To HITT or not to HITT?

Barts-MS rose-tinted-odometer: ★★★★★ (Saturday – a red-hot poker day #f54303)

There is little doubt that exercise is good for you and is a form of disease modification. However, there is a big debate about whether high-intensity interval (HIIT) or moderate continuous training (MCT) (aerobic) is best for you. This study below suggests HIIT is best. 

Positive changes in cardiorespiratory fitness were larger and the non-response less with HIIT compared to MCT. Younger age and lower starting or baseline fitness predicted a higher absolute improvement following the exercise intervention. 

The problem with HIIT and even MCT is that pwMS who are disabled may have difficulty exercising. Saying this, many of my patients who are even wheelchair-bound have found ways to work out using upper limb exercises. What is not addressed is how to get pwMS to start exercising; it is easy to prescribe exercise, but long term adherence with exercise and other lifestyle interventions is very poor. 

If you have been successful in maintaining an exercise program can you let your fellow pwMS know your secret? Thanks. 

Schlagheck et al.  VO2peak Response Heterogeneity in Persons with Multiple Sclerosis: To HIIT or Not to HIIT? Int J Sports Med . 2021 Jul 1. doi: 10.1055/a-1481-8639.

Exercise is described to provoke enhancements of cardiorespiratory fitness in persons with Multiple Sclerosis (pwMS). However, a high inter-individual variability in training responses has been observed. This analysis investigates response heterogeneity in cardiorespiratory fitness following high intensity interval (HIIT) and moderate continuous training (MCT) and analyzes potential predictors of cardiorespiratory training effects in pwMS. 131 pwMS performed HIIT or MCT 3-5x/ week on a cycle ergometer for three weeks. Individual responses were classified. Finally, a multiple linear regression was conducted to examine potential associations between changes of absolute peak oxygen consumption (absolute ∆V̇O2peak/kg), training modality and participant’s characteristics. Results show a time and interaction effect for ∆V̇O2peak/kg. Absolute changes of cardiorespiratory responses were larger and the non-response proportions smaller in HIIT vs. MCT. The model accounting for 8.6% of the variance of ∆V̇O2peak/kg suggests that HIIT, younger age and lower baseline fitness predict a higher absolute ∆V̇O2peak/kg following an exercise intervention. Thus, this work implements a novel approach that investigates potential determinants of cardiorespiratory response heterogeneity within a clinical setting and analyzes a remarkable bigger sample. Further predictors need to be identified to increase the knowledge about response heterogeneity, thereby supporting the development of individualized training recommendations for pwMS.

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General Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice.