Comparative effects of aerobic training modalities with and without blood flow restriction on maximal and peak oxygen uptake in adults: A systematic review and network meta-analysis.

Background: Maximal oxygen uptake (VO 2 max) and peak oxygen uptake (VO 2 peak) are key indicators of cardiorespiratory fitness. Blood flow restriction (BFR) training may augment the metabolic stimulus elicited by aerobic exercise (AE) across a range of exercise intensities in adults. However, the comparative effects of BFR-based AE strategies and conventional AE on VO 2 max/VO 2 peak remain uncertain. This network meta-analysis (NMA) compared the relative effects, at the group level, of BFR-based AE strategies and conventional exercise interventions on VO 2 max/VO 2 peak in adults across different exercise modalities, intensity levels, and comparator conditions, thereby providing a context-specific reference for understanding the potential effects of these exercise strategies on aerobic capacity.

Methods: Six databases (PubMed, Web of Science, Embase, Cochrane Library, Scopus, and SPORTDiscus) were searched through January 21, 2026 for randomized controlled trials involving adults and reporting VO 2 max or VO 2 peak. A Bayesian NMA was performed using the gemtc package in R v4.4.1. Relative effects were summarized with league tables, and intervention rankings were estimated using the surface under the cumulative ranking curve (SUCRA).

Results: Thirty-four studies including 1042 participants were included. Overall, high-intensity interval training combined with BFR (HIIT + BFR), low-intensity continuous training combined with BFR (LICT + BFR), and moderate-intensity continuous training (MICT) ranked highest. Subgroup analyses showed that HIIT + BFR ranked highest in 4-6-week interventions, trained participants, and running-based protocols. LICT + BFR ranked highest in untrained participants, walking-based protocols, and low-to-moderate-intensity exercise. MICT ranked highest in 8-12-week interventions, male participants, cycling-based protocols, and trained participants. Low-intensity interval training alone showed a consistently low ranking.

Conclusion: At the group level, BFR combined with AE may improve VO 2 max/VO 2 peak in some intervention settings, while MICT remains an effective conventional training strategy. However, given the limited comparative evidence, these

Findings: should be interpreted cautiously, and further high-quality studies are needed to inform protocol-specific recommendations.