Blood flow-restricted resistance exercise (BFR-RE) is increasingly applied to promote muscle hypertrophy and strength development with relatively low external loads, which has led to growing interest in its use in clinical and rehabilitation settings. 

However, concerns about potential cardiovascular responses during exercise have prompted closer evaluation of its hemodynamic effects. A systematic review and meta-analysis published in BMJ Open Sport & Exercise Medicine examined acute cardiovascular responses during low-intensity BFR-RE (LI-BFR) compared with low-intensity resistance exercise (LI-RE) and high-intensity resistance exercise (HI-RE).

Literature searches were conducted in MEDLINE, EMBASE, ResearchGate, Web of Science, and Cochrane Library through February 2025. Randomized controlled trials assessing systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) during LI-BFR compared with LI-RE and/or HI-RE in healthy adults were considered eligible. Four trials comparing LI-BFR with LI-RE (n = 86) and three trials comparing LI-BFR with HI-RE (n = 46) were identified, with six reports included in random-effects meta-analyses adjusted for muscle group and age.

Relative to LI-RE, LI-BFR was associated with significantly higher SBP (mean difference [MD] 14.06 mm Hg; 95% CI 0.24-27.90) and DBP (MD 11.18 mm Hg; 95% CI 2.8-19.57), whereas differences in HR were not statistically significant (MD 6.00 bpm; 95% CI −5.47 to 17.5). When LI-BFR was compared with HI-RE, no significant differences were observed for SBP (MD 0.53 mm Hg; 95% CI −15.21 to 16.28), DBP (MD 2.54 mm Hg; 95% CI −5.59 to 10.67), or HR (MD −5.90 bpm; 95% CI −12.55 to 0.74).

Overall, arterial blood pressure during exercise was higher with LI-BFR than with LI-RE. The certainty of evidence ranged from low to moderate, and additional research measuring real-time hemodynamic parameters during BFR-RE was recommended.