Ischemic preconditioning: Potential impact on exercise performance and underlying mechanisms

Abstract

Originally, in clinical settings, ischemic preconditioning (IPC) has been used to delay cardiac cell injury and protect against myocardial and vascular damage. Furthermore, as this manipulation is relatively easy and noninvasive, previous studies have examined how IPC may have beneficial effects on exercise performance. However, because of various factors, such as different populations, exercise modes and intensities, and IPC protocols, not enough evidence is available to achieve a consensus on the impact of IPC on exercise performance, e.g., time to failure during exercise, time trial performance, and peak power. Existing evidence suggests that IPC seems not to impair exercise performance, though one study found an impairment. However, about half of the previous studies showed beneficial effects of IPC on exercise performance. Similarly, the physiological responses from IPC are varied. It is still possible that various factors, such as exercise mode and intensity, heterogeneous population and IPC protocol may affect exercise performance. Previous studies showed that effective blood flow via an increase in nitric oxide and the improvement of metabolic efficiency might be candidate factors that can explain the effect of IPC on exercise performance, although no direct evidence has been obtained. This review aims to identify potential sources of variation in these effects on exercise performance with IPC.

The effect of ischaemic preconditioning on central and peripheral fatiguing mechanisms in humans following sustained maximal isometric exercise

“…However, sEMG measures are influenced by multiple factors, rendering comparisons between electrical activity within the muscle and neural drive inappropriate (Dimitrova & Dimitrov, 2003;Farina et al, 2010). Alternatively, these increases in sEMG signals might in fact be related to humoral benefits induced by IPC enabling an increase in skeletal muscle performance (Bailey et al, 2012a;Lindsay et al, 2017;Paradis-Deschênes et al, 2016, 2017. As such, prior observations of increased sEMG activity might have been a byproduct of IPC-augmented humoral pathways, rather than a direct neural response.…”

“…Performance trials have demonstrated small to moderate (Cohen's d > 0.11) ergogenic effects across a range of modalities, including a 2.5% reduction in 5 km time trial running (Bailey et al., ), a 2.2% increase in maximal power (6 s cycling sprint; Patterson, Bezodis, Glaister, & Pattison, ), a 1.1% reduction in 100 m time trial swimming (Jean‐St‐Michel et al., ) and a 0.4% reduction in 1000 m rowing times (Kjeld, Rasmussen, Jattu, Nielsen, & Secher, ). The IPC technique generally imposes three or four 5 min cycles of contralateral limb occlusion followed by a 5 min reperfusion period, accumulating 30–40 min of sustained limb ischaemia (Horiuchi, ). This preparatory exposure to ischaemia before exercise presumably induces increased cellular tolerance to high levels of metabolic perturbation experienced during high‐intensity exercise (Quindry & Hamilton, ).…”

“…The IPC technique generally imposes three or four 5 min cycles of contralateral limb occlusion followed by a 5 min reperfusion period, accumulating 30-40 min of sustained limb ischaemia (Horiuchi, 2017 This preparatory exposure to ischaemia before exercise presumably induces increased cellular tolerance to high levels of metabolic perturbation experienced during high-intensity exercise (Quindry & Hamilton, 2013). However, the exact mechanisms responsible for the improvement in performance remain unknown.…”

Ischemic Preconditioning Enhances Performance and Erythrocyte Deformability of Responders

“…Whether an IPC conducted at a remote body part that is not primarily engaged in the cycle ergometer exercise (i. e. arms) also leads to improvements in performance is still unclear. This type of IPC is then referred to as remote ischemic preconditioning (rIPC) [24] and goes along with an easier application of the cuff to occlude vessels in the arm. Further, subjects might find it uncomfortable to undergo leg occlusion prior to a legdominant exercise compared to the occlusion of the thighs.…”

Effect of Ischemic Preconditioning on Maximal Swimming Performance

“…Ischemic preconditioning (IPC), involving cycles of ischemia and reperfusion achieved through the application of cuffs to the arms or thighs (11), has also been reported to improve indices of athletic performance when used between 15 mins and 8h before performance assessments (12).…”