AUTHOR=Wang Xiaolin , Wang Yifei , Yang Xuezhen , Mohd Nasiruddin Nasnoor Juzaily Bin , Dong Delong , Samsudin Shamsulariffin Bin , Qin Xin-Min 

TITLE=Effects of blood flow restriction training on bone metabolism: a systematic review and meta-analysis

JOURNAL=Frontiers in Physiology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2023.1212927

DOI=10.3389/fphys.2023.1212927

ISSN=1664-042X

ABSTRACT=<p><bold>Introduction:</bold> The efficacy of low-intensity blood flow restriction (LI-BFR) training programs in bone metabolism remains unclear compared to low-intensity (LI) training and high-intensity (HI) training. The aim of this review was to quantitatively identify the effects of LI-BFR training on changes in bone formation markers (i.e., bone-specific alkaline phosphatase, BALP), bone resorption (i.e., C-terminal telopeptide of type I collagen, CTX) and bone mineral density (BMD) compared with conventional resistance training programmes. Additionally, the effectiveness of walking with and without BFR was assessed.</p><p><bold>Methods:</bold> PubMed, Scopus, SPORTDiscus, Web of Science and Google Scholar databases were searched for articles based on eligibility criteria. Review Manager Version 5.4 was used for Meta-analysis. Physiotherapy Evidence Database (PEDro) was applied to assess the methodological quality of studies.</p><p><bold>Results:</bold> 12 articles were included in the meta-analysis, with a total of 378 participants. Meta-results showed that compared with LI training, LI-BFR training induced greater increments in BALP (young adults: MD = 6.70, <italic>p</italic> &lt; 0.001; old adults: MD = 3.94, <italic>p</italic> = 0.002), slight increments in BMD (young adults: MD = 0.05, <italic>p</italic> &lt; 0.00001; old adults: MD = 0.01, <italic>p</italic> &lt; 0.00001), and greater decrements in CTX (young adults: MD = −0.19, <italic>p</italic> = 0.15; old adults: MD = −0.07, <italic>p</italic> = 0.003). Compared with HI training, LI-BFR training produced smaller increments in BALP (young adults: MD = −6.87, <italic>p</italic> = 0.24; old adults: MD = −0.6, <italic>p</italic> = 0.58), similar increments in BMD (MD = −0.01, <italic>p</italic> = 0.76) and similar decrements in CTX (young adults: MD = 0, <italic>p</italic> = 0.96; old adults: MD = −0.08, <italic>p</italic> = 0.13). Although there were only two studies on walking training intervention, walking training with BFR had a better effect on bone metabolism than training without BFR.</p><p><bold>Discussion:</bold> In conclusion, LI-BFR training induces greater improvements in bone health than LI training, but is less effective than HI training. Therefore, LI-BFR training may be an effective and efficient way to improve bone health for untrained individuals, older adults, or those undergoing musculoskeletal rehabilitation.</p><p><bold>Clinical Trial Registration:</bold> [<ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/prospero/</ext-link>], identifier [CRD42023411837].</p>