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Acute Inflammatory Responses to Blood Flow Restriction Training: A Systematic Review
Sarah Barawi1, Kevin Happ2, Michael Behringer2
1Department of Sports Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany. barawi@sport.uni-frankfurt.de.
Background:
The effects of Blood Flow Restriction (BFR) training are well-established, but its impact on the inflammatory response remains unclear. This systematic review evaluates whether BFR training induces acute inflammation by analyzing changes in inflammatory parameters.
Methods:
This review was conducted according to PRISMA guidelines. The literature search was performed across PubMed, Web of Science, BISp-Surf and Google Scholar up to July 2025. Studies were included if they reported acute changes in inflammatory markers within 72 h after BFR training, as well as macrophage presence up to 14 days. Only trials involving healthy adults with inflammatory parameters assessed via peripheral blood or muscle biopsy were considered. Risk of bias was assessed using RoB 2 and ROBINS-I. Standardized mean differences (SMDs) were calculated to quantify within-study changes. In addition, relative percentage changes were calculated to enable a comparison of the magnitude of inflammatory responses across studies. An effect direction plot was created to summarize the direction of inflammatory marker changes (SWiM 2020).
Results:
Nine studies involving 189 healthy adults were included in the systematic review. Transient increases in total leukocytes (18-33%) and lymphocytes (37-43%) were consistently observed in peripheral blood following exercise. Significant increases in total tissue macrophages (200%) were also reported. Findings on neutrophils (up to + 40%), cytokines (up to + 340%), and lymphocyte subpopulations (TCD4⁺: +25%, TCD8⁺: +39%) varied across studies.
Conclusion:
The findings suggest that BFR training induces acute inflammation, characterized by transient leukocytosis, lymphocytosis, and increased macrophage activity. However, the variability in neutrophil and cytokine responses, as well as in lymphocyte subsets, may be attributed to variations in training parameters and methodological approaches. Overall, these responses appear comparable to those observed following high-load resistance training (HL-RT). Further research is needed to clarify the underlying mechanisms and their potential contribution to muscle adaptation.
