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Lazić A, Stanković D, Trajković N, Cadenas-Sanchez C. Effects of HIIT Interventions on Cardiorespiratory Fitness and Glycemic Parameters in Adults with Type 1 Diabetes: A Systematic Review and Meta-Analysis. Sports Med 2024:10.1007/s40279-024-02059-4. [PMID: 38904921 DOI: 10.1007/s40279-024-02059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Individuals with type 1 diabetes mellitus (T1DM) face impaired cardiorespiratory fitness and glycemic control, increasing the risk of cardiovascular complications. High-intensity interval training (HIIT) has emerged as a promising exercise modality with potential benefits for both aspects in this population. OBJECTIVES The primary aim was to investigate the effects of HIIT on cardiorespiratory fitness and glycemic parameters in patients with T1DM. The secondary aim was to examine the most effective HIIT protocol for cardiorespiratory fitness and glycemic parameters in patients with T1DM. DESIGN Systematic review and meta-analysis. DATA SOURCES Two major electronic databases (Web of Science and PubMed) were searched up to February 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomized and non-randomized trials involving adult patients with T1DM, free of complications and other diseases examining the effects of HIIT (HIIT pre vs. post; HIIT vs. control group or HIIT vs. moderate-intensity continuous training (MICT)) on cardiorespiratory fitness and glycemic parameters were included. RESULTS A total of ten studies met the inclusion criteria. The meta-analysis revealed a significant improvement in cardiorespiratory fitness following HIIT interventions (pre vs. post) in patients with T1DM (standardized mean difference (SMD) = 0.59, 95% confidence interval (CI) = 0.16 to 1, p = 0.01). Furthermore, HIIT (pre vs. post) was associated with significant improvements in 24-h mean glucose control (SMD = - 0.44, 95% CI = - 0.81 to - 0.06, p = 0.02), but the results (pre vs. post) failed to identify significant improvements in fasting glucose (SMD = - 0.26, 95% CI = - 0.78 to 0.24, p = 0.3) and glycated hemoglobin (HbA1C) values (SMD = - 0.28, 95% CI = - 0.61 to 0.05, p = 0.1). However, in comparison with a control group, HIIT showed significantly favorable effects on HbA1C (SMD = - 0.74, 95% CI = - 1.35 to - 0.14, p = 0.02). Finally, the meta-regression analysis did not find any moderating effect of any HIIT characteristics (i.e., intervention duration, session duration, work time, rest time, number of bouts, and intensity) on cardiorespiratory fitness and glycemic parameters. CONCLUSION Our systematic review and meta-analysis show that T1DM patients who performed a HIIT intervention significantly improved cardiorespiratory fitness and reduced their 24-h mean glucose levels, but not their HbA1C and fasting glucose. These findings support the application of HIIT interventions in T1DM patients. However, the guidelines for the most effective protocol remain unclear; hence, future studies are needed.
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Affiliation(s)
- Anja Lazić
- Faculty of Sport and Physical Education, University of Niš, Niš, Serbia
| | - Dušan Stanković
- Faculty of Sport and Physical Education, University of Niš, Niš, Serbia
| | - Nebojša Trajković
- Faculty of Sport and Physical Education, University of Niš, Niš, Serbia
| | - Cristina Cadenas-Sanchez
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada; CIBEROBN, ISCIII, Granada, Spain.
- Stanford University, Department of Cardiology, Stanford; Veterans Affair Palo Alto Health Care System, Palo Alto, California, USA.
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Cannataro R, Cione E, Cerullo G, Rondanelli M, Micheletti P, Crisafulli O, Micheli ML, D'Antona G. Type 1 diabetes management in a competitive athlete: A five-year case report. Physiol Rep 2023; 11:e15740. [PMID: 37402564 PMCID: PMC10319554 DOI: 10.14814/phy2.15740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 07/06/2023] Open
Abstract
Type I diabetes has an incidence of 15 per 100,000 people. Though it is a metabolic disorder, it can be seen in top, even professional athletes. Physical activity is recommended to manage diabetes, but there is a lack of specific knowledge on diabetes management and exercise from dedicated medical staff. This bias leads to suboptimal diabetes management, causing frequent hyper and hypoglycemia, a dysregulation of glycated hemoglobin, blood glucose out of control, and consequent needs to often intervene with extra insulin or carbohydrates. For 5 years, we followed a highly competitive male Caucasian athlete Vovinam Viet Vo Dao, with type I diabetes, aged 17. We monitored his glycated hemoglobin, the insulin drug administered, and glycemia blood level averages. We obtained, over time, a decrease in glycated hemoglobin by almost -22% and insulin administered by -37.33%, and average blood glycemia levels diminished by almost -27%. In addition, we carried out bioimpedance analysis and stratigraphy on the abdomen. Federation trainers supervised all physical training; we recorded an improvement in the general condition, underlined in particular by an increase in phase angle (from bioimpedance) of +17%.
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Affiliation(s)
- Roberto Cannataro
- Galascreen LaboratoriesUniversity of CalabriaRendeItaly
- Department of Pharmacy, Health and Nutritional SciencesUniversity of CalabriaRendeItaly
| | - Erika Cione
- Galascreen LaboratoriesUniversity of CalabriaRendeItaly
- Department of Pharmacy, Health and Nutritional SciencesUniversity of CalabriaRendeItaly
| | | | - Mariangela Rondanelli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Mondino FoundationPaviaItaly
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS)‐Sport Medicine Centre, University of PaviaPaviaItaly
| | - Piero Micheletti
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS)‐Sport Medicine Centre, University of PaviaPaviaItaly
| | - Oscar Crisafulli
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS)‐Sport Medicine Centre, University of PaviaPaviaItaly
| | - Matteo Levi Micheli
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
- M. Marella Laboratory of Motor Sciences Applied to MedicineFlorenceItaly
| | - Giuseppe D'Antona
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS)‐Sport Medicine Centre, University of PaviaPaviaItaly
- Department of Public Health, Experimental and Forensic MedicineUniversity of PaviaPaviaItaly
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Martin-Rivera F, Maroto-Izquierdo S, García-López D, Alarcón-Gómez J. Exercise interventions for patients with type 1 diabetes mellitus: A narrative review with practical recommendations. World J Diabetes 2023; 14:539-548. [PMID: 37273254 PMCID: PMC10236987 DOI: 10.4239/wjd.v14.i5.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/08/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
Type 1 diabetes mellitus (T1DM) is a chronic endocrine disease that results from autoimmune destruction of pancreatic insulin-producing β cells, which can lead to microvascular (e.g., retinopathy, neuropathy, and nephropathy) and macro-vascular complications (e.g., coronary arterial disease, peripheral artery disease, stroke, and heart failure) as a consequence of chronic hyperglycemia. Despite the widely available and compelling evidence that regular exercise is an efficient strategy to prevent cardiovascular disease and to improve functional capacity and psychological well-being in people with T1DM, over 60% of individuals with T1DM do not exercise regularly. It is, therefore, crucial to devise approaches to motivate patients with T1DM to exercise, to adhere to a training program, and to inform them of its specific characteristics (e.g., exercise mode, intensity, volume, and frequency). Moreover, given the metabolic alterations that occur during acute bouts of exercise in T1DM patients, exercise prescription in this population should be carefully analyzed to maximize its benefits and to reduce its potential risks.
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Affiliation(s)
- Fernando Martin-Rivera
- Department of Physical Education and Sports, University of Valencia, Valencia 46010, Spain
| | - Sergio Maroto-Izquierdo
- Department of Health Sciences, Miguel de Cervantes European University, Valladolid 47012, Spain
| | - David García-López
- Department of Health Sciences, Miguel de Cervantes European University, Valladolid 47012, Spain
| | - Jesús Alarcón-Gómez
- Department of Physical Education and Sports, University of Valencia, Valencia 46010, Spain
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Abstract
Regular physical activity improves cardiometabolic and musculoskeletal health, helps with weight management, improves cognitive and psychosocial functioning, and is associated with reduced mortality related to cancer and diabetes mellitus. However, turnover rates of glucose in the blood increase dramatically during exercise, which often results in either hypoglycaemia or hyperglycaemia as well as increased glycaemic variability in individuals with type 1 diabetes mellitus (T1DM). A complex neuroendocrine response to an acute exercise session helps to maintain circulating levels of glucose in a fairly tight range in healthy individuals, while several abnormal physiological processes and limitations of insulin therapy limit the capacity of people with T1DM to exercise in a normoglycaemic state. Knowledge of the acute and chronic effects of exercise and regular physical activity is critical for the formulation of clinical strategies for the management of insulin and nutrition for active patients with T1DM. Emerging diabetes-related technologies, such as continuous glucose monitors, automated insulin delivery systems and the administration of solubilized glucagon, are demonstrating efficacy for preserving glucose homeostasis during and after exercise in this population of patients. This Review highlights the beneficial effects of regular exercise and details the complex endocrine and metabolic responses to different types of exercise for adults with T1DM. An overview of basic clinical strategies for the preservation of glucose homeostasis using emerging technologies is also provided.
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Affiliation(s)
- Michael C Riddell
- Muscle Health Research Centre, School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
- LMC Diabetes and Endocrinology, Toronto, Ontario, Canada.
| | - Anne L Peters
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Murillo S, Brugnara L, Servitja JM, Novials A. High Intensity Interval Training reduces hypoglycemic events compared with continuous aerobic training in individuals with type 1 diabetes: HIIT and hypoglycemia in type 1 diabetes. DIABETES & METABOLISM 2022; 48:101361. [PMID: 35714884 DOI: 10.1016/j.diabet.2022.101361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/17/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022]
Abstract
AIMS to investigate if a High Intensity Interval Training (HIIT) protocol improves glycemic control and fitness capacity, compared to traditional moderate Intensity Continuous Training (MICT) exercise. METHODS 30 sedentary individuals with type 1 diabetes (T1D) and 26 healthy controls were assigned to a 3-week HIIT or MICT protocol. Blood glucose levels by continuous glucose monitoring system and fitness status were compared before and after the study period. RESULTS During workouts, blood glucose levels remained stable in HIIT exercise (+3.2 ± 16.2 mg/dl (p = 0.43)), while decreased in MICT (-27.1 ± 17.5 mg/dl (p < 0.0001)) exercise. In addition, out of the 9 training sessions, HIIT volunteers needed to take carbohydrate supplements to avoid hypoglycemia in 0.56 ± 0.9 sessions, compared to 1.83 ± 0.5 sessions (p < 0.04) in MICT individuals. In the analysis of blood glucose levels between rest and training days (24h-period), training significantly reduced mean glycemic levels in both groups, but the MICT exercise results in an increase in the frequency of hypoglycemic episodes. The response to exercise seems to be attenuated in individuals with T1D, especially in HIIT group. CONCLUSION HIIT training results in a greater glycemic stability, with reduction of hypoglycemic episodes.
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Affiliation(s)
- Serafin Murillo
- IDIBAPS, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; CIBERDEM, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Barcelona, Spain; Hospital Clinic de Barcelona, Barcelona, Spain; Sant Joan de Déu Hospital, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Laura Brugnara
- IDIBAPS, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; CIBERDEM, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Barcelona, Spain; Hospital Clinic de Barcelona, Barcelona, Spain
| | - Joan-Marc Servitja
- IDIBAPS, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; CIBERDEM, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Barcelona, Spain
| | - Anna Novials
- IDIBAPS, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; CIBERDEM, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Barcelona, Spain; Hospital Clinic de Barcelona, Barcelona, Spain.
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Szalai I, Csorba A, Pálya F, Jing T, Horváth E, Bosnyák E, Györe I, Nagy ZZ, DeBuc DC, Tóth M, Somfai GM. The assessment of acute chorioretinal changes due to intensive physical exercise in young adults. PLoS One 2022; 17:e0268770. [PMID: 35613112 PMCID: PMC9132279 DOI: 10.1371/journal.pone.0268770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 05/08/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose
There is abundant evidence on the benefits of physical activity on cardiovascular health. However, there are only few data on the acute effects of physical exercise on the retina and choroid. Our aim was the in vivo examination of chorioretinal alterations following short intense physical activity by spectral domain optical coherence tomography (SD-OCT).
Methods
Twenty-one eyes of 21 healthy, young subjects (mean age 22.5 ± 4.1 years, 15 males and 6 females) were recruited. Macular scanning with a SD-OCT was performed before and following a vita maxima-type physical strain exercise on a rowing ergometer until complete fatigue. Follow-up OCT scans were performed 1, 5, 15, 30 and 60 minutes following the exercise. The OCT images were exported and analyzed using our custom-built OCTRIMA 3D software and the thickness of 7 retinal layers was calculated, along with semi-automated measurement of the choroidal thickness. One-way ANOVA analysis was performed followed by Dunnett post hoc test for the thickness change compared to baseline and the correlation between performance and thickness change has also been calculated. The level of significance was set at 0.001.
Results
We observed a significant thinning of the total retina 1 minute post-exercise (-7.3 ± 0.6 μm, p < 0.001) which was followed by a significant thickening by 5 and 15 minutes (+3.6 ± 0.6 μm and +4.0 ± 0.6 μm, respectively, both p <0.001). Post-exercise retinal thickness returned to baseline by 30 minutes. This trend was present throughout the most layers of the retina, with significant changes in the ganglion cell–inner plexiform layer complex, (-1.3 ± 0.1 μm, +0.6 ± 0.1 μm and +0.7 ± 0.1 μm, respectively, p <0.001 for all), in the inner nuclear layer at 1 and 5 minutes (-0.8 ± 0.1 μm and +0.8 ± 0.1 μm, respectively, p <0.001 for both), in the outer nuclear layer–photoreceptor inner segment complex at 5 minute (+2.3 ± 0.4 μm, p <0.001 for all) and in the interdigitation zone–retinal pigment epithelium complex at 1 and 15 minutes (-3.3 ± 0.4 μm and +1.8 ± 0.4 μm, respectively, p <0.001 for both). There was no significant change in choroidal thickness; however, we could detect a tendency towards thinning at 1, 15, and 30 minutes following exercise. The observed changes in thickness change did not correlate with performance. Similar trends were observed in both professional and amateur sportsmen (n = 15 and n = 6, respectively). The absolute changes in choroidal thickness did not show any correlation with the thickness changes of the intraretinal layers.
Conclusions
Our study implies that in young adults, intense physical exercise has an acute effect on the granular layers of the retina, resulting in thinning followed by rebound thickening before normalization. We could not identify any clear correlation with either choroidal changes or performance that might explain our observations, and hence the exact mechanism warrants further clarification. We believe that a combination of vascular and mechanic changes is behind the observed trends.
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Affiliation(s)
- Irén Szalai
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Anita Csorba
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Fanni Pálya
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Tian Jing
- Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | | | - Edit Bosnyák
- Department of Health Sciences and Sport Medicine, University of Physical Education, Budapest, Hungary
| | - István Györe
- Department of Health Sciences and Sport Medicine, University of Physical Education, Budapest, Hungary
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Delia Cabrera DeBuc
- Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Miklós Tóth
- Department of Health Sciences and Sport Medicine, University of Physical Education, Budapest, Hungary
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Gábor Márk Somfai
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Stadtspital, Zürich, Switzerland
- Spross Research Institute, Zürich, Switzerland
- * E-mail:
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González-Rosalén J, Medina-Mirapeix F, Cuerda-Del Pino A, Moreno-Segura N, Gacto-Sánchez M, Martín-San Agustín R. Analysis of Compliance with Time under Tension and Force during Strengthening Exercises with Elastic Bands. Diagnostics (Basel) 2021; 11:diagnostics11112016. [PMID: 34829363 PMCID: PMC8620485 DOI: 10.3390/diagnostics11112016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022] Open
Abstract
Quantifying training variables of a physical exercise modality is essential for an appropriate dosage. In training with elastic bands, time under tension (TUT) and force represent the duration and intensity of this force-training modality. The aims of this study were to evaluate the degree of compliance to TUT prescription for three different scenarios of two exercises and the comparison of the force values obtained versus the estimate values. A total of 29 healthy volunteers were evaluated in a clinical environment under controlled conditions in 3 different scenarios (different velocities or ROMs) of both shoulder abduction and knee extension in 2 sets of 10 repetitions per scenario within a single session. Concentric and isometric phases showed a higher degree of compliance for their TUTs than the eccentric phase TUTs for all scenarios of both exercises, whereas the degree of compliance was higher for the total TUT than for the phases’ TUTs. Additionally, the eccentric phase showed a general tendency to develop for longer time periods than prescribed, whilst the fast scenario showed a higher degree of compliance for isometric phase TUTs and total TUTs than the extant two scenarios in both exercises. On the other hand, the force of the elastic bands tends to be overestimated according to the estimates of the manufacturers. These findings, both those related to the degree of compliance with TUTs and the force analysis, can be used by physiotherapists and other exercise professionals as a reference to achieve a good dosage of routine exercises with elastic bands.
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Affiliation(s)
- Javier González-Rosalén
- Department of Physiotherapy, University of Valencia, CP 46010 Valencia, Spain; (J.G.-R.); (A.C.-D.P.); (N.M.-S.)
| | | | - Alba Cuerda-Del Pino
- Department of Physiotherapy, University of Valencia, CP 46010 Valencia, Spain; (J.G.-R.); (A.C.-D.P.); (N.M.-S.)
| | - Noemi Moreno-Segura
- Department of Physiotherapy, University of Valencia, CP 46010 Valencia, Spain; (J.G.-R.); (A.C.-D.P.); (N.M.-S.)
| | - Mariano Gacto-Sánchez
- Department of Physiotherapy, University of Murcia, CP 30100 Murcia, Spain; (F.M.-M.); (M.G.-S.)
| | - Rodrigo Martín-San Agustín
- Department of Physiotherapy, University of Valencia, CP 46010 Valencia, Spain; (J.G.-R.); (A.C.-D.P.); (N.M.-S.)
- Correspondence:
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Atakan MM, Li Y, Koşar ŞN, Turnagöl HH, Yan X. Evidence-Based Effects of High-Intensity Interval Training on Exercise Capacity and Health: A Review with Historical Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7201. [PMID: 34281138 PMCID: PMC8294064 DOI: 10.3390/ijerph18137201] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 12/13/2022]
Abstract
Engaging in regular exercise results in a range of physiological adaptations offering benefits for exercise capacity and health, independent of age, gender or the presence of chronic diseases. Accumulating evidence shows that lack of time is a major impediment to exercise, causing physical inactivity worldwide. This issue has resulted in momentum for interval training models known to elicit higher enjoyment and induce adaptations similar to or greater than moderate-intensity continuous training, despite a lower total exercise volume. Although there is no universal definition, high-intensity interval exercise is characterized by repeated short bursts of intense activity, performed with a "near maximal" or "all-out" effort corresponding to ≥90% of maximal oxygen uptake or >75% of maximal power, with periods of rest or low-intensity exercise. Research has indicated that high-intensity interval training induces numerous physiological adaptations that improve exercise capacity (maximal oxygen uptake, aerobic endurance, anaerobic capacity etc.) and metabolic health in both clinical and healthy (athletes, active and inactive individuals without any apparent disease or disorder) populations. In this paper, a brief history of high-intensity interval training is presented, based on the novel findings of some selected studies on exercise capacity and health, starting from the early 1920s to date. Further, an overview of the mechanisms underlying the physiological adaptations in response to high-intensity interval training is provided.
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Affiliation(s)
- Muhammed Mustafa Atakan
- Division of Exercise Nutrition and Metabolism, Faculty of Sport Sciences, Hacettepe University, 06800 Ankara, Turkey; (M.M.A.); (Ş.N.K.); (H.H.T.)
| | - Yanchun Li
- China Institute of Sport and Health Science, Beijing Sport University, Beijing 100192, China
| | - Şükran Nazan Koşar
- Division of Exercise Nutrition and Metabolism, Faculty of Sport Sciences, Hacettepe University, 06800 Ankara, Turkey; (M.M.A.); (Ş.N.K.); (H.H.T.)
| | - Hüseyin Hüsrev Turnagöl
- Division of Exercise Nutrition and Metabolism, Faculty of Sport Sciences, Hacettepe University, 06800 Ankara, Turkey; (M.M.A.); (Ş.N.K.); (H.H.T.)
| | - Xu Yan
- Institute for Health and Sport (iHeS), Victoria University, Melbourne 8001, Australia;
- Sarcopenia Research Program, Australia Institute for Musculoskeletal Sciences (AIMSS), Melbourne 3021, Australia
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