Measurement properties and operational feasibility of an automated arterial occlusion pressure assessment system for blood flow restriction exercise

Objective. To evaluate the validity, reliability, agreement, and operational feasibility of an automated arterial occlusion pressure (AOP) assessment system compared with a manual Doppler-based assessment.

Approach. Forty healthy adults (20 men and 20 women) completed upper- and lower-limb (LL) AOP assessments using automated and MDA methods in a randomized and counterbalanced design. Concurrent validity, agreement, intraday and interday reliability, operational feasibility, perceptual responses, and procedure-related symptoms were evaluated. Exploratory analyses examined whether sex modified the difference between automated and MDA-derived AOP measurements.

Main results. MDA demonstrated good-to-excellent reliability (ICC = 0.84–0.98; CV = 1.38%–3.25%). The automated system demonstrated moderate-to-good intraday reliability (ICC = 0.74–0.85) but poor LL interday reliability (ICC = 0.36). Compared with MDA, automated AOP showed systematic bias and wide limits of agreement. No evidence of a sex-related difference in the between-method discrepancy was observed for either upper- or LL AOP. Although automated assessment reduced testing time by 81.9%–86.7%, frequent upper-limb (UL) measurement failures reduced the automated measurement success rate to approximately 57%, substantially increasing adjusted assessment time and limiting operational feasibility, while discomfort and affective responses were more favorable than with MDA.

Significance. The automated AOP system improved assessment efficiency and participant experience but demonstrated less favorable reliability estimates, limited agreement, and frequent upper-limb measurement failures. Consequently, automated and MDA should not be considered interchangeable for individualized AOP prescription.