Can exercise training enhance the repeated remote ischaemic preconditioning stimulus on peripheral and cerebrovascular function in high risk individuals?

Background: Repeated exposure to remote ischaemic preconditioning (rIPC; short bouts of non-lethal ischaemia) enhances peripheral vascular function within 1 week, whereas longer periods of rIPC (~1 year) may improve cerebral perfusion. Increasing the ‘dose’ of rIPC may lead to superior effects. Given the similarities between exercise and rIPC, we examined whether adding exercise to the rIPC stimulus leads to greater adaptation in systemic vascular function. Methods: Nineteen individuals with increased risk for cardiovascular disease (CVD) were randomly allocated to either 8 weeks of rIPC (n=9) or 8 weeks of rIPC + exercise (rIPC+Ex) (n=10). rIPC was applied three times per week in both conditions, and exercise consisted of 50 minutes (70% heart rate max) of cycling 3 times per week. Peripheral endothelial function was assessed using flow mediated dilation (FMD) before and after ischemia-reperfusion (IR). Cerebrovascular function was assessed by dynamic cerebral autoregulation (dCA) and cerebrovascular reactivity (CVR), and cardio-respiratory fitness (VO2peak) using a maximal aerobic capacity test. Results: FMD% increased by 1.6% (95% CI, 0.4, 2.8) following rIPC+Ex and by 0.3% (-1.1, 1.5) in the only rIPC but this did not reach statistical significance (P = 0.65). Neither intervention evoked a change in dCA or in CVR (P>0.05). VO2peak increased by 2.8 ml/kg/min (1.7, 3.9) following the rIPC+Ex and by 0.1 ml/kg/min (-1.0, 1.4) following the rIPC only intervention (P=0.69). Conclusion: Combining exercise with rIPC across an 8-week intervention does not lead to superior effects in cerebrovascular and peripheral vascular function compared to a repeated rIPC intervention in individuals at risk of CVD