Effects of blood flow restriction training combined with resistance training on lower-limb strength and sport-specific performance in athletes: a systematic review and meta-analysis

Background and Purpose: Lower-limb strength is crucial for athletes' performance and their capacity to tolerate training loads. However, sustained high-load resistance training (RT) is not always feasible across a competitive season, particularly during congested phases or rehabilitation periods. Blood flow restriction training (BFRT) combined with low-load RT has emerged as a promising alternative to induce muscular adaptations while minimizing mechanical stress. While BFRT's efficacy for strength and hypertrophy is increasingly recognized, its transferability to dynamic, sport-specific performance remains unclear. Therefore, the primary purpose of this systematic review and meta-analysis is to comprehensively evaluate the effects of BFRT combined with RT on lower-limb muscle strength, muscle hypertrophy, and sport-specific performance in athletes across various disciplines. Expected Outcomes: This study will synthesize data from relevant randomized controlled trials (RCTs) to determine the efficacy of BFRT combined with RT compared to conventional training. The primary outcomes of interest include indices of lower-limb strength (e.g., isokinetic strength, squat performance, and peak torque) and sport-specific performance (assessed via field-based tests such as sprinting, vertical jumping, and change-of-direction tasks). Secondary outcomes include measures of muscle hypertrophy (e.g., muscle circumference). By conducting meta-analyses and subgroup analyses (e.g., by sport type, training duration, and specific strength indicators), this project aims to provide evidence-based insights and practical guidelines for coaches and clinicians regarding the optimal prescription of BFRT in athletic preparation and rehabilitation.