Evaluating the effectiveness of blood flow restriction training in older adults: An overview of systematic reviews

Objective. To synthesize evidence from systematic reviews on the effects of blood flow restriction (BFR) training on muscle strength, hypertrophy, and functional performance in older adults.

Methods. An umbrella review was conducted after a comprehensive search in PubMed, Scopus, SPORTDiscus, and Web of Science until June 17, 2025. Eligible studies were systematic reviews, with or without meta-analyses, examining low-load BFR training in adults aged ≥ 50 years. Outcomes included muscle strength, hypertrophy, and physical function. Study selection and data extraction were performed independently by two reviewers, and methodological quality was assessed using AMSTAR 2.

Results. Twenty-three systematic reviews comprising 53 unique trials were included. Meta-analyses consistently indicated that BFR training promotes hypertrophy comparable to high-load resistance training (HL-RT) and superior to low-load training without BFR. Evidence on strength is mixed: some meta-analyses found gains similar to HL-RT, others reported inferior or superior results. Nevertheless, the majority of evidence suggests that BFR provides greater strength improvements compared to low-load training without BFR. Findings on functional performance were inconsistent. All reviews were rated as low or critically low in methodological quality. Across comparisons, heterogeneity and recurring methodological limitations-such as inadequate blinding and allocation concealment-were noted in primary studies.

Conclusion. BFR training is a promising approach to enhance muscle strength and hypertrophy in older adults, but evidence certainty is limited by methodological weaknesses in both trials and reviews. Well-designed, high-quality studies are needed to confirm these effects and support clinical implementation.