This is an early access version
Blood flow restriction endurance exercise and endurance performance in athletes
,
Matevž Arčon
Kinesiology, Faculty of Health Sciences, University of Primorska , Koper , Slovenia
Nejc Črnčič
Contact Nejc Črnčič
Kinesiology, Faculty of Health Sciences, University of Primorska , Koper , Slovenia
Abstract
The development and advancement of sports training over time have been accompanied by continuous innovations, which significantly contribute to improving athletic performance. In this process, research has played a crucial role in understanding the effectiveness of various training methods, including blood flow restriction (BFR) exercise, which is increasingly gaining attention due to its potential to enhance athletic performance. BFR training can be implemented in both: resistance exercise and endurance exercise. The studies discussed indicate a growing interest in the application of BFR through endurance type of exercise to enhance aerobic capacity.
This narrative review examined the role of BFR training in enhancing endurance performance by reviewing relevant literature. We performed a comprehensive search on PubMed and Google Scholar using keywords such as “Blood Flow Restriction”, “endurance exercise”, “aerobic capacity”, and “athletes”. The focus was on peer-reviewed articles published in the last decade that investigated the effects of BFR training on endurance and aerobic capacity, specifically within athletic populations. Studies included in this review were selected based on their relevance to BFR training and its impact on endurance performance, while those not directly related to BFR or involving non-athlete populations were excluded. Key findings concerning BFR training protocols and their impact on endurance metrics were summarized. This review aims to provide an overview of the current evidence regarding the effectiveness of BFR training in endurance exercise and its potential implications for optimizing athletic performance.
These investigations adopting BFR training show promising results, with several studies reporting significant improvements in key physiological parameters such as maximal oxygen consumption (VO2 max) and muscular endurance.
Overall evidence suggests that integrating BFR training into endurance exercise training regimens holds potential for optimizing aerobic capacity in athletes.
How to cite:
Arčon, M., and Črnčič, N. Blood flow restriction endurance exercise and endurance performance in athletes. Exercise and Quality of Life. Advance online publication. https://doi.org/10.31382/preprint.000005
Keywords
References
Abe, T., Fujita, S., Nakajima, T., Sakamaki, M., Ozaki, H., & Ogasawara, R. (2010). Effects of low-intensity cycle training with restricted leg blood flow on thigh muscle volume and VO2MAX in young men. J Sports Sci Med, 9, 452–458.
Amani, A., Sadeghi, H., & Afsharnezhad, T. (2018). Interval training with blood flow restriction on aerobic performance among young soccer players at transition phase. Montenegrin J Sports Sci Med, 7.
Amani-Shalamzari, S., Sarikhani, A., Paton, C., Rajabi, H., Bayati, M., Nikolaidis, P. T., & Knechtle, B. (2020). Occlusion Training During Specific Futsal Training Improves Aspects of Physiological and Physical Performance. Journal of Sports Science & Medicine, 19(2), 374–382.
Amann, M., Sidhu, S. K., Weavil, J. C., Mangum, T. S., & Venturelli, M. (2014). Autonomic responses to exercise: Group III/IV muscle afferents and fatigue. Autonomic Neuroscience: Basic & Clinical, 184, 66–73. https://doi.org/10.1016/j.autneu.2014.10.007
Behrendt, T., Bielitzki, R., Behrens, M., & Schega, L. (2023). Acute performance, physiological, and perceptual changes in response to repeated cycling sprint exercise combined with systemic and local hypoxia in young males. Physiology & Behavior, 267, 114217. https://doi.org/10.1016/j.physbeh.2023.114217
Bourgeois, A. (2025). High-intensity interval training with blood-flow restriction enhances sprint and maximal aerobic power in male endurance athletes. Journal of Applied Physiology, 138(1), 44–53.
Buckner, S. L., Jessee, M. B., Dankel, S. J., Mattocks, K. T., Mouser, J. G., Bell, Z. W., Abe, T., & Loenneke, J. P. (2019). Acute skeletal muscle responses to very low‐load resistance exercise with and without the application of blood flow restriction in the upper body. Clinical Physiology and Functional Imaging, 39(3), 201–208. https://doi.org/10.1111/cpf.12557
Castilla-López, C., Molina-Mula, J., & Romero-Franco, N. (2022). Blood flow restriction during training for improving the aerobic capacity and sport performance of trained athletes: A systematic review and meta-analysis. Journal of Exercise Science & Fitness, 20(2), 190–197. https://doi.org/10.1016/j.jesf.2022.03.004
Centner, C., Wiegel, P., Gollhofer, A., & König, D. (2019). Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis. Sports Medicine, 49(1), 95–108. https://doi.org/10.1007/s40279-018-0994-1
Chen, Y.-T., Hsieh, Y.-Y., Ho, J.-Y., Ho, C.-C., Lin, T.-Y., & Lin, J.-C. (n.d.). Running interval training combined with blood flow restriction increases maximal running performance and muscular fitness in male runners. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-14253-3
Chua, M. T., Sim, A., & Burns, S. F. (2022). Acute and Chronic Effects of Blood Flow Restricted High-Intensity Interval Training: A Systematic Review. Sports Medicine - Open, 8(1). https://doi.org/10.1186/s40798-022-00506-y
Clarkson, M. J., Conway, L., & Warmington, S. A. (2017). Blood flow restriction walking and physical function in older adults: A randomized control trial. Journal of Science and Medicine in Sport, 20(12), 1041–1046. https://doi.org/10.1016/j.jsams.2017.04.012
CONCEIÇÃO, M. S., JUNIOR, E. M. M., TELLES, G. D., LIBARDI, C. A., CASTRO, A., ANDRADE, A. L. L., BRUM, P. C., URIAS, Ú., KURAUTI, M. A., JÚNIOR, J. M. C., BOSCHERO, A. C., CAVAGLIERI, C. R., CAMERA, D. M., & CHACON-MIKAHIL, M. P. T. (2019). Augmented Anabolic Responses after 8-wk Cycling with Blood Flow Restriction. Medicine & Science in Sports & Exercise, 51(1), 84–93. https://doi.org/10.1249/mss.0000000000001755
Cook, C. J., Kilduff, L. P., & Beaven, C. M. (2014). Improving Strength and Power in Trained Athletes With 3 Weeks of Occlusion Training. International Journal of Sports Physiology and Performance, 9(1), 166–172. https://doi.org/10.1123/ijspp.2013-0018
de Oliveira, M. F. M., Caputo, F., Corvino, R. B., & Denadai, B. S. (2016a). Short‐term low‐intensity blood flow restricted interval training improves both aerobic fitness and muscle strength. Scandinavian Journal of Medicine & Science in Sports, 26(9), 1017–1025. https://doi.org/10.1111/sms.12540
de Oliveira, M. F. M., Caputo, F., Corvino, R. B., & Denadai, B. S. (2016b). Short‐term low‐intensity blood flow restricted interval training improves both aerobic fitness and muscle strength. Scandinavian Journal of Medicine & Science in Sports, 26(9), 1017–1025. https://doi.org/10.1111/sms.12540
de Queiros, V. S., Rolnick, N., Sabag, A., Wilde, P., Peçanha, T., Aniceto, R. R., Rocha, R. F. C., Delgado, D. Z., Cabral, B. G. de A. T., & Dantas, P. M. S. (n.d.). Effect of High-Intensity Interval Exercise versus Continuous Low-Intensity Aerobic Exercise with Blood Flow Restriction on Psychophysiological Responses: A Randomized Crossover Study. Journal of Sports Science and Medicine, 114–125. https://doi.org/10.52082/jssm.2024.114
DH, G. R., AM, W., PM, R., CE, P., JE, L., & MS, S. (2024). Acute effects of sprint interval training and blood flow restriction on neuromuscular and muscle function. J Musculoskelet Neuronal Interact, 24, 38–46.
Doma, K., Leicht, A. S., Boullosa, D., & Woods, C. T. (2020). Lunge exercises with blood-flow restriction induces post-activation potentiation and improves vertical jump performance. European Journal of Applied Physiology, 120(3), 687–695. https://doi.org/10.1007/s00421-020-04308-6
Dong, K., Tang, J., Xu, C., Gui, W., Tian, J., Chun, B., Li, D., & Wang, L. (n.d.). The effects of blood flow restriction combined with endurance training on athletes’ aerobic capacity, lower limb muscle strength, anaerobic power and sports performance: a meta-analysis. BMC Sports Science, Medicine and Rehabilitation, 17(1). https://doi.org/10.1186/s13102-025-01072-y
Flewwelling, L. D., Hannaian, S. J., Cao, V., Chaillou, T., Churchward-Venne, T. A., & Cheng, A. J. (2025). What are the potential mechanisms of fatigue-induced skeletal muscle hypertrophy with low-load resistance exercise training? American Journal of Physiology-Cell Physiology, 328(3), C1001–C1014. https://doi.org/10.1152/ajpcell.00266.2024
Formiga, M. F., Fay, R., Hutchinson, S., Locandro, N., Ceballos, A., & Lesh, A. (2020). Effect of aerobic exercise training with and without blood flow restriction on aerobic capacity in healthy young adults: a systematic review with meta-analysis. Int J Sports Phys Ther, 15, 175–187.
Freitas, E., Poole, C., Miller, R., Heishman, A., Kaur, J., Bemben, D., & Bemben, M. (2017). Time Course Change in Muscle Swelling: High-Intensity vs. Blood Flow Restriction Exercise. International Journal of Sports Medicine, 38(13), 1009–1016. https://doi.org/10.1055/s-0043-118342
Held, S., Behringer, M., & Donath, L. (2020). Low intensity rowing with blood flow restriction over 5 weeks increases V̇O2max in elite rowers: A randomized controlled trial. Journal of Science and Medicine in Sport, 23(3), 304–308. https://doi.org/10.1016/j.jsams.2019.10.002
Held, S., Rappelt, L., Deutsch, J., Rein, R., Wiedenmann, T., Schiffer, A., Bieder, A., Staub, I., & Donath, L. (2023). Low‐intensity swimming with blood flow restriction over 5 weeks increases VO2peak: A randomized controlled trial using Bayesian informative prior distribution. European Journal of Sport Science, 23(8), 1622–1628. https://doi.org/10.1080/17461391.2023.2180671
Held, S., Rappelt, L., Rein, R., Wiedenmann, T., & Donath, L. (2023). Low‐intensity climbing with blood flow restriction over 5 weeks increases grip and elbow flexor endurance in advanced climbers: A randomized controlled trial. European Journal of Sport Science, 23(10), 2031–2037. https://doi.org/10.1080/17461391.2023.2207079
Hosseini Kakhak, S. A., Kianigul, M., Haghighi, A.-H., Nooghabi, M. J., & Scott, B. R. (2022). Performing Soccer-Specific Training With Blood Flow Restriction Enhances Physical Capacities in Youth Soccer Players. Journal of Strength and Conditioning Research, 36(7), 1972–1977. https://doi.org/10.1519/jsc.0000000000003737
Ilett, M. J., Rantalainen, T., Keske, M. A., May, A. K., & Warmington, S. A. (n.d.). The Effects of Restriction Pressures on the Acute Responses to Blood Flow Restriction Exercise. Frontiers in Physiology, 10. https://doi.org/10.3389/fphys.2019.01018
Karabulut, M., & Garcia, S. D. (2017). Hemodynamic responses and energy expenditure during blood flow restriction exercise in obese population. Clinical Physiology and Functional Imaging, 37(1), 1–7. https://doi.org/10.1111/cpf.12258
Kilgas, M. A., Yoon, T., McDaniel, J., Phillips, K. C., & Elmer, S. J. (n.d.). Physiological Responses to Acute Cycling With Blood Flow Restriction. Frontiers in Physiology, 13. https://doi.org/10.3389/fphys.2022.800155
Kumagai, K., Kurobe, K., Zhong, H., Loenneke, J., Thiebaud, R., Ogita, F., & Abe, T. (2012). Cardiovascular drift during low intensity exercise with leg blood flow restriction. Acta Physiologica Hungarica, 99(4), 392–399. https://doi.org/10.1556/aphysiol.99.2012.4.3
LI, R., CHEE, C. S., KAMALDEN, T. F., RAMLI, A. S., & YANG, K. (2023). Effects of blood flow restriction training on sports performance in athletes: a systematic review with meta-analysis. The Journal of Sports Medicine and Physical Fitness, 64(1). https://doi.org/10.23736/s0022-4707.23.15220-0
Lixandrão, M. E., Ugrinowitsch, C., Laurentino, G., Libardi, C. A., Aihara, A. Y., Cardoso, F. N., Tricoli, V., & Roschel, H. (2015). Effects of exercise intensity and occlusion pressure after 12 weeks of resistance training with blood-flow restriction. European Journal of Applied Physiology, 115(12), 2471–2480. https://doi.org/10.1007/s00421-015-3253-2
Loenneke, J. P., Fahs, C. A., Rossow, L. M., Abe, T., & Bemben, M. G. (2012). The anabolic benefits of venous blood flow restriction training may be induced by muscle cell swelling. Medical Hypotheses, 78(1), 151–154. https://doi.org/10.1016/j.mehy.2011.10.014
Loenneke, J. P., Thrower, A. D., Balapur, A., Barnes, J. T., & Pujol, T. J. (2011). The energy requirement of walking with restricted blood flow. Sport Science, 4(2), 7–11.
MCLAUGHLIN, J. E., HOWLEY, E. T., BASSETT, D. R., THOMPSON, D. L., & FITZHUGH, E. C. (2010). Test of the Classic Model for Predicting Endurance Running Performance. Medicine & Science in Sports & Exercise, 42(5), 991–997. https://doi.org/10.1249/mss.0b013e3181c0669d
Mendonca, G., Vaz, J., Pezarat-Correia, P., & Fernhall, B. (2015). Effects of Walking with Blood Flow Restriction on Excess Post-exercise Oxygen Consumption. International Journal of Sports Medicine, 36(03), e11–e18. https://doi.org/10.1055/s-0034-1395508
Ozaki, H., Brechue, W. F., Sakamaki, M., Yasuda, T., Nishikawa, M., Aoki, N., Ogita, F., & Abe, T. (2010). Metabolic and cardiovascular responses to upright cycle exercise with leg blood flow reduction. Journal of Sports Science & Medicine, 9(2), 224–230.
Pageaux, B. (2016). Perception of effort in Exercise Science: Definition, measurement and perspectives. European Journal of Sport Science, 16(8), 885–894. https://doi.org/10.1080/17461391.2016.1188992
Park, S., Kim, J. K., Choi, H. M., Kim, H. G., Beekley, M. D., & Nho, H. (2010). Increase in maximal oxygen uptake following 2-week walk training with blood flow occlusion in athletes. European Journal of Applied Physiology, 109(4), 591–600. https://doi.org/10.1007/s00421-010-1377-y
Paton, C. D., Addis, S. M., & Taylor, L.-A. (2017). The effects of muscle blood flow restriction during running training on measures of aerobic capacity and run time to exhaustion. European Journal of Applied Physiology, 117(12), 2579–2585. https://doi.org/10.1007/s00421-017-3745-3
Rolnick, N., & Schoenfeld, B. J. (2020). Blood Flow Restriction Training and the Physique Athlete: A Practical Research-Based Guide to Maximizing Muscle Size. Strength & Conditioning Journal, 42(5), 22–36. https://doi.org/10.1519/ssc.0000000000000553
Saraf, A., Goyal, M., & Goyal, K. (2022). Blood Flow Restriction Training-An Overview and Implication in New Generation Physical Therapy: A Narrative Review. Journal of Lifestyle Medicine, 12(2), 63–68. https://doi.org/10.15280/jlm.2022.12.2.63
Silva, J. C. G., Domingos-Gomes, J. R., Freitas, E. D. S., Neto, G. R., Aniceto, R. R., Bemben, M. G., Lima-dos-Santos, A., & Cirilo-Sousa, M. S. (2021). Physiological and Perceptual Responses to Aerobic Exercise With and Without Blood Flow Restriction. Journal of Strength and Conditioning Research, 35(9), 2479–2485. https://doi.org/10.1519/jsc.0000000000003178
Silva, J. C. G., Neto, E. P., Brittar, S. T., Domingos-Gomes, J. R., Neto, G. R., & Cirilo-Sousa, M. S. (2018). Effect of interval and continuous aerobic exercise with and without restriction of blood flow on post-exercise blood pressure. Motricidade, 14(S1), 89.
Slysz, J., Stultz, J., & Burr, J. F. (2016). The efficacy of blood flow restricted exercise: A systematic review & meta-analysis. Journal of Science and Medicine in Sport, 19(8), 669–675. https://doi.org/10.1016/j.jsams.2015.09.005
Sugawara, J., Tomoto, T., & Tanaka, H. (2015). Impact of leg blood flow restriction during walking on central arterial hemodynamics. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 309(7), R732–R739. https://doi.org/10.1152/ajpregu.00095.2015
SUGIMOTO, T., SUGA, T., TOMOO, K., DORA, K., MOK, E., TSUKAMOTO, H., TAKADA, S., HASHIMOTO, T., & ISAKA, T. (2021). Blood Flow Restriction Improves Executive Function after Walking. Medicine & Science in Sports & Exercise, 53(1), 131–138. https://doi.org/10.1249/mss.0000000000002446
Takarada, Y., Nakamura, Y., Aruga, S., Onda, T., Miyazaki, S., & Ishii, N. (2000). Rapid increase in plasma growth hormone after low-intensity resistance exercise with vascular occlusion. Journal of Applied Physiology, 88(1), 61–65. https://doi.org/10.1152/jappl.2000.88.1.61
TANGCHAISURIYA, P., CHUENSIRI, N., TANAKA, H., & SUKSOM, D. (2022). Physiological Adaptations to High-Intensity Interval Training Combined with Blood Flow Restriction in Masters Road Cyclists. Medicine & Science in Sports & Exercise, 54(5), 830–840. https://doi.org/10.1249/mss.0000000000002857
THOMPSON, K. M. A., PETHICK, W. A., CLARKE, J., WINEGARDEN, A., JOHNSON, E., COATES, A. M., STELLINGWERFF, T., & BURR, J. F. (2024). Blood Flow-Restricted Training and Time Trial Performance: A Cohort Study of World-Class Rowers. Medicine & Science in Sports & Exercise, 56(9), 1606–1614. https://doi.org/10.1249/mss.0000000000003459
Tranum-Jensen, J., Janse, M. J., Fiolet, W. T., Krieger, W. J., D’Alnoncourt, C. N., & Durrer, D. (1981). Tissue osmolality, cell swelling, and reperfusion in acute regional myocardial ischemia in the isolated porcine heart. Circulation Research, 49(2), 364–381. https://doi.org/10.1161/01.res.49.2.364
Wernbom, M., & Aagaard, P. (2020). Muscle fibre activation and fatigue with low‐load blood flow restricted resistance exercise—An integrative physiology review. Acta Physiologica, 228(1). https://doi.org/10.1111/apha.13302
Wilk, M., Krzysztofik, M., Gepfert, M., Poprzecki, S., Gołaś, A., & Maszczyk, A. (2018). Technical and Training Related Aspects of Resistance Training Using Blood Flow Restriction in Competitive Sport - A Review. Journal of Human Kinetics, 65(1), 249–260. https://doi.org/10.2478/hukin-2018-0101
Yanagisawa, O., & Fukutani, A. (2018). Effects of low-load resistance exercise with blood flow restriction on intramuscular hemodynamics, oxygenation level and water content. The Journal of Sports Medicine and Physical Fitness, 58(6). https://doi.org/10.23736/s0022-4707.17.07463-1
Yang, Y. (2024). Effects of blood flow restriction training on physical fitness among athletes: A systematic review and meta-analysis. Journal of Sports Science & Medicine, 23(2), 187–196.
Yin, J. (2025). Physiological adaptations and performance enhancement with combined blood flow restricted and interval training: A systematic review with meta-analysis. European Journal of Sport Science, 25(1), 88–104.
Citation
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Article metrics
Google scholar:
See link
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
