Enhancing physical performance with ischemic preconditioning: a systematic review and meta-analysis of moderators and performance outcomes

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This study examined the effects of ischemic preconditioning (IPC) on physical performance, considering the influence of timing, warm-up (WU), participant characteristics, and IPC protocols structure. A total of 90 trials (1,439 participants) were retrieved from three databases and assessed using PICOS criteria. Multilevel meta-analyses with cluster-robust variance adjustments were conducted to calculate pooled effect sizes (Hedge's g). Risk of bias and certainty of evidence were assessed using the RoB 2 tool and GRADE framework. IPC produced a trivial but significant improvement in physical performance (g = 0.13, P < 0.01), which persisted after excluding SHAM effects (g = 0.10; P < 0.01). Significant improvements were observed for maximum repetitions, time to failure, and power output, but not for jump ability, strength, or oxygen uptake. Comparable benefits were found for anaerobic (g = 0.15) and aerobic (g = 0.10) exercise, with greater effects in males and less-trained participants. Performance was further enhanced when IPC was followed by WU (g = 0.16), with the optimal IPC-to-WU interval being ~42 minutes. Without WU, the effective IPC window narrowed to 6-7 minutes. In practice, IPC can enhance physical performance, independently of sham effects, moderated by sex, training level, and WU. For competition or testing, the most effective strategy appears to be 3 or 4 × 5-min IPC protocol, followed by a 42-min interval, standardized warm-up, and endurance testing. For mechanistic studies, WU should be excluded, and testing conducted 6-7 minutes post-IPC. Future research should target women, middle-aged individuals, and elite athletes.

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