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 (MDA). APPROACH: Forty healthy adults (20 men and 20 women) completed upper- and lower-limb 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 lower-limb 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 lower-limb AOP. Although automated assessment reduced testing time by 81.9-86.7%, frequent upper-limb 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.