Cardiovascular Hemodynamics During Blood Flow Restriction Exercise: A Narrative Review of Responses, Mechanisms, and Misconceptions.

Abstract

Abstract: Mladen, SPS and Tschakovsky, ME. Cardiovascular hemodynamics during blood flow restriction exercise: A narrative review of responses, mechanisms, and misconceptions. J Strength Cond Res XX(X): 000-000, 2026-Blood flow restriction (BFR) is an exercise modality involving the application of a pneumatic cuff to the proximal portion of an exercising limb and is currently the subject of considerable attention in the strength and conditioning literature. It is well established that the addition of BFR to low-intensity aerobic or resistance exercise augments muscle adaptations compared with exercise alone. Consequently, BFR training has important implications for populations who are contraindicated to high-load exercise training. Generally, compromised oxygen delivery is proposed to underlie the enhanced adaptations to BFR through augmentation of the muscle metabolic disturbance for a given exercising work rate. Despite this, little focus has been given to directly characterizing the acute hemodynamic perturbations imposed by external cuff-inflation, and how those perturbations interact with cuff pressures, cuff location, exercise intensities, and exercise modalities. Therefore, the primary purpose of this paper is to examine the fundamental processes which govern how external pressurizing cuffs impair exercising muscle perfusion and the potential for that impairment to be offset by mechanical aspects of muscle contraction and compensatory cardiovascular mechanisms. The secondary purpose is to review how the perturbations imposed by BFR at the exercising limb are ultimately reflected at the systemic level through alterations to cardiovascular circuit flow. Overall, this review provides novel perspectives on integrated cardiovascular control during BFR exercise, the understanding of which can inform the design and implementation of effective BFR training protocols.