Effects of blood flow restriction training on aerobic capacity and performance in endurance athletes: a systematic review and meta-analysis

Abstract Background Although blood flow restriction (BFR) training has been increasingly investigated for its potential to enhance aerobic capacity and performance in endurance athletes, its overall effectiveness remains inconclusive. This systematic review and meta-analysis aimed to evaluate the im...

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Main Authors: Zekai Zhang, Xuejiao Gao, Lang Gao
Format: Article
Language:English
Published: BMC 2025-07-01
Series:BMC Sports Science, Medicine and Rehabilitation
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Online Access:https://doi.org/10.1186/s13102-025-01194-3
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author Zekai Zhang
Xuejiao Gao
Lang Gao
author_facet Zekai Zhang
Xuejiao Gao
Lang Gao
author_sort Zekai Zhang
collection DOAJ
description Abstract Background Although blood flow restriction (BFR) training has been increasingly investigated for its potential to enhance aerobic capacity and performance in endurance athletes, its overall effectiveness remains inconclusive. This systematic review and meta-analysis aimed to evaluate the impact of BFR training on aerobic capacity, muscle strength, and endurance performance in endurance athletes compared to the same training without BFR. Methodology Databases searched included PubMed, Scopus, Web of Science, and SPORTDiscus through September 2024. The methodological quality of the included studies was assessed using the PEDro tool, with meta-analyses conducted using the R program. Results A total of 20 studies, involving 407 subjects, were included in the meta-analysis. The results revealed that BFR training had moderate effects on improving VO2max (ES = 0.465, 95% CI [0.222, 0.707], P < 0.001)) and endurance performance (ES = 0.693, 95% CI [0.252, 1.135], P < 0.01). Additionally, it demonstrated a large effect on maximal strength (ES = 1.022, 95% CI [0.267, 1.778], P < 0.01) and a small effect on aerobic power (ES = 0.315, 95% CI [0.015, 0.616], P < 0.05). Furthermore, subgroup analyses showed that age, athlete level, training duration, frequency, type, and cuff pressure did not significantly moderate the effectiveness of BFR training. Conclusions BFR training significantly enhances aerobic capacity, muscle strength, and overall performance in endurance athletes compared to similar training without BFR. This approach provides a practical strategy for improving endurance and strength, especially during periods when high-intensity training is less feasible, such as recovery phases or in-season maintenance. The prospero registration number CRD42024581910.
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spelling doaj-art-77f72311514040a0bcf3fd91e574a2a62025-08-20T03:37:38ZengBMCBMC Sports Science, Medicine and Rehabilitation2052-18472025-07-0117111010.1186/s13102-025-01194-3Effects of blood flow restriction training on aerobic capacity and performance in endurance athletes: a systematic review and meta-analysisZekai Zhang0Xuejiao Gao1Lang Gao2Department of Physical Education, Beijing Language and Culture UniversityFaculty of Educational Studies, University Putra MalaysiaDepartment of Physical Education, Gengdan Institute of Beijing University of TechnologyAbstract Background Although blood flow restriction (BFR) training has been increasingly investigated for its potential to enhance aerobic capacity and performance in endurance athletes, its overall effectiveness remains inconclusive. This systematic review and meta-analysis aimed to evaluate the impact of BFR training on aerobic capacity, muscle strength, and endurance performance in endurance athletes compared to the same training without BFR. Methodology Databases searched included PubMed, Scopus, Web of Science, and SPORTDiscus through September 2024. The methodological quality of the included studies was assessed using the PEDro tool, with meta-analyses conducted using the R program. Results A total of 20 studies, involving 407 subjects, were included in the meta-analysis. The results revealed that BFR training had moderate effects on improving VO2max (ES = 0.465, 95% CI [0.222, 0.707], P < 0.001)) and endurance performance (ES = 0.693, 95% CI [0.252, 1.135], P < 0.01). Additionally, it demonstrated a large effect on maximal strength (ES = 1.022, 95% CI [0.267, 1.778], P < 0.01) and a small effect on aerobic power (ES = 0.315, 95% CI [0.015, 0.616], P < 0.05). Furthermore, subgroup analyses showed that age, athlete level, training duration, frequency, type, and cuff pressure did not significantly moderate the effectiveness of BFR training. Conclusions BFR training significantly enhances aerobic capacity, muscle strength, and overall performance in endurance athletes compared to similar training without BFR. This approach provides a practical strategy for improving endurance and strength, especially during periods when high-intensity training is less feasible, such as recovery phases or in-season maintenance. The prospero registration number CRD42024581910.https://doi.org/10.1186/s13102-025-01194-3Occlusion trainingPhysical enduranceMaximal strengthPhysical functional performanceAthletes
spellingShingle Zekai Zhang
Xuejiao Gao
Lang Gao
Effects of blood flow restriction training on aerobic capacity and performance in endurance athletes: a systematic review and meta-analysis
BMC Sports Science, Medicine and Rehabilitation
Occlusion training
Physical endurance
Maximal strength
Physical functional performance
Athletes
title Effects of blood flow restriction training on aerobic capacity and performance in endurance athletes: a systematic review and meta-analysis
title_full Effects of blood flow restriction training on aerobic capacity and performance in endurance athletes: a systematic review and meta-analysis
title_fullStr Effects of blood flow restriction training on aerobic capacity and performance in endurance athletes: a systematic review and meta-analysis
title_full_unstemmed Effects of blood flow restriction training on aerobic capacity and performance in endurance athletes: a systematic review and meta-analysis
title_short Effects of blood flow restriction training on aerobic capacity and performance in endurance athletes: a systematic review and meta-analysis
title_sort effects of blood flow restriction training on aerobic capacity and performance in endurance athletes a systematic review and meta analysis
topic Occlusion training
Physical endurance
Maximal strength
Physical functional performance
Athletes
url https://doi.org/10.1186/s13102-025-01194-3
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AT xuejiaogao effectsofbloodflowrestrictiontrainingonaerobiccapacityandperformanceinenduranceathletesasystematicreviewandmetaanalysis
AT langgao effectsofbloodflowrestrictiontrainingonaerobiccapacityandperformanceinenduranceathletesasystematicreviewandmetaanalysis