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To systematically search and assess studies that have combined blood flow restriction (BFR) with exercise, and to perform meta-analysis of the reported results to quantify the effectiveness of BFR exercise on muscle strength and hypertrophy. A systematic review. A computer assisted database search was conducted for articles investigating the effect of exercise combined with BFR on muscle hypertrophy and strength. A total of 916 hits were screened in order based on title, abstract, and full article, resulting in 47 articles that fit the review criteria. A total of 400 participants were included from 19 different studies measuring muscle strength increases when exercise is combined with BFR. Exercise was separated into aerobic and resistance exercise. Resulting from BFR aerobic exercise, there was a mean strength improvement of 0.4Nm between the experimental group and control group, while BFR resistance exercise resulted in a mean improvement of 0.3kg. A total of 377 participants were included in 19 studies measuring muscle size increase (cross sectional area) when exercise was combined with BFR. The mean difference in muscle size between the experimental group and control group was 0.4cm2. Current evidence suggests that the addition of BFR to dynamic exercise training is effective for augmenting changes in both muscle strength and size. This effect was consistent for both resistance training and aerobically-based exercise, although the effect sizes varied. The magnitude of observed changes are noteworthy, particularly considering the relatively short duration of the average intervention.

BackgroundQuadriceps strengthening exercises are part of the treatment of patellofemoral pain (PFP), but the heavy resistance exercises may aggravate knee pain. Blood flow restriction (BFR) training may provide a low-load quadriceps strengthening method to treat PFP.MethodsSeventy-nine participants were randomly allocated to a standardised quadriceps strengthening (standard) or low-load BFR. Both groups performed 8 weeks of leg press and leg extension, the standard group at 70% of 1 repetition maximum (1RM) and the BFR group at 30% of 1RM. Interventions were compared using repeated-measures analysis of variance for Kujala Patellofemoral Score, Visual Analogue Scale for ‘worst pain’ and ‘pain with daily activity’, isometric knee extensor torque (Newton metre) and quadriceps muscle thickness (cm). Subgroup analyses were performed on those participants with painful resisted knee extension at 60°.ResultsSixty-nine participants (87%) completed the study (standard, n=34; BFR, n=35). The BFR group had a 93% greater reduction in pain with activities of daily living (p=0.02) than the standard group. Participants with painful resisted knee extension (n=39) had greater increases in knee extensor torque with BFR than standard (p<0.01). No between-group differences were found for change in Kujala Patellofemoral Score (p=0.31), worst pain (p=0.24), knee extensor torque (p=0.07) or quadriceps thickness (p=0.2). No difference was found between interventions at 6 months.ConclusionCompared with standard quadriceps strengthening, low load with BFR produced greater reduction in pain with daily living at 8 weeks in people with PFP. Improvements were similar between groups in worst pain and Kujala score. The subgroup with painful resisted knee extension had larger improvements in quadriceps strength from BFR.Trial registration number12614001164684.

ObjectiveTo examine the effects of autoregulated (AUTO) and non-autoregulated (NAUTO) blood flow restriction (BFR) application on adverse effects, performance, cardiovascular and perceptual responses during resistance exercise.MethodsFifty-six healthy participants underwent AUTO and NAUTO BFR resistance exercise in a randomised crossover design using a training session with fixed amount of repetitions and a training session until volitional failure. Cardiovascular parameters, rate of perceived effort (RPE), rate of perceived discomfort (RPD) and number of repetitions were investigated after training, while the presence of delayed onset muscle soreness (DOMS) was verified 24 hours post-session. Adverse events during or following training were also monitored.ResultsAUTO outperformed NAUTO in the failure protocol (p<0.001), while AUTO scored significantly lower for DOMS 24 hours after exercise (p<0.001). Perceptions of effort and discomfort were significantly higher in NAUTO compared with AUTO in both fixed (RPE: p=0.014, RPD: p<0.001) and failure protocol (RPE: p=0.028, RPD: p<0.001). Sixteen adverse events (7.14%) were recorded, with a sevenfold incidence in the fixed protocol for NAUTO compared with AUTO (NAUTO: n=7 vs AUTO: n=1) and five (NAUTO) vs three (AUTO) adverse events in the failure protocol. No significant differences in cardiovascular parameters were found comparing both pressure applications.ConclusionAutoregulation appears to enhance safety and performance in both fixed and failure BFR-training protocols. AUTO BFR training did not seem to affect cardiovascular stress differently, but was associated with lower DOMS, perceived effort and discomfort compared with NAUTO.Trial registration number NCT04996680.

Purpose To determine what factors should be accounted for when setting the blood flow restriction (BFR) cuff pressure for the upper and lower body. Methods One hundred and seventy one participants visited the laboratory for one testing session. Arm circumference, muscle (MTH) and fat (FTH) thickness were measured on the upper arm. Next, brachial systolic (SBP) and diastolic (DBP) blood pressure measurements were taken in the supine position. Upper body arterial occlusion was then determined using a Doppler probe. Following this, thigh circumference and lower body arterial occlusion were determined. Models of hierarchical linear regression were used to determine the greatest predictor of arterial occlusion in the upper and lower body. Two models were employed in the upper body, a Field (arm size) and a Laboratory model (arm composition). Results The Laboratory model explained 58 % of the variance in arterial occlusion with SBP ( β  = 0.512, part = 0.255), MTH ( β  = 0.363, part = 0.233), and FTH ( β  = 0.248, part = 0.213) contributing similarly to explained variance. The Field model explained 60 % of the variance in arterial occlusion with arm circumference explaining the greatest amount ( β  = 0.419, part = 0.314) compared to SBP ( β  = 0.394, part = 0.266) and DBP ( β  = 0.147, part = 0.125). For the lower body model the third block explained 49 % of the variance in arterial occlusion with thigh circumference ( β  = 0.579, part = 0.570) and SBP ( β  = 0.281, part = 0.231) being significant predictors. Conclusions Our findings indicate that arm circumference and SBP should be taken into account when determining BFR cuff pressures. In addition, we confirmed our previous study that thigh circumference is the greatest predictor of arterial occlusion in the lower body.

The purpose of this study was to determine the difference in cuff pressure which occludes arterial blood flow for two different types of cuffs which are commonly used in blood flow restriction (BFR) research. Another purpose of the study was to determine what factors (i.e., leg size, blood pressure, and limb composition) should be accounted for when prescribing the restriction cuff pressure for this technique. One hundred and sixteen (53 males, 63 females) subjects visited the laboratory for one session of testing. Mid-thigh muscle (mCSA) and fat (fCSA) cross-sectional area of the right thigh were assessed using peripheral quantitative computed tomography. Following the mid-thigh scan, measurements of leg circumference, ankle brachial index, and brachial blood pressure were obtained. Finally, in a randomized order, arterial occlusion pressure was determined using both narrow and wide restriction cuffs applied to the most proximal portion of each leg. Significant differences were observed between cuff type and arterial occlusion (narrow: 235 (42) mmHg vs. wide: 144 (17) mmHg; p  = 0.001, Cohen’s D  = 2.52). Thigh circumference or mCSA/fCSA with ankle blood pressure, and diastolic blood pressure, explained the most variance in the cuff pressure required to occlude arterial flow. Wide BFR cuffs restrict arterial blood flow at a lower pressure than narrow BFR cuffs, suggesting that future studies account for the width of the cuff used. In addition, we have outlined models which indicate that restrictive cuff pressures should be largely based on thigh circumference and not on pressures previously used in the literature.

This study aimed to collate current evidence regarding the efficacy of various blood flow restriction (BFR) strategies for well-trained athletes, and to provide insight regarding how such strategies can be used by these populations. Review article. Studies that had investigated the acute or adaptive responses to BFR interventions in athletic participants were identified from searches in MEDLINE (PubMed), SPORTDiscus (EBSCO) and Google Scholar databases up to April 2015. The reference lists of identified papers were also examined for relevant studies. Twelve papers were identified from 11 separate investigations that had assessed acute and adaptive responses to BFR in athletic cohorts. Of these, 7 papers observed enhanced hypertrophic and/or strength responses and 2 reported alterations in the acute responses to low-load resistance exercise when combined with BFR. One paper had examined the adaptive responses to moderate-load resistance training with BFR, 1 noted improved training responses to low-work rate BFR cardiovascular exercise, and 1 reported on a case of injury following BFR exercise in an athlete. Current evidence suggests that low-load resistance training with BFR can enhance muscle hypertrophy and strength in well-trained athletes, who would not normally benefit from using light loads. For healthy athletes, low-load BFR resistance training performed in conjunction with normal high-load training may provide an additional stimulus for muscular development. As low-load BFR resistance exercise does not appear to cause measureable muscle damage, supplementing normal high-load training using this novel strategy may elicit beneficial muscular responses in healthy athletes.

PurposeArterial occlusion pressure (AOP) measured in a supine position is often used to set cuff pressures for blood flow restricted exercise (BFRE). However, supine AOP may not reflect seated or standing AOP, thus potentially influencing the degree of occlusion. The primary aim of the study was to investigate the effect of body position on AOP. A secondary aim was to investigate predictors of AOP using wide and narrow cuffs.MethodsTwenty-four subjects underwent measurements of thigh circumference, skinfold and blood pressure, followed by assessments of thigh AOP in supine and seated positions with a wide and a narrow cuff, respectively, using Doppler ultrasound.ResultsIn the supine position, AOP was 148 ± 19 and 348 ± 94 mmHg with the wide and narrow cuff, respectively. This increased to 177 ± 20 and 409 ± 101 mmHg in the seated position, with correlations between supine and seated AOP of R2 = 0.81 and R2 = 0.50 for the wide and narrow cuff, respectively. For both cuff widths, thigh circumference constituted the strongest predictor of AOP, with diastolic blood pressure explaining additional variance with the wide cuff. The predictive strength of these variables did not differ between body positions.ConclusionOur results indicate that body position strongly influences lower limb AOP, especially with narrow cuffs, yielding very high AOP (≥ 500–600 mmHg) in some subjects. This should be taken into account in the standardization of cuff pressures used during BFRE to better control the physiological effects of BFRE.

Purpose Resistance exercise can attenuate muscular impairments associated with multiple sclerosis (MS), and blood flow restriction (BFR) may provide a viable alternative to prescribing heavy training loads. The purpose of this investigation was to examine the progression of upper and lower body low-load (30% of one-repetition maximum [1RM]) resistance training (RT) with BFR applied intermittently during the exercise intervals (RT + BFR) versus volume-matched heavy-load (65% of 1RM) RT. Methods Men and women with MS ( n  = 16) were randomly assigned to low-load RT + BFR (applied intermittently) or heavy-load RT and completed 12 weeks (2 × /week) of RT that consisted of bilateral chest press, seated row, shoulder press, leg press, leg extension, and leg curl exercises. Exercise load, tonnage, and rating of perceived exertion were assessed at baseline and every 6 weeks. Results Training load increased to a greater extent and sometimes earlier for RT + BFR (57.7–106.3%) than heavy-load RT (42.3–54.3%) during chest press, seated row, and leg curl exercises, while there were similar increases (63.5–101.1%) for shoulder press, leg extension, and leg press exercises. Exercise tonnage was greater across all exercises for RT + BFR than heavy-load RT, although tonnage only increased during the chest press (70.7–80.0%) and leg extension (89.1%) exercises. Perceptions of exertion (4.8–7.2 au) and compliance (97.9–99.0%) were similar for both interventions. Conclusion The training-induced increases in load, high compliance, and moderate levels of exertion suggested that RT + BFR and heavy-load RT are viable interventions among people with MS. RT + BFR may be a preferred modality if heavy loads are not well tolerated and/or to promote early-phase training responses.

Regular participation in physical activity can slow age-related functional and cognitive decline but many have cited a lack of time and energy as key barriers to exercise adherence. Hence, exercises with lower time commitment may appeal to sedentary individuals or working adults who perform insufficient physical activity. Sprint interval exercise with blood flow restriction (BFR-SIE) is a time-efficient exercise modality that may augment cognitive gains through enhanced metabolic stimulation and cerebrovascular alterations. Therefore, we aimed to investigate the effect of BFR-SIE on capillary blood lactate, cognition and perceptual response in healthy young adults. This study involved randomized controlled trials with unblinded crossover design. 18 participants (10 males; 8 females; age 26.4 ± 3.3 years; body mass 60.5 ± 12.6 kg; height 1.65 ± 0.07 m) completed sprint interval cycling involving six sets of 10 s all-out sprints with 1-min rest intervals, performed (1) with BFR applied at 50% occlusion pressure on both thighs (BFR-SIE), and (2) without BFR (SIE). Before and after each session, capillary blood lactate level was assessed, and cognitive assessments (Digit Span and Stroop test) were performed to evaluate working memory, selective attention, and executive function. Cycling power output was measured during sprints. Both BFR-SIE and SIE groups displayed comparable improvements in Stroop reaction times while task accuracies were largely unaltered for Stroop and Digit Span tests ( p  > 0.05). Both groups experienced similar increases in blood lactate levels despite a higher peak power output observed in SIE (366 ± 118 W vs. 336 ± 119 W; p  < 0.001). Despite a lower power output during BFR-SIE, participants reported a higher mean rating of perceived exertion (5.3 ± 1.9 vs. 4.9 ± 1.8; p  = 0.003). A single bout of sprint interval exercise with BFR did not further increase capillary blood lactate levels nor benefit cognition, likely due to the counteracting effect of higher perceived exertion. While BFR remains a promising tool to amplify the physiological responses to exercise, it may be suboptimal to implement for self-paced exercise, maximal exercise or exercise to exhaustion. ISRCTN registration : ISRCTN16365146; retrospectively registered on 07 Oct 2025.

The primary objective of this investigation was to quantitatively identify which training variables result in the greatest strength and hypertrophy outcomes with lower body low intensity training with blood flow restriction (LI-BFR). Searches were performed for published studies with certain criteria. First, the primary focus of the study must have compared the effects of low intensity endurance or resistance training alone to low intensity exercise with some form of blood flow restriction. Second, subject populations had to have similar baseline characteristics so that valid outcome measures could be made. Finally, outcome measures had to include at least one measure of muscle hypertrophy. All studies included in the analysis utilized MRI except for two which reported changes via ultrasound. The mean overall effect size (ES) for muscle strength for LI-BFR was 0.58 [95% CI: 0.40, 0.76], and 0.00 [95% CI: −0.18, 0.17] for low intensity training. The mean overall ES for muscle hypertrophy for LI-BFR training was 0.39 [95% CI: 0.35, 0.43], and −0.01 [95% CI: −0.05, 0.03] for low intensity training. Blood flow restriction resulted in significantly greater gains in strength and hypertrophy when performed with resistance training than with walking. In addition, performing LI-BFR 2–3 days per week resulted in the greatest ES compared to 4–5 days per week. Significant correlations were found between ES for strength development and weeks of duration, but not for muscle hypertrophy. This meta-analysis provides insight into the impact of different variables on muscular strength and hypertrophy to LI-BFR training.