Potential Short- and Long-Term Physiological Effects of Ischemic Preconditioning as an Ergogenic Aid: Revisiting Foundational Mechanisms and Applications

Abstract

Ischemic preconditioning (IPC) has emerged as a promising intervention for enhancing health- and exercise-related outcomes. Initially recognized in the 1980s and 1990s for its cardioprotective effects in clinical and animal studies, IPC has since garnered attention for its potential ergogenic benefits. Despite growing interest, the underlying physiological mechanisms remain poorly understood, leading to research exploring cause-effect relationship and evaluating IPC efficacy across diverse exercise models, often yielding mixed results. This Leading Article aims to clarify proposed mechanisms by which IPC may enhance athletic performance and facilitate healing effects. Specifically, this Leading Article discusses both the immediate (short-term) and sustained (long-term) effects of IPC. Short-term effects primarily involve acute improvements in vascular function and exercise capacity, while long-term effects may include cumulative benefits such as enhanced recovery, mitigation of exercise-induced muscle damage and adaptative physiological responses. This article highlights the importance of optimizing experimental protocols by extending the time window between IPC application and testing, to maximize performance outcomes, particularly under conditions associated with muscle damage. Future research should prioritize exploring the long-term effects of IPC on performance and recovery to better understand its potential as a reliable ergogenic aid.

Fig. 1

Proposed mechanisms by which IPC could improve athletic performance and recovery. The left side of the figure depicts short-term effects encompassing alterations in bottom-up afferent and increases in top-down efferent drive by cuff-pressure, enhancements of red blood cells deformability as well as vasodilation-inducing vasoactive substances, optimizing blood flow in the microcirculation and facilitating a greater supply of oxygen and nutrients, as well as the removal of CO₂ and metabolic waste. The right side of the figure outlines the long-term effects, which are associated with a signaling cascade that increases mitochondrial activity while reducing oxidative stress and the inflammatory response. The sequential occurrence of these factors could mitigate EIMD and accelerate the healing process, thereby optimizing athletic performance. Notably, short-term vascular effects (10), although transient, could enhance EIMD healing in a post-exercise condition. EIMD exercise-induced muscle damage, IPC ischemic preconditioning, ROS reactive oxidative species