol or illegal drugs such as heroin, cocaine, or amphetamines
• Extreme muscle strain (especially in an untrained individual; it can occur in elite athletes and may be more dangerous with higher muscle mass)
• Crush injuries from accidents, falls, or building collapses
• Prolonged muscle compression from immobilization after a fall or lying unconscious on a hard surface due to illness, alcohol, or medication
• Use of medications such as antipsychotics or statins, particularly in high doses
• Other causes include:
  • Injury from electrical shock, lightning, or third-degree burns
  • Very high body temperature (hyperthermia) or heatstroke
  • Seizures
  • Metabolic disorders such as ketoacidosis
  • Muscle diseases (myopathy) like congenital muscle enzyme deficiencies or Duchenne muscular dystrophy
  • Viral infections like influenza, HIV, or herpes simplex virus
  • Bacterial infections leading to toxins in tissues or bloodstream (sepsis)

The conditions necessary for rhabdomyolysis due to KAATSU training would be extreme and extremely rare, and would likely involve several other conditions that could cause rhabdomyolysis.

Original KAATSU equipment is specifically designed not to occlude, and protocols ensure that pressure is not maintained for more than 20 minutes or combined with heavy weight training.