Abstract
BACKGROUND: Blood Flow Restriction (BFR) training is increasingly recognized as an effective method for enhancing physical performance. BFR combined with low-intensity continuous or resistance training could improve aerobic capacity, muscle hypertrophy, and muscle strength just as effectively as high-intensity training in healthy adults. However, the effects of BFR combined with interval training (BFRIT) on aerobic capacity, anaerobic capacity, and muscle strength are not clear, and experts do not agree in the literature. METHODS: A comprehensive literature search was conducted across six databases by the PRISMA guidelines. Data were extracted from the included studies, and random-effects meta-analyses were conducted to synthesize the effect size (ES), expressed as standardized mean differences (SMD). The heterogeneity was assessed using the I² statistic. Additionally, the GRADE framework was employed to evaluate the quality of the evidence derived from this meta-analysis. RESULTS: Twenty-four studies consisting of 607 participants were included. Aerobic capacity was measured using maximal oxygen uptake (V̇O(2max)) or peak oxygen uptake (V̇O(2peak)). Anaerobic capacity was assessed through peak power output (PPO) or mean power output (MPO). Muscle strength was quantified via peak force or torque in knee extension; if unavailable, knee flexion data or one-repetition maximum (1RM) were used instead. The ES of BFRIT on aerobic capacity was significant and small (SMD = 0.33, p < 0.001, I(2) = 5.20%); the ES of BFRIT on muscle strength was significant and moderate (SMD = 0.61, p < 0.001, I(2) = 29.76%); but the ES of BFRIT on PPO was not significant and trivial(SMD=-0.07, p = 0.74, I(2) = 0.0%); the ES of BFRIT on MPO was not significant and small (SMD = 0.23, p = 0.25, I(2) = 0%). Subgroup analysis revealed that the effects of BFRIT on aerobic capacity and muscle strength were impacted by the training intensity (high vs. low to moderate), training duration (≥ 6 weeks vs. < 6 weeks), training status (untrained vs. trained), cuff pressure modes (fixed vs. incremental), cuff pressure types (absolute vs. relative), and cuff application phases (during exercise vs. rest intervals alone). CONCLUSIONS: BFRIT is beneficial for healthy adults in improving aerobic capacity and muscle strength. However, the impact of BFRIT on anaerobic capacity remains uncertain due to the limited sample sizes and statistical power in current studies. Future research should focus on larger sample sizes and more robust designs to clarify the potential anaerobic adaptations related to BFRIT. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024609590. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13102-025-01413-x.