Effects of blood flow restriction training in athletes: a systematic review meta-analysis

This systematic review and meta-analysis evaluated the effects of blood flow restriction (BFR) training on strength and aerobic capacity in athletes, examining how training variables and participant characteristics influenced outcomes. Four databases were searched for peer-reviewed English-language studies, and the risk of bias and quality of evidence were assessed using RoB 2 and GRADEpro GDT. We evaluated pre- and post-test differences by a three-level meta-analysis using the meta and metafor packages. Subgroup analyses and both linear and nonlinear meta-regression methods were used to explore moderating factors. Sixteen studies with 'some concerns' risk of bias and low evidence level were included. Combining BFR with low-intensity resistance training produced an effect size (ES) of 0.25 for strength, while combining BFR with aerobic training had an ES of 0.42. For aerobic capacity, the ES of combining BFR with aerobic training was 0.58. Subgroup and regression analyses showed no significant differences. While BFR with low-intensity resistance training enhances strength, it does not result in additional gains. Adding BFR with aerobic training enhances both strength and aerobic capacity. Overall, BFR appears to offer the most benefits for male athletes in improving strength and aerobic capacity.