Blood flow restriction training for lower-limb function, walking and functional recovery after stroke: a systematic review and meta-analysis
5 affiliations
- 1School of Integrated Traditional Chinese and Western Medicine, Hebei University of Chinese Medicine
- 2Hebei General Hospital
- 3School of Physical Education, Hebei Normal University
- 4Graduate School, Hebei Medical University
- 5School of Nursing and Rehabilitation, North China University of Science and Technology
Abstract
Background: Blood flow restriction training (BFRT) is increasingly used as a low-load rehabilitation strategy after stroke, but the magnitude, clinical relevance, and certainty of its effects remain uncertain. We evaluated the effects and safety of BFRT on lower-limb function and mobility after stroke.
Methods: PubMed, Embase, Web of Science Core Collection, CENTRAL, CNKI, Wanfang, VIP, and SinoMed were searched from inception to June 10, 2026. Randomized controlled trials evaluating lower-limb BFRT in adults after stroke were included. Risk of bias was assessed using RoB 2, certainty using GRADE, and random-effects meta-analyses were performed.
Results: Nineteen randomized controlled trials were included. BFRT improved Fugl-Meyer Assessment of the Lower Extremity scores (10 studies, 646 participants; MD = 2.14 points, 95% CI 0.74 to 3.54) and Berg Balance Scale scores (8 studies, 581 participants; MD = 4.72 points, 95% CI 1.62 to 7.82). The 10-meter walk test analysis showed higher walking speed (4 studies, 322 participants; MD = 0.14 m/s, 95% CI 0.03 to 0.25), but the estimate attenuated after eligible grey literature was included (6 studies, 410 participants; MD = 0.09 m/s, 95% CI − 0.03 to 0.21). Six-minute walk distance increased by 8.01 m (5 studies, 271 participants; 95% CI 2.31 to 13.71). No clear pooled effects were observed for Timed Up and Go, sit-to-stand performance, cadence, or standard full-scale Barthel Index/Modified Barthel Index scores. FMA-LE and 6MWT effects were below reported clinically important thresholds; the BBS estimate was close to an approximately 5-point reference, with its confidence interval spanning effects below and above that threshold. Certainty was moderate for 6MWT, low for FMA-LE, and very low for BBS and 10MWT walking speed. No BFRT-related serious adverse or thrombotic events were reported among studies with explicit safety information, although reporting was limited.
Conclusion: BFRT may improve selected lower-limb outcomes after stroke, but clinical importance remains uncertain for several outcomes and certainty ranges from moderate to very low. Better-designed trials with standardized BFRT protocols and more complete safety reporting are needed.
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261477739 , PROSPERO CRD420261477739.
Related
- Dose–response effects of robot-assisted training on poststroke functional recovery : A systematic review and meta-analysis
- Long-term effects of voice training and swallowing function exercises on postoperative functional recovery in laryngeal cancer patients: a retrospective cohort study.
- Effects of inspiratory or respiratory muscle training on respiratory function, perceived exertion, and exercise or functional performance in team-sport athletes: a systematic review and meta-analysis.
- Effects of respiratory muscle training on respiratory function, functional outcomes, and pulmonary complications in patients with stroke: a systematic review and meta-analysis of randomized controlled trials
- Effects of muscle strength training with blood flow restriction on glomerular function in people with stage 3 chronic kidney disease.
BibTeX
@article{kang2026blood,
title = {{Blood flow restriction training for lower-limb function, walking and functional recovery after stroke: a systematic review and meta-analysis}},
author = {Honghu Kang and Zhexuan Yan and Zhongrui Zhang and Yushan Xu and Wenjing Jiang and Zhongsheng Yang and Qian Zhang and Yu Yin},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1987031},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1987031/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Blood flow restriction training for lower-limb function, walking and functional recovery after stroke: a systematic review and meta-analysis
AU - Honghu Kang
AU - Zhexuan Yan
AU - Zhongrui Zhang
AU - Yushan Xu
AU - Wenjing Jiang
AU - Zhongsheng Yang
AU - Qian Zhang
AU - Yu Yin
PY - 2026
DA - 2026/10/26
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1987031
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1987031/full
AB - Background: Blood flow restriction training (BFRT) is increasingly used as a low-load rehabilitation strategy after stroke, but the magnitude, clinical relevance, and certainty of its effects remain uncertain. We evaluated the effects and safety of BFRT on lower-limb function and mobility after stroke. Methods: PubMed, Embase, Web of Science Core Collection, CENTRAL, CNKI, Wanfang, VIP, and SinoMed were searched from inception to June 10, 2026. Randomized controlled trials evaluating lower-limb BFRT in adults after stroke were included. Risk of bias was assessed using RoB 2, certainty using GRADE, and random-effects meta-analyses were performed. Results: Nineteen randomized controlled trials were included. BFRT improved Fugl-Meyer Assessment of the Lower Extremity scores (10 studies, 646 participants; MD = 2.14 points, 95% CI 0.74 to 3.54) and Berg Balance Scale scores (8 studies, 581 participants; MD = 4.72 points, 95% CI 1.62 to 7.82). The 10-meter walk test analysis showed higher walking speed (4 studies, 322 participants; MD = 0.14 m/s, 95% CI 0.03 to 0.25), but the estimate attenuated after eligible grey literature was included (6 studies, 410 participants; MD = 0.09 m/s, 95% CI − 0.03 to 0.21). Six-minute walk distance increased by 8.01 m (5 studies, 271 participants; 95% CI 2.31 to 13.71). No clear pooled effects were observed for Timed Up and Go, sit-to-stand performance, cadence, or standard full-scale Barthel Index/Modified Barthel Index scores. FMA-LE and 6MWT effects were below reported clinically important thresholds; the BBS estimate was close to an approximately 5-point reference, with its confidence interval spanning effects below and above that threshold. Certainty was moderate for 6MWT, low for FMA-LE, and very low for BBS and 10MWT walking speed. No BFRT-related serious adverse or thrombotic events were reported among studies with explicit safety information, although reporting was limited. Conclusion: BFRT may improve selected lower-limb outcomes after stroke, but clinical importance remains uncertain for several outcomes and certainty ranges from moderate to very low. Better-designed trials with standardized BFRT protocols and more complete safety reporting are needed. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261477739 , PROSPERO CRD420261477739.
SN - 1664-2295
ER -