{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T20:54:28Z","timestamp":1783112068076,"version":"3.54.6"},"reference-count":119,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sports Med"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Load-compromised athletes are individuals with acute or chronic injuries or disabilities that hinder their ability to perform at peak levels. Hypoxia conditioning is broadly categorized into systemic (i.e., exposure to terrestrial or normobaric hypoxia) or localized (ischemic preconditioning, blood flow restriction training) approaches and could represent a viable option to increase exercise tolerance of load-compromised athletes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This review evaluates the potential of hypoxia conditioning as a training and rehabilitation tool for load-compromised athletes. It explores its applications across various rehabilitation stages and key para-athlete sub-groups including spinal cord injury, limb deficiency, and cerebral palsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Evidence<\/jats:title>\n                    <jats:p>Passive hypoxia conditioning strategies using external limb compression help maintain musculoskeletal function during early rehabilitation stages involving immobilization or minimal loading. As rehabilitation progresses, both systemic and localized hypoxia conditioning (i.e., blood flow restricted exercise) effectively modulates external load while maintaining adequate (internal) physiological strain to induce beneficial cardiometabolic or musculoskeletal adaptations with lower mechanical stress. Para-athletes facing challenges such as biomechanical limitations, reduced active muscle mass, or muscle weakness can benefit from hypoxia conditioning\u2019s capacity to enhance muscle aerobic function, promote muscle strength and hypertrophy, and improve cardiorespiratory performance at lower mechanical loads.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Hypoxia conditioning emerges as a promising intervention to potentially overcome the physical and physiological challenges faced by load-compromised athletes. By addressing their specific limitations, hypoxia conditioning can optimize rehabilitation and training outcomes. Future research is essential to refine hypoxia conditioning protocols and tailor them to maximize individual adaptability and performance across diverse load-compromised athlete populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40279-025-02322-2","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T16:20:23Z","timestamp":1759249223000},"page":"2773-2787","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Hypoxia Conditioning for Load-Compromised Athletes: A Narrative Review Exploring Potential Applications in Injury and Disability Management"],"prefix":"10.1007","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2303-5911","authenticated-orcid":false,"given":"Wing-Chun Vincent","family":"Yeung","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4158-8329","authenticated-orcid":false,"given":"Vincent","family":"Kwok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5592-6888","authenticated-orcid":false,"given":"Mohammed","family":"Ihsan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4797-182X","authenticated-orcid":false,"given":"Olivier","family":"Girard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"2322_CR1","unstructured":"Ihsan M, Girard O. Load-compromised individuals. In: Girard O, Burtscher J Burtscher M, Millet G, editors. Hypoxia Conditioning in Health, Exercise and Sport: Principles, Mechanisms and Applications. Routledge; 2024. p. 169\u2013181."},{"key":"2322_CR2","doi-asserted-by":"publisher","DOI":"10.1177\/23259671221079637","volume":"10","author":"KS Mody","year":"2022","unstructured":"Mody KS, Fletcher AN, Akoh CC, Parekh SG. Return to play and performance after anterior cruciate ligament reconstruction in National Football League players. Orthop J Sports Med. 2022;10:23259671221079637. https:\/\/doi.org\/10.1177\/23259671221079637.","journal-title":"Orthop J Sports Med"},{"key":"2322_CR3","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1123\/ijsnem.2018-0391","volume":"29","author":"L Anderson","year":"2019","unstructured":"Anderson L, Close GL, Konopinksi M, Rydings D, Milsom J, Hambly C, et al. Case study: muscle atrophy, hypertrophy and energy expenditure of a Premier League soccer player during rehabilitation from ACL injury. Int J Sport Nutr Exerc Metab. 2019;29:559\u2013656. https:\/\/doi.org\/10.1123\/ijsnem.2018-0391.","journal-title":"Int J Sport Nutr Exerc Metab"},{"key":"2322_CR4","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1123\/ijsnem.2013-0209","volume":"24","author":"J Milsom","year":"2014","unstructured":"Milsom J, Barreira P, Burgess DJ, Iqbal Z, Morton JP. Case study: muscle atrophy and hypertrophy in a premier league soccer player during rehabilitation from ACL injury. Int J Sport Nutr Exerc Metab. 2014;24:543\u201352. https:\/\/doi.org\/10.1123\/ijsnem.2013-0209.","journal-title":"Int J Sport Nutr Exerc Metab"},{"key":"2322_CR5","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1097\/00005768-200103000-00013","volume":"33","author":"I Mujika","year":"2001","unstructured":"Mujika I, Padilla S. Cardiorespiratory and metabolic characteristics of detraining in humans. Med Sci Sports Exerc. 2001;33:413\u201321. https:\/\/doi.org\/10.1097\/00005768-200103000-00013.","journal-title":"Med Sci Sports Exerc"},{"key":"2322_CR6","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1111\/sms.12675","volume":"27","author":"U Tranaeus","year":"2017","unstructured":"Tranaeus U, Heintz E, Johnson U, Forssblad M, Werner S. Injuries in Swedish floorball: a cost analysis. Scand J Med Sci Sports. 2017;27:508\u201313. https:\/\/doi.org\/10.1111\/sms.12675.","journal-title":"Scand J Med Sci Sports"},{"key":"2322_CR7","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1136\/bjsm.35.1.43","volume":"35","author":"RD Hawkins","year":"2001","unstructured":"Hawkins RD, Hulse MA, Wilkinson C, Hodson A, Gibson M. The association football medical research programme: an audit of injuries in professional football. Br J Sports Med. 2001;35:43\u20137. https:\/\/doi.org\/10.1136\/bjsm.35.1.43.","journal-title":"Br J Sports Med"},{"key":"2322_CR8","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1136\/bjsm.2003.009134","volume":"38","author":"J Ekstrand","year":"2004","unstructured":"Ekstrand J, Wald\u00e9n M, H\u00e4gglund M. A congested football calendar and the wellbeing of players: correlation between match exposure of European footballers before the World Cup 2002 and their injuries and performers during that World Cup. Br J Sports Med. 2004;38:493\u20137. https:\/\/doi.org\/10.1136\/bjsm.2003.009134.","journal-title":"Br J Sports Med"},{"key":"2322_CR9","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/j.pmr.2018.01.008","volume":"29","author":"D Legg","year":"2018","unstructured":"Legg D. Paralympic games: history and legacy of a global movement. Phys Med Rehabil Clin N Am. 2018;29:417\u201325. https:\/\/doi.org\/10.1016\/j.pmr.2018.01.008.","journal-title":"Phys Med Rehabil Clin N Am"},{"key":"2322_CR10","unstructured":"International Paralympic Committe. Paris 2024 Paralympic Games sports. 2024. https:\/\/www.paralympic.org\/paris-2024\/sports. Accessed 8 Sept 2025."},{"key":"2322_CR11","doi-asserted-by":"publisher","first-page":"e579","DOI":"10.1519\/JSC.0000000000004858","volume":"38","author":"L Snyder","year":"2024","unstructured":"Snyder L, Goods PSR, Peeling P, Balloch A, Peiffer JJ, Binnie MJ, et al. Contribution of physical characteristics to game performance in male wheelchair basketball athletes at the Tokyo Paralympic Games. J Strength Cond Res. 2024;38:e579\u201386. https:\/\/doi.org\/10.1519\/JSC.0000000000004858.","journal-title":"J Strength Cond Res"},{"key":"2322_CR12","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1001\/jamacardio.2020.4306","volume":"6","author":"A Pelliccia","year":"2021","unstructured":"Pelliccia A, Quattrini FM, Cavarretta E, Squeo MR, Adami PE, Di Paolo FM, et al. Physiologic and clinical features of the Paralympic athlete\u2019s heart. JAMA Cardiol. 2021;6:30\u20139. https:\/\/doi.org\/10.1001\/jamacardio.2020.4306.","journal-title":"JAMA Cardiol"},{"key":"2322_CR13","doi-asserted-by":"publisher","first-page":"58","DOI":"10.3390\/sports12020058","volume":"12","author":"G Jouira","year":"2024","unstructured":"Jouira G, Alexe DI, Toh\u0103nean DI, Alexe CI, Tomozei RA, Sahli S. The relationship between dynamic balance, jumping ability, and agility with 100\u00a0m sprinting performance in athletes with intellectual disabilities. Sports. 2024;12:58. https:\/\/doi.org\/10.3390\/sports12020058.","journal-title":"Sports"},{"key":"2322_CR14","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.jns.2018.02.026","volume":"387","author":"U Dalgas","year":"2018","unstructured":"Dalgas U, Langeskov-Christensen M, Skjerb\u00e6k A, Jensen E, Baert I, Romberg A, et al. Is the impact of fatigue related to walking capacity and perceived ability in persons with multiple sclerosis? A multicenter study. J Neurol Sci. 2018;387:179\u201386. https:\/\/doi.org\/10.1016\/j.jns.2018.02.026.","journal-title":"J Neurol Sci"},{"key":"2322_CR15","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/j.rehab.2019.11.005","volume":"63","author":"C Ramari","year":"2020","unstructured":"Ramari C, Hvid LG, de David AC, Dalgas U. The importance of lower-extremity muscle strength for lower-limb functional capacity in multiple sclerosis: systematic review. Ann Phys Rehabil Med. 2020;63:123\u201337. https:\/\/doi.org\/10.1016\/j.rehab.2019.11.005.","journal-title":"Ann Phys Rehabil Med"},{"key":"2322_CR16","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1136\/bjsports-2020-103186","volume":"55","author":"O Girard","year":"2021","unstructured":"Girard O, Girard IM, Peeling P. Hypoxic conditioning: a novel therapeutic solution for load-compromised individuals to achieve similar exercise benefits by doing less mechanical work! Br J Sports Med. 2021;55:944\u20135. https:\/\/doi.org\/10.1136\/bjsports-2020-103186.","journal-title":"Br J Sports Med"},{"key":"2322_CR17","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1123\/ijspp.2022-0501","volume":"18","author":"O Girard","year":"2023","unstructured":"Girard O, Levine BD, Chapman RF, Wilber R. \u201cLiving high-training low\u201d for Olympic medal performance: what have we learned 25\u00a0years after implementation? Int J Sports Physiol Perform. 2023;18:563\u201372. https:\/\/doi.org\/10.1123\/ijspp.2022-0501.","journal-title":"Int J Sports Physiol Perform"},{"key":"2322_CR18","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1007\/s00421-023-05135-1","volume":"123","author":"J Soo","year":"2023","unstructured":"Soo J, Raman A, Lawler NG, Goods PSR, Deldicque L, Girard O, et al. The role of exercise and hypoxia on glucose transport and regulation. Eur J Appl Physiol. 2023;123:1147\u201365. https:\/\/doi.org\/10.1007\/s00421-023-05135-1.","journal-title":"Eur J Appl Physiol"},{"key":"2322_CR19","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/S0092-8674(00)81957-1","volume":"98","author":"GL Semenza","year":"1999","unstructured":"Semenza GL. Perspectives on oxygen sensing. Cell. 1999;98:281\u20134.","journal-title":"Cell"},{"key":"2322_CR20","doi-asserted-by":"publisher","first-page":"5510","DOI":"10.1073\/pnas.92.12.5510","volume":"92","author":"GL Wang","year":"1995","unstructured":"Wang GL, Jiang B-H, Rue EA, Semenza GL. Hypoxia-inducible factor 1 is a basic-helix-loop-helix-PAS heterodimer regulated by cellular O2 tension. Proc Natl Acad Sci USA. 1995;92:5510\u20134. https:\/\/doi.org\/10.1073\/pnas.92.12.5510.","journal-title":"Proc Natl Acad Sci USA"},{"key":"2322_CR21","doi-asserted-by":"publisher","first-page":"1775","DOI":"10.1271\/bbb.64.1775","volume":"64","author":"R Sasaki","year":"2000","unstructured":"Sasaki R, Masuda S, Nagao M. Erythropoietin: multiple physiological functions and regulation of biosynthesis. Biosci Biotechnol Biochem. 2000;64:1775\u201393. https:\/\/doi.org\/10.1271\/bbb.64.1775.","journal-title":"Biosci Biotechnol Biochem"},{"key":"2322_CR22","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1007\/s42978-021-00159-5","volume":"4","author":"L Deldicque","year":"2022","unstructured":"Deldicque L. Does normobaric hypoxic resistance training confer benefit over normoxic training in athletes? A narrative review. J Sci Sport Exerc. 2022;4:306\u201314. https:\/\/doi.org\/10.1007\/s42978-021-00159-5.","journal-title":"J Sci Sport Exerc"},{"key":"2322_CR23","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1515\/hukin-2016-0013","volume":"53","author":"J Chycki","year":"2016","unstructured":"Chycki J, Czuba M, Go\u0142a\u015b A, Zaj\u0105c A, Fidos-Czuba O, M\u0142ynarz A, et al. Neuroendocrine responses and body composition changes following resistance training under normobaric hypoxia. J Hum Kinet. 2016;53:91\u20138. https:\/\/doi.org\/10.1515\/hukin-2016-0013.","journal-title":"J Hum Kinet"},{"key":"2322_CR24","doi-asserted-by":"publisher","first-page":"828","DOI":"10.7752\/jpes.2020.02119","volume":"20","author":"C Namboonlue","year":"2020","unstructured":"Namboonlue C, Hamlin MJ, Sirasaporn P, Manimmanakorn N, Wonnabussapawich P, Thuwakum W, et al. Optimal degree of hypoxia combined with low-load resistance training for muscle strength and thickness in athletes. J Phys Educ Sport. 2020;20:828\u201338. https:\/\/doi.org\/10.7752\/jpes.2020.02119.","journal-title":"J Phys Educ Sport"},{"key":"2322_CR25","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1519\/JSC.0000000000001056","volume":"30","author":"B Yan","year":"2016","unstructured":"Yan B, Lai X, Yi L, Wang Y, Hu Y. Effects of five-week resistance training in hypoxia on hormones and muscle strength. J Strength Cond Res. 2016;30:184\u201393. https:\/\/doi.org\/10.1519\/JSC.0000000000001056.","journal-title":"J Strength Cond Res"},{"key":"2322_CR26","doi-asserted-by":"publisher","unstructured":"van Doorslaer de Ten Ryen S, Warnier G, Gnimassou O, Belhaj MR, Benoit N, Naslain D, et al. Higher strength gain after hypoxic vs normoxic resistance training despite no changes in muscle thickness and fractional protein synthetic rate. FASEB J. 2021;35:e21773. https:\/\/doi.org\/10.1096\/fj.202100654RR.","DOI":"10.1096\/fj.202100654RR"},{"key":"2322_CR27","doi-asserted-by":"publisher","first-page":"335","DOI":"10.3389\/fphys.2020.00335","volume":"11","author":"A T\u00f6rpel","year":"2020","unstructured":"T\u00f6rpel A, Peter B, Schega L. Effect of resistance training under normobaric hypoxia on physical performance, hematological parameters, and body composition in young and older people. Front Physiol. 2020;11:335. https:\/\/doi.org\/10.3389\/fphys.2020.00335.","journal-title":"Front Physiol"},{"key":"2322_CR28","doi-asserted-by":"publisher","DOI":"10.14814\/phy2.12033","volume":"2","author":"M Kon","year":"2014","unstructured":"Kon M, Ohiwa N, Honda A, Matsubayashi T, Ikeda T, Akimoto T, et al. Effects of systemic hypoxia on human muscular adaptations to resistance exercise training. Physiol Rep. 2014;2:e12033. https:\/\/doi.org\/10.14814\/phy2.12033.","journal-title":"Physiol Rep"},{"key":"2322_CR29","doi-asserted-by":"publisher","first-page":"3676","DOI":"10.1038\/s41598-023-30808-4","volume":"13","author":"C Benavente","year":"2023","unstructured":"Benavente C, Schoenfeld BJ, Padial P, Feriche B. Efficacy of resistance training in hypoxia on muscle hypertrophy and strength development: a systematic review with meta-analysis. Sci Rep. 2023;13:3676. https:\/\/doi.org\/10.1038\/s41598-023-30808-4.","journal-title":"Sci Rep"},{"key":"2322_CR30","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1007\/s40279-015-0433-5","volume":"46","author":"AV Incognito","year":"2016","unstructured":"Incognito AV, Burr JF, Millar PJ. The effects of ischemic preconditioning on human exercise performance. Sports Med. 2016;46:531\u201344. https:\/\/doi.org\/10.1007\/s40279-015-0433-5.","journal-title":"Sports Med"},{"key":"2322_CR31","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1113\/JP277185","volume":"597","author":"JA Lang","year":"2019","unstructured":"Lang JA, Kim J, Franke WD, Vianna LC. Seven consecutive days of remote ischaemic preconditioning improves cutaneous vasodilatory capacity in young adults. J Physiol. 2019;597:757\u201365. https:\/\/doi.org\/10.1113\/JP277185.","journal-title":"J Physiol"},{"key":"2322_CR32","doi-asserted-by":"publisher","first-page":"463","DOI":"10.3389\/fphys.2018.00463","volume":"9","author":"O Jeffries","year":"2018","unstructured":"Jeffries O, Waldron M, Pattison JR, Patterson SD. Enhanced local skeletal muscle oxidative capacity and microvascular blood flow following 7-day ischemic preconditioning in healthy humans. Front Physiol. 2018;9:463. https:\/\/doi.org\/10.3389\/fphys.2018.00463.","journal-title":"Front Physiol"},{"key":"2322_CR33","doi-asserted-by":"publisher","first-page":"2798","DOI":"10.1080\/02640414.2019.1664537","volume":"37","author":"O Jeffries","year":"2019","unstructured":"Jeffries O, Evans DT, Waldron M, Coussens A, Patterson S. Seven-day ischemic preconditioning improves muscle efficiency during cycling. J Sports Sci. 2019;37:2798\u2013805.","journal-title":"J Sports Sci"},{"key":"2322_CR34","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1080\/02640414.2019.1664537","volume":"51","author":"MS Concei\u00e7\u00e3o","year":"2019","unstructured":"Concei\u00e7\u00e3o MS, Junior EMM, Telles GD, Libardi CA, Castro A, Andrade ALL, et al. Augmented anabolic responses after 8-wk cycling with blood flow restriction. Med Sci Sports Exerc. 2019;51:84\u201393. https:\/\/doi.org\/10.1080\/02640414.2019.1664537.","journal-title":"Med Sci Sports Exerc"},{"key":"2322_CR35","doi-asserted-by":"publisher","first-page":"1731","DOI":"10.1152\/japplphysiol.00464.2021","volume":"131","author":"CJ Davids","year":"2021","unstructured":"Davids CJ, N\u00e6ss TC, Moen M, Cumming KT, Horwath O, Psilander N, et al. Acute cellular and molecular responses and chronic adaptations to low-load blood flow restriction and high-load resistance exercise in trained individuals. J Appl Physiol. 2021;131:1731\u201349. https:\/\/doi.org\/10.1152\/japplphysiol.00464.2021.","journal-title":"J Appl Physiol"},{"key":"2322_CR36","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1152\/japplphysiol.00195.2007","volume":"103","author":"S Fujita","year":"2007","unstructured":"Fujita S, Abe T, Drummond MJ, Cadenas JG, Dreyer HC, Sato Y, et al. Blood flow restriction during low-intensity resistance exercise increases S6K1 phosphorylation and muscle protein synthesis. J Appl Physiol. 2007;103:903\u201310. https:\/\/doi.org\/10.1152\/japplphysiol.00195.2007.","journal-title":"J Appl Physiol"},{"key":"2322_CR37","doi-asserted-by":"publisher","first-page":"4351","DOI":"10.1113\/jphysiol.2012.237008","volume":"590","author":"JL Nielsen","year":"2012","unstructured":"Nielsen JL, Aagaard P, Bech RD, Nygaard T, Hvid LG, Wernbom M, et al. Proliferation of myogenic stem cells in human skeletal muscle in response to low-load resistance training with blood flow restriction. J Physiol. 2012;590:4351\u201361. https:\/\/doi.org\/10.1113\/jphysiol.2012.237008.","journal-title":"J Physiol"},{"key":"2322_CR38","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1007\/s00421-010-1377-y","volume":"109","author":"S Park","year":"2010","unstructured":"Park S, Kim JK, Choi HM, Kim HG, Beekley MD, Nho H. Increase in maximal oxygen uptake following 2-week walk training with blood flow occlusion in athletes. Eur J Appl Physiol. 2010;109:591\u2013600. https:\/\/doi.org\/10.1007\/s00421-010-1377-y.","journal-title":"Eur J Appl Physiol"},{"key":"2322_CR39","doi-asserted-by":"publisher","DOI":"10.1111\/apha.13045","volume":"223","author":"D Christiansen","year":"2018","unstructured":"Christiansen D, Murphy RM, Bangsbo J, Stathis CG, Bishop DJ. Increased FXYD1 and PGC-1\u03b1 mRNA after blood flow-restricted running is related to fibre type-specific AMPK signalling and oxidative stress in human muscle. Acta Physiol. 2018;223:e13045. https:\/\/doi.org\/10.1111\/apha.13045.","journal-title":"Acta Physiol"},{"key":"2322_CR40","doi-asserted-by":"publisher","first-page":"2077","DOI":"10.1249\/MSS.0b013e3182625928","volume":"44","author":"KA Larkin","year":"2012","unstructured":"Larkin KA, MacNeil RG, Dirain M, Sandesara B, Manini TM, Buford TW. Blood flow restriction enhances post-resistance exercise angiogenic gene expression. Med Sci Sports Exerc. 2012;44:2077\u201383. https:\/\/doi.org\/10.1249\/MSS.0b013e3182625928.","journal-title":"Med Sci Sports Exerc"},{"key":"2322_CR41","doi-asserted-by":"publisher","first-page":"21401","DOI":"10.1073\/pnas.0909131106","volume":"106","author":"J Chinsomboon","year":"2009","unstructured":"Chinsomboon J, Ruas J, Gupta RK, Thom R, Shoag J, Rowe GC, et al. The transcriptional coactivator PGC-1alpha mediates exercise-induced angiogenesis in skeletal muscle. Proc Natl Acad Sci USA. 2009;106:21401\u20136. https:\/\/doi.org\/10.1073\/pnas.0909131106.","journal-title":"Proc Natl Acad Sci USA"},{"key":"2322_CR42","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1038\/nature06613","volume":"451","author":"Z Arany","year":"2008","unstructured":"Arany Z, Foo SY, Ma Y, Ruas JL, Bommi-Reddy A, Girnun G, et al. HIF-independent regulation of VEGF and angiogenesis by the transcriptional coactivator PGC-1alpha. Nature. 2008;451:1008\u201312. https:\/\/doi.org\/10.1038\/nature06613.","journal-title":"Nature"},{"key":"2322_CR43","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1152\/japplphysiol.00035.2004","volume":"97","author":"BM Prior","year":"2004","unstructured":"Prior BM, Yang HT, Terjung RL. What makes vessels grow with exercise training? J Appl Physiol. 2004;97:1119\u201328. https:\/\/doi.org\/10.1152\/japplphysiol.00035.2004.","journal-title":"J Appl Physiol"},{"key":"2322_CR44","first-page":"793","volume":"69","author":"CS Fulco","year":"1998","unstructured":"Fulco CS, Rock PB, Cymerman A. Maximal and submaximal exercise performance at altitude. Aviat Space Environ Med. 1998;69:793\u2013801.","journal-title":"Aviat Space Environ Med"},{"key":"2322_CR45","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.jesf.2021.12.003","volume":"20","author":"Y Li","year":"2022","unstructured":"Li Y, Li J, Atakan MM, Wang Z, Hu Y, Nazif M, et al. Methods to match high-intensity interval exercise intensity in hypoxia and normoxia: a pilot study. J Exerc Sci Fit. 2022;20:70\u20136. https:\/\/doi.org\/10.1016\/j.jesf.2021.12.003.","journal-title":"J Exerc Sci Fit"},{"key":"2322_CR46","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1007\/s00421-005-0081-9","volume":"96","author":"JP Wehrlin","year":"2006","unstructured":"Wehrlin JP, Hall\u00e9n J. Linear decrease in VO2max and performance with increasing altitude in endurance athletes. Eur J Appl Physiol. 2006;96:404\u201312. https:\/\/doi.org\/10.1007\/s00421-005-0081-9.","journal-title":"Eur J Appl Physiol"},{"key":"2322_CR47","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1186\/s40798-024-00759-9","volume":"10","author":"R Bielitzki","year":"2024","unstructured":"Bielitzki R, Behrens M, Behrendt T, Franz A, Centner C, Hughes L, et al. The discrepancy between external and internal load\/intensity during blood flow restriction exercise: understanding blood flow restriction pressure as modulating factor. Sports Med Open. 2024;10:95.","journal-title":"Sports Med Open"},{"key":"2322_CR48","doi-asserted-by":"publisher","first-page":"1560","DOI":"10.1080\/17461391.2022.2107436","volume":"23","author":"TP Walden","year":"2023","unstructured":"Walden TP, Girard O, Scott BR, Jonson AM, Peiffer JJ. Low- to moderate-intensity blood flow restricted walking is not an acute equivalent for unrestricted jogging in young active adults. Eur J Sport Sci. 2023;23:1560\u20139. https:\/\/doi.org\/10.1080\/17461391.2022.2107436.","journal-title":"Eur J Sport Sci"},{"key":"2322_CR49","doi-asserted-by":"publisher","first-page":"1481315","DOI":"10.3389\/fspor.2024.1481315","volume":"6","author":"T Walden","year":"2025","unstructured":"Walden T, Smith N, Dempsey A, Joson AM, Girard O. Blood flow restricted walking: does the hypoxic environment compromise walking technique? Front Sports Act Living. 2025;6:1481315. https:\/\/doi.org\/10.3389\/fspor.2024.1481315.","journal-title":"Front Sports Act Living"},{"key":"2322_CR50","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/j.jsams.2023.06.008","volume":"26","author":"SN Li","year":"2023","unstructured":"Li SN, Ihsan M, Shaykevich A, Girard O. Exercise responses to heart rate clamped cycling with graded blood flow restriction. J Sci Med Sport. 2023;26:434\u20139. https:\/\/doi.org\/10.1016\/j.jsams.2023.06.008.","journal-title":"J Sci Med Sport"},{"key":"2322_CR51","doi-asserted-by":"publisher","first-page":"2242","DOI":"10.1177\/0363546515591258","volume":"43","author":"C Zwolski","year":"2015","unstructured":"Zwolski C, Schmitt LC, Quatman-Yates C, Thomas S, Hewett TE, Paterno MV. The influence of quadriceps strength asymmetry on patient-reported function at time of return to sport after anterior cruciate ligament reconstruction. Am J Sports Med. 2015;43:2242\u20139. https:\/\/doi.org\/10.1177\/0363546515591258.","journal-title":"Am J Sports Med"},{"key":"2322_CR52","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1177\/0363546514526139","volume":"42","author":"B Barenius","year":"2014","unstructured":"Barenius B, Ponzer S, Shalabi A, Bujak R, Norl\u00e9n L, Eriksson K. Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial. Am J Sports Med. 2014;42:1049\u201357. https:\/\/doi.org\/10.1177\/0363546514526139.","journal-title":"Am J Sports Med"},{"key":"2322_CR53","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1007\/s00167-008-0498-x","volume":"16","author":"MA Kessler","year":"2008","unstructured":"Kessler MA, Behrend H, Henz S, Stutz G, Rukavina A, Kuster MS. Function, osteoarthritis and activity after ACL-rupture: 11\u00a0years follow-up results of conservative versus reconstructive treatment. Knee Surg Sports Traumatol Arthrosc. 2008;16:442\u20138. https:\/\/doi.org\/10.1007\/s00167-008-0498-x.","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"2322_CR54","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1186\/s13075-020-02156-5","volume":"22","author":"LJ Wang","year":"2020","unstructured":"Wang LJ, Zeng N, Yan ZP, Li JT, Ni GX. Post-traumatic osteoarthritis following ACL injury. Arthritis Res Ther. 2020;22:57. https:\/\/doi.org\/10.1186\/s13075-020-02156-5.","journal-title":"Arthritis Res Ther"},{"key":"2322_CR55","doi-asserted-by":"publisher","first-page":"750","DOI":"10.2519\/jospt.2012.4194","volume":"42","author":"LC Schmitt","year":"2012","unstructured":"Schmitt LC, Paterno MV, Hewett TE. The impact of quadriceps femoris strength asymmetry on functional performance at return to sport following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2012;42:750\u20139. https:\/\/doi.org\/10.2519\/jospt.2012.4194.","journal-title":"J Orthop Sports Phys Ther"},{"key":"2322_CR56","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1136\/bjsports-2016-096031","volume":"50","author":"H Grindem","year":"2016","unstructured":"Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50:804\u20138. https:\/\/doi.org\/10.1136\/bjsports-2016-096031.","journal-title":"Br J Sports Med"},{"key":"2322_CR57","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1016\/j.ptsp.2013.08.001","volume":"14","author":"L Herrington","year":"2013","unstructured":"Herrington L, Myer G, Horsley I. Task based rehabilitation protocol for elite athletes following anterior cruciate ligament reconstruction: a clinical commentary. Phys Ther Sport. 2013;14:188\u201398. https:\/\/doi.org\/10.1016\/j.ptsp.2013.08.001.","journal-title":"Phys Ther Sport"},{"key":"2322_CR58","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1007\/s40279-020-01400-x","volume":"51","author":"M Buckthorpe","year":"2021","unstructured":"Buckthorpe M, Danelon F, Rosa GL, Nanni G, Stride M, Della Villa F. Recommendations for hamstring function recovery after ACL reconstruction. Sports Med. 2021;51:607\u201324. https:\/\/doi.org\/10.1007\/s40279-020-01400-x.","journal-title":"Sports Med"},{"key":"2322_CR59","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1136\/bjsports-2016-096410","volume":"50","author":"P Kyritsis","year":"2016","unstructured":"Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Infographic. Avoid ACL graft rupture: meet discharge criteria. Br J Sports Med. 2016;50:952. https:\/\/doi.org\/10.1136\/bjsports-2016-096410.","journal-title":"Br J Sports Med"},{"key":"2322_CR60","doi-asserted-by":"publisher","first-page":"2035","DOI":"10.1097\/00005768-200012000-00011","volume":"32","author":"Y Takarada","year":"2000","unstructured":"Takarada Y, Takazawa H, Ishii N. Applications of vascular occlusion diminish disuse atrophy. Med Sci Sports Exerc. 2000;32:2035\u20139. https:\/\/doi.org\/10.1097\/00005768-200012000-00011.","journal-title":"Med Sci Sports Exerc"},{"key":"2322_CR61","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1249\/MSS.0b013e31815ddac6","volume":"40","author":"A Kubota","year":"2008","unstructured":"Kubota A, Sakuraba K, Sawaki K, Sumide T, Tamura Y. Prevention of disuse muscular weakness by restriction of blood flow. Med Sci Sports Exerc. 2008;40:529\u201334. https:\/\/doi.org\/10.1249\/MSS.0b013e31815ddac6.","journal-title":"Med Sci Sports Exerc"},{"key":"2322_CR62","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.jsams.2010.08.007","volume":"14","author":"A Kubota","year":"2011","unstructured":"Kubota A, Sakuraba K, Koh S, Ogura Y, Tamura Y. Blood flow restriction by low compressive force prevents disuse muscular weakness. J Sci Med Sport. 2011;14:95\u20139. https:\/\/doi.org\/10.1016\/j.jsams.2010.08.007.","journal-title":"J Sci Med Sport"},{"key":"2322_CR63","doi-asserted-by":"publisher","first-page":"2621","DOI":"10.1249\/MSS.0000000000000722","volume":"47","author":"T Natsume","year":"2015","unstructured":"Natsume T, Ozaki H, Saito AI, Abe T, Naito H. Effects of electrostimulation with blood flow restriction on muscle size and strength. Med Sci Sports Exerc. 2015;47:2621\u20137. https:\/\/doi.org\/10.1249\/MSS.0000000000000722.","journal-title":"Med Sci Sports Exerc"},{"key":"2322_CR64","doi-asserted-by":"publisher","first-page":"1182249","DOI":"10.3389\/fphys.2023.1182249","volume":"14","author":"N Li","year":"2023","unstructured":"Li N, Yang J, Liao Y. The effect of blood flow restriction training combined with electrical muscle stimulation on neuromuscular adaptation: a randomized controlled trial. Front Physiol. 2023;14:1182249. https:\/\/doi.org\/10.3389\/fphys.2023.1182249.","journal-title":"Front Physiol"},{"key":"2322_CR65","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1123\/jsr.2017-0002","volume":"27","author":"JT Slysz","year":"2018","unstructured":"Slysz JT, Burr JF. The effects of blood flow restricted electrostimulation on strength and hypertrophy. J Sport Rehabil. 2018;27:257\u201362. https:\/\/doi.org\/10.1123\/jsr.2017-0002.","journal-title":"J Sport Rehabil"},{"key":"2322_CR66","unstructured":"Andrade SF, Skiba GH, Krueger E, Rodacki AF. Effects of electrostimulation with blood flow restriction on muscle thickness and strength of the soleus. J Exerc Physiol Online. 2016;19(3):59\u201369."},{"key":"2322_CR67","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1123\/jsr.2021-0101","volume":"31","author":"JGA Bergamasco","year":"2022","unstructured":"Bergamasco JGA, Alvarez IF, de Campos Biazon TMP, Ugrinowitsch C, Libardi CA. Effects of blood flow restriction combined with resistance training or neuromuscular electrostimulation on muscle cross-sectional area. J Sport Rehabil. 2022;31:319\u201324. https:\/\/doi.org\/10.1123\/jsr.2021-0101.","journal-title":"J Sport Rehabil"},{"key":"2322_CR68","doi-asserted-by":"publisher","first-page":"334","DOI":"10.26603\/001c.33151","volume":"17","author":"BB Koc","year":"2022","unstructured":"Koc BB, Truyens A, Heymans MJLF, Jansen EJP, Schotanus MGM. Effect of low-load blood flow restriction training after anterior cruciate ligament reconstruction: a systematic review. Int J Sports Phys Ther. 2022;17:334\u201346. https:\/\/doi.org\/10.26603\/001c.33151.","journal-title":"Int J Sports Phys Ther"},{"key":"2322_CR69","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1113\/EP089280","volume":"106","author":"RA Ferguson","year":"2021","unstructured":"Ferguson RA, Mitchell EA, Taylor CW, Bishop DJ, Christiansen D. Blood-flow-restricted exercise: strategies for enhancing muscle adaptation and performance in the endurance-trained athlete. Exp Physiol. 2021;106:837\u201360. https:\/\/doi.org\/10.1113\/EP089280.","journal-title":"Exp Physiol"},{"key":"2322_CR70","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.ptsp.2019.06.014","volume":"39","author":"A Hughes","year":"2019","unstructured":"Hughes A, Patterson L, Haddad SD. Examination of the comfort and pain experienced with blood flow restriction training during post-surgery rehabilitation of anterior cruciate ligament reconstruction patients: a UK National Health Service trial. Phys Ther Sport. 2019;39:90\u20138. https:\/\/doi.org\/10.1016\/j.ptsp.2019.06.014.","journal-title":"Phys Ther Sport"},{"key":"2322_CR71","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.ptsp.2018.05.021","volume":"32","author":"V Korakakis","year":"2018","unstructured":"Korakakis V, Whiteley R, Epameinontidis K. Blood flow restriction induces hypoalgesia in recreationally active adult male anterior knee pain patients allowing therapeutic exercise loading. Phys Ther Sport. 2018;32:235\u201343. https:\/\/doi.org\/10.1016\/j.ptsp.2018.05.021.","journal-title":"Phys Ther Sport"},{"key":"2322_CR72","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.ptsp.2018.09.007","volume":"34","author":"V Korakakis","year":"2018","unstructured":"Korakakis V, Whiteley R, Giakas G. Low load resistance training with blood flow restriction decreases anterior knee pain more than resistance training alone: a pilot randomised controlled trial. Phys Ther Sport. 2018;34:121\u20138. https:\/\/doi.org\/10.1016\/j.ptsp.2018.09.007.","journal-title":"Phys Ther Sport"},{"key":"2322_CR73","doi-asserted-by":"publisher","first-page":"1688","DOI":"10.1136\/bjsports-2016-096329","volume":"51","author":"L Giles","year":"2017","unstructured":"Giles L, Webster KE, McClelland J, Cook JL. Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: a double-blind randomised trial. Br J Sports Med. 2017;51:1688\u201394. https:\/\/doi.org\/10.1136\/bjsports-2016-096329.","journal-title":"Br J Sports Med"},{"issue":"3","key":"2322_CR74","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1016\/j.jsams.2019.10.002","volume":"23","author":"S Held","year":"2020","unstructured":"Held S, Behringer M, Donath L. Low intensity rowing with blood flow restriction over 5\u00a0weeks increases $$\\dot{V}$$O2max in elite rowers: a randomized controlled trial. J Sci Med Sport. 2020;23(3):304\u20138. https:\/\/doi.org\/10.1016\/j.jsams.2019.10.002.","journal-title":"J Sci Med Sport"},{"key":"2322_CR75","doi-asserted-by":"publisher","first-page":"1622","DOI":"10.1080\/17461391.2023.2180671","volume":"23","author":"S Held","year":"2023","unstructured":"Held S, Rappelt L, Deutsch J-P, Rein R, Wiedenmann T, Schiffer A, et al. Low-intensity swimming with blood flow restriction over 5 weeks increases VO2peak: a randomized controlled trial using Bayesian informative prior distribution. Eur J Sport Sci. 2023;23:1622\u20138. https:\/\/doi.org\/10.1080\/17461391.2023.2180671.","journal-title":"Eur J Sport Sci"},{"key":"2322_CR76","doi-asserted-by":"publisher","first-page":"26","DOI":"10.3389\/fspor.2020.00026","volume":"2","author":"O Girard","year":"2020","unstructured":"Girard O, Brocherie F, Goods PSR, Millet GP. An updated panorama of \u201cliving low-training high\u201d altitude\/hypoxic methods. Front Sports Act Living. 2020;2:26. https:\/\/doi.org\/10.3389\/fspor.2020.00026.","journal-title":"Front Sports Act Living"},{"key":"2322_CR77","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsem-2022-001520","volume":"9","author":"M Papoti","year":"2023","unstructured":"Papoti M, Manchado-Gobatto FB, Gobatto CA. Inter-effort recovery hypoxia: a new paradigm in sport science? BMJ Open Sport Exerc Med. 2023;9:e001520. https:\/\/doi.org\/10.1136\/bmjsem-2022-001520.","journal-title":"BMJ Open Sport Exerc Med"},{"key":"2322_CR78","doi-asserted-by":"publisher","unstructured":"Narang BJ, Drole K, Barber JFP, Goods PSR, Debevec T. Utility of hypoxic modalities for musculoskeletal injury rehabilitation in athletes: a narrative review of mechanisms and contemporary perspectives. J Sports Sci. 2024. Online ahead of print. https:\/\/doi.org\/10.1080\/02640414.2024.2416779.","DOI":"10.1080\/02640414.2024.2416779"},{"key":"2322_CR79","doi-asserted-by":"publisher","first-page":"514","DOI":"10.3389\/fphys.2017.00514","volume":"8","author":"S Pramsohler","year":"2017","unstructured":"Pramsohler S, Burtscher M, Faulhaber M, Gatterer H, Rausch L, Eliasson A, et al. Endurance training in normobaric hypoxia imposes less physical stress for geriatric rehabilitation. Front Physiol. 2017;8:514. https:\/\/doi.org\/10.3389\/fphys.2017.00514.","journal-title":"Front Physiol"},{"key":"2322_CR80","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1007\/s00421-007-0409-8","volume":"100","author":"JS Wang","year":"2007","unstructured":"Wang JS, Chen LY, Fu LL, Chen ML, Wong MK. Effects of moderate and severe intermittent hypoxia on vascular endothelial function and haemodynamic control in sedentary men. Eur J Appl Physiol. 2007;100:127\u201335. https:\/\/doi.org\/10.1007\/s00421-007-0409-8.","journal-title":"Eur J Appl Physiol"},{"key":"2322_CR81","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.resp.2008.10.012","volume":"165","author":"M Burtscher","year":"2009","unstructured":"Burtscher M, Haider T, Domej W, Linser T, Gatterer H, Faulhaber M, et al. Intermittent hypoxia increases exercise tolerance in patients at risk for or with mild COPD. Respir Physiol Neurobiol. 2009;165:97\u2013103. https:\/\/doi.org\/10.1016\/j.resp.2008.10.012.","journal-title":"Respir Physiol Neurobiol"},{"key":"2322_CR82","doi-asserted-by":"publisher","first-page":"1767","DOI":"10.1007\/s00421-013-2605-z","volume":"113","author":"A Manimmanakorn","year":"2013","unstructured":"Manimmanakorn A, Manimmanakorn N, Taylor R, Draper N, Billaut F, Shearman JP, et al. Effects of resistance training combined with vascular occlusion or hypoxia on neuromuscular function in athletes. Eur J Appl Physiol. 2013;113:1767\u201374. https:\/\/doi.org\/10.1007\/s00421-013-2605-z.","journal-title":"Eur J Appl Physiol"},{"key":"2322_CR83","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1016\/j.jsams.2012.08.009","volume":"16","author":"A Manimmanakorn","year":"2013","unstructured":"Manimmanakorn A, Hamlin MJ, Ross JJ, Taylor R, Manimmanakorn N. Effects of low-load resistance training combined with blood flow restriction or hypoxia on muscle function and performance in netball athletes. J Sci Med Sport. 2013;16:337\u201342. https:\/\/doi.org\/10.1016\/j.jsams.2012.08.009.","journal-title":"J Sci Med Sport"},{"key":"2322_CR84","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13102792","volume":"13","author":"J Motowid\u0142o","year":"2024","unstructured":"Motowid\u0142o J, Stronska-Garbien K, Bichowska-Paw\u0119ska M, Kostrzewa M, Zaj\u0105c A, Ficek K, et al. Effect of step load based on time under tension in hypoxia on the ACL pre-operative rehabilitation and hormone levels: a case study. J Clin Med. 2024;13:2792. https:\/\/doi.org\/10.3390\/jcm13102792.","journal-title":"J Clin Med"},{"key":"2322_CR85","unstructured":"IPC Athlete Classification Code. 2015. https:\/\/www.paralympic.org\/classification-code. Accessed 1 Nov 2024."},{"key":"2322_CR86","doi-asserted-by":"publisher","DOI":"10.3389\/fresc.2021.732342","volume":"2","author":"CM Gee","year":"2021","unstructured":"Gee CM, Lacroix MA, Stellingwerff T, Gavel EH, Logan-Sprenger HM, West CR. Physiological considerations to support podium performance in para-athletes. Front Rehabil Sci. 2021;2:732342. https:\/\/doi.org\/10.3389\/fresc.2021.732342.","journal-title":"Front Rehabil Sci"},{"key":"2322_CR87","doi-asserted-by":"publisher","DOI":"10.1016\/j.imu.2020.100355","volume":"19","author":"Y Muangkram","year":"2020","unstructured":"Muangkram Y, Honda M, Amano A, Himeno Y, Noma A. Exploring the role of fatigue-related metabolite activity during high-intensity exercise using a simplified whole-body mathematical model. Inform Med Unlocked. 2020;19:100355. https:\/\/doi.org\/10.1016\/j.imu.2020.100355.","journal-title":"Inform Med Unlocked"},{"key":"2322_CR88","doi-asserted-by":"publisher","DOI":"10.1038\/emm.2017.194","volume":"49","author":"JJ Wan","year":"2017","unstructured":"Wan JJ, Qin Z, Wang PY, Sun Y, Liu X. Muscle fatigue: general understanding and treatment. Exp Mol Med. 2017;49:e384. https:\/\/doi.org\/10.1038\/emm.2017.194.","journal-title":"Exp Mol Med"},{"key":"2322_CR89","doi-asserted-by":"publisher","first-page":"1448","DOI":"10.1152\/ajpregu.00824.2004","volume":"289","author":"JAL Calbet","year":"2005","unstructured":"Calbet JAL, Holmberg H-C, Rosdahl H, Van Hall G, Jensen-Urstad M, Saltin B. Why do arms extract less oxygen than legs during exercise? Am J Physiol Regul Integr Comp Physiol. 2005;289:1448\u201358. https:\/\/doi.org\/10.1152\/ajpregu.00824.2004.","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"key":"2322_CR90","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.3389\/fphys.2018.01031","volume":"9","author":"N \u00d8rtenblad","year":"2018","unstructured":"\u00d8rtenblad N, Nielsen J, Boushel R, S\u00f6derlund K, Saltin B, Holmberg HC. The muscle fiber profiles, mitochondrial content, and enzyme activities of the exceptionally well-trained arm and leg muscles of elite cross-country skiers. Front Physiol. 2018;9:1031. https:\/\/doi.org\/10.3389\/fphys.2018.01031.","journal-title":"Front Physiol"},{"key":"2322_CR91","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1152\/jappl.2000.88.1.61","volume":"88","author":"Y Takarada","year":"2000","unstructured":"Takarada Y, Nakamura Y, Aruga S, Onda T, Miyazaki S, Ishii N. Rapid increase in plasma growth hormone after low-intensity resistance exercise with vascular occlusion. J Appl Physiol. 2000;88:61\u20135. https:\/\/doi.org\/10.1152\/jappl.2000.88.1.61.","journal-title":"J Appl Physiol"},{"key":"2322_CR92","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1249\/MSS.0b013e318233b4bc","volume":"44","author":"GC Laurentino","year":"2012","unstructured":"Laurentino GC, Ugrinowitsch C, Roschel H, Aoki MS, Soares AG, Neves M, et al. Strength training with blood flow restriction diminishes myostatin gene expression. Med Sci Sports Exerc. 2012;44:406\u201312. https:\/\/doi.org\/10.1249\/MSS.0b013e318233b4bc.","journal-title":"Med Sci Sports Exerc"},{"key":"2322_CR93","doi-asserted-by":"publisher","first-page":"861","DOI":"10.3390\/ijerph17030861","volume":"17","author":"HY Park","year":"2020","unstructured":"Park HY, Jung WS, Kim J, Hwang H, Kim SW, An Y, et al. Effects of 2-week exercise training in hypobaric hypoxic conditions on exercise performance and immune function in Korean national cycling athletes with disabilities: a case report. Int J Environ Res Public Health. 2020;17:861. https:\/\/doi.org\/10.3390\/ijerph17030861.","journal-title":"Int J Environ Res Public Health"},{"key":"2322_CR94","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.1589\/jpts.29.1116","volume":"29","author":"S-H Kim","year":"2017","unstructured":"Kim S-H, An H-J, Choi J-H, Kim Y-Y. Effects of 2-week intermittent training in hypobaric hypoxia on the aerobic energy metabolism and performance of cycling athletes with disabilities. J Phys Ther Sci. 2017;29:1116\u201320. https:\/\/doi.org\/10.1589\/jpts.29.1116.","journal-title":"J Phys Ther Sci"},{"key":"2322_CR95","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1152\/ajpregu.00932.2005","volume":"292","author":"AL Chu","year":"2007","unstructured":"Chu AL, Jay O, White MD. The effects of hyperthermia and hypoxia on ventilation during low-intensity steady-state exercise. Am J Physiol Regul Integr Comp Physiol. 2007;292:195\u2013203. https:\/\/doi.org\/10.1152\/ajpregu.00932.2005.","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"key":"2322_CR96","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1152\/japplphysiol.00444.2020","volume":"129","author":"JA Dempsey","year":"2020","unstructured":"Dempsey JA, La GA, Hull JH, Sutton JR. Is the healthy respiratory system built just right, overbuilt, or underbuilt to meet the demands imposed by exercise? J Appl Physiol. 2020;129:1235\u201356. https:\/\/doi.org\/10.1152\/japplphysiol.00444.2020.","journal-title":"J Appl Physiol"},{"key":"2322_CR97","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1007\/s00421-016-3385-z","volume":"116","author":"AS Gorgey","year":"2016","unstructured":"Gorgey AS, Timmons MK, Dolbow DR, Bengel J, Fugate-Laus KC, Michener LA, et al. Electrical stimulation and blood flow restriction increase wrist extensor cross-sectional area and flow meditated dilatation following spinal cord injury. Eur J Appl Physiol. 2016;116:1231\u201344. https:\/\/doi.org\/10.1007\/s00421-016-3385-z.","journal-title":"Eur J Appl Physiol"},{"key":"2322_CR98","doi-asserted-by":"publisher","first-page":"jrm40608","DOI":"10.2340\/jrm.v56.40608","volume":"56","author":"B Shadgan","year":"2024","unstructured":"Shadgan B, Nourizadeh M, Saremi Bkin Y, Baktash L, Mortezanezhad S, Lazarevic S. enhancing upper extremity muscle strength in individuals with spinal cord injury using low-intensity blood flow restriction exercise. J Rehabil Med. 2024;56:jrm40608. https:\/\/doi.org\/10.2340\/jrm.v56.40608.","journal-title":"J Rehabil Med"},{"key":"2322_CR99","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s10072-021-05307-x","volume":"43","author":"GH Skiba","year":"2022","unstructured":"Skiba GH, Andrade SF, Rodacki AF. Effects of functional electro-stimulation combined with blood flow restriction in affected muscles by spinal cord injury. Neurol Sci. 2022;43:603\u201313. https:\/\/doi.org\/10.1007\/s10072-021-05307-x.","journal-title":"Neurol Sci"},{"key":"2322_CR100","doi-asserted-by":"publisher","first-page":"I9","DOI":"10.1161\/01.CIR.0000078469.07362.E6","volume":"107","author":"FA Anderson","year":"2003","unstructured":"Anderson FA, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107:I9-16. https:\/\/doi.org\/10.1161\/01.CIR.0000078469.07362.E6.","journal-title":"Circulation"},{"key":"2322_CR101","doi-asserted-by":"publisher","first-page":"1368","DOI":"10.1016\/j.pmrj.2018.05.013","volume":"10","author":"J Stavres","year":"2018","unstructured":"Stavres J, Singer TJ, Brochetti A, Kilbane MJ, Brose SW, McDaniel J. The feasibility of blood flow restriction exercise in patients with incomplete spinal cord injury. PM&R. 2018;10:1368\u201379. https:\/\/doi.org\/10.1016\/j.pmrj.2018.05.013.","journal-title":"PM&R"},{"key":"2322_CR102","doi-asserted-by":"publisher","first-page":"1202","DOI":"10.2106\/00004623-196143080-00012","volume":"43","author":"CH Frantz","year":"1961","unstructured":"Frantz CH, O\u2019Rahilly R. Congenital skeletal limb deficiencies. J Bone Jt Surg. 1961;43:1202\u20134.","journal-title":"J Bone Jt Surg"},{"key":"2322_CR103","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1007\/s00421-018-4039-0","volume":"119","author":"AS Gorgey","year":"2019","unstructured":"Gorgey AS, Witt O, O\u2019Brien L, Cardozo C, Chen Q, Lesnefsky EJ, et al. Mitochondrial health and muscle plasticity after spinal cord injury. Eur J Appl Physiol. 2019;119:315\u201331. https:\/\/doi.org\/10.1007\/s00421-018-4039-0.","journal-title":"Eur J Appl Physiol"},{"key":"2322_CR104","doi-asserted-by":"crossref","unstructured":"Paulson T, Goosey-Tolfrey V. Applying strength and conditioning practises to athletes with a disability. In: Turner A, editior. Routledge handbook of strength and conditioning: sport-specific programming for high performance. London: Routledge; 2018: p. 38\u201348.","DOI":"10.4324\/9781315542393-4"},{"key":"2322_CR105","doi-asserted-by":"publisher","first-page":"207","DOI":"10.2165\/00007256-199520040-00001","volume":"20","author":"KH Ward","year":"1995","unstructured":"Ward KH, Meyers MC. Exercise performance of lower-extremity amputees. Sports Med. 1995;20:207\u201314. https:\/\/doi.org\/10.2165\/00007256-199520040-00001.","journal-title":"Sports Med"},{"key":"2322_CR106","doi-asserted-by":"publisher","first-page":"1714","DOI":"10.1519\/JSC.0000000000002667","volume":"33","author":"S Sanz-Quinto","year":"2019","unstructured":"Sanz-Quinto S, Ra\u00fa R, L\u00f3pez R, L\u00f3pez-Grueso L, Brizuela G, Flatt AA, et al. Influence of training models at 3,900-m altitude on the physiological response and performance of a professional wheelchair athlete: a case study. J Strength Cond Res. 2019;33:1714\u201322. https:\/\/doi.org\/10.1519\/JSC.0000000000002667.","journal-title":"J Strength Cond Res"},{"key":"2322_CR107","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2519\/josptcases.2023.11327","volume":"4","author":"E Prescott","year":"2024","unstructured":"Prescott E, Schweizer B, Cheney C. Novel blood flow restriction therapy protocol for the treatment of postamputation weakness and pain due to osteosarcoma: a case study. JOSPT Cases. 2024;4:1\u20137. https:\/\/doi.org\/10.2519\/josptcases.2023.11327.","journal-title":"JOSPT Cases"},{"key":"2322_CR108","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/j.pmr.2018.01.004","volume":"29","author":"P Runciman","year":"2018","unstructured":"Runciman P, Derman W. Athletes with brain injury: pathophysiologic and medical challenges. Phys Med Rehabil Clin N Am. 2018;29:267\u201381. https:\/\/doi.org\/10.1016\/j.pmr.2018.01.004.","journal-title":"Phys Med Rehabil Clin N Am"},{"key":"2322_CR109","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1177\/001872089003200407","volume":"38","author":"P Runciman","year":"2016","unstructured":"Runciman P, Tucker R, Ferreira S, Albertus-Kajee Y, Derman W. Effects of exercise training on performance and function in individuals with cerebral palsy: a critical review. S Afr J Res Sport Phys Educ Recreat. 2016;38:177\u201393. https:\/\/doi.org\/10.1177\/001872089003200407.","journal-title":"S Afr J Res Sport Phys Educ Recreat"},{"key":"2322_CR110","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1177\/001872089003200407","volume":"32","author":"JE Fernandez","year":"1990","unstructured":"Fernandez JE, Pitetti KH, Betzen MT. Physiological capacities of individuals with cerebral palsy. Hum Factors. 1990;32:457\u201366. https:\/\/doi.org\/10.1177\/001872089003200407.","journal-title":"Hum Factors"},{"key":"2322_CR111","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1111\/j.1600-0838.2009.01086.x","volume":"21","author":"C Nieuwenhuijsen","year":"2011","unstructured":"Nieuwenhuijsen C, Van der Slot WMA, Dallmeijer AJ, Janssens PJ, Stam HJ, Roebroeck ME, et al. Physical fitness, everyday physical activity, and fatigue in ambulatory adults with bilateral spastic cerebral palsy. Scand J Med Sci Sports. 2011;21:535\u201342. https:\/\/doi.org\/10.1111\/j.1600-0838.2009.01086.x.","journal-title":"Scand J Med Sci Sports"},{"key":"2322_CR112","doi-asserted-by":"publisher","first-page":"e222","DOI":"10.1111\/j.1469-8749.2010.03747.x","volume":"52","author":"O Verschuren","year":"2010","unstructured":"Verschuren O, Bloemen M, Kruitwagen CAS, Takken TIM. Reference values for anaerobic performance and agility in ambulatory children and adolescents with cerebral palsy. Dev Med Child Neurol. 2010;52:e222\u20138. https:\/\/doi.org\/10.1111\/j.1469-8749.2010.03747.x.","journal-title":"Dev Med Child Neurol"},{"key":"2322_CR113","doi-asserted-by":"publisher","first-page":"932","DOI":"10.2340\/16501977-1037","volume":"44","author":"S De Groot","year":"2012","unstructured":"De Groot S, Dallmeijer AJ, Bessems PJC, Lamberts ML, Van Der Woude LHV, Janssen TWJ. Comparison of muscle strength, sprint power and aerobic capacity in adults with and without cerebral palsy. J Rehabil Med. 2012;44:932\u20138. https:\/\/doi.org\/10.2340\/16501977-1037.","journal-title":"J Rehabil Med"},{"key":"2322_CR114","doi-asserted-by":"publisher","DOI":"10.1002\/brb3.70044","volume":"14","author":"C Martin-Sanchez","year":"2024","unstructured":"Martin-Sanchez C, Barbero-Iglesias FJ, Amor-Esteban V, Martin-Sanchez M, Martin-Nogueras AM. Benefits of inspiratory muscle training therapy in institutionalized adult people with cerebral palsy: a double-blind randomized controlled trial. Brain Behav. 2024;14:e70044. https:\/\/doi.org\/10.1002\/brb3.70044.","journal-title":"Brain Behav"},{"key":"2322_CR115","doi-asserted-by":"publisher","first-page":"533","DOI":"10.3389\/fphys.2019.00533","volume":"10","author":"SD Patterson","year":"2019","unstructured":"Patterson SD, Hughes L, Warmington S, Burr J, Scott BR, Owens J, et al. Blood flow restriction exercise position stand: considerations of methodology, application, and safety. Front Physiol. 2019;10:533. https:\/\/doi.org\/10.3389\/fphys.2019.00533.","journal-title":"Front Physiol"},{"key":"2322_CR116","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1097\/NPT.0000000000000475","volume":"48","author":"C Joyce","year":"2024","unstructured":"Joyce C, Aylward B, Rolnick N, Lachowski S. Implementation and clinical outcomes of blood flow restriction training on adults with cerebral palsy: a case series. J Neurol Phys Ther. 2024;48:224\u201331. https:\/\/doi.org\/10.1097\/NPT.0000000000000475.","journal-title":"J Neurol Phys Ther"},{"key":"2322_CR117","doi-asserted-by":"publisher","first-page":"31","DOI":"10.21598\/JKPNFA.2022.20.1.31","volume":"20","author":"J-C Park","year":"2022","unstructured":"Park J-C, Lee D-K. Effects of general exercise after blood flow restriction on trunk muscles thickness for children with spasticity cerebral palsy. PNF Move. 2022;20:31\u20139. https:\/\/doi.org\/10.21598\/JKPNFA.2022.20.1.31.","journal-title":"PNF Move"},{"key":"2322_CR118","doi-asserted-by":"publisher","first-page":"441","DOI":"10.21598\/JKPNFA.2021.19.3.441","volume":"19","author":"D-J Mun","year":"2021","unstructured":"Mun D-J, Jae-Cheol PT, Park PT. Effect of strength training combined with blood flow restriction exercise on leg muscle thickness in children with cerebral palsy. PNF Move. 2021;19:441\u20139. https:\/\/doi.org\/10.21598\/JKPNFA.2021.19.3.441.","journal-title":"PNF Move"},{"key":"2322_CR119","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.jbmt.2012.04.006","volume":"17","author":"JP Loenneke","year":"2013","unstructured":"Loenneke JP, Young KC, Wilson JM, Andersen JC. Rehabilitation of an osteochondral fracture using blood flow restricted exercise: a case review. J Bodyw Mov Ther. 2013;17:42\u20135. https:\/\/doi.org\/10.1016\/j.jbmt.2012.04.006.","journal-title":"J Bodyw Mov Ther"}],"container-title":["Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40279-025-02322-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40279-025-02322-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40279-025-02322-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T11:05:38Z","timestamp":1761908738000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40279-025-02322-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,30]]},"references-count":119,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["2322"],"URL":"https:\/\/doi.org\/10.1007\/s40279-025-02322-2","relation":{},"ISSN":["0112-1642","1179-2035"],"issn-type":[{"value":"0112-1642","type":"print"},{"value":"1179-2035","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,30]]},"assertion":[{"value":"1 September 2025","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 September 2025","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"No funding was received for the preparation of this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"Wing-Chun Vincent\u00a0Yeung, Vincent Kwok, Mohammed Ihsan, and Olivier Girard have no conflicts of interest that are directly relevant to the content of this article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"Not applicable.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}},{"value":"Not applicable.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Availability of Data and Material"}},{"value":"Not applicable.","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Code Availability"}},{"value":"WCVY and VK prepared the initial draft of the manuscript and developed the figures. MI and OG led the revision process and contributed to subsequent versions. All authors critically reviewed the content, provided intellectual input, and approved the final version of the manuscript.","order":9,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 Contributions"}}]}}