Key result
HIIT and low-intensity continuous training with blood flow restriction rank highest for improving VO2 max.
Why the study?
The comparative effects of blood flow restriction-based aerobic exercise strategies versus conventional aerobic exercise on VO2 max or VO2 peak remained uncertain across different exercise modalities and intensities.
Do aerobic training modalities with blood flow restriction improve maximal and peak oxygen uptake compared to conventional aerobic training in adults?
Meta-Analysis (n=1,042)
Do aerobic training modalities with blood flow restriction improve maximal and peak oxygen uptake compared to conventional aerobic training in adults?
Blood flow restriction combined with aerobic exercise, particularly high-intensity interval training or low-intensity continuous training, may be an effective strategy to improve cardiorespiratory fitness in adults.
May support BFR with HIIT or low-intensity training to enhance VO2 max; extends meta-analytic evidence for aerobic modalities in adults.
Background Maximal oxygen uptake (VO 2 max) and peak oxygen uptake (VO 2 peak) are key indicators of cardiorespiratory fitness. Blood flow restriction (BFR) training may augment the metabolic stimulus elicited by aerobic exercise (AE) across a range of exercise intensities in adults. However, the comparative effects of BFR-based AE strategies and conventional AE on VO 2 max/VO 2 peak remain uncertain. This network meta-analysis (NMA) compared the relative effects, at the group level, of BFR-based AE strategies and conventional exercise interventions on VO 2 max/VO 2 peak in adults across different exercise modalities, intensity levels, and comparator conditions, thereby providing a context-specific reference for understanding the potential effects of these exercise strategies on aerobic capacity. Methods Six databases (PubMed, Web of Science, Embase, Cochrane Library, Scopus, and SPORTDiscus) were searched through January 21, 2026 for randomized controlled trials involving adults and reporting VO 2 max or VO 2 peak. A Bayesian NMA was performed using the gemtc package in R v4.4.1. Relative effects were summarized with league tables, and intervention rankings were estimated using the surface under the cumulative ranking curve (SUCRA). Results Thirty-four studies including 1,042 participants were included. Overall, high-intensity interval training combined with BFR (HIIT+BFR), low-intensity continuous training combined with BFR (LICT+BFR), and moderate-intensity continuous training (MICT) ranked highest. Subgroup analyses showed that HIIT+BFR ranked highest in 4–6-week interventions, trained participants, and running-based protocols. LICT+BFR ranked highest in untrained participants, walking-based protocols, and low-to-moderate-intensity exercise. MICT ranked highest in 8–12-week interventions, male participants, cycling-based protocols, and trained participants. Low-intensity interval training alone showed a consistently low ranking. Conclusion At the group level, BFR combined with AE may improve VO 2 max/VO 2 peak in some intervention settings, while MICT remains an effective conventional training strategy. However, given the limited comparative evidence, these findings should be interpreted cautiously, and further high-quality studies are needed to inform protocol-specific recommendations.
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Chen et al. (2026) conducted a meta-analysis in Cardiorespiratory fitness (n=1,042). Aerobic training modalities with blood flow restriction (BFR) vs. Conventional aerobic exercise (e.g., moderate-intensity continuous training) was evaluated on Maximal oxygen uptake (VO2 max) and peak oxygen uptake (VO2 peak). High-intensity interval training and low-intensity continuous training combined with blood flow restriction ranked highest for improving VO2 max/VO2 peak across 34 studies and 1,042 participants.
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