Journal of exercise science and fitness · 2026
Comparative effects of aerobic training modalities with and without blood flow restriction on maximal and peak oxygen uptake in adults: A systematic review and network meta-analysis.
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Chen Hangxin, Xu Feng, Fan Ziqi, Liu Yangyang, Gao Dongxu
Аннотация
BACKGROUND: Maximal oxygen uptake (VO2max) and peak oxygen uptake (VO2peak) 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 VO2max/VO2peak 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 VO2max/VO2peak 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 VO2max or VO2peak. 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 1042 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 VO2max/VO2peak 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.
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 VO2max or VO2peak. 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 1042 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 VO2max/VO2peak 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.