obesity reviews
12583
Letter to the Editor
High‐intensity interval training vs. moderate interval
training: the lack of equalisation, an ongoing problem
Dear Editor:
Initially, we highlighted the systematic review and meta‐
analysis by Wewege et al., ‘The effects of high‐intensity
interval training vs. moderate‐intensity continuous training
on body composition in overweight and obese adults’,
which evaluated the effects of intervention programs
involving high‐intensity interval training (HIIT) and
moderate‐intensity continuous training (MICT) on body
weight and composition of overweight and obese adults
(1). Body weight and body composition of overweight and
obese adults are worldwide public health problems (2),
and the preventive and therapeutic roles of physical exercise
should be considered (3).
In this meta‐analysis, no significant differences were
observed between HIIT and MICT for the effects on body
mass and body fat. Body mass was not significantly reduced
in any of the interventions (HIIT: −0.17 [95% confidence
interval: −0.36 to 0.03 kg]; MICT: −0.18 [95% CI: −0.37
to 0.02 kg]). However, the effectiveness of the HIIT and
MICT training programs was evaluated using an intra‐group
analysis. Pre‐ and post‐intervention results were compared
without a control group (non‐exercise), which could
contribute to the reduction of the risk of bias, allowing for
a better understanding of the real effects of the trainings.
In only 7 out of the 13 studies included in the meta‐
analysis, some equalisation by workload or energy
expenditure was observed (1). This is extremely relevant in
the analysis of the results because the process of body mass
regulation is closely associated with energetic balance
(energy intake/energy expenditure) (4). This was
demonstrated in other studies, including Kong et al. (5),
where MICT was compared with HIIT. Kong et al. found
an energy expenditure approximately 102% higher for
MICT than HIIT (HIIT: 12,919 ± 2,159 kJ; MICT:
26,125 ± 2,986 kJ) as well as an approximately 124% higher
weekly training volume for MICT (HIIT: 66 ± 4 min; MICT:
148 ± 12 min). Sawyer et al. (6) verified that MICT sessions
resulted in approximately 33% higher energy expenditure
than HIIT sessions (HIIT: 753 kJ; MICT: 1,004 kJ), which
is a possible source of bias in the results.
Our concern is that the main argument in favour of HIIT
is the short duration of training sessions. The central idea of
the HIIT proposal is not ‘to train in less time’ but ‘to train
for a longer period at high‐intensity’. Some researchers have
© 2017 World Obesity Federation
doi: 10.1111/obr.
suggested that the energy expenditure in the ‘short training
session’ could not be high. For example, a session in a cycle
ergometer that consisted of a 5‐min warm‐up at 50–60% of
the HRmax + 10 × 1 min at 90–95% of the HRmax: 1 min at
approximately 25–50 W + a 5‐min cool‐down at 50–60%
of the HRmax resulted in an energy expenditure of only
753 kJ in obese men and women, which is equivalent to
an oxidation of approximately 23 g of fat (6).
We emphasise that we do not want to question the
benefits of HIIT, but we want to warn about serious
methodological failures that have been constantly repeated,
especially in studies that have analysed the effect of HIIT on
weight loss, which limit a correct comparison between HIIT
and MICT results in overweight and obese adults.
Therefore, future studies involving obese patients should
adopt iso‐caloric protocols to compare the different types
of training. Review studies need to consider sub‐analyses
that include only iso‐caloric protocols.
In their study, Wewege et al. (1) compared exercise modes
(treadmill running vs. cycle ergometer) and observed a large
effect on body fat (kg) and a small effect on body mass for
HIIT and MICT treadmill running protocols. However, no
significant effects were identified for HIIT or MICT cycle
ergometer protocols on these measures. Nevertheless, the
interpretation of these results has a high bias because the
protocols (treadmill vs. cycle ergometer) were not equalised.
For example (considering the information presented by
Wewege et al. (1) in Table 2), compared with the cycle
ergometer protocols, HIIT running in treadmill protocols
had 25.8% more follow‐up time (running: 11.7 weeks; cycle
ergometer: 9.3 weeks) and 55.6% more exercise time per
week (running: 117.9 min/week; cycle: 75.8 min/week),
with 107.2% more exercise time during the entire program
(running: 1,471 min; cycle ergometer: 710 min).
In the MICT group, compared with the cycle ergometers,
running on a treadmill had 25.8% more follow‐up time
(running: 11.7 weeks; cycle ergometer: 9.3 weeks) and
10.5% more exercise time per week (running: 166.8 min/
week; cycle: 151.0 min/week), with 53.3% more exercise
time during the entire program (running: 2,004 min; cycle
ergometer: 1,307 min). The superiority in the effectiveness
of the treadmill compared to the cycle ergometer, as found
by Wewege et al., can be easily associated with the longer
exercise exposure time in the treadmill protocols.
Obesity Reviews
2 The lack of equalization in the HIIT L. V. Andreato et al.
It is important to be cautious when analysing the results
of studies that focus on the effectiveness of HIIT or that
compare HIIT and MICT in overweight and obese
populations, especially because of the absence of a control
group and/or the lack of equalisation of caloric expenditure
in most studies.
Lastly, the possibility of bias, which was indicated earlier,
was not addressed by the authors in the text or in the
Strengths and Limitations section. However, we still
congratulate the authors for their work, which offers
important contributions to a better understanding of the
effects of HIIT in overweight and obese adults.
Conflict of interest statement
The authors declare no conflict of interest.
References
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. https://doi.
org/10.1111/obr.12532.
2. Ng M, Fleming T, Robinson M et al. Global, regional, and
national prevalence of overweight and obesity in children and
adults during 1980‐2013: a systematic analysis for the Global
Burden of Disease Study 2013. Lancet 2014; 384: 766–781.
3. Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW,
Smith BK. American College of Sports Medicine. American College
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4. Chin SH, Kahathuduwa CN, Binks M. Physical activity and
obesity: what we know and what we need to know. Obes Rev
2016; 17: 1226–1244.
5. Kong ZW, Fan XT, Sun SY, Song LL, Shi QD, Nie J.
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.
6. Sawyer BJ, Tucker WJ, Bhammar DM, Ryder JR, Sweazea KL,
Gaesser GA. Effects of high‐intensity interval training and
moderate‐intensity continuous training on endothelial function
and cardiometabolic risk markers in obese adults. J Appl Physiol
2016; 121: 279–288.
L.V. Andreato
Sciences Center of Health and Sport, State University of
Santa Catarina, Florianopolis, Brazil
Email: vidal.leo@hotmail.com
D.R. Coimbra
Sciences Center of Health and Sport, State University of
Santa Catarina, Florianopolis, Brazil
T. de Carvalho
Sciences Center of Health and Sport, State University of
Santa Catarina, Florianopolis, Brazil
© 2017 World Obesity Federation