Repeated bouts of ischemia followed by reperfusion (i.e., ischemic preconditioning (IPC)) protect against damage after a myocardial infarction. Recent observational data indicate that IPC improves exercise performance. However, no previous study has examined potential underlying mechanisms for this effect of IPC. Therefore, we examined the potential of IPC to improve 5-km running time trial performance and reduce lactate accumulation during an incremental exercise test. In a randomized, crossover study, 13 healthy men performed running exercise, which was preceded by IPC (4 × 5-min 220 mm Hg bilateral leg occlusion) or a control intervention (C) (4 × 5-min 20 mm Hg bilateral leg occlusion). Participants performed a graded maximal treadmill running test, starting with five 3-min submaximal stages (10-14 km·h), followed by increments of 1 km·h every 2 min to 16 km·h, followed by an incline of the treadmill of 2% every 2 min. Blood lactate was examined at each 3-min stage. After 45 min of rest in the supine position, subjects then performed a 5-km running time trial. We found similar submaximal gas parameters during running exercise with both interventions. The overall increase in blood lactate during the submaximal stages was 1.07 ± 0.11 mmol·L lower when exercise was preceded with IPC versus C (P = 0.023). The 5-km running time trial was completed in a time that was 34 s faster after IPC versus C (95% confidence interval, 5-64 s; P = 0.027). IPC improves 5-km time trial performance in healthy male individuals. Moreover, we found that IPC is associated with an attenuated rise in blood lactate concentration at submaximal level during an incremental running test. This could indicate that IPC allows for higher work rates and thus improves time trial performance.

Ischemic preconditioning (IPC) protects tissue against ischemia-induced injury inside and outside ischemic areas. The purpose was to examine the hypothesis that daily IPC leads to improvement in endothelial function and skin microcirculation not only in the arm exposed to IPC but also in the contralateral arm. Thirteen healthy, young, normotensive male individuals (aged 22±2 years) were assigned to 7-day daily exposure of the arm to IPC (4×5 minutes). Assessment of brachial artery endothelial function (using flow-mediated dilation (FMD)) and forearm microcirculation (cutaneous vascular conductance (CVC) at baseline and during local heating) was performed before and after 7 days to examine the local (i.e., intervention arm) and remote (i.e., control arm) effect of IPC. We repeated the assessment tests 8 days after the intervention (Post+8). FMD increased after repeated IPC (P = 0.03) and remained significantly elevated at Post+8 in the intervention (5.0±2.2%, 6.1±2.2%, and 6.6±2.3%) and contralateral arms (5.4±2.2%, 6.0±2.2%, and 7.5±2.2%). Forearm CVC also increased following repeated IPC (P = 0.006) and remained elevated at Post+8 in both arms (intervention: 0.12±0.03, 0.14±0.04, 0.16±0.04 mV/mm Hg; contralateral: 0.14±0.04, 0.015±0.04, 0.17±0.07). No interaction between IPC arm and time was evident for FMD and CVC (both P > 0.05). IPC intervention did not alter CVC responses to local heating (P > 0.05). Daily exposure to IPC for 7 days leads to local and remote improvements in brachial artery FMD and resting skin microcirculation that remain after cessation of the intervention and beyond the late phase of protection. These findings may have clinical relevance for micro- and macrovascular improvements.

Strenuous exercise is associated with an immediate decrease in endothelial function. Repeated bouts of ischemia followed by reperfusion, known as remote ischemic preconditioning (RIPC), is able to protect the endothelium against ischemia-induced injury beyond the ischemic area. We examined the hypothesis that RIPC prevents the decrease in endothelial function observed after strenuous exercise in healthy men. In a randomized, crossover study, 13 healthy men performed running exercise preceded by RIPC of the lower limbs (4 × 5-min 220-mmHg bilateral occlusion) or a sham intervention (sham; 4 × 5-min 20-mmHg bilateral occlusion). Participants performed a graded maximal treadmill running test, followed by a 5-km time trial (TT). Brachial artery endothelial function was examined before and after RIPC or sham, as well as after the 5-km TT. We measured flow-mediated dilation (FMD), an index of endothelium-dependent function, using high-resolution echo-Doppler. We also calculated the shear rate area-under-the-curve (from cuff deflation to peak dilatation; SR_AUC). Data are described as mean and 95% confidence intervals. FMD changed by 0.30). In the sham trial, FMD changed from 5.1 (4.4–5.9) to 3.7% (2.6–4.8) following the 5-km TT ( P = 0.02). In the RIPC trial, FMD changed negligibly from 5.4 (4.4–6.4) post-IPC and 5.7% (4.6–6.8) post 5-km TT ( P = 0.60). Baseline diameter, SR_AUC, and time-to-peak diameter were all increased following the 5-km TT ( P < 0.05), but these changes did not influence the IPC-mediated maintenance of FMD. In conclusion, these data indicate that strenuous lower-limb exercise results in an acute decrease in brachial artery FMD of ∼1.4% in healthy men. However, we have shown for the first time that prior RIPC of the lower limbs maintains postexercise brachial artery endothelium-dependent function at preexercise levels.

Endothelial function, assessed using brachial artery flow-mediated dilation (FMD), predicts future cardiovascular disease (CVD) risk. This study established age- and sex-specific reference intervals for brachial artery FMD in healthy individuals and examined the relation with CVD risk factors. In a retrospective study design, we pooled brachial artery FMD (acquired according to expert-consensus guidelines for FMD protocol and analysis) and participant characteristics/medical history from 5362 individuals (4–84 years; 2076 females). Healthy individuals (n=1403 [582 females]) were used to generate age-/sex-specific percentile curves. Subsequently, we included individuals with CVD risk factors, without overt disease (unmedicated n=3167 [1247 females] and medicated n=792 [247 females]). Multiple linear regression tested the relation of CVD risk factors (body mass index, blood pressure, cholesterol, diabetes, dyslipidemia, and smoking) with FMD. Healthy males showed a negative, curvilinear relation between FMD and age, while females revealed a negative linear relation that started higher but declined at a faster rate than males. Age- and sex-specific differences in FMD relate, at least partly, to baseline artery diameter. FMD was related to CVD risk factors in unmedicated (eg, systolic/diastolic blood pressure) and medicated individuals (eg, diabetes/dyslipidemia). Sex mediated some of these effects ( P <0.05), with normalization of FMD in medicated men, but not women with dyslipidemia. In conclusion, sex alters the age-related decline in FMD, which may partly be explained through differences in baseline diameter. Sex also alters the influence of some CVD risk factors and medication on FMD. This work improves interpretation and future use of the FMD technique.

Exercise training has the potential to enhance cerebrovascular function. Warm water immersion has recently been shown to enhance vascular function including the cerebrovascular response to heating. We suggest that passive heating can be used alternatively to exercise. Our aim was to compare the effects of exercise with warm-water immersion training on cerebrovascular and thermoregulatory function. 18 females (25±5 y) performed 8 weeks of cycling (70% HR_max) or warm water immersion (42°C) for 30 min 3 times per week. Brachial artery flow-mediated dilation (FMD) and peak cardiorespiratory fitness (VO_2peak) were measured prior to and following both interventions. A passive heat stress was employed to obtain temperature thresholds (T_b) and sensitivities for sweat rate (SR) and cutaneous vasodilation (CVC). Middle cerebral artery velocity (MCAv) was measured throughout. FMD and VO_2peak improved following both interventions (p<0.05). MCAv and cerebrovascular conductance were higher at rest and during passive heating (p<0.001 and <0.001, respectively) following both interventions. SR occurred at a lower T_b following both interventions and SR sensitivity also increased, with a larger increase at the chest (p<0.001) following water immersion. CVC occurred at a lower T_b (p<0.001) following both interventions. Warm water immersion elicits similar cerebrovascular, conduit, and thermoregulatory adaptations compared to a period of moderate-intensity exercise training.