Introduction: The efficacy of low-intensity blood flow restriction (LI-BFR) training programs in bone metabolism remains unclear compared to low-intensity (LI) training and high-intensity (HI) training. The aim of this review was to quantitatively identify the effects of LI-BFR training on changes in bone formation markers (i.e., bone-specific alkaline phosphatase, BALP), bone resorption (i.e., C-terminal telopeptide of type I collagen, CTX) and bone mineral density (BMD) compared with conventional resistance training programmes. Additionally, the effectiveness of walking with and without BFR was assessed. Methods: PubMed, Scopus, SPORTDiscus, Web of Science and Google Scholar databases were searched for articles based on eligibility criteria. Review Manager Version 5.4 was used for Meta-analysis. Physiotherapy Evidence Database (PEDro) was applied to assess the methodological quality of studies. Results: 12 articles were included in the meta-analysis, with a total of 378 participants. Meta-results showed that compared with LI training, LI-BFR training induced greater increments in BALP (young adults: MD = 6.70, p < 0.001; old adults: MD = 3.94, p = 0.002), slight increments in BMD (young adults: MD = 0.05, p < 0.00001; old adults: MD = 0.01, p < 0.00001), and greater decrements in CTX (young adults: MD = -0.19, p = 0.15; old adults: MD = -0.07, p = 0.003). Compared with HI training, LI-BFR training produced smaller increments in BALP (young adults: MD = -6.87, p = 0.24; old adults: MD = -0.6, p = 0.58), similar increments in BMD (MD = -0.01, p = 0.76) and similar decrements in CTX (young adults: MD = 0, p = 0.96; old adults: MD = -0.08, p = 0.13). Although there were only two studies on walking training intervention, walking training with BFR had a better effect on bone metabolism than training without BFR. Discussion: In conclusion, LI-BFR training induces greater improvements in bone health than LI training, but is less effective than HI training. Therefore, LI-BFR training may be an effective and efficient way to improve bone health for untrained individuals, older adults, or those undergoing musculoskeletal rehabilitation. Clinical Trial Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42023411837].
This meta-analysis aimed to examine the effects of plyometric training on physical fitness attributes in handball players. A systematic literature search across PubMed, SCOPUS, SPORTDiscus, and Web of Science identified 20 studies with 563 players. Plyometric training showed significant medium-to-large effects on various attributes: countermovement jump with arms (ES = 1.84), countermovement jump (ES = 1.33), squat jump (ES = 1.17), and horizontal jump (ES = 0.83), ≤ 10-m linear sprint time (ES = -1.12), > 10-m linear sprint time (ES = -1.46), repeated sprint ability with change-of-direction time (ES = -1.53), agility (ES = -1.60), maximal strength (ES = 0.52), and force-velocity (muscle power) (ES = 1.13). No significant impact on balance was found. Subgroup analysis indicated more pronounced agility improvements in players ≤ 66.6 kg compared to > 66.6 kg (ES = -1.93 vs. -0.23, p = 0.014). Additionally, greater improvements were observed in linear sprint and repeat sprint ability when comparing training durations of > 8 weeks with those ≤ 8 weeks (ES = -2.30 to -2.89 vs. ES = -0.92 to -0.97). In conclusion, plyometric training effectively improves various physical fitness attributes, including jump performance, linear sprint ability, maximal strength, muscle power and agility.