Ischemic preconditioning and exercise performance: shedding light through smallest worthwhile change

Ischemic preconditioning (IPC) has been suggested as a potential ergogenic aid to improve exercise performance, although controversial findings exist. The controversies may be explained by several factors, including the mode of exercise, the ratio between the magnitude of improvement, or the error of measurement and physiological meaning. However, a relevant aspect has been lacking in the literature: the interpretation of the findings considering statistical tests and adequate effect size (ES) according to the fitness level of individuals. Thus, we performed a systematic review with meta-analysis to update the effects of IPC on exercise performance and physiological responses, using traditional statistics (P values), ES, and smallest worth change (SWC) approach contextualizing the IPC application to applied Sports and Exercise performance. Forty-five studies met the inclusion criteria. Overall, the results show that IPC has a minimal or nonsignificant effect on performance considering the fitness level of the individuals, using statistical approaches (i.e., tests with P value, ES, and SWC). Therefore, IPC procedures should be revised and refined in future studies to evaluate if IPC promotes positive effects on performance in a real-world scenario with more consistent interpretation.