Table 1

Overview of studies included in the systematic and meta-analyses

StudyClinical focusStudy designMethodOcclusion pressure/cuff widthDurationPhysiological adaptationsPhysical function
Mattar et al 53 Polymyositis and dermatomyositisProspective, longitudinal, quasiexperimental4 weeks of 4 × 15 reps of bilateral leg press and knee extension exercises with BFR at 30% 1RM, 2 days/week, then 8 weeks of 5 × 15 reps, 2 days/week70% LOP/17.5 cm12 weeks↑19.6% and 25.2% in maximal dynamicstrength for leg press and knee extension, respectively
↑4.57% in quadriceps CSA
↑15.1% in timed stands
↑−4.5% in TUG Improvements in all SF-36 subscales and VAS (p<0.05)
Yokokawa etal 54 ElderlyRandomised controlled trialA combination of six different body weight movements for 45 min70–150 mm Hg/4.5 cm8 weeks↑20.4% and 6.9% in left and right leg knee extension, respectively
↑5.1% and 4.1% in left and right hand grip power, respectively
↓12.1% in reaction time
↓15.3% in TUG
↓9.4% 10 m walking time
↑9.4% in functional reach test
↓15.5% and 8.7% in left and right maximum step distance, respectively
↓7.2% and ↓34.1% in left and right leg standing time with open eye
Karabulut etal 55 Elderly menRandomised controlled trialThree sets (30, 15, 15 reps) of leg press and knee extensions at 20% 1RM with BFR, 3 days/week16–240 mm Hg/5 cm6 weeks↑19.3% leg press strength
↑19.1% leg extension strength
Not assessed
Abe et al 56 ElderlyRandomised controlled trial20 min treadmill walking with BFR at 67 m/min on 5 days/week160–200 mm Hg/NA6 weeks↑11% and 7%–16% in isometric and isokinetic knee extension and flexion torques, respectively
↑5.8 % and 5.1% in CSA of thigh and lower leg, respectively
↑6.0% and 10.7% inmuscle mass for total mass, and thigh mass, respectively
Significant improvements in TUG and chair stand performance (p<0.05)
Patterson andFerguson57 ElderlyRandomised controlled trialThree sets of single-leg plantar flexion to failure at 25% 1RM110 mm Hg/10 cm4 weeks↑ 13.5% 1RM
↑ 17.6% MVC
↑ isokinetic torque of 15.6% (0.52 rad/s); 11.3% (1.05 rad/s); 9.8% (2.09 rad/s; no change in Rbf
↑ PObf
Not assessed
Ozaki et al 26 ElderlyControlled trial20 min treadmill walking with BFR at 45% of HR reserve, 4 days/week140–200 mm Hg/5 cm10 weeks↑115% maximum knee joint strength
↑ 3% thigh muscle CSA
↑ 50% carotid arterial compliance
↓ 10.7% in TUG
↑ 20.5% in chair stand test
Ozaki et al 27 Elderly womenRandomised controlled trial20 min treadmill walking
with BFR at 45% of HR
reserve, 4 days/week
140–200 mm Hg/5 cm10 weeks↑ 3.1% and 3.7% in thigh muscle CSA and volume, respectively
↑ 5.9% MVC
↑ 22% isokinetic strength
Increased VO2peak (p < 0.05)
Not assessed
Iida et al 58 ElderlyRandomised controlled trial20 min treadmill walking with BFR at 67 m/min for 5 days/week140–200 mm Hg/NA6 weeks↑ 19.5 % leg venous compliance,
↑ 21.3 % MVO,
↑ 1.2% leg girth
Not assessed
Karabulut et al 59 ElderlyRandomised controlled trialThree sets (30, 15, 15) of leg press and knee extension at 20% 1RM, and three sets of upper body exercises (three sets, eight reps) at 80% 1RM, 3 days/week mm60–240 Hg/5 cm6 weeks↑ 1.3% muscle CSA
↓ 2.7 thigh fat CSA
No significant increases in inflammatory or muscle damage markers or testosterone, IGF-1 or IGFBP-3 (p<0.05)
Not assessed
Thiebaud et al 60 Elderly/Post-menopausal womenQuasi experimentalThree sets (30, 15, 15) of lower body exercises and upper body exercises with BFR using an elastic band at ~10%–30% 1RM, 3 days/week80–120 mm Hg/3.3 cm8 weeks↑ 14.6% chest press 1RM
↑ 5.9% seated row 1RM
↑ 5.3% shoulder press 1 RM
↑ muscle thickness of pectoralis major (p<0.05)
Not assessed
Yasuda et al 61 ElderlyControlled trialFour sets (30, 15, 15, 15) of arm curls and tricep pull down exercises with BFR using an elastic band, 2 days/week180–270 mm Hg/3 cm12 weeks↑ 17.6% and 17.4% in CSA of elbow flexors and extensors, respectively
↑ 7.8% and 16.1% in elbow flexion and extension MVIC, respectively No significant changes in haemodynamic parameters or muscle damage markers (CK)
Not assessed
Vechin et al 62 ElderlyRandomised controlled trialFour sets (30, 15, 15, 15) of leg press with BFR at 20% 1RM for 6 weeks, then 30% 1RM for 6 weeks, 2 days/week50% LOP/1812 weeks↑ 17% leg press 1RM
↑ 6.6% quadriceps CSA
Not assessed
Libardi et al 63 ElderlyRandomised controlled trialFour sets (30, 15, 15, 15) of leg press with BFR at 20% 1RM 2 days/week for 6 weeks, then 30% 1RM for 6 weeks. Subjects also did 30 40 min walking/running at 50%–80% VO2 peak, 2 days/week for 6 weeks50% LOP/17.5 cm12 weeks↑ 7.6% in quadriceps CSA
↑ 35.4% 1RM
↑ 10.3% VOpeak
Not assessed
Shimizu et al 64 ElderlyRandomised controlled trial3×20 reps of leg press, leg extension, rowing and chest press at 20% 1RM with BFR once a day, 3 days/weekSystolic blood pressure/10 cm4 weeks↑ 500% lactate
↑ 55% NE
↑ 42% VEGF
↑ 244% GH
↑ 11% RHI
↑ 10% foot-tcPO2 M
↓ 11% vWF (All p<0.001)
Not assessed
Segal et al 41 Symptomatic risk factors of knee osteoarthritis (women)Randomised, double-blinded, controlled trialFour sets (30, 15, 15, 15) of leg press, 3× per week at 30% 1 RM either alone or with BFR, 3 days/week160–200 mm Hg/6.5 cm4 weeksSignificant
↑ (28.3 kg) in isotonic 1RM
Significant ↑ in isokinetic knee extensor strength scaled to body mass
Significant ↑ (0.62 W) in scaled 40% 1RM leg press power
↑ (1.3%) in quadriceps volume
↑ (29.3 W) in stair climb power No significant (2.0) increase in knee pain score (KOOS)
Segal et al 49 Symptomatic risk factors of knee osteoarthritis (men)Randomised, double-blinded, controlled trialFour sets (30, 15, 15, 15) of leg press, 3× per week at 30% 1RM either alone or with BFR, 3 days/week160–200 mmHg/6.5 cm4 weeks↑ 3.1% in isotonic leg press 1RM (p=0.003)
↑ 0.4% isokinetic knee extensor strength (p=0.883)
Non-significant (4.9%) change in KOOS pain score (p=1.55)
Fernandes-Bryk et al 50 Knee osteoarthritisRandomised, blinded, clinical trial3 × 20 reps of seated knee extensions at 30% 1RM, 3 days/week. Subjects also performed regular stretching200 mm Hg/NA6 weeks↑ 72% quadriceps strength
Lower NPRS knee pain score during exercise compared with highload (2.5 vs 6.2, respectively)
Higher level of function:
↓ 43% and
↓, 16% in Lequesne and TUG test scores, respectively (p<0.05) Less pain:
↓ 51% NPRS score
Takarada et al 51 Patients with ACLRControlled trial5 × 5 min occlusion and 3 min reperfusion, 2× per day or no intervention200–260 mm Hg/9 cm3rd to 14th day post operation↓ 9.4% &
↓ 9.2% in CSA of knee extensors and flexors, respectively, which was significantly lower than control group (p <0.05)
Not assessed
ohta et al42 ACLR PatientsProspective, randomised controlled trialRange of lower limbs exercises, reps, (20–60) sets (1–3 per day), 6 d/wk180 mmHg/NA16 weeks postsurgery (BFR began in week 2)Significant
↑ inmuscular strength & CSA with BFR compared to matched protocol without BFR (p < 0.05)
↑ in short diameters of type I and II of medial vastus lateralis fibres in BFR group
Not assessed
Iverson et al52 ACLR patients (Athletes)Randomised, blinded, controlled trial5 × 20 reps of quadriceps exercises with or without BFR (5 min occlusion, followed by 3 min reperfusion), 2 × per day130–180 mmHg/14 cm2 weeks postsurgery (BFR began on second day)↓ 13.8% in quadriceps CSA with BFR, which was not significantly different to the control group (↓ 13.1%, p = 0.62)Not assessed
  • 1RM, one repetition maximum; ACLR, anterior cruciate ligament reconstruction; BFR, blood flow restriction; CK, creatine kinase; CSA, cross-sectional area; IGF-1, insulin like growth factor; IGFBP-3, insulin like growth factor binding protein 3; GH, growth hormone; KOOS, Knee Injury and Osteoarthritis Outcome Score; LOP, limb occlusive pressure; MVC, maximal voluntary contraction; MVO, maximal venous outflow; MVIC, maximal voluntary isometric contraction; NA, not applicable; NE, norepinephrine; NPRS, Numerical Pain Rating Scale; PObf, peak occlusive blood flow; Rbf, resting blood flow; reps, repetition; RHI, Reactive Hyperemia Index; SF, Short Form-36 Health Survey Questionnaire; tcPO2, transcutaneous oxygen pressure; TUG, timed up and go; VAS, Visual Analogue Scale; VEGF, vascular endothelial growth factor; VO2peak, peak O2 consumption; vWF, von Willebrand factor.