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Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis
  1. Luke Hughes1,
  2. Bruce Paton2,
  3. Ben Rosenblatt3,
  4. Conor Gissane1,
  5. Stephen David Patterson1
  1. 1 School of Sport, Health and Applied Science, St. Mary’s University, London, UK
  2. 2 Institute of Sport, Exercise and Health, University College London, London, UK
  3. 3 The Football Association, St. George’s Park, Burton-Upon-Trent, UK
  1. Correspondence to Luke Hughes, School of Sport, Health and Applied Science, St. Mary’s University, Waldegrave Road, Twickenham, London TW1 4SX, UK ;{at}


Background and objective Low-load exercise training with blood flow restriction (BFR) can increase muscle strength and may offer an effective clinical musculoskeletal (MSK) rehabilitation tool. The aim of this review was to systematically analyse the evidence regarding the effectiveness of this novel training modality in clinical MSK rehabilitation.

Design This is a systematic review and meta-analysis of peer-reviewed literature examining BFR training in clinical MSK rehabilitation (Research Registry; researchregistry91).

Data sources A literature search was conducted across SPORTDiscus (EBSCO), PubMed and Science Direct databases, including the reference lists of relevant papers. Two independent reviewers extracted study characteristics and MSK and functional outcome measures. Study quality and reporting was assessed using the Tool for the assEssment of Study qualiTy and reporting in EXercise.

Eligibility Search results were limited to exercise training studies investigating BFR training in clinical MSK rehabilitation, published in a scientific peer-reviewed journal in English.

Results Twenty studies were eligible, including ACL reconstruction (n=3), knee osteoarthritis (n=3), older adults at risk of sarcopenia (n=13) and patients with sporadic inclusion body myositis (n=1). Analysis of pooled data indicated low-load BFR training had a moderate effect on increasing strength (Hedges’ g=0.523, 95% CI 0.263 to 0.784, p<0.001), but was less effective than heavy-load training (Hedges’ g=0.674, 95% CI 0.296 to 1.052, p<0.001).

Conclusion Compared with low-load training, low-load BFR training is more effective, tolerable and therefore a potential clinical rehabilitation tool. There is a need for the development of an individualised approach to training prescription to minimise patient risk and increase effectiveness.

  • Blood flow restriction
  • musculoskeletal
  • strength
  • rehabilitation

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  • Contributors LH and SDP participated in protocol design, data extraction, data analyses and manuscript preparation. CG participated in data analyses and manuscript preparation. BR and BP participated in protocol design and manuscript preparation. All authors have read and approved the final manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.