Chinese Journal of Tissue Engineering Research ›› 2026, Vol. 30 ›› Issue (23): 6150-6146.doi: 10.12307/2026.387

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Effect of blood flow restriction training on the magnitude and temporal characteristics of post-activation performance enhancement: a systematic review and meta-analysis

Li Yanfeng1, Zhang Yilin2, Kong Hao2, Zheng Hang3, Liu Jiajun4, Yin Mingyue3, 5, Qiu Bopeng4, Huang Kongyun3, Liu Hengxian3, Zhong Yuming3, Chen Jun1, Xu Kai3   

  1. 1Institute of Physical Education and Training, Capital University of Physical Education and Sports, Beijing 100191, China; 2School of Sports Training, Tianjin University of Sport, Tianjin 301617, China; 3School of Athletic Performance, Shanghai University of Sport, Shanghai 200438, China; 4School of Strength and Conditioning, Beijing Sport University, Beijing 100084, China; 5The Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
  • Received:2025-08-18 Accepted:2025-09-29 Online:2026-08-18 Published:2026-01-06
  • Contact: Xu Kai, MS, School of Athletic Performance, Shanghai University of Sport, Shanghai 200438, China
  • About author:Li Yanfeng, MS, Institute of Physical Education and Training, Capital University of Physical Education and Sports, Beijing 100191, China Zhang Yilin, MS candidate, School of Sports Training, Tianjin University of Sport, Tianjin 301617, China Li Yanfeng and Zhang Yilin contributed equally to this work.
  • Supported by:
    Australian Government Research Training Program Funding Scholarships

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Abstract: OBJECTIVE: Multi-level meta-analysis was used to systematically compare the acute effects of blood flow restriction combined with conditioning activity (that is used to induce post-activation performance enhancement) versus conditioning activity alone, conditioning activity plus blood flow restriction versus seated rest, low-intensity conditioning activity plus blood flow restriction versus high-intensity conditioning activity, and seated rest plus blood flow restriction versus seated rest on exercise performance. 
METHODS: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we systematically searched the Web of Science, PubMed, SPORTDiscus, and CNKI databases from their inception to May 24, 2025. The inclusion criteria were: (1) participants were at least physically active and healthy; (2) those reported at least one of the following four comparisons: blood flow restriction+conditioning activity versus conditioning activity alone, conditioning activity+blood flow restriction versus seated rest, low-intensity conditioning activity+blood flow restriction versus high-intensity conditioning activity, and seated rest+blood flow restriction versus seated rest alone; (3) exercise performance (e.g., jump height, sprint time, and bench throw) reported as the primary outcome; (4) randomized or non-randomized crossover/parallel intervention designs; and (5) relevant articles published in peer-reviewed English or Chinese journals. Risk of bias was assessed using ROB-2, and evidence quality was evaluated via Grading of Recommendations Assessment Development and Evaluation (GRADE). Data were synthesized using cluster-robust variance estimation and three-level mixed-effects models with small-sample adjustments. Subgroup analyses and meta-regression were conducted to explore moderators and heterogeneity sources.
RESULTS: A total of 12 studies involving 196 participants (12 females and 184 males) were included. The main findings were: (1) conditioning activity+blood flow restriction was more effective than conditioning activity alone in acutely enhancing performance (ES=0.21, 95% confidence interval [CI]=0.01-0.40, GRADE=low), with optimal effects at 4-12 minutes of recovery and 50% arterial occlusion pressure (ES=1.49); (2) conditioning activity+blood flow restriction showed no significant difference compared with seated rest (ES=0.52, 95% CI=-0.12 to 1.15, GRADE=very low), but the conditioning activity+140 mmHg blood flow restriction outperformed conditioning activity alone (ES=1.21, 95% CI=0.14-2.28); (3) low-intensity conditioning activity+blood flow restriction had similar effects to high-intensity conditioning activity (ES=-0.10, 95% CI=-0.84 to 0.64, GRADE=low); and (4) seated rest+blood flow restriction did not differ from seated rest alone (ES=0.24, 95% CI=-0.03-0.52, GRADE=very low). Notably, the latter two comparisons showed performance declines over recovery time (β=-0.04, P < 0.01 and β=-0.04, P=0.02).
CONCLUSION: A preliminary suggestion is that blood flow restriction combined with conditioning activity can enhance post-activation performance enhancement more than conditioning activity alone, with 50% arterial occlusion pressure and a recovery period of 4-12 minutes being potentially optimal. However, conditioning activity+blood flow restriction does not appear to outperform seated rest, possibly due to limited studies. In addition, low-intensity conditioning activity+blood flow restriction can achieve similar post-activation performance enhancement as high-intensity conditioning activity, while the potential benefits of seated blood combined with blood flow restriction on exercise performance may diminish over time. Overall, the preliminary recommendation is to use low-intensity conditioning activity (e.g., 30% of one-repetition maximum squat or body weight exercises) combined with 50% arterial occlusion pressure or 140 mmHg blood flow restriction with a recovery period of 4-12 minutes for subsequent exercise performance testing.

Key words:  blood flow restriction, post-activation performance enhancement, squat, leg press, jump, sprint, multi-level meta-analysis

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