The effect of blood flow restriction in chronic obstructive pulmonary disease: A systematic review and meta-analysis

ObjectiveTo evaluate the efficacy and safety of blood flow restriction (BFR) training on exercise capacity, muscle strength, pulmonary function, and fatigue in individuals with chronic obstructive pulmonary disease (COPD).MethodsA comprehensive search was conducted in six databases up to April 2025. Randomized controlled trials involving adults with COPD undergoing BFR training were included. Methodological quality was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of evidence was graded according to Grading of Recommendations Assessment, Development and Evaluation guidelines.ResultsOf 573 records identified, three randomized clinical trials with a total of 127 participants met the inclusion criteria. Intervention durations ranged from 2 to 24 weeks with varying occlusion pressures and outcome measures. Meta-analysis showed no significant improvements in six-minute walk distance (mean difference: 20.83; 95% CI [-14.97 to 56.63]; very low certainty), or muscle strength (SMD: 0.78; 95% CI [-0.66 to 2.22]; very low certainty). A significant reduction in fatigue was observed (SMD: -0.48; 95% CI [-0.92 to -0.04]; very low certainty). Overall, the quality of evidence was rated very low.ConclusionCurrent evidence is insufficient to draw firm conclusions regarding the efficacy and safety of BFR training in COPD. Further high-quality, standardized RCTs are necessary to clarify its clinical utility and safety.