Comparative effects of aerobic training modalities with and without blood flow restriction on maximal and peak oxygen...

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.

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).

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.

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.