Effect of blood flow restricted walking on cardiovascular fitness, muscular development, and functional performance in adults: A systematic review with meta-analysis

Increasing evidence from randomised controlled trials demonstrates blood flow restriction (BFR) improves walking intervention outcomes compared to walking without BFR. This systematic review and meta-analysis examined the effects of BFR walking interventions on cardiovascular fitness, muscle strength and hypertrophy, and functional performance in adults, and moderators of age, health status, training volume and intensity. Six databases were systematically searched following PRISMA guidelines, up to April 2025. Studies were eligible if participants were ≥ 18 years, included randomised controlled trials with BFR walking interventions ≥ 12 sessions and ≥10 min/session, at least one measure of cardiovascular fitness, muscular strength, muscular hypertrophy, functional performance, and a non-BFR walking control group. Twelve studies met inclusion criteria. BFR walking improved cardiovascular fitness (g = 0.31, CI95%: 0.05 to 0.59), lower-limb muscular strength (g = 0.32, CI95%: 0.06 to 0.57), hypertrophy (g = 0.26, CI95%: 0.01 to 0.51), and functional performance (g = 0.57, CI95%: 0.21 to 0.92) compared to non-BFR walking. BFR walking improves physiological adaptations and functional performance compared to non-BFR walking, without additional workload. This may benefit load-compromised individuals such as older or clinical populations. More evidence is needed to develop specific prescription guidelines for BFR walking. Practitioners should adhere to current guidelines for prescribing BFR with aerobic exercise.Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024494720.