Magnitude of Muscle Strength and Mass Adaptations Between High-Load Resistance Training Versus Low-Load Resistance Training Associated with Blood-Flow Restriction: A Systematic Review and Meta-Analysis
Low-load resistance training (< 50% of one-repetition maximum [1RM]) associated with blood-flow restriction (BFR-RT) has been thought to promote increases in muscle strength and mass. However, it remains unclear if the magnitude of these adaptations is similar to conventional high-load resistance training (> 65% 1RM; HL-RT).
To compare the effects of HL- versus BFR-RT on muscle adaptations using a systematic review and meta-analysis procedure.
Studies were identified via electronic databases based on the following inclusion criteria: (a) pre- and post-training assessment of muscular strength; (b) pre- and post-training assessment of muscle hypertrophy; (c) comparison of HL-RT vs. BFR-RT; (d) score ≥ 4 on PEDro scale; (e) means and standard deviations (or standard errors) are reported from absolute values or allow estimation from graphs. If this last criterion was not met, data were directly requested from the authors.
The main results showed higher increases in muscle strength for HL- as compared with BFR-RT, even when considering test specificity, absolute occlusion pressure, cuff width, and occlusion pressure prescription. Regarding the hypertrophic response, results revealed similar effects between HL- and BFR-RT, regardless of the absolute occlusion pressure, cuff width, and occlusion pressure prescription.
Based on the present data, maximum muscle strength may be optimized by specific training methods (i.e., HL-RT) while both HL- and BFR-RT seem equally effective in increasing muscle mass. Importantly, BFR-RT is a valid and effective approach for increasing muscle strength in a wide spectrum of ages and physical capacity, although it may seem particularly of interest for those individuals with physical limitations to engage in HL-RT.
Compliance with Ethical Standards
The authors are grateful to Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) for financial support and Fundação de Amparo à Pesquisa (FAPESP). Manoel Lixandrão is supported by CNPq and FAPESP (141733/2016-0 and 2016/22635-6, respectively). Hamilton Roschel is supported by CNPq and FAPESP (307023/2014-1 and 2016/10993-5, respectively). Carlos Ugrinowitsch is supported by CNPq (304205/2011-7 and 2016/09759-8, respectively).
Conflict of interest
Manoel Lixandrão, Carlos Ugrinowitsch, Ricardo Berton, Felipe Vechin, Miguel Conceição, Felipe Damas, Cleiton Libardi, and Hamilton Roschel declare that they have no conflicts of interest relevant to the content of this review.
- 5.ACSM. ACSM clinician profile. David T. Bernhardt, M.D. Curr Sports Med Rep. 2009;8(4):161. doi: 10.1249/JSR.0b013e3181adff73.
- 7.Vechin FC, Libardi CA, Conceicao MS, et al. Comparisons between low-intensity resistance training with blood flow restriction and high-intensity resistance training on quadriceps muscle mass and strength in elderly. J Strength Cond Res. 2015;29(4):1071–6. doi: 10.1519/JSC.0000000000000703.CrossRefPubMedGoogle Scholar
- 9.Mattar MA, Gualano B, Perandini LA, et al. Safety and possible effects of low-intensity resistance training associated with partial blood flow restriction in polymyositis and dermatomyositis. Arthritis Res Ther. 2014;16(5):473. doi: 10.1186/s13075-014-0473-5.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Ozaki H, Yasuda T, Ogasawara R, et al. Effects of high-intensity and blood flow-restricted low-intensity resistance training on carotid arterial compliance: role of blood pressure during training sessions. Eur J Appl Physiol. 2013;113(1):167–74. doi: 10.1007/s00421-012-2422-9.CrossRefPubMedGoogle Scholar
- 18.Thiebaud RS, Loenneke JP, Fahs CA, et al. The effects of elastic band resistance training combined with blood flow restriction on strength, total bone-free lean body mass and muscle thickness in postmenopausal women. Clin Physiol Funct Imaging. 2013;33(5):344–52. doi: 10.1111/cpf.12033.CrossRefPubMedGoogle Scholar
- 19.Ellefsen S, Hammarstrom D, Strand TA, et al. Blood flow-restricted strength training displays high functional and biological efficacy in women: a within-subject comparison with high-load strength training. Am J Physiol Regul Integr Comp Physiol. 2015;309(7):R767–79. doi: 10.1152/ajpregu.00497.2014.CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Schoenfeld BJ, Ogborn D, Krieger JW. Dose-response relationship between weekly resistance training volume and increases in muscle mass: a systematic review and meta-analysis. J Sports Sci. 2016. doi: 10.1080/02640414.2016.1210197.