Strength training with blood flow restriction, or KAATSU training, has been shown to be as effective as conventional strength training to promote muscular strength and hypertrophy. Several mechanisms have been suggested as hypotheses to explain the adaptations arising from this training method. Among these is metabolic stress, which exerts important physiological effects and may influence the training adaptations in question. In addition, hypoxia produced by the technique may change the neural recruitment pattern. Growth hormone (GH) concentrations increase as a result of practicing this method, which can trigger an increase in plasmatic and, perhaps, muscular insulin-like growth factor-1 (IGF-1) concentrations. The increase in concentrations of these factors can play a leading role in responses to KAATSU training. Among the effects of the GH/IGF-1 axis in muscle cells is the increase in the signalling pathway activity of the mammalian target of rapamycin (mTOR), which has been associated with increased protein synthesis. On the other hand, the decrease in the activity of the myostatin pathway, which has an antagonistic effect to mTOR, has been demonstrated after training with occlusion. Other factors, such as increases in the expression of heat shock proteins, may play an important role in adaptations to exercise. Nitric oxide synthase could increase nitric oxide concentration, which in turn has an effect on satellite cells and blood flow. However, despite the results obtained, the transfer to other situations (e.g. speed sports) is not yet clear.