The effects of lower limb blood flow restriction training on post-activation potentiation enhancement and fatigue: a meta-analysis

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• Picked for Physiology (medical) (top studies of the week, 26 July 2026).

Abstract

OBJECTIVE: This study aims to systematically explore the effects of lower limb blood flow restriction (BFR) training on post-activation potentiation enhancement (PAPE) and the Rating of Perceived Exertion (RPE) through meta-analysis, and to identify optimal BFR protocol parameters, so as to provide scientific evidence for strength and conditioning training and rehabilitation interventions. METHODS: A systematic search was conducted in PubMed, Web of Science, Scopus, and EBSCO databases to retrieve randomized controlled trials (RCTs) investigating the acute effects of lower limb BFR training on PAPE and RPE. The search timeframe covered the inception of each database to Dec 1, 2025. The Cochrane Collaboration's Risk of Bias Tool was used for literature quality assessment. Review Manager 5.4 and Stata 17.0 software were employed for statistical analysis, including heterogeneity testing, subgroup analysis, sensitivity analysis, and publication bias assessment. RESULTS: A total of 15 eligible RCTs were included, involving 244 subjects aged 17-35 years. Meta-analysis results showed that lower limb BFR training significantly enhanced PAPE-related explosive performance [SMD = 0.55, 95%CI (0.08, 1.01), P = 0.02] with high heterogeneity (I² = 78%, P < 0.001). Subgroup analysis revealed that the optimal parameters for PAPE enhancement were: multi-joint movements such as squats [SMD = 1.20, 95%CI (0.78, 1.63), P < 0.001], rest intervals > 4 min [SMD = 0.98, 95%CI (0.67, 1.30), P < 0.001], occlusion pressure of 40-60% arterial occlusion pressure (AOP) [SMD = 0.83, 95%CI (0.29, 1.36), P = 0.002]. Countermovement jump (CMJ) was the most sensitive outcome measure for PAPE assessment [SMD = 0.83, 95%CI (0.44, 1.21), P < 0.001]. Notably, several subgroups were based on only 1-2 primary studies, and these findings should be interpreted with extreme caution due to limited sample size and evidence volume. Regarding RPE, BFR training significantly increased subjective fatigue [SMD = 0.82, 95%CI (0.39, 1.26), P < 0.001] with moderate heterogeneity (I² = 60%, P = 0.001). Subgroup analysis indicated that more pronounced fatigue perception was observed in knee flexion/compound exercises [SMD = 0.91/1.54, P <0.001], rest intervals ≤ 4 min [SMD = 0.79/1.16, P = 0.05], low exercise intensity (< 40% 1RM) [SMD = 0.86, 95%CI (0.30, 1.42), P = 0.003], and occlusion pressure > 60% AOP [SMD = 1.37, 95%CI (0.80, 1.94), P < 0.001]. Sensitivity analysis confirmed the stability of the results, and funnel plots combined with Egger's test showed no significant publication bias (P > 0.05). CONCLUSION: Lower limb BFR training can effectively induce PAPE, with optimal effects achieved through multi-joint movements, rest intervals > 4 min, 40-60% AOP, and 40-70% 1RM intensity. Meanwhile, BFR training significantly elevates subjective fatigue (RPE), which is more prominent under conditions of knee flexion/compound exercises, shorter rest intervals, low intensity, and high occlusion pressure (> 60% AOP). SYSTEMATIC REVIEW REGISTRATION: https://inplasy.com/inplasy-2026-5-0041/, identifier INPLASY202430008.

Abstract as published, via PubMed.