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June 1, 2026The Journal of Strength and Conditioning Research

Acute and Chronic Effects of High-Load Resistance Training With Blood Flow Restriction in Healthy Adults: A Systematic Review and Meta-Analysis

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Key result

High-load training with blood flow restriction shows no strength or size benefit over conventional training.

  • g 0.11
  • 95% CI -0.11 to 0.33

Why the study?

While blood flow restriction enhances muscle adaptations with low loads, findings are conflicting regarding its effects when combined with higher resistance training loads of 60% or more of maximal strength.

Does high-load resistance training with blood flow restriction improve muscle size and strength in healthy adults compared to conventional high-load resistance training?

Comparison

High-load resistance training with blood flow restriction vs conventional high-load resistance training

Design

Systematic review and meta-analysis

Authors

JMJames R. McKeeIRIsaac Selva RajKMKieran J. Marston

Discussion

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Overview

No benefit from adding BFR to high-load training; challenges its adjunctive use at higher loads and confirms efficacy is limited to low-load protocols.

Study Design

Type

Meta-Analysis

Structured PICO

Does high-load resistance training with blood flow restriction improve muscle size and strength in healthy adults compared to conventional high-load resistance training?

P
Population
Systematic review and meta-analysis of 8 chronic and 34 acute studies examining high-load resistance training with blood flow restriction in healthy adults.
I
Intervention
High-load resistance training (≥60% of maximal strength) with blood flow restriction (BFR)
C
Comparator
Conventional high-load resistance training
O
Outcome
Muscle strength and size adaptationssurrogate

Main Result

Standardized Mean Difference: 0.11 (95% CI -0.11–0.33)

Adding blood flow restriction to high-load resistance training does not provide additional benefits for muscle size and strength in healthy adults.

Limitations

  • Very-low certainty evidence

Cite This Study

McKee et al. (2026) conducted a meta-analysis in Healthy adults. High-load resistance training with blood flow restriction vs. Conventional high-load resistance training was evaluated on Muscle strength (g 0.11, 95% CI -0.11 to 0.33). High-load resistance training with blood flow restriction does not further improve muscle strength (g=0.11; 95% CI -0.11 to 0.33) or size compared with conventional high-load resistance training.

synapsesocial.com/papers/6a1f2ee80a1e4e63fe91633dhttps://doi.org/10.1519/jsc.0000000000005467
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Effect of moderate intensity resistance training with blood flow restriction on muscle strength and girth in young adults – a randomized control trial2021 · 4 citations
  2. 2An Updated Panorama of Blood-Flow-Restriction Methods2023 · 34 citations
  3. 3Acute effects of resistance exercise with blood flow restriction on cardiovascular response: a meta-analysis2022 · 11 citations
  4. 4Effects of Blood flow Restriction and Load on Mean Propulsive Velocity and Subjective Perceived Exertion During Squat and Bench Press Exercises2024 · 3 citations
  5. 5The Association Between Muscle Deoxygenation and Muscle Hypertrophy to Blood Flow Restricted Training Performed at High and Low Loads2019 · 105 citations