Cardioprotective and anti-inflammatory properties of blood flow restriction training in older or high-risk cardiovascular disease population: systematic review and meta-analysis.

Abstract

Introduction: Blood flow restriction (BFR) training combined with aerobic exercise (AE) is proposed to benefit elderly and high-risk cardiovascular populations due to its lower joint and cardiovascular strain. However, its safety remains unclear. This meta-analysis evaluates the efficacy and safety of BFR training in improving cardiovascular health and inflammatory markers in elderly and high-risk individuals.

Evidence acquisition: Following PRISMA guidelines, six databases were systematically searched for studies involving BFR training in elderly (>60 years) or high-risk cardiovascular populations. Primary outcomes included systolic and diastolic blood pressure (SBP, DBP), vascular endothelial growth factor (VEGF), insulin-like growth factor 1 (IGF-1), high-density lipoprotein (HDL), hypoxia-inducible factor 1α, nitric oxide, interleukin-6, tumor necrosis factor α (TNF-α), reactive oxygen species, and adverse events. Dichotomous outcomes were analyzed using odds ratios, and continuous outcomes using mean differences. Meta-analysis and meta-regression were conducted with RevMan 5.4 and RStudio.

Evidence synthesis: Thirty-six studies met inclusion criteria. BFR training significantly increased VEGF (P=0.03) and IGF-1 (P=0.02), indicating angiogenic and metabolic benefits. No significant effects were found for blood pressure, HDL, or inflammatory markers overall. Subgroup analysis revealed increased SBP among healthy elderly individuals (mean difference: 7.48 mmHg; P=0.01), suggesting possible sympathetic activation and altered vascular compliance.

Conclusions: BFR training shows potential for cardiovascular and metabolic improvements; however, its inconsistent effects on blood pressure and inflammation warrant further safety evaluation.