Blood Flow Restriction Training in Seniors: An Alternative to High-Load Resistance Training

Background: High-load resistance training is the primary intervention to counteract sarcopenia; however, it may be contraindicated or poorly tolerated in some older adults. Low-load resistance training with blood flow restriction (LL-BFR) has been proposed as an option for these individuals. This review compared LL-BFR with high-load resistance training in older adults. Methods: The review followed the PRISMA 2020 and SWiM guidelines. PubMed, Web of Science, Scopus, and EBSCOhost were searched for controlled trials (sample mean age ≥ 60 years) with an intervention lasting ≥4 weeks and a parallel high-load arm (≥60% 1RM). Risk of bias was assessed with RoB 2, study-level effects were expressed as Hedges' g without statistical pooling, and the certainty of evidence was rated using GRADE. Results: Nine randomized trials (n = 198) were included. For dynamic maximal strength, the point estimates available from four trials were in the direction of high-load training (g 0.04 to 1.14), but confidence intervals were wide, and only one excluded no difference; isometric and isokinetic estimates were inconsistent in direction (g -0.77 to 0.79). For muscle mass and cross-sectional area, study-level estimates ranged from -0.15 to 0.42, and all confidence intervals included no difference. The BFR dose was incompletely reported in four trials. The certainty of evidence was low for muscle mass and very low for strength and functional outcomes; these ratings are upper bounds, because publication bias could not be assessed. Conclusions: No clear difference between LL-BFR and high-load training was observed for muscle mass, whereas dynamic strength outcomes tended to favor high-load training; these data do not establish equivalence. LL-BFR may be considered cautiously when high loads are unsuitable, although no included trial enrolled individuals in whom high-load training was contraindicated. Registration: PROSPERO CRD420261484121.