Cross-Education Responses to Unilateral Blood Flow Restriction Walking Exercise

Cross-Education Responses to Unilateral Blood Flow Restriction Walking Exercise | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cross-Education Responses to Unilateral Blood Flow Restriction Walking Exercise Damla ERCAN KÖSE, Ezgi AYAZ, Tolga AKŞİT This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7357175/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The aim of this study was to investigate whether unilateral blood flow restriction (BFR) training can promote strength development in both the directly trained and untrained limbs through the cross-education effect. Methods Thirty-three male volunteer athletes participated in the study; three were excluded due to brachial index values outside the required range, leaving 30 participants (age = 19.53 ± 1.79 years; body mass = 70.84 ± 9.76 kg; height = 177.23 ± 5.17 cm; brachial index = 0.97 ± 0.08). The vascular restriction level, determined using the tibialis posterior artery, was monitored via Doppler device. Walking exercise was performed with 40% arterial occlusion pressure (AOP) applied to the dominant leg for six sessions at 48-hour intervals. Countermovement jump (CMJ) measurements were collected for the dominant, non-dominant, and bilateral legs immediately after each session. Data were analyzed using JASP software (v0.19.3) with significance set at p ≤ 0.05. Results Friedman analysis showed significant changes in dominant leg performance over time (TFLight (s): χ²(6) = 77.25, p ≤ .001, Kendall’s W = .429; Height (cm): χ²(6) = 105.67, p ≤ .001, Kendall’s W = .587; Jump Point: χ²(6) = 18.52, p = .005; Used Area: χ²(6) = 19.32, p = .004). In the non-dominant leg, significant differences were found for TFLight (χ²(6) = 62.76, p ≤ .001, Kendall’s W = .349) and Height (χ²(6) = 62.97, p ≤ .001, Kendall’s W = .350). No significant differences were observed for Jump Point, Used Area, and Verticality variables (p > 0.05). Conclusions Unilateral low-pressure BFR walking exercise induced significant improvements in both the BFR-applied (dominant) leg and the non-applied (non-dominant) leg, as well as in bilateral jump performance. These findings support the use of BFR as an effective method to facilitate the cross-education effect, even with low-pressure protocols. Blood flow restriction Arterial occlusion pressure Cross-education effect Countermovement jump Unilateral training Low pressure BFR Walking exercise Figures Figure 1 Figure 2 Background The pursuit of enhancing neuromuscular performance while minimizing mechanical loading has accelerated the development of alternative training strategies in sports science and rehabilitation. Blood Flow Restriction (BFR) involves the partial restriction of arterial inflow and complete restriction of venous return to a limb by applying pneumatic cuffs to the most proximal portion of the extremities. In BFR training, blood flow to the working muscles is partially occluded using a pressurized cuff [ 1 , 2 ]. Even during low-intensity exercise, this application creates a localized hypoxic environment, thereby increasing muscle activation. Through the combination of metabolic stress, hypoxia, and vascular shear stress — similar to high-intensity training — BFR can stimulate the release of growth factors, enhance muscle protein synthesis, and promote muscle hypertrophy and strength gains [ 3 , 4 ]. Indeed, consistent evidence has demonstrated that BFR training performed at low loads (20–30% of one-repetition maximum, 1RM) produces significantly greater adaptations compared to identical exercises without BFR [ 5 , 6 ]. Over the past two decades, studies have shown that low-intensity BFR training can elicit physiological adaptations comparable to those achieved through high-intensity resistance training in terms of muscle hypertrophy and strength gains [ 7 , 8 ]. These effects have been observed across a wide range of populations, from elite athletes to individuals undergoing postoperative rehabilitation, and BFR has been proposed as an important alternative particularly for those who cannot tolerate high joint stress [ 9 , 10 ]. In this context, another phenomenon known as Cross-Education (CE) has been shown to produce strength gains in the contralateral limb following unilateral resistance training [ 11 – 14 ]. CE is widely accepted to arise primarily from neurological adaptations, such as increased motor unit activity in the untrained limb, elevated cortical excitability, and enhanced reflex responses at the spinal level [ 14 – 16 ]. These neural adaptations allow, for example, the left arm to gain partial strength when only the right arm is trained, making CE a useful strategy for mitigating atrophy and strength loss in an injured limb by training the uninjured side [ 17 , 18 ]. Recent studies have suggested that unilateral BFR-supported resistance training may further enhance the CE effect. In a meta-analysis, Liang Sun et al., [ 11 ] reported that low-load BFR training resulted in greater cross-transfer than both high-load training and low-load training without BFR. Similarly, Wong et al., [ 12 ] found that isometric strength training with BFR improved contralateral strength gains. These findings suggest that the metabolic stress and afferent feedback induced by BFR can enhance central nervous system activation and strengthen the CE effect at a neural level. Hill et al., [ 9 ] observed up to a 13% strength increase in the contralateral arm in an eccentric BFR group, whereas the concentric BFR group did not achieve significant cross-transfer, indicating that muscle action type may also play a role in CE. However, the number of studies examining BFR in the context of CE remains limited, and most available data are based on isometric or isokinetic strength measurements. A recent review [ 11 ] confirmed that low-intensity BFR training produces significantly greater contralateral strength gains compared to conventional unilateral training. That same review, however, emphasized that structural adaptations such as muscle hypertrophy do not show a notable transfer to the untrained limb, suggesting that the CE effect induced by BFR is largely neuromuscular and does not necessarily result in hypertrophy. Notable limitations exist in the current literature: most studies have focused on isometric contractions or upper-limb protocols [ 9 , 10 ], with insufficient investigation of dynamic, functional lower-limb activities such as walking or jumping. Furthermore, the effects of low-pressure BFR protocols (≤ 40% AOP) on CE have been assessed in only a few studies [ 6 , 19 ]. While there is evidence supporting a synergistic interaction between BFR and CE, most research to date has been restricted to single muscle groups, used isometric testing protocols, and reported outcomes that do not directly translate to functional performance. Although unilateral BFR-assisted walking presents an appealing option due to its low joint loading and high practical feasibility, its impact on cross-transfer effects has yet to be systematically evaluated. Of particular interest is whether low-intensity, lower-limb–dominant exercise such as walking, when combined with BFR, can improve contralateral performance in explosive tasks such as vertical jump height — a critical indicator of lower-limb power output. Most CE studies have evaluated outcomes via maximal isometric strength, 1RM, or isokinetic power, yet countermovement jump (CMJ) height serves as a practical, sport-relevant measure of lower-limb power and explosive capacity, typically requiring coordinated contributions from both legs. Whether unilateral training can yield cross-transfer to high-velocity, power-oriented tasks like CMJ remains a gap in the literature. Previous research has shown that CE is generally achieved through high-intensity resistance training, and that low-intensity walking alone does not produce this effect [ 20 , 21 ]. However, the present study is noteworthy for examining the potential of inducing CE by adding BFR to a low-intensity activity such as walking. Accordingly, the aim of this study was to determine whether a six-session unilateral low-pressure (40% AOP) BFR walking protocol could elicit a cross-education effect in healthy, resistance-trained young men. Specifically, we investigated the effects of unilateral low-pressure BFR walking on jump height in both the trained (dominant) and untrained (non-dominant) legs, as well as bilateral CMJ performance. This approach allows for CE assessment in functional motor outputs (e.g., jump height, flight time) rather than purely isometric strength, providing a more sport-relevant evaluation. We hypothesized that low-intensity BFR walking would improve jump performance in the trained limb and, more importantly, induce a significant CE effect in the untrained limb through neural adaptations. This would clarify whether unilateral BFR training can yield bilateral benefits in lower-limb explosive power and provide a scientific basis for new applications in both rehabilitation and athletic performance. Methods Participants A total of 33 male volunteers participated in the study (age (years): 19.53 ± 1.79; height (cm): 177.23 ± 5.17; body mass (kg): 70.84 ± 9.76; BMI (kg/m²): 22.21 ± 2.63; lean mass of the left leg (kg): 10.37 ± 1.08; lean mass of the right leg (kg): 10.70 ± 0.99; systolic blood pressure (mmHg): 113.85 ± 9.75; diastolic blood pressure (mmHg): 72.97 ± 9.23; 40% occlusion pressure: 77.93 ± 0.97; and brachial index: 0.97 ± 0.08). However, three participants were excluded from the study due to ankle–brachial pressure index values below 0.9 or above 1.3, resulting in the evaluation of 30 participants. Although the G*Power analysis determined the target minimum sample size as 20 participants (power (1–β) = 0.90, effect size = 0.25, type I error (α) = 0.05, number of groups = 1), the study was completed with 30 participants. Prior to measurements and testing, participants were informed in detail according to the procedures outlined in the Declaration of Helsinki about the aim, content, significance, and implementation of the study, the possible risks, and their right to withdraw at any time without penalty. Familiarization measurements and tests were conducted, and all participants signed an informed consent form. Inclusion criteria were: being male, volunteering to participate, aged between 18–25 years, free from any health problems, not taking any medication or dietary supplements, abstaining from alcohol and smoking, and engaging in regular exercise for at least three years. Exclusion criteria were: experiencing any health problems during the study, failure to comply with the research protocol, missing any training session, occurrence of symptoms such as dizziness or chest pain during the study, ankle–brachial pressure index below 0.9 or above 1.3, hypertension (≥ 140/90 mmHg), obesity (BMI ≥ 30 kg·m⁻²), presence of varicose veins, history of deep vein thrombosis or pulmonary embolism in the participant or their family. StudyDesign The study was conducted in accordance with the principles of the Declaration of Helsinki, relevant national laws, and regulations governing the ethical use of human participants, following approval from the Istanbul Nişantaşı University Ethics Committee (SBETKK-2025-03). Participants first attended familiarization sessions in which they were informed about the blood flow restriction (BFR) procedure to be applied. Prior to testing, baseline measurements were recorded, including age, height, body mass, body fat percentage, lean body mass percentage, thigh circumference, resting systolic blood pressure, and diastolic blood pressure. Participants were instructed to refrain from high-intensity exercise for 48 hours before the study, to maintain their usual dietary intake for 24 hours prior to testing, and to avoid smoking, alcohol, and caffeine consumption during this period. During the walking exercise, cuff pressure was set to 40% of the individual’s arterial occlusion pressure (AOP) (Smart Tools Plus LLC, Strongsville, OH, United States). The BFR walking training was performed unilaterally on the dominant leg for six sessions, with 48-hour intervals between sessions. Each walking session lasted five minutes at a speed of 5 km/h. Immediately after each walking session, countermovement jump (CMJ) performance was assessed for the dominant, non-dominant, and bilateral legs, recording the variables: Height (cm), Tflight (s), Jump Point, Used Area, and Verticality. Familiarization Sessions Familiarization sessions were conducted one week prior to the main experiment. During these sessions, participants’ descriptive anthropometric data (height, body mass, body fat percentage, and lean body mass) were recorded. Height was measured using a stadiometer with 1 mm precision (Seca 213, Germany). Body mass and body composition were assessed in a fasted state using a bioelectrical impedance body analyzer (Tanita BC 545 N, USA). Resting blood pressure and heart rate were also recorded. Following the determination of full arterial occlusion pressure (AOP), participants performed a 2-minute walking exercise at a speed of 5 km/h with 40% AOP applied. Immediately after the walking exercise, countermovement jump (CMJ) tests were conducted for the dominant, non-dominant, and bilateral legs (OptoJump, Microgate, Bolzano, Italy). Determination of Individual Arterial Occlusion Pressure (AOP) To determine individual arterial occlusion pressure, full arterial occlusion pressure (AOP) values were measured twice for each lower limb in a supine resting position. These values were then used to set the cuff pressure for the exercise sessions. The level of vascular restriction was monitored via Doppler ultrasound at the tibialis posterior artery (OLED display Edan SD3 Doppler with a 2 MHz probe; Edan Instruments, Shenzhen, China). Determination of Brachial Index The brachial index (BI) is a simple, non-invasive test used to assess circulatory system health. Brachial artery pressure is measured in both upper limbs in the supine position using a blood pressure cuff. Bilateral ankle pressures (dorsalis pedis and posterior tibial arteries) are determined using a Doppler device (Edan Instruments, Shenzhen, China) with a 2 MHz probe. Brachial index categories are classified as follows: Low BI: BI ≤ 0.90, Normal BI: 0.90 < BI < 1.30, and High BI: BI ≥ 1.30. BI is calculated using the following formula: Higher ankle pressure (dorsalis pedis or posterior tibial artery) / brachial systolic pressure [ 22 , 23 ]. Countermovement Jump Tests The vertical jump height achieved from the participants’ center of mass, along with elastic force parameters affecting anaerobic power levels and explosive strength, was measured using the OptoJump system (Microgate, Bolzano, Italy). Prior to the measurement, participants were instructed to remain in an upright position for 2 seconds, ensuring full knee extension and maintaining an erect posture [ 24 ]. Following a rapid semi-squat movement, participants performed a maximal vertical jump. This test aims to evaluate the function of the stretch–shortening cycle, the utilization of elastic energy, and the explosive power capacity of the lower-extremity extensor muscles [ 25 ]. During the jump, the arms-free protocol was applied, and vertical jump performance was recorded for the dominant, non-dominant, and bilateral legs, assessing the variables: Height (cm), Tflight (s), Jump Point, Used Area, and Verticality. Statistical analysis Data are presented as Ortalamas and standard deviations. Normality of the data was assessed using the Shapiro–Wilk test, which indicated that the data did not show a normal distribution (p < 0.05). Therefore, non-parametric tests were performed. For the analysis of repeated measures, the Friedman analysis was applied. Effect size was reported using Kendall’s W. The general classification of Kendall’s W; W < 0.10 indicates a very weak effect; 0.10 ≤ W < 0.30 indicates a weak effect; 0.30 ≤ W < 0.50 indicates a moderate effect; and W ≥ 0.50 indicates a strong effect. Post hoc comparisons were applied using the Conover test with Bonferroni correction. Effect sizes for post-hoc analyses were reported using the rank-biserial correlation coefficient. The general classification of rank-biserial correlation r < 0.10 indicates a very weak effect; 0.10 ≤ r < 0.30 a weak effect; 0.30 ≤ r < 0.50 a moderate effect; and r ≥ 0.50 a strong effect. All statistical analyses were performed using JASP software (version 0.19.3, Netherlands). A significance level was set at p ≤ 0.05. Results The baseline characteristics of the male participants (n = 30) are presented in Table 1. The mean brachial index (BI) was 0.97 ± 0.08, and the average occlusion pressure at 40% AOP was 77.93 ± 0.97 mmHg. For countermovement jump performance at baseline, the dominant limb flight time was 0.392 ± 0.038 s with a jump height of 19.020 ± 3.853 cm, while the non-dominant limb showed a flight time of 0.390 ± 0.042 s and a height of 18.813 ± 4.108 cm. Bilateral jumps had a flight time of 0.541 ± 0.044 s and a height of 36.060 ± 6.046 cm Table 1 Baseline demographic and performance characteristics of participants (n = 30) BI 40% OP DTFlight B DHeight B NDom- TFlight B NDom- Height B BL TFlight B BL Height B 0.97 ± 0.08 77.93 ± 0.97 0.392 ± 0.038 19.020 ± 3.853 0.390 ± 0.042 18.813 ± 4.108 0.541 ± 0.044 36.060 ± 6.046 Values are presented as Mean ± Standard Deviation. Brakial Index; BI, %40 OP; 40% Oclussion Pressure, DTFlight B; Dom- TFligfht Basal, DHeight B; Dominant Height Basal, NDom- TFlight B; Non Dominant TFlight Basal, NDom- Height B; Non Dominant Height Basal, BL TFlight B; Bilateral TFlight Basal, BL Height B; Bilateral Height Basal The changes in flight time (TFlight) and jump height (Height) across six training sessions were analyzed separately for dominant and non-dominant limbs (Table 2). In the dominant limb, TFlight showed a progressive increase from 0.392 ± 0.040 s in the first session to 0.426 ± 0.047 s in the sixth session. Statistically significant changes were observed starting from the fourth session onwards (p < 0.001), with large effect sizes (rrb ≥ − 0.899). Similar patterns were found for jump height, with significant increases emerging from the fourth session (from 19.02 ± 3.85 cm to 22.52 ± 5.41 cm, p < 0.001). Table 2 Changes in Flight Time (TFlight) and Jump Height (Height) across six sessions for dominant and non-dominant limbs Reference: Basal Dominant Limb Non- Dominant Limb TFLight Height TFLight Height Session Mean ± SD r rb p bonf Mean ± SD r rb p bonf Mean ± SD r rb p bonf Mean ± SD r rb p bonf First 0.392 ± 0.040 -0.265 1.000 19.54 ± 4.166 -0.280 1.000 0.397 ± 0.044 -0.571 0.117 19.563 ± 4.435 -0.579 0.103 Second 0.397 ± 0.039 -0.370 1.000 19.655 ± 3,956 -0.387 1.000 0.406 ± 0.043 -0.778 0.004 20.429 ± 4.424 -0.766 0.004 Third 0.399 ± 0.041 -0.604 0.251 20.543 ± 4.276 -0.609 0.107 0.412 ± 0.049 -0.724 < .001* 21.110 ± 5.201 -0.764 < .001* Fourth 0.408 ± 0.043 -0.899 < .001* 21.750 ± 4.529 -0.892 < .001* 0.416 ± 0.047 -0.832 < .001* 21.437 ± 5.140 -0.828 < .001* Fifth 0.419 ± 0.05 -0.908 < .001* 22.523 ± 5.411 -0.906 < .001* 0.422 ± 0.049 -0.970 < .001* 22.160 ± 5.299 -0.981 < .001* Sixth 0.426 ± 0.047 -0.946 < .001* 23.222 ± 5.208 1.000 < .001* 0.428 ± 0.048 -0.946 < .001* 22.756 ± 5.350 -0.944 < .001* Abbreviations: TFlight, flight time; Height, jump height; Mean ± standard deviation (SD) values of flight time (TFlight) and jump height are shown across six measurement sessions for both dominant and non-dominant limbs. Statistical analysis was performed using Friedman test followed by Bonferroni-corrected post-hoc Wilcoxon signed-rank tests. Effect sizes are presented as rank biserial correlation coefficients (rrb). Statistical significance was set at * p ≤ 0.05. In the non-dominant limb, improvements in both TFlight and jump height became statistically significant basal from the second session (p = 0.004) and continued to increase significantly in later sessions. TFlight rose from 0.390 ± 0.042 s to 0.422 ± 0.049 s, and jump height from 18.81 ± 4.10 cm to 22.16 ± 5.30 cm by the final session (p < 0.001) (Table 2). These findings indicate a consistent and significant enhancement in neuromuscular performance over time, with the non-dominant limb showing earlier adaptation than the dominant limb. In the dominant limb, the median ± IQR values for countermovement jump (CMJ) parameters were as follows: TFlight 0.40 ± 0.06 s, Height 19.6 ± 5.95 cm, Jump Point − 5.2 ± 13.1 cm, Used Area 33.3 ± 16.6 cm², and Verticality 2.47 ± 3.36 cm/s. In the non-dominant limb, the corresponding median ± IQR values were highly comparable: TFlight 0.40 ± 0.05 s, Height 19.7 ± 5.35 cm, Jump Point − 4.7 ± 13.55 cm, Used Area 34.4 ± 17.7 cm², and Verticality 3.24 ± 4.72 cm/s (Table 3). Table 3 Friedman test results, effect sizes, and median ± IQR values for countermovement jump parameters across dominant, non- dominant, and bilateral limbs. Measurement Dominant Limb Non- Dominant Limb Bilateral Limb χ² (6) p Kendall’s W Median ± IQR χ² (6) p Kendall’s W Median ± IQR χ² (6) p Kendall’s W Median ± IQR Tflight 77.253 ≤ 0.001* 0.429 0.40 ± 0.06 62.760 ≤ 0.001* 0.349 0.40 ± 0.05 76.220 ≤ 0.001* 0.423 0.54 ± 0.06 Height 105.672 ≤ 0.001* 0.587 19.60 ± 5.95 62.968 ≤ 0.001* 0.350 19.70 ± 5.35 76.220 ≤ 0.001* 0.423 36.80 ± 9.05 Jump Point 18.524 0.005* 0.103 -5.20 ± 13.10 8.611 0.197 0.048 -4.70 ± 13.55 8.085 0.232 0.045 -5.70 ± 15.65 Used Area 19.315 0.004* 0.107 33.30 ± 16.60 11.163 0.083 0.062 34.40 ± 17.70 27.032 ≤ 0.001* 0.150 31.30 ± 7.30 Verticality 3.886 0.692 0.022 2.47 ± 3.36 5.026 0.540 0.028 3.24 ± 4.71 5.614 0.468 0.031 4.81 ± 7.48 Abbreviations: TFlight, flight time; Height, jump height; Used Area, contact area during jump; Verticality, vertical velocity. (χ²): Chi-square test statistics; Kendall’s W: effect sizes. Statistical significance was set at * p ≤ 0.05. These values indicate that unilateral BFR walking exercise led to consistent improvements in CMJ performance across both trained (dominant) and untrained (non-dominant) limbs. The similarity of TFlight and Height medians between limbs suggests an effective cross-education effect. While Jump Point variability (IQR) remained wide in both limbs, the comparable Used Area and Verticality distributions reflect the transfer of motor coordination and power output to the non-dominant side. The Friedman test revealed significant time effects for TFlight and Height across all limbs (p ≤ 0.001), with effect sizes ranging from moderate to large (Kendall’s W = 0.349–0.587). In the dominant limb, median ± IQR values were TFlight 0.40 ± 0.06 s and Height 19.6 ± 5.95 cm. Comparable values were observed in the non-dominant limb (TFlight 0.40 ± 0.05 s, Height 19.7 ± 5.35 cm), supporting the presence of a cross-education effect (Table 3). In the bilateral condition, the highest absolute performance values were recorded for both TFlight (0.54 ± 0.06 s) and Height (36.8 ± 9.05 cm), reflecting the combined contribution of both limbs. Jump Point and Verticality did not show statistically significant changes in any limb (p > 0.05). Used Area demonstrated significant improvements in the dominant and bilateral conditions (p = 0.004 and p ≤ 0.001, respectively), whereas no significant changes were detected in the non-dominant limb. These findings suggest that motor control adaptations, as reflected in spatial utilization, are more evident when both limbs are engaged (Table 3). The analysis of percentage change (Δ%) from baseline across sessions revealed progressive improvements in countermovement jump parameters for all limbs (Table 4). Table 4 Percentage Delta Differences (Δ%) in countermovement jump parameters across sessions for dominant, non-dominant, and bilateral limbs. Reference: Basal Session Dominant Limb Non- Dominant Limb Bilateral Limb TFLight Height Used Area Jump Point Verticality TFLight Height Used Area Jump Point Verticality TFLight Height Used Area Jump Point Verticality First + 1.28% + 2.73% + 0.61% + 1.59% + 3.39% 0.00% + 0.58% + 1.25% + 3.29% + 0.83% + 1.66% + 3.33% + 1.78% + 3.37% + 0.84% Second + 1.79% + 3.34% + 2.41% + 3.19% + 1.69% + 1.54% + 4.30% + 2.22% + 6.58% + 1.67% + 3.33% + 7.41% + 3.64% + 6.74% + 1.68% Third + 4.08% + 8.01% + 4.01% + 8.37% 0.00% + 3.59% + 9.02% + 3.81% + 10.29% + 0.83% + 4.81% + 10.48% + 4.89% + 10.11% + 0.84% Fourth + 6.89% + 14.34% + 5.45% + 13.55% –0.85% + 5.13% + 14.31% + 4.88% + 12.76% 0.00% + 5.36% + 12.17% + 5.87% + 13.48% 0.00% Fifth + 8.67% + 18.43% + 6.41% + 15.94% –1.69% + 6.92% + 19.48% + 7.12% + 15.64% –0.83% + 6.28% + 13.92% + 8.43% + 16.85% –0.84% Sixth + 10.46% + 22.06% + 8.90% + 19.92% –3.39% + 9.74% + 20.93% + 8.25% + 18.11% –1.67% + 7.03% + 14.78% + 9.10% + 20.22% –1.68% Abbreviations: TFlight, flight time; Height, jump height; Used Area, contact area during jump; Verticality, vertical velocity. In the dominant limb, TFlight increased steadily from + 1.28% in the first session to + 10.46% in the sixth session, and Height rose from + 2.73% to + 22.06%. Used Area also demonstrated notable growth (+ 0.61% to + 8.90%). Jump Point showed a positive trend despite small fluctuations, whereas Verticality exhibited a gradual decrease (− 3.39% at the sixth session), indicating a more controlled vertical movement pattern. In the non-dominant limb, a similar pattern was observed, supporting the cross-education effect. TFlight improved from 0% to + 9.74%, and Height from + 0.58% to + 20.93%. Used Area gains were comparable (+ 1.25% to + 8.25%), while Jump Point and Verticality changes mirrored those of the dominant limb. In the bilateral condition, both TFlight and Height reached the highest relative increases (+ 7.03% and + 14.78%, respectively, at the sixth session), reflecting the combined contribution of both limbs. Used Area and Jump Point demonstrated consistent enhancements, and Verticality changes remained minimal, supporting the interpretation of stable motor control despite performance gains (Table 4). Overall, these findings indicate that unilateral low-pressure BFR walking exercise elicits consistent and progressive improvements in CMJ performance parameters, with clear transfer to the untrained limb and additive effects in bilateral performance. Percentage changes from baseline are presented for TFlight, Height, Used Area, Jump Point, and Verticality across six training sessions. Progressive improvements were observed in TFlight and Height in all limbs, with the greatest absolute gains in the bilateral condition. Non-dominant limb changes paralleled those of the dominant limb, indicating a clear cross-education effect. Used Area showed moderate improvements, while Jump Point and Verticality changes were minimal, suggesting stable motor control despite performance gains. Figure 1 shows the changes in flight time (top panel) and jump height (bottom panel) of the dominant and non-dominant limbs from the baseline to the sixth training session (n = 30, male participants). Both limbs demonstrated a progressive increase in flight time and jump height across sessions. The dominant limb exhibited slightly lower flight time values than the non-dominant limb until the fourth session, after which the gap narrowed. In contrast, jump height of the dominant limb surpassed that of the non-dominant limb from the fourth session onwards, with both showing a steady upward trend throughout the study period. The graph illustrates the change in countermovement jump (CMJ) height for the non-dominant limb from pre-test to post-test. Individual participant data (gray lines) show a consistent upward trend, with the group mean (blue line) indicating an overall improvement in performance. This increase supports the presence of a cross-education effect, suggesting that unilateral BFR walking exercise on the dominant limb transferred performance gains to the non-dominant limb (Fig. 2). Discussion This study was designed as a low-intensity, dynamic exercise intervention in the form of walking, combined with unilateral low-pressure (40% Arterial Occlusion Pressure, AOP) Blood Flow Restriction (BFR) to examine its effects on countermovement jump (CMJ) performance in the dominant, non-dominant, and bilateral legs. Our findings revealed significant improvements, particularly in the non-dominant leg — which did not receive direct BFR application — for key performance parameters such as jump height (Height) and flight time (TFlight). The cross-education (CE; Çapraz Transfer) effect is defined as an increase in strength in the untrained limb following unilateral training, and is primarily attributed to central neural mechanisms [ 17 ]. In the literature, the CE effect has typically been reported following high-intensity resistance training, and it is known that low-intensity walking exercise without BFR is insufficient to induce this effect [ 20 , 21 ]. However, the present study is significant in demonstrating that adding BFR to a low-intensity activity such as walking can elicit a CE effect. For the dominant leg, the most notable finding was a substantial and statistically significant increase in CMJ jump height (Δ% = +22.06), supporting the role of BFR in enhancing local muscular strength and explosive power. Similar outcomes were observed in an eccentric-focused upper-limb BFR protocol, where strength gains occurred in both the trained and untrained arms, attributed to metabolic stress–induced afferent stimulation and increased cortical recruitment [ 9 ]. In our study, the repetitive nature of walking, when combined with hypoxia and blood flow restriction, likely triggered both intramuscular metabolic responses (e.g., H⁺ accumulation, phosphocreatine depletion) and systemic hormonal adaptations [ 3 , 27 ]. In the non-dominant leg, the observed increases in jump height (Δ% = +20.93) and flight time strongly support the presence of a CE effect. A systematic review and meta-analysis by Sun et al., [ 11 ] reported that unilateral BFR training can produce significant strength gains in the non-dominant leg, particularly via interhemispheric facilitation at the corticospinal level. Unlike most CE studies relying on isometric strength measures, our work is the first to demonstrate the CE effect through a walking-based intervention. This effect may be explained by increased bilateral activation in the motor cortex, improved reciprocal excitability in neuromuscular circuits, and reorganization of the sensorimotor cortex [ 15 , 16 ]. Moreover, the metabolic stress induced by BFR is known to provide strong afferent feedback via group III–IV afferent fibers, thereby enhancing neuromotor responses bilaterally [ 26 , 27 ]. The 40% AOP used in our protocol likely offered a safe yet effective loading stimulus, maintaining participant comfort while increasing metabolic stress and neuromuscular activation, thereby contributing to contralateral performance gains [ 18 , 28 ]. In bilateral CMJ tests, performance improvements relative to baseline reached Δ% = +14.78. The literature contains limited data on how unilateral training affects bilateral functional outcomes. Loenneke et al., [ 19 ] suggested that low-intensity BFR may induce systemic neural adaptations, though evidence of such effects in dynamic tasks (e.g., jumping) has been scarce. Our results demonstrate that a complex, multi-joint, and synergistically controlled task like the CMJ can be improved through unilateral loading alone. Findings from previous studies align with ours. Clarkson et al., [ 29 ] reported that a six-week low-intensity walking program with BFR resulted in 2–4 times greater improvements in functional tests (30 s sit-to-stand, 6-min walk, timed up-and-go) compared to controls. This is consistent with our observation that just six sessions of low-intensity BFR walking yielded significant gains in jump height and flight time. Similarly, Abe et al., [ 30 ] found that combining low-intensity walking with BFR led to significant increases in muscle strength and lower-limb power. Abe et al., [ 31 ] further demonstrated that a 15-minute, 40% VO₂max BFR walking protocol produced meaningful increases in thigh muscle volume and aerobic capacity in young men. These findings suggest that BFR enhances not only hypertrophic but also cardiovascular adaptations. Beere et al., [ 32 ] showed that low-volume BFR walking in older adults improved functional performance despite halving total exercise time, highlighting its applicability in populations where high-intensity training is not feasible. Sex-specific differences have also been noted. Nancekievill et al., [ 33 ] reported that while BFR supports muscle development in both men and women, strength gains were more pronounced in men a finding potentially linked to the predominance of type II fibers, which adapt rapidly to BFR, and to the exclusively male cohort in our study. Similarly, Centner et al., [ 34 ] concluded that low-load BFR exercise produces significant increases in muscle strength and mass, paralleling our observed gains in CMJ parameters. Notably, the choice of a low-pressure setting (40% AOP) indicates that these benefits can be achieved with minimal risk. Contradictory findings exist, with some studies [ 35 , 36 ] reporting no effect of BFR on jump performance — differences likely due to protocol type (e.g., acute high-pressure 200 mmHg [ 35 ]) or participant characteristics. Chen et al., [ 6 ] showed that low-load BFR training enhanced both jump and strength performance in basketball players; our walking-based protocol achieved similar gains without sport-specific drills. Mladen et al., [ 37 ] suggested that reduced limb blood flow during exercise triggers compensatory physiological adaptations, aligning with our interpretation of the biological basis for the observed improvements. Conceição et al., [ 38 ] demonstrated that adding BFR to low-intensity cycling produced strength and hypertrophy outcomes comparable to high-intensity resistance training, whereas endurance-only groups showed no change. These findings collectively position BFR as an effective alternative when high-intensity loading is impractical. In our study, CMJ performance improvements were consistent across all six sessions (48-hour intervals), emphasizing the substantial role of CE in explosive performance outcomes. Horiuchi et al., [ 35 ] found that BFR-supported resistance training improved jump height and power under both bodyweight and loaded conditions, supporting the idea that low mechanical load with BFR can enhance explosive performance. Sun, Yang, and Luo [ 11 ] noted that BFR-based CE protocols produce similar strength gains without significant hypertrophy, suggesting that reduced mechanical intensity may preferentially enhance neural activation. A recent meta-analysis [ 39 ] confirmed that BFR-supported resistance training significantly improves lower-limb explosive power, particularly in individuals with low load tolerance. Additionally, BFR combined with aerobic exercise has been shown to improve muscular endurance, maximal oxygen uptake, and maximal heart rate [ 40 ]. Daryani and Borkar [ 41 ] also observed significant increases in thigh circumference following BFR-aerobic exercise, consistent with our functional performance gains. The CE phenomenon is primarily mediated by neural pathways, with BFR accelerating motor unit recruitment and enhancing neuromuscular adaptation through locally induced high metabolic stress. Importantly, BFR can increase muscle strength and mass in the untrained contralateral limb when applied unilaterally, whether alone or in conjunction with exercise [ 42 ]. Colomer-Poveda et al., [ 43 ] found that while high-load resistance training increased maximal strength in both trained and untrained limbs, low-load training without BFR did not produce a CE effect. In contrast, our study demonstrated chronic performance benefits in both limbs using a low-intensity exercise combined with BFR. The absence of differences in jump performance measures unrelated to BFR further supports that the observed improvements were attributable to the intervention itself. Given that walking is a low-intensity aerobic activity, it would not normally be expected to enhance vertical jump performance — a task requiring high mechanical loading and neuromuscular stimulus [ 44 ]. Consistent with the literature, low-intensity exercise alone does not induce CE; however, when combined with BFR, the effect emerges [ 12 ]. The significant increases in flight time and jump height in both dominant and non-dominant legs indicate that CE can be triggered even in a low-intensity modality like walking when coupled with BFR. Future studies should compare the CE effects of BFR combined with different exercise modalities (e.g., cycle ergometry, stair climbing, isometric holds) and assess safety and efficacy in female athletes, older adults, and clinical populations. Given that injury rehabilitation and periods of immobilization are often accompanied by declines in strength, power, and functional capacity, strategies that provide rapid and substantial gains with minimal mechanical stress are highly valuable. Our findings suggest that the low-intensity BFR walking protocol may be an effective tool for both rehabilitation and performance optimization in a wide range of individuals. This study included only healthy, young, resistance-trained males, which limits generalizability. We also did not include a non-BFR unilateral walking control group, preventing direct quantification of the additive effect of BFR. Finally, neural adaptations were inferred but not directly measured. Conclusion This study demonstrates that unilateral low-pressure (40% AOP) BFR walking exercise leads to significant functional performance improvements not only in the trained limb but also in the contralateral untrained limb (non-dominant) and in bilateral tasks. Notably, enhancements in explosive power indicators such as jump height and flight time highlight the combined contributions of local muscle activation and systemic neuromotor adaptations. Our findings offer a novel contribution to the limited body of literature on the BFR–cross-education relationship by employing a dynamic protocol (walking) and a functional test (CMJ). The ability to safely apply low-pressure BFR while eliciting contralateral performance gains supports its use as a valuable tool in both rehabilitation and performance enhancement contexts. Practical Recommendations In cases of unilateral injury in athletes, applying low-pressure BFR (40% AOP) exercises to the healthy limb can help maintain performance in both legs. The low-risk, low-intensity BFR walking protocol can be utilized in rehabilitation clinics and by performance coaches aiming to optimize in-season training loads. Assessing gains through functional outcomes such as jump height — rather than strength measures alone — provides direct insight into performance relevance. In rehabilitation, BFR protocols can be a safe and effective method to preserve performance in immobilized limbs. For competitive athletes, unilateral BFR exercises during recovery or post-injury phases can help maintain bilateral jump performance. In older adults, where high-load lifting may be risky, low-load CE-based strength strategies can be implemented safely. Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Istanbul Nişantaşı University Ethics Committee (Approval No: SBETKK-2025-03), All participants provided written informed consent prior to participation. Consent for publication Not applicable. Availability of data and materials The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was funded by the Istanbul Nişantaşı University Scientific Research Projects Coordination with grant number/2025/08. Authors’ contributions DEK and TA conceived the ideas; DEK and EA searched articles; DEK and EA collected the data; DEK, TA and EA were involved in the methodology; DEK, TA and EA reviewed and edited; All authors have read and agreed to the published version of the manuscript. Acknowledgements The authors would like to thank all participants for their valuable contributions to this research. Clinical trial number: Not applicable References Patterson SD, Hughes L, Warmington S, Burr J, Scott BR, Owens J, et al., Blood flow restriction exercise: considerations of methodology, application, and safety. 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1","display":"","copyAsset":false,"role":"figure","size":232843,"visible":true,"origin":"","legend":"\u003cp\u003eChanges in Dominant and Non-Dominant Limb Jump Height/Flight Time\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7357175/v1/51ace0a3382b45d68a5a35be.png"},{"id":91841511,"identity":"9e6a399c-c165-440c-9a8f-2a551ef72a78","added_by":"auto","created_at":"2025-09-22 09:55:52","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":190662,"visible":true,"origin":"","legend":"\u003cp\u003eChanges in Non-Dominant Limb Jump Height from Pre-Test to Post-Test\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7357175/v1/4797f79b02ff858cb37023ed.png"},{"id":92518205,"identity":"cbf374b9-2f6a-418b-bf20-718b503b408d","added_by":"auto","created_at":"2025-09-30 14:32:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1343375,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7357175/v1/bfc7eb6e-c63b-4b41-b580-82940cc321ea.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cross-Education Responses to Unilateral Blood Flow Restriction Walking Exercise","fulltext":[{"header":"Background","content":"\u003cp\u003eThe pursuit of enhancing neuromuscular performance while minimizing mechanical loading has accelerated the development of alternative training strategies in sports science and rehabilitation. Blood Flow Restriction (BFR) involves the partial restriction of arterial inflow and complete restriction of venous return to a limb by applying pneumatic cuffs to the most proximal portion of the extremities. In BFR training, blood flow to the working muscles is partially occluded using a pressurized cuff [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Even during low-intensity exercise, this application creates a localized hypoxic environment, thereby increasing muscle activation. Through the combination of metabolic stress, hypoxia, and vascular shear stress \u0026mdash; similar to high-intensity training \u0026mdash; BFR can stimulate the release of growth factors, enhance muscle protein synthesis, and promote muscle hypertrophy and strength gains [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIndeed, consistent evidence has demonstrated that BFR training performed at low loads (20\u0026ndash;30% of one-repetition maximum, 1RM) produces significantly greater adaptations compared to identical exercises without BFR [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Over the past two decades, studies have shown that low-intensity BFR training can elicit physiological adaptations comparable to those achieved through high-intensity resistance training in terms of muscle hypertrophy and strength gains [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These effects have been observed across a wide range of populations, from elite athletes to individuals undergoing postoperative rehabilitation, and BFR has been proposed as an important alternative particularly for those who cannot tolerate high joint stress [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this context, another phenomenon known as Cross-Education (CE) has been shown to produce strength gains in the contralateral limb following unilateral resistance training [\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. CE is widely accepted to arise primarily from neurological adaptations, such as increased motor unit activity in the untrained limb, elevated cortical excitability, and enhanced reflex responses at the spinal level [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These neural adaptations allow, for example, the left arm to gain partial strength when only the right arm is trained, making CE a useful strategy for mitigating atrophy and strength loss in an injured limb by training the uninjured side [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRecent studies have suggested that unilateral BFR-supported resistance training may further enhance the CE effect. In a meta-analysis, Liang Sun et al., [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] reported that low-load BFR training resulted in greater cross-transfer than both high-load training and low-load training without BFR. Similarly, Wong et al., [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] found that isometric strength training with BFR improved contralateral strength gains. These findings suggest that the metabolic stress and afferent feedback induced by BFR can enhance central nervous system activation and strengthen the CE effect at a neural level. Hill et al., [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] observed up to a 13% strength increase in the contralateral arm in an eccentric BFR group, whereas the concentric BFR group did not achieve significant cross-transfer, indicating that muscle action type may also play a role in CE.\u003c/p\u003e\u003cp\u003eHowever, the number of studies examining BFR in the context of CE remains limited, and most available data are based on isometric or isokinetic strength measurements. A recent review [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] confirmed that low-intensity BFR training produces significantly greater contralateral strength gains compared to conventional unilateral training. That same review, however, emphasized that structural adaptations such as muscle hypertrophy do not show a notable transfer to the untrained limb, suggesting that the CE effect induced by BFR is largely neuromuscular and does not necessarily result in hypertrophy.\u003c/p\u003e\u003cp\u003eNotable limitations exist in the current literature: most studies have focused on isometric contractions or upper-limb protocols [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], with insufficient investigation of dynamic, functional lower-limb activities such as walking or jumping. Furthermore, the effects of low-pressure BFR protocols (\u0026le;\u0026thinsp;40% AOP) on CE have been assessed in only a few studies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. While there is evidence supporting a synergistic interaction between BFR and CE, most research to date has been restricted to single muscle groups, used isometric testing protocols, and reported outcomes that do not directly translate to functional performance.\u003c/p\u003e\u003cp\u003eAlthough unilateral BFR-assisted walking presents an appealing option due to its low joint loading and high practical feasibility, its impact on cross-transfer effects has yet to be systematically evaluated. Of particular interest is whether low-intensity, lower-limb\u0026ndash;dominant exercise such as walking, when combined with BFR, can improve contralateral performance in explosive tasks such as vertical jump height \u0026mdash; a critical indicator of lower-limb power output. Most CE studies have evaluated outcomes via maximal isometric strength, 1RM, or isokinetic power, yet countermovement jump (CMJ) height serves as a practical, sport-relevant measure of lower-limb power and explosive capacity, typically requiring coordinated contributions from both legs. Whether unilateral training can yield cross-transfer to high-velocity, power-oriented tasks like CMJ remains a gap in the literature.\u003c/p\u003e\u003cp\u003ePrevious research has shown that CE is generally achieved through high-intensity resistance training, and that low-intensity walking alone does not produce this effect [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, the present study is noteworthy for examining the potential of inducing CE by adding BFR to a low-intensity activity such as walking.\u003c/p\u003e\u003cp\u003eAccordingly, the aim of this study was to determine whether a six-session unilateral low-pressure (40% AOP) BFR walking protocol could elicit a cross-education effect in healthy, resistance-trained young men. Specifically, we investigated the effects of unilateral low-pressure BFR walking on jump height in both the trained (dominant) and untrained (non-dominant) legs, as well as bilateral CMJ performance. This approach allows for CE assessment in functional motor outputs (e.g., jump height, flight time) rather than purely isometric strength, providing a more sport-relevant evaluation.\u003c/p\u003e\u003cp\u003eWe hypothesized that low-intensity BFR walking would improve jump performance in the trained limb and, more importantly, induce a significant CE effect in the untrained limb through neural adaptations. This would clarify whether unilateral BFR training can yield bilateral benefits in lower-limb explosive power and provide a scientific basis for new applications in both rehabilitation and athletic performance.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eA total of 33 male volunteers participated in the study (age (years): 19.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79; height (cm): 177.23\u0026thinsp;\u0026plusmn;\u0026thinsp;5.17; body mass (kg): 70.84\u0026thinsp;\u0026plusmn;\u0026thinsp;9.76; BMI (kg/m\u0026sup2;): 22.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.63; lean mass of the left leg (kg): 10.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08; lean mass of the right leg (kg): 10.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99; systolic blood pressure (mmHg): 113.85\u0026thinsp;\u0026plusmn;\u0026thinsp;9.75; diastolic blood pressure (mmHg): 72.97\u0026thinsp;\u0026plusmn;\u0026thinsp;9.23; 40% occlusion pressure: 77.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97; and brachial index: 0.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08). However, three participants were excluded from the study due to ankle\u0026ndash;brachial pressure index values below 0.9 or above 1.3, resulting in the evaluation of 30 participants.\u003c/p\u003e\u003cp\u003eAlthough the G*Power analysis determined the target minimum sample size as 20 participants (power (1\u0026ndash;β)\u0026thinsp;=\u0026thinsp;0.90, effect size\u0026thinsp;=\u0026thinsp;0.25, type I error (α)\u0026thinsp;=\u0026thinsp;0.05, number of groups\u0026thinsp;=\u0026thinsp;1), the study was completed with 30 participants. Prior to measurements and testing, participants were informed in detail according to the procedures outlined in the Declaration of Helsinki about the aim, content, significance, and implementation of the study, the possible risks, and their right to withdraw at any time without penalty. Familiarization measurements and tests were conducted, and all participants signed an informed consent form.\u003c/p\u003e\u003cp\u003eInclusion criteria were: being male, volunteering to participate, aged between 18\u0026ndash;25 years, free from any health problems, not taking any medication or dietary supplements, abstaining from alcohol and smoking, and engaging in regular exercise for at least three years.\u003c/p\u003e\u003cp\u003eExclusion criteria were: experiencing any health problems during the study, failure to comply with the research protocol, missing any training session, occurrence of symptoms such as dizziness or chest pain during the study, ankle\u0026ndash;brachial pressure index below 0.9 or above 1.3, hypertension (\u0026ge;\u0026thinsp;140/90 mmHg), obesity (BMI\u0026thinsp;\u0026ge;\u0026thinsp;30 kg\u0026middot;m⁻\u0026sup2;), presence of varicose veins, history of deep vein thrombosis or pulmonary embolism in the participant or their family.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudyDesign\u003c/h3\u003e\n\u003cp\u003e The study was conducted in accordance with the principles of the Declaration of Helsinki, relevant national laws, and regulations governing the ethical use of human participants, following approval from the Istanbul Nişantaşı University Ethics Committee (SBETKK-2025-03).\u003c/p\u003e\u003cp\u003e Participants first attended familiarization sessions in which they were informed about the blood flow restriction (BFR) procedure to be applied. Prior to testing, baseline measurements were recorded, including age, height, body mass, body fat percentage, lean body mass percentage, thigh circumference, resting systolic blood pressure, and diastolic blood pressure. Participants were instructed to refrain from high-intensity exercise for 48 hours before the study, to maintain their usual dietary intake for 24 hours prior to testing, and to avoid smoking, alcohol, and caffeine consumption during this period.\u003c/p\u003e\u003cp\u003eDuring the walking exercise, cuff pressure was set to 40% of the individual\u0026rsquo;s arterial occlusion pressure (AOP) (Smart Tools Plus LLC, Strongsville, OH, United States). The BFR walking training was performed unilaterally on the dominant leg for six sessions, with 48-hour intervals between sessions. Each walking session lasted five minutes at a speed of 5 km/h. Immediately after each walking session, countermovement jump (CMJ) performance was assessed for the dominant, non-dominant, and bilateral legs, recording the variables: Height (cm), Tflight (s), Jump Point, Used Area, and Verticality.\u003c/p\u003e\n\u003ch3\u003eFamiliarization Sessions\u003c/h3\u003e\n\u003cp\u003eFamiliarization sessions were conducted one week prior to the main experiment. During these sessions, participants\u0026rsquo; descriptive anthropometric data (height, body mass, body fat percentage, and lean body mass) were recorded. Height was measured using a stadiometer with 1 mm precision (Seca 213, Germany). Body mass and body composition were assessed in a fasted state using a bioelectrical impedance body analyzer (Tanita BC 545 N, USA). Resting blood pressure and heart rate were also recorded.\u003c/p\u003e\u003cp\u003eFollowing the determination of full arterial occlusion pressure (AOP), participants performed a 2-minute walking exercise at a speed of 5 km/h with 40% AOP applied. Immediately after the walking exercise, countermovement jump (CMJ) tests were conducted for the dominant, non-dominant, and bilateral legs (OptoJump, Microgate, Bolzano, Italy).\u003c/p\u003e\n\u003ch3\u003eDetermination of Individual Arterial Occlusion Pressure (AOP)\u003c/h3\u003e\n\u003cp\u003eTo determine individual arterial occlusion pressure, full arterial occlusion pressure (AOP) values were measured twice for each lower limb in a supine resting position. These values were then used to set the cuff pressure for the exercise sessions. The level of vascular restriction was monitored via Doppler ultrasound at the tibialis posterior artery (OLED display Edan SD3 Doppler with a 2 MHz probe; Edan Instruments, Shenzhen, China).\u003c/p\u003e\n\u003ch3\u003eDetermination of Brachial Index\u003c/h3\u003e\n\u003cp\u003eThe brachial index (BI) is a simple, non-invasive test used to assess circulatory system health. Brachial artery pressure is measured in both upper limbs in the supine position using a blood pressure cuff. Bilateral ankle pressures (dorsalis pedis and posterior tibial arteries) are determined using a Doppler device (Edan Instruments, Shenzhen, China) with a 2 MHz probe. Brachial index categories are classified as follows: Low BI: BI\u0026thinsp;\u0026le;\u0026thinsp;0.90, Normal BI: 0.90\u0026thinsp;\u0026lt;\u0026thinsp;BI\u0026thinsp;\u0026lt;\u0026thinsp;1.30, and High BI: BI\u0026thinsp;\u0026ge;\u0026thinsp;1.30. BI is calculated using the following formula: Higher ankle pressure (dorsalis pedis or posterior tibial artery) / brachial systolic pressure [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eCountermovement Jump Tests\u003c/h2\u003e\u003cp\u003eThe vertical jump height achieved from the participants\u0026rsquo; center of mass, along with elastic force parameters affecting anaerobic power levels and explosive strength, was measured using the OptoJump system (Microgate, Bolzano, Italy). Prior to the measurement, participants were instructed to remain in an upright position for 2 seconds, ensuring full knee extension and maintaining an erect posture [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFollowing a rapid semi-squat movement, participants performed a maximal vertical jump. This test aims to evaluate the function of the stretch\u0026ndash;shortening cycle, the utilization of elastic energy, and the explosive power capacity of the lower-extremity extensor muscles [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. During the jump, the arms-free protocol was applied, and vertical jump performance was recorded for the dominant, non-dominant, and bilateral legs, assessing the variables: Height (cm), Tflight (s), Jump Point, Used Area, and Verticality.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eData are presented as Ortalamas and standard deviations. Normality of the data was assessed using the Shapiro\u0026ndash;Wilk test, which indicated that the data did not show a normal distribution (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Therefore, non-parametric tests were performed. For the analysis of repeated measures, the Friedman analysis was applied. Effect size was reported using Kendall\u0026rsquo;s W. The general classification of Kendall\u0026rsquo;s W; W\u0026thinsp;\u0026lt;\u0026thinsp;0.10 indicates a very weak effect; 0.10\u0026thinsp;\u0026le;\u0026thinsp;W\u0026thinsp;\u0026lt;\u0026thinsp;0.30 indicates a weak effect; 0.30\u0026thinsp;\u0026le;\u0026thinsp;W\u0026thinsp;\u0026lt;\u0026thinsp;0.50 indicates a moderate effect; and W\u0026thinsp;\u0026ge;\u0026thinsp;0.50 indicates a strong effect. Post hoc comparisons were applied using the Conover test with Bonferroni correction. Effect sizes for post-hoc analyses were reported using the rank-biserial correlation coefficient. The general classification of rank-biserial correlation r\u0026thinsp;\u0026lt;\u0026thinsp;0.10 indicates a very weak effect; 0.10\u0026thinsp;\u0026le;\u0026thinsp;r\u0026thinsp;\u0026lt;\u0026thinsp;0.30 a weak effect; 0.30\u0026thinsp;\u0026le;\u0026thinsp;r\u0026thinsp;\u0026lt;\u0026thinsp;0.50 a moderate effect; and r\u0026thinsp;\u0026ge;\u0026thinsp;0.50 a strong effect. All statistical analyses were performed using JASP software (version 0.19.3, Netherlands). A significance level was set at p\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe baseline characteristics of the male participants (n = 30) are presented in Table 1. The mean brachial index (BI) was 0.97 ± 0.08, and the average occlusion pressure at 40% AOP was 77.93 ± 0.97 mmHg. For countermovement jump performance at baseline, the dominant limb flight time was 0.392 ± 0.038 s with a jump height of 19.020 ± 3.853 cm, while the non-dominant limb showed a flight time of 0.390 ± 0.042 s and a height of 18.813 ± 4.108 cm. Bilateral jumps had a flight time of 0.541 ± 0.044 s and a height of 36.060 ± 6.046 cm\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eBaseline demographic and performance characteristics of participants (n = 30)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e40% OP\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDTFlight B\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDHeight B\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNDom- TFlight B\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNDom- Height B\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBL TFlight B\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBL Height B\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.97 ± 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.93 ± 0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.392 ± 0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.020 ± 3.853\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.390 ± 0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.813 ± 4.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.541 ± 0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.060 ± 6.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003eValues are presented as Mean ± Standard Deviation. Brakial Index; BI, %40 OP; 40% Oclussion Pressure, DTFlight B; Dom- TFligfht Basal, DHeight B; Dominant Height Basal, NDom- TFlight B; Non Dominant TFlight Basal, NDom- Height B; Non Dominant Height Basal, BL TFlight B; Bilateral TFlight Basal, BL Height B; Bilateral Height Basal\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe changes in flight time (TFlight) and jump height (Height) across six training sessions were analyzed separately for dominant and non-dominant limbs (Table 2). In the dominant limb, TFlight showed a progressive increase from 0.392 ± 0.040 s in the first session to 0.426 ± 0.047 s in the sixth session. Statistically significant changes were observed starting from the fourth session onwards (p \u0026lt; 0.001), with large effect sizes (rrb ≥ − 0.899). Similar patterns were found for jump height, with significant increases emerging from the fourth session (from 19.02 ± 3.85 cm to 22.52 ± 5.41 cm, p \u0026lt; 0.001).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eChanges in Flight Time (TFlight) and Jump Height (Height) across six sessions for dominant and non-dominant limbs \u003cem\u003eReference: Basal\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eDominant Limb\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eNon- Dominant Limb\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eTFLight\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eTFLight\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSession\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean ± SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003erb\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003csub\u003ebonf\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean ± SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003erb\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003csub\u003ebonf\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean ± SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003erb\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003csub\u003ebonf\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean ± SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003erb\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003csub\u003ebonf\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.392 ± 0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.54 ± 4.166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.397 ± 0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.571\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.563 ± 4.435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecond\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.397 ± 0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.655 ± 3,956\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.406 ± 0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.429 ± 4.424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.766\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eThird\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.399 ± 0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.543 ± 4.276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.609\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.412 ± 0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.724\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.110 ± 5.201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.764\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFourth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.408 ± 0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.899\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.750 ± 4.529\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.892\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.416 ± 0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.437 ± 5.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.828\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFifth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.419 ± 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.908\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.523 ± 5.411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.422 ± 0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.970\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.160 ± 5.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSixth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.426 ± 0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.946\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.222 ± 5.208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.428 ± 0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.946\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.756 ± 5.350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.944\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\"\u003eAbbreviations: TFlight, flight time; Height, jump height; Mean ± standard deviation (SD) values of flight time (TFlight) and jump height are shown across six measurement sessions for both dominant and non-dominant limbs. Statistical analysis was performed using Friedman test followed by Bonferroni-corrected post-hoc Wilcoxon signed-rank tests. Effect sizes are presented as rank biserial correlation coefficients (rrb). \u003cem\u003eStatistical significance was set at * p ≤ 0.05.\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eIn the non-dominant limb, improvements in both TFlight and jump height became statistically significant basal from the second session (p = 0.004) and continued to increase significantly in later sessions. TFlight rose from 0.390 ± 0.042 s to 0.422 ± 0.049 s, and jump height from 18.81 ± 4.10 cm to 22.16 ± 5.30 cm by the final session (p \u0026lt; 0.001) (Table 2).\u003c/p\u003e\n\u003cp\u003eThese findings indicate a consistent and significant enhancement in neuromuscular performance over time, with the non-dominant limb showing earlier adaptation than the dominant limb.\u003c/p\u003e\n\u003cp\u003eIn the dominant limb, the median ± IQR values for countermovement jump (CMJ) parameters were as follows: TFlight 0.40 ± 0.06 s, Height 19.6 ± 5.95 cm, Jump Point − 5.2 ± 13.1 cm, Used Area 33.3 ± 16.6 cm², and Verticality 2.47 ± 3.36 cm/s. In the non-dominant limb, the corresponding median ± IQR values were highly comparable: TFlight 0.40 ± 0.05 s, Height 19.7 ± 5.35 cm, Jump Point − 4.7 ± 13.55 cm, Used Area 34.4 ± 17.7 cm², and Verticality 3.24 ± 4.72 cm/s (Table 3).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eFriedman test results, effect sizes, and median ± IQR values for countermovement jump parameters across dominant, non- dominant, and bilateral limbs.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMeasurement\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eDominant Limb\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eNon- Dominant Limb\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eBilateral Limb\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eχ²\u003csub\u003e(6)\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eKendall’s W\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian ± IQR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eχ²\u003csub\u003e(6)\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eKendall’s W\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian ± IQR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eχ²\u003csub\u003e(6)\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eKendall’s W\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian ± IQR\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTflight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77.253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e≤ 0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.40 ± 0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62.760\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e≤ 0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.349\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.40 ± 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76.220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e≤ 0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.54 ± 0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e105.672\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e≤ 0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.587\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.60 ± 5.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62.968\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e≤ 0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.70 ± 5.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76.220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e≤ 0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.80 ± 9.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJump Point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-5.20 ± 13.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.611\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-4.70 ± 13.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-5.70 ± 15.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUsed Area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.30 ± 16.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.40 ± 17.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e≤ 0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.30 ± 7.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVerticality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.886\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.692\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.47 ± 3.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.540\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.24 ± 4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.468\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.81 ± 7.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\"\u003eAbbreviations: TFlight, flight time; Height, jump height; Used Area, contact area during jump; Verticality, vertical velocity. (χ²): Chi-square test statistics; Kendall’s W: effect sizes. Statistical significance was set at * p ≤ 0.05.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThese values indicate that unilateral BFR walking exercise led to consistent improvements in CMJ performance across both trained (dominant) and untrained (non-dominant) limbs. The similarity of TFlight and Height medians between limbs suggests an effective cross-education effect. While Jump Point variability (IQR) remained wide in both limbs, the comparable Used Area and Verticality distributions reflect the transfer of motor coordination and power output to the non-dominant side.\u003c/p\u003e\n\u003cp\u003eThe Friedman test revealed significant time effects for TFlight and Height across all limbs (p ≤ 0.001), with effect sizes ranging from moderate to large (Kendall’s W = 0.349–0.587). In the dominant limb, median ± IQR values were TFlight 0.40 ± 0.06 s and Height 19.6 ± 5.95 cm. Comparable values were observed in the non-dominant limb (TFlight 0.40 ± 0.05 s, Height 19.7 ± 5.35 cm), supporting the presence of a cross-education effect (Table 3).\u003c/p\u003e\n\u003cp\u003eIn the bilateral condition, the highest absolute performance values were recorded for both TFlight (0.54 ± 0.06 s) and Height (36.8 ± 9.05 cm), reflecting the combined contribution of both limbs.\u003c/p\u003e\n\u003cp\u003eJump Point and Verticality did not show statistically significant changes in any limb (p \u0026gt; 0.05). Used Area demonstrated significant improvements in the dominant and bilateral conditions (p = 0.004 and p ≤ 0.001, respectively), whereas no significant changes were detected in the non-dominant limb. These findings suggest that motor control adaptations, as reflected in spatial utilization, are more evident when both limbs are engaged (Table 3).\u003c/p\u003e\n\u003cp\u003eThe analysis of percentage change (Δ%) from baseline across sessions revealed progressive improvements in countermovement jump parameters for all limbs (Table 4).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003ePercentage Delta Differences (Δ%) in countermovement jump parameters across sessions for dominant, non-dominant, and bilateral limbs. \u003cem\u003eReference: Basal\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSession\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eDominant Limb\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eNon- Dominant Limb\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eBilateral Limb\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTFLight\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUsed Area\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eJump Point\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVerticality\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTFLight\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUsed Area\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eJump Point\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVerticality\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTFLight\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUsed Area\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eJump Point\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVerticality\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 1.28%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 2.73%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 0.61%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 1.59%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 3.39%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 0.58%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 1.25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 3.29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 0.83%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 1.66%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 3.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 1.78%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 3.37%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 0.84%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecond\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 1.79%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 3.34%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 2.41%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 3.19%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 1.69%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 1.54%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 4.30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 2.22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 6.58%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 1.67%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 3.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 7.41%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 3.64%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 6.74%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 1.68%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eThird\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 4.08%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 8.01%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 4.01%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 8.37%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 3.59%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 9.02%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 3.81%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 10.29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 0.83%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 4.81%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 10.48%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 4.89%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 10.11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 0.84%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFourth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 6.89%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 14.34%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 5.45%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 13.55%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e–0.85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 5.13%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 14.31%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 4.88%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 12.76%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 5.36%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 12.17%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 5.87%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 13.48%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFifth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 8.67%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 18.43%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 6.41%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 15.94%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e–1.69%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 6.92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 19.48%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 7.12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 15.64%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e–0.83%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 6.28%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 13.92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 8.43%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 16.85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e–0.84%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSixth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 10.46%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 22.06%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 8.90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 19.92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e–3.39%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 9.74%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 20.93%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 8.25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 18.11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e–1.67%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 7.03%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 14.78%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 9.10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+ 20.22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e–1.68%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"17\"\u003eAbbreviations: TFlight, flight time; Height, jump height; Used Area, contact area during jump; Verticality, vertical velocity.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eIn the dominant limb, TFlight increased steadily from + 1.28% in the first session to + 10.46% in the sixth session, and Height rose from + 2.73% to + 22.06%. Used Area also demonstrated notable growth (+ 0.61% to + 8.90%). Jump Point showed a positive trend despite small fluctuations, whereas Verticality exhibited a gradual decrease (− 3.39% at the sixth session), indicating a more controlled vertical movement pattern.\u003c/p\u003e\n\u003cp\u003eIn the non-dominant limb, a similar pattern was observed, supporting the cross-education effect. TFlight improved from 0% to + 9.74%, and Height from + 0.58% to + 20.93%. Used Area gains were comparable (+ 1.25% to + 8.25%), while Jump Point and Verticality changes mirrored those of the dominant limb.\u003c/p\u003e\n\u003cp\u003eIn the bilateral condition, both TFlight and Height reached the highest relative increases (+ 7.03% and + 14.78%, respectively, at the sixth session), reflecting the combined contribution of both limbs. Used Area and Jump Point demonstrated consistent enhancements, and Verticality changes remained minimal, supporting the interpretation of stable motor control despite performance gains (Table 4).\u003c/p\u003e\n\u003cp\u003eOverall, these findings indicate that unilateral low-pressure BFR walking exercise elicits consistent and progressive improvements in CMJ performance parameters, with clear transfer to the untrained limb and additive effects in bilateral performance.\u003c/p\u003e\n\u003cp\u003ePercentage changes from baseline are presented for TFlight, Height, Used Area, Jump Point, and Verticality across six training sessions. Progressive improvements were observed in TFlight and Height in all limbs, with the greatest absolute gains in the bilateral condition. Non-dominant limb changes paralleled those of the dominant limb, indicating a clear cross-education effect. Used Area showed moderate improvements, while Jump Point and Verticality changes were minimal, suggesting stable motor control despite performance gains.\u003c/p\u003e\n\u003cp\u003eFigure 1 shows the changes in flight time (top panel) and jump height (bottom panel) of the dominant and non-dominant limbs from the baseline to the sixth training session (n = 30, male participants). Both limbs demonstrated a progressive increase in flight time and jump height across sessions. The dominant limb exhibited slightly lower flight time values than the non-dominant limb until the fourth session, after which the gap narrowed. In contrast, jump height of the dominant limb surpassed that of the non-dominant limb from the fourth session onwards, with both showing a steady upward trend throughout the study period.\u003c/p\u003e\n\u003cp\u003eThe graph illustrates the change in countermovement jump (CMJ) height for the non-dominant limb from pre-test to post-test. Individual participant data (gray lines) show a consistent upward trend, with the group mean (blue line) indicating an overall improvement in performance. This increase supports the presence of a cross-education effect, suggesting that unilateral BFR walking exercise on the dominant limb transferred performance gains to the non-dominant limb (Fig. 2).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study was designed as a low-intensity, dynamic exercise intervention in the form of walking, combined with unilateral low-pressure (40% Arterial Occlusion Pressure, AOP) Blood Flow Restriction (BFR) to examine its effects on countermovement jump (CMJ) performance in the dominant, non-dominant, and bilateral legs. Our findings revealed significant improvements, particularly in the non-dominant leg \u0026mdash; which did not receive direct BFR application \u0026mdash; for key performance parameters such as jump height (Height) and flight time (TFlight).\u003c/p\u003e\u003cp\u003eThe cross-education (CE; \u0026Ccedil;apraz Transfer) effect is defined as an increase in strength in the untrained limb following unilateral training, and is primarily attributed to central neural mechanisms [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In the literature, the CE effect has typically been reported following high-intensity resistance training, and it is known that low-intensity walking exercise without BFR is insufficient to induce this effect [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, the present study is significant in demonstrating that adding BFR to a low-intensity activity such as walking can elicit a CE effect.\u003c/p\u003e\u003cp\u003eFor the dominant leg, the most notable finding was a substantial and statistically significant increase in CMJ jump height (Δ% = +22.06), supporting the role of BFR in enhancing local muscular strength and explosive power. Similar outcomes were observed in an eccentric-focused upper-limb BFR protocol, where strength gains occurred in both the trained and untrained arms, attributed to metabolic stress\u0026ndash;induced afferent stimulation and increased cortical recruitment [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In our study, the repetitive nature of walking, when combined with hypoxia and blood flow restriction, likely triggered both intramuscular metabolic responses (e.g., H⁺ accumulation, phosphocreatine depletion) and systemic hormonal adaptations [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the non-dominant leg, the observed increases in jump height (Δ% = +20.93) and flight time strongly support the presence of a CE effect. A systematic review and meta-analysis by Sun et al., [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] reported that unilateral BFR training can produce significant strength gains in the non-dominant leg, particularly via interhemispheric facilitation at the corticospinal level. Unlike most CE studies relying on isometric strength measures, our work is the first to demonstrate the CE effect through a walking-based intervention. This effect may be explained by increased bilateral activation in the motor cortex, improved reciprocal excitability in neuromuscular circuits, and reorganization of the sensorimotor cortex [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Moreover, the metabolic stress induced by BFR is known to provide strong afferent feedback via group III\u0026ndash;IV afferent fibers, thereby enhancing neuromotor responses bilaterally [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The 40% AOP used in our protocol likely offered a safe yet effective loading stimulus, maintaining participant comfort while increasing metabolic stress and neuromuscular activation, thereby contributing to contralateral performance gains [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn bilateral CMJ tests, performance improvements relative to baseline reached Δ% = +14.78. The literature contains limited data on how unilateral training affects bilateral functional outcomes. Loenneke et al., [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] suggested that low-intensity BFR may induce systemic neural adaptations, though evidence of such effects in dynamic tasks (e.g., jumping) has been scarce. Our results demonstrate that a complex, multi-joint, and synergistically controlled task like the CMJ can be improved through unilateral loading alone.\u003c/p\u003e\u003cp\u003eFindings from previous studies align with ours. Clarkson et al., [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] reported that a six-week low-intensity walking program with BFR resulted in 2\u0026ndash;4 times greater improvements in functional tests (30 s sit-to-stand, 6-min walk, timed up-and-go) compared to controls. This is consistent with our observation that just six sessions of low-intensity BFR walking yielded significant gains in jump height and flight time. Similarly, Abe et al., [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] found that combining low-intensity walking with BFR led to significant increases in muscle strength and lower-limb power. Abe et al., [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] further demonstrated that a 15-minute, 40% VO₂max BFR walking protocol produced meaningful increases in thigh muscle volume and aerobic capacity in young men. These findings suggest that BFR enhances not only hypertrophic but also cardiovascular adaptations. Beere et al., [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] showed that low-volume BFR walking in older adults improved functional performance despite halving total exercise time, highlighting its applicability in populations where high-intensity training is not feasible.\u003c/p\u003e\u003cp\u003eSex-specific differences have also been noted. Nancekievill et al., [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] reported that while BFR supports muscle development in both men and women, strength gains were more pronounced in men a finding potentially linked to the predominance of type II fibers, which adapt rapidly to BFR, and to the exclusively male cohort in our study. Similarly, Centner et al., [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] concluded that low-load BFR exercise produces significant increases in muscle strength and mass, paralleling our observed gains in CMJ parameters. Notably, the choice of a low-pressure setting (40% AOP) indicates that these benefits can be achieved with minimal risk.\u003c/p\u003e\u003cp\u003eContradictory findings exist, with some studies [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] reporting no effect of BFR on jump performance \u0026mdash; differences likely due to protocol type (e.g., acute high-pressure 200 mmHg [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]) or participant characteristics. Chen et al., [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] showed that low-load BFR training enhanced both jump and strength performance in basketball players; our walking-based protocol achieved similar gains without sport-specific drills. Mladen et al., [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] suggested that reduced limb blood flow during exercise triggers compensatory physiological adaptations, aligning with our interpretation of the biological basis for the observed improvements. Concei\u0026ccedil;\u0026atilde;o et al., [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] demonstrated that adding BFR to low-intensity cycling produced strength and hypertrophy outcomes comparable to high-intensity resistance training, whereas endurance-only groups showed no change. These findings collectively position BFR as an effective alternative when high-intensity loading is impractical.\u003c/p\u003e\u003cp\u003eIn our study, CMJ performance improvements were consistent across all six sessions (48-hour intervals), emphasizing the substantial role of CE in explosive performance outcomes. Horiuchi et al., [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] found that BFR-supported resistance training improved jump height and power under both bodyweight and loaded conditions, supporting the idea that low mechanical load with BFR can enhance explosive performance. Sun, Yang, and Luo [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] noted that BFR-based CE protocols produce similar strength gains without significant hypertrophy, suggesting that reduced mechanical intensity may preferentially enhance neural activation. A recent meta-analysis [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] confirmed that BFR-supported resistance training significantly improves lower-limb explosive power, particularly in individuals with low load tolerance.\u003c/p\u003e\u003cp\u003eAdditionally, BFR combined with aerobic exercise has been shown to improve muscular endurance, maximal oxygen uptake, and maximal heart rate [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Daryani and Borkar [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] also observed significant increases in thigh circumference following BFR-aerobic exercise, consistent with our functional performance gains. The CE phenomenon is primarily mediated by neural pathways, with BFR accelerating motor unit recruitment and enhancing neuromuscular adaptation through locally induced high metabolic stress.\u003c/p\u003e\u003cp\u003eImportantly, BFR can increase muscle strength and mass in the untrained contralateral limb when applied unilaterally, whether alone or in conjunction with exercise [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Colomer-Poveda et al., [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e] found that while high-load resistance training increased maximal strength in both trained and untrained limbs, low-load training without BFR did not produce a CE effect. In contrast, our study demonstrated chronic performance benefits in both limbs using a low-intensity exercise combined with BFR. The absence of differences in jump performance measures unrelated to BFR further supports that the observed improvements were attributable to the intervention itself.\u003c/p\u003e\u003cp\u003eGiven that walking is a low-intensity aerobic activity, it would not normally be expected to enhance vertical jump performance \u0026mdash; a task requiring high mechanical loading and neuromuscular stimulus [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Consistent with the literature, low-intensity exercise alone does not induce CE; however, when combined with BFR, the effect emerges [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The significant increases in flight time and jump height in both dominant and non-dominant legs indicate that CE can be triggered even in a low-intensity modality like walking when coupled with BFR.\u003c/p\u003e\u003cp\u003eFuture studies should compare the CE effects of BFR combined with different exercise modalities (e.g., cycle ergometry, stair climbing, isometric holds) and assess safety and efficacy in female athletes, older adults, and clinical populations. Given that injury rehabilitation and periods of immobilization are often accompanied by declines in strength, power, and functional capacity, strategies that provide rapid and substantial gains with minimal mechanical stress are highly valuable. Our findings suggest that the low-intensity BFR walking protocol may be an effective tool for both rehabilitation and performance optimization in a wide range of individuals.\u003c/p\u003e\u003cp\u003eThis study included only healthy, young, resistance-trained males, which limits generalizability. We also did not include a non-BFR unilateral walking control group, preventing direct quantification of the additive effect of BFR. Finally, neural adaptations were inferred but not directly measured.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that unilateral low-pressure (40% AOP) BFR walking exercise leads to significant functional performance improvements not only in the trained limb but also in the contralateral untrained limb (non-dominant) and in bilateral tasks. Notably, enhancements in explosive power indicators such as jump height and flight time highlight the combined contributions of local muscle activation and systemic neuromotor adaptations.\u003c/p\u003e\u003cp\u003eOur findings offer a novel contribution to the limited body of literature on the BFR\u0026ndash;cross-education relationship by employing a dynamic protocol (walking) and a functional test (CMJ). The ability to safely apply low-pressure BFR while eliciting contralateral performance gains supports its use as a valuable tool in both rehabilitation and performance enhancement contexts.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePractical Recommendations\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIn cases of unilateral injury in athletes, applying low-pressure BFR (40% AOP) exercises to the healthy limb can help maintain performance in both legs.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe low-risk, low-intensity BFR walking protocol can be utilized in rehabilitation clinics and by performance coaches aiming to optimize in-season training loads.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAssessing gains through functional outcomes such as jump height \u0026mdash; rather than strength measures alone \u0026mdash; provides direct insight into performance relevance.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIn rehabilitation, BFR protocols can be a safe and effective method to preserve performance in immobilized limbs.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eFor competitive athletes, unilateral BFR exercises during recovery or post-injury phases can help maintain bilateral jump performance.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIn older adults, where high-load lifting may be risky, low-load CE-based strength strategies can be implemented safely.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Istanbul Nişantaşı University Ethics Committee (Approval No: SBETKK-2025-03), All participants provided written informed consent prior to participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the Istanbul Nişantaşı University Scientific Research Projects Coordination with grant number/2025/08.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDEK and TA conceived the ideas; DEK and EA searched articles; DEK and EA collected the data; DEK, TA and EA were involved in the methodology; DEK, TA and EA reviewed and edited; All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all participants for their valuable contributions to this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePatterson SD, Hughes L, Warmington S, Burr J, Scott BR, Owens J, et al., Blood flow restriction exercise: considerations of methodology, application, and safety. 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J Appl Physiol. 2006;101(5):1514\u0026ndash;22.\u003c/li\u003e\n\u003cli\u003eFarthing JP, Zehr EP. Restoring symmetry: clinical applications of cross-education. Exerc Sport Sci Rev. 2014;42(2):70\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eRuddy KL, Carson RG. Neural pathways mediating cross education of motor function. Front Hum Neurosci. 2013;7:397.\u003c/li\u003e\n\u003cli\u003eLoenneke JP, Hammert WB, Kataoka R, Yamada Y, Abe T. Twenty-five years of blood flow restriction training: what we know, what we don\u0026rsquo;t, and where to next? J Sports Sci. 2025;1\u0026ndash;18.\u003c/li\u003e\n\u003cli\u003eGreen, LA, Gabriel DA. The cross education of strength and skill following unilateral strength training in the upper and lower limbs. 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J Clin Exerc Physiol. 2024;13(s2):439.\u003c/li\u003e\n\u003cli\u003eNancekievill D, Seaman K, Bouchard DR, Thomson AM, S\u0026eacute;n\u0026eacute;chal M. Impact of exercise with blood flow restriction on muscle hypertrophy and performance outcomes in men and women. PLoS One. 2025;20(1):e0301164.\u003c/li\u003e\n\u003cli\u003eCentner C, Wiegel P, Gollhofer A, K\u0026ouml;nig D. Effects of blood flow restriction training on muscular strength and hypertrophy in older individuals: a systematic review and meta-analysis. Sports Med. 2019;49(1):95\u0026ndash;108.\u003c/li\u003e\n\u003cli\u003eHoriuchi M, Endo J, Sato T, Okita K. Jump training with blood flow restriction has no effect on jump performance. Biol Sport. 2018;35(4):343\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eBichowska-Paweska M, Fostiak K, Gawel D, Trybulski R, Alexe DI, Szura E, et al., The acute effect of blood flow restriction or ischemia on countermovement jump performance. J Hum Sport Exerc. 2025;20(2):658\u0026ndash;70.\u003c/li\u003e\n\u003cli\u003eMladen SP, Forbes SP, Zedic AK, England VS, Drouin PJ, Tschakovsky ME. Leg blood flow during exercise with blood flow restriction: evidence for and implications of compensatory cardiovascular mechanisms. J Appl Physiol. 2025;138(2):492\u0026ndash;507.\u003c/li\u003e\n\u003cli\u003eConceicao MS, Junior EM, Telles GD, Libardi CA, Castro A, Andrade AL, et al., Augmented anabolic responses after 8-wk cycling with blood flow restriction. Med Sci Sports Exerc. 2019;51(1):84\u0026ndash;93.\u003c/li\u003e\n\u003cli\u003eWang J, Liu H, Jiang L. The effects of blood flow restriction training on PAP and lower limb muscle activation: a meta-analysis. Front Physiol. 2023;14:1243302.\u003c/li\u003e\n\u003cli\u003ePark 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(4):591\u0026ndash;600.\u003c/li\u003e\n\u003cli\u003eDaryani A, Borkar T. A comparative study of low intensity aerobic blood flow restriction training and conventional aerobic training on VO₂max and thigh muscle girth in healthy 18-25-year-old adults. IJPESH 2020;7(1):158-161.\u003c/li\u003e\n\u003cli\u003eLi S, Li S, Wang L, Quan H, Yu W, Li T, et al., The effect of blood flow restriction exercise on angiogenesis-related factors in skeletal muscle among healthy adults: a systematic review and meta-analysis. Front Physiol. 2022;13:814965.\u003c/li\u003e\n\u003cli\u003eColomer-Poveda D, Hortob\u0026aacute;gyi T, Keller M, Romero-Arenas S, M\u0026aacute;rquez G. Training intensity-dependent increases in corticospinal but not intracortical excitability after acute strength training. Scand J Med Sci Sports. 2020;30(4):652\u0026ndash;61.\u003c/li\u003e\n\u003cli\u003eOliveira LP, Vieira LH, Aquino R, Manechini JP, Santiago PR, Puggina, EF. Acute effects of active, ballistic, passive, and proprioceptive neuromuscular facilitation stretching on sprint and vertical jump performance in trained young soccer players. J Strength Cond Res, 2018;32(8), 2199-2208.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Blood flow restriction, Arterial occlusion pressure, Cross-education effect, Countermovement jump, Unilateral training, Low pressure BFR, Walking exercise","lastPublishedDoi":"10.21203/rs.3.rs-7357175/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7357175/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe aim of this study was to investigate whether unilateral blood flow restriction (BFR) training can promote strength development in both the directly trained and untrained limbs through the cross-education effect.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThirty-three male volunteer athletes participated in the study; three were excluded due to brachial index values outside the required range, leaving 30 participants (age\u0026thinsp;=\u0026thinsp;19.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79 years; body mass\u0026thinsp;=\u0026thinsp;70.84\u0026thinsp;\u0026plusmn;\u0026thinsp;9.76 kg; height\u0026thinsp;=\u0026thinsp;177.23\u0026thinsp;\u0026plusmn;\u0026thinsp;5.17 cm; brachial index\u0026thinsp;=\u0026thinsp;0.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08). The vascular restriction level, determined using the tibialis posterior artery, was monitored via Doppler device. Walking exercise was performed with 40% arterial occlusion pressure (AOP) applied to the dominant leg for six sessions at 48-hour intervals. Countermovement jump (CMJ) measurements were collected for the dominant, non-dominant, and bilateral legs immediately after each session. Data were analyzed using JASP software (v0.19.3) with significance set at p\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFriedman analysis showed significant changes in dominant leg performance over time (TFLight (s): χ\u0026sup2;(6)\u0026thinsp;=\u0026thinsp;77.25, p\u0026thinsp;\u0026le;\u0026thinsp;.001, Kendall\u0026rsquo;s W\u0026thinsp;=\u0026thinsp;.429; Height (cm): χ\u0026sup2;(6)\u0026thinsp;=\u0026thinsp;105.67, p\u0026thinsp;\u0026le;\u0026thinsp;.001, Kendall\u0026rsquo;s W\u0026thinsp;=\u0026thinsp;.587; Jump Point: χ\u0026sup2;(6)\u0026thinsp;=\u0026thinsp;18.52, p\u0026thinsp;=\u0026thinsp;.005; Used Area: χ\u0026sup2;(6)\u0026thinsp;=\u0026thinsp;19.32, p\u0026thinsp;=\u0026thinsp;.004). In the non-dominant leg, significant differences were found for TFLight (χ\u0026sup2;(6)\u0026thinsp;=\u0026thinsp;62.76, p\u0026thinsp;\u0026le;\u0026thinsp;.001, Kendall\u0026rsquo;s W\u0026thinsp;=\u0026thinsp;.349) and Height (χ\u0026sup2;(6)\u0026thinsp;=\u0026thinsp;62.97, p\u0026thinsp;\u0026le;\u0026thinsp;.001, Kendall\u0026rsquo;s W\u0026thinsp;=\u0026thinsp;.350). No significant differences were observed for Jump Point, Used Area, and Verticality variables (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eUnilateral low-pressure BFR walking exercise induced significant improvements in both the BFR-applied (dominant) leg and the non-applied (non-dominant) leg, as well as in bilateral jump performance. These findings support the use of BFR as an effective method to facilitate the cross-education effect, even with low-pressure protocols.\u003c/p\u003e","manuscriptTitle":"Cross-Education Responses to Unilateral Blood Flow Restriction Walking Exercise","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-22 09:54:19","doi":"10.21203/rs.3.rs-7357175/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a51c6f9f-5b04-4df7-8287-e34aef73205b","owner":[],"postedDate":"September 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-30T14:23:55+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-22 09:54:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7357175","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7357175","identity":"rs-7357175","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}