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

## TL;DR

Ischemic preconditioning slightly improves physical performance, with effects influenced by warm-up timing, sex, and training level.

## Contribution

This study provides a meta-analysis of ischemic preconditioning effects on physical performance, identifying key moderators like warm-up and participant characteristics.

## Key findings

- IPC improves physical performance with a small but significant effect (g = 0.13).
- Performance benefits are greater for males and less-trained individuals.
- IPC followed by a warm-up after ~42 minutes yields optimal results.

## Abstract

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.