The effects of upper body blood flow restriction training on muscles located proximal to the applied occlusive pressure: A systematic review with meta-analysis

PLoS One. 2023 Mar 23;18(3):e0283309. doi: 10.1371/journal.pone.0283309. eCollection 2023.

Abstract

Background: Blood flow restriction combined with low load resistance training (LL-BFRT) is associated with increases in upper limb muscle strength and size. The effect of LL-BFRT on upper limb muscles located proximal to the BFR cuff application is unclear.

Objective: The aim of this systematic review was to evaluate the effect of LL-BFRT compared to low load, or high load resistance training (LL-RT, HL-RT) on musculature located proximal to cuff placement.

Methods: Six electronic databases were searched for randomized controlled trials (RCTs). Two reviewers independently evaluated the risk of bias using the PEDro scale. We performed a meta-analysis using a random effects model, or calculated mean differences (fixed-effect) where appropriate. We judged the certainty of evidence using the GRADE approach.

Results: The systematic literature searched yielded 346 articles, of which 9 studies were eligible. The evidence for all outcomes was of very low to low certainty. Across all comparisons, a significant increase in bench press and shoulder flexion strength was found in favor of LL-BFRT compared to LL-RT, and in shoulder lean mass and pectoralis major thickness in favor of the LL-BFRT compared to LL-RT and HL-RT, respectively. No significant differences were found between LL-BFRT and HL-RT in muscle strength.

Conclusion: With low certainty LL-BFRT appears to be equally effective to HL-RT for improving muscle strength in upper body muscles located proximal to the BFR stimulus in healthy adults. Furthermore, LL-BFRT may induce muscle size increase, but these adaptations are not superior to LL-RT or HL-RT.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Flow Restriction Therapy*
  • Exercise Therapy
  • Humans
  • Muscle Strength / physiology
  • Muscle, Skeletal / physiology
  • Quadriceps Muscle / physiology
  • Regional Blood Flow / physiology
  • Resistance Training*

Grants and funding

If accepted for publication, this research may have open access fees paid for by the Qatar National Library Open Access Research Fund. Aside from this, this research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Qatar National Library Open Access Research Fund had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. To be clear, the authors received no specific funding for this work.