Effect of blood flow restricted walking on cardiovascular fitness, muscular development, and functional performance in adults: A systematic review with meta-analysis

Abstract

ABSTRACT Increasing evidence from randomised controlled trials demonstrates blood flow restriction (BFR) improves walking intervention outcomes compared to walking without BFR. This systematic review and meta-analysis examined the effects of BFR walking interventions on cardiovascular fitness, muscle strength and hypertrophy, and functional performance in adults, and moderators of age, health status, training volume and intensity. Six databases were systematically searched following PRISMA guidelines, up to April 2025. Studies were eligible if participants were ≥ 18 years, included randomised controlled trials with BFR walking interventions ≥ 12 sessions and ≥10 min/session, at least one measure of cardiovascular fitness, muscular strength, muscular hypertrophy, functional performance, and a non-BFR walking control group. Twelve studies met inclusion criteria. BFR walking improved cardiovascular fitness (g = 0.31, CI95%: 0.05 to 0.59), lower-limb muscular strength (g = 0.32, CI95%: 0.06 to 0.57), hypertrophy (g = 0.26, CI95%: 0.01 to 0.51), and functional performance (g = 0.57, CI95%: 0.21 to 0.92) compared to non-BFR walking. BFR walking improves physiological adaptations and functional performance compared to non-BFR walking, without additional workload. This may benefit load-compromised individuals such as older or clinical populations. More evidence is needed to develop specific prescription guidelines for BFR walking. Practitioners should adhere to current guidelines for prescribing BFR with aerobic exercise. Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024494720 KEY POINTS The addition of blood flow restriction to low-moderate intensity walking exercise delivers small-moderate effects for improvements in cardiovascular fitness, muscular strength and hypertrophy, and functional performance in adult populations. Exercise prescription variables of intensity and volume did not seem to significantly affect the adaptations achieved from BFR walking in an adult population. The quality of studies included in this review was considered low to very low, combined with a high risk of bias, therefore reducing confidence the results and cautious interpretation is warranted.