Comparative Effects of Blood Flow Restriction Resistance Training Versus Blood Flow Restriction Cycling on Pain, Quadriceps Strength, and Functional Outcomes in Athletes With Patellofemoral Pain (BFR-PFP-RCT)

May 15, 2026 updated by: Hafsah Gul Khattak, Ibadat International University, Islamabad

Comparative Effects of Blood Flow Restriction Resistance Training Versus Blood Flow Restriction Cycling on Pain, Quadriceps Strength, and Functional Outcomes in Athletes With Patellofemoral Pain: A Randomized Controlled Trial

This randomized controlled trial compares blood flow restriction (BFR) resistance training (leg press and seated knee extension at 30% 1RM) versus BFR cycling (stationary cycling at low resistance) in 60 athletes (aged 18-40 years) diagnosed with patellofemoral pain syndrome. Both interventions are delivered over 8 weeks (3 sessions/week) with a pneumatic cuff set at 80% limb occlusion pressure. Primary outcomes include pain intensity (NPRS), quadriceps strength (handheld dynamometer), and functional ability (Kujala Anterior Knee Pain Scale), assessed at baseline and post-intervention.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Patellofemoral pain (PFP) is among the most prevalent musculoskeletal conditions in athletes, with reported prevalence of 30-40% in sports populations. High-load resistance training is the conventional rehabilitation approach but often exacerbates joint stress and reduces adherence. Blood flow restriction (BFR) training enables strength gains at low loads by applying a pneumatic cuff at 80% LOP on the proximal thigh.

This trial compares two BFR modalities:

  • Group A (BFR-RT): Leg press and seated knee extension, 1x30 + 3x15 reps at 30% 1RM, 3x/week for 8 weeks.
  • Group B (BFR-CYC): Stationary cycling at low resistance, 4x5-minute intervals at 70-80 RPM (RPE 11-13), 3x/week for 8 weeks.

All sessions are supervised one-on-one by a physiotherapist. Assessments are conducted at baseline and week 8. The study is single-blinded (outcome assessor blinded). Randomization via computer-generated sequence. Statistical analysis via SPSS v27 (paired t-test / Wilcoxon for within-group; independent t-test / Mann-Whitney for between-group, alpha=0.05).

Study Type

Interventional

Enrollment (Estimated)

48

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Pakistan
      • Islamabad, Pakistan, 46000
        • Ibadat International University, Islamabad (Iiui)
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. Male and female athletes aged 18-40 years
  2. Clinically diagnosed with patellofemoral pain syndrome
  3. Anterior or retropatellar knee pain of at least 3 months duration
  4. Pain provoked by at least two functional activities (e.g., squatting, stair climbing, running, prolonged sitting)
  5. Willingness to participate and provide written informed consent

Exclusion Criteria:

  1. History of knee surgery or significant knee trauma in the past 6 months
  2. Presence of ligament, meniscal, or cartilage injuries
  3. Neurological, vascular, or systemic inflammatory conditions
  4. Contraindications to BFR training (e.g., deep vein thrombosis, uncontrolled hypertension)
  5. Pregnancy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: BFR Resistance Training Group
Participants perform leg press and seated knee extension exercises at 30% of 1RM with a pneumatic cuff (12 cm wide, Delfi Medical) applied to the proximal thigh at 80% limb occlusion pressure (LOP). Protocol: 1 set of 30 + 3 sets of 15 repetitions, with 60-second rest between sets (cuff deflated). Frequency: 3 sessions/week for 8 weeks (24 sessions total). 1RM re-estimated every 2 weeks for progressive load adjustment. Warm-up: 10 min low-resistance cycling (no BFR). Cool-down: 5 min lower-limb stretching.
Device: Blood Flow Restriction Resistance Training
Participants will undergo blood flow restriction (BFR) resistance training using a pneumatic cuff applied to the proximal thigh at 80% limb occlusion pressure. Exercises include leg press and seated knee extension performed at 30% of one-repetition maximum (1RM). Training will be conducted for 8 weeks, with supervised sessions 3 times per week. Cuff pressure will be monitored and adjusted using BP cuff. The aim is to improve quadriceps strength and reduce pain in patients with patellofemoral pain.
Experimental: BFR Cycling Group
Participants perform stationary cycling at low resistance targeting RPE 11-13, with a pneumatic cuff (12 cm wide, Delfi Medical) applied to the proximal thigh at 80% LOP. Protocol: 4 x 5-minute cycling intervals at 70-80 RPM, with 1-minute rest between intervals (cuff deflated). Frequency: 3 sessions/week for 8 weeks (24 sessions total). Cadence increased by 5 RPM if RPE <11. Warm-up: 10 min low-resistance cycling (no BFR). Cool-down: 5 min lower-limb stretching.
Device: Blood Flow Restriction Cycling
Participants will perform stationary cycling combined with blood flow restriction (BFR) applied to the proximal thigh at 80% limb occlusion pressure. Cycling will be performed at low resistance with controlled cadence for 8 weeks, 3 sessions per week under physiotherapist supervision. The protocol includes structured cycling intervals with rest periods and continuous monitoring of pain and perceived exertion. The intervention aims to improve quadriceps strength, reduce pain, and enhance functional outcomes in patients with patellofemoral pain.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Quadriceps Strength - Handheld Dynamometer
Time Frame: Baseline (Week 0) and Post-intervention (Week 8)
Isometric quadriceps muscle strength measured in Newtons using a calibrated handheld dynamometer (ICC > 0.90). Measurement taken in a standardized seated position at 60° knee flexion.
Baseline (Week 0) and Post-intervention (Week 8)
Pain Intensity - Numeric Pain Rating Scale (NPRS)
Time Frame: Baseline (Week 0) and Post-intervention (Week 8)
Self-reported pain intensity rated on a 0-10 scale (0 = no pain, 10 = worst imaginable pain). The NPRS has excellent test-retest reliability (ICC 0.95).
Baseline (Week 0) and Post-intervention (Week 8)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Functional Outcomes - Kujala Anterior Knee Pain Scale (AKPS)
Time Frame: Baseline (Week 0) and Post-intervention (Week 8)
13-item patient-reported outcome measure assessing functional limitations due to anterior knee pain. Scored 0-100 (higher = better function). High internal consistency (α = 0.83-0.91).
Baseline (Week 0) and Post-intervention (Week 8)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Ibadat International University, Islamabad

Investigators

  • Principal Investigator: Hafsah Gul Khattak, DPT, MS-NMPT, Ibadat International University, Islamabad (Iiui)

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

May 10, 2026

Primary Completion (Estimated)

July 10, 2026

Study Completion (Estimated)

July 25, 2026

Study Registration Dates

First Submitted

May 7, 2026

First Submitted That Met QC Criteria

May 7, 2026

First Posted (Actual)

May 13, 2026

Study Record Updates

Last Update Posted (Actual)

May 18, 2026

Last Update Submitted That Met QC Criteria

May 15, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IIUI/RERC/ADT/2026/04/286

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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