Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis

Abstract

Background: The combination of low-load resistance training with blood flow restriction (BFR) has recently been shown to promote muscular adaptations in various populations. To date, however, evidence is sparse on how this training regimen influences muscle mass and strength in older adults.

Purpose: The purpose of this systematic review and meta-analysis was to quantitatively identify the effects of low-load BFR (LL-BFR) training on muscle mass and strength in older individuals in comparison with conventional resistance training programmes. Additionally, the effectiveness of walking with and without BFR was assessed.

Methods: A PRISMA-compliant systematic review and meta-analysis was conducted. The systematic literature research was performed in the following electronic databases from inception to 1 June 2018: PubMed, Web of Science, Scopus, CINAHL, SPORTDiscus and CENTRAL. Subsequently, a random-effects meta-analysis with inverse variance weighting was conducted.

Results: A total of 2658 articles were screened, and 11 studies with a total population of N = 238 were included in the meta-analysis. Our results revealed that during both low-load training and walking, the addition of BFR elicits significantly greater improvements in muscular strength with pooled effect sizes (ES) of 2.16 (95% CI 1.61 to 2.70) and 3.09 (95% CI 2.04 to 4.14), respectively. Muscle mass was also increased when comparing walking with and without BFR [ES 1.82 (95% CI 1.32 to 2.32)]. In comparison with high-load training, LL-BFR promotes similar muscle hypertrophy [ES 0.21 (95% CI - 0.14 to 0.56)] but lower strength gains [ES - 0.42 (95% CI - 0.70 to - 0.14)].

Conclusion: This systematic review and meta-analysis reveals that LL-BFR and walking with BFR is an effective interventional approach to stimulate muscle hypertrophy and strength gains in older populations. As BFR literature is still scarce with regard to potential moderator variables (e.g. sex, cuff pressure or training volume/frequency), further research is needed for strengthening the evidence for an effective application of LL-BFR training in older people.

Fig. 1

Flow chart presenting the search process and study selection

Fig. 2

Forest plot demonstrating the effects of LL-BFR versus HL training on muscular strength. Different letters for the same study represent different muscular strength assessment methods. CI confidence interval, HL high-load, IV inverse variance, LL-BFR low-load blood flow restriction, Random random effects model

Fig. 3

Forest plot demonstrating the effects of LL-BFR versus HL training on muscle mass. Different letters for the same study represent different assessment methods for muscle mass. CI confidence interval, HL high-load, IV inverse variance, LL-BFR low-load blood flow restriction, Random random effects model

Fig. 4

Forest plot demonstrating the effects of LL-BFR versus LL training on muscular strength. Different letters for the same study represent different muscular strength assessment methods. CI confidence interval, IV inverse variance, LL low-load, LL-BFR low-load blood flow restriction, Random random effects model

Fig. 5

Forest plot demonstrating the effects of walking + BFR versus normal walking on muscular strength. Different letters for the same study represent different muscular strength assessment methods. BFR blood flow restriction, CI confidence interval, IV inverse variance, Random random effects model

Fig. 6

Forest plot demonstrating the effects of walking + BFR versus normal walking on muscle mass. Different letters for the same study represent different muscle mass assessment methods. BFR blood flow restriction, CI confidence interval, IV inverse variance, Random random effects model