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Martins Et Al., 2015
Martins Et Al., 2015
http://dx.doi.org/10.1123/ijsnem.2015-0078
© 2016 Human Kinetics, Inc. ORIGINAL RESEARCH
This study aimed to determine the effects of 12 weeks of isocaloric programs of high-intensity intermittent
training (HIIT) or moderate-intensity continuous training (MICT) or a short-duration HIIT (1/2HIIT) induc-
ing only half the energy deficit on a cycle ergometer, on body weight and composition, cardiovascular fitness,
resting metabolism rate (RMR), respiratory exchange ratio (RER), nonexercise physical activity (PA) levels
and fasting and postprandial insulin response in sedentary obese individuals. Forty-six sedentary obese indi-
viduals (30 women), with a mean BMI of 33.3 ± 2.9 kg/m2 and a mean age of 34.4 ± 8.8 years were randomly
assigned to one of the three training groups: HIIT (n = 16), MICT (n = 14) or 1/2HIIT (n = 16) and exercise
was performed 3 times/week for 12 weeks. Overall, there was a significant reduction in body weight, waist
(p < .001) and hip (p < .01) circumference,, trunk and leg fat mass (FM; p < .01) and an increase in trunk and
leg fat free mass (FFM; p < .01) and cardiovascular fitness (VO2max in ml/kg/min; p < .001) with exercise.
However, no significant differences were observed between groups. There was no significant change in RMR,
RER, nonexercise PA levels, fasting insulin or insulin sensitivity with exercise or between groups. There was
a tendency for a reduction in AUC insulin with exercise (p = .069), but no differences between groups. These
results indicate that isocaloric training protocols of HIIT or MICT (or 1/2HIIT inducing only half the energy
deficit) exert similar metabolic and cardiovascular improvements in sedentary obese individuals.
It is widely accepted that exercise should always (Ross et al. 2000) and preserving fat-free mass (Stiegler
be present in any intervention aimed to manage obesity, and Cunliffe 2006). However, most reviews and meta-
due to its potential in improving cardiovascular fitness analyses looking at the effect of exercise on weight loss
(WL) report disappointing results, with only a moderate
Martins, Kazakova, and Kulseng are with the Obesity Research WL (2–3kg) being achieved with exercise alone (Cat-
Group, Dept. of Cancer Research and Molecular Medicine, enacci and Wyatt 2007; Shaw et al. 2006).
Faculty of Medicine, Norwegian University of Science and The most recent international physical activity (PA)
Technology, Trondheim, Norway. Ludviksen is with the Center recommendations for WL advocate at least 150 min of
for Obesity, Dept. of Surgery, St. Olav Hospital—Trondheim exercise/week to achieve minimum WL (2–3kg; Don-
University Hospital, Trondheim, Norway. Mehus is with the nelly et al. 2009). This duration involves a considerable
Dept. of Sociology and Political Science—Sport Science, commitment and is likely to contribute to low compliance
Faculty of Social Sciences and Technology Management, from exercise programs, especially in the obese popula-
Norwegian University of Science and Technology, Trondheim, tion, with lack of time being the most commonly referred
Norway. Wisloff is with the K.G. Jebsen Center for Exercise barrier for not exercising in this group (Fox et al. 2012;
in Medicine at Dept. of Circulation and Medical Imaging, Rye et al. 2009).
Trondheim, Norway. Morgan is with the School of Biomedical High intensity exercise offers a more time-efficient
and Molecular Sciences, University of Surrey, Guildford, UK. option, but is potentially a problem because of low
King is with the Institute of Health and Biomedical Innovation tolerance in obese people (De Feo 2013). A solution to
and School of Exercise and Nutrition Sciences, Queensland this barrier would be to perform bouts of high-intensity
University of Technology, Brisbane, Australia. Address author exercise alternated with bouts of low-intensity exercise;
correspondence to Catia Martins at catia.martins@ntnu.no. known as high-intensity interval training (HIIT). Even
197
198 Martins et al.
though HIIT has been advocated as the new exercise pill Detailed Description of the Study
(Boutcher, 2011), the impact of HIIT on body weight and
composition is controversial, with some showing better Participants underwent a 12-week supervised exercise
results after HIIT, compared with moderate intensity program and were asked to maintain their normal diet
continuous training (MICT), in normal-weight (Trapp et throughout the study. Several measurements were
al., 2008) and obese individuals (Sijie et al., 2012), others performed before and after the intervention including:
no difference (Tjonna et al., 2008) or even superiority anthropometric measurements, body composition, maxi-
of MICT (Keating et al., 2014; Nybo et al., 2010). More mal oxygen consumption (VO2max), resting metabolic rate
research is, therefore, needed to test the potential superi- (RMR) and fasting substrate oxidation, habitual food
ority of HIIT (vs MICT) on body weight and composition intake, nonexercise physical activity (PA) levels and
and metabolism in general. fasting and postprandial insulin levels.
Therefore, the aim of this study was to compare the Exercise Intervention. All participants exercised
effects of 12 weeks of isocaloric programs of HIIT or three times per week for 12 weeks and all sessions were
MICT, or a short-duration HIIT, inducing only half the supervised. Exercise was carried out on a Monark cycle
energy deficit of HIIT and MICT (1/2 HIIT), performed ergometer (Ergomedic 839E, Monark 2008, Sweden).
on a cycle ergometer, on body weight and composition, Each exercise session started with a 5-min warm-up,
fasting and postprandial insulin response and cardiovas- and finished with a 5-min cool down. Heart rate (HR)
cular fitness in obese individuals. Moreover we were was recorded during each exercise session using Polar
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interested in investigating the potential role of fat oxida- F6M heart rate monitor (Polar type 610, Polar Electro
tion and nonexercise PA levels on the superiority of HIIT. Oy, Finland).
It was hypothesized that HIIT would result in a larger The HIIT protocol consisted of 8 s of sprinting
weight and fat mass loss than MICT and that 1/2HIIT (during which participants worked as hard as possible)
would produce similar results to MICT. and 12 s of recovery phase (during which participants
turned the pedals as slowly as possible). Participants fol-
Subjects and Methods lowed a prerecorded tape, indicating when to start sprint-
ing and when to slow down. The resistance used was that
Subjects needed to increase the participants HR to 85–90% of their
maximal HR (HRmax). A ramping approach was used to
Forty six sedentary obese individuals (30 female, 16 accommodate any increase in training effect and VO2max.
male), with an age of 34.4 ± 8.8 years, a weight of 98.5 Therefore, resistance and work load were accordingly
± 14.3kg and a BMI of 33.3 ± 2.9 kg/m2 were recruited increased when appropriate. To account for changes in
for this study. VO2max and body weight, a submaximal VO2max test was
Sedentary lifestyle was defined as not engaged in performed at week 4 and 8 to recalculate the prescribed
strenuous work or in regular brisk leisure physical activ- exercise duration and energy deficit for all three groups.
ity more than once a week or in light exercise for more The HIIT protocol was designed to induce a 250kcal
than 20 min/day on more than three times per week. This energy deficit and the duration of the exercise session was
was assessed through an exercise history of the 3 months individually tailored. Participants in the 1/2HIIT group
before the study. Exclusion criteria included: being on a followed the same protocol as the HIIT group, but aiming
weight loss diet or weight unstable (>2kg variation over at an energy deficit of 125kcal (approximately half of
the last 3 months), taking any medication known to affect time of the HIIT). The MICT consisted of continuous
appetite or induce WL or having a restraint score derived cycling at 70% of HRmax. As in HIIT group, the duration
from the Three Factor Eating Behavior Questionnaire of exercise session was estimated for each participant
(Stunkard and Messick 1985) >12. individually, to induce a 250kcal energy deficit.
This study was conducted according to the guide-
lines laid down in the Declaration of Helsinki and was Anthropometrics and Body Composition. Weight,
approved by the regional Ethics Committee for Medical height, waist and hip circumference were measured in
Research (Ref. 2010/447). Written informed consent fasting, after emptying the bladder and with participants
was obtained from all participants before enrolling in wearing underwear only. Weight was measured using an
the study. electronic platform scale (Seca 877, Hamburg, Germany)
Participants were randomly allocated to either HIIT and height using a wall-mounted stadiometer (Seca 217,
(n = 16), 1/2HIIT (n = 16) or MICT (n = 14) for 12 weeks. Hamburg, Germany).
However, for various reasons, three withdrew from the A dual energy X-ray absorptiometry (DXA) scan
HIIT (one due to muscle pain and 2 due to lack of time), (Hologic, Discovery A, software version 12.7.4.2. USA.)
one from the MICT (for family reasons) and seven from was used for assessing body composition, three hours
the S-HIIT groups (three due to muscle pain, three due to after a standardized breakfast. Participants wore under-
lack of time and one for family reasons). There were no wear during scan procedures and were scanned in supine
significant differences in age, BMI or any of the variables position. Due to size constrains of the DXA platform,
measured, between those who withdraw and those who the majority of the participants did not fit in the scan,
completed the intervention. with parts of the arms being cut. For that reason only
the composition of the trunk (area distal to the head and measurement of insulin. Samples were then centrifuged
superior to the pelvis without the upper limbs) and legs at 2000 g for 10 min and analyzed immediately, for
were analyzed. Moreover, due to a systematic error, data glucose, using standard procedures, or kept at –20 °C
were only available in 17 out of the 35 participants. All for later analyses of insulin. Insulin was measured using
the scans were analyzed by the same person, to minimize a human-specific RIA kit (Linco Research, St Charles,
interobserver variation. USA). All samples were batch analyzed in duplicate at
the end of the study to reduce interassay variability. The
VO2max Measurement. VO2max was measured on a cycle
sensitivity of the assay was 2.71 uU/ml and the intra-assay
ergometer (Ergomedic 839E, Monark 2008, Sweden),
coefficient of variation was <10%.
using the system Oxigen Pro (Viasys Healthcare,
Hoechberg, Germany). The test started with a 5 min warm Diet Monitoring. Participants were asked to maintain
up, at a resistance of 50 W and afterward the workload their normal diet during the exercise training period. Three-
was gradually increased until maximal resistance. A day food diaries were collected at baseline and on the last
respiratory exchange ratio of 1.05 or above was set week of training (two weekdays and one weekend day)
as criteria for achieving VO2max. HR was monitored and analyzed using the program Mat på Data (version 5.1).
throughout the test using a Polar F6M HR monitor (Polar
type 610, Polar Electro Oy, Finland). Maximal HR was Statistical Analysis
defined by adding five beats to the highest HR value
obtained during the VO2max test. Statistical analysis was carried out using SPSS 20.0
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with exercise, but no significant main effect of group or Leg FM was also significantly reduced overtime
interactions. (p < .01), while leg FFM increased significantly with
Changes in cardiovascular fitness overtime were also exercise. However, no significant main effect of group
not significant different between exercise groups (Table or interactions was found.
2). A significant overall increase (p < .001) in VO2max was
observed, both in absolute values and adjusted for body Changes in Resting Metabolic Rate
weight, with exercise, but no significant effect of group
and Substrate Oxidation
or interaction was found.
No significant main effect of time, group or interaction
Changes in Body Composition was found for RMR or RER (data not shown).
Changes in body composition overtime were not signifi- Changes in Physical Activity Levels
cant different between exercise groups (Table 3). Overall,
trunk FM was significantly reduced overtime (p < .01), No significant effect of time, group or interaction was
while trunk FFM increased significantly (p < .01) with found on the amount of time spent on sedentary activi-
exercise. However, no significant main effect of group ties, light, or moderate to vigorous PA, as well as on total
or interactions was found. counts per minute outside of the training period (Table 4).
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Diet
No significant effect of time, group or interaction was
found on energy or macronutrient intake (expressed as a
percentage of EI) (data not shown).
Figure 1 — Changes in AUC (0–180 min) for insulin after 12
weeks of training. Results are expressed as mean± SD. HIIT,
Discussion high-intensity intermittent training; 1/2HIIT, half duration
high-intensity intermittent training, MICT, moderate-intensity
The major finding of this study was that all training continuous training. Analysis using mixed between-within
programs lead to similar improvements on body weight subjects ANOVA showed a tendency for an effect of time (p
and composition, metabolism (insulin sensitivity, RMR = .069), but no effect of group or interaction on insulin AUC.
and substrate oxidation) and cardiovascular fitness. Our
findings are in contrast with a previous study using an
identical HIIT cycling protocol, showing that HIIT, was
superior to MICT, in inducing FM loss and improving weight and composition between isocaloric program of
insulin sensitivity (Trapp et al., 2008). However, other HIIT and MICT (Schjerve et al., 2008; Tjonna et al.,
studies using treadmill protocols, in “healthy” overweight 2008). Although it can be hypothesized that exercise
and obese subjects, have not shown any difference in body mode is implicated in the above described discrepancies,
a more likely explanation is the duration of the HIIT between groups. The impact of HIIT on insulin sensitivity
intervals. The studies employing treadmill (Schjerve et is controversial, with some showing significant improve-
al., 2008; Tjonna et al., 2008) used longer exercise inter- ments (Trapp et al., 2008; Whyte et al., 2010) and others
vals, while those with cycling (Trapp et al., 2008) used no change (Gillen et al., 2013; Heydari et al., 2012).
short- to medium-intervals. There is evidence to suggest Differences in exercise protocols and study populations
that the metabolic responses to HIIT vary depending on (gender, BMI, baseline fasting insulin levels) are likely
the duration of the work:rest periods (Christmass et al., to play a role.
1999; Essen and Kaijser, 1978; McGarvey et al., 2005; There is a large controversy regarding the impact of
Schjerve et al., 2008; Trapp et al., 2007). Nevertheless, exercise on nonexercise PA levels, even though the overall
we found no difference between exercise programs in trend is for nonexercise PA to decrease (Melanson et al.
terms of FM loss in the current study. 2013). Unfortunately, no study had, up to now, evaluated
HIIT has also been claimed to be superior in terms the impact of isocaloric programs of HIIT vs MICT, on
of enhancing fat oxidation (Boutcher 2011), even though nonexercise PA. We found no changes in nonexercise PA
studies comparing isocaloric protocols of HIIT and MICT over time or between groups in our study.
have not, from our knowledge been perfomed, and this Our study is strengthened by the fact that the exercise
could be one of the mechanisms leading to more fat mass prescriptions were ramped to accommodate any training
loss after HIIT. However, we found no difference between effect. One limitation is that we were unable to measure
training protocols in term of changes in fasting substrate total body composition and could only report changes in
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oxidation with exercise, which is in line with the similar FM and FFM in the trunk and legs. However, given that
improvements in body composition observed after HIIT abdominal fat is more strongly correlated with metabolic
and MICT in the current study. abnormalities than total fat (Wiklund et al., 2008), we
Several studies, using treadmill protocols, in over- believe a reduction in trunk FM is more relevant than a
weight and obese individuals, have shown the superiority reduction in total body FM. Moreover, our study has a
of HIIT vs MICT in improving cardiovascular fitness relatively small sample size and short duration and, there-
(VO2max; Schjerve et al., 2008; Tjonna et al., 2008). fore, larger and longer studies are needed to determine
However, we, as Trapp and colleagues (2008), reported the impact of HIIT on body weight and composition,
similar improvements in VO2max regardless of the exercise cardiovascular fitness ad insulin sensitivity.
program. Interestingly, a recent study in our laboratory The present study adds new important data to the
showed that one 4-min interval of intense (90% HRmax) current controversy regarding the efficacy of HIIT versus
training (3 times/week for 10 weeks) on a treadmill pro- MICT, on body weight and composition and metabolism
duced the same improvement in VO2max compared with in general. The novelty of the current study was that the
four 4-min intervals of intense training, in sedentary 8s:12s HIIT cycling protocol had not been previously
overweight males (Tjonna et al., 2013). This, together investigated in an obese sedentary population and that
with the findings of the current study, suggests that a short few of the previous studies had employed isocaloric
bout of high-intensity exercise may be enough to reduce exercise protocols. Future research should try to elucidate
cardiovascular risk in overweight and obese individuals. further the role of exercise mode (jogging/running versus
It is rather surprising that the 1/2HIIT, demanding cycling) and the duration of the work:rest periods on the
only half of the time of the HIIT, produced exactly the potential metabolic benefits of HIIT.
same results as HIIT or MICT, showing that in sedentary In conclusion, isocaloric training protocols of HIIT
obese individuals, even a very small volume of exercise or MICT, or short duration HIIT (1/2 HIIT) seem to
can induce improvements in metabolic and cardiovascular offer a similar metabolic and cardiovascular protection
risk factors. Although there is some evidence suggest- it sedentary obese individuals.
ing that exercise alters eating behavior and food choice
(Finlayson et al., 2009; King, 1999), we found no differ- Acknowledgments
ences in energy intake or, indeed nonexercise PA between
groups. Moreover, the three exercise programs had an Catia Martins was supported by a postdoctoral grant from the
identical impact on substrate oxidation (RER). Therefore, Liaison Committee between the Central Norway Regional
the larger than expected WL in the 1/2HIIT group remains Health Authority (RHA) and the Norwegian University of
unexplained. Interestingly, in a recent published study, Science and Technology (NTNU). We would like to thank all
a similar weight and FM loss was reported in sedentary the participants that took part in this study for their time and
overweight men, regardless of exercise dose (30 min vs enthusiasm and Mrs. Sissel Salater and Hege Bjøru for their
60 min of exercise/day, respectively), potentially due to help with cannulation. The study was designed by CM, UW, LM
differences in nonexercise activity and energy intake in and NK; data were collected by CM; IK and ML and analyzed
response to the two exercise doses (Rosenkilde et al., by CM and BK; data interpretation and manuscript preparation
2012). were undertaken by all authors. All authors approved the final
Unexpectedly, we found no changes in fasting insulin version of the paper.
plasma levels or insulin sensitivity and only a tendency The authors declare that there is no conflict of interest that
toward a reduction in insulin AUC, and no differences would prejudice the impartiality of this scientific work.
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