Blood Flow Restriction Training in Stroke Rehabilitation: A Narrative Review of Current Evidence and Future Directions

Abstract

ABSTRACT Background Post‐stroke motor deficits cause disability, while paresis and comorbidities may limit high‐intensity training. Blood flow restriction training (BFRT) combines low‐intensity exercise with partial vascular occlusion and may promote neuromuscular adaptations at low loads. Methods This narrative review synthesized peer‐reviewed evidence on BFRT in stroke rehabilitation. Stroke‐specific clinical studies, particularly randomized controlled trials (RCTs), were prioritized for evaluating clinical effects; experimental, preclinical, physiological, mechanistic, review, and guideline evidence provided context. RCT data included participant characteristics, protocols, outcomes, and adverse events. Two reviewers independently assessed risk of bias using the Cochrane Risk of Bias tool (RoB 1). Findings were synthesized qualitatively without meta‐analysis or GRADE assessment. Results Sixty‐seven reports were included, comprising eight stroke‐specific clinical studies and 59 contextual reports. Participants represented early, subacute, and chronic stroke stages, although stroke stage and baseline impairment were inconsistently reported. Studies generally enrolled medically stable individuals with adequate motor control, postural stability, or walking capacity; those with severe paresis or substantial mobility dependence were underrepresented. Improvements were reported in strength, motor function, balance, walking, mobility, activities of daily living, muscle morphology, and cortical activation. However, between‐group benefits were inconsistent, and BFRT was not consistently superior to conventional, unrestricted, or high‐intensity resistance exercise. No serious BFRT‐related adverse events were reported, but safety reporting was incomplete. Conclusion BFRT may be a useful low‐load adjunct for selected stroke survivors, particularly in lower‐limb rehabilitation. Evidence remains preliminary because of risk of bias, small samples, heterogeneous protocols, short follow‐up, and limited representation of severely impaired patients. Well‐controlled studies are needed before broad implementation.