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Presented by Chad Hensel, PT, DPT, MHS, CSCSWith Will Kirkpatrick, 1st Year Nursing Student
High Intensity Interval Training (HIIT):
Applications for Fitness and Rehab
.
Provider Disclaimer
• Allied Health Education does not have any financial or other
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displayed in this presentation.
• There was no commercial support for this presentation.
• The views expressed in this presentation are the views and
opinions of the presenter.
• Participants must use discretion when using the information
contained in this presentation.
Will Kirkpatrick, 1st year Nursing Student, Marion Tech College
Author, Rise to Summer fitness program
Dean’s List
Former college football player Triple sport athlete
Student Member, NSCA
“I have been doing HIIT for a little over a year and have
noticed more results than from any other training program”
Website: https://kirkpatrick2112.wixsite.com/mysite
Dr. Chad Hensel, PT, DPT, MHS, CSCS
Director, PTA Program, Marion Tech College
20 years of clinical experience
NSCA Certified Strength and Conditioning Specialist
Professor
www.mtc.edu
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High-Intensity
Interval
Training
HIIT:
HIIT describes a workout strategy that employs alternating cycles of bursts of
activity with periods of active recovery or rest.
What is it?
HIIT has many benefits that can be incorporated to any fitness level.
Benefits
Metabolic spikes4/
VARIETY--NOTBoring…compliance!?3/
No equipment required
2/Time efficient!
1/
6 Benefits…
Burn more calories!6/
Cardiovascular gains5/
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Evidence shows subjects feel that the time went quicker during HIIT than doing regular low-impact cardio.
Faster completion
perception
6 week study () group showed a 13% increase in
absolute VO2 max.
VO2 max benefits
In less time
The nature of HIIT allows for an almost endless supply of exercise choices, often with no equipment needed.
Limited time, more choices
15 min of HIIT can burn the same calories as 1 hour on
a treadmill!.
Can burn more calories
In less time
1. TIME EFFICIENT
Nearly endless options can be mixed and matched or modified
No Equipment Needed
Effects on Compliance!
Variety- Not Boring!!!
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HIIT has been shown to increase growth hormone levels– involved with fat burning and metabolic
enhancement.
Hormone changes
INSULIN/ BLOOD SUGAR CHANGES– HIIT training is linked with bringing blood glucose levels down while
enhancing glucose utilization in the muscles and insulin sensitivity.
Metabolic Spikes
Cardiovascular Gains
• Several studies confirm that HIIT does have some intriguing effects
• Increases in Max VO2– aerobic power
• Increase in pulse oximetry
• Muscular power output improved
• Varying lengths of time studied for the gains, but 48 hours or longer seems valid
--Big gains in excess post-exercise oxygen consumption (EPOC)
--According to the ACSM, HIIT can increase calorie burn and achieve faster cardiovascular benefits.
Burn more calories
-a 154lb man will
burn 320 calories
running at 8mph.
-the same man will
burn only 235
calories walking for
an hour at 3mph
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Study Name Subjects Results Supports HIIT?
Rozenek et al. Acute cardiopulmonary and metabolic
responses to high-intensity interval training protocols using
60s of work and 60s of recovery. 2016
11 healthy adults
around age 26; 5 m, 6
f
Peak power output levels examined in 4 HIIT workouts–
100/50 had best results, but 80/0, 80/50, and 100/0 also
showed benefits and would be appropriate for lesser
trained ind.
yes
Laurent et al. Sex-specific resopnses to self-paced high-
intensity interval training with variable recovery periods. 2014
16 (8 male, 8 female)
19-30yo moderate
fitness level
Findings support the notion that women may demonstrate
improved recovery with HIIT and will also self-select more
challenging intensities for cardiovascular strain. 2:1 work-
to-rest ratio optimal for both sexes.
Yes
Lanzi et al. Short-term HIIT and Fat-max training increase
aerobic and metabolic fitness in men with class II and III
obesity. 2015
19 males with BMI
over 35
Steady aerobic exercise vs HIIT studied for 8 cycling
sessions over 14 days where one group did a HIIT and the
other did steady aerobic. Results show that both versions
were beneficial to improving fat loss and improving health.
Partially
Astrorino et al. Effect of high-intensity interval training on
cardiovascular function, VO2 max and muscular force. 2012
20 active, men and
women approx. age
25 with 14%bf
Significant improvements in VO2max, O2 pulse, and
power output with HIITyes
Ziemann, et al. Aerobic and anaerobic changes with high-
intensity interval training in active college-aged men. 2011
21 men age 21
assigned to HIIT or
control group
27 min of cycling at 80% VO2max applied with work-rest
ratio of 1:2 and spread over 3 sessions per week x 6
weeks was effective to improve aerbic and anaerobic
performance.
yes
What does the literature say?
Evidence
Study Name Subjects Results Supports HIIT?
Zoran et al. Effectiveness of high-intensity interval training
(HIT) and continuous endurance training for VO2max
improvements: a systematic review and meta-analysis of
controlled trials. 2015
28 studies examined
totaling 723
participants.
In healthy, young to middle-aged adults, HIIT improves
maximal oxygen uptake to a greater extent than
traditional endurance training.
yes
Maillard et al. Effect of high-intensity training on total,
abdominal and visceral fat mass: a meta-analysis. 2018
39 studies involving
619 subjects were
examined
HIIT significantly reduced abdominal and visceral fat
levels. Greater than 90% of max HR was more effectiveYes
What does the literature say?
Evidence
Oxygendebt assessment4/
Ability tocompleteplanned movements
3/
RPE
2/ExercisePhysiology Review1/
Assessment of HIIT Fitness Level
Heart rate5/
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Exercise
Physiology
Review
• Exercise places a high amount of stress on the body
• Muscles are used in exercise which puts increased demands on the body for energy to allow the movements
• The body reacts in several ways:
• Increased heart rate
• Increases ATP production
• Heat manaagment
Heart Rate
-- The heart beats faster to provide oxygen rich blood to the muscles demanding it.
--Larger muscle groups require the heart to work harder
--Resting Heart Rate (RHR) can be indicative of overall fitness; 60-100 normal
--Target Heart Rates: Calculate Max HR 220-age, then multiply by .50-.85 for the 50-85% zone
--Example: 220-44= 88-149bpm
ATP Needs
• Phosphagen system is quick energy, short duration
• Glycogen-lactic acid system utilizes the muscles own stores of carbs–glycogen– still short duration with lactic acid byproduct
• Aerobic is finally when the body “comes around”. Long duration provided O2 demand keeps pace with intensity
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Aerobic
Respiration
• Acute changes to exercise: HR, cardiac output, stroke volume, mean art. BP, coronary artery diameter all increase
• Chronic changes include: improved VO2max, decrease resting BP in hypertensive individuals, improved ventilatoryefficiency, decreased minute resp rate, enhanced insulin sensitivity, reduced body fat, improved bone mineral density
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Borg and many other versions out there. This is a good use of determining subjective work perception! One could set a
maximum level that we don’t want to go above to help determine HIIT selections.
Rate of Perceived Exertion
RPE
Assess the subject’s ROM, strength and endurance
Can the subject complete the
planned motions?
IF the subject is unable to complete any component of the motions planned, then modifications must be
planned and then re-assessed for ability.
Ability:
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Oxygen Debt Assessment
• Pulse oximeter
• Normal values above 90%
• Should assessment reveal <90% activity should cease until levels are restored
• This can be an indicator to modify the activity and should correlate to the other indicators
Heart Rate:
220-age x percentages
Heart Rate
bpm
Effort EFFECT
171-190 Very hard; 90-100% Performance Redline; max performance
and speed development
152-171 Hard; 80-90% Threshold zone; increase max
performance capacity
133-152 Moderate; 70-80% Aerobic Zone; improve aerobic fitness
levels
114-133 Light; 60-70% Temperate Zone; Improves basic
endurance and fat burning
95-114 Very Light; 50-60% Heart Healthy Zone; improves overall
health and helps with recovery
Heart Rate cont.
• Training in different intensities stimulates your body to improve its fitness level
• Assessment of resting heart rate and then checking rate during and after activity
• Consider wearing heart rate monitor or fitbit, etc
• HIIT should have at least some aspects into the Hard or Very Hard category
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Strategies to adapt HIIT based on physical
ability and/or disability: A.A.R.
Ability
AccommodationReassess
Ability
• Can the client/patient perform the activity pain free?
• All else comes back to this skill
Accommodation
• Adapt the movement
• Clinical decision making- base on ABILITY not the DISABILITY
• Example: subject cannot perform a medicine ball toss at shoulder height with an 8lb ball without pain
• Accommodation: • 1- lower the height of the toss and/or
• 2- decrease weight of the ball and/or
• 3- decrease the reps
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Reassess
• Determine if the new activity works
• If no, return to step one and look at the ability again
• Then consider a different accommodation
• As a last resort, does the activity need to be completely changed? If yes, can we come up with a new one that targets the same muscle groups
Diabetes4/
COPD3/
HTN2/
Osteoarthritis1/
HIIT Indications for Medical Dx
6/
Obesity5/ Neurological?
Osteoarthritis
• Common arthritis type (3 million US cases per year), occurs when protective cartilage at bone ends wears down over time.
• Keogh et al looked at HIIT cycling with knee OA patients– compared to a moderate intensity constant training program Results showed HIIT group had a higher gain in the TUG and overall indicate that HIIT has similar gains and may be feasible for this population.
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HTN
• Varying degrees of severity when pressure is elevated above the 120/80 normal; peripheral resistance and/or force of heart contractions can play a role
• Weston et al performed a systematic review and meta-analysis in patient with lifestyle induced cardiometabolic disease. HIIT resulted in sig higher VO2 peak. Cardiorespiratory fitness was increased by 2x compared to MICT
COPD
• Creates obstructed airflow from the lungs–coughing, increased mucus, wheezing. Caused by long term exposure to particulate matter.
• Guadalupe-Grau A et al. looked at short and long term effects of HIIT training concurrently with strength training in Octogenarians with COPD. They concluded physical fitness increased in the short term and there are potential long term benefits.
Diabetes mellitus
• Group of diseases affecting how the body utilizes glucose– the body’s primary fuel source. May be insulin dependent or NIDDM.
• Jelleyman et al looked at the effects of HIIT on glucose regulation and insulin resistance. Their meta-analysis included 50 studies showed significant reductions of fasting glucose. Concluded HIIT appears effective at improving metabolic health, especially in NIDDM
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Obesity
• Current categorization is centered on the Body Mass Index (BMI)
• BMI calculated from body height/weight measurements
• ((weight (lbs)/height (inches sq)) x 703
• An adult who has a BMI between 25 and 29.9 is considered overweight
• An adult who has a BMI of 30 or higher is considered obese
Obesity
• CDC reports 1 in 3 adults age 20 and over are overweight or obese in the USA
• Maillard et al (2018) used a meta-analysis to study the effect of HIIT on total, abdominal and visceral fat mass
• HIIT significantly reduced whole body adipose, while lower intensities had greater effect on abdominal and visceral levels
• Conclusion: HIIT is an effective strategy to reduce fat levels in a time efficient manner
Neurological?
• Not much evidence to support HIIT in neurological patients (CVA, TBI, TIA, etc)
• Madhaven et al. (2016) specifically looked at HIIT treadmill training on corticomotor excitability following stroke
• Although a small sample, concluded that HIIT suppresses corticomotor excitability in some people with chronic stroke
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Using the AAR method, these are suggestions and examples of ways to modify all of the workouts presented.
MODIFIED WORKOUTS
Upper body routines for the athlete, many utilize the
core and muscles of posture.
.
ATHLETE UB 1-4
Less intense workouts for those striving to improve their fitness and health. Combinations of upper and lower body exercises.
STRIVE 1-3
Lower Body focused, these four routines maximize
calories burned..
ATHLETE LB 1-4
HIIT WORKOUTS
Athlete LB-1
-Box Squat 5x
-Medicine Ball Jump Press 3x
-Sit to Jump (off of box) 3x
-Rest
Muscles
Utilized
• Quadriceps
• Hamstrings
• Gluteus maximus
• Stabilizers
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Video: Athlete LB-1
Modified Athlete LB-1
• Box Squat– adjust height or depth of squat
• Med Ball Jump- adjust weight of ball and/or jump height
• Sit to jump (off of box)-- same
Video: Modified Athlete LB-1
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Athlete LB-2
• Deadlift
• Hip thrust
• Broad jump
• 3x each
• Rest 30-60s
Muscles
Utilized
• Quadriceps
• Gastroc-soleus
• Gluteals
• Quadratus Lumborum
• Erector spinae
Video: Athlete LB-2
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Modified Athlete LB-2
• Deadlift– terminal range adjusted deadlift
• Hip thrust- change to a bridging activity
• Broad jump – decrease range and height or do long stepping
• 5-10x each
• Rest 60s
Video: Modified Athlete
LB-2
Athlete LB-3
• Split Squat
• Hip flexor flexion
• Sled Push
• Rest
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Muscles
Utilized
• illiopsoas
• Quadriceps
• Gluteus medius
• Gluteus maximus
Video: Athlete LB-3
Modified Athlete LB-3
• Split squat – alternate step back lunges, decrease depth
• Hip flexor flexion – provide support for balance stability (cane, walker, chair, etc.)
• Sled push - decrease load or even use wall push isometric
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Video: Modified Athlete LB-3
Athlete LB-4
• Lateral Sled Shuffle – 30M down and back
• Box lateral step up - 3x each side
• Side Shuffle- same as sled
• Rest 60s
Muscles
Utilized
• Tensor Fascia Latae
• Quadriceps, vastus lateralis
• Gluteus medius
• Peroneals
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Video: Athlete LB-4
Modified Athlete LB-4
• Lateral sled shuffle– reduce load and step lengths as needed
• Box lateral step-up-- reduce height of step
• Side shuffle– reduce cadence, provide chair for balance
Video: Modified
Athlete LB-4
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Athlete UB-1
• Floor press (w/ barbell)
• Burpee
• Medicine ball wall toss
• Rest
Muscles
Utilized
• Pectoralis major and minor
• Triceps
• Deltoids, all heads
• Core
• Some lower muscle power for burpee
Video: Athlete UB-1
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Modified Athlete UB-1
• Floor press (w/ barbell) – mat table or bench – body bar or pole
• Burpee – wall burpee, normal pattern but without push-up or jump
• Medicine ball wall toss – unweighted ball/ reduced weight
Video: Modified Athlete UB-1
Athlete UB-2
• Dip
• Medicine ball floor press toss
• Band crossover
• Rest
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Muscles
Utilized
• Pectoralis major and minor
• Triceps
• Deltoids, all heads
• Core
Video: Athlete UB-2
Modified Athlete UB-2
• Dip-- assisted dip machine or utilize chair dip
• Medicine ball floor press toss– use mat table or bench, lower the weight of the ball
• Band crossover– theraband options
• 15-20 reps each
• 60s Rest
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Video: Modified Athlete UB-2
Athlete UB-3
• Bodyweight Row
• Sled Pull
• Heavy single DB row
• Rest
Muscles
Utilized
• Latissimus dorsi
• rhomboids
• trapezius
• Biceps brachii
• RTC
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Video: Athlete UB-3
Modified Athlete UB-3
• Bodyweight row– change angles to reduce bodyweight
• Sled pull– reduce friction of load
• Heavy single DB row– reduce weight or use theraband row option
Video: Modified Athlete UB-3
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Athlete UB-4
• Push-press
• Medicine ball jump press
• Battle Rope
• Rest
Muscles
Utilized
• Rectus Abdominus
• Serratus anterior
• Obliques
• Anterior deltoids
• Upper pectoralis major
• LE muscles for power
Video: Athlete UB-4
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Modified Athlete UB-4
• Push-press – far too risky for anyone with shoulder problems or spinal issues, use a medicine ball or light dumbbells to mimic the motion – a med ball high toss would also be an option
• Medicine ball jump press– similar to above, limit jump and/or include a small step up as a substitute
• Battle rope– use trx straps or no straps and mimic the motion until able
Video: Modified Athlete UB-4
Strive-1
• Row Machine
• Burpees
• Jack Knife
• Rest
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Muscles
Utilized
• Rectus Abdominus
• Serratus anterior
• Obliques
• Anterior deltoids
• Upper pectoralis major
• LE muscles for power
Video: Strive-1
Modified Strive-1
• Row Machine – if balance or mobility issues, consider airdyne bicycle
• Burpees – consider wall burpees or “down and plank” options
• Jack Knife – alternating single leg to reduce lumbar stresses
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Video: Modified Strive-1
Strive-2
• Battle Rope
• Kettlebell swing
• Box Step-ups
• Rest
Muscles
Utilized
• RTC
• Anterior deltoids
• Upper pectoralis major
• LE muscles for power and balance
• Quadriceps
• Hamstrings
• Gastrocnemius
• soleus
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Video: Strive-2
Modified Strive-2
• Battle Rope - use trx straps or no straps and mimic the motion until able
• Kettlebell swings - reduce weight, consider using a wall for back support, reduce depth
• Box step-ups – reduce height of box, provide pole for assist and for balance
Video: Modified Strive-2
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Strive-3
• Crunches- 20-25x
• Medicine ball slams- 10x
• Dumbbell squats- 10x
• Rest 60s
Muscles
Utilized
• Rectus abdominus
• Obliques
• Serratus anterior
• Triceps
• LE muscles for power and balance
• Quadriceps
• Hamstrings
• Gastrocnemius
• soleus
Video: Strive-3
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Modified Strive-3
• Crunches – reduce reps and ROM prn
• Medicine ball slams – reduce weight of ball and reps, limit ROM prn
• DB squats – reduce ROM, consider using a wall or smith machine option
Video: Modified Strive-3
Additional References
• Madhavan S, Stinear J, Kanekar N. Effects of a single session of high intensity interval treadmill training on corticomotor excitability following stroke: implications for therapy. Neural Plasticity, vol 2016, pp. 1-8, 2016.
• Maillard F, Periera B, Boisseau N. Effect of high-intensity interval training on total, abdominal and visceral fat mass: a meta-analysis. Sports Med, vol 48: 269-288, 2018.
• Jelleyman C, Yates T, O’Donovan G, Gray L, King J, KhuntiK, Davies M. The effects of high-intensity interval training on glucose regulation and insulin resistance: a meta-analysis. Obes Rev, vol 16(11): 942-61, 2015.
• Guadalupe-Grau A, Aznar-Lain S, Manas A, Castellanos J, Alcazar J, Ara I, Mata E, Daimiel R, Garcia F. Short and long-term effects of concurrent strength and HIIT training in octogenarians with COPD. J Aging Phys Act, vol 25(1): 105-115, 2016.
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Additional References
• Weston KS, Wisloff U, Coombes JS. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med, 48(16): 1227-34, 2014.
• Keogh JW, Grigg J, Vertullo CJ. Is home-based, high-intensity interval training cycling feasible and safe for patients with knee osteoarthritis?: Study protocol for a randomized pilot study. Orthop J Sports Med, vol 5(3), 2017.
THANK YOU
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