Effects of very low volume high intensity versus moderate intensity interval training in obese metabolic syndrome patients: a randomized controlled study

Dejan Reljic, Fabienne Frenk, Hans J Herrmann, Markus F Neurath, Yurdagül Zopf, Dejan Reljic, Fabienne Frenk, Hans J Herrmann, Markus F Neurath, Yurdagül Zopf

Abstract

Physical activity is a cornerstone in the treatment of obesity and metabolic syndrome (MetS). Given the leading physical activity barrier of time commitment and safety concerns about vigorous exercise in high-risk groups, this study aimed to investigate the effects of two extremely time-efficient training protocols (< 30 min time effort per week), either performed as high- (HIIT) or moderate-intensity interval training (MIIT) over 12 weeks, in obese MetS patients. In total, 117 patients (49.8 ± 13.6 years, BMI: 38.2 ± 6.2 kg/m2) were randomized to HIIT (n = 40), MIIT (n = 37) or an inactive control group (n = 40). All groups received nutritional counseling to support weight loss. Maximal oxygen uptake (VO2max), MetS severity (MetS z-score), body composition and quality of life (QoL) were assessed pre-and post-intervention. All groups significantly reduced body weight (~ 3%) but only the exercise groups improved VO2max, MetS z-score and QoL. VO2max (HIIT: + 3.1 mL/kg/min, p < 0.001; MIIT: + 1.2 mL/kg/min, p < 0.05) and MetS z-score (HIIT: - 1.8 units, p < 0.001; MIIT: - 1.2 units, p < 0.01) improved in an exercise intensity-dependent manner. In conclusion, extremely low-volume interval training, even when done at moderate intensity, is sufficiently effective to improve cardiometabolic health in obese MetS patients. These findings underpin the crucial role of exercise in the treatment of obesity and MetS.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Study flow chart. HIIT, high-intensity interval training group; MIIT, moderate-intensity interval training group; CON, control group. *other exercise group (data not shown because not part of this specific study objective).
Figure 2
Figure 2
Changes in body weight (A), waist circumference (B), absolute maximal oxygen uptake (C), relative maximal oxygen uptake (D), mean arterial blood pressure (E), and metabolic syndrome z-score (F). HIIT, high-intensity interval training group; MIIT, moderate-intensity interval training group; CON, control group; VO2max, maximal oxygen uptake; MAB, mean arterial blood pressure; MetS, metabolic syndrome. *(p < 0.05), **(p < 0.01), ***(p < 0.001), significantly different from pre-intervention. +(p < 0.05), ++(p < 0.01), +++(p < 0.001), significant difference vs. CON; ##(p < 0.01), significant difference vs. MIIT.

References

    1. Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism. 2019;92:6–10. doi: 10.1016/j.metabol.2018.09.005.
    1. GBD 2015 Obesity Collaborators et al. Health effects of overweight and obesity in 195 countries over 25 years. N. Engl. J. Med. 377, 13–27 (2017).
    1. Esposito K, Chiodini P, Colao A, Lenzi A, Giugliano D. Metabolic syndrome and risk of cancer: a systematic review and meta-analysis. Diabetes Care. 2012;35:2402–2411. doi: 10.2337/dc12-0336.
    1. Wu SH, Liu W, Ho SC. Metabolic syndrome and all-cause mortality: a meta-analysis of prospective cohort studies. Eur. J. Epidemiol. 2010;25:375–384. doi: 10.1007/s10654-010-9496-7.
    1. Mauvais-Jarvis F. Aging, male sex, obesity, and metabolic inflammation create the perfect storm for COVID-19. Diabetes. 2020;69:1857–1863. doi: 10.2337/dbi19-0023.
    1. Petersen A, et al. The role of visceral adiposity in the severity of COVID-19: highlights from a unicenter cross-sectional pilot study in Germany. Metabolism. 2020;110:154317. doi: 10.1016/j.metabol.2020.154317.
    1. Barry VW, et al. Fitness vs. fatness on all-cause mortality: a meta-analysis. Prog. Cardiovasc. Dis. 2014;56:382–390. doi: 10.1016/j.pcad.2013.09.002.
    1. Myers J, et al. Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk: their independent and interwoven importance to health status. Prog. Cardiovasc. Dis. 2015;57:306–314. doi: 10.1016/j.pcad.2014.09.011.
    1. Tudor-Locke C, Brashear MM, Johnson WD, Katzmarzyk PT. Accelerometer profiles of physical activity and inactivity in normal weight, overweight, and obese U.S. men and women. Int. J. Behav. Nutr. Phys. Act. 2010;7:60. doi: 10.1186/1479-5868-7-60.
    1. Andersen RE, Jakicic JM. Interpreting the physical activity guidelines for health and weight management. J. Phys. Act. Health. 2009;6:651–656. doi: 10.1123/jpah.6.5.651.
    1. Knox EC, Webb OJ, Esliger DW, Biddle SJ, Sherar LB. Using threshold messages to promote physical activity: implications for public perceptions of health effects. Eur. J. Public Health. 2014;24:195–199. doi: 10.1093/eurpub/ckt060.
    1. Gibala MJ, Gillen JB, Percival ME. Physiological and health-related adaptations to low-volume interval training: influences of nutrition and sex. Sports Med. 2014;44:127–137. doi: 10.1007/s40279-014-0259-6.
    1. Batacan RB, Jr, Duncan MJ, Dalbo VJ, Tucker PS, Fenning AS. Effects of high-intensity interval training on cardiometabolic health: a systematic review and meta-analysis of intervention studies. Br. J. Sports Med. 2017;51:494–503. doi: 10.1136/bjsports-2015-095841.
    1. Su L, et al. (2019) Effects of HIIT and MICT on cardiovascular risk factors in adults with overweight and/or obesity: a meta-analysis. PLoS ONE. 2019;14:e0210644. doi: 10.1371/journal.pone.0210644.
    1. Türk Y, et al. High intensity training in obesity: a meta-analysis. Obes. Sci. Pract. 2017;3:258–271. doi: 10.1002/osp4.109.
    1. Weston KS, Wisløff U, Coombes JS. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br. J. Sports Med. 2014;48:1227–1234. doi: 10.1136/bjsports-2013-092576.
    1. Andreato LV, Esteves JV, Coimbra DR, Moraes AJ, de Carvalho T. The influence of high-intensity interval training on anthropometric variables of adults with overweight or obesity: a systematic review and network meta-analysis. Obes. Rev. 2019;20:142–155. doi: 10.1111/obr.12766.
    1. Viana RB, et al. Is interval training the magic bullet for fat loss? A systematic review and meta-analysis comparing moderate-intensity continuous training with high-intensity interval training (HIIT) Br. J. Sports Med. 2019;3:655–664. doi: 10.1136/bjsports-2018-099928.
    1. Wewege M, van den Berg R, Ward RE, Keech A. The effects of high-intensity interval training vs. moderate-intensity continuous training on body composition in overweight and obese adults: a systematic review and meta-analysis. Obes. Rev. 2017;18:635–646. doi: 10.1111/obr.12532.
    1. Marc-Hernández A, Ruiz-Tovar J, Aracil A, Guillén S, Moya-Ramón M. Effects of a high-intensity exercise program on weight regain and cardio-metabolic profile after 3 years of bariatric surgery: a randomized trial. Sci. Rep. 2020;10:3123. doi: 10.1038/s41598-020-60044-z.
    1. Gillen JB, Gibala MJ. Is high-intensity interval training a time-efficient exercise strategy to improve health and fitness? Appl. Physiol. Nutr. Metab. 2014;39:409–412. doi: 10.1139/apnm-2013-0187.
    1. Vollaard NB, Metcalfe RS. Research into health benefits of sprint interval training should focus on protocols with fewer and shorter sprints. Sports Med. 2017;47:2443–2451. doi: 10.1007/s40279-017-0727-x.
    1. Sultana RN, Sabag A, Keating SE, Johnson NA. The effect of low-volume high-intensity interval training on body composition and cardiorespiratory fitness: a systematic review and meta-analysis. Sports Med. 2019;49:1687–1721. doi: 10.1007/s40279-019-01167-w.
    1. Vollaard NB, Metcalfe RS, Williams S. Effect of number of sprints in an SIT session on change in VO2max: a meta-analysis. Med. Sci Sports Exerc. 2017;49:1147–1156. doi: 10.1249/MSS.0000000000001204.
    1. Weston M, Taylor KL, Batterham AM, Hopkins WG. Effects of low-volume high-intensity interval training (HIT) on fitness in adults: a meta-analysis of controlled and non-controlled trials. Sports Med. 2014;44:1005–1017. doi: 10.1007/s40279-014-0180-z.
    1. Hess PL, et al. The metabolic syndrome and risk of sudden cardiac death: the atherosclerosis risk in communities study. J. Am. Heart Assoc. 2017;6:e006103. doi: 10.1161/JAHA.117.006103.
    1. Ramos JS, et al. Low-volume high-intensity interval training is sufficient to ameliorate the severity of metabolic syndrome. Metab. Syndr. Relat. Disord. 2017;15:319–328. doi: 10.1089/met.2017.0042.
    1. Alvarez C, et al. Low-volume high-intensity interval training as a therapy for type 2 diabetes. Int. J. Sports Med. 2016;37:723–729. doi: 10.1055/s-0042-104935.
    1. Little JP, et al. Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type 2 diabetes. J. Appl. Physiol. 2011;111:1554–1560. doi: 10.1152/japplphysiol.00921.2011.
    1. Madsen SM, Thorup AC, Overgaard K, Jeppesen PB. High intensity interval training improves glycaemic control and pancreatic β cell function of type 2 diabetes patients. PLoS ONE. 2015;10:e0133286. doi: 10.1371/journal.pone.0133286.
    1. Way KL, et al. The effect of low-volume high-intensity interval training on cardiovascular health outcomes in type 2 diabetes: a randomised controlled trial. Int. J. Cardiol. 2020 doi: 10.1016/j.ijcard.2020.06.019.
    1. Hardcastle SJ, Ray H, Beale L, Hagger MS. Why sprint interval training is inappropriate for a largely sedentary population. Front. Psychol. 2014;5:1505. doi: 10.3389/fpsyg.2014.01505.
    1. Franklin BA, Billecke S. Putting the benefits and risks of aerobic exercise in perspective. Curr. Sports Med. Rep. 2012;11:201–208. doi: 10.1249/JSR.0b013e31825dabd4.
    1. Reljic D, Wittmann F, Fischer JE. Effects of low-volume high-intensity interval training in a community setting: a pilot study. Eur. J. Appl. Physiol. 2018;118:1153–1167. doi: 10.1007/s00421-018-3845-8.
    1. Huang PL. A comprehensive definition for metabolic syndrome. Dis. Model Mech. 2009;2:231–237. doi: 10.1242/dmm.001180.
    1. ACSM’s Guidelines for Exercise Testing and Prescription (8th ed) 26–27 (Lippincott Williams & Wilkins, 2010).
    1. Moroshko I, Brennan L, O'Brien P. Predictors of dropout in weight loss interventions: a systematic review of the literature. Obes. Rev. 2011;12:912–934. doi: 10.1111/j.1467-789X.2011.00915.x.
    1. Reljic D, Konturek PC, Herrmann HJ, Neurath MF, Zopf Y. Effects of whole-body electromyostimulation exercise and caloric restriction on cardiometabolic risk profile and muscle strength in obese women with the metabolic syndrome: a pilot study. J. Physiol. Pharmacol. 2020 doi: 10.26402/jpp.2020.1.08.
    1. Tholl U, et al. The German Hypertension League (Deutsche Hochdruckliga) quality seal protocol for blood pressure-measuring devices: 15-year experience and results from 105 devices for home blood pressure control. Blood Press. Monit. 2016;21:197–205. doi: 10.1097/MBP.0000000000000186.
    1. Whelton PK, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/ PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;138:e426–e483. doi: 10.1161/HYP.0000000000000065.
    1. Jensen B, et al. Limitations of fat-free mass for the assessment of muscle mass in obesity. Obes. Facts. 2019;12:307–315. doi: 10.1159/000499607.
    1. Earnest CP, et al. Maximal estimated cardiorespiratory fitness, cardiometabolic risk factors, and metabolic syndrome in the aerobics center longitudinal study. Mayo Clin. Proc. 2013;88:259–270. doi: 10.1016/j.mayocp.2012.11.006.
    1. Johnson JL, et al. Exercise training amount and intensity effects on metabolic syndrome (from studies of a targeted risk reduction intervention through defined exercise) Am. J. Cardiol. 2007;100:1759–1766. doi: 10.1016/j.amjcard.2007.07.027.
    1. Howley ET, Bassett DR, Welch HG. Criteria for maximal oxygen uptake: review and commentary. Med. Sci Sports Exer. 1996;27:1292–1301.
    1. Meyer T, Georg T, Becker C, Kindermann W. Reliability of gas exchange measurements from two different spiroergometry systems. Int. J. Sports Med. 2001;22:593–597. doi: 10.1055/s-2001-18523.
    1. Meyer T, Lucía A, Earnest CP, Kindermann W. A conceptual framework for performance diagnosis and training prescription from submaximal gas exchange parameters—theory and application. Int. J. Sports Med. 2005;26:S38–48. doi: 10.1055/s-2004-830514.
    1. Grochtdreis T, Dams J, König HH, Konnopka A. Health-related quality of life measured with the EQ-5D-5L: estimation of normative index values based on a representative German population sample and value set. Eur. J. Health Econ. 2019;20:933–944. doi: 10.1007/s10198-019-01054-1.
    1. Carels RA, et al. Can following the caloric restriction recommendations from the Dietary Guidelines for Americans help individuals lose weight? Eat Behav. 2008;9:328–335. doi: 10.1016/j.eatbeh.2007.12.003.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. London: Taylor and Francis; 1988.
    1. Hassinen M, et al. Cardiorespiratory fitness as a feature of metabolic syndrome in older men and women: the dose-responses to exercise training study (DR's EXTRA) Diabetes Care. 2008;31:1242–1247. doi: 10.2337/dc07-2298.
    1. Lee CD, Blair SN, Jackson AS. Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. Am. J. Clin. Nutr. 1999;69:373–380. doi: 10.1093/ajcn/69.3.373.
    1. Kavanagh T, et al. Prediction of long-term prognosis in 12 169 men referred for cardiac rehabilitation. Circulation. 2002;106:666–671. doi: 10.1161/01.CIR.0000024413.15949.ED.
    1. Wu LH, Chang SC, Fu TC, Huang CH, Wang JS. High-intensity interval training improves mitochondrial function and suppresses thrombin generation in platelets undergoing hypoxic stress. Sci. Rep. 2017;7:4191. doi: 10.1038/s41598-017-04035-7.
    1. Rønnestad BR, Hansen J, Vegge G, Tønnessen E, Slettaløkken G. Short intervals induce superior training adaptations compared with long intervals in cyclists - an effort-matched approach. Scand. J. Med. Sci. Sports. 2015;25:143–151. doi: 10.1111/sms.12165.
    1. Ettehad D, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387:957–967. doi: 10.1016/S0140-6736(15)01225-8.
    1. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:1665. doi: 10.1136/bmj.b1665.
    1. Ross R, et al. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat. Rev. Endocrinol. 2020;16:177–189. doi: 10.1038/s41574-019-0310-7.
    1. Gillen JB, et al. Twelve weeks of sprint interval training improves indices of cardiometabolic health similar to traditional endurance training despite a five-fold lower exercise volume and time commitment. PLoS ONE. 2016;11:e01540752016. doi: 10.1371/journal.pone.0154075.
    1. Goodpaster BH, Wolfe RR, Kelley DE. Effects of obesity on substrate utilization during exercise. Obes. Res. 2002;10:575–584. doi: 10.1038/oby.2002.78.
    1. Salvadori A, et al. Respiratory and metabolic responses during exercise and skeletal muscle morphology in obesity. Sport Sci. Health. 2004;1:47–54. doi: 10.1007/s11332-004-0010-z.
    1. Martinez N, Kilpatrick MW, Salomon K, Jung ME, Little JP. Affective and enjoyment responses to high-intensity interval training in overweight-to-obese and insufficiently active adults. J. Sport Exerc. Psychol. 2015;37:138–149. doi: 10.1123/jsep.2014-0212.
    1. Kong Z, et al. Comparison of high-intensity interval training and moderate-to-vigorous continuous training for cardiometabolic health and exercise enjoyment in obese young women: a randomized controlled trial. PLoS ONE. 2016;11:e0158589. doi: 10.1371/journal.pone.0158589.
    1. Reljic D, et al. Prevalence and predictors of dropout from high-intensity interval training in sedentary individuals: a meta-analysis. Scand. J. Med. Sci. Sports. 2019;29:1288–1304. doi: 10.1111/sms.13452.
    1. Jiménez-Pavón D, Lavie CJ. High-intensity intermittent training versus moderate-intensity intermittent training: is it a matter of intensity or intermittent efforts? Br. J. Sports Med. 2017;51:1319–1320. doi: 10.1136/bjsports-2016-097015.
    1. Racil G, et al. Greater effects of high- compared with moderate-intensity interval training on cardio-metabolic variables, blood leptin concentration and ratings of perceived exertion in obese adolescent females. Biol. Sport. 2016;33:145–152. doi: 10.5604/20831862.1198633.
    1. Nazari M, Minasian V, Hovsepian S. Effects of two types of moderate- and high-intensity interval training on serum salusin-α and salusin-β levels and lipid profile in women with overweight/obesity. Diabetes Metab. Syndr. Obes. 2020;13:1385–1390. doi: 10.2147/DMSO.S248476.
    1. Ross R, de Lannoy L, Stotz PJ. Separate effects of intensity and amount of exercise on interindividual cardiorespiratory fitness response. Mayo Clin. Proc. 2015;90:1506–1514. doi: 10.1016/j.mayocp.2015.07.024.
    1. Wen CP, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. 2011;378:1244–1253. doi: 10.1016/S0140-6736(11)60749-6.
    1. Skelly LE, et al. High-intensity interval exercise induces 24-h energy expenditure similar to traditional endurance exercise despite reduced time commitment. Appl. Physiol. Nutr. Metab. 2014;39:845–848. doi: 10.1139/apnm-2013-0562.
    1. Boutcher SH. High-intensity intermittent exercise and fat loss. J. Obes. 2011;2011:868305. doi: 10.1155/2011/868305.
    1. Pritzlaff CJ, et al. Catecholamine release, growth hormone secretion, and energy expenditure during exercise vs. recovery in men. J. Appl. Physiol. 2000;89:937–946. doi: 10.1152/jappl.2000.89.3.937.
    1. Moniz SC, Islam H, Hazell TJ. Mechanistic and methodological perspectives on the impact of intense interval training on post-exercise metabolism. Scand. J. Med. Sci. Sports. 2020;30:638–651. doi: 10.1111/sms.13610.
    1. Unick JL, et al. Acute effect of walking on energy intake in overweight/obese women. Appetite. 2010;55:413–419. doi: 10.1016/j.appet.2010.07.012.
    1. Vanderheyden LW, McKie GL, Howe GJ, Hazell TJ. Greater lactate accumulation following an acute bout of high-intensity exercise in males suppresses acylated ghrelin and appetite postexercise. J. Appl. Physiol. 2020;128:1321–1328. doi: 10.1152/japplphysiol.00081.2020.
    1. Crabtree DR, Chambers ES, Hardwick RM, Blannin AK. The effects of high-intensity exercise on neural responses to images of food. Am. J. Clin. Nutr. 2014;99:258–267. doi: 10.3945/ajcn.113.071381.
    1. Taylor J, Keating SE, Holland DJ, Coombes JS, Leveritt MD. The chronic effect of interval training on energy intake: a systematic review and meta-analysis. J. Obes. 2018;2018:6903208. doi: 10.1155/2018/6903208.
    1. VanWormer JJ, Martinez AM, Cosentino D, Pronk NP. Satisfaction with a weight loss program: what matters? Am. J. Health Promot. 2010;24:238–245. doi: 10.4278/ajhp.080613-QUAN-92.
    1. Gillison FB, Skevington SM, Sato A, Standage M, Evangelidou S. The effects of exercise interventions on quality of life in clinical and healthy populations; a meta-analysis. Soc. Sci. Med. 2009;68:1700–1710. doi: 10.1016/j.socscimed.2009.02.028.
    1. Kolotkin RL, Andersen JR. A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life. Clin. Obes. 2017;7:273–289. doi: 10.1111/cob.12203.
    1. Zanini A, et al. Estimation of minimal clinically important difference in EQ-5D visual analog scale score after pulmonary rehabilitation in subjects with COPD. Respir. Care. 2015;60:88–95. doi: 10.4187/respcare.03272.
    1. Feng Y, Parkin D, Devlin NJ. Assessing the performance of the EQ-VAS in the NHS PROMs programme. Qual. Life Res. 2014;23:977–989. doi: 10.1007/s11136-013-0537-z.
    1. National Institute for Health and Care Excellence (NICE). Weight Management: Lifestyle Services for Overweight or Obese Adults. Public Health Guideline PH53. London, NICE, 2014. (accessed November 2020).
    1. Williamson DA, Bray GA, Ryan DH. Is 5% weight loss a satisfactory criterion to define clinically significant weight loss? Obesity (Silver Spring) 2015;23:2319–2320. doi: 10.1002/oby.21358.
    1. Ross R, Janiszewski PM. Is weight loss the optimal target for obesity-related cardiovascular disease risk reduction? Can. J. Cardiol. 2008;24(Suppl D):25D–31D. doi: 10.1016/S0828-282X(08)71046-8.
    1. Weiss EP, Jordan RC, Frese EM, Albert SG, Villareal DT. Effects of weight loss on lean mass, strength, bone, and aerobic capacity. Med. Sci. Sports Exerc. 2017;49:206–217. doi: 10.1249/MSS.0000000000001074.
    1. Reljic D, Feist J, Jost J, Kieser M, Friedmann-Bette B. Rapid body mass loss affects erythropoiesis and hemolysis but does not impair aerobic performance in combat athletes. Scand. J. Med Sci Sports. 2016;26:507–517. doi: 10.1111/sms.12485.
    1. Sloan RA, Sawada SS, Martin CK, Church T, Blair SN. Associations between cardiorespiratory fitness and health-related quality of life. Health Qual. Life Outcomes. 2009;7:47. doi: 10.1186/1477-7525-7-47.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere