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Evidence-Based Effects of High-Intensity Interval Training on Exercise Capacity and Health: a Review with Historical Perspective

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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 Review Evidence-Based Effects of High-Intensity Interval Training on Exercise Capacity and Health: A Review with Historical Perspective Muhammed Mustafa Atakan 1,† , Yanchun Li 2,*,†, ¸SükranNazan Ko¸sar 1 , Hüseyin Hüsrev Turnagöl 1 and Xu Yan 3,4 1 Division of Exercise Nutrition and Metabolism, Faculty of Sport Sciences, Hacettepe University, 06800 Ankara, Turkey; [email protected] (M.M.A.); [email protected] (¸S.N.K.); [email protected] (H.H.T.) 2 China Institute of Sport and Health Science, Beijing Sport University, Beijing 100192, China 3 Institute for Health and Sport (iHeS), Victoria University, Melbourne 8001, Australia; [email protected] 4 Sarcopenia Research Program, Australia Institute for Musculoskeletal Sciences (AIMSS), Melbourne 3021, Australia * Correspondence: [email protected]; Tel.: +86-10-6298-9306 † These authors contributed equally to this work. 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 Citation: Atakan, M.M.; Li, Y.; Ko¸sar, continuous training, despite a lower total exercise volume. Although there is no universal definition, ¸S.N.;Turnagöl, H.H.; Yan, X. high-intensity interval exercise is characterized by repeated short bursts of intense activity, performed Evidence-Based Effects of with a “near maximal” or “all-out” effort corresponding to ≥90% of maximal oxygen uptake or High-Intensity Interval Training on Exercise Capacity and Health: A >75% of maximal power, with periods of rest or low-intensity exercise. Research has indicated that Review with Historical Perspective. high-intensity interval training induces numerous physiological adaptations that improve exercise Int. J. Environ. Res. Public Health 2021, capacity (maximal oxygen uptake, aerobic endurance, anaerobic capacity etc.) and metabolic health 18, 7201. https://doi.org/10.3390/ in both clinical and healthy (athletes, active and inactive individuals without any apparent disease or ijerph18137201 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 Academic Editor: John Babraj early 1920s to date. Further, an overview of the mechanisms underlying the physiological adaptations in response to high-intensity interval training is provided. Received: 26 May 2021 Accepted: 28 June 2021 Keywords: exercise; intermittent training; physical endurance; health benefits; physiological adaptation Published: 5 July 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in 1. Introduction published maps and institutional affil- iations. Exercise is a cornerstone in the primary prevention of chronic diseases including diabetes mellitus, cancer, obesity, hypertension, coronary heart disease, cardiovascular disease, and depression [1–3]. For centuries, exercise has long been prescribed by physicians as a medicine for their patients [4], and quotes attributed to Hippocrates, the father of Western medicine, include: “Walking is man’s best medicine” and “if there is a deficiency in Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. food and exercise, the body will fall sick [5,6].” Evidence-based scientific guidelines suggest This article is an open access article that exercise is a novel non-pharmacological strategy in the prevention and management distributed under the terms and of chronic diseases [7–11]. Despite these well-documented benefits of exercise, a third conditions of the Creative Commons of adults and four-fifths of adolescents—approximately 1.4 billion people—do not meet Attribution (CC BY) license (https:// public health guidelines for recommended levels of exercise [7], making physical inactivity creativecommons.org/licenses/by/ a global problem [12]. The recently updated World Health Organization 2020 Guidelines 4.0/). on physical activity and sedentary behavior [13] recommend performing at least 150 to Int. J. Environ. Res. Public Health 2021, 18, 7201. https://doi.org/10.3390/ijerph18137201 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021, 18, 7201 2 of 27 300 min of moderate-intensity physical activity, or 75 to 150 min of vigorous-intensity aerobic exercise, per week to achieve substantial health benefits [14]. However, the lack of sufficient time is the most common barrier to adhering to regular exercise [15]. Therefore, research has recently focused on interval training models, which consist of brief periods of intense activity performed with a “near-maximal” or “all-out” effort corresponding to ≥90 . of maximal oxygen uptake (VO2max)[16] or >75% of maximal power [17], interspersed with passive or active recovery periods, that can induce similar or even greater physiological adaptations when compared to moderate-intensity continuous training (MICT) [17–19], which generally consists of 30–60 min of moderate-intensity exercise at 40% to <60% of oxygen consumption reserve [20,21]. There are numerous excellent reviews on the effects of interval training on exercise capacity and general health in healthy and clinic populations as well as the mechanisms underlying these effects [15,18,22–24]. However, to the best of our knowledge, no study to date has applied a historical approach. In this review, after defining the types of different interval-training models, the findings of some selected high-intensity interval-training studies that have received considerable interest due to their novel findings on exercise capacity and health, which can be considered milestone studies in the related literature, are presented. Finally, a brief overview of the mechanisms underlying the physiological adaptations in response to high-intensity interval training is presented. 2. Interval Training Interval training is characterized by short bursts of intense activities that elicit ≥90% of . VO2max [16], >75% of maximal power [17] or supra-maximal effort [16–18], with periods of rest or low-intensity exercise for recovery. The most used types of interval training models are: (1) the high-intensity interval training (HIIT) model with submaximal efforts that elicit . ≥90% of VO2max [16] or >75% of maximal power [18,25]; (2) the sprint interval training (SIT) model, a more intense version of HIIT that involves maximal or supramaximal efforts . greater than VO2max or maximal power; and (3) the repeated-sprint training (RST) model, which is characterized by performing a high number of sprints lasting less than 10 s interspersed with relatively shorter recoveries (<60 s) compared to the recovery periods of SIT [26]. Interval training has been an integral part of training for coaches and athletes to enhance performance for over a century, and it has received considerable scientific inquiry due to its ability to induce remarkable physiological adaptations and health benefits that resemble MICT with less time commitment [27]. Besides, it should be noted that from a mechanistic standpoint, physiological adaptations elicited by interval training is not only attributable to intensity per se but also the intrinsic nature of the intermittent exercise. It is well documented that HIIT provides a robust stimulus for central cardiovascular adaptations and metabolic stress [28], while MICT mainly triggers peripheral adaptations contributing to muscular oxygen extraction and metabolic efficiency [29–31]. HIIT is known to elicit higher enjoyment than MICT, as reported by original research [32] and meta-analysis [33], making the interval training model a practical and enjoyable exercise mode for the general population. Furthermore, a meta-analysis by Reljic et al. [34] reported that following HIIT-based interventions, there were lower dropout rates than traditional exercise programs in previously sedentary individuals, showing that HIIT is tolerable and acceptable. However, a single bout of high-intensity interval exercise performed at a strenuous intensity with a low resting period likely results in decreased enjoyment, and thus, adequate resting intervals between high-intensity sessions are essential in preventing negative affective responses for long-term exercise maintenance. Due to its time-saving nature and the induced physiological adaptations similar to MICT, HIIT has been ranked first in 2018 [35] and third in 2019 in Worldwide Fitness Trends [36]. Growing evidence-based research, both original research and meta-analysis studies, shows that interval training programs ranging from 5 days to 12 months are . effective in improving VO2max [37], endurance capacity [38,39], resting metabolic rate [40], Int. J. Environ. Res. Public Health 2021, 18, 7201 3 of 27 substrate metabolism [41,42], body composition [43], insulin sensitivity [44,45], and cogni- tive functions [46–48]. Besides, interval training has been shown to decrease the risk for cardiovascular diseases [15,25], breast cancer [49], metabolic syndrome [50], osteoarthri- tis [51,52], and rheumatoid arthritis known to cause lower back pain [53–57] (Figure1). In the following subheadings,
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