INTRODUCTION AND AIMS Low-load resistance training (RT) with blood flow restriction (BFR; 20–40% of 1-repetition maximum [1RM]) increases muscle mass and strength comparably to unrestricted high-load RT. As healthy populations are not limited to low-loads, some researchers have also examined whether the adaptations to high-load RT could be enhanced with BFR, though results are inconsistent. Therefore, we conducted a systematic review to investigate whether moderate to high-load resistance training (M-HL RT) with BFR increases muscle mass or strength more than the equivalent training without BFR. METHODS Studies involving M-HL RT (≥60% 1RM) with BFR applied during exercise sets or rest intervals were included. The following databases were searched: PubMed, Web of Science, Scopus, ScienceDirect, ProQuest Central, and Google Scholar. Two researchers independently screened the titles and abstracts for eligibility based on the inclusion and exclusion criteria. The full texts of included studies were then independently screened by two researchers. Conflicts were resolved by a third researcher. Following screening, study and participant characteristics, intervention protocol for each group and outcome measures were extracted for each included study. RESULT Ten studies met the criteria for inclusion in this review. All included studies measured muscle strength, with only three reporting greater strength increases after M-HL RT with BFR compared to equivalent training without BFR. Five studies assessed muscle mass, with four reporting similar increases after M-HL RT with and without BFR. One observed a smaller increase in mass after M-HL RT with BFR than without. CONCLUSION Most studies did not observe additional benefit of applying BFR during M-HL RT for muscle strength or mass. Studies which did report benefits of BFR may be limited by methodological issues, impacting the applicability of their findings. Overall, this review does not support using BFR during M-HL RT for additional improvements in muscle strength or mass.
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