Differential effects of ischemic preconditioning and cold compression on recovery in recreational crossfit athletes aged ≥ 40 years: a 2-week randomized controlled trial

To compare ischemic preconditioning (IPC), cold compression (CC), and passive recovery on acute and short-term recovery after plyometric fatigue in CrossFit athletes. In this randomized repeated-measures trial, 60 athletes were allocated 1:1:1 to IPC, CC, or control. Outcomes were assessed at baseline, post-exercise, 24, 48, 72 h, 7 d, and 14 d. Tissue perfusion was the primary confirmatory endpoint. Creatine kinase, reactive strength index, Total Quality Recovery, Borg CR10, and lactate dehydrogenase were secondary recovery-domain outcomes interpreted as supportive and hypothesis-generating rather than as independently confirmatory endpoints. Group-by-time interactions were significant for outcomes (all p < 0.001). At 14 d, resting superficial cutaneous/subcutaneous perfusion was higher in IPC than control by 1.94 PU (95% CI, 1.81–2.07; g = 2.98) and in CC than control by 0.88 PU (95% CI, 0.75–1.01; g = 1.35). Creatine kinase was lower in IPC and CC versus control at 72 h (geometric mean ratios, 0.58 and 0.55; both p < 0.001). CC improved reactive strength index versus control at 72 h (0.15 m·s − 1; 95% CI, 0.07–0.24; p = 0.009) and Total Quality Recovery at 14 d (3.28 points; 95% CI, 2.90–3.66; p < 0.001). IPC and CC produced domain-specific recovery benefits, namely IPC showed the clearest resting superficial cutaneous/subcutaneous perfusion signal, whereas CC most consistently improved perceived recovery and transient neuromuscular recovery. These findings should not be interpreted as direct evidence of endothelial function, nitric-oxide-mediated vascular adaptation, or deep muscle perfusion. Clinical trial registration: ISRCTN49499065 date: 23/06/2025.