From Protecting the Heart to Improving Athletic Performance – the Benefits of Local and Remote Ischaemic Preconditioning

Abstract

Remote Ischemic Preconditioning (RIPC) is a non-invasive cardioprotective intervention that involves brief cycles of limb ischemia and reperfusion. This is typically delivered by inflating and deflating a blood pressure cuff on one or more limb(s) for several cycles, each inflation-deflation being 3–5 min in duration. RIPC has shown potential for protecting the heart and other organs from injury due to lethal ischemia and reperfusion injury, in a variety of clinical settings. The mechanisms underlying RIPC are under intense investigation but are just beginning to be deciphered. Emerging evidence suggests that RIPC has the potential to improve exercise performance, via both local and remote mechanisms. This review discusses the clinical studies that have investigated the role of RIPC in cardioprotection as well as those studying its applicability in improving athletic performance, while examining the potential mechanisms involved.

Ischaemic preconditioning does not alter the determinants of endurance running performance in the heat

“…Occlusion pressure for the group was between 160-170 mmHg, therefore 220 mmHg ensured the pressure was at least 50 mmHg above systolic blood pressure. This pressure is supported by similar IP literature (Bailey, Jones, et al 2012;de Groot et al 2010;Sharma et al 2015), however recent near infrared spectroscopy data indicates arterial pulses may be observed up to 300 mmHg (Kido et al 2015). Pilot data, collected using Doppler ultrasound, as well as published literature (Gibson et al 2013), identified 50 mmHg as an appropriate control pressure, as it provides a sensation of pressure, without impairing arterial flow.…”

The effect of 1 week of repeated ischaemic leg preconditioning on simulated Keirin cycling performance: a randomised trial

“…The results suggest that seven consecutive days of IPC may provide ergogenic benefit; however, the optimal conditioning required to elicit a performance or physiological adaptation is yet to be investigated and remains a topic of interest in cardioprotection. 6 The magnitude of physiological changes seen is substantially greater than reported by de Groot et al 4 and Lalonde and Curnier 27 who noted that a single application of leg ischaemia improves maximal oxygen consumption by 3%, aerobic power output by 1.6% and had no change in anaerobic capacity. Our within-treatment group improvement of 12.8% in maximal oxygen consumption, 18.5% enhancement in aerobic power, and 11% and 4.3% increase in peak and average anaerobic power, respectively, looks to justify 7 days of IPC.…”

Remote Ischemic Conditioning and the Long Road to Clinical Translation

“…[4][5][6] RIC has largely been investigated as a pretreatment before planned ischemic events, including elective coronary artery bypass grafting (CABG), and is particularly well suited to the controlled surgical environment. Among the phase II trials that focused on CABG in adult patients and provided the foundation for ERICCA and RIPHeart, the primary end point was postoperative release of cardiac enzymes: ie, well-established surrogate markers of cardiomyocyte damage that have been associated with increased perioperative morbidity and mortality and attributed to ischemia-reperfusion injury.…”

“…6,7 Most (but not all) of these proof-of-concept studies provided encouraging evidence of a significant attenuation in plasma concentrations of creatine kinase and/or cardiac troponins after surgery in patients randomized to receive RIC when compared with controls. [4][5][6] ERICCA is the largest clinical trial to date evaluating RIC in cardiac surgery. Higher-risk patients (those with a European System for Cardiac Operative Risk Evaluation ≥5) undergoing elective CABG with or without concomitant valve surgery were randomly assigned to receive either a standard RIC stimulus (four 5-minute manual inflations of a sphygmomanometer, positioned on the upper arm, to a pressure ≥200 mm Hg: n=801) or time-matched simulated sham inflations (n=811).…”