Acute effects of aerobic exercise with blood flow restriction on blood pressure: a systematic review
DOI:
https://doi.org/10.47197/retos.v76.118320Keywords:
blood pressure, randomized clinical trial, blood flow restriction therapy, exercise, systematic reviewAbstract
Introduction: The acute effects of aerobic exercise with blood flow restriction (AE+BFR) on systolic, diastolic, and mean blood pressure remain scarce and inconsistent in the literature.
Objective: To systematically review the acute effects of AE+BFR on systolic (SBP), diastolic (DBP), and mean blood pressure (MBP) in adults and older adults.
Methods: Searches were conducted in October 2025 in PubMed, EMBASE, Cochrane Library, LILACS, Scopus, and gray literature. Randomized controlled trials comparing the acute effects of a single session of AE+BFR with conventional aerobic exercise (AE-C) on blood pressure were included. Two independent reviewers performed study selection, data extraction, and assessment of risk of bias (RoB 2) and certainty of evidence (GRADE).
Results: Eight studies, totaling 130 participants, were included. The qualitative synthesis indicated that seven studies found no differences in SBP, DBP, or MBP after AE+BFR compared with AE-C. One study reported an increase in DBP immediately after AE+BFR (79.23 ± 10.56 vs. 69.69 ± 8.79 mmHg; p = 0.001). All studies showed some concerns regarding risk of bias, and the certainty of evidence was rated as very low for all three outcomes.
Conclusions: Most studies indicate that AE+BFR does not acutely change SBP, DBP, or MBP compared with conventional aerobic exercise. However, the small number of studies, heterogeneity of protocols, and very low certainty of evidence suggest that the findings should be interpreted with caution.
References
Abe, T., Kearns, C. F., Fihlho, H. C. M., Sato, Y., & McKeever, K. H. (2006). Muscle, tendon, and somatotropin responses to the restriction of muscle blood flow induced by KAATSU-walk training. Equine Veterinary Journal, 36, 345–348. https://doi.org/10.1111/j.2042-3306.2006.tb05566.x
Barili, A., Corralo, V. S., Cardoso, A. M., Mânica, A., Bonadiman, B. S. R., Bagatini, M. D., Grigoletto, M.E.S., Oliveira, G.G., & De Sá, C.A. (2018). Acute responses of hemodynamic and oxidative stress parameters to aerobic exercise with blood flow restriction in hypertensive elderly women. Molecular Biology Reports, 45(6), 1099–1109. https://doi.org/10.1007/s11033-018-4261-1
Barroso, W.K.S., Rodrigues, C.I.S, Bortolotto, L.A., Gomes, M.A.M., Brandão, A.A., Feitosa, A.D.M., Machado, C.A., Poli-de-Figueiredo, C.E., Amodeo, C., Mion Júnior, D., Barbosa, E.C.D., Nobre, F., Guimarães, I.C.B., Vilela-Martin, J.F., Yugar-Toledo, J.C., Magalhães, M.E.C., Neves, M.F.T., Jardim, P.C.B.V., Miranda, R.D., ... Nadruz, W. (2020). Diretrizes Brasileiras de Hipertensão Arterial – 2020. Arquivos Brasileiros de Cardiologia, 1-138. https://doi.org/10.36660/abc.20201238
Cirilo-Sousa, M. S., Araújo, J., Freitas, E., Ancieto, R. R., Araújo, V. C., Pereira, P. M. G., Júnior, A.T.A., Souza, T.S.P., Batista, G.R., & Neto, G.R. (2017). Acute effect of aerobic exercise with blood flow restriction on blood pressure and heart rate in healthy young subjects. Motricidade, 13(1), 17–24. https://doi.org/10.6063/motricidade.12874
Clarkson, M. J., Brumby, C., Fraser, S. F., McMahon, L. P., Bennett, P. N., & Warmington, S. A. (2020). Hemodynamic and perceptual responses to blood flow-restricted exercise among patients undergoing dialysis. American Journal of Physiology-Renal Physiology, 318(5), F843–F850. https://doi.org/10.1152/ajprenal.00576.2019
Cortes-Chacón, J., Chávez, G. E. M., Olivares, L. A. F., Peña-Vázquez, O., Quintana-Mendias, E., Hernandez, N. C., & Enriquez-del Castillo, L. A. (2025). Efectividad de los protocolos de ejercicio en adultos con hipertensión: metaanálisis actualizado de ensayos clínicos. Retos, 70, 517-532. https://doi.org/10.47197/retos.v70.113302
Ferreira, M. L. V., Sardeli, A. V., Souza, G. V., Bonganha, V., Santos, L. C., Castro, A., Cavaglieri, C.R., & Chacon-Mikahil, M.P.T. (2017). Cardiac autonomic and haemodynamic recovery after a single session of aerobic exercise with and without blood flow restriction in older adults. Journal of Sports Sciences, 35(24), 2412–2420. https://doi.org/10.1080/02640414.2016.1271139
Ferreira S.A., Gualberto P.I.B., Deresz L.F., Brito, C. J., Santos, D. A. & Queiroz A.C.C. (2025). Acute Effect of Aerobic Exercise with Blood Flow Restriction on Blood Pressure: a Systematic Review of Randomized Clinical ”, Mendeley Data, v1, doi: 10.17632/24w4r6mzgy.1
Formiga, M. F., Fay, R., Hutchinson, S., Locandro, N., Ceballos, A., Lesh, A., Buscheck, J., Meanor, J., Owens, J. G., & Cahalin, L. P. (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. International journal of sports physical therapy, 15(2), 175. https://doi.org/10.26603/ijspt20200175
Garber, C.E., Blissmer, B., Deschenes, M.R., Franklin, B.A., Lamonte, M.J., Lee, I.M., Nieman, D.C., & Swain, D.P. (2011). Quantity and Quality of Exercise for Developing and Maintaining Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise. Medicine & Science in Sports & Exercise, 43(7), 1334–1359. https://doi.org/10.1249/MSS.0b013e318213fefb
Heffernan, K. S., Kelly, E. E., Collier, S. R., & Fernhall, B. (2005). Cardiac autonomic modulation during recovery from acute endurance versus resistance exercise. European Journal of Cardiovascular Prevention and Rehabilitation, 13(1), 80–86. https://doi.org/10.1097/01.hjr.0000197470.74070.46
Higgins J.P.T., Green S., Ben Van Den, A. (2020). Cochrane Handbook for Systematic Reviews of Interventions. Int Coach Psychol Rev, 15(2), 123–125. https://doi.org/10.53841/bpsicpr.2020.15.2.123
Jensen, M. T., Suadicani, P., Hein, H. O., & Gyntelberg, F. (2013). Elevated resting heart rate, physical fitness and all-cause mortality: A 16-year follow-up in the Copenhagen Male Study. Heart, 99, 882–887. https://doi.org/10.1136/heartjnl-2012-303375
Karabulut M., & Garcia S.D. (2018). Hemodynamic responses and energy expenditure during blood flow restriction exercise in obese population. Clinical Physiology and Functional Imaging, 37, 1–7. https://doi.org/10.1111/cpf.12258
Keller-Ross, M. L., Sarkinen, A. L., Chantigian, D. P., Cross, T. J., Johnson, B. D., & Olson, T. P. (2019). Interaction of hypoxia and vascular occlusion on cardiorespiratory responses during exercise. Translational Sports Medicine, 2, 64–72. https://doi.org/10.1002/tsm2.60
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
Mahoney, S. J., Dicks, N. D., Lyman, K. J., Christensen, B. K., & Hackney, K. J. (2019). Acute cardiovascular, metabolic, and muscular responses to blood flow restricted rowing exercise. Aerospace Medicine and Human Performance, 90(5), 440–446. https://doi.org/10.3357/AMHP.5258.2019
Manica, A., De Sá, C. A., Barili, A., Corralo, V. S., Bonadiman, B. S., Oliveira, G. G., Bagatini, M.D., & Cardoso, A,M. (2020). Exercise with blood flow restriction as a new tool for health improvement in hypertensive elderly women: The role of purinergic enzymes. Journal of Sports Medicine and Physical Fitness, 60(10), 1477–1485. https://doi.org/10.23736/S0022-4707.20.10956-3
Motin, C. (2019). Efeitos hemodinâmicos pós-exercícios de uma sessão de caminhada com e sem oclusão vascular [Dissertação de mestrado, Universidade Estadual de Ponta Grossa]. https://tede2.uepg.br/jspui/bitstream/prefix/3026/1/Cleverson Motin.pdf
Murad M.H., Mustafa R.A., Schünemann H.J., Sultan S., & Santesso N. (2017). Rating the certainty in evidence in the absence of a single estimate of effect. BMJ Evidence-Based Medicine, 22(3), 85-87. https://doi.org/10.1136/ebmed-2017-110668
Namboonlue, S., Tongterm, T., Phannikul, T., La-bantao, K., Buttichak, A., Thangtong, P. & Namboonlue, C. (2026). Effects of aerobic exercise with blood flow restriction on aerobic capacity and hemoglobin in male university athletes. Retos, 76, 142-153. https://doi.org/10.47197/retos.v76.118470
Netto, E.R., Silva, M.G., Costa, M.W.B., Gualberto, P.I.B., Júnior, N.D.S., Santos, D.A., Forjaz, C.L.M., Queiroz, A.C.C (2025). Comparação das respostas cardiovasculares clínicas e ambulatoriais após uma sessão de caminhada com e sem restrição de fluxo sanguíneo em idosos hipertensos. Cuadernos de Educación y Desarrollo, 17(3), 1-22. https://doi.org/10.55905/cuadv17n3-071
Okuno, N. M., Pedro, R. E., Leicht, A. S., Ramos, S. P., & Nakamura, F. Y. (2014). Cardiac autonomic recovery after a single session of resistance exercise with and without vascular occlusion. Journal of Strength and Conditioning Research, 28(4), 1143–1150. https://doi.org/10.1519/JSC.0000000000000245
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 and Medicine, 9(2), 224–230. https://pubmed.ncbi.nlm.nih.gov/24149689/
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I, Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J.M., Akl, E.A., Brennan, S.E., Chou, R., Granville, J., Grimshaw, J.M., Hróbjartsson, A., Lalu, M.M., Li, T., Loder, E.W., Mayo-Wilson, E., McDonald, S., ... Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Pimenta F.C., Montrezol, F.T., Dourado, V.Z., Silva, L.F.M., Borba, G.A., Vieira, W.O., & Medeiros, A. (2019). High-intensity interval exercise promotes post-exercise hypotension of greater magnitude compared to moderate-intensity continuous exercise. European Journal of Applied Physiology, 119(5), 1235–1243. https://doi.org/10.1007/s00421-019-04114-9
Renzi, C. P., Tanaka, H., & Sugawara, J. (2010). Effects of leg blood flow restriction during walking on cardiovascular function. Medicine & Science in Sports & Exercise, 42(4), 726–732. https://doi.org/10.1249/MSS.0b013e3181bdb454
Rolnick, N., & Schoenfeld, B. J. (2020). Can Blood Flow Restriction Used During Aerobic Training Enhance Body Composition in Physique Athletes? Strength & Conditioning Journal, 42(5), 37–47. https://doi.org/10.1519/SSC.0000000000000585
Silva, J. C. G., Alves, E., Neto, P., & Bittar, S. T. (2018). Effect of interval and continuous aerobic exercise with and without restriction of blood flow on post-exercise blood pressure. Motricidade, 14(S1), 89–96.
Silva, J.C.G., Pereira Neto, E.A., Pfeiffer, P.A.S., Neto, G.R., Rodrigues, A.S., Bemben, M.G., Patterson, S.D., Batista, G.R., & Cirilo-Sousa M.S. (2019). Acute and Chronic Responses of Aerobic Exercise With Blood Flow Restriction: A Systematic Review. Frontiers in Physiology, 10, 1–16. https://doi.org/10.3389/fphys.2019.01239
Sprick, J. D., & Rickards, C. A. (2017). Combining remote ischemic preconditioning and aerobic exercise: A novel adaptation of blood flow restriction exercise. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 313(5), R497–R506. https://doi.org/10.1152/ajpregu.00111.2017
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(8), R732–R739. https://doi.org/10.1152/ajpregu.00095.2015
Thomas, H. J., Scott, B. R., & Peiffer, J. J. (2018). Acute physiological responses to low-intensity blood flow restriction cycling. Journal of Science and Medicine in Sport, 21, 969–974. https://doi.org/10.1016/j.jsams.2018.01.013
Thompson, K. M., Gamble, A. S., Coates, A. M., & Burr, J. F. (2024). Impact of blood flow restriction exercise on central hemodynamics and fluid regulating hormones. Medicine & Science in Sports & Exercise, 56, 362–369. https://doi.org/10.1249/mss.0000000000003307
Walden T.P., Girard O., Scott B.R., Jonson A.M., & Peiffer J.J. (2022). Does the application of blood flow restriction during walking exercise influence the accuracy of indirect calorimetry? Journal of Science and Medicine in Sport, 25, 673–677. https://doi.org/10.1016/j.jsams.2022.04.006
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