A systematic review examining if blood flow restriction can enhance the effectiveness of electrical stimulations

The use of blood flow restriction (BFR) has been shown to promote greater increases in muscle size and strength when applied during low intensity aerobic exercise and low load resistance exercise. Whether BFR can enhance the effectiveness of E-STIM has been less explored and is the purpose of this study.The databases of Pubmed, Scopus, and Web of Science were searched using the following search: "blood flow restriction" OR "occlusion training" OR "KAATSU" AND "electrical stimulation" OR "E-STIM" OR "neuromuscular electrical stimulation" OR "NMES" OR "electromyostimulation." A three-level random effects restricted maximum likelihood model was computed.Four studies met the inclusion criteria. There was no additive effect of performing E-STIM under BFR when compared to E-STIM in the absence of BFR [ES: 0.88 (95% CI: -0.28, 2.05); P=0.13]. There was a greater increase in strength when E-STIM was performed under BFR as compared to the same protocol without BFR [ES: 0.88 (95% CI: 0.21, 1.54); P=0.01].The lack of effectiveness for BFR to enhance muscle growth may be related to the non-orderly recruitment of motor units when performing E-STIM. The ability of BFR to augment increases in strength may also allow individuals to utilize lower amplitudes to reduce participant discomfort.