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Application of high-intensity training methods in clinical populations- concepts, progress, and challenges

Collection Editors: Dr Flavio Cadegiani (Federal University of São Paulo, Brazil), and Dr Fred DiMenna (Icahn School of Medicine at Mount Sinai, USA). 

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High-intensity training: It’s not just for athletes anymore - by Fred DiMenna

In 1930, Swedish coach Gustaf Holmér decided that for his cross-country runners to improve their race pace, they would have to train at a pace that was faster; albeit, necessarily, for a shorter period of time. Known at the time as Fartlek, which means ‘speed time’ in Swedish, Holmér’s runners performed periods of fast running interspersed with slower runs that were required for recovery. Athletes embraced the concept (after all, no pain, no gain) and what we now call high-intensity interval training (HIIT) was born. However, training at intensities that exceed the maximal sustainable pace has undergone more than a name change during the 90 years that followed. 

There is now growing acceptance for the contention that recreationally-active individuals, previously-sedentary novices and even certain patient populations can benefit from high-intensity exercise if prescribed with research-based precision. The 11 articles we have published for this Article Collection will help to inform such a process. For example, with respect to patient populations, Nytrøen et al. found that young heart-transplant recipients benefited more from HIIT compared to moderate-intensity continuous exercise, while the feasibility of HIIT in cardiac rehabilitation and as an intervention to improve prognosis for African American women at risk for metabolic syndrome were explored in retrospective analyses of data by Way et al. and Arad et al., respectively. In contrast, planning for the future, Frimpong et al. detailed a randomized controlled trial designed to determine the effectiveness and feasibility of home-based HIIT for women with overweight/obesity. As for patients with chronic pulmonary disease, Sawyer et al. provide a narrative review of the literature and conclude that more research is required to determine the effects of HIIT compared to moderate-intensity continuous exercise, while Reuveny et al. provide preliminary findings to guide such research for cystic fibrosis patients who demonstrated faster oxygen-uptake kinetics and increased exercise tolerance after eight weeks of HIIT. The feasibility nature of some of these studies still demonstrates the early stages of this exciting exercise-based medicine, and we expect more concrete evidence to appear. 

High-intensity resistance training is also accounted for in this series as Tjøsvoll et al. present preliminary evidence which suggests that a program comprising weekly undulating periodization is feasible for individuals with persistent non-specific lower back pain, and Saeterbakken et al. found that daily bouts of resistance training at the workplace reduced neck and shoulder pain and improved quality of life for office workers. Interestingly, in the latter study, one 10-min bout was equally as effective as two, which confirms that the training effect attributable to high-intensity exercise is not necessarily amplified by increased volume. This coheres with observations by Reuveny et al. that oxygen supplementation, which allowed more high-intensity work to be performed by one group of patients in their study did not enhance the training effect derived from HIIT. Finally, Cockcroft et al. observed an inverse relationship between baseline insulin sensitivity and the change in insulin sensitivity that occurred for healthy adolescent boys after two weeks of HIIT. This means that youngsters with the greatest risk of falling victim to progression to type-2 diabetes stand to benefit the most from this type of training. Consequently, the usefulness of high-intensity exercise in the clinical setting might actually predate and, therefore, delay or prevent the onset of disease. 

Collectively, these studies and the others in this thematic review are representative of a large and growing body of research which indicates that properly-prescribed high-intensity training is appropriate for man and woman, young and old, conditioned and deconditioned and healthy and diseased alike. In short, it’s not just for athletes anymore.

  1. African American (AA) women have a higher prevalence of obesity and related metabolic dysfunction and lower level of physical activity compared to white counterparts. Determining feasible exercise alternatives...

    Authors: Avigdor D. Arad, Jeanine B. Albu and Fred J. DiMenna

    Citation: BMC Sports Science, Medicine and Rehabilitation 2020 12:59

    Content type: Research article

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  2. Cardiovascular disease is the leading cause of death worldwide. Notwithstanding the well-known benefits of cardiac rehabilitation (CR), adherence to CR remains low, particularly in women. High-intensity interv...

    Authors: Kimberley L. Way, Sol Vidal-Almela, Marja-Leena Keast, Harleen Hans, Andrew L. Pipe and Jennifer L. Reed

    Citation: BMC Sports Science, Medicine and Rehabilitation 2020 12:38

    Content type: Research article

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  3. Little is known about the effect of exercise in young heart transplant recipients, and results on group level is lacking. This study summarizes the findings of the youngest participants in two previous randomi...

    Authors: Kari Nytrøen, Katrine Rolid, Marianne Yardley and Lars Gullestad

    Citation: BMC Sports Science, Medicine and Rehabilitation 2020 12:35

    Content type: Research article

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  4. We investigated the feasibility of a 16-week supervised heavy resistance training program with weekly undulating periodization for individuals with persistent non-specific low-back pain (LBP).

    Authors: Svein O. Tjøsvoll, Paul J. Mork, Vegard M. Iversen, Marit B. Rise and Marius S. Fimland

    Citation: BMC Sports Science, Medicine and Rehabilitation 2020 12:30

    Content type: Research article

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  5. Although numerous studies have reported the effect of inspiratory muscle training for improving exercise performance, the outcome of whether exercise performance is improved by inspiratory muscle training is c...

    Authors: Takeshi Ogawa, Maiko Nagao, Naoto Fujii and Takeshi Nishiyasu

    Citation: BMC Sports Science, Medicine and Rehabilitation 2020 12:25

    Content type: Research article

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  6. Exercise training provides benefits for individuals with cystic fibrosis; however, the optimal program is unclear. High-intensity interval training is safe and effective for improving ‘functional capacity’ in ...

    Authors: Ronen Reuveny, Fred J. DiMenna, Cedric Gunaratnam, Avigdor D. Arad, Gerry N. McElvaney, Davide Susta, Michael Peled and Niall M. Moyna

    Citation: BMC Sports Science, Medicine and Rehabilitation 2020 12:9

    Content type: Research article

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  7. Musculoskeletal disorders are highly prevalent among office workers, with strong evidence suggesting that workplace-based resistance training programs can prevent several upper extremity musculoskeletal disord...

    Authors: Atle Hole Saeterbakken, Paula Makrygiannis, Nicolay Stien, Tom Erik Jorung Solstad, Matthew Shaw, Vidar Andersen and Helene Pedersen

    Citation: BMC Sports Science, Medicine and Rehabilitation 2020 12:8

    Content type: Research article

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  8. Exercise training is important in the management of adults with chronic pulmonary conditions. However, achieving high intensity exercise may be challenging for this clinical population. There has been clinical...

    Authors: Abbey Sawyer, Vinicius Cavalheri and Kylie Hill

    Citation: BMC Sports Science, Medicine and Rehabilitation 2020 12:22

    Content type: Review

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  9. There is a high prevalence of women in South Africa with overweight and obesity which is associated with an increased risk of cardiometabolic disorders. Perceived barriers such as lack of time and motivation r...

    Authors: Emmanuel Frimpong, Chloe Dafkin, Janine Donaldson, Aletta Maria Esterhuyse Millen and Rebecca Mary Meiring

    Citation: BMC Sports Science, Medicine and Rehabilitation 2019 11:39

    Content type: Study protocol

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  10. Current evidence of metabolic health benefits of high-intensity interval training (HIIT) are limited to longer training periods or conducted in overweight youth. This study assessed 1) fasting and postprandial...

    Authors: Emma J. Cockcroft, Bert Bond, Craig A. Williams, Sam Harris, Sarah R. Jackman, Neil Armstrong and Alan R. Barker

    Citation: BMC Sports Science, Medicine and Rehabilitation 2019 11:29

    Content type: Research article

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  11. The recent development of wearable devices has enabled easy and continuous measurement of heart rate (HR). Exercise intensity can be calculated from HR with indices such as percent HR reserve (%HRR); however, ...

    Authors: Hirotaka Matsuura, Masahiko Mukaino, Yohei Otaka, Hitoshi Kagaya, Yasushi Aoshima, Takuya Suzuki, Ayaka Inukai, Emi Hattori, Takayuki Ogasawara and Eiichi Saitoh

    Citation: BMC Sports Science, Medicine and Rehabilitation 2019 11:27

    Content type: Research article

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