Effects of Individualized Ischemic Preconditioning on Protection Against Eccentric Exercise–Induced Muscle Damage: A Randomized Controlled Trial

Abstract

Background: The effects of ischemic preconditioning (IPC) versus a deceptive sham protocol on indirect markers of exercise-induced muscle damage (EIMD) after the application of individualized occlusion pressure were examined. The goal of using a sham protocol is to control for the potential effect of placebo. Hypothesis: IPC would surpass the sham protocol in protecting against EIMD. Study Design: A randomized, double-blinded, clinical trial. Level of Evidence: Level 1. Methods: Thirty healthy young men were randomly assigned to an eccentric exercise for the knee extensor muscles preceded by IPC (4 × 5 minutes of individualized total occlusion pressure) or sham protocol (4 × 5 minutes using 20 mm Hg). Maximal voluntary isometric torque (MVIT), rate of torque development, muscle soreness, pressure pain threshold, knee range of motion, thigh girth, and creatine kinase (CK) activity were assessed before IPC or sham protocol and up to 72 hours after the eccentric EIMD. Affective valence and perceived exertion were also evaluated. Results: MVIT decreased 17.1% in the IPC and 18.1% in the sham groups, with no differences between groups. Differences from baseline were observed in the sham group for muscle soreness at 48 hours ( P < 0.001) and 72 hours ( P = 0.02), and for CK activity at 72 hours ( P = 0.04). Muscle soreness was reduced in the IPC group at 48 hours compared with the sham group (∆ = 15.8 mm; P = 0.008) but without achieving the minimal clinically important difference. IPC induced a smaller perceived exertion than the sham protocol (∆ = 1.1 a.u.; P = 0.02). The remaining outcomes were not statistically different in both groups. Conclusion: IPC does not surpass the sham protocol to protect against mild EIMD of the knee extensors muscles. Clinical Relevance: Although IPC is a noninvasive, low-cost, and easy-to-administer intervention, the IPC effects can, in part, be explained by the placebo effect. In addition, individualized IPC promotes attenuation in perceived exertion during eccentric exercise.

Effects of remote ischemic conditioning on conditioned pain modulation and cardiac autonomic modulation in women with knee osteoarthritis: placebo-controlled randomized clinical trial protocol

“…In both study groups, the TOP will be determined: first, participants will be asked to remain at rest in the supine position for 10 min in an acclimatized room (21–23°C) and silent [ 43 , 44 ]. To determine the TOP, a vascular Doppler (DF-7000 V; Medpej, Ribeirão Preto, São Paulo, Brazil) will be used, which will be positioned over the posterior tibial artery (located in the middle distance between the medial malleolus of the tibia and the Achilles tendon) to capture the auscultatory pulse [ 45 ].…”

“…A cuff (velcro; 12.5 cm wide and 84 cm long and inflatable chamber 7 cm wide and 52 cm long, Cardiomed, Curitiba, Paraná, Brazil) will be positioned in the region of the inguinal fold with the inflatable region of the cuff in the medial portion of the thigh covering the femoral artery [ 46 ] of the lower limb with the greatest complaint of knee pain [ 45 , 46 ] and then it will be progressively inflated waiting 30 s every 50 mmHg and completely deflating and pausing for 10 s, and 40 mmHg will be added to the initial 50 mmHg (total of 90 mmHg).…”

“…Then wait 30 s and slowly deflate until the auscultatory pulse returns. The TOP will be defined when the lowest pressure capable of completely obstructing blood flow is reached [ 45 , 47 – 49 ]. A wider cuff was chosen, as it has been proven that the width of the cuff has a great influence on the pressure needed to achieve full restriction of blood flow [ 49 ].…”

Effects of Ischemic Pre and Postconditioning on Indirect Markers of muscle damage: A Systematic Review and Meta-Analysis

“…Thirty-three studies proceeded to abstract screening, and the full-text version of 20 studies were screened for eligibility. Nine studies reporting data from 178 healthy participants (174 men and 4 women) were eligible for the systematic review (10,11,20,21,(32)(33)(34)(35)(36). Studies were published between 2012 and 2021.…”

Blood Flow Restriction: Cause for Optimism, But Let’s Not Abandon The Fundamentals

“…While it is early to make any definitive conclusions, there is some early evidence that ischemic preconditioning may enhance recovery after athletic performance, [45][46][47][48][49] but evidence to the contrary exists as well. 50,51 While BFR appears to be a very promising and exciting innovation in our field, it is important to keep in mind that accepted, proven training practices and principles are not abandoned. Prior to incorporation of BFR training clinicians should ask themselves several questions.…”