# Ischemic Preconditioning to Augment muscle Function in Individuals with Spinal Cord Injuries

> **NIH VA I21** · LOUIS STOKES CLEVELAND VA MEDICAL CENTER · 2022 · —

## Abstract

Spinal cord injury (SCI) often results in a sedentary lifestyle and profound deconditioning due
to limited options for exercise. This decreased physical activity often leads to weight gain,
bone loss, muscle atrophy, poor circulation, impaired cardiovascular function along with
depression and decreased self-confidence. Options to exercise the muscles below the level
of injury are restricted to electrical stimulation driven exercise that is constrained to reduced
muscular force and work output. This ultimately results in reduced cardiorespiratory, metabolic
and muscular adaptations compared to volitional exercise interventions in able bodied
individuals. For this reason, an intervention that can increase the muscular force and work
performed during electrical stimulation (ES) exercise is of utmost importance for individuals
with SCI as it can lead to improved maintenance of lower limb muscle mass, better
physiological adaptations and improved quality of life. Ischemic preconditioning (IPC) consists
of brief periods of ischemia followed by reperfusion performed prior to exercise. In the general
population, IPC has shown positive muscular benefits such as increased aerobic and
anaerobic exercise performance, prolonging the time to skeletal muscle fatigue and improved
recovery from maximal effort. However, this promising intervention has yet to be tested with
ES exercise in those with SCI. Thus, the purpose of this SPiRE proposal is to determine if IPC
prior to exercise with ES is safe and can improve skeletal muscle function and endurance in
Veteran’s with complete SCI. 20 subjects will be recruited for a study consisting of 5 sessions
that will involve performing IPC or a sham prior to ES isolated muscle contractions or ES lower
body exercise. Specific Aim 1 will determine the safety of performing an acute bout of IPC
prior to performing knee extension and if maximal muscle strength and fatigue resistance
(Biodex isokinetic dynamometer) improves after IPC. In addition, tissue oxygenation, femoral
blood flow and blood lactate will be assessed to identify potential impact of IPC on tissue
perfusion and vascular function. Specific Aim 2 will determine whether performing an acute
bout of IPC prior to ES cycling exercise (cycling on a recumbent tricycle) will improve
performance including power output and time/distance cycled. Tissue oxygenation, femoral
blood flow and blood lactate will also be collected during these sessions. Ultimately, if an acute
bout of IPC is safe and augments muscle performance during ES exercise, further studies to
determine long-term physiological benefits of chronic ES exercise in combination with IPC
would be warranted. IPC has the potential to enhance the current rehabilitation standards for
Veterans with SCI. In addition the ability to increase exercise intensity and cycling
performance has potential to provide Veterans with SCI the additional muscle strength
required to cycle overground and in the community on modified tr...

## Key facts

- **NIH application ID:** 10426263
- **Project number:** 5I21RX003603-02
- **Recipient organization:** LOUIS STOKES CLEVELAND VA MEDICAL CENTER
- **Principal Investigator:** Lisa Lombardo
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-07-01 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10426263

## Citation

> US National Institutes of Health, RePORTER application 10426263, Ischemic Preconditioning to Augment muscle Function in Individuals with Spinal Cord Injuries (5I21RX003603-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10426263. Licensed CC0.

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