The effects of blood flow restriction training on lower limb motor function and balance in stroke patients: a randomized clinical trial.

To evaluate the effects of blood flow restriction (BFR) training, delivered as BFR‑walking or low‑load resistance training with BFR (LL‑BFR), on lower limb motor function and balance in stroke survivors. A single-blind randomized clinical trial. Inpatient intensive rehabilitation unit. Ninety-six stroke patients had a mean (SD) age of 55.80 (13.17) years, and 27% were female. Participants were allocated 1:1:1 to undergo a 3-week intervention (five sessions/week) consisting of either walking without BFR (Control), BFR-walking (120 mmHg cuff pressure), or LL-BFR (120 mmHg low-load resistance training at 20% 1RM). All received concurrent standard rehabilitation. The primary outcome was the Fugl-Meyer Assessment of Lower Extremity (FMA-LE), with secondary outcomes including the Berg Balance Scale (BBS), Timed Up and Go Test (TUG), 30-Second Sit-to-Stand Test (30sSTS), and Limits of Stability. Significant Group × Time interactions were found for FMA‑LE (F [2, 93.054] =8.418, P<0.001, η²p=0.153), BBS (F [2, 93.000]=4.615, P=0.012, η²p=0.090), TUG (F [2, 93.000]=9.121, P<0.001, η²p=0.164), and 30sSTS (F [2, 93.000]=26.020, P<0.001, η²p=0.359). Both BFR‑Walking (adjusted mean difference vs. control: 1.66 points; 95% CI, 0.27 to 3.04; P=0.010) and LL‑BFR (2.25 points; 95% CI, 0.86 to 3.64; P<0.001) showed greater FMA‑LE improvements than control, with no difference between BFR modalities (P=0.165). Both BFR groups outperformed control on BBS, TUG, and 30sSTS (all P<0.05). Responder analysis showed 34.4% of LL‑BFR participants achieved FMA‑LE MCID (≥4 points) versus 15.6% in control (P=0.04). No serious adverse events occurred. A 3‑week BFR‑Walking or LL‑BFR regimen improved balance and mobility beyond conventional training. Although the average improvement is modest, a significantly greater number of patients may achieve clinically meaningful improvement, warranting larger, longer‑term trials before routine clinical use.