Blood flow restriction training in COPD: A systematic review with exploratory meta-analysis of emerging evidence

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is often accompanied by skeletal muscle dysfunction, limiting exercise tolerance and quality of life. Blood flow restriction training (BFRT) is a low-load strategy that may induce adaptations comparable to conventional resistance training. This systematic review and meta-analysis evaluated the effects of BFRT in individuals with COPD. METHODS: PubMed, Embase, Web of Science and Google Scholar were searched to April 2025. Randomized controlled trials comparing BFRT with conventional training were included. Methodological quality was assessed with PEDro and TESTEX scales, and certainty of evidence with GRADE. RESULTS: Four studies (103 participants) were included, three eligible for meta-analysis. Pooled analyses did not demonstrate statistically significant differences between BFRT and conventional training for exercise capacity (6-Minute Walk Test: MD 6.76 m, 95% CI -31.80 to 45.31), health status (COPD Assessment Test: MD -0.11, 95% CI -3.65 to 3.43), or knee-extension strength (SMD -0.08, 95% CI -0.44 to 0.29). It is important to note that the absence of a statistically significant difference does not imply equivalence or non-inferiority. No adverse events were reported. DISCUSSION: BFRT may yield similar outcomes to conventional resistance training in COPD and may offer a safe, feasible alternative for patients unable to tolerate high loads. However, due to the limited number of studies and the exploratory nature of this meta-analysis, these findings should be considered inconclusive. Larger, high-quality trials are needed to strengthen the evidence base.