Muscle hypertrophy and strength improvements following blood flow restriction combined with resistance training in team-athletes: a systematic review and meta-analysis

Figure 1. Flowchart illustrating a systematic review process with stages of identification, screening, eligibility, and inclusion; records are narrowed from 11,676 to 12 studies included in meta-analysis through exclusions for duplicates, relevance, and methodological criteria.

Figure 2. Bar chart and dot matrix summarizing risk of bias across seven study domains, using green for low risk, yellow for unclear risk, and red for high risk. Most domains have predominantly low risk, except “Blinding of outcome assessment” and “Blinding of participants and personnel”, which show higher proportions of high risk. The dot matrix maps individual studies to each bias domain using color-coded circles matching the bar chart, with a legend explaining the color scheme.

Figure 3. Forest plot summarizing a meta-analysis of eleven studies comparing experimental and control groups, showing standardized mean differences with confidence intervals. The overall effect favors the experimental group with an effect size of 0.32 [0.05, 0.58], low heterogeneity, and a test for overall effect Z = 2.36 P = 0.02.

Figure 4. Forest plot displaying a meta-analysis comparing standardized mean differences between experimental and control groups across thirteen studies, with confidence intervals shown as horizontal lines. The summary effect size is 0.42, favoring the experimental group, with low heterogeneity reported.

Figure 5. Forest plot summarizing eight studies comparing experimental and control groups for standard mean difference. Green squares indicate individual study results with confidence intervals; the overall effect size is 0.12 with confidence interval from negative 0.22 to 0.46, favoring neither group.

Figure 6. Forest plot of nine studies comparing experimental and control groups, showing standardized mean differences with confidence intervals. Pooled result is negative zero point zero seven, indicating no significant effect. All confidence intervals cross zero.

Figure 7. Four-panel figure showing funnel plots labeled a, b, c, and d, each with effect size on the x-axis and standard error of effect size on the y-axis. Each plot contains a triangle formed by dashed lines representing pseudo ninety-five percent confidence limits, along with green dots representing data points scattered within each triangle. Plots (b, d) contain more data points than (a, c). Each plot visually assesses publication bias or heterogeneity in a meta-analysis context. (a): funnel plots of Muscle hypertrophy, (b): funnel plots of Muscle strength, (c): funnel plots of Jump performance, (d): funnel plots of Sprint performance.

Figure 8. Four-panel graphic showing Egger’s publication bias plots with regression lines. Panel (a): P equals 0.35; panel (b): P equals 0.099; panel (c): P equals 0.932; panel (d): P equals 0.06. Each plot depicts standardized effect against precision with no significant publication bias indicated. (a): Egger’s publication bias plots of Muscle hypertrophy, (b): Egger’s publication bias plots of Muscle strength, (c): Egger’s publication bias plots of Jump performance, (d): Egger’s publication bias plots of Sprint performance.

Figure 9. Four-panel figure showing leave-one-out meta-analysis plots labeled a, b, c, and d. Each panel lists individual studies on the y-axis and displays point estimates with lower and upper confidence intervals along the x-axis. Each plot visually assesses the influence of omitting one study at a time on the summary effect estimate, with circles representing estimates and horizontal lines for confidence intervals. The panels are arranged in a two-by-two grid and each study is identified by author and year. (a): leave-one-out meta-analysis plots of Muscle hypertrophy, (b): leave-one-out meta-analysis plots of Muscle strength, (c): leave-one-out meta-analysis plots of Jump performance, (d): leave-one-out meta-analysis plots of Sprint performance.