Purpose The effects of short-term blood flow restriction (BFR) exercise on muscle blood flow perfusion and performance during high-intensity exercise were determined in elite para-alpine standing skiers to assess whether this would be an effective training regimen for elite athletes with disabilities. Methods Nine national-level para-alpine standing skiers (mean age, 20.67 ± 1.34 yr; four women) were recruited. Nondominant lower limbs were trained with BFR (eight in final analyses), and dominant lower limbs were trained without BFR (seven in final analyses). The 2-wk protocol included high-load resistance, local muscle endurance (circuit resistance training), and aerobic endurance (stationary cycling) training performed 4 times a week, with BFR during local muscle endurance and aerobic endurance sessions. Muscle strength was measured by maximal voluntary isometric contraction (MVIC) in the knee extensors; microcirculatory blood perfusion (MBP), by laser Doppler blood flow; and muscle strength and endurance, by the total amount of work (TW) performed during high-intensity centrifugal and concentric contractions. Results BFR significantly increased absolute and relative MVIC ( P < 0.001, P = 0.001), MBP ( P = 0.011, P = 0.008), and TW ( P = 0.006, P = 0.007) from pretraining values, whereas only absolute MVIC increased without BFR ( P = 0.047). However, the MVIC increase with BFR exercise (35.88 ± 14.83 N·m) was significantly greater ( P = 0.040) than without BFR exercise (16.71 ± 17.79 N·m). Conclusions Short-term BFR exercise significantly increased strength endurance, muscle strength, and MBP in national-level para-alpine standing skiers. Our study provides new evidence that BFR exercise can improve local muscle blood perfusion during high-intensity exercise and informs BFR exercise strategies for athletes with disabilities.