Ischemic preconditioning enhances critical power during a 3 minute all-out cycling test

Active ischemic pre-conditioning does not additively improve short-term high-intensity cycling performance when combined with caffeine ingestion in trained young men

We investigated the effect of ischemic preconditioning (IPC) with and without caffeine supplementation on mean power output (MPO) during a 4-min cycling time-trial (TT). In a double-blinded, randomized, crossover-design, 11 trained men performed a TT on 4 days separated by ∼1 week. One hour before TT, participants ingested either caffeine (3 mg kg bw-1) or placebo pills, after which femoral blood-flow was either restricted with occlusion cuffs inflated to ∼180 mmHg (IPC), or sham-restricted (0-10 mmHg; Sham) during 3 × 2-min low-intensity cycling (10% of incremental peak power output). Then, participants performed a standardized warm-up followed by the TT. Plasma lactate and K+ concentrations and ratings of perceived exertion (RPE) were measured throughout trials. TT MPO was 382 ± 17 W in Placebo + Sham and not different from Placebo + IPC (-1 W; 95% CI: -9 to 7; p = 0.848; d: 0.06), whereas MPO was higher with Caffeine + Sham (+6W; 95% CI: -2 to 14; p = 0.115; d: 0.49) and Caffeine + IPC (+8 W; 95% CI: 2-13; p = 0.019; d: 0.79) versus Placebo + Sham. MPO differences were attributed to caffeine (caffeine main-effect: +7 W; 95% CI: 2-13; p = 0.015; d: 0.54. IPC main-effect: 0 W; 95% CI: -6 to 7; p = 0.891; d: 0.03; caffeine × IPC interaction-effect: p = 0.580; d: 0.17). TT RPE and plasma variables were not different between treatments. In conlcusion, IPC with co-ingestion of placebo does not improve short-term high-intensity performance in trained men versus a double-placebo control (Placebo + Sham) and does not additively enhance performance with caffeine. These data do not support IPC as a useful strategy for athletes prior to competition but confirms caffeine's performance-enhancing effect.

Muscle Oximetry in Sports Science: An Updated Systematic Review

BACKGROUND

In the last 5 years since our last systematic review, a significant number of articles have been published on the technical aspects of muscle near-infrared spectroscopy (NIRS), the interpretation of the signals and the benefits of using the NIRS technique to measure the physiological status of muscles and to determine the workload of working muscles.

OBJECTIVES

Considering the consistent number of studies on the application of muscle oximetry in sports science published over the last 5 years, the objectives of this updated systematic review were to highlight the applications of muscle oximetry in the assessment of skeletal muscle oxidative performance in sports activities and to emphasize how this technology has been applied to exercise and training over the last 5 years. In addition, some recent instrumental developments will be briefly summarized.

METHODS

Preferred Reporting Items for Systematic Reviews guidelines were followed in a systematic fashion to search, appraise and synthesize existing literature on this topic. Electronic databases such as Scopus, MEDLINE/PubMed and SPORTDiscus were searched from March 2017 up to March 2023. Potential inclusions were screened against eligibility criteria relating to recreationally trained to elite athletes, with or without training programmes, who must have assessed physiological variables monitored by commercial oximeters or NIRS instrumentation.

RESULTS

Of the identified records, 191 studies regrouping 3435 participants, met the eligibility criteria. This systematic review highlighted a number of key findings in 37 domains of sport activities. Overall, NIRS information can be used as a meaningful marker of skeletal muscle oxidative capacity and can become one of the primary monitoring tools in practice in conjunction with, or in comparison with, heart rate or mechanical power indices in diverse exercise contexts and across different types of training and interventions.

CONCLUSIONS

Although the feasibility and success of the use of muscle oximetry in sports science is well documented, there is still a need for further instrumental development to overcome current instrumental limitations. Longitudinal studies are urgently needed to strengthen the benefits of using muscle oximetry in sports science.

The effects of lower limb ischaemic preconditioning: a systematic review

Ischaemic preconditioning (IPC) involves the use of repeated occlusions and reperfusions of the peripheral muscle blood supply at a limb. This systematic literature review examines the typical responses in response to the method of application during an IPC applied at the lower limb. This review focuses on the physiological responses for VO2max, haemoglobin, metabolic and genetic responses to various IPC interventions. The literature search was performed using four databases and assessed using the PRISMA search strategy and COSMIN to assess the quality of the articles. Seventeen articles were included in the review, with a total of 237 participants. While there is variation in the method of application, the average occlusion pressure was 222 ± 34 mmHg, ranging from 170 to 300 mmHg typically for 3 or 4 occlusion cycles. The distribution of this pressure is influenced by cuff width, although 8 studies failed to report cuff width. The majority of studies applies IPC at the proximal thigh with 16/17 studies applying an occlusion below this location. The results highlighted the disparities and conflicting findings in response to various IPC methods. While there is some agreement in certain aspects of the IPC manoeuvre such as the location of the occlusion during lower limb IPC, there is a lack of consensus in the optimal protocol to elicit the desired responses. This offers the opportunity for future research to refine the protocols, associated responses, and mechanisms responsible for these changes during the application of IPC.

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.

Ischaemic preconditioning improves upper-body endurance performance without altering ⩒O2 kinetics

PURPOSE

Whilst pre-exercise ischaemic preconditioning (IPC) can improve lower-body exercise performance, its impact on upper-limb performance has received little attention. This study examines the influence of IPC on upper-body exercise performance and oxygen uptake (⩒O₂) kinetics.

METHODS

Eleven recreationally-active males (24 ± 2 years) completed an arm-crank graded exercise test to exhaustion to determine the power outputs at the ventilatory thresholds (VT1 and VT2) and ⩒O_2peak (40.0 ± 7.4 ml·kg^-1·min^-1). Four main trials were conducted, two following IPC (4 × 5-min, 220 mmHg contralateral upper-limb occlusion), the other two following SHAM (4 × 5-min, 20 mmHg). The first two trials consisted of a 15-minute constant work rate and the last two time-to-exhaustion (TTE) arm-crank tests at the power equivalents of 95% VT1 (LOW) and VT2 (HIGH), respectively. Pulmonary ⩒O₂ kinetics, heart rate, blood-lactate concentration, and rating of perceived exertion were recorded throughout exercise.

RESULTS

TTE during HIGH was longer following IPC than SHAM (459 ± 115 vs 395 ± 102 s, p = 0.004). Mean response time and change in ⩒O₂ between 2-min and end exercise (Δ⩒O₂) were not different between IPC and SHAM for arm-cranking at both LOW (80.3 ± 19.0 vs 90.3 ± 23.5 s [p = 0.06], 457 ± 184 vs 443 ± 245 ml [p = 0.83]) and HIGH (96.6 ± 31.2 vs 92.1 ± 24.4 s [p = 0.65], 617 ± 321 vs 649 ± 230 ml [p = 0.74]). Heart rate, blood-lactate concentration, and rating of perceived exertion did not differ between conditions (all p≥0.05).

CONCLUSION

TTE was longer following IPC during upper-body exercise despite unchanged ⩒O₂ kinetics.

Active Relative to Passive Ischemic Preconditioning Enhances Intense Endurance Performance in Well-Trained Men

PURPOSE

This study tested the hypothesis of whether ischemic exercise preconditioning (IPC-Ex) elicits a better intense endurance exercise performance than traditional ischemic preconditioning at rest (IPC-rest) and a SHAM procedure.

METHODS

Twelve men (average V˙O2max ∼61 mL·kg-1·min-1) performed 3 trials on separate days, each consisting of either IPC-Ex (3 × 2-min cycling at ∼40 W with a bilateral-leg cuff pressure of ∼180 mm Hg), IPC-rest (4 × 5-min supine rest at 220 mm Hg), or SHAM (4 × 5-min supine rest at <10 mm Hg) followed by a standardized warm-up and a 4-minute maximal cycling performance test. Power output, blood lactate, potassium, pH, rating of perceived exertion, oxygen uptake, and gross efficiency were assessed.

RESULTS

Mean power during the performance test was higher in IPC-Ex versus IPC-rest (+4%; P = .002; 95% CI, +5 to 18 W). No difference was found between IPC-rest and SHAM (-2%; P = .10; 95% CI, -12 to 1 W) or between IPC-Ex and SHAM (+2%; P = .09; 95% CI, -1 to 13 W). The rating of perceived exertion increased following the IPC-procedure in IPC-Ex versus IPC-rest and SHAM (P < .001). During warm-up, IPC-Ex elevated blood pH versus IPC-rest and SHAM (P ≤ .027), with no trial differences for blood potassium (P > .09) or cycling efficiency (P ≥ .24). Eight subjects anticipated IPC-Ex to be best for their performance. Four subjects favored SHAM.

CONCLUSIONS

Performance in a 4-minute maximal test was better following IPC-Ex than IPC-rest and tended to be better than SHAM. The IPC procedures did not affect blood potassium, while pH was transiently elevated only by IPC-Ex. The performance-enhancing effect of IPC-Ex versus IPC-rest may be attributed to a placebo effect, improved pH regulation, and/or a change in the perception of effort.

Local and Remote Ischemic Preconditioning Improves Sprint Interval Exercise Performance in Team Sport Athletes

The aim of this study was to investigate the effects of local (LIPC) and remote (RIPC) ischemic preconditioning on sprint interval exercise (SIE) performance. Fifteen male collegiate basketball players underwent a LIPC, RIPC, sham (SHAM), or control (CON) trial before conducting six sets of a 30-s Wingate-based SIE test. The oxygen uptake and heart rate were continuously measured during SIE test. The total work in the LIPC (+2.2%) and RIPC (+2.5%) conditions was significantly higher than that in the CON condition (p < 0.05). The mean power output (MPO) at the third and fourth sprint in the LIPC (+4.5%) and RIPC (+4.9%) conditions was significantly higher than that in the CON condition (p < 0.05). The percentage decrement score for MPO in the LIPC and RIPC condition was significantly lower than that in the CON condition (p < 0.05). No significant interaction effects were found in pH and blood lactate concentrations. There were no significant differences in the accumulated exercise time at ≥80%, 90%, and 100% of maximal oxygen uptake during SIE. Overall, both LIPC and RIPC could improve metabolic efficiency and performance during SIE in athletes.

Remote Ischemic Preconditioning Reduces Marathon-Induced Oxidative Stress and Decreases Liver and Heart Injury Markers in the Serum

Clinical studies continue to provide evidence of organ protection by remote ischemic preconditioning (RIPC). However, there is lack of insight into impact of RIPC on exercise-induce changes in human organs' function. We here aimed to elucidate the effects of 10-day RIPC training on marathon-induced changes in the levels of serum markers of oxidative stress, and liver and heart damage. The study involved 18 male amateur runners taking part in a marathon. RIPC training was performed in the course of four cycles, by inflating and deflating a blood pressure cuff at 5-min intervals (RIPC group, n=10); the control group underwent sham training (n=8). The effects of RIPC on levels of oxidative stress, and liver and heart damage markers were investigated at rest after 10 consecutive days of training and after the marathon run. The 10-day RIPC training decreased the serum resting levels of C-reactive protein (CRP), alanine transaminase (ALT), γ-glutamyl transpeptidase (GGT), and malondialdehyde (MDA). After the marathon run, creatinine kinase MB (CK-MB), lactate dehydrogenase (LDH), cardiac troponin level (cTn), aspartate aminotransferase (AST), alkaline phosphatase (ALP), ALT, total bilirubin (BIL-T), and MDA levels were increased and arterial ketone body ratio (AKBR) levels were decreased in all participants. The changes were significantly diminished in the RIPC group compared with the control group. The GGT activity remained constant in the RIPC group but significantly increased in the control group after the marathon run. In conclusion, the study provides evidence for a protective effect of RIPC against liver and heart damage induced by strenuous exercise, such as the marathon.

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.

Ischemic preconditioning has no effect on maximal arm cycling exercise in women

PURPOSE

We investigated the effect of ischemic preconditioning (IPC) on performance of a 3 min maximal effort arm ergometer test in young women.

METHODS

Twenty healthy women (23.1 (SD 3.3) years) performed a 3 min maximal effort arm cycling exercise, preceded by IPC on both arms or SHAM in a counterbalanced randomized crossover design. Both blood flow (via high resolution ultrasound; n = 17) and muscle oxygenation/deoxygenation (via near infrared spectroscopy; n = 5) were measured throughout the IPC/SHAM. Performance and perceptual/physiological (i.e., heart rate, blood lactate, rating of perceived exertion, and triceps brachialis oxygenation) parameters were recorded during the exercise test.

RESULTS

Occlusion during IPC completely blocked brachial artery blood flow, decreased oxygenated hemoglobin/myoglobin (Δ[oxy(Hb + Mb)]), and increased deoxygenated Hb/Mb (Δ[deoxy(Hb + Mb)]). There were no differences (P > 0.797) in performance (peak, mean, and end power output) or in any perceptual/physiological variables during the 3 min all-out test between IPC/SHAM. During exercise, Δ[oxy(Hb + Mb)] initially decreased with no differences (P ≥ 0.296) between conditions and returned towards baseline by the completion of the test while Δ[deoxy(Hb + Mb)] increased with no differences between conditions and remained elevated until completion of the test (P ≥ 0.755).

CONCLUSIONS

We verified the successful application of IPC via blood flow and NIRS measures but found no effects on performance of a 3 min maximal effort arm cranking test in young women.

Oral taurine improves critical power and severe-intensity exercise tolerance

This study investigated the effects of acute oral taurine ingestion on: (1) the power-time relationship using the 3-min all-out test (3MAOT); (2) time to exhaustion (TTE) 5% > critical power (CP) and (3) the estimated time to complete (T_lim) a range of fixed target intensities. Twelve males completed a baseline 3MAOT test on a cycle ergometer. Following this, a double-blind, randomised cross-over design was followed, where participants were allocated to one of four conditions, separated by 72 h: TTE + taurine; TTE + placebo; 3MAOT + taurine; 3MAOT + placebo. Taurine was provided at 50 mg kg^-1, whilst the placebo was 3 mg kg^-1 maltodextrin. CP was higher (P < 0.05) in taurine (212 ± 36 W) than baseline (197 ± 40 W) and placebo (193 ± 35 W). Work end power was not affected by supplement (P > 0.05), yet TTE 5% > CP increased (P < 0.05) by 1.7 min after taurine (17.7 min) compared to placebo (16.0 min) and there were higher (P < 0.001) estimated T_lim across all work targets. Acute supplementation of 50 mg kg^-1 of taurine improved CP and estimated performance at a range of severe work intensities. Oral taurine can be taken prior to exercise to enhance endurance performance.

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 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.

Impact of 8 weeks of repeated ischemic preconditioning on running performance

PURPOSE

To examine if repeated exposure to IPC treatment prior to training sessions improves oxygen uptake and 1-km running performance in highly trained middle-distance runners.

METHODS

Fourteen highly trained endurance runners (11 male/3 female, 19 ± 2 years, 64 ± 5 ml kg^-1 min^-1) completed a baseline maximal oxygen consumption ([Formula: see text]) test and 1-km running performance test before random assignment to an IPC or control group. Both groups were prescribed identical endurance training over an 8-week varsity season; however, the IPC group performed an IPC protocol (5 min ischemia, repeated 3 times, each separated by 5 min reperfusion) before every training session. After 8 weeks of training, participants completed a follow-up [Formula: see text] test and 1-km time trial.

RESULTS

[Formula: see text] did not increase from baseline in either group following the 8-week training bout (P = 0.2), and neither group varied more than the other ([Formula: see text] = IPC 0.6 ± 2 ml kg^-1 min^-1; control 1.5 ± 2 ml kg^-1 min^-1, P = 0.6) or beyond typical measurement error. The IPC decreased 1-km time trial time by 0.4% (0.5 ± 2 s), while the control group decreased by 1% (1.5 ± 3 s), but neither change was significant compared to baseline (P = 0.2). There was also no difference in time trial improvement between IPC and control (P = 0.6). However, there was a trend towards IPC significantly improving running economy at low intensity (P = 0.057).

CONCLUSION

Our data suggest that over a normal 8-week season in a population of highly trained middle-distance runners there is no benefit of undergoing chronic, repeated IPC treatments before training for augmenting maximal aerobic power or 1-km performance time.

The effect of IPC on central and peripheral fatiguing mechanisms in humans following maximal single limb isokinetic exercise

Ischemic preconditioning (IPC) has been suggested to preserve neural drive during fatiguing dynamic exercise, however, it remains unclear as to whether this may be the consequence of IPC-enhanced muscle oxygenation. We hypothesized that the IPC-enhanced muscle oxygenation during a dynamic exercise task would subsequently attenuate exercise-induced reductions in voluntary activation. Ten resistance trained males completed three 3 min maximal all-out tests (AOTs) via 135 isokinetic leg extensions preceded by treatments of IPC (3 × 5 min bilateral leg occlusions at 220 mmHg), SHAM (3 × 5 min at 20 mmHg) or CON (30 min passive rest). Femoral nerve stimulation was utilized to assess voluntary activation and potentiated twitch torque during maximal voluntary contractions (MVCs) performed at baseline (BL), prior to the AOT (Pre), and then 10 sec post (Post). Tissue oxygenation (via near-infrared spectroscopy) and sEMG activity was measured throughout the AOT. MVC and twitch torque levels declined (MVC: -87 ± 23 Nm, 95% CI = -67 to -107 Nm; P < 0.001, twitch: -30 ± 13 Nm; 95% CI = -25 to -35 Nm; P < 0.001) between Pre and Post without reductions in voluntary activation (P = 0.72); there were no differences between conditions (MVC: P = 0.75, twitch: P = 0.55). There were no differences in tissue saturation index (P = 0.27), deoxyhemoglobin concentrations (P = 0.86) or sEMG activity (P = 0.92) throughout the AOT. These findings demonstrate that IPC does not preserve neural drive during an all-out 3 min isokinetic leg extension task.

Lower limb ischemic preconditioning combined with dietary nitrate supplementation does not influence time-trial performance in well-trained cyclists

OBJECTIVES

Dietary nitrate (NO₃^-) supplementation and ischaemic preconditioning (IPC) can independently improve exercise performance. The purpose of this study was to explore whether NO₃^- supplementation, ingested prior to an IPC protocol, could synergistically enhance parameters of exercise.

DESIGN

Double-blind randomized crossover trial.

METHODS

Ten competitive male cyclists (age 34±6years, body mass 78.9±4.9kg, V⋅O_2peak 55±4 mLkgmin^-1) completed an incremental exercise test followed by three cycling trials comprising a square-wave submaximal component and a 16.1km time-trial. Oxygen uptake (V⋅O₂) and muscle oxygenation kinetics were measured throughout. The baseline (BASE) trial was conducted without any dietary intervention or IPC. In the remaining two trials, participants received 3×5min bouts of lower limb bilateral IPC prior to exercise. Participants ingested NO₃^--rich gel (NIT+IPC) 90min prior to testing in one trial and a low NO₃^- placebo in the other (PLA+IPC). Plasma NO₃^- and nitrite (NO₂^-) were measured immediately before and after application of IPC.

RESULTS

Plasma [NO₃^-] and [NO₂^-] were higher before and after IPC in NIT+IPC compared to BASE (P<0.001) but did not differ between BASE and PLA+IPC. There were no differences in V⋅O₂ kinetics or muscle oxygenation parameters between trials (all P>0.4). Performance in the time-trial was similar between trials (BASE 1343±72s, PLA+IPC 1350±75s, NIT+IPC 1346±83s, P=0.98).

CONCLUSIONS

Pre-exercise IPC did not improve sub-maximal exercise or performance measures, either alone or in combination with dietary NO₃^- supplementation.

Short-Term Preconditioning With Blood Flow Restricted Exercise Preserves Quadriceps Muscle Endurance in Patients After Anterior Cruciate Ligament Reconstruction

Surgical ACL reconstruction performed with a tourniquet induces compression and ischemic stress of the quadriceps femoris (QF) muscle which can accelerate postoperative weakness. Given that low-load blood flow restricted (BFR) exercise is potent in enhancing muscle oxygenation and vascular function, we hypothesized that short-term preconditioning with low-load BFR exercise can attenuate QF muscle endurance deterioration in the postoperative period. Twenty subjects undergoing arthroscopic ACL reconstruction performed 5 exercise sessions in the last 8 days prior to surgery. They were assigned into either BFR group, performing low-load BFR knee-extension exercise, or SHAM-BFR group, replicating equal training volume with sham occlusion. Blood flow (near-infrared spectroscopy) and surface EMG of QF muscle during sustained isometric contraction at 30% of maximal voluntary isometric contraction (MVIC) torque performed to volitional failure were measured prior to the intervention and again 4 and 12 weeks after surgery. There was an overall decrease (p = 0.033) in MVIC torque over time, however, no significant time-group interaction was found. The time of sustained QF contraction shortened (p = 0.002) in SHAM-BFR group by 97 ± 85 s at week 4 and returned to preoperative values at week 12. No change in the time of sustained contraction was detected in BFR group at any time point after surgery. RMS EMG amplitude increased (p = 0.009) by 54 ± 58% at week 4 after surgery in BFR group only. BFm increased (p = 0.004) by 52 ± 47% in BFR group, and decreased (p = 0.023) by 32 ± 19% in SHAM-BFR group at week 4 after surgery. Multivariate regression models of postoperative changes in time of sustained QF contraction revealed its high correlation (R2 = 0.838; p < 0.001) with changes in BFm and RMS EMG in the SHAM-BFR group, whereas no such association was found in the BFR group. In conclusion, enhanced endurance of QF muscle was triggered by combination of augmented muscle fiber recruitment and enhanced muscle perfusion. The latter alludes to a preserving effect of preconditioning with BFR exercise on density and function of QF muscle microcirculation within the first 4 weeks after ACL reconstruction.

Influence and reliability of lower-limb arterial occlusion pressure at different body positions

Background

Total arterial occlusive pressure (AOP) is used to prescribe pressures for surgery, blood flow restriction exercise (BFRE) and ischemic preconditioning (IPC). AOP is often measured in a supine position; however, the influence of body position on AOP measurement is unknown and may influence level of occlusion in different positions during BFR and IPC. The aim of this study was therefore to investigate the influence of body position on AOP.

Methods

Fifty healthy individuals (age = 29 ± 6 y) underwent AOP measurements on the dominant lower-limb in supine, seated and standing positions in a randomised order. AOP was measured automatically using the Delfi Personalised Tourniquet System device, with each measurement separated by 5 min of rest.

Results

Arterial occlusive pressure was significantly lower in the supine position compared to the seated position (187.00 ± 32.5 vs 204.00 ± 28.5 mmHg, p < 0.001) and standing position (187.00 ± 32.5 vs 241.50 ± 49.3 mmHg, p < 0.001). AOP was significantly higher in the standing position compared to the seated position (241.50 ± 49.3 vs 204.00 ± 28.5 mmHg, p < 0.001).

Discussion

Arterial occlusive pressure measurement is body position dependent, thus for accurate prescription of occlusion pressure during surgery, BFR and IPC, AOP should be measured in the position intended for subsequent application of occlusion.