An examination of individual responses to ischemic preconditioning and the effect of repeated ischemic preconditioning on cycling performance

No ergogenic effect of ischemic preconditioning applied 5 or 30 min before maximal self-paced cycling exercise

Ischemic preconditioning (IPC) is a potential ergogenic technique but the response rates vary considerably in the literature. The use of markedly different IPC protocols among the published literature, including pressure, rounds of ischemia, and time latencies potentially contribute to heterogenous responses. This study investigated whether the duration of time between the application of IPC and the commencement of exercise may explain equivocal ergogenic results. Fourteen (n = 11 male, n = 3 female) moderately trained volunteers participated in a familiarization and three experimental trials: no IPC (CON), IPC-5 (4 × 5 min IPC applied 5 min before exercise), and IPC-30 (4 × 5 min IPC applied 30 min before exercise). Participants completed maximal 10-min accumulated work (kJ) cycling time trials. Oxygen uptake (V . O2 ), heart rate, vastus lateralis tissue oxygenation, and blood lactate concentrations ([La-]b) were measured before, during, and after exercise. There were no differences in performance or physiological responses during or after exercise among CON, IPC-5, and IPC-30. These findings add further evidence to the existing literature reporting that IPC-related ergogenicity is equivocal when administered 5 or 30 min before exercise. These results reinforce the requirement to clarify whether there exists an IPC protocol that reliably elicits an ergogenic effect.

The influence of cuff location on the oxygenation and reperfusion of the foot during ischemic preconditioning: A reliability study

Ischemic preconditioning (IPC) involves the application of occlusion cycles, typically prior to exercise. IPC is commonly applied at the arm or thigh for improving exercise performance, which can be combined with near-infrared spectroscopy (NIRS) to assess the microcirculation and tissue oxygenation. Despite the use of NIRS during IPC, few studies have investigated the reliability of NIRS during lower limb IPC with no relevant publications investigating IPC at the ankle. Therefore, the purpose of this study was to investigate the intra-session reliability in the NIRS measurements during repeated IPC at the thigh, ankle and arm. Eighteen participants volunteered. IPC was applied at the thigh (220 mmHg), ankle (individualized arterial occlusion pressure: 212 ± 24 mmHg) and arm (220 mmHg) in a randomized order involving 3 repeated cycles of 5-min occlusion and reperfusion, within a session. NIRS recorded tissue oxygen saturation (SO2), oxygenated (O2Hb) and deoxygenated hemoglobin (HHb) at the abductor hallucis muscle. Reliability was assessed using intraclass correlation coefficients. For all NIRS measurements assessed, there was excellent reliability (All ICC > 0.94) for the average, minimum and maximum values. The results indicate that IPC can successfully be applied at the ankle, offering reliable measures between three repeated occlusions within a session.

Does ischemic preconditioning enhance sports performance more than placebo or no intervention? A systematic review with meta-analysis

BACKGROUND

Ischemic preconditioning (IPC) is purported to have beneficial effects on athletic performance, although findings are inconsistent, with some studies reporting placebo effects. The majority of studies have investigated IPC alongside a placebo condition, but without a control condition that was devoid of experimental manipulation, thereby limiting accurate determination of the IPC effects. Therefore, the aims of this study were to assess the impact of the IPC intervention, compared to both placebo and no intervention, on exercise capacity and athletic performance.

METHODS

A systematic search of PubMed, Embase, SPORTDiscus, Cochrane Library, and Latin American and Caribbean Health Sciences Literature (LILACS) covering records from their inception until July 2023 was conducted. To qualify for inclusion, studies had to apply IPC as an acute intervention, comparing it with placebo and/or control conditions. Outcomes of interest were performance (force, number of repetitions, power, time to exhaustion, and time trial performance), physiological measurements (maximum oxygen consumption, and heart rate), or perceptual measurements (RPE). For each outcome measure, we conducted 3 independent meta-analyses (IPC vs. placebo, IPC vs. control, placebo vs. control) using an inverse-variance random-effects model. The between-treatment effects were quantified by the standardized mean difference (SMD), accompanied by their respective 95% confidence intervals. Additionally, we employed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to assess the level of certainty in the evidence.

RESULTS

Seventy-nine studies were included in the quantitative analysis. Overall, IPC demonstrates a comparable effect to the placebo condition (using a low-pressure tourniquet), irrespective of the subjects' training level (all outcomes presenting p > 0.05), except for the outcome of time to exhaustion, which exhibits a small magnitude effect (SMD = 0.37; p = 0.002). Additionally, the placebo exhibited effects notably greater than the control condition (outcome: number of repetitions; SMD = 0.45; p = 0.03), suggesting a potential influence of participants' cognitive perception on the outcomes. However, the evidence is of moderate to low certainty, regardless of the comparison or outcome.

CONCLUSION

IPC has significant effects compared to the control intervention, but it did not surpass the placebo condition. Its administration might be influenced by the cognitive perception of the receiving subject, and the efficacy of IPC as an ergogenic strategy for enhancing exercise capacity and athletic performance remains questionable.

Assessment of the Impact of Sensor-Based Ischemic Preconditioning with Different Cycling Periods on Upper Limb Strength in Bodybuilding Athletes

Objective: This study designed experiments to explore the effects of ischemic preconditioning (IPC) intervention with different cycling periods on the upper limb strength performance of college male bodybuilding athletes. Methods: Ten bodybuilding athletes were recruited for a randomized, double-blind, crossover experimental study. All subjects first underwent pre-tests with two sets of exhaustive bench presses at 60% of their one-repetition maximum (1RM) to assess upper limb strength performance. They then experienced three different IPC intervention modes (T1: 1 × 5 min, T2: 2 × 5 min, T3: 3 × 5 min), as well as a non-IPC intervention mode (CON), followed by a retest of the bench press. An Enode pro device was used to record the barbell's velocity during the bench press movement (peak velocity (PV), mean velocity (MV)); power (peak power (PP), mean power (MP)); and time under tension (TUT) to evaluate upper limb strength performance. Results: PV values: T1 showed significant increases compared to pre-tests in the first (p = 0.02) and second (p = 0.024) tests, and were significantly greater than the CON (p = 0.032); T2 showed a significant increase in PV in the first test (p = 0.035), with no significant differences in other groups. MV values: T1 showed a significant increase in MV in the first test compared to the pre-test (p = 0.045), with no significant differences in other groups. PP values: T1 showed a highly significant increase in PP in the first test compared to the pre-test (p = 0.001), and was significantly higher than the CON (p = 0.025). MP values: T1 showed highly significant increases in MP in both the first (p = 0.004) and second (p = 0.003) tests compared to the pre-test; T2 showed a highly significant increase in MP in the first test (p = 0.039) and a significant increase in the second test (p = 0.039). T1's MP values were significantly higher than the CON in both tests; T2's MP values were significantly higher than the CON in the first (p = 0.005) and second (p = 0.024) tests. TUT values: T1 showed highly significant increases in TUT in the first (p < 0.001) and second (p = 0.002) tests compared to the pre-test, and were significantly higher than the CON. Conclusions: (1) Single-cycle and double-cycle IPC interventions both significantly enhance upper limb strength performance, significantly improving the speed and power in exhaustive bench press tests, with the single-cycle IPC intervention being more effective than the double-cycle IPC intervention. (2) The triple-cycle IPC intervention does not improve the upper limb strength performance of bodybuilding athletes in exhaustive bench presses.

Ergogenic effect of ischemic preconditioning is not directly conferred to isolated skeletal muscle via blood

PURPOSE

Ischemic preconditioning (IPC) in humans has been demonstrated to confer ergogenic benefit to aerobic exercise performance, with an improvement in the response rate when the IPC stimulus is combined with concurrent exercise. Despite potential performance improvements, the nature of the neuronal and humoral mechanisms of conferral and their respective contributions to ergogenic benefit remain unclear. We sought to examine the effects of the humoral component of ischemic preconditioning on skeletal muscle tissue using preconditioned human serum and isolated mouse soleus.

METHODS

Isolated mouse soleus was electrically stimulated to contract while in human serum preconditioned with either traditional (IPC) or augmented (AUG) ischemic preconditioning compared to control (CON) and exercise (ERG) preconditioning. Force frequency (FF) curves, twitch responses, and a fatigue-recovery protocol were performed on muscles before and after the addition of serum. After preconditioning, human participants performed a 4 km cycling time trial in order to identify responders and non-responders to IPC.

RESULTS

No differences in indices of contractile function, fatiguability, nor recovery were observed between conditions in mouse soleus muscles. Further, no human participants improved performance in a 4-km cycling time trial in response to traditional nor augmented ischemic preconditioning compared to control or exercise conditions (CON 407.7 ± 41.1 s, IPC 411.6 ± 41.9 s, ERG 408.8 ± 41.4 s, AUG 414.1 ± 41.9 s).

CONCLUSIONS

Our findings do not support the conferral of ergogenic benefit via a humoral component of IPC at the intracellular level. Ischemic preconditioning may not manifest prominently at submaximal exercise intensities, and augmented ischemic preconditioning may have a hormetic relationship with performance improvements.

Ischemic Preconditioning Acutely Improves Functional Sympatholysis during Handgrip Exercise in Healthy Males but not Females

PURPOSE

Ischemic preconditioning (IPC), a procedure that involves the cyclic induction of limb ischemia and reperfusion via tourniquet inflation, has been reported to improve exercise capacity and performance, but the underlying mechanisms remain unclear. During exercise, sympathetically mediated vasoconstriction is dampened in active skeletal muscle. This phenomenon, termed functional sympatholysis, plays a critical role in maintaining oxygen delivery to working skeletal muscle and may contribute to determining exercise capacity. Herein, we investigate the effects of IPC on functional sympatholysis in humans.

METHODS

In 20 (10M/10F) healthy young adults, forearm blood flow (Doppler ultrasound) and beat-to-beat arterial pressure (finger photoplethysmography) were measured during lower body negative pressure (LBNP; -20 mm Hg) applied at rest and simultaneously during rhythmic handgrip exercise (30% maximum contraction) before and after local IPC (4 × 5-min 220 mm Hg) or sham (4 × 5-min 20 mm Hg). Forearm vascular conductance (FVC) was calculated as forearm blood flow/mean arterial pressure and the magnitude of sympatholysis as the difference of LBNP-induced changes in FVC between handgrip and rest.

RESULTS

At baseline, LBNP decreased FVC (females [F] = ∆-41% ± 19%; males [M] = ∆-44% ± 10%), and these responses were attenuated during handgrip (F = ∆-8% ± 9%; M = ∆-8% ± 7%). After IPC, LBNP induced similar decreases in resting FVC (F = ∆-37% ± 19%; M = ∆-44% ± 13%). However, during handgrip, this response was further attenuated in males (∆-3% ± 9%, P = 0.02 vs pre) but not females (∆-5% ± 10%, P = 0.13 vs pre), which aligned with an IPC-mediated increase in sympatholysis (M-pre = 36% ± 10% vs post = 40% ± 9%, P = 0.01; F-pre = 32% ± 15% vs post = 32% ± 14%, P = 0.82). Sham IPC had no effect on any variables.

CONCLUSIONS

These findings highlight a sex-specific effect of IPC on functional sympatholysis and provide evidence of a potential mechanism underlying the beneficial effects of IPC on human exercise performance.

Potential physiological responses contributing to the ergogenic effects of acute ischemic preconditioning during exercise: A narrative review

Ischemic preconditioning (IPC) has been reported to augment exercise performance, but there is considerable heterogeneity in the magnitude and frequency of performance improvements. Despite a burgeoning interest in IPC as an ergogenic aid, much is still unknown about the physiological mechanisms that mediate the observed performance enhancing effects. This narrative review collates those physiological responses to IPC reported in the IPC literature and discusses how these responses may contribute to the ergogenic effects of IPC. Specifically, this review discusses documented central and peripheral cardiovascular responses, as well as selected metabolic, neurological, and perceptual effects of IPC that have been reported in the literature.

Methodological Variations Contributing to Heterogenous Ergogenic Responses to Ischemic Preconditioning

Ischemic preconditioning (IPC) has been repeatedly reported to augment maximal exercise performance over a range of exercise durations and modalities. However, an examination of the relevant literature indicates that the reproducibility and robustness of ergogenic responses to this technique are variable, confounding expectations about the magnitude of its effects. Considerable variability among study methodologies may contribute to the equivocal responses to IPC. This review focuses on the wide range of methodologies used in IPC research, and how such variability likely confounds interpretation of the interactions of IPC and exercise. Several avenues are recommended to improve IPC methodological consistency, which should facilitate a future consensus about optimizing the IPC protocol, including due consideration of factors such as: location of the stimulus, the time between treatment and exercise, individualized tourniquet pressures and standardized tourniquet physical characteristics, and the incorporation of proper placebo treatments into future study designs.

Cardiac autonomic recovery following traditional and augmented remote ischemic preconditioning

PURPOSE

While the possible ergogenic benefits of remote ischemic preconditioning (RIPC) make it an attractive training modality, the mechanisms of action remain unclear. Alterations in neural tone have been demonstrated in conjunction with circulatory occlusion, yet investigation of the autonomic nervous system following RIPC treatment has received little attention. We sought to characterize alterations in autonomic balance to both RIPC and augmented RIPC (RIPC_aug) performed while cycling, using acute and sustained autonomic indices.

METHODS

Thirteen participants (8M:5F) recorded baseline waking heart rate variability (HRV) for 5 days prior to treatment. Participants then completed control exercise (CON), RIPC, and RIPC_aug interventions in a randomized cross-over design. Cardiovascular measurements were recorded immediately before and after each intervention at rest, and during an orthostatic challenge. Waking HRV was repeated the morning after each intervention.

RESULTS

RIPC resulted in acutely reduced resting heart rates (HR) (∆ - 4 ± 6 bpm, P = 0.02) and suppressed HR 30 s following the orthostatic challenge compared to CON (64 ± 10 vs 74 ± 9 bpm, P = 0.003). RIPC_aug yielded elevated HRs compared to CON and RIPC prior to (P = 0.003) and during the orthostatic challenge (P = 0.002). RIPC_aug reduced LnSDNN (Baseline 4.39 ± 0.27; CON 4.44 ± 0.39; RIPC 4.41 ± 0.34; RIPC_aug 4.22 ± 0.29, P = 0.02) and LnHfa power (Baseline 7.82 ± 0.54; CON 7.73 ± 1.11; RIPC 7.89 ± 0.78; RIPC_aug 7.23 ± 0.87, P = 0.04) the morning after treatment compared to all other conditions.

CONCLUSIONS

Our data suggest that RIPC may influence HR acutely, possibly through a reduction in cardiac sympathetic activity, and that RIPC_aug reduces HRV through cardiac vagal withdrawal or increased cardiac sympathetic modulation, with alterations persisting until the following morning. These findings imply a dose-response relationship with potential for optimization of performance.