Effects of Resistance Training with Blood Flow Restriction on Explosive Power of Lower Limbs: A Systematic Review and Meta-Analysis
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Department of Sports Studies, Faculty of Educational Studies, University Putra Malaysia, Selangor, Malaysia
Department of Smart Health Science and Technology Convergence, Kangwon National University, Chuncheon, Korea
Department of Sport Science, Kangwon National University, Chuncheon, Korea
School of Teacher Education, Taizhou University, Zhejiang, China
Department of Physical Education, Ludong University, Shandong, China
Submission date: 2022-09-21
Acceptance date: 2022-11-14
Online publication date: 2023-07-06
Corresponding author
Xin-Min Qin   

1. Department of Smart Health Science and Technology Convergence; 2. Department of Sport Science, Kangwon National University, Kangwon National University, Korea (South)
Journal of Human Kinetics 2023;89:259–268
The purpose of this systematic review and meta-analysis was to compare changes in explosive power between blood flow restriction training and traditional resistance training protocols. Searches of PubMed, Scopus, Web of Science, and OVID Medline were conducted for studies. Inclusion criteria were: (a) healthy people; (b) randomized controlled or controlled trials; (c) outcome measures of explosive performance (peak power, rate of force development, jump performance, sprint performance, etc.); (d) involving a comparison between blood flow restriction training and traditional resistance training. Quality assessment was conducted using the Physiotherapy Evidence Database (PEDro) scale. A total of 12 studies (262 subjects) were finally included for analysis. The PEDro scale score had a median of 5 of 10 points (range: 3–6 points). Significant small to moderate improvements were observed in blood flow restriction training [jump: standard mean difference (SMD) of 0.36 (95% CI: 0.02; 0.69); sprint: SMD of 0.54 (95% CI: 0.00; 1.07); power: SMD of 0.72 (95% CI: 0.17; 1.27)] when compared to traditional resistance training. The findings indicate that blood flow restriction training is more effective in improving explosive power of lower limbs compared to traditional resistance training in healthy people. In addition, blood flow restriction with a wide cuff ( 10 cm) during training improved explosive power better than with a narrow cuff or during the rest interval. Blood flow restriction training is very suitable for athletes in short competitive seasons and those who are not able to tolerate high loads (i.e., rehabilitators and the elderly).
Abe, T., Kawamoto, K., Yasuda, T., CF, K., Midorikawa, T., & Sato, Y. (2005). Eight days KAATSU-resistance training improved sprint but not jump performance in collegiate male track and field athletes. International Journal of KAATSU Training Research, 1(1), 19–23.
Abe, T., Kearns, C. F., & Sato, Y. (2006). Muscle size and strength are increased following walk training with restricted venous blood flow from the leg muscle, Kaatsu-walk training. Journal of Applied Physiology, 100(5), 1460–1466.
Amani-Shalamzari, S., Sarikhani, A., Paton, C., Rajabi, H., Bayati, M., Nikolaidis, P. T., & Knechtle, B. (2020). Occlusion training during specific futsal training improves aspects of physiological and physical performance. Journal of Sports Science and Medicine, 19(2), 374.
Behringer, M., Behlau, D., Montag, J. C., McCourt, M. L., & Mester, J. (2017). Low-intensity sprint training with blood flow restriction improves 100-m dash. Journal of Strength and Conditioning Research, 31(9), 2462‒2472.
Borenstein, M., Hedges, L. V., Higgins, J. P., & Rothstein, H. R. (2010). A basic introduction to fixed‐effect and random‐effects models for meta‐analysis. Research Synthesis Methods, 1(2), 97‒111.
Boyanmis, A.H., Akın, M. (2022). Effectiveness of plyometric or blood flow restriction training on technical kick force in taekwondo. Balt J Health Phys Act, 14(1): Article 5. doi: 10.29359/BJHPA.14.1.05.
Cook, C. J., Kilduff, L. P., & Beaven, C. M. (2014). Improving strength and power in trained athletes with 3 weeks of occlusion training. International Journal of Sports Physiology and Performance, 9(1), 166‒172.
de Mendonca, G., Margarida Correia, J., Gomes, M., Dias Gonçalves, A., Vila-Chã, C. & Pezarat-Correia, P. (2022). Neuromuscular Impact of Acute Hypertrophic Resistance Loading With and Without Blood-Flow Restriction. Journal of Human Kinetics, 82(1), 27–37.
De Morton, N. A. (2009). The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Australian Journal of Physiotherapy, 55(2), 129‒133.
de Oliveira, M. F. M. d., Caputo, F., Corvino, R. B., & Denadai, B. S. (2016). Short‐term low‐intensity blood flow restricted interval training improves both aerobic fitness and muscle strength. Scandinavian Journal of Medicine and Science in Sports, 26(9), 1017‒1025.
Doma, K., Leicht, A. S., Boullosa, D., & Woods, C. T. (2020). Lunge exercises with blood-flow restriction induces post-activation potentiation and improves vertical jump performance. European Journal of Applied Physiology, 120(3), 687‒695.
Granacher, U., Zahner, L., & Gollhofer, A. (2008). Strength, power, and postural control in seniors: Considerations for functional adaptations and for fall prevention. European Journal of Sport Science, 8(6), 325‒340.
Gundermann, D. M., Fry, C. S., Dickinson, J. M., Walker, D. K., Timmerman, K. L., Drummond, M. J., Volpi, E., Rasmussen, B. B. (2012). Reactive hyperemia is not responsible for stimulating muscle protein synthesis following blood flow restriction exercise. Journal of Applied Physiology, 112(9), 1520‒1528.
Hecht, J., Lester, J., Venezia, J., Donnelly, J., Kang, S., Petrizzo, J., Otto, R. M., Wygand, J. (2016). The Effects of Post-Activation Potentiation in Conjunction with Blood Flow Restriction on Sprint Performance. Medicine and Science in Sports and Exercise, 48(5S), 474.
Hedges, L. V., & Olkin, I. (2014). Statistical Methods for Meta-analysis. Princeton, NJ: Academic press.
Horiuchi, M., Endo, J., Sato, T., & Okita, K. (2018). Jump training with blood flow restriction has no effect on jump performance. Biology of Sport, 35(4), 343‒348.
Jessee, M. B., Buckner, S. L., Dankel, S. J., Counts, B. R., Abe, T., & Loenneke, J. P. (2016). The influence of cuff width, sex, and race on arterial occlusion: implications for blood flow restriction research. Sports Medicine, 46(6), 913‒921.
Laurentino, G. C., Ugrinowitsch, C., Roschel, H., Aoki, M. S., Soares, A. G., Neves Jr, M., Aihara, Andre, Y., Fernandes, A. R., Tricoli, V. (2012). Strength training with blood flow restriction diminishes myostatin gene expression. Med Sci Sports Exerc, 44(3), 406‒412.
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P., Clarke, M., Devereaux, P. J., Kleijnen, J., Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Journal of Clinical Epidemiology, 62(10), e1‒e34.
Lindner, T. D., Scholten, S. D., Halverson, J. M., Baumgarten, K. M., Birger, C. B., & Nowotny, B. G. (2021). The acute effects of ischemic preconditioning on power and sprint performance. South Dakota Medicine, 74(5), 210‒219.
Loenneke, J., Wilson, J., Wilson, G., Pujol, T., & Bemben, M. (2011). Potential safety issues with blood flow restriction training. Scandinavian Journal of Medicine and Science in Sports, 21(4), 510‒518.
Loenneke, J. P., Thiebaud, R. S., Fahs, C. A., Rossow, L. M., Abe, T., & Bemben, M. G. (2013). Effect of cuff type on arterial occlusion. Clinical Physiology and Functional Imaging, 33(4), 325‒327.
Luebbers, P. E., Fry, A. C., Kriley, L. M., & Butler, M. S. (2014). The effects of a 7-week practical blood flow restriction program on well-trained collegiate athletes. Journal of Strength and Conditioning Research, 28(8), 2270‒2280.
Maciel Batista, M., da Silva, D. S. G., & Bento, P. C. B. (2020). Effects of blood flow restriction training on strength, muscle mass and physical function in older individuals-systematic review and meta-analysis. Physical and Occupational Therapy In Geriatrics, 38(4), 400‒417.
Madarame, H., Ochi, E., Tomioka, Y., Nakazato, K., & Ishii, N. (2011). Blood flow-restricted training does not improve jump performance in untrained young men. Acta Physiologica Hungarica, 98(4), 465‒471.
Maffiuletti, N. A., Aagaard, P., Blazevich, A. J., Folland, J., Tillin, N., & Duchateau, J. (2016). Rate of force development: physiological and methodological considerations. European Journal of Applied Physiology, 116(6), 1091‒1116.
Manimmanakorn, A., Hamlin, M. J., Ross, J. J., Taylor, R., & Manimmanakorn, N. (2013). Effects of low-load resistance training combined with blood flow restriction or hypoxia on muscle function and performance in netball athletes. Journal of Science and Medicine in Sport, 16(4), 337‒342.
Manini, T. M., Vincent, K. R., Leeuwenburgh, C. L., Lees, H. A., Kavazis, A. N., Borst, S. E., & Clark, B. C. (2011). Myogenic and proteolytic mRNA expression following blood flow restricted exercise. Acta Physiologica, 201(2), 255‒263.
Moritani, T., Sherman, W. M., Shibata, M., Matsumoto, T., & Shinohara, M. (1992). Oxygen availability and motor unit activity in humans. European Journal of Applied Physiology and Occupational Physiology, 64(6),.
Paradis-Deschênes, P., Joanisse, D. R., & Billaut, F. (2016). Ischemic preconditioning increases muscle perfusion, oxygen uptake, and force in strength-trained athletes. Applied Physiology, Nutrition, and Metabolism, 41(9), 938‒944.
Patterson, S., Hughes, L., & Warmington, S. (2019). Blood flow restriction exercise position stand: considerations of methodology, application, and safety. Frontiers in Physiology, 10, 533.
Rossow, L. M., Fahs, C. A., Loenneke, J. P., Thiebaud, R. S., Sherk, V. D., Abe, T., & Bemben, M. G. (2012). Cardiovascular and perceptual responses to blood‐flow‐restricted resistance exercise with differing restrictive cuffs. Clinical Physiology and Functional Imaging, 32(5), 331‒337.
Sa, H. K., Kianigul, M., Haghighi, A.-H., Nooghabi, M. J., & Scott, B. R. (2020). Performing Soccer-Specific Training With Blood Flow Restriction Enhances Physical Capacities in Youth Soccer Players. Journal of Strength and Conditioning Research, 36(7), 1972‒1977.
Scott, B. R., Peiffer, J. J., & Goods, P. S. (2017). The effects of supplementary low-load blood flow restriction training on morphological and performance-based adaptations in team sport athletes. Journal of Strength and Conditioning Research, 31(8), 2147‒2154.
Shinohara, M., Kouzaki, M., Yoshihisa, T., & Fukunaga, T. (1997). Efficacy of tourniquet ischemia for strength training with low resistance. European Journal of Applied Physiology and Occupational Physiology, 77(1), 189‒191.
Stojanović, E., Ristić, V., McMaster, D. T., & Milanović, Z. (2017). Effect of plyometric training on vertical jump performance in female athletes: a systematic review and meta-analysis. Sports Medicine, 47(5), 975‒986.
Takarada, Y., Takazawa, H., Sato, Y., Takebayashi, S., Tanaka, Y., & Ishii, N. (2000a). Effects of resistance exercise combined with moderate vascular occlusion on muscular function in humans. Journal of Applied Physiology, 86(6), 2097‒2106.
Takarada, Y., Nakamura, Y., Aruga, S., Onda, T., Miyazaki, S., & Ishii, N. (2000b). Rapid increase in plasma growth hormone after low-intensity resistance exercise with vascular occlusion. Journal of Applied Physiology, 88(1), 61‒65.
Taylor, C. W., Ingham, S. A., & Ferguson, R. A. (2016). Acute and chronic effect of sprint interval training combined with postexercise blood‐flow restriction in trained individuals. Experimental Physiology, 101(1), 143‒154.
Wilk, M., Gepfert, M., Krzysztofik, M., Stastny, P., Zajac, A., & Bogdanis, G. C. (2020a). Acute effects of continuous and intermittent blood flow restriction on movement velocity during bench press exercise against different loads. Frontiers n Physiology, 11, 569915.
Wilk, M., Krzysztofik, M., Filip, A., Zajac, A., Bogdanis, G. C., & Lockie, R. G. (2020b). Short-term blood flow restriction increases power output and bar velocity during the bench press. Journal of Strength and Conditioning Research, 36(8), 2082‒2088.
Yamanaka, T., Farley, R. S., & Caputo, J. L. (2012). Occlusion training increases muscular strength in division IA football players. Journal of Strength and Conditioning Research, 26(9), 2523‒2529.
Yang, S., Zhang, P., Sevilla-Sanchez, M., Zhou, D., Cao, J., He, J., Gao, B., Carballeira, E. (2022). Low-Load Blood Flow Restriction Squat as Conditioning Activity Within a Contrast Training Sequence in High-Level Preadolescent Trampoline Gymnasts. Frontiers in Physiology, 13, 1146.
Zlowodzki, M., Poolman, R. W., Kerkhoffs, G. M., Tornetta III, P., Bhandari, M., & Group, I. E.-B. O. S. W. (2007). How to interpret a meta-analysis and judge its value as a guide for clinical practice. Acta Orthopaedica, 78(5), 598‒609.