Blood flow restriction during small-sided games enhances physiological adaptations and performance improvements in well-trained basketball players: A randomized controlled trial

This study examined whether adding blood flow restriction (BFR) to small-sided games (SSG) augments cardiorespiratory/anaerobic adaptations and lower-limb muscular performance in well-trained male collegiate basketball players. Twenty-four atheletes (age: 21.0 ± 1.6 years) were randomized to either an experimental (SSG+BFR; 100-130% of leg systolic pressure) or a control group (SSG; without BFR) and completed eight 3 <i>vs</i>. 3 player-SSG sessions over four weeks (4 sets of 3-4.5-min bouts; 3-min rest intervals). Peak aerobic power, Peak oxygen uptake [VO_2peak], Wingate 30-s peak/mean power, lower-limb performance (back-squat 1RM, countermovement-jump [CMJ] height/power, T-test, 30-m sprint, repeated-sprint ability [RSA best/mean and decrement score]) were assessed pre- and post-intervention. Linear mixed-effects models were used to test group, time, and group × time effects. The SSG+BFR group had greater improvements in Peak aerobic power than SSG (+9.5% <i>vs</i>. +4.5%; <i>p</i> = 0.035). The SSG+BFR group also significantly improved Wingate mean power, countermovement jump height, and repeated sprint ability best time (+4.6%, +6.8%, and -1.1%, respectively), while the SSG group showed no significant changes (<i>p</i> = 0.573). Both groups showed comparable improvements in VO_2peak (+6.4% and +4.4% in SSG+BFR and SSG, respectively). Back-squat 1RM increased over time without between-group differences. T-test performance favored SSG+BFR (group effect). These findings demonstrate that adding BFR to four weeks of 3 <i>vs</i>. 3 player-basketball SSG provides additional performance benefits by further enhancing cardiorespiratory and anaerobic outcomes, jump height and repeated sprint ability compared to SSG alone.