Overview of studies included in the systematic and meta-analyses
| Study | Clinical focus | Study design | Method | Occlusion pressure/cuff width | Duration | Physiological adaptations | Physical function |
| Mattar et al 53 | Polymyositis and dermatomyositis | Prospective, longitudinal, quasiexperimental | 4 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/week | 70% LOP/17.5 cm | 12 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 | Elderly | Randomised controlled trial | A combination of six different body weight movements for 45 min | 70–150 mm Hg/4.5 cm | 8 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 men | Randomised controlled trial | Three sets (30, 15, 15 reps) of leg press and knee extensions at 20% 1RM with BFR, 3 days/week | 16–240 mm Hg/5 cm | 6 weeks | ↑19.3% leg press strength ↑19.1% leg extension strength | Not assessed |
| Abe et al 56 | Elderly | Randomised controlled trial | 20 min treadmill walking with BFR at 67 m/min on 5 days/week | 160–200 mm Hg/NA | 6 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 | Elderly | Randomised controlled trial | Three sets of single-leg plantar flexion to failure at 25% 1RM | 110 mm Hg/10 cm | 4 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 | Elderly | Controlled trial | 20 min treadmill walking with BFR at 45% of HR reserve, 4 days/week | 140–200 mm Hg/5 cm | 10 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 women | Randomised controlled trial | 20 min treadmill walking with BFR at 45% of HR reserve, 4 days/week | 140–200 mm Hg/5 cm | 10 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 | Elderly | Randomised controlled trial | 20 min treadmill walking with BFR at 67 m/min for 5 days/week | 140–200 mm Hg/NA | 6 weeks | ↑ 19.5 % leg venous compliance, ↑ 21.3 % MVO, ↑ 1.2% leg girth | Not assessed |
| Karabulut et al 59 | Elderly | Randomised controlled trial | Three 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 mm | 60–240 Hg/5 cm | 6 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 women | Quasi experimental | Three sets (30, 15, 15) of lower body exercises and upper body exercises with BFR using an elastic band at ~10%–30% 1RM, 3 days/week | 80–120 mm Hg/3.3 cm | 8 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 | Elderly | Controlled trial | Four sets (30, 15, 15, 15) of arm curls and tricep pull down exercises with BFR using an elastic band, 2 days/week | 180–270 mm Hg/3 cm | 12 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 | Elderly | Randomised controlled trial | Four sets (30, 15, 15, 15) of leg press with BFR at 20% 1RM for 6 weeks, then 30% 1RM for 6 weeks, 2 days/week | 50% LOP/18 | 12 weeks | ↑ 17% leg press 1RM ↑ 6.6% quadriceps CSA | Not assessed |
| Libardi et al 63 | Elderly | Randomised controlled trial | Four 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 weeks | 50% LOP/17.5 cm | 12 weeks | ↑ 7.6% in quadriceps CSA ↑ 35.4% 1RM ↑ 10.3% VO2 peak | Not assessed |
| Shimizu et al 64 | Elderly | Randomised controlled trial | 3×20 reps of leg press, leg extension, rowing and chest press at 20% 1RM with BFR once a day, 3 days/week | Systolic blood pressure/10 cm | 4 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 trial | Four sets (30, 15, 15, 15) of leg press, 3× per week at 30% 1 RM either alone or with BFR, 3 days/week | 160–200 mm Hg/6.5 cm | 4 weeks | Significant ↑ (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 trial | Four sets (30, 15, 15, 15) of leg press, 3× per week at 30% 1RM either alone or with BFR, 3 days/week | 160–200 mmHg/6.5 cm | 4 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 osteoarthritis | Randomised, blinded, clinical trial | 3 × 20 reps of seated knee extensions at 30% 1RM, 3 days/week. Subjects also performed regular stretching | 200 mm Hg/NA | 6 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 ACLR | Controlled trial | 5 × 5 min occlusion and 3 min reperfusion, 2× per day or no intervention | 200–260 mm Hg/9 cm | 3rd 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 Patients | Prospective, randomised controlled trial | Range of lower limbs exercises, reps, (20–60) sets (1–3 per day), 6 d/wk | 180 mmHg/NA | 16 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 trial | 5 × 20 reps of quadriceps exercises with or without BFR (5 min occlusion, followed by 3 min reperfusion), 2 × per day | 130–180 mmHg/14 cm | 2 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.