Author Identifier (ORCID)
Kai Xu: https://orcid.org/0009-0000-2874-881X
Renee Graham: https://orcid.org/0000-0001-8725-0296
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.
Keywords
Blood flow restriction, exercise performance, ergogenic aids, warm-up protocols, time window training level placebo
Document Type
Journal Article
Date of Publication
1-1-2026
Volume
43
Issue
1
Publication Title
Biology of Sport
Publisher
Institute of Sport
School
Centre for Human Performance / School of Medical and Health Sciences
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
First Page
511
Last Page
554
Comments
Zhang, Y., Xu, K., Kong, H., Yin, M., Liu, C., Xie, Y., Kilduff, L., Mota, G., & Girard, O. (2025). Enhancing physical performance with ischemic preconditioning: A systematic review and meta-analysis of moderators andperformance outcomes. Biology of Sport, 43, 511–554. https://doi.org/10.5114/biolsport.2026.154945