Effects of low-load blood flow restriction vs. high-load resistance training on upper-body strength in male collegiate gymnasts: A randomized controlled trial

TL;DR

This study found that low-load blood flow restriction training works as well as high-load training for improving upper-body strength in male gymnasts.

Contribution

The study demonstrates comparable efficacy of BFR-LRT and HRT in elite athletes, with distinct adaptation pathways.

Findings

Both BFR-LRT and HRT improved upper-body strength and endurance more than control training.

BFR-LRT and HRT showed no significant differences in outcomes, supported by Bayesian analysis.

Mediation analysis revealed modality-specific pathways for endurance gains in handstand push-ups.

Abstract

High-load resistance training (HRT) is the standard for developing strength, characterized by high mechanical loads. Low-load training with blood flow restriction (BFR-LRT) has emerged as an alternative that uses lower mechanical loads but greater repetition volume to induce metabolic stress. While these training modalities impose differing physiological demands, the extent to which they produce comparable adaptations in highly trained athletes remains unclear. This study aimed to compare the effects of a 6-week BFR-LRT program versus a traditional HRT program on upper-body maximal strength and strength endurance in male collegiate gymnasts.

Thirty male collegiate gymnasts completed the experiment in three parallel groups: HRT (3 sets of 10 repetitions at 75% 1-repetition maximum [1RM]), BFR-LRT (1 set of 30 and 3 sets of 15 repetitions at 30% 1RM), or a control group (CG) that performed only regular gymnastics training. The 6-week intervention was preceded by familiarization and reliability testing. Upper-body maximal strength (1RM for bar dip, pull-up, and shoulder press) and strength endurance (maximal repetitions for bar dips 60s, pull-ups 40s, and handstand push-ups 40s) were assessed at baseline and post-intervention. A one-way Analysis of Covariance (ANCOVA), with baseline scores as a covariate, was used to compare post-intervention outcomes. To formally interpret non-significant comparisons between the HRT and BFR-LRT groups, a follow-up Bayesian ANCOVA was performed. Additionally, mediation analysis was conducted to determine if improvements in maximal strength mediated the observed gains in strength endurance.

Both HRT and BFR-LRT produced significantly greater improvements than the control group across all outcomes. The primary comparison revealed no statistically significant differences between the HRT and BFR-LRT groups on any measure. The 95% confidence intervals for the adjusted mean differences consistently included zero, supporting their comparable efficacy. Follow-up Bayesian analysis consistently provided anecdotal evidence supporting comparable efficacy between the two training groups (Bayes Factor BF01 > 2.0 for five of six outcomes). Exploratory mediation analysis revealed divergent mechanistic pathways for these adaptations: for handstand push-ups, endurance gains were statistically mediated by increased maximal strength in the HRT group, whereas this pathway was not significant for the BFR-LRT group.

In this cohort of elite gymnasts, a 6-week BFR-LRT program produced comparable adaptations in upper-body strength and strength endurance to traditional HRT, with Bayesian analysis supporting their similar efficacy. Mediation analysis revealed that the pathways to these gains were modality-specific: improvements in handstand push-up endurance were statistically mediated by gains in maximal strength for the HRT group, but not for the BFR-LRT group. These findings establish BFR-LRT as a viable low-load training alternative that may stimulate adaptations through distinct physiological mechanisms, offering important practical implications for managing training volume and mitigating joint stress.

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