To synthesize evidence from systematic reviews on the effects of blood flow restriction (BFR) training on muscle strength, hypertrophy, and functional performance in older adults.

An umbrella review was conducted after a comprehensive search in PubMed, Scopus, SPORTDiscus, and Web of Science until June 17, 2025. Eligible studies were systematic reviews, with or without meta-analyses, examining low-load BFR training in adults aged ≥ 50 years. Outcomes included muscle strength, hypertrophy, and physical function. Study selection and data extraction were performed independently by two reviewers, and methodological quality was assessed using AMSTAR 2.

Twenty-three systematic reviews comprising 53 unique trials were included. Meta-analyses consistently indicated that BFR training promotes hypertrophy comparable to high-load resistance training (HL-RT) and superior to low-load training without BFR. Evidence on strength is mixed: some meta-analyses found gains similar to HL-RT, others reported inferior or superior results. Nevertheless, the majority of evidence suggests that BFR provides greater strength improvements compared to low-load training without BFR. Findings on functional performance were inconsistent. All reviews were rated as low or critically low in methodological quality. Across comparisons, heterogeneity and recurring methodological limitations-such as inadequate blinding and allocation concealment-were noted in primary studies.

BFR training is a promising approach to enhance muscle strength and hypertrophy in older adults, but evidence certainty is limited by methodological weaknesses in both trials and reviews. Well-designed, high-quality studies are needed to confirm these effects and support clinical implementation.