Effects of Blood Flow Restriction and Exercise Intensity on Aerobic, Anaerobic, and Muscle Strength Adaptations in Physically Active Collegiate Women

Blood Flow-Restricted Training and Time Trial Performance: A Cohort Study of World-Class Rowers

INTRODUCTION

This study aimed to explore the potential impact of incorporating blood flow restriction (BFR) training within a training block characterized by minimal high-intensity work on 2000-m rowing ergometer time trial (TT) performance in elite/world-class rowers. Physiological markers often associated with endurance performance (maximal aerobic capacity, V̇O 2max ; blood lactate thresholds and hemoglobin mass, Hb mass ) were measured to determine whether changes are related to an improvement in performance.

METHODS

Using a quasi-experimental, observational study design (no control group), 2000-m TT performance, V̇O 2max , submaximal work rates eliciting blood lactate concentrations of ~2 and ~4 mmol·L -1 , and Hb mass were measured before and after 4 wk of noncompetitive season training, which included BFR rowing. BFR training consisted of 11 sessions of 2 × 10 min of BFR rowing at a workload equating to blood lactate concentrations of ~2 mmol·L -1 . Paired t -tests were used to compare pre-/postvalues, and Pearson correlation was used to examine whether physiological changes were associated with changes to TT performance.

RESULTS

TT performance improved in both female (1.09% ± 1.2%, ~4.6 ± 5.2 s; P < 0.01) and male (1.17% ± 0.48%, ~4.5 ± 1.9 s; P < 0.001) athletes. V̇O 2max increased in female rowers only ( P < 0.01), but both sexes had an increase in work rates eliciting blood lactate concentrations of 2 mmol·L -1 (female: 184 ± 16 to 195 ± 15 W, P < 0.01; male: 288 ± 23 to 317 ± 26 W, P = 0.04) and 4 mmol·L -1 (female: 217 ± 13 to 227 ± 14 W, P = 0.02; male: 339 ± 43 to 364 ± 39 W, P < 0.01). No changes in Hb mass (both sexes, P = 0.8) were observed. Improvements in TT performance were not related to physiological changes (all correlations P ≥ 0.2).

CONCLUSIONS

After 4 wk of training with BFR, the improvement in TT performance was greater than what is typical for this population. Physiological variables improved during this training block but did not explain improved TT performance.

Lower limb blood flow occlusion increases systemic pressor response without increasing brachial arterial blood flow redistribution in women

This study was conducted to investigate the systemic hemodynamic and vascular changes in women during and after two commonly used clinical blood flow restriction (BFR) pressures at rest. There are minimal data regarding the independent effects of BFR on hemodynamic and systemic vascular changes due to pressor response, particularly among women. Therefore, this study investigated BFR-induced alterations in pressor response and systemic flow redistribution at rest during two commonly used pressures (50% and 80% limb occlusion pressure [LOP]). Fifteen women (22.1 ± 4.2 years) completed two randomised sessions involving 8-min of bilateral, lower limb restriction at 50% or 80% LOP followed by 8-min of recovery post-deflation. Changes in vascular (arterial diameter [DIA], time-averaged mean velocity [TAMV], volume flow [VF], and area) and hemodynamic (heart rate [HR] and blood pressure) measures over time (pre-, during, post-occlusion) and by session (50% vs. 80% LOP) were tested using repeated measures analysis of variance. Repeated measures correlations (rrm) quantified common intraindividual associations between BFR-induced hemodynamic and vascular responses. HR increased from baseline during 50% LOP and remained elevated during recovery (p < 0.05). HR increased from baseline during 80% LOP, while tibial VF and TAMV decreased (p < 0.03 for all). HR and TAMV values returned to baseline during recovery, while brachial artery VF decreased (p < 0.05). Changes in HR, brachial VF, and brachial TAMV were similar between 50% and 80% LOP (rrm = 0.32-0.70, p < 0.05 for all). At 80% LOP, changes in HR were positively correlated with brachial VF (rrm = 0.38) and TAMV (rrm = 0.43) and negatively correlated with tibial VF (rrm = -0.36) and TAMV (rrm = -0.30) (p < 0.05 for all). Results suggest that BFR at 80% LOP elicits an acute systemic pressor reflex without concomitant increases in brachial arterial flow, while 50% LOP elicits a subdued response.

Low- and high-volume blood-flow restriction treadmill walking both improve maximal aerobic capacity independently of blood volume

AIM

Assess the effect of low- and high-volume blood flow restriction training (BFR) on maximal aerobic capacity (VO2 max) and determine if alteration in VO2 max is mediated through changes in hemoglobin mass (Hbmass) and blood volume.

METHODS

Participants' Hbmass (CO-rebreathe), single, and double-leg VO2 max and blood volume regulating hormonal responses (renin and copeptin) were measured before and after BFR training. Training consisted of treadmill walking either (1) twice-daily for 4week (CON and BFRHV ) or (2) twice-weekly for 6week (BFRLV ). Each session consisted of five intervals (3 min, 5% incline, 5 km/h, 100% of lowest occlusion pressure), with 1 min of standing rest between sets.

RESULTS

VO2 max increased using both training exposures, in as quickly as 2-weeks (BFRLV baseline to 4week: +315 ± 241 mL (8.7%), p = 0.02; BFRHV baseline to 2week: +360 ± 261 mL (7.9%), p < 0.01), for the BFRLV and BFRHV groups, with no change in CON. Single- and double-leg VO2 max improved proportionately (single/double-leg VO2 max ratio: BFRLV 78 ± 4.9-78 ± 5.8%, BFRHV 79 ± 6.5-77 ± 6.5%), suggesting that the mechanism for increased VO2 max is not solely limited to central or peripheral adaptations. Hbmass remained unchanged across groups (CON: +10.2 ± 34 g, BFRLV : +6.6 ± 42 g, BFRHV : +3.2 ± 44 g; p = 0.9), despite a significant release of blood volume regulating hormones after initial BFR exposure (renin +20.8 ± 21.9 ng/L, p < 0.01; copeptin +22.0 ± 23.8 pmol/L, p < 0.01), which was blunted following BFRHV training (renin: +13.4 ± 12.4 ng/L, p = 0.09; copeptin: +1.9 ± 1.7 pmol/L, p = 0.98).

CONCLUSION

BFR treadmill walking increases VO2 max irrespective of changes in Hbmass or blood volume despite a large release of blood volume regulating hormones in response to BFR treadmill walking.

The Effects of Accessory Blood Flow Restriction Training on Muscle Size and Strength in Division III Soccer Athletes: A Preliminary Ecological Study

Blood flow restriction training (BFRT) uses occlusion during low-intensity resistance training (< 50% of 1-repetition maximum, 1RM) to reduce arterial blood flow and venous return, imposing greater metabolic stress but similar muscular hypertrophy and strength gains as high-intensity resistance training (HIRT). However, no study, to date, has incorporated BFRT in a collegiate strength and conditioning setting to assess ecological validity. We aimed to investigate the effects of adding 6-weeks of accessory BFRT or HIRT to NCAA Division III soccer players prescribed resistance training regimen on muscle strength and size. Male and female (n = 17) athletes were randomly assigned to complete biceps curls 2x/week under BFRT or control (HIRT), following regularly scheduled strength training. Bicep strength (1RM) and circumference (BC) were assessed at weeks 0, 3, and 6 (men only). In men, for BC no significant interaction of condition x time was observed (p = 0.861), though condition (BFRT vs Control, p = 0.025) and time (p = 0.024) were significant. For 1RM, there was no significant interaction of condition x time (BFRT vs HIRT, p = 0.067) or of condition (p = 0.598), but there was a significant effect of time (p = 0.004). In women, there was no significant interaction between time and condition (p = 0.765) or of condition (p = 0.971) on BC, but time was significant (p = 0.045). For 1RM, there was no significant interaction of condition x time (p = 0.227) or of condition (p = 0.741), but time was (p = 0.018). In this preliminary ecological study, BFRT induced similar increases in muscle strength and circumference as HIRT in soccer players, suggesting that BFRT could be incorporated into collegiate athlete training.

Aerobic Training With Blood Flow Restriction for Endurance Athletes: Potential Benefits and Considerations of Implementation

ABSTRACT

Smith, NDW, Scott, BR, Girard, O, and Peiffer, JJ. Aerobic training with blood flow restriction for endurance athletes: potential benefits and considerations of implementation. J Strength Cond Res 36(12): 3541-3550, 2022-Low-intensity aerobic training with blood flow restriction (BFR) can improve maximal oxygen uptake, delay the onset of blood lactate accumulation, and may provide marginal benefits to economy of motion in untrained individuals. Such a training modality could also improve these physiological attributes in well-trained athletes. Indeed, aerobic BFR training could be beneficial for those recovering from injury, those who have limited time for training a specific physiological capacity, or as an adjunct training stimulus to provide variation in a program. However, similarly to endurance training without BFR, using aerobic BFR training to elicit physiological adaptations in endurance athletes will require additional considerations compared with nonendurance athletes. The objective of this narrative review is to discuss the acute and chronic aspects of aerobic BFR exercise for well-trained endurance athletes and highlight considerations for its effective implementation. This review first highlights key physiological capacities of endurance performance. The acute and chronic responses to aerobic BFR exercise and their impact on performance are then discussed. Finally, considerations for prescribing and monitoring aerobic BFR exercise in trained endurance populations are addressed to challenge current views on how BFR exercise is implemented.

Acute and Chronic Effects of Blood Flow Restricted High-Intensity Interval Training: A Systematic Review

Background

The implementation of blood flow restriction (BFR) during exercise is becoming an increasingly useful adjunct method in both athletic and rehabilitative settings. Advantages in pairing BFR with training can be observed in two scenarios: (1) training at lower absolute intensities (e.g. walking) elicits adaptations akin to high-intensity sessions (e.g. running intervals); (2) when performing exercise at moderate to high intensities, higher physiological stimulus may be attained, leading to larger improvements in aerobic, anaerobic, and muscular parameters. The former has been well documented in recent systematic reviews, but consensus on BFR (concomitant or post-exercise) combined with high-intensity interval training (HIIT) protocols is not well established. Therefore, this systematic review evaluates the acute and chronic effects of BFR + HIIT.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify relevant studies. A systematic search on 1 February 2022, was conducted on four key databases: ScienceDirect, PubMed, Scopus and SPORTDiscus. Quality of each individual study was assessed using the Physiotherapy Evidence Database (PEDro) scale. Extraction of data from included studies was conducted using an adapted version of the 'Population, Intervention, Comparison, Outcome' (PICO) framework.

Results

A total of 208 articles were identified, 18 of which met inclusion criteria. Of the 18 BFR + HIIT studies (244 subjects), 1 reported both acute and chronic effects, 5 examined acute responses and 12 investigated chronic effects. Acutely, BFR challenges the metabolic processes (vascular and oxygenation responses) during high-intensity repeated sprint exercise—which accelerates central and peripheral neuromuscular fatigue mechanisms resulting in performance impairments. Analysis of the literature exploring the chronic effects of BFR + HIIT suggests that BFR does provide an additive physiological training stimulus to HIIT protocols, especially for measured aerobic, muscular, and, to some extent, anaerobic parameters.

Conclusion

Presently, it appears that the addition of BFR into HIIT enhances physiological improvements in aerobic, muscular, and, to some extent, anaerobic performance. However due to large variability in permutations of BFR + HIIT methodologies, it is necessary for future research to explore and recommend standardised BFR guidelines for each HIIT exercise type.

Blood flow restriction during training for improving the aerobic capacity and sport performance of trained athletes: A systematic review and meta-analysis

BACKGROUND

/Objective: Combining blood flow restriction (BFR) with endurance training is exponentially increasing although the benefits are unclear in trained athletes. We aimed to describe the effects of aerobic and/or anaerobic training programmes combined with BFR on the aerobic capacity and related sport performance of trained athletes.

METHODS

Databases used were MEDLINE, SPORTDiscus, LILACS, IBECS, CINHAL, COCHRANE, SCIELO and PEDro, through October 2021. For study selection, criteria included (a) clinical trials that recruited trained healthy athletes, that (b) proposed BFR in combination with aerobic/anaerobic training programmes (≥8 sessions) and that (c) evaluated either aerobic capacity or related sport performance. For data extraction, a reviewer extracted the data, and another reviewer independently verified it. The tool RoB 2 (Risk of bias 2) was used to assess risk of bias.

RESULTS

Ten studies met the eligibility criteria, capturing a total of 207 participants. Although it did not reveal any significant effects from training with BFR on aerobic capacity compared to the same training without BFR, effect sizes were extremely high. Subgroup analyses according to the intensity of the training programmes found similar results for low-to-moderate or high-intensity training compared to the same sessions without BFR.

CONCLUSION

Although adding BFR to training sessions always produce benefits from baseline in aerobic capacity and sport performance of trained athletes, these results are not better than those observed after the same training sessions without BFR. The reduced number of studies, small sample sizes and some concerns regarding risk of bias should be highlighted as limitations.

REGISTRATION NUMBER

CRD42021248212.

Effect of different recovery modes during resistance training with blood flow restriction on hormonal levels and performance in young men: a randomized controlled trial

BACKGROUND

Resistance training with blood flow restriction (BFR) results in hypertrophy, and its magnitude depends on various training variables. This study aimed to compare the long-term effect of passive recovery (PR) and active recovery (AR) during low-intensity resistance training with BFR on hormonal levels and performance in young men.

METHODS

In the randomized clinical trial, 20 men were randomly divided into PR and AR groups during resistance training with BFR. The intervention consisted of six upper and lower body movements with 30% of one maximum repetition (1RM), three sessions per week for six weeks. Both groups wore pneumatic cuffs on the proximal part of thighs and arms. The cuff pressure was 60% of the calculated arterial blood occlusion and increased 10% every two weeks. The AR group performed seven repetitions in 30 s break between sets by one second for concentric and eccentric phases and two seconds rest, and the other group had passive rest. The blood samples and a series of performance tests were gathered before and after the intervention. A repeated measure ANOVA was used to analyze data.

RESULTS

AR and PR interventions significantly improved the C-reactive protein (CRP) (- 38% vs. - 40%), Lactate dehydrogenase (LDH) (- 11% vs. - 3%), Sargent jump (9% vs. 10%), peak power (20% vs.18%), and average power (14% vs. 14%), upper 1RM (8% vs. 8%) and no significant differences were observed between groups. The AR intervention significantly increased growth hormone (GH) (423% vs. 151%, p = 0.03), lower body 1RM (18% vs. 11%) and muscle endurance (34% vs. 22% for the upper body, p = 0.02 and 32% vs. 24% for the lower body, p = 0.04) than the PR group. The PR intervention further increased the minimum power than the AR group (19% vs. 10%). There were no significant changes in testosterone (p = 0.79) and cortisol (p = 0.34) following interventions.

CONCLUSION

The findings indicated that by increasing muscle activation and higher metabolic load, AR during resistance training with BFR might cause more remarkable improvements in serum GH, muscle strength, and endurance. Thus, to gain further benefits, AR during training with BFR is recommended.

TRIAL REGISTRATION

IRCT20191207045644N1. Registration date: 14/03/2020. URL: https://www.irct.ir/search/result?query=IRCT20191207045644N1.

Current and Future Trends in Strength and Conditioning for Female Athletes

Participation by female athletes in competitive sport has increased dramatically since the inception of Title IX, although female athletes are represented significantly less than their male counterparts in strength and conditioning (S&C) literature. This is apparent when examining current identified trends in the field, such as implementation of blood flow restriction (BFR) training, functional assessments to predict injuries, or the ever-increasing use of technology in sports. The aim of this review is to examine three prevalent trends in contemporary S&C literature as they relate to female athletes in order to expose areas lacking in research. We conducted journal and database searches to progressively deepen our examination of available research, starting first with broad emerging themes within S&C, followed next by an inquiry into literature concerning S&C practices in females, ending finally with a review of emerging topics concerning female athletes. To this end, 534 articles were reviewed from PubMed, Academic Search Complete, Google Scholar, CINAHL, MEDLINE, and Web of Science. Results demonstrate the utility of implementing BFR, functional movement assessments, and various technologies among this population to expand representation of female athletes in S&C literature, improve athletic capabilities and performance, and decrease potential for injury over time.

Effects of different exercise programs on cardiorespiratory fitness and body composition in college students

Objective

The cardiorespiratory fitness (CRF) of college students is showing a downward trend, this study aimed to explore the effects of three exercise programs on CRF and body composition indicators in college students.

Methods

A total of 50 non-smoking, healthy and physically inactive students were recruited from campus in Beijing, China, and randomly assigned to 4 groups: low-intensity continuous training with blood flow restriction (LICT-BFR, n = 13), moderate-intensity continuous training (MICT, n = 13), high-intensity interval training (HIIT, n = 12), and no exercise control (n = 12), the intervention continued for 8 weeks. Body composition and aerobic capacity were measured before and after the intervention.

Results

Exercise groups reached significant improvements in maximal oxygen uptake (VO₂max, p < 0.01) and a decrease in body fat percentage (p < 0.05) comparing to the control group. The fat mass and visceral fat area reduced significantly (p < 0.05) with a muscle mass growth (p < 0.05) in the LICT-BFR and MICT groups comparing to the control group. Changes of fat and muscle mass were trivial in the HIIT group (p = 0.842, p = 0.247).

Conclusion

All three exercise programs can improve the CRF of college students, with LICT-BFR has the most profound effects, and MICT is more beneficial for body composition improvement than other programs. From an overall perspective, LICT-BFR should be the ideal choice, however, due to limited equipment, college students can choose MICT or HIIT according to their situations.

The Evolution of Blood Flow Restricted Exercise

The use of blood flow restricted (BFR) exercise has become an accepted alternative approach to improve skeletal muscle mass and function and improve cardiovascular function in individuals that are not able to or do not wish to use traditional exercise protocols that rely on heavy loads and high training volumes. BFR exercise involves the reduction of blood flow to working skeletal muscle by applying a flexible cuff to the most proximal portions of a person’s arms or legs that results in decreased arterial flow to the exercising muscle and occluded venous return back to the central circulation. Safety concerns, especially related to the cardiovascular system, have not been consistently reported with a few exceptions; however, most researchers agree that BFR exercise can be a relatively safe technique for most people that are free from serious cardiovascular disease, as well as those with coronary artery disease, and also for people suffering from chronic conditions, such as multiple sclerosis, Parkinson’s, and osteoarthritis. Potential mechanisms to explain the benefits of BFR exercise are still mostly speculative and may require more invasive studies or the use of animal models to fully explore mechanisms of adaptation. The setting of absolute resistive pressures has evolved, from being based on an individual’s systolic blood pressure to a relative measure that is based on various percentages of the pressures needed to totally occlude blood flow in the exercising limb. However, since several other issues remain unresolved, such as the actual external loads used in combination with BFR, the type of cuff used to induce the blood flow restriction, and whether the restriction is continuous or intermittent, this paper will attempt to address these additional concerns.

Current Techniques Used for Practical Blood Flow Restriction Training: A Systematic Review

ABSTRACT

Bielitzki, R, Behrendt, T, Behrens, M, and Schega, L. Current techniques used for practical blood flow restriction training: a systematic review. J Strength Cond Res 35(10): 2936-2951, 2021-The purpose of this article was to systematically review the available scientific evidence on current methods used for practical blood flow restriction (pBFR) training together with application characteristics as well as advantages and disadvantages of each technique. A literature search was conducted in different databases (PubMed, Web of Science, Scopus, and Cochrane Library) for the period from January 2000 to December 2020. Inclusion criteria for this review were (a) original research involving humans, (b) the use of elastic wraps or nonpneumatic cuffs, and (c) articles written in English. Of 26 studies included and reviewed, 15 were conducted using an acute intervention (11 in the lower body and 4 in the upper body), and 11 were performed with a chronic intervention (8 in the lower body, 1 in the upper body, and 2 in both the upper and the lower body). Three pBFR techniques could be identified: (a) based on the perceptual response (perceived pressure technique), (b) based on the overlap of the cuff (absolute and relative overlap technique), and (c) based on the cuffs' maximal tensile strength (maximal cuff elasticity technique). In conclusion, the perceived pressure technique is simple, valid for the first application, and can be used independently of the cuffs' material properties, but is less reliable within a person over time. The absolute and relative overlap technique as well as the maximal cuff elasticity technique might be applied more reliably due to markings, but require a cuff with constant material properties over time.

Multicomponent Training Prevents Memory Deficit Related to Amyloid-β Protein-Induced Neurotoxicity

BACKGROUND

Alzheimer's disease (AD) is characterized by the accumulation of the amyloid-β peptide in the brain, leading to early oxidative stress and neurotoxicity. It has been suggested that physical exercise could be beneficial in preventing AD, but studies with multicomponent training are scanty.

OBJECTIVE

Verify the effects of multicomponent exercise training to prevent deficits in recognition memory related to Aβ neurotoxicity.

METHODS

We subjected Wistar rats to multicomponent training (including aerobic and anaerobic physical exercise and cognitive exercise) and then infused amyloid-β peptide into their hippocampus.

RESULTS

We show that long-term multicomponent training prevents the amyloid-β-associated neurotoxicity in the hippocampus. It reduces hippocampal lipid peroxidation, restores antioxidant capacity, and increases glutathione levels, finally preventing recognition memory deficits.

CONCLUSION

Multicomponent training avoids memory deficits related to amyloid-β neurotoxicity on an animal model.

The Acute Impact of External Compression on Back Squat Performance in Competitive Athletes

The aim of the present study was to evaluate the effects of external compression with blood flow restriction on power output and bar velocity changes during the back-squat exercise (SQ). The study included 10 judo athletes (age = 28.4 ± 5.8 years; body mass = 81.3 ± 13.1 kg; SQ one-repetition maximum (1-RM) 152 ± 34 kg; training experience 10.7 ± 2.3 years).

METHODS

The experiment was performed following a randomized crossover design, where each participant performed three different exercise protocols: (1) control, without external compression (CONT); (2) intermittent external compression with pressure of 100% arterial occlusion pressure (AOP) (EC-100); and (3) intermittent external compression with pressure of 150% AOP (EC-150). To assess the differences between conditions, the participants performed 3 sets of 3 repetitions of the SQ at 70% 1-RM. The differences in peak power output (PP), mean power output (MP), peak bar velocity (PV), and mean bar velocity (MV) between the three conditions were examined using repeated measures two-way ANOVA.

RESULTS

The post hoc analysis for the main effect of conditions showed a significant increase in PP (p = 0.03), PV (p = 0.02), MP (p = 0.04), and MV (p = 0.03), for the EC-150, compared to the CONT. Furthermore, a statistically significant increase in PP (p = 0.04), PV (p = 0.03), MP (p = 0.02), and MV (p = 0.01) were observed for the EC-150 compared to EC-100. There were no significant changes in PP, PV, MP, and MV, between EC-100 and CONT conditions.

CONCLUSION

The results indicate that the use of extremely high-pressure external compression (150% AOP) during high-loaded (70% 1-RM) lower limb resistance exercise elicits an acute increase in power output and bar velocity.

Occlusion Training During Specific Futsal Training Improves Aspects of Physiological and Physical Performance

This study aimed to examine the effects of lower limb blood flow restriction (BFR) performed during 3-a-side futsal game training on aerobic and anaerobic performance of futsal players. Twelve male futsal players were randomized into two groups (n = 6); both groups performed ten sessions of the 3-a-side game every other day in half of a futsal court; but one group trained under BFR conditions. Pneumatic cuffs used for the BFR group were inflated to 110% leg systolic blood pressure and increased by 10% after each two completed sessions. Before and after the training sessions subjects completed a series of tests to assess aerobic and anaerobic performances along with changes in blood lactate and anabolic and catabolic hormones. All aerobic and anaerobic performance variables improved in both group after training, however improvements in mean power (12.2%, p = 0.03), run time to fatigue (TTF), (7.1%, p = 0.02) and running economy (RE), (-22.7%, p = 0.01) were significantly greater in the BFR group. There were also significant increases in growth hormone (p = 0.01), testosterone to cortisol ratio at first session (p = 0.01) and rate of lactate removal (p = 0.01) at last session in the BFR group compared to the non-BFR group. Small-sided game (SSG) training with the addition of BFR because of accumulated metabolites and hormonal changed leads to substantially greater increases in performance than SSGs training alone.

Exercise-Induced Vascular Adaptations under Artificially Versus Pathologically Reduced Blood Flow: A Focus Review with Special Emphasis on Arteriogenesis

Background: The vascular effects of training under blood flow restriction (BFR) in healthy persons can serve as a model for the exercise mechanism in lower extremity arterial disease (LEAD) patients. Both mechanisms are, inter alia, characterized by lower blood flow in the lower limbs. We aimed to describe and compare the underlying mechanism of exercise-induced effects of disease- and external application-BFR methods. Methods: We completed a narrative focus review after systematic literature research. We included only studies on healthy participants or those with LEAD. Both male and female adults were considered eligible. The target intervention was exercise with a reduced blood flow due to disease or external application. Results: We identified 416 publications. After the application of inclusion and exclusion criteria, 39 manuscripts were included in the vascular adaption part. Major mechanisms involving exercise-mediated benefits in treating LEAD included: inflammatory processes suppression, proinflammatory immune cells, improvement of endothelial function, remodeling of skeletal muscle, and additional vascularization (arteriogenesis). Mechanisms resulting from external BFR application included: increased release of anabolic growth factors, stimulated muscle protein synthesis, higher concentrations of heat shock proteins and nitric oxide synthase, lower levels in myostatin, and stimulation of S6K1. Conclusions: A main difference between the two comparators is the venous blood return, which is restricted in BFR but not in LEAD. Major similarities include the overall ischemic situation, the changes in microRNA (miRNA) expression, and the increased production of NOS with their associated arteriogenesis after training with BFR.