The effects of resistance exercise with blood flow restriction on muscle performance, muscle mass, and function in older adults: a systematic review

Blood flow restriction resistance exercise is emerging as a promising strategy for older adults who are unable to perform high intensity resistance exercise. The purpose of this systematic review was to evaluate the effects of blood flow restriction resistance exercise on muscle performance, muscle mass, and function in healthy older adults.

A systematic literature review was conducted in the PubMed, Cochrane Central, PEDro, and ScienceDirect databases. Randomized controlled trials published in English up to May 2026 were included. Eligible studies involved healthy older adults (mean age ≥ 60 years) and compared blood flow restriction resistance exercise with low intensity resistance exercise, high intensity resistance exercise, or non-exercise control group. Six studies were included in the analysis, comprising 197 participants. Due to heterogeneity of outcome measures and intervention protocols, results were synthesized descriptively. The methodological quality of the included studies was assessed using the PEDro scale, and the risk of bias was evaluated using the Cochrane Risk of Bias tool for randomized controlled trials (RoB 2.0).

Blood flow restriction resistance exercise may improve lower-limb muscle strength and cross-sectional area, particularly of the quadriceps femoris muscle, with effects comparable to traditional high intensity resistance exercise. One-repetition maximum increased by 15.6-54%, and quadriceps femoris cross-sectional area increased by 3.23-4.2 cm². Limited data were available for functional outcomes but suggested potential benefits. No adverse side effects were reported. None of the included studies was judged to be at overall low risk of bias.

Despite methodological limitations, small sample sizes, and heterogeneity of exercise protocols, blood flow restriction resistance exercise appears to be a safe and effective alternative for improving lower-limb muscle strength and muscle mass in healthy older adults. Certainty of evidence is limited by risk of bias and the small number of available studies. Future research should investigate long-term and upper-limb effects and standardized exercise protocols to support the development of clinical guidelines. This research was financially supported by the Slovenian Research and Innovation Agency (KINSPO, P5-0443; grant No. 58589), and the review was not prospectively registered.