SYSTEMATIC REVIEW article
Front. Physiol.
Sec. Exercise Physiology
Volume 16 - 2025 | doi: 10.3389/fphys.2025.1603568
This article is part of the Research TopicImpact of Blood Flow Restriction Device Features and Methodological Considerations on Acute- and Longitudinal Responses to Blood Flow Restricted ExerciseView all 12 articles
Effects of blood flow restriction combined with high-load training on muscle strength and sports performance in athletes: a systematic review and meta-analysis
Provisionally accepted
- 1School of Physical Education, Chongqing Technology and Business University, Chongqing, China
- 2Graduate School, Harbin Sport University, Harbin, Heilongjiang Province, China
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AbstractObjective: This study aimed to assess the effects of high-load resistance training combined with blood flow restriction (HL-BFRT) on athletes’ physiological adaptations (muscle strength, body composition) and athletic performance (power, speed, and endurance).Methods: A systematic search was conducted in PubMed, Web of Science, and Embase for studies published up to February 2025. The methodological quality of included studies was evaluated using the Cochrane Risk of Bias Tool. Meta-analyses, heterogeneity assessments, subgroup analyses, and sensitivity tests were conducted using RevMan 5.4 and STATA 17.0. Publication bias was assessed via funnel plots and Egger’s test.Results: Ten studies met the inclusion criteria, including 93 athletes who received HL-BFRT and 91 who received traditional HL-RT. HL-BFRT produced significant improvements in muscle strength (SMD = 0.65, I² = 44%), power (SMD = 0.45, I² = 0%), speed (SMD = 0.78, I² = 60%), and endurance (SMD = 0.90, I² = 51%), while no significant effects were observed for body composition (p > 0.05). Subgroup analyses revealed benefits across isokinetic (SMD = 0.78) and 1RM (SMD = 0.69) strength tests, with higher heterogeneity in isokinetic measures. Short-term interventions (≤6 weeks, SMD = 0.80) and higher training frequency (≥3 sessions/week, SMD = 0.92) led to greater gains. Absolute pressure protocols demonstrated more favorable outcomes in power, speed, and endurance than individualized pressure, although subgroup heterogeneity remained low (I² = 0–32%).Conclusion: HL-BFRT appears to be a viable and effective alternative to traditional HL-RT, offering significant benefits for improving athletes’ strength and performance outcomes. Short-duration, high-frequency protocols using absolute pressure may optimize results, while individualized pressure settings could be better suited for clinical or rehabilitation contexts.Registration: PROSPERO (CRD42025636274).
Keywords: Blood flow restricted training, Athlete, Meta-analysis, high-load training, Systematic review
Received: 31 Mar 2025; Accepted: 16 Jun 2025.
Copyright: © 2025 Su, Zhang, Liang, Zhou and Long. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhenglong Zhang, Graduate School, Harbin Sport University, Harbin, Heilongjiang Province, China
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