Is delayed ischemic preconditioning as effective on running performance during a 5km time trial as acute IPC?

Ischemic Conditioning to Reduce Fatigue in Isometric Skeletal Muscle Contraction

Ischemic preconditioning (IPC) is a non-invasive protective maneuver that alternates short periods of occlusion and reperfusion of tissue blood flow. Given the heterogeneity in the magnitude and frequency of IPC-induced improvements in physical performance, here we aimed to investigate, in a well-controlled experimental set-up, the local effects of IPC in exposed muscles in terms of tissue oxygenation and muscle fatigue. Nineteen subjects were enrolled in one of the two groups, IPC (3 × 5/5 min right arm ischemia/reperfusion; cuff inflations 250 mmHg) and SHAM (3 × 5/5 min pseudo ischemia/reperfusion; 20 mmHg). The subjects performed a fatiguing contraction protocol before and 30 min after the IPC treatment, consisting of unilateral intermittent isometric elbow flexions (3 s ON/OFF, 80% of maximal voluntary contraction) until exhaustion. While muscle strength did not differ between groups, post- vs. pre-treatment endurance was significantly reduced in the SHAM group (4.1 ± 1.9 vs. 6.4 ± 3.1 repetitions until exhaustion, p < 0.05) but maintained in IPC (7.3 ± 2.0 vs. 7.1 ± 4.3, n.s.). The decrease in tissue oxygenation and the increase in deoxygenated hemoglobin were significantly reduced post- vs. pre-IPC (p < 0.05), but not post- vs. pre-SHAM. The results suggest that IPC delays the onset of fatigue likely through improved metabolic efficiency of muscles.

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.

Effects of different ischemic preconditioning occlusion pressures on muscle damage induced by eccentric exercise: a study protocol for a randomized controlled placebo clinical trial

Introduction

Due to its greater generation of muscle strength and less metabolic demand, eccentric exercise has been widely used in rehabilitation and for improving physical fitness. However, eccentric exercise can induce muscle damage by providing structural changes and reduced muscle function, so even with the protection caused by the repeated bout effect from eccentric exercise, it is necessary to seek alternatives to reduce this damage caused by stress. Thus, ischemic preconditioning could represent an aid to reduce the damage muscle or increase the protective effect caused by eccentric exercise.

Objectives

To compare the effects of ischemic preconditioning, using different occlusion pressures, on acute and delayed responses to perceptual outcomes, markers of muscle damage, and performance in post-eccentric exercise recovery.

Methods

A randomized controlled placebo clinical trial will be carried out with 80 healthy men aged 18 to 35 years who will be randomly divided into four groups: ischemic preconditioning using total occlusion pressure, ischemic preconditoning with 40% more than total occlusion pressure, placebo (10 mmHg), and control. The ischemic preconditioning protocol will consist of four cycles of ischemia and reperfusion of five minutes each. All groups will perform an eccentric exercise protocol, and assessments will be carried out before, immediately after, and 24, 48, 72, and 96 h after the end of the eccentric exercise to evaluate creatine kinase, blood lactate, perception of recovery using the Likert scale, being sequentially evaluated, pain by the visual analog scale, pain threshold using a pressure algometer, muscle thickness by ultrasound, muscle tone, stiffness and elasticity by myotonometry, vectors of cell integrity through electrical bioimpedance, and maximal voluntary isometric contraction using the isokinetic dynamometer. The trial was registered at ClinicalTrials.gov (NCT04420819).

Discussion

The present study aims to present an alternative technique to reduce muscle damage caused by eccentric exercise, which is easy to apply and low cost. If the benefits are proven, ischemic preconditioning could be used in any clinical practice that aims to minimize the damage caused by exercise, presenting an advance in the prescription of eccentric exercise and directly impacting on the results of post-exercise recovery.

Trial registration

ClinicalTrials.gov NCT04420819. Registered on 19 May 2020; Last update 24 March 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05285-7.

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.

Effect of Ischemic Preconditioning on Maximal Swimming Performance

ABSTRACT

Williams, N, Russell, M, Cook, CJ, and Kilduff, LP. Effect of ischemic preconditioning on maximal swimming performance. J Strength Cond Res 35(1): 221-226, 2021-The effect of ischemic preconditioning (IPC) on swimming performance was examined. Using a randomized, crossover design, national- and international-level swimmers (n = 20; 14 men, 6 women) participated in 3 trials (Con, IPC-2h, and IPC-24h). Lower-body IPC (4 × 5-minute bilateral blood flow restriction at 160-228 mm Hg and 5-minute reperfusion) was used 2 hours (IPC-2h) or 24 hours (IPC-24h) before a self-selected (100 m, n = 15; 200 m, n = 5) swimming time trial (TT). The Con trial used a sham intervention (15 mm Hg) 2 hours before exercise. All trials required a 40-minute standardized precompetition swimming warm-up (followed by 20-minute rest; replicating precompetition call room procedures) 1 hour before TT. Capillary blood (pH, blood gases, and lactate concentrations) was taken immediately before and after IPC, before TT and after TT. No effects on TT for 100 m (P = 0.995; IPC-2h: 64.94 ± 8.33 seconds; IPC-24h: 64.67 ± 8.50 seconds; Con: 64.94 ± 8.24 seconds), 200 m (P = 0.405; IPC-2h: 127.70 ± 10.66 seconds; IPC-24h: 129.26 ± 12.99 seconds; Con: 130.19 ± 10.27 seconds), or combined total time (IPC-2h: 84.27 ± 31.52 seconds; IPC-24h: 79.87 ± 29.72 seconds; Con: 80.55 ± 31.35 seconds) were observed after IPC. Base excess (IPC-2h: -13.37 ± 8.90 mmol·L-1; Con: -13.35 ± 7.07 mmol·L-1; IPC-24h: -16.53 ± 4.65 mmol·L-1), pH (0.22 ± 0.08; all conditions), bicarbonate (IPC-2h: -11.66 ± 3.52 mmol·L-1; Con: -11.62 ± 5.59 mmol·L-1; IPC-24h: -8.47 ± 9.02 mmol·L-1), total carbon dioxide (IPC-2h: -12.90 ± 3.92 mmol·L-1; Con: -11.55 ± 7.61 mmol·L-1; IPC-24h: 9.90 ± 8.40 mmol·L-1), percentage oxygen saturation (IPC-2h: -0.16 ± 1.86%; Con: +0.20 ± 1.93%; IPC-24h: +0.47 ± 2.10%), and blood lactate (IPC-2h: +12.87 ± 3.62 mmol·L-1; Con: +12.41 ± 4.02 mmol·L-1; IPC-24h: +13.27 ± 3.81 mmol·L-1) were influenced by swimming TT (P < 0.001), but not condition (all P > 0.05). No effect of IPC was seen when applied 2 or 24 hours before swimming TT on any indices of performance or physiological measures recorded.

Low-Dose Ammonium Preconditioning Enhances Endurance in Submaximal Physical Exercises

Preconditioning is often used in medicine to protect organs from ischemic damage and in athletes to enhance the performances. We tested whether low-dose ammonium preconditioning (AMP) could have a beneficial effect on physical exercises (PE). We used Cardiopulmonary Exercise Testing (CPET) on a treadmill to investigate the effects of low-dose AMP on the physical exercise capacity of professional track and field athletes and tested twenty-five athletes. Because of the individual differences between athletes, we performed a preliminary treadmill test (Pre-test) and, according to the results, the athletes were randomly allocated into the AMP and control (placebo, PL) group based on the similarity of the total distance covered on a treadmill. In the AMP group, the covered distance increased (11.3 ± 3.6%, p < 0.02) compared to Pre-test. Similarly, AMP significantly increased O₂ uptake volume—VO₂ (4.6 ± 2.3%, p < 0.03) and pulmonary CO₂ output—VCO₂ (8.7 ± 2.8%, p < 0.01). Further, the basic blood parameters (pH, pO₂, and lactate) shift was lower despite the greater physical exercise progress in the AMP group compared to Pre-test, whereas in the placebo group there were no differences between Pre-test and Load-test. Importantly, the AMP significantly increased red blood cell count (6.8 ± 2.0%, p < 0.01) and hemoglobin concentration (5.3 ± 1.9%, p < 0.01), which might explain the beneficial effects in physical exercise progress. For the first time, we showed that low-dose AMP had clear beneficial effects on submaximal PE.

Ischemic Preconditioning, O2 Kinetics, and Performance in Normoxia and Hypoxia

INTRODUCTION

Ischemic preconditioning (IPC) before exercise has been shown to be a novel approach to improve performance in different exercise modes in normoxia (NORM). Few studies have been conducted examining potential mechanisms behind these improvements, and less has been done examining its influence during exercise in hypoxia (HYP). Oxygen uptake and extraction kinetics are factors that have been implicated as possible determinants of cycling performance. We hypothesized that IPC would lead to improvements in oxygen extraction and peripheral blood flow kinetics, and this would translate to improvements in cycling time trial (TT) performance in both NORM and HYP.

METHODS

Thirteen men (age, 24 ± 7 yr; V˙O2max, 63.1 ± 5.1 mL·kg·min) participated in the study. Subjects completed trials of each combination of normobaric HYP (FiO2 = 0.16, simulating ~8000 ft/2500 m) or NORM (FiO2 = 0.21) with preexercise IPC protocol (4 × 5 min at 220 mm Hg) or SHAM procedure. Trials included submaximal constant load cycle exercise bouts (power outputs of 15% below gas exchange threshold, and 85% of V˙O2max), and a 5-km cycling performance TT.

RESULTS

Ischemic preconditioning significantly improved 5-km TT time in NORM by 0.9% ± 1.8% compared with SHAM (IPC, 491.2 ± 35.2 s vs SHAM, 495.9 ± 36.0 s; P < 0.05). Ischemic preconditioning did not alter 5-km TT performance times in HYP (P = 0.231). Ischemic preconditioning did, however, improve tissue oxygen extraction in HYP (deoxygenated hemoglobin/myoglobin: IPC, 21.23 ± 10.95 μM; SHAM, 19.93 ± 9.91 μM; P < 0.05) during moderate-intensity exercise.

CONCLUSIONS

Our data confirm that IPC is an effective ergogenic aid for athletes performing 5-km cycling TT bouts in NORM. Ischemic preconditioning did mitigate the declines in tissue oxygen during moderate-intensity exercise in HYP, but this did not translate to a significant effect on mean group performance. These data suggest that IPC may be of benefit for athletes training and competing in NORM.

Ischemic preconditioning and exercise performance: shedding light through smallest worthwhile change

Ischemic preconditioning (IPC) has been suggested as a potential ergogenic aid to improve exercise performance, although controversial findings exist. The controversies may be explained by several factors, including the mode of exercise, the ratio between the magnitude of improvement, or the error of measurement and physiological meaning. However, a relevant aspect has been lacking in the literature: the interpretation of the findings considering statistical tests and adequate effect size (ES) according to the fitness level of individuals. Thus, we performed a systematic review with meta-analysis to update the effects of IPC on exercise performance and physiological responses, using traditional statistics (P values), ES, and smallest worth change (SWC) approach contextualizing the IPC application to applied Sports and Exercise performance. Forty-five studies met the inclusion criteria. Overall, the results show that IPC has a minimal or nonsignificant effect on performance considering the fitness level of the individuals, using statistical approaches (i.e., tests with P value, ES, and SWC). Therefore, IPC procedures should be revised and refined in future studies to evaluate if IPC promotes positive effects on performance in a real-world scenario with more consistent interpretation.

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

PURPOSE

To use repeated control trials to measure within-subject variability and assess the existence of responders to ischemic preconditioning (IPC). Secondly, to determine whether repeated IPC can evoke a dosed ergogenic response.

METHODS

Twelve aerobically fit individuals each completed three control and three IPC 5-km cycling time trials. IPC trials included: (i) IPC 15-min preceding the trial (traditional IPC), (ii) IPC 24-h and 15-min preceding (IPC × 2), (iii) IPC 48-h, 24-h, and 15-min preceding (IPC × 3). IPC consisted of 3 × 5-min cycles of occlusion and reperfusion at the upper thighs. To assess the existence of a true response to IPC, individual performance following traditional IPC was compared to each individual's own 5-km TT coefficient of variation. In individuals who responded to IPC, all three IPC conditions were compared to the mean of the three control trials (CON_avg) to determine whether repeated IPC can evoke a dosed ergogenic response.

RESULTS

9 of 12 (75%) participants improved 5-km time (-1.8 ± 1.7%) following traditional IPC, however, only 7 of 12 (58%) improved greater than their own variability between repeated controls (true responders). In true responders only, we observed a significant mean improvement in 5-km TT completion following traditional IPC (478 ± 50 s), IPC × 2 (481 ± 51 s), and IPC × 3 (480.5 ± 49 s) compared to mean CON_avg (488 ± 51s; p < 0.006), with no differences between various IPC trials (p > 0.05).

CONCLUSION

A majority of participants responded to IPC, providing support for a meaningful IPC-mediated performance benefit. However, repeated bouts of IPC on consecutive days do not enhance the ergogenic effect of a single bout of IPC.

An overview of ischemic preconditioning in exercise performance: A systematic review

Ischemic preconditioning (IPC) is an attractive method for athletes owing to its potential to enhance exercise performance. However, the effectiveness of the IPC intervention in the field of sports science remains mitigated. The number of cycles of ischemia and reperfusion, as well as the duration of the cycle, varies from one study to another. Thus, the aim of this systematic review was to provide a comprehensive review examining the IPC literature in sports science. A systematic literature search was performed in PubMed (MEDLINE) (from 1946 to May 2018), Web of Science (sport sciences) (from 1945 to May 2018), and EMBASE (from 1974 to May 2018). We included all studies investigating the effects of IPC on exercise performance in human subjects. To assess scientific evidence for each study, this review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The electronic database search generated 441 potential articles that were screened for eligibility. A total of 52 studies were identified as eligible and valid for this systematic review. The studies included were of high quality, with 48 of the 52 studies having a randomized, controlled trial design. Most studied showed that IPC intervention can be beneficial to exercise performance. However, IPC intervention seems to be more beneficial to healthy subjects who wish to enhance their performance in aerobic exercises than athletes. Thus, this systematic review highlights that a better knowledge of the mechanisms generated by the IPC intervention would make it possible to optimize the protocols according to the characteristics of the subjects with the aim of suggesting to the subjects the best possible experience of IPC intervention.

Remote ischemic preconditioning increases accumulated oxygen deficit in middle-distance runners

The mediators underlying the putative benefits of remote ischemic preconditioning (IPC) on dynamic whole body exercise performance have not been widely investigated. Our objective was to test the hypothesis that remote IPC improves supramaximal exercise performance in National Collegiate Athletic Association (NCAA) Division I middle-distance runners by increasing accumulated oxygen deficit (AOD), an indicator of glycolytic capacity. A randomized sham-controlled crossover study was employed. Ten NCAA Division I middle-distance athletes [age: 21 ± 1 yr; maximal oxygen uptake (V̇o2max): 65 ± 7 ml·kg−1·min−1] completed three supramaximal running trials (baseline, after mock IPC, and with remote IPC) at 110% V̇o2max to exhaustion. Remote IPC was induced in the right arm with 4 × 5 min cycles of brachial artery ischemia with 5 min of reperfusion. Supramaximal AOD (ml/kg) was calculated as the difference between the theoretical oxygen demand required for the supramaximal running bout (linear regression extrapolated from ~12 × 5 min submaximal running stages) and the actual oxygen demand for these bouts. Remote IPC [122 ± 38 s, 95% confidence interval (CI): 94–150] increased ( P < 0.001) time to exhaustion 22% compared with baseline (99 ± 23 s, 95% CI: 82–116, P = 0.014) and sham (101 ± 30 s, 95% CI: 80–123, P = 0.001). In the presence of IPC, AOD was 47 ± 36 ml/kg (95% CI: 20.8–73.9), a 29% increase compared with baseline (36 ± 28 ml/kg, 95% CI: 16.3–56.9, P = 0.008) and sham (38 ± 32 ml/kg, 95% CI: 16.2–63.0, P = 0.024). Remote IPC considerably improved supramaximal exercise performance in NCAA Division I middle-distance athletes. Greater glycolytic capacity, as estimated by increased AOD, is a potential mediator for these performance improvements.

NEW & NOTEWORTHY Our novel findings indicate that ischemic preconditioning enhanced glycolytic exercise capacity, enabling National Collegiate Athletic Association (NCAA) middle-distance track athletes to run ~22 s longer before exhaustion compared with baseline and mock ischemic preconditioning. The increase in “all-out” performance appears to be due to increased accumulated oxygen deficit, an index of better supramaximal capacity. Of note, enhanced exercise performance was demonstrated in a specific group of in-competition NCAA elite athletes that has already undergone substantial training of the glycolytic energy systems.

Declines in exercise performance are prevented 24 hours after post-exercise ischemic conditioning in amateur cyclists

Brief moments of blood flow occlusion followed by reperfusion may promote enhancements in exercise performance. Thus, this study assessed the 24-h effect of post-exercise ischemic conditioning (PEIC) on exercise performance and physiological variables in trained cyclists. In a randomized, single-blind study, 28 trained cyclists (27.1 ± 1.4 years) performed a maximal incremental cycling test (MICT). The outcome measures were creatine kinase (CK), muscle soreness and perceived recovery status, heart rate, perceived exertion and power output. Immediately after the MICT, the cyclists performed 1 of the following 4 interventions: 2 sessions of 5-min occlusion/5-min reperfusion (PEIC or SHAM, 2 x 5) or 5 sessions of 2-min occlusion/2-min reperfusion (PEIC or SHAM, 5 x 2). The PEIC (50 mm Hg above the systolic blood pressure) or SHAM (20 mm Hg) treatment was applied unilaterally on alternating thighs. At 24 h after the interventions, a second MICT was performed. In all the groups, the CK levels were increased compared with the baseline (p < 0.05) after the 24-h MICT. The PEIC groups (2 x 5 and 5 x 2) felt more tired at 24 h post intervention (p < 0.05). However, both PEIC groups maintained their performance (2 x 5: p = 0.819; 5 x 2: p = 0.790), while the SHAM groups exhibited decreased performance at 24 h post intervention compared to baseline (2 x 5: p = 0.015; 5 x 2: p = 0.045). A decrease in the maximal heart rate (HR) was found only in the SHAM 2 x 5 group (p = 0.015). There were no other significant differences in the heart rate, power output or perceived exertion after 24 h compared with the baseline values for any of the interventions (p > 0.05). In conclusion, PEIC led to maintained exercise performance 24 h post intervention in trained cyclists.

Combining Chronic Ischemic Preconditioning and Inspiratory Muscle Warm-Up to Enhance On-Ice Time-Trial Performance in Elite Speed Skaters

Elite athletes in varied sports typically combine ergogenic strategies in the hope of enhancing physiological responses and competitive performance, but the scientific evidence for such practices is very scarce. The peculiar characteristics of speed skating contribute to impede blood flow and exacerbate deoxygenation in the lower limbs (especially the right leg). We investigated whether combining preconditioning strategies could modify muscular oxygenation and improve performance in that sport. Using a randomized, single-blind, placebo-controlled, crossover design, seven male elite long-track speed skaters performed on-ice 600-m time trials, preceded by either a combination of preconditioning strategies (COMBO) or a placebo condition (SHAM). COMBO involved performing remote ischemic preconditioning (RIPC) of the upper limbs (3 × 5-min compression at 180 mmHg and 5-min reperfusion) over 3 days (including an acute treatment before trials), with the addition of an inspiratory muscle warm-up [IMW: 2 × 30 inspirations at 40% maximal inspiratory pressure (MIP)] on the day of testing. SHAM followed the same protocol with lower intensities (10 mmHg for RIPC and 15% MIP). Changes in tissue saturation index (TSI), oxyhemoglobin–oxymyoglobin ([O₂HbMb]), deoxyhemoglobin–deoxymyoglobin ([HHbMb]), and total hemoglobin–myoglobin ([THbMb]) in the right vastus lateralis muscle were monitored by near-infrared spectroscopy (NIRS). Differences between COMBO and SHAM were analyzed using Cohen’s effect size (ES) and magnitude-based inferences. Compared with SHAM, COMBO had no worthwhile effect on performance time while mean Δ[HHbMb] (2.7%, ES 0.48; -0.07, 1.03) and peak Δ[HHbMb] (1.8%, ES 0.23; -0.10, 0.57) were respectively likely and possibly higher in the last section of the race. These results indicate that combining ischemic preconditioning and IMW has no practical ergogenic impact on 600-m speed-skating performance in elite skaters. The low-sitting position in this sport might render difficult enhancing these physiological responses.

Ischemic preconditioning does not alter muscle sympathetic responses to static handgrip and metaboreflex activation in young healthy men

Ischemic preconditioning (IPC) has been hypothesized to elicit ergogenic effects by reducing feedback from metabolically sensitive group III/IV muscle afferents during exercise. If so, reflex efferent neural outflow should be attenuated. We investigated the effects of IPC on muscle sympathetic nerve activity (MSNA) during static handgrip (SHG) and used post‐exercise circulatory occlusion (PECO) to isolate for the muscle metaboreflex. Thirty‐seven healthy men (age: 24 ± 5 years [mean ± SD]) were randomized to receive sham (n = 16) or IPC (n = 21) interventions. Blood pressure, heart rate, and MSNA (microneurography; sham n = 11 and IPC n = 18) were collected at rest and during 2 min of SHG (30% maximal voluntary contraction) and 3 min of PECO before (PRE) and after (POST) sham or IPC treatment (3 × 5 min 20 mmHg or 200 mmHg unilateral upper arm cuff inflation). Resting mean arterial pressure was higher following sham (79 ± 7 vs. 83 ± 6 mmHg, P < 0.01) but not IPC (81 ± 6 vs. 82 ± 6 mmHg, P > 0.05), while resting MSNA burst frequency was unchanged (P > 0.05) with sham (18 ± 7 vs. 19 ± 9 bursts/min) or IPC (17 ± 7 vs. 19 ± 7 bursts/min). Mean arterial pressure, heart rate, stroke volume, cardiac output, and total vascular conductance responses during SHG and PECO were comparable PRE and POST following sham and IPC (All P > 0.05). Similarly, MSNA burst frequency, burst incidence, and total MSNA responses during SHG and PECO were comparable PRE and POST with sham and IPC (All P > 0.05). These findings demonstrate that IPC does not reduce hemodynamic responses or central sympathetic outflow directed toward the skeletal muscle during activation of the muscle metaboreflex using static exercise or subsequent PECO.

No influence of ischemic preconditioning on running economy

PURPOSE

Many of the potential performance-enhancing properties of ischemic preconditioning suggest that the oxygen cost for a given endurance exercise workload will be reduced, thereby improving the economy of locomotion. The aim of this study was to identify whether ischemic preconditioning improves exercise economy in recreational runners.

METHODS

A randomized sham-controlled crossover study was employed in which 18 adults (age 27 ± 7 years; BMI 24.6 ± 3 kg/m²) completed two, incremental submaximal (65-85% VO_2max) treadmill running protocols (3 × 5 min stages from 7.2-14.5 km/h) coupled with indirect calorimetry to assess running economy following ischemic preconditioning (3 × 5 min bilateral upper thigh ischemia) and sham control. Running economy was expressed as mlO₂/kg/km and as the energy in kilocalories required to cover 1 km of horizontal distance (kcal/kg/km).

RESULTS

Ischemic preconditioning did not influence steady-state heart rate, oxygen consumption, minute ventilation, respiratory exchange ratio, energy expenditure, and blood lactate. Likewise, running economy was similar (P = 0.647) between the sham (from 201.6 ± 17.7 to 204.0 ± 16.1 mlO₂/kg/km) and ischemic preconditioning trials (from 202.8 ± 16.2 to 203.1 ± 15.6 mlO₂/kg/km). There was no influence (P = 0.21) of ischemic preconditioning on running economy expressed as the caloric unit cost (from 0.96 ± 0.12 to 1.01 ± 0.11 kcal/kg/km) compared with sham (from 1.00 ± 0.10 to 1.00 ± 0.08 kcal/kg/km).

CONCLUSIONS

The properties of ischemic preconditioning thought to affect exercise performance at vigorous to severe exercise intensities, which generate more extensive physiological challenge, are ineffective at submaximal workloads and, therefore, do not change running economy.