Biology of Sport
eISSN: 2083-1862
ISSN: 0860-021X
Biology of Sport
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abstract:
Review paper

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

Yilin Zhang
1
,
Kai Xu
2
,
Hao Kong
3
,
Mingyue Yin
3
,
Chenghao Liu
1
,
Yun Xie
1
,
Liam Kilduff
4, 5
,
Gustavo R Mota
6
,
Olivier Girard
7

  1. School of Sports Training, Tianjin University of Sport, No.16 Donghai Road, Tuanbo New Town West, Jinghai District, Tianjin, 301617, China
  2. School of Medical and Healt Sciences, Centre for Human Performance, Edith Cowan University, Joondalup, Australia
  3. The Mar MacKillop Institute for Health Research, Australian Catholic University, Melbourne,VIC. 3000, Australia
  4. A-STEM, School of Engineering, Swansea University, Swansea, UK
  5. Welsh Institute of Performance Science (WIPS), Swansea University Performance Science, Swansea, UK
  6. Exercise Science, Health and Human Performance Research Group, Department of Sport Sciences, Institute of Health Sciences, Federal University of Triângulo Mineiro, Uberaba/MG, Brazil
  7. School of Human Science (Exercise and Sport Sciences), The University of Western Australia, Perth, Western Australia, Australia
Biol Sport. 2026;43:511–554
DOI: https://doi.org/10.5114/biolsport.2026.154945
Online publish date: 2025/10/31
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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.
keywords:

Blood flow restriction , Exercise performance, Ergogenic aids, Warm-up protocols, Time window, Training level, Placebo

  
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