{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T16:36:34Z","timestamp":1791650194215,"version":"4.3.4"},"reference-count":64,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,18]],"date-time":"2021-06-18T00:00:00Z","timestamp":1623974400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The purpose of this review was to systematically analyze the evidence regarding the occurrence of muscle damage (changes in muscle damage markers) after resistance training with blood flow restriction sessions.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>This systematic review was conducted in accordance with the PRISMA recommendations. Two researchers independently and blindly searched the following electronic databases: PubMed, Scopus, Web of Science, CINAHL, LILACS and SPORTdicus. Randomized and non-randomized clinical trials which analyzed the effect of resistance training with blood flow restriction on muscle damage markers in humans were included. The risk of bias assessment was performed by two blinded and independent researchers using the RoB2 tool.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 21 studies involving 352 healthy participants (men, n = 301; women, n = 51) were eligible for this review. The samples in 66.6% of the studies (n = 14) were composed of untrained individuals. All included studies analyzed muscle damage using indirect markers. Most studies had more than one muscle damage marker and Delayed Onset Muscle Soreness was the measure most frequently used. The results for the occurrence of significant changes in muscle damage markers after low-load resistance training with blood flow restriction sessions were contrasting, and the use of a pre-defined repetition scheme versus muscle failure seems to be the determining point for this divergence, mainly in untrained individuals.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In summary, the use of sets until failure is seen to be determinant for the occurrence of significant changes in muscle damage markers after low-load resistance training with blood flow restriction sessions, especially in individuals not used to resistance exercise.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Trial registration<\/jats:title>\n<jats:p><jats:bold>Register number: PROSPERO number<\/jats:bold>: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?RecordID=77119\" xlink:type=\"simple\">CRD42020177119<\/jats:ext-link>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0253521","type":"journal-article","created":{"date-parts":[[2021,6,18]],"date-time":"2021-06-18T17:27:15Z","timestamp":1624037235000},"page":"e0253521","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Effect of resistance training with blood flow restriction on muscle damage markers in adults: A systematic review"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4117-0295","authenticated-orcid":true,"given":"Victor Sabino","family":"de Queiros","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00cdsis Kelly","family":"dos Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo Francisco","family":"Almeida-Neto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matheus","family":"Dantas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid Martins","family":"de Fran\u00e7a","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3588-5577","authenticated-orcid":true,"given":"Wouber H\u00e9rickson de Brito","family":"Vieira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Rodrigues","family":"Neto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo Moreira Silva","family":"Dantas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Breno Guilherme de Ara\u00fajo Tin\u00f4co","family":"Cabral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,6,18]]},"reference":[{"key":"pone.0253521.ref001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3806\/ijktr.1.1","article-title":"The history and future of KAATSU training","volume":"1","author":"Y. 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Effects of blood flow restriction during moderate-intensity eccentric knee extensions","volume":"68","author":"M Behringer","year":"2018","journal-title":"J Physiol Sci"},{"key":"pone.0253521.ref041","doi-asserted-by":"crossref","first-page":"2363","DOI":"10.1007\/s00421-019-04220-8","article-title":"Eccentric and concentric blood flow restriction resistance training on indices of delayed onset muscle soreness in untrained women","volume":"119","author":"EC Hill","year":"2019","journal-title":"Eur J Appl Physiol"},{"key":"pone.0253521.ref042","doi-asserted-by":"crossref","first-page":"S52","DOI":"10.1097\/00002060-200211001-00007","article-title":"Exercise-induced muscle damage in humans","volume":"81","author":"PM Clarkson","year":"2002","journal-title":"Am J Phys Med Rehabil"},{"key":"pone.0253521.ref043","doi-asserted-by":"crossref","first-page":"E474","DOI":"10.1152\/ajpendo.00277.2001","article-title":"l-Carnitine l-tartrate supplementation favorably affects markers of recovery from exercise stress","volume":"282","author":"JS Volek","year":"2002","journal-title":"Am J Physiol Endocrinol Metab"},{"key":"pone.0253521.ref044","doi-asserted-by":"crossref","first-page":"2387","DOI":"10.1007\/s00421-017-3725-7","article-title":"Time course of recovery following resistance training leading or not to failure","volume":"117","author":"R Mor\u00e1n-Navarro","year":"2017","journal-title":"Eur J Appl Physiol"},{"issue":"1","key":"pone.0253521.ref045","first-page":"58","article-title":"Rhabdomyolysis: pathogenesis, diagnosis, and treatment","volume":"15","author":"PA Torres","year":"2015","journal-title":"Ochsner Journal"},{"issue":"6","key":"pone.0253521.ref046","doi-asserted-by":"crossref","first-page":"e415","DOI":"10.1111\/sms.12210","article-title":"Does blood flow restriction result in skeletal muscle damage? 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