Manual Therapy, Posturology & Rehabilitation Journal
Manual Therapy, Posturology & Rehabilitation Journal
Study Protocol

Effects of ischemic preconditioning on indirect markers of exercise-induced muscle damage: protocol for a randomized placebo-controlled trial.

Mikhail Santos Cerqueira, Ingrid Martins de França, Mauro Bezerra Montello, Daniel Kovacs, Wouber Hérickson de Brito Vieira

Downloads: 0
Views: 290


Background: Ischemic preconditioning (IPC) has been used to improve exercise performance, but its role in protecting against exercise-induced muscle damage (EIMD) is still unclear. Objective: To investigate the effects of IPC on the indirect markers of EIMD when compared to placebo. Methods: 30 healthy young men, with no recent experience in lower limb strength training, will be recruited. Subjects will be allocated randomly into two groups: IPC or placebo. The IPC group will undergo 4 x 5 min of occlusion (with individualized total occlusion pressure), interspersed with 5 min of reperfusion. The placebo group will be submitted to the same protocol, but with minimum pressure (10mmHg) being applied during the occlusion period. After the interventions, volunteers will be submitted to muscle damage induced by isokinetic exercise (10 sets of 12 maximum eccentric repetitions) in the non-dominant femoral quadriceps. The primary outcome will be isometric peak torque, measured both before and up to 72 hours after exercise. Secondary outcomes include rate of torque development, muscle soreness, knee range of motion, thigh circumference and blood levels of creatine kinase. Discussion: The results of this trial will indicate whether the effects of IPC are superior to placebo in the protection against EIMD


Blood Flow Restriction; Prevention; Eccentric Exercise; Muscle Recovery; Placebo Effect


1. McHugh MP. Recent advances in the understanding of the repeated bout effect: The protective effect against muscle damage from a single bout of eccentric exercise. Scand. J Med. Sci. Sports. 2003;13:88-97.

2. Chen TC, Lin KY, Chen HL, Lin MJ, Nosaka K. Comparison in eccentric exercise-induced muscle damage among four limb muscles. Eur. J Appl. Physiol. 2011;111:211-223.

3. Bishop PA, Jones E, Woods AK. Recovery from training: a brief review. J Strength Cond. Res. 2008; 22:1015-1024.

4. Cerqueira MS, Santos Borges L, dos Santos Rocha JA, et al. Twelve hours of a compression sleeve is not enough to improve the muscle recovery of an exercise-damaged upper arm. Apunts Med. de l’Esport. 2015;185:23-28.

5. Nampo FK, Cavalheri V, Dos Santos Soares F, de Paula Ramos S, Camargo EA. Low-level phototherapy to improve exercise capacity and muscle performance: a systematic review and meta-analysis. Lasers Med. Sci. 2016;9:1957-1970.

6. Howatson G, Van Someren KA. The prevention and treatment of exerciseinduced muscle damage. Sports Med. 2008;38:483-503.

7. Borges LS, Cerqueira MS, Dos Santos Rocha JA, et al. Light-emitting diode phototherapy improves muscle recovery after a damaging exercise. Lasers Med. Sci. 2014;29:1139-1144.

8. Chen TCC, Chen HL, Pearce AJ, Nosaka K. Attenuation of eccentric exerciseinduced muscle damage by preconditioning exercises. Med. Sci. Sports Exerc. 2012;44:2090-8.

9. Toma RL, Oliveira MX, Renno ACM, Laakso EL. Photobiomodulation (PBM) therapy at 904 nm mitigates effects of exercise-induced skeletal muscle fatigue in young women. Lasers Med. Sci. 2018;33:1197-1205.

10. Franz A, Behringer M, Nosaka K, et al. Mechanisms underpinning protection against eccentric exercise-induced muscle damage by ischemic preconditioning. Med. Hypotheses. 2017;98:21-27.

11. Salvador AF, De Aguiar RA, Lisbôa FD, Pereira KL, De Cruz RSO, Caputo F. Ischemic preconditioning and exercise performance: A systematic review and meta-analysis. Int. J Sports Physiol. Perform. 2016;11:4-14.

12. Sharma V, Marsh R, Cunniffe B, Cardinale M, Yellon DM, Davidson SM. From Protecting the Heart to Improving Athletic Performance - the Benefits of Local and Remote Ischaemic Preconditioning. Cardiovasc. Drugs Ther. 2015;29:573-588.

13. Incognito A V., Burr JF, Millar PJ. The Effects of Ischemic Preconditioning on Human Exercise Performance. Sports Med. 2016;46:531-44.

14. Beaven CM, Cook CJ, Kilduff L, Drawer S, Gill N. Intermittent lower-limb occlusion enhances recovery after strenuous exercise. Appl. Physiol. Nutr. Metab. 2012;37:1132-1139.

15. Sabino-Carvalho JL, Lopes TR, Obeid-Freitas T, et al. Effect of Ischemic Preconditioning on Endurance Performance Does Not Surpass Placebo. Med. Sci. Sports Exerc. 2017;49:124-132.

16. Franz A, Behringer M, Harmsen JF, et al. Ischemic Preconditioning Blunts Muscle Damage Responses Induced by Eccentric Exercise. Med. Sci. Sports Exerc. 2018;50:109-115.

17. Marocolo M, da Mota GR, Simim MAM, Appell Coriolano H-J. Myths and Facts About the Effects of Ischemic Preconditioning on Performance. Int. J Sports Med. 2016;37:87-96.

18. Bezerra de Morais AT, Cerqueira MS, Moreira Sales R, Rocha T, Galvão de Moura Filho A. Upper limbs total occlusion pressure assessment: Doppler ultrasound reproducibility and determination of predictive variables. Clin. Physiol. and Funct. Imaging. 2017;37:437-441.

19. Loenneke JP, Allen KM, Mouser JG, et al. Blood flow restriction in the upper and lower limbs is predicted by limb circumference and systolic blood pressure. Eur. J Appl. Physiol. 2015;115:397-405.

20. Ferreira TN, Sabino-Carvalho JLC, Lopes TR, et al. Ischemic Preconditioning and Repeated Sprint Swimming: A Placebo and Nocebo Study. Med. Sci. Sports Exerc. 2016;48:1967-75.

21. Damas F, Nosaka K, Libardi C, Chen T, Ugrinowitsch C. Susceptibility to Exercise-Induced Muscle Damage: a Cluster Analysis with a Large Sample. Int. J Sports Med. 2016;37:633-640.

22. Aagaard P, Simonsen EB, Andersen JL, Magnusson P, Dyhre-Poulsen P. Increased rate of force development and neural drive of human skeletal muscle following resistance training. J Appl. Physiol. 2002;93:1318-1326.

23. Peñailillo L, Blazevich A, Numazawa H, Nosaka K. Rate of force development as a measure of muscle damage. Scand. J Med. Sci. Sports. 2015;25:417-427.

24. Chan A-W, Tetzlaff JM, Altman DG, et al. SPIRIT 2013 Statement: Defining Standard Protocol Items for Clinical Trials. Ann. Intern. Med. 2013;158:200-7.

25. Fuzari HKB, de Andrade AD, Cerqueira MS, et al. Whole body vibration to attenuate reduction of explosive force in chronic kidney disease patients: a randomized controlled trial. J. Exerc. Rehabil. 2018;14:883-890.

26. Chen TC, Chen HL, Lin MJ, Wu CJ, Nosaka K. Potent protective effect conferred by four bouts of low-intensity eccentric exercise. Med. Sci. Sports Exerc. 2010;42:1004-1012.

27. Ferraresi C, De Brito Oliveira T, De Oliveira Zafalon L, et al. Effects of low level laser therapy (808 nm) on physical strength training in humans. Lasers Med. Sci. 2011;26:349-358.

28. Barbosa TC, Machado AC, Braz ID, et al. Remote ischemic preconditioning delays fatigue development during handgrip exercise. Scand. J Med. Sci. Sports. 2015;25:356-64.

29. Seeger JPH, Timmers S, Ploegmakers DJM, Cable NT, Hopman MTE, Thijssen DHJ. Is delayed ischemic preconditioning as effective on running performance during a 5km time trial as acute IPC? J Sci. Med. Sport. 2016;20:208-212.

30. Baroni BM, Junior ECPL, Marchi T De, et al. Low level laser therapy before eccentric exercise reduces muscle damage markers in humans. Eur. J Appl. Physiol. 2010;110:789-796.

31. Foster C, Florhaug JA, Franklin J, et al. A New Approach to Monitoring Exercise Training. J Strength Cond. Res. 2001;15:109-15.

32. Tseng K-W, Tseng W-C, Lin M-J, Chen H-L, Nosaka K, Chen TC. Protective effect by maximal isometric contractions against maximal eccentric exercise-induced muscle damage of the knee extensors. Res. Sports Med. 2016;24:228-241.

5df12c290e8825d966b5f733 mtprehab Articles
Links & Downloads

Man. Ther., Posturology Rehabil. J.

Share this page
Page Sections