Frontiers in Physiology · Oct 30, 2026
Acute responses and chronic effects of blood flow restriction training on bone-related outcomes: a systematic review and multilevel meta-analysis
By Hao Hu, Yang Jiang, Hao Peng
ObjectiveTo evaluate the effects of blood flow restriction training (BFRT) on bone-related outcomes by distinguishing outcome domains, comparator structures, and acute versus chronic responses.MethodsRandomized controlled trials investigating BFRT and bone-related outcomes were searched across nine databases from inception to September 1, 2026. Risk of bias, methodological quality, and certainty of evidence were evaluated with RoB 2, TESTEX, and GRADE. Three-level meta-analysis modeled clustering of multiple effect sizes within studies.ResultsTwenty-two reports were included. BFRT was associated with a small positive BMD effect (SMD = 0.20, 95% CI 0.08 to 0.32, p < 0.01) and an exploratory positive pooled estimate across heterogeneous bone-related regulatory biomarkers (SMD = 0.73, 95% CI 0.28 to 1.19, p < 0.01); the prediction interval for the latter included no effect. No clear pooled effects were observed for acute or chronic bone turnover markers. Study-level moderator findings were exploratory.ConclusionBFRT may modestly improve BMD under some conditions, but evidence is insufficient to infer fracture prevention or long-term clinical benefit. Regulatory biomarkers differ in function and timing, and their pooled response does not demonstrate increased bone formation. Benefits relative to conventional high-load training remain uncertain. Larger trials with standardized BFRT protocols and clinically relevant skeletal outcomes are needed.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251101440.