Blood Flow Restriction Training Improves Cardiac Structure and Diastolic Function in Runners with Exercise-Induced Hypertension

Q: What is the clinical evidence from this study?

Population: Exercise-induced hypertension (EIH) in runners (n=29). Intervention: Blood flow restriction (BFR) training vs. Control group without BFR training (non-BFRTg). Primary outcome: Left ventricular interventricular septal thickness at end-diastole (LVIVSd, cm) (p=0.009).

Q: What does this research mean for the field?

Blood flow restriction training reduces interventricular septal thickness and improves left ventricular diastolic function in runners with exercise-induced hypertension. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Young‐Joo Kim; Jong‐Young Lee; Choung-Hwa Park; Han Soo Park

doi:10.3390/jcm14217795

November 3, 2025Journal of Clinical MedicineOpen Access

Blood Flow Restriction Training Improves Cardiac Structure and Diastolic Function in Runners with Exercise-Induced Hypertension

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Key result

Blood flow restriction training reduces septal thickness and improves diastolic function in runners with exercise hypertension.

P=0.009
n=29

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Why the study?

Exercise-induced hypertension in runners predisposes to cardiovascular disease, but whether changes in myocardial structure and function accompany the known benefits of blood flow restriction training was unknown.

Does a 2-month blood flow restriction training program improve cardiac structure and diastolic function in middle-aged male long-distance runners with exercise-induced hypertension?

Key Points

To investigate whether blood flow restriction training induces favorable adaptations in myocardial structure and diastolic function in middle-aged runners with exercise-induced hypertension.
Enrolled runners demonstrating a maximal exercise systolic blood pressure of ≥210 mmHg during an exercise stress test.
Assigned participants to either an 8-week blood flow restriction training group (n = 15; 20 minutes per session, twice weekly) or a non-training control group (n = 14).
Evaluated left ventricular structure, diastolic indices, and systolic performance before and after the intervention using echocardiography alongside graded exercise testing.
BFR training significantly reduced maximal exercise systolic blood pressure from 222.8 ± 7.3 mmHg to 179.7 ± 17.4 mmHg (p < 0.001; time × group interaction p < 0.001), while extending exercise duration and improving VO2max (time × group interaction p < 0.05).
Left ventricular interventricular septal thickness decreased significantly in the BFR group (0.96 ± 0.09 cm to 0.92 ± 0.07 cm) compared with controls (0.95 ± 0.11 cm to 0.97 ± 0.11 cm; time × group interaction p = 0.009), with no changes in systolic parameters.
Diastolic function improved in the BFR group, characterized by an increased E′/A′ ratio (1.08 ± 0.15 to 1.21 ± 0.13; time × group interaction p = 0.021) and a decreased E/E′ ratio (9.6 ± 2.1 to 8.3 ± 1.9; time × group interaction p = 0.005).

Structured PICO

Does a 2-month blood flow restriction training program improve cardiac structure and diastolic function in middle-aged male long-distance runners with exercise-induced hypertension?

P

Population

29 middle-aged male long-distance runners in South Korea with exercise-induced hypertension (maximal exercise SBP >=210 mmHg) evaluated over an 8-week intervention.

I

Intervention

Blood flow restriction (BFR) training on a treadmill (at 40-60% Heart Rate Reserve) with cuffs applied to the proximal thighs (pressures 150-300 mmHg in cyclic and constant modes) for 20 minutes per session, twice weekly for 2 months (8 weeks) (n=15).

C

Comparator

Control group without BFR training (non-BFRTg, n=14) who exercised at 40-60% Heart Rate Reserve.

O

Outcome

Cardiac structural and functional adaptations measured by M-mode and pulsed-wave tissue Doppler echocardiography (specifically interventricular septal thickness at end-diastole [LVIVSd], E′/A′ ratio, and E/E′ ratio) after the 8-week intervention.surrogate

Main Result

Absolute Event Rate: 0.92% vs 0.97%

p-value: p=0.009

An 8-week blood flow restriction training program in male marathon runners with exercise-induced hypertension significantly reduced interventricular septal thickness and improved left ventricular diastolic function alongside reductions in maximal exercise systolic blood pressure.

Limitations

Relatively small sample size (n=29) limits generalizability
Non-randomized design with participant self-selection introduces potential selection bias
Short intervention duration (8 weeks, twice-weekly sessions) may be insufficient for broader structural remodeling such as LV mass reduction
Participants were exclusively experienced male marathon runners, limiting generalizability to other populations
Lack of mechanistic biomarker measurements (e.g., nitric oxide, endothelin-1, VEGF, arterial stiffness)
Secondary analysis of an existing cohort
Absence of long-term follow-up to assess persistence of benefits
Echocardiographic assessments were not blinded, introducing potential observer bias
Relatively small sample size limits generalizability
Non-randomized design with participant self-selection introduces potential self-selection bias
Relatively short intervention period (8 weeks with twice-weekly sessions)
Participants were all experienced male marathon runners, limiting generalizability to novice runners or the general hypertensive population
Mechanistic biomarkers (e.g., nitric oxide, endothelin-1, VEGF) and indices of arterial stiffness were not measured
Absence of long-term follow-up
Echocardiographic assessments were not performed under blinded conditions

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Implication

BFR training was associated with improved cardiac structure and diastolic function in exercise-induced hypertension runners; hypothesis-generating and requires RCTs before practice change.

Abstract

Background/Objectives: Exercise-induced hypertension (EIH) in runners predisposes them to cardiovascular diseases, including myocardial hypertrophy, arrhythmias, and coronary artery disease. Blood flow restriction (BFR) training has been reported to exert non-pharmacological benefits in runners with EIH by improving blood pressure, myocardial workload, and cardiorespiratory fitness. The purpose of this study was to investigate whether changes in myocardial structure and function accompany these effects of BFR training in middle-aged runners with EIH. Methods: Participants who exhibited a maximal systolic blood pressure of ≥210 mmHg during an exercise stress test were assigned either to a BFR training group (BFRTg, n = 15) or to a control group without BFR training (non-BFRTg, n = 14). The BFRTg underwent a two-month BFR training program, performed twice per week for 20 min per session. Cardiac structure and function were evaluated before and after the intervention, and exercise stress test data were obtained from secondary sources of a previous study. Results: Compared with controls, the BFR group showed lower maximal exercise SBP, longer exercise duration, and higher VO2max. Echocardiography revealed reduced interventricular septal thickness and improved diastolic indices (higher E′/A′, lower E/E′), while systolic function remained unchanged. Conclusions: In conclusion, reductions in septal thickness and improvements in diastolic function induced by blood flow restriction training in runners with exercise-induced hypertension suggest a favorable cardiac adaptation, accompanied by concurrent improvements in exercise blood pressure and cardiorespiratory fitness.

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Cite This Study

Kim et al. (2025) studied Exercise-induced hypertension (EIH) in runners (n=29). Blood flow restriction (BFR) training vs. Control group without BFR training (non-BFRTg) was evaluated on Left ventricular interventricular septal thickness at end-diastole (LVIVSd, cm) (p=0.009). Blood flow restriction training reduced interventricular septal thickness (0.96 to 0.92 cm; p=0.009) and E/E' ratio (9.6 to 8.3; p=0.005) in runners with exercise-induced hypertension.

synapsesocial.com/papers/6a7316e26616758592c22e24 https://doi.org/10.3390/jcm14217795

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Blood Flow Restriction Training Improves Cardiac Structure and Diastolic Function in Runners with Exercise-Induced Hypertension

Figures

Key Points

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Blood Flow Restriction Training Improves Cardiac Structure and Diastolic Function in Runners with Exercise-Induced Hypertension

Figures

Key Points

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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