The effect of blood flow restricted exercise on measures of health and physical fitness across all populations: An umbrella review and meta-meta-analysis

Abstract

Purpose: To consolidate and evaluate meta-analyses reporting the effects of blood flow restricted exercise (BFRE) on measures of health and physical fitness across all populations.

Methods: This preregistered umbrella review followed PRISMA guidelines. A comprehensive search of five databases identified meta-analyses evaluating the effects of BFRE interventions (aerobic, resistance, combined) compared to exercising and non-exercising control conditions on measures of health and performance. A multilevel meta-analysis of standardised mean differences (SMDs) was conducted to examine the effects of BFRE. Subgroup analyses were conducted for the participant and intervention characteristics. Risk of bias was assessed using the AMSTAR-2.

Results: 47 meta-analyses comprised of 265 unique studies were included. All reviews were rated as low-moderate quality. BFRE had a small effect on hypertrophy (SMD ​= ​0.39, p ​< ​0.001) and a moderate effect on strength (SMD ​= ​0.61, p ​< ​0.001) when compared to low load, but not high load resistance training (hypertrophy, SMD = −0.13, p ​= ​0.142; strength, SMD = -0.28, p ​< ​0.001). BFRE had small-to-moderate effects on aerobic fitness (SMD = 0.50, p ​< ​0.001), vascular health (SMD = 0.45, p ​< ​0.001), blood pressure (SMD = 0.46, p ​< ​0.001), and muscular power (SMD = 0.56, p ​< ​0.001). BFRE had no effect on physical function (SMD = 0.16, p ​= ​0.096), pain (SMD = 0.00, p ​= ​0.996), and speed (SMD = 0.22, p ​= ​0.213).

Conclusions: BFRE is a viable option to improve hypertrophy, strength, aerobic fitness, and vascular health across various populations, though its effects on hypertrophy and strength are smaller when compared to traditional high load resistance training. It doesn't appear to offer any additional benefits than other training methods for physical function, pain, or speed, although sub-analyses suggest further research is warranted in select areas of application.

Keywords

Blood flow occlusion / Blood flow restriction / KAATSU / Rehabilitation / Hypertrophy / Strength / Performance

CRediT authorship contribution statement

Cooper Oborn: Writing - review & editing, Writing - original draft, Supervision, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Maximillian J. Nelson: Writing - review & editing, Visualization, Supervision, Project adminis-tration, Methodology, Conceptualization. Kade Davison: Writing - re-view & editing, Visualization, Supervision, Project administration, Methodology, Conceptualization. James Murray: Writing - review & editing, Visualization, Validation, Resources, Methodology, Investiga-tion, Data curation. Kent Green: Writing - review & editing, Visualiza-tion, Validation, Methodology, Investigation, Data curation. Jawaria Shahid: Writing - review & editing, Visualization, Validation, Method-ology, Data curation. Hunter Bennett: Writing - review & editing, Visualization, Validation, Supervision, Resources, Project administra-tion, Methodology, Investigation, Formal analysis, Data curation, Conceptualization.

Declaration of competing interest

The authors have no direct or indirect competing interests to declare.

Protocol registration

This umbrella review was registered on the open science framework (OSF.IO/K67F2)40 on the July 9, 2024 and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Data availability statement

The data and code used for the analyses on this study are available on the Open Science Framework page for this project (https://osf. io/b5wv3/).

Appendix A. Supplementary data

Supplementary data to this article can be found online at https://doi.org/10.1016/j.smhs.2025.02.011.

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