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Citation: TOLFREY, K. and SMALLCOMBE, J., 2017. High-intensity inter-

val training. IN: Armstrong, N and van Mechelen, W. (eds.) Oxford Textbook

of Children's Sport and Exercise Medicine, 3rd ed., Oxford: OUP, pp. 477-491.

Additional Information:

• This is a draft of a chapter that has been accepted for publication by Ox-

ford University Press in the forthcoming book Paediatric Exercise Science

and Medicine edited by N. Armstrong and W. van Mechelen published in

2017.

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Chapter 34

High Intensity Interval Training

Keith Tolfrey and James Smallcombe

Author contact details:

Paediatric Exercise Physiology Research Group

School of Sport, Exercise and Health Sciences
Loughborough University
Loughborough
Leicestershire
LE11 3TU
UK
K.Tolfrey@lboro.ac.uk
+44(0)1509 226355
Introduction

High-intensity interval training (HIIT) describes exercise ‘characterised by brief, intermittent

bursts of vigorous activity, interspersed by periods of rest or low-intensity exercise’

(p.1047)1. The popularity of this type of training has increased recently as a time-efficient and

potent alternative to ‘traditional’ moderate-intensity continuous training (MCT). With a

global crisis in chronic, non-communicable diseases2 providing an alarming backdrop, much

of this attention has centred on the potential of HIIT to assist in the fight against lifestyle-

related disease (e.g., cardiovascular disease and type 2 diabetes mellitus).

The popular discourse surrounding HIIT has been fuelled by renewed academic interest in

this form of exercise3,4,5,6 and emerging evidence supporting the notion that HIIT may induce

physiological adaptations comparable to those from higher volume MCT5. Perhaps the most

alluring feature of HIIT is the priority afforded to intensity over duration, and thus, the

purported time-efficiency7. The remarkably low-volume of exercise performed typically

during HIIT is also likely to be appealing to a modern society, which frequently cites a ‘lack

of time’ as a major barrier to regular exercise participation8.

Although HIIT has only been aligned recently to public health promotion, the origins of this

training method may be traced back to, at least, the early twentieth century9. The history of

modern sport is littered with accounts of elite athletes and coaches using, and honing through

anecdotal inquiry, various forms of HIIT to optimise sport performance. High intensity

interval training is by no means a new phenomenon, but instead a training concept long-

appreciated by athletes. This training technique has, however, evolved recently, from

rudimentary origins, into a contemporary exercise tool utilised by sport- and health-

professionals alike. This chapter will examine the scientific evidence supporting the efficacy
of HIIT to confer benefit to both sports performance and health in children and adolescents

(young people).

The use of HIIT by young people is particularly relevant because: first, it seems that high-

intensity exercise may be completed by children without substantial fatigue compared with

adults10. Second, it has been suggested that HIIT may resemble the spontaneous, intermittent

nature of habitual physical activity in young people11. Third, it is possible that HIIT is less

susceptible to the monotony that young people often associate with MCT12 and is,

consequently, more conducive to longer-term exercise adherence. However, considering

most young people fail to meet international physical activity guidelines13, perhaps the most

compelling rationale for HIIT is that it could offer them a viable alternative to more

“traditional” forms of exercise and encourage greater engagement during these formative

years14. Of course, HIIT is not a panacea; indeed, numerous caveats come with HIIT training

in young people and will be addressed throughout the proceeding discussion.

When critically appraising any research findings, the contextual framework is very important.

Training is defined as methods used to enhance or develop skills and/or knowledge with the

intention of improving one or more predetermined outcomes. In this chapter, training refers

specifically to physical activity or exercise, which is completed repeatedly over time, to

enhance a physical, physiological or sports performance outcome that can be quantified using

recognised measurement techniques. Moreover, because training implies sustainable

improvements are sought, we will make every effort to differentiate chronic training

adaptations from acute exercise responses. We define “high intensity” as exercise that can be

sustained for up to 4 min (240-s) before a rest interval is required. It is also critical to

determine whether the emphasis on exercise training is for gains in sports performance or
physical health. The literature includes some outcome measures that relate explicitly to one of

these two paradigms and others apply to both (e.g., peak V̇O2; a measure of cardiorespiratory

fitness). We will review the literature from both perspectives and there may be some overlap.

Finally, there are many detailed reviews on the scientific basis and prescription of high

intensity training,9,15,16,17,18,19 which are based on a multitude of laboratory and field studies

with adults. Buchheit and Laursen9 indicated recently that further research is required with

“youth”; therefore, it is not our intention to indicate how HIIT should be prescribed for young

people, but to critically appraise the current scientific literature to evaluate the efficacy of this

form of exercise training with young people. Finally, whilst most researchers use traditional

null-hypothesis significance testing (NHST) methods to compare outcome measures over

time and between groups or training conditions, we have used their published means and

standard deviations to estimate pairwise effect sizes to determine whether the findings might

be meaningful from a sport performance or health perspective. Thus, the following

descriptors suggested by Cohen20 were used to describe the range of effect sizes: trivial <0.2,

small 0.2 to <0.5, moderate 0.5 to <0.8 and large ≥0.8.

High-intensity Interval Training and the Young Performance Athlete

Participation in organised youth sport is progressing constantly to new heights of

competitiveness and sophistication. Indeed, optimising the performance of young athletes has

emerged as a burgeoning area of interest for sport scientists and coaches alike. The provision

of highly-structured training now pervades the broad spectrum of youth sport. Although not

comparable in number to those conducted with adults, various studies have examined the

efficacy of HIIT to improve sport performance outcomes in young people. The following

section will highlight the key findings, with specific focus on the physiological parameters

associated with sporting success. At this point, it is important that the reader recognises some
of the difficulties faced when attempting to evaluate the effect of a training intervention on

sporting performance per se. The complex nature of sports performance - dependent on a

number of intricately linked physiological, biomechanical, psychological, technical and

tactical factors - renders the laboratory-based assessment of sporting capability inherently

difficult. Consequently, many researchers rely on the assessment of the components of fitness

(e.g., speed, aerobic endurance and strength) associated with successful sport performance.

Whilst tightly-controlled laboratory measures can provide reliable, valid and comparable

data, it is much more challenging to interpret these data and establish whether training-

induced changes in such parameters translate to meaningful improvements in sport

performance under free-living, competitive conditions. There has, however, been some

endeavour to bridge this gap in knowledge and an emerging body of research provides

valuable insight into the role that HIIT might play in enhancing athletic performance.

An array of studies have examined the effect of HIIT on a wide range of performance

outcomes in male and female athletes aged 8 to 18 years (Table 34.1). The characteristics of

the training protocols varied considerably with the interventions spanning 11 days to 10

weeks and 2 or 3 training sessions per week. The repetitions ranged from 3 to 40 and lasted

between 10-s and 4 min (240-s). In most studies, exercise intensity was fixed at 90 to 95%

predicted HRmax. Alternatively, high-intensity exercise was defined as all-out (maximum)

intensities; >95% maximal aerobic speed (MAS); and/or >90% of personal best time.

Cardiorespiratory fitness

Cardiorespiratory fitness (CRF) is recognised as an important determinant of athletic

performance in sports requiring a high aerobic energy provision. Hence, its response to HIIT

in the context of sports performance will be examined here; whereas a latter sub-section will
approach it from a health perspective. Peak oxygen consumption (V̇O2), measured during

exhaustive exercise, is the criterion measure of CRF. Although a high level of CRF alone

does not guarantee sporting success, it is often exhibited by elite athletes. It has been reported

consistently that the performance of 14 to 30 HIIT sessions, over a period ranging from 11

days to 10 weeks, leads to significant increases in CRF in both trained and untrained young

people (Table 34.1). These studies have demonstrated that HIIT is efficacious in increasing

peak V̇O2 by 6 to 12%, typically. A number of studies have employed laboratory-based

measures of gas exchange (e.g., indirect calorimetry) to quantify HIIT-induced changes in

peak V̇O2, whilst others have used field-based fitness tests to estimate it; the former will be

prioritised for discussion in this section.

Baseline CRF is an important factor when assessing training-induced changes. As young

athletes regularly engage in structured aerobic exercise training programmes, they will have

an enhanced capacity for oxidative metabolism at baseline, compared with their untrained

counterparts. Hence, gains may be more difficult through increased sub-maximal training

load alone21,22,23. Consequently, it has been suggested that HIIT may be a particularly useful

training tool to use with youth athletes. Impressive baseline fitness ≥63 mL∙kg-1∙min-1 was

seen in two studies24,25, though the former was scaled using lean body mass. The 8.3%

increase found by Chamari et al.24 was in 14 y old male footballers who completed 8 weeks

of HIIT, comprised of 4 min (240-s) intervals at 90 to 95% individual HRmax. Similarly, it

was reported that an 8-week HIIT programme resulted in a 10.1% increase in peak V̇O2 in

late adolescent male footballers25. Collectively, these studies support the efficacy of HIIT in

already well-trained youth athletes, but the omission of a control group in both studies

precludes direct causality. Furthermore, as HIIT was performed alongside their regular

technical and tactical sessions, it is not possible to attribute the change in CRF to HIIT
exclusively.

<< INSERT TABLE 34.1 HERE >>

Athletes and coaches may question how HIIT-induced changes in CRF compare to those

conferred by high-volume, MCT; some studies have compared the different regimes directly

(Table 34.1). In a randomised, crossover study conducted in 9 to 11 year old competitive

swimmers, Sperlich and colleagues31 compared changes in peak V̇O2 after 5 weeks of HIIT

and, what was called, high-volume training (HVT). The within measures research design

eliminates between group variance common to all mixed design studies and the 8.5 week

wash-out period should have countered a possible period effect. Significant, moderate and

small (d=0.57 & 0.46) increases were observed after HIIT (10.2%) and HVT (8.5%),

respectively. It was concluded that desirable, short-term changes in CRF could be achieved

through HIIT despite a comparatively reduced training time (2 hours less each week) and

volume (5.5 vs. 11.9 km∙week-1). Importantly, the authors recognised the limitation of a cycle

ergometer-based test in swimmers. Indeed, this was reflected in the modest baseline peak

V̇O2 values (~40 mL∙kg-1∙min-1), which were considerably lower than might be expected in

children accustomed to training at least four times a week. However, the difficulties

associated with the in-pool measurement of gaseous exchange with young children were

highlighted and provided justification for the surrogate use of cycle-ergometry.

In a later study, conducted with 14 year old footballers using a between-measures

experimental design, it was reported that peak V̇O2 increased significantly by ~7% following

5 weeks of HIIT yet was unchanged (non-significant, ~2% increase) following 5 weeks of

high-volume training32. Although the boys continued to participate in regular football-

specific training during the intervention period, this additional training load was similar in

both groups. Other studies suggest that similar changes in CRF are induced by both HIIT and

continuous cycle ergometer training in untrained prepubertal girls and boys34,35. Interestingly,

in the latter of these studies, the interval training group exhibited pre- to post-increases in a

number of physiological parameters, including ventilatory threshold, that were not observed

in the continuous training group35. This limited body of research, provides preliminary

evidence that HIIT appears to be at least as efficacious as MCT at enhancing CRF in young

athletes.

The timeframe over which CRF may be enhanced through HIIT represents an interesting

point for discussion. Whilst the majority of studies with young athletes (Table 34.1) have

examined the effect of 4 to 10 weeks of HIIT on peak V̇O2, mixed findings emerged from

two studies that assessed the efficacy of a shorter “shock microcycle”28,40. It was

demonstrated, in a well-controlled study conducted in the off-season preparatory period, that

15 HIIT sessions performed over 11 days resulted in a 6% increase in peak V̇O2 in late

adolescent alpine skiers28. In contrast, a control group exhibited no change in

cardiorespiratory fitness following maintenance of their habitual training patterns. The

magnitude of change was relatively modest in comparison to those reported following HIIT

regimes spanning a longer period of time with young athletes (Table 34.1). The authors

suggested that the high frequency of HIIT may have compromised the efficiency of the

training with regard to the maximal capacity for improvement in aerobic capacity. However,

it is reasonable to conclude that a moderate 6% (d=0.58) increase in peak V̇O2 represents a

generous return from 11 days of training for skiers with good baseline fitness (53 mL⋅kg-
1
⋅min-1).
In contrast to these findings, Wahl and colleagues40 reported no meaningful change (d=0.02)

in peak V̇O2 in 16 young triathletes following a similar microcycle of HIIT consisting of 15

sessions performed over 14 days. The authors speculated that a slight decrease in post-HIIT

[haemoglobin], possibly the result of a loss of red blood cells due to the high impact of the

HIIT regime, might explain the failure of the training microcycle to induce meaningful

improvements. It is possible that these losses could not be fully compensated in the 7 day

recovery period post-intervention. A particularly pertinent finding of this latter study was that

significant decreases were observed in some dimensions of the Persons Perceived Physical

State Scale (PEPS), including perceived physical energy, perceived physical flexibility and

readiness to train, highlighting the exhausting nature of this training intervention. This, of

course, raises important questions surrounding the extent to which this form of high-

frequency HIIT may be tolerated as well as the possibility that such training, if not carefully

managed, might lead to the manifestation of overtraining symptoms and the impairment of

performance often associated with this condition. Future research is undoubtedly warranted to

further elucidate the optimal combination of HIIT frequency, intensity and recovery time for

use with young athletes.

Similar increases in aerobic performance – estimated using field-based fitness tests – have

also been reported27,29,31,32,36. Typically, such studies have employed incremental fitness tests,

the assessment of intermittent exercise performance (e.g., shuttle run test, intermittent fitness

test), and/or physiological parameters such as individual anaerobic threshold as surrogate

measures of aerobic capacity. Of course, field-based estimates of endurance performance do

not provide the quality of data associated with the sophisticated laboratory assessment of gas

exchange. However, such field-based tests represent a convenient and inexpensive method of

estimating endurance performance and represent a valuable tool to track changes over a
period of training, especially with large groups of athletes. Ultimately, the emerging findings

from these studies provide further, albeit weaker, evidence supporting the efficacy of HIIT to

induce desirable improvements in endurance performance, which is likely to be underpinned

by cardiorespiratory fitness in young people.

Explosive strength

The effect of HIIT on explosive strength (power), the ability to exert maximal muscular

contraction in the shortest possible time, has been examined in several studies (Table 34.1)

using a battery of jump tests. Typically, a selection of the following jump tests have been

used to assess training-induced changes in the explosive strength of the lower limbs: counter

movement jump (CMJ); drop jump (DJ); standing broad (long) jump (SBJ); squat jump (SJ)

and vertical jump (VJ). Explosive strength is a component of physical fitness that may be

particularly important to sports in which sprinting and/or jumping (vertical and/or horizontal)

are integral to successful performance, with the obvious examples being the 100 m sprint and

long jump. There are, however, many other sports in which explosive strength represents an

essential, yet more subtle, determinant of sports performance and/or skill execution. Of

course, sports performance outcomes are normally very complex and it is likely that the

changes in the ability to produce explosive strength, as measured by the performance of

simple jump tasks in isolation to other sport-related skills, represents an ill-defined fraction of

these outcomes. Nonetheless, jumping ability remains a useful performance assessment tool

and a number of noteworthy findings have emerged from HIIT studies in which explosive

strength has been assessed by this method.

Changes in power are more heterogeneous than CRF following HIIT; untrained, prepubertal

children, completing 7 weeks of high-intensity interval running (10 or 20s at 100 to 130%
MAS) experienced a significant, but moderate increase (d=0.62; 9.6%) in SBJ distance27. The

authors concluded that HIIT performed at velocities greater than MAS enhanced lower limb

explosive strength and speculated that this likely resulted from a combination of both

neurological adaptations and/or alterations in muscle fibre type characteristics; although, it

was suggested that the former was likely to be the primary mechanism of the observed

improvement. It should be reiterated that this study was conducted in untrained boys and

girls, which could magnify the increase. This is supported by trained, late adolescent

professional footballers who experienced only small gains in CMJ (d=0.35; 2.7%) and SJ

(d=0.42; 6.9%) performance after 10 weeks of HIIT involving football-specific interval

running at a fixed intensity of 90 to 95% of HRmax25. As expected, these “statistically

significant”, but small effects, in jump performance did not translate into a concomitant

improvement in 10 m sprint time, which illustrates that jump-specific measures of explosive

strength may not always translate to a holistic enhancement of power-related performance.

A number of studies have reported no meaningful improvement in explosive jump

performance following HIIT. Buchheit and colleagues29 demonstrated that 10 weeks of HIIT

resulted in trivial changes in CMJ (d=0.13) and 10 m sprint time (d=0.13) in well-trained

male and female handball players. Similarly, trivial and small increases in SBJ were

exhibited amongst youth football players following a 7 week HIIT programme consisting of

either all-out short-sprint repetitions (50 m; d=0.19) or long-sprint repetitions (200 m;

d=0.32) performed at 85% of maximal 100 m time36. These findings were contrary to the

authors’ hypothesis that the short-sprint programme would yield improvements in jump

ability and led to the conclusion that the technical aspects of jump performance may need to

be practised during HIIT if meaningful improvements in performance are to be conferred.

Finally, in a well-designed, but somewhat underpowered study, 5 weeks of HIIT resulted in

only small increases in CMJ or SJ performance in adolescent football players39. Although

these studies reported no meaningful improvement in jump performance following HIIT, it is

equally noteworthy that the weekly performance of two to three sessions of high intensity

exercise over a period of 5 to 10 weeks resulted in no impairment of power-related

performance. This is particularly encouraging given concern about potential incompatibility

of endurance training and maintenance of power-related performance. The evidence that has

emerged from studies conducted with young people may reassure athletes and coaches that

HIIT, if designed and supervised appropriately, can be utilised to enhance important

components of fitness (e.g., cardiorespiratory fitness) without compromising explosive

strength and power-related performance.

The importance of design and management of HIIT is, however, highlighted further by the

findings of Breil et al.28; following an 11-day shock micro-cycle of HIIT consisting of 15

sessions, participants experienced a moderate reduction (d=-0.54; 4.8%) in CMJ

performance. This performance decrement was observed despite an improvement in

cardiorespiratory fitness. The authors speculated that the high-frequency training microcycle

could have contributed to persistent muscle fatigue and subsequent impairment of

performance. The authors28 concluded that participants may have needed more than 7 days

post-HIIT recovery to fully restore explosive strength capacity.

Overall, the weight of the available evidence suggests that HIIT, if carefully managed, is

unlikely to result in an impairment of explosive strength and, in some cases, might lead to

performance enhancement. It is, however, important for young athletes and their coaches to

consider the frequency of HIIT sessions carefully as well as the recovery time provided

between exercise bouts. Furthermore, particular attention should be paid to the recovery
period following the completion of an intensive block of HIIT, especially in the lead-up to

competition.

Sport-specific performance outcomes

A small number of studies have attempted to assess the effect of HIIT on competitive

sporting performance and/or sport-specific capacities directly. Impellizzeri et al.33 used a

matched, randomised, parallel-group experimental model with young footballers. Employing

increases in total running distance, number of sprints performed, and time spent performing

at higher exercise intensities, they concluded that competitive match performance had

improved after HIIT. These improvements in sport-specific parameters were accompanied by

an increase in peak V̇O2. Another interesting finding from this study was the observed

improvement in performance during the football-specific Ekblom aerobic endurance field

test, which comprises several activities typical of football, including: changes in direction,

jumps, and backwards running41. Similar changes in football performance and

cardiorespiratory fitness were also observed, in a parallel experimental group, following

small-sided game-based training33. The authors of this study concluded that HIIT and small-

sided game training were equally effective modes of aerobic training for use with youth

football players. Another important consideration is that the training interventions were

completed in addition to the players’ regular football training (technical and tactical

sessions). Although the authors reported that this additional football-specific training was

performed at low intensities, it is possible that it provided an additional training stimulus. It

is, therefore, impossible to isolate the effect of HIIT and establish a causal and independent

relationship between the training interventions and the changes in sport-specific outcome

measures.
Faude and colleagues32 found that 4 weeks of HIIT resulted in no improvement in 100 or 400

m swim times in competitive adolescent swimmers; however, they did report that 7 out of 9

swimmers swam personal best times (PBs) in the 3 months after the HIIT training cycle.

Whether these PBs can be attributed to HIIT directly is questionable. In another swimming

study by Sperlich et al.38, described previously, competitive performance was assessed before

and after 5 weeks of HIIT and high volume training (HVT). Significant changes in 2000 m

swim time and scoring on the LEN (“Ligue Européenne de Natation”, the European

Governing Body) international pointing system for competition performance were reported

only after HIIT (not HVT); however, the magnitude of these effects were small (d≤0.48).

Moreover, the group reduction in 100 m swim times was trivial (d≤0.18). Based on these

differences between HIIT and HVT, Sperlich et al.38 concluded that high training volumes

provided no advantage compared to lower volumes of HIIT. They went on to suggest that the

use of HIIT may enable a greater proportion of training time to be spent on technical

development, whilst conferring similar benefit to physiological parameters.

The efficacy of a two week shock microcycle of HIIT to enhance cycling performance in

young triathletes has been assessed using average power output (PO in watts) during a 20 min

time trial (TT) performance test40, which is deemed a valid and reliable simulation of a race

event in adults42. Wahl et al.40 also compared passive and active recovery by dividing the 16

girls and boys equally into two separate training groups. Time trial average PO increased

significantly from 2.9 to 3.3 W⋅kg-1 in the passive group (d=0.66; 12%); whereas the change

in the active recovery group was only small (d=0.24; ~3%) and within the reported

coefficient of variation for this performance measure. The increase in 20 min TT performance

was despite non-significant, trivial (d≤0.19) changes in peak V̇O2 in both groups;

interestingly, the total cycling distance achieved during the TT was not reported. This
finding led the authors to recommend that when working with athletes, the measurement of

performance should represent the main criterion for the efficacy of a training programme as

physiological parameters may not be sensitive to change.

<< INSERT TABLE 34.2 HERE >>

High Intensity Interval Training for Health

Cardiorespiratory fitness

In line with the general paediatric exercise science and medicine literature, CRF is one of the

most commonly measured outcome variable in studies that have that examined the efficacy of

HIIT in young people (Tables 34.1 and 34.2). Although it is normally defined as peak V̇O2 ,

some studies have included endurance performance measures (e.g., 20-m multistage fitness

test; MSFT14,27,55), maximal endurance speed56, running economy26 or gas exchange

threshold44. Whilst it can be argued that most young people rarely exercise at intensities that

would elicit peak V̇O2, it has a strong empirical relationship with cardiometabolic health;

therefore, the results from health-focused HIIT studies including MSFT will be included.

We are aware that numerous early studies employed interval training techniques, common to

endurance athletes, with healthy young people; however, they were not designed specifically

to examine the efficacy of HIIT. Consequently, their study design features often do not allow

us to isolate the independent effect of the high intensity elements of the research.

Nevertheless, much can be learnt from these pioneers. For example, Rotstein et al.37 reported

a large (d=1.41; 8%) increase in peak V̇O2 in 16, 10 to 11 year old boys who completed a

series of 150 to 600 m runs, 3 times⋅week-1 over nine weeks, compared with an age and

activity matched non-training control group (Table 34.2). The precise exercise intensity was
not provided, but described as being suitable to each participant’s condition at baseline and it

is not clear how long it took the boys to complete the various intervals. Moreover, each

training session lasted 45 min with a 15 to 20 min warm-up; so, it does not fit the time

efficient model HIIT is characterised as regularly. Despite all of these limitations, in the

context of this chapter, this study was published when there was considerable doubt whether

it was possible for children (i.e., preadolescents) to increase their CRF via exercise training57

and the mean baseline peak V̇O2 was an impressive 54 mL⋅kg-1⋅min-1. Before attempting to

tease-out potential moderators of HIIT effects on CRF, the focus will now turn to a study44

that adopted a very similar research design as Burgomaster et al.,4 which stimulated the

recent renewed interest in HIIT. In Barker et al’s study44, ten adolescent boys were exposed

to only six maximal intensity, cycling training sessions spanning 14 days (Table 34.2). The

training progressed from 4 × 30-s “all-out” sprints on the bike (i.e., Wingate anaerobic tests)

with 4 min active recovery in session one to 7 × 30-s sprints in the final session. The change

in peak V̇O2 was small (d=0.30; 5%) whether expressed relative to body mass or not.

Interestingly, the mean change of 2.7 mL⋅kg-1⋅min-1 is almost identical to that found in a

recent meta-analysis of eight studies with adolescents58 who completed between 13 and 36

HIIT sessions over 5 to 15 weeks. The authors44 justified the exclusion of a control group by

suggesting that growth or maturation changes would be minimal over just two weeks. They

indicated any changes could be ascribed to HIIT because the participants agreed to suspend

their habitual organised sports activities for the duration of the study; a similar argument has

been posited by the same group below in a different study measuring endothelial and

autonomic function45.

Numerous potential moderators may influence the size of the HIIT-induced effect, the most

obvious being the training programme components and participant characteristics or

behaviours. Costigan et al.58 included 20 HIIT studies with adolescents in a meta-analytic

review recently, from eight of these it was found that study duration, type of comparison

group and risk of bias were not significant moderators. After we reviewed studies with

participants ranging from healthy weight to obese, it would appear that obese participants are

more likely to experience large gains in CRF following HIIT46,47,48,51,53. It was apparent that

the obese participants in these studies were exposed to a greater dose (volume) of the high

intensity exercise stimulus – this was usually because the training programme extended over

a longer period (minimum 12 weeks46,47,48,51,53 vs. 2 to 9 weeks34,35,37,44,50,55) than in healthy

weight young people coupled with a lower baseline level of fitness, which is more susceptible

to change and has been highlighted previously59. Whilst changes in healthy weight

prepubescent girls34 and late-adolescent boys and girls55 range from large to trivial

respectively, closer scrutiny of both studies reveals that McManus et al.34 only reported

changes in absolute peak V̇O2, which may not account completely for subtle changes in body

size over the eight week training period. Buchan and colleagues55 measured endurance

performance via the MSFT rather than oxygen consumption; however, other publications by

this same group, using the same training intervention, but with a heterogeneous mixed-sex

sample that included healthy and overweight participants, found that changes in MSFT

performance were small14. It should be noted that most effect sizes reported by Buchan et

al.14 appeared to be inflated compared with pairwise values derived from the means and

standard deviations provided in their results (i.e., mean difference⋅SD-1(pooled)) – it is not clear

how they calculated their effect sizes specifically.

A key question when examining so-called “traditional” MCT has been whether biological

maturation is an important moderator. Katch57 hypothesised that training-induced changes in

cardiovascular function could only be small before the onset of puberty because of a
maturational “trigger point”, which had been proposed initially by Gilliam and Freedson60

after scrutinising the findings of their small mixed-sex, school-based training study.

However, Shephard61 cited early study design limitations, including inadequate sample sizes,

missing control groups, poor training programme characteristics relative to baseline levels of

fitness and inadequate exposure to the training stimulus, when dismissing differences in the

training response between children and adolescents. Whilst there is now considerable

evidence from MCT studies that a blunted adaptation is common in children, scrutiny of the

small number of HIIT studies that have measured peak V̇O2 appear to be equivocal. There is

considerable heterogeneity from the nine available studies with prepubertal

children26,27,34,37,43,46,50,52,54. After randomly assigning 45 prepubertal boys equally to sprint

interval training (SIT), continuous cycling training (CCT) and habitual control (CON)

groups, Williams et al.54 found that peak V̇O2 did not change meaningfully in SIT (n=12; d=-

0.11), whereas CCT experienced a small increase (n=13; d=0.35); as expected CON was

virtually unchanged (n=14; d=0.04). It is possible that the relatively high baseline fitness

(~55 mL⋅kg-1⋅min-1) of the boys contributed to this outcome; however, a direct comparison

with the Rotstein study37, where prepubertal, healthy weight boys also had a high baseline,

but increased their peak V̇O2 substantially, does not support this. The contrasting large

(d=1.00; ~15%) increase in peak V̇O2 reported in a well-controlled study of Brazilian

children by Corte de Araujo et al.46 was most likely because the children were obese with

very low baseline fitness (~26 mL⋅kg-1⋅min-1). Furthermore, the substantial inter-study

difference in total HIIT times (108 min46 vs. 72 min54) will have been a critical factor – the

obese boys and girls also “recovered” at 50% of their peak aerobic velocity between the high

intensity running bouts whereas the boys in the Williams54 study rested passively. When

considering inter-study differences, the contribution of a warm-up, exercise recovery periods

between repetitions, and an active cool-down should not be underestimated when they are
incorporated into every training session.

The influence of participant sex on the training effect could be an important factor; however,

it is very difficult to identify an independent sex effect that is not due to baseline differences

in peak V̇O2 or maturation. The majority of HIIT studies we reviewed recruited mixed-sex

samples (Tables 34.1 and 34.2) and often pooled the participants after failing to find a

statistically significant sex by time interaction, which should not be interpreted as meaning

the study was powered adequately from the outset. In the study with the largest sample55,

there was an imbalance between the number of girls (n=12) and boys (n=30) who completed

the HIIT; this is not meant as a criticism, we know from first-hand experience that girls are

more difficult to recruit than boys. The statistical analyses included power calculation details,

but fell short of partitioning the sample into sub-groups to account for the independent sex

effect. Only two studies were identified that included girls exclusively34,51 with both reporting

large increases in peak V̇O2. Racil51 studied obese, post-adolescent girls with a total HIIT

time of 264 min, whereas McManus34 recruited healthy weight, prepubertal girls who

accumulated 72 min of HIIT over eight weeks; direct comparisons are obviously difficult.

Hence, more research with girls is needed and their data should be analysed separately from

boys in studies designed specifically to address this intriguing question.

Total HIIT time calculated from the training characteristics included in Table 34.2 is a

possible moderator. This should not be confused with volume, a composite of time and

intensity, which was too complicated to estimate because of the intra- and inter-study

variation in intensity. The HIIT time varied from 16.5 min44 to 416 min47 – these equated to

2.75 and 16 min of exercise per training session respectively. Despite the dichotomous

training times, the effect sizes were small44 and small to moderate47 depending on the factor
used to scale the peak V̇O2 data. This comparison is included specifically to highlight that

there are a multitude of factors that determine to what extent young participants adapt when

exposed to chronic exercise stimuli; the amount of training is just one them. About half of

the studies that measured peak V̇O2 before and after HIIT reported a large

effect34,35,37,46,48,50,51,53, with the remaining being small to trivial (Table 34.2). A very recent

study49 was designed, using novel analytical techniques, to examine whether HIIT training

effects are dose-dependent; the final sample was 26, 16 year old boys assigned randomly to

one of five training groups (n ≅ 5 per group). Each group completed 4 × 20-s near maximal

effort bursts across a variety of exercise modes with the dose being titrated from 1 to 5 sets

per session (i.e., 80 to 400-s HIIT per session), twice a week for eight weeks. Whilst the

exercise fidelity was good, the quadratic trend used to identify the dose-adaptation explained

less than 2% of the variance in the data. The authors highlighted the wide variation in

individual responses across all five groups despite group one doing only a fifth of the

exercise volume compared with those in group five. This likely reflected large differences in

baseline fitness ranging from 34 to 41 mL⋅kg-1⋅min-1. Finally, many studies rationalise HIIT

training by claiming it may be more efficacious than MCT for increasing health via

improvement in peak V̇O2; however, few include an MCT comparison group to examine this

directly34,35,37,46,48,50,51,53. Notwithstanding difficulties in matching participant characteristics

in independent groups, three studies37,50,53 found HIIT (10.0%) was more efficacious than

MCT (2.8%) and four34,35,46,48 had similar effects HIIT (9.8%) ≅ MCT (9.5%); all of these

studies were better than a habitual control group. Although Williams et al.54 concluded that

neither HIIT nor MCT changed peak V̇O2, the small MCT-induced increase (d=0.35; 5.1%)

was marginally better than HIIT (d=-0.11; -1.6%).

<< INSERT TABLE 34.3 HERE >>

Body size and composition

Obesity is at the forefront of public consciousness because it is more overt than many other

health problems and it has numerous disease co-morbidities63. It is, therefore, not surprising

that measurement of various body size variables are as common in HIIT studies as

cardiorespiratory fitness; in fact, researchers have questioned whether fitness or fatness may

be more important from a public health perspective64. Most readers will be aware that

changes in body size or composition, particularly adipose tissue, require longer-term

exposure to an exercise-induced energy deficit; however, it is a critical adjunct to dietary

intervention and lasting weight or fat loss. Most HIIT interventions in young people are

between 2 and 13 weeks long, which is relatively short when considering meaningful changes

in body composition; hence, of the 17 studies shown in Table 34.3, 13 found only trivial or

small changes. Although some studies reported that the changes in body size were

statistically significant49,46, the effect sizes suggest these are unlikely to meaningful; however,

it is possible that prolonged adherence to HIIT may result in changes that have long-term

health implications if sustained. On-going growth and maturation can confound exercise

interventions unless controlled adequately with well-matched comparison groups; although

the HIIT group may not reduce body size or composition, it is possible that the exercise could

delay changes relative to habitual controls55, but this has yet to be shown consistently and

with adequate dietary control.

Of the studies that reported a moderate or large change in body size measures37,47,51,53,62, two

used skinfolds37,62 with healthy and overweight prepubertal participants, respectively. Neither

controlled for habitual dietary or physical activity variations over the intervention period, but

the relative changes (~12%) were very similar and, seemingly, impressive following only

nine and six weeks of HIIT. Using bioelectrical impedance analysis (BIA), 11 mixed-
maturation, obese, 15 year old girls reduced their body fat from 37% to 34% (~8%) over 12

weeks51. The total HIIT time (264 min) is one of the highest reported in this rare girls only

study; differences in maturation between the girls were accounted for statistically, and,

although diet was measured at baseline, it was not clear if it or habitual physical activity

changed over the 12 weeks. Racil et al.51 concluded that HIIT may be a better approach to

improving health in “young women” than moderate intensity training, but added that their

study was an important first step. The two studies from Wisløff’s team, in Norway47,53, with

obese adolescents are included here because of the large total HIIT time (~416 min) and the

studies are well-designed and controlled. They are, however, considered to be proof of

concept studies with small mixed-sex samples, which precludes widespread application of the

results. The same HIIT protocol, consisting of 4 × 4 min bouts of uphill walking or running at

90 to 95% HRmax per session, was completed twice a week for three months. In the Tjønna

study53, 13 of the 20 HIIT participants who completed the three month HIIT also trained at

home or in a gym for a further nine months (not included in HIIT time calculations shown in

Table 34.3) twice a week. Dual-energy x-ray absorptiometry (DXA) derived measures

showed that changes in body fat were small in both studies regardless of training programme

length (d≤-0.43; ~5%). However, a moderate effect (d=-0.67; ~7%) for waist circumference

was evident after 12 months53. It is important to note that eight and a further seven

participants were lost to follow-up after the 3 month and 12 month training periods,

respectively; though, it was suggested the data did not differ from those who completed all

measurements. Ingul et al.47 have suggested that the objective of exercise interventions for

obese adolescents should be weight stagnation rather than reduction with subtle

improvements in lean and adipose tissue; when allied with improved CRF, see above, it

should be possible to “decrease the risk of developing obesity-related comorbid conditions

despite minimal weight loss” (p.858).

Biochemical metabolites

We identified eight HIIT studies that included blood samples (Table 34.3); due to the wide

array of metabolites measured in these studies, we will attempt to identify study or participant

characteristics that may have exerted a meaningful influence on the results. Racil et al’s51

study with obese adolescents girls stands out for its numerous adaptations indicative of

improved physical health (see Tables 34.2 and 34.3). Large (d≥0.80), significant reductions

in fasting concentrations of insulin (d=-2.78; 27%), triacylglycerol (TAG) (d=-0.83; 7%),

low-density lipoprotein cholesterol (LDL-C) (d=-1.29; 12%), total cholesterol (TC) (d=-1.17;

7%) and homeostatic model assessment for insulin resistance (HOMA-IR) (d=-2.28; 30%)

were found; whereas, high density lipoprotein cholesterol (HDL-C) increased (d=1.20; 6%)

over the 12 weeks. In contrast, a small reduction in fasting glucose concentration was

reported (d=-0.23), which is a common finding in the other HIIT studies reviewed14,45,49,55.

The only exception was Tjønna et al.53 who reported meaningful reductions in obese

adolescents after 3 and 12 months of training; this study measured both fasting glucose and

after an oral glucose load test (d=-0.58 to -0.94). Meaningful reductions in fasting insulin46,53

and HOMA-IR46 were also reported in other studies with obese participants who completed

HIIT programmes with total exercise times ranging from 108 to 416 min. This improvement

in glucose control and insulin sensitivity is less likely to be experienced by participants who

are relatively healthy at the start of short interventions14,45,55.

Changes in the lipid profile varied considerably across the studies, which will be a function of

the large day-to-day variability65 (particularly for TAG), baseline concentrations and total

training time, but the small group of HIIT studies provide little empirical direction on

moderators. Half (four) of the HIIT studies that estimated changes in LDL-C reported

significant reductions, with effects ranging from small49 to large51,52. Only the obese boys
who completed the running programme by Koubaa et al.48 had a moderate (d=0.78; 4%)

increase in HDL-C, which was similar in relative terms to Racil’s51 girls above. However, a

lack of dietary control means it is not possible to be certain changes were exercise-induced in

this Tunisian study48. Measurement of high sensitivity C-reactive protein (hs-CRP),

adiponectin and interleukin 6 (IL-6) are still rare in HIIT studies with young people14,49,51,53,55

and the results are inconsistent. For example, effect sizes for adiponectin range from -1.41

(51% reduction)14 to 2.43 (34% increase)51; although an increase in this adipose tissue

derived adipokine has been found in obese adults undergoing chronic exercise training, it has

not been shown consistently66. Only Logan49 reported a significant increase in IL-6 across

their five small training groups, ranging from 5 to 62%, but the omnibus effect size (d=0.45)

probably underestimated within group pairwise effects. Two separate studies by Buchan et

al.14,55 reported small reductions (d≤-0.35) in IL-6 after 54 min of HIIT spanning seven

weeks. Finally, only two studies45,49 stated explicitly that their post-intervention measures

were completed at least 48 hours after the final training session to ensure the results reflected

a chronic training adaptation rather an acute, last exercise bout response. It is unfortunate that

this important design feature is rarely built into the studies, which means it is difficult to

differentiate acute responses from chronic adaptations.

Vascular health

In this final health-related sub-section, HIIT-induced adaptations in blood pressure and

endothelial function (flow mediated dilation; FMD) will be examined. Although blood

pressure is often measured in exercise studies with young people, endothelial function is still

considered a “novel” cardiovascular disease (CVD) risk factor that may precede changes in

more “traditional” risk factors in the atherosclerotic pathway67. Significant decreases in

systolic blood pressure (SBP) are reported in the majority of HIIT studies (Table 34.3); the
magnitude of effects are small55, moderate14,47,53 and large46,48 (d=-0.36 to -1.00; 2 to 8%).

Higher baseline SBP (≥125 mm Hg) in obese young people who experienced the greatest

total HIIT times (>100 min), or longest training programmes (>12 weeks), appear to be

requisite characteristics for meaningful reductions in SBP. Although fewer studies found

significant or meaningful reductions in diastolic blood pressure (DBP), they were those that

managed to supervise their young obese or overweight charges through HIIT programmes

lasting at least 12 weeks47,48,53 (Table 34.3).

Tjønna et al.53, see above for HIIT details, used high-resolution vascular ultrasound to

measure FMD with random, investigator blinded analyses in their study of obese boys and

girls. They reported improvements of 5.1% and 6.3% above baseline after three and 12

months of training respectively; this compared well with the multidisciplinary training group

(3.9% and return to baseline) who experienced standard clinical practice over the same

period. The authors linked concomitant changes in HDL-C, blood glucose and insulin with

enhanced bioavailability of nitrous oxide (NO), the primary regulator of endothelial function,

and large increases in the anti-inflammatory hormone adiponectin (see above). Importantly,

they hypothesised that exercise training improves endothelial function regardless of changes

in body size providing CRF improved – this may be a very important strategy to consider

when helping overweight or obese young people to choose to exercise regularly. Also from

Norway, Ingul et al.47 designed a HIIT study to see if it “corrected” impaired measures of

resting and exercise cardiac function in obese adolescents when compared with a lean group

of age and sex matched 13 to 16 year olds. Interested readers are encouraged to refer to the

publication directly to access the methods, which are too detailed to include here; the Dubois

body surface area (m2) formula68 was used to scale cardiac dimensions for between group

differences in body size. The 32 min of HIIT per week over 3 months increased most
measures of systolic function and left ventricular (LV) volumes that were impaired originally

so that pre-training obese vs. lean group differences were eradicated; these included large

effects for stroke volume index (d=1.13), global strain rate (d=1.94), fractional shortening

(d=1.22) and peak systolic tissue velocity (S`; d=1.00). In contrast, LV end-systolic volume

and cardiac output were virtually unchanged. Similarly, significant HIIT-induced

normalisation of diastolic function in the obese group was seen, with large effects for

deceleration time (DT; d=-1.33) and isovolumetric relaxation time (IVRT; d=-0.81). Echo

with tissue doppler and doppler flow velocities revealed pre-intervention impaired mitral

annulus excursion (MAE; 24%), flow velocity time integral of the LV outflow tract (16%),

global strain rate (32%), global strain (22%) and peak early tissue doppler velocity (18%) in

the obese versus lean at both rest and exercise. However, most of these impairments were

resolved following HIIT with small to moderate, non-significant differences (d≤-0.62)

between the obese and lean groups. Although the difference in global strain was more than

halved, it was still large (d=-0.90) and in favour of the lean participants (~8.5%). In contrast,

MAE improved to such an extent at rest that it was slightly higher in the obese group

(d=0.77). Despite these very promising changes in the exercise trained obese adolescents, the

authors47 highlighted that they need to be replicated in a multicentre study with a

representative sample and intent-to-treat research design.

The very low volume, HIIT used by Bond and colleagues45 consisted of just six training

sessions spread over two weeks similar to previously published studies with sedentary69 and

type-2 diabetic adults70. The study was designed so that it was possible to separate the acute

response, from the last exercise session, and the chronic two week training adaptation by

including pre-exercise, 1-day post-exercise and 3-day post-exercise measurements; however,

a non-exercise matched control group was not included due to the brevity of the training
period. Statistically significant changes (P≤0.04) in FMD, baseline arterial diameter and heart

rate variability (HRV) were found; effect sizes ranged from small to large (d=0.39 to 0.97).

The 1-day post-exercise effects were larger than those found 3-days after the last exercise

training session (compared with the pre-exercise baseline). There were also some subtle, but

noteworthy differences between fasting and postprandial measures, which could mean post-

meal measurements provide a more insightful window to metabolism than overnight fasting

conditions. The postprandial reductions in FMD and HRV were expected given the test

breakfast meal had a very high energy content of 7134 kJ (~1704 kcal) amounting to a large

proportion (≥82%) of the samples’ measured mean daily energy intakes. The authors

highlighted the primary study outcomes as: (i) a HIIT-induced improvement in endothelial

function and HRV in boys and girls; (ii) changes in novel and traditional CVD risk factors

may occur independently; and (iii) the changes (∆) in endothelial function and HRV were

transient (%∆1-day > %∆3-day), which suggest their findings may reflect an acute response

from the last exercise training bout rather than a chronic physiological or metabolic

adaptation.

Time efficiency and enjoyment of HIIT

Two commonly cited potential advantages of HIIT, compared with MCT, are the purported

time-efficiency of the exercise modality and the enjoyment associated with this form of

training. Although, the amount of time spent exercising (i.e., actively engaged in power-

producing activity) during HIIT is relatively small, it is questionable how much time may

actually be ‘saved’ by this form of exercise, especially when one considers the time

committed to an appropriate warm-up, active or passive recovery between interval repetitions

and, finally, post-session recovery. The importance of exercise volume per se, and the impact

this may have on long-term exercise adherence, should not be dismissed and may represent
an interesting avenue for future research with young people.

Physical activity enjoyment has been identified as a consistent predictor of childhood

physical activity levels71. Unfortunately, very little research exists that has quantified exercise

enjoyment during HIIT with young people. Encouragingly, however, evidence derived from

studies conducted with adults suggests that HIIT may be a more enjoyable form of exercise,

compared with continuous, steady-state exercise of a lower intensity70,72,73,74. Furthermore, a

recent study conducted with children indicates that the perceived enjoyment of steady-state

exercise may be increased by the addition of intermittent all-out sprints, despite the latter

exercise resulting in a greater total amount of work compared to steady-state exercise alone12.

Although additional research is required to confirm this finding, it raises important questions

surrounding the optimal manipulation of exercise intensity and duration to maximise

enjoyment and adherence, during childhood and adolescence. Longitudinal experimental

studies are undoubtedly warranted to examine perceived enjoyment during HIIT as well as

adherence to this form of exercise over a prolonged period of time. Such studies may also

provide valuable insight into the extent to which this form of exercise training can be

tolerated and sustained by young people and help to further delineate the priority that should

be afforded to this form of training.

Conclusion

It is clear from our comprehensive search and critical appraisal of the literature that research

examining the efficacy of HIIT in young people is still in its infancy. Nevertheless, there are

some promising findings for sports performance and health outcome measures. However,

these are all based on training studies that are limited by their brevity and need to be

followed-up with longer studies involving both male and female, children and adolescents in
more representative samples. There is insufficient evidence to suggest that young people,

even highly motivated athletes, can sustain such high intensity exercise over longer than three

consecutive months and retain their interest, motivation and enjoyment whilst remaining free

from exercise training-induced injury. These issues must be addressed systematically before

we can be confident in prescribing this type of training for performance or health gains in

young people.

Summary
• Inclusion of HIIT in programmes for young athletes may compliment moderate

continuous activity in light of widespread non-compliance with the current international

recommendations for physical activity in young people.

• Despite recent growth in the number of scientific studies examining the efficacy of HIIT

in young people, longitudinal studies are rare; these studies have focused on both sports

performance and health outcomes with athletes and non-athletes. This dual focus reflects

the continued interest in maximising sports performance, but also the growing concern

about perceived low levels of cardiometabolic fitness and the high proportion of young

people who are overweight or obese, with related co-morbidities, in this segment of the

population.

• Cardiorespiratory fitness, defined as peak V̇O2, has been the most popular outcome

measure of sports performance and health-related studies with young people. HIIT can

increase peak V̇O2 meaningfully, but whether it is better than alternative exercise regimes

has yet to be confirmed reliably. Longer-term studies, which include comprehensive,

valid measures of compliance, injuries and enjoyment are required.

• Explosive strength (power) gains following HIIT in young athletes are small to moderate,

but do not appear to be impaired. Recovery time, built into individual training sessions
 and cycles, should be considered carefully when leading into competitive performance.

• The effect of HIIT on direct measures of sports performance are limited to only a few

studies and the results suggest that the gains are moderate at best. However, it should be

recognised that even small gains in performance for young people who are already well-

trained may be meaningful if maintained and applied consistently.

• Changes in body size and composition following HIIT have, typically, been trivial to

small, which reflects study design more than the efficacy of the training per se. This is

because HIIT has only been prescribed typically from 2 and 13 weeks in the scientific

literature.

• The small number of studies taking blood samples before and after HIIT make it difficult

to identify any trends in the variety of biochemical metabolites investigated; reductions in

fasting insulin and LDL-C are promising findings to date, particularly in obese girls and

boys. However, these need to be verified in larger studies extended over longer periods.

• Finally, three HIIT studies have focused on vascular health; unsurprisingly, they are

dependent on the baseline levels of the outcome variables like systolic blood pressure and

cardiac function. Again, more well-controlled research is required to reach firmer

conclusions.

8,664 words

Tables 2,321 words

Grand total (excluding references and title page) 10,985 words

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Table 34.1 Prospective high-intensity interval training (HIIT) studies with children and adolescents that assessed athletic performance outcomes.

HIIT Control Age Length

Citation Sex Sport Training programme Performance (∆%)
sample sample (years) (wk)
F2, 30-min of short intermittent
Baquet Peak V̇O2: +8*†
33 20a M&F N/A 8-11 7 aerobic running (10 or 20 s) at
et al.26 MS: +5*†
100 to 130% MAS.
F2, 30-min of high-intensity
Baquet MS: +5 *†
36 36a M &F N/A 8-11 7 intermittent running (10 or 20 s)
et al.27 SBJ: +10*†
at 100 to 130% MAS.
Peak V̇O2 +6*
Shock Micro-cycle of HIIT. 15 PPO: +6*
high-intensity aerobic interval VT: +10*
Breil 13 8b Alpine 11
M&F 16-17 sessions in 11 days. 4 × 4-min at Lacmax: +11*
et al.28 Skiing days
90-95% HRmax, 3-min recovery Tlim: +5
periods. CMJ: -5*
SJ: -4*
G1: F2, HIIT, 12-24 × 15-s runs G1: G2:
at 95% MAS, with 15-s passive VIFT: +6* +7*
Buchheit G1:15 recovery. Tlim: +36* +27*
N/A M&F Handball 15.5 10
et al.29 G2:17 G2: F2, Small-sided handball RSA: +3* +5*
games performed over similar 10m Sprint: +1 +2
time period. CMJ: +3 +3
G1: F1, Repeated Sprint Training: G1: G2:
2-3 sets of 5-6 × 15 to 20m 10m Sprint: +2 +33
repeated shuttle sprints with 14-s 30m Sprint: +2* +2*
Buchheit G1: 7 of passive or 23-s of active RSAmean: +3* +1*
N/A M Football 14.5 10
et al.30 G2: 8 recovery. CMJ: +7* +15*†
G2: F1, Explosive Strength Hop: +14* +28*
Training: 4-6 series of 4-6
explosive strength exercises.
F2, 1 session 4 × 4 min at 90-95% Peak V̇O2: +8
Chamari
18 N/A M Football 14.0 8 HRmax. 3 min active recovery. Peak V̇O2
et al.24
1 session 4 × 4 min small sided (abs): +15*

1
 games (4 × 4 players) at 90 -95% RE: +14*
HRmax. Hoff-Test: +10*
G1: F2, HIIT. Intermittent
running at 95% maximal aerobic
performance. 15-s exercise bouts G1: G2:
interspersed with 15-s of active VIFT: +3* +4*
Delextrat & G1: 9 G1: 16.0
N/A M Basketball 6 recovery for 8-13 min. e.g. 2 × (8- Defence: -3 +5
Martinez31 G2: 9 G2: 16.3
13 min of 15-s – 15-s). Offence: +4* +7*
G2: F2, Small-sided games. 2 vs
2 small sided games. e.g. 2 × (2-
3 × 3-min 45s – 4-min 15s).
G1: F6, HIIT, 30.8% above
individual anaerobic threshold.
Various interval duration and G1: G2:
G1 &
Faude Swimmin repetitions. IAT: +* +*
G2: 10 N/A M&F 16.6 4
et al.32 g G2: F6, High-volume Training, T100: -1 -1
Crossover
23.3% above individual anaerobic T400: 0 0
threshold. Various interval
duration and repetitions.
G1: G2:
Peak V̇O2: +8* +7*
G1:F2, Generic Interval Training. V̇O2 at LT: +13* +11*
4× 4-min at 90-95% HRmax with V at LT: +9* +10*
Impellizzeri G1: 15 3-min active recovery. Eckblom: +14* +16*
N/A M Football 17.2 4&8
et al.33 G2: 14 Distance
G2: F2, Small-sided Football run: +6* +4*
Games. HI running: +23* +26*
LI running: +18* +7*
Walking: -9* -8*
G1: F3, Sprint Running. 3×10-s
maximal speed sprints with 10-s
McManus G1: 11
7a F N/A 9.6 8 rest followed by 3×30-s sprints G1: G2:
et al.34 G2: 12
with 90-s rest. Increased to 4, 5 Peak V̇O2: +8* +10*
and 6 sets after two, four and six PPO: +10* +20*
2
 weeks, respectively. MPO: +3 -1
G2: F3, Cycle Ergometer
Exercise 20-min cycling at HR
160-170 b⋅min-1.
G1: F3, Interval training. 7×30-s
maximal speed sprint on cycle G1: G2:
ergometer with 2-min 45-s active Peak V̇O2: +12* +6*
McManus G1:10
15a M N/A 10.3 8 recovery. PPO: +33*† +22
et al.35 G2:10
G2: F3, Continuous training. 20- V̇O2 at VT: +22*† +3
min steady state cycling at HR
160-170 b⋅min-1.
Peak V̇O2: +10*
F2, Football-specific running.
RE: 0
McMillan 4×4-min at 90-95% HRmax
11 N/A M Football 16.9 10 CMJ: +3*
et al.25 separated by 3-min recovery at
SJ: +7*
70% HRmax.
10m Sprint: 0
G1: F3, Short-sprint repetition
training. 4-6 sets of 4×50m reps G1: G2:
of all out sprints with 2- and 4- Peak V̇O2: +7* +10*
min rest between reps and sets, T250 +4* +3*
Meckel G1:11
N/A M Football 14.3 7 respectively. 30m Sprint +3* +2*
et al.36 G2:13
G2: F3, Long-sprint repetition T4×10 +3* +1*
training. 4-6 200m reps at 85% SBJ: +1 +2
max 100m speed with 5-min rest
between reps.
F3, Interval Running. 1-2 sets of Peak V̇O2: +8*
3×600m with 2.5-min rest, T1200 +10*
Rotstein
16 12a M N/A 10.8 9 5×400m with 2-min rest and PPO +14*
et al.37
6×150m with 1.5-min rest. MPO +10*
Varying intensity. LAIV +2*

3
 G1: F5, HIIT. 30-min, 50-300m G1: G2:
intervals. Intensity 92% personal Peak V̇O2: +12* +9*
best 100m freestyle time. Lacmax +26* -24*
G1 &
Sperlich Swimmin LEN: +17* +6
G2: 26 N/A M&F 10.5 5
et al.38 g G2: F5, High Volume Training. T2000: +3* 0
Crossover
60-min, 100-800m intervals, T100: +2 +2
Intensity 85% personal best for
each distance.
G1: F3-4, HIIT. < 30-min running G1: G2:
session (4-15 × 30-s – 4min) at Peak V̇O2: +7* +2
90-95% HRmax. Intervals T1000: +4* +2
separated by 1- to 3-min jogging 20m Sprint: +4* +4*
Sperlich G1: 9
N/A M Football 13.5 5 at 50-60% HRmax. 30m Sprint: +4* +4*
et al.39 G2: 8
40m Sprint: +3* +3*
G2: F3-4, High Volume Training. Drop Jump: +15 +7
45 to 60-min exercise session at CMJ: +12 +26
50-70% HRmax. SJ: +11 +14
Shock Micro-cycle. 15 sessions G1: G2:
within three, 3-day training blocks Peak V̇O2: -1 +3
over 14 days. HIIT training at 90- TTPO (W) +3 +14*
Wahl G1: 8 95% HRmax. 40-s – 4-min TTLactate +12 +23*
N/A M&F Triathlon 15.4 2
et al.40 G2: 8 intervals. Variable sets and Wingate +2 -2
repetitions. PPO: +5* -2
G1: Active recovery Wingate
G2: Passive Recovery MP:

Peak V̇O2 – peak oxygen uptake (mL·kg-1·min-1); MS – maximal speed (velocity) at the end of a graded field test; SBJ – standing broad jump; PPO –
peak power output; VT – ventilatory threshold; Lacmax – maximal blood lactate concentration; Tlim – time to exhaustion at relative, pre-intervention
exercise intensity; CMJ – counter movement jump; SJ – squat jumps; VIFT – velocity reached at end of the 30-15IFT test; RSA (mean) – mean sprint
time during repeated sprint ability test; 10/20/30/40-m Sprint – sprint time over 10/20/30/40 metres; Hop – mean height during hopping test; Peak
V̇O2 (abs) – peak oxygen uptake (L·min-1); RE – running economy; Hoff-Test – football-specific circuit; Defence – defensive agility; Offence –
offensive agility; IAT – individual anaerobic threshold; T100 – maximal 100-m swim time; T400 – maximal 400-m swim time; V̇O2 at LT – oxygen
uptake at lactate threshold; Vat LT – velocity at lactate threshold; Eckblom – football-specific endurance test; Distance run – distanced run during
competitive football match; HI running – time spent in high-intensity running during competitive football match; LI running – time spent in low-
4
intensity running during competitive football match; Walking – time spent walking during competitive football match; MPO – mean power output;
V̇O2 at VT – oxygen uptake at ventilatory threshold; T250 – 250-m running time; T4×10 – 4 × 10-m shuttle running time; T1200 – 1200-m running time;
LAIV – lactate inflection point velocity; LEN – “Ligue Européenne de Natation”, the European governing body – international pointing system for
competition performance; T2000 – maximal 2000-m swim time; TTPO – time trial power output; TTLactate – time trial blood lactate concentration;
Wingate PPO – peak power output during Wingate test; Wingate MP – mean power out during Wingate test.
* Significant difference pre- to post-intervention; † Significant difference between-groups. a Habitual Physical Activity; b Habitual Training.

5
Table 34.2 Peak oxygen consumption (peak V̇O2): prospective high intensity interval training (HIIT) studies with children and adolescents that
included a comparison with either an untrained control or at least two different training programmes

Sample Sex & Age Length HIIT

Citation HIIT Training Programme Peak V̇O2 (∆%)d
sizesa body sizeb (years) (wk) (min)c
33:20 M&F F2e, 4 sets × 5-10 reps × 10-20-s
Baquet et al.26 8-11 7 93 8§ vs -2
(53) NW-OB @ 100-130% MAS run
22:22:19 M&F F3, 5 sets × 5-10 reps × 10-20-s
Baquet et al.27 8-11 7 152 5§ vs 7§ vs -2
(77) NW-OW @ 100-130% MAS run
22:22:19 M&F F3, 5 sets × 5-10 reps × 10-20-s
Baquet et al.43 8-11 7 152
(77) NW-OW @ 100-130% MAS run
M&F F1e, 2 sets × 10 reps × 10-s
Baquet et al.56 503:48 10-16 10 35
NW-OW @ 100-120% MAS run
10 M
Barker et al.44 15 2 16.5 F3, 1 set × 4-7 reps × 30-s “all-out” cycling 5§
(10) NW
13 M&F F3, 1 set × 8-10 reps × 60-s
Bond et al.45 13 2 54 3
(16) NW-OW @ 90% peak aerobic cycling power
M&F
Buchan et al.14 17:16:24 16 7 54 F3, 1 set × 4-6 reps × 30-s “all-out” running
NW-OW
M&F
Buchan et al.55 42:47 16 7 54 F3, 1 set × 4-6 reps × 30-s “all-out” running
NW
15:15 M&F
Corte de Araujo46 8-12 12 108 F2, 1 set × 3-6 reps × 60-s @ MAS run 15§ vs 13§
(39) OB
10:10 M&F F2, 1 set × 4 reps × 240-s
Ingul et al.47 14 13 416 9§
(20) OB @ 90% HRmax run
M F3, 1 set × 7 reps × 120-s
Koubaa et al.48 14:15 13 12 504 11§ vs 5§
OB @ 80-90% MAS run
15:21:12 M&F F3, 1 set × 12 reps × 15-s
Lau et al.62 11 6 54
(48) OW @ 120% MAS run
5:5:6:5:5 M 21 to F2, 1-5 sets × 4 reps × 20-s “all-out”
Logan et al.49 16 8 5 vs 7§ vs 3 vs 9§ vs 7§
(29) NW-OB 107 various exercise modes

6
 11:12:7 F
McManus et al.34 9 8 72 F3, 3-6 × 10s + 3-6 × 30s “all-out” running 8§ vs 10§ vs -2
(45) NW
10:10:15 F
McManus et al.35 10 8 84 F3, 3-6 × 10s + 3-6 × 30s “all-out” cycling 11§ vs 8§ vs 2
(45) NW
9:9 M&F F2, 4 sets × 5-10 reps × 10-20-s
Nourry et al.50 10 8 187 16§ vs -1
(24) NW @ 100-130 MAS run
11:11:12 F F3, 2 sets × 6-8 reps × 30-s
Racil et al.51 16 12 264 8§ vs 5§ vs 1
(36) OB @ 100-110 MAS run
8:8 M&F F2, 4 sets × 5-10 reps × 10-20-s
Rosenkranz*52 7-12 8 107 25§ vs -8
(18) NW-OW @ 100-130 MAS run
16:12 M Not F3, 1-2 sets: 3 × 600-m + 5 × 400-m + 6 ×
Rotstein et al.37 10-11 9 8§ vs 2
(28) NW known 150-m, ‘high’ intensity running
9§ vs 0
22:20 M&F F2, 1 set × 4 reps × 240-s
Tjønna† et al.53 14 12 384
(54) OW-OB @ 90% HRmax run
11§ vs -1
12:13:14 M
Williams et al.54 10 8 72 F3, 3-6 × 10s + 3-6 × 30s “all-out” running -2 vs 5
(45) NW
a HIIT:Other training:Habitual control (starting total sample size)
b M – male, F – female; NW – normal weight, OW – overweight, OB - obese
c Total HIIT time (does not include warm-up or cool down)
d Percentage changes for HIIT vs other training and/or habitual control
e F – weekly training frequency (e.g., F3 = 3 sessions per week)
§ Significant within HIIT group change
* Low maximum heart rates suggest peak V̇O2 were invalid
† Top row of results (n=20) 3 months of HIIT; bottom row of results (n=13) 12 months of HIIT

7
Table 34.3 Body size, biochemical metabolites and vascular health: prospective high intensity interval training (HIIT) studies with children and
adolescents that included a comparison with either an untrained control or at least two different training programmes (only HIIT group
results displayed for biochemical metabolites).

a Biochemical Metabolites (∆%)a Vascular Health (∆%)a

Citation Body Size (∆%)
Glub Ins TAG HDL LDL TC SBP DBP FMD

Baquet et al.26 %BF -4 vs -3

Baquet et al.27 %BF 1 vs 1

Baquet et al.43 BMI 1 vs 1 vs -2

Baquet et al.56 %BF 9 vs 6

Barker et al.44 BMI <1 1 3

F 15§ & 15§
Bond et al.45 0 <1 -8 5 -5 -2 -2 & 0 -11 & -11
P 29§ & 17§
Buchan et al.14 %BF -3 vs -11§ vs 0 -9 112 65§ 20 -24 3 -5 vs -4 vs -4 -3 vs 0 vs -6

Buchan* et al.55 WC <1 vs 2 2 8 10 21 -44§ -16 -4§ vs -3 -1 vs -6

Corte de Araujo46 %BF -3 vs -3 -3 -29§ -10 7 2 <1 -8§ vs 0 -6 vs -8

Ingul et al.47 %BF -5§ -6§ -13§

Koubaa et al.48 WC -2 -6§ 4§ -2 -1 -2§ vs -2§ -3§ vs -2

Lau et al.62 ΣSF -14§ vs -1 vs 8§

8
Logan et al.49 -1 vs -4§ vs -6§ vs -2 vs -6§ -6§ to 5§ -13§ to 3

Nourry et al.50 %BF -8 vs -3

Racil* et al.51 %BF -8§ vs -5§ vs -1 -2 -27§ -7§ 6§ -12§ -7§

Rosenkranz52 %BF -10 vs -4 6 - -17 22 -36§ -13§ -2 vs -2 -4 vs -2

%BF -12§ vs -3§ -6§ -29§ -11 10 -7§ vs -2§ -8§ vs -3 5§ vs 4

Tjønna† et al.53
%BF -3§ vs <1 -6§ -34§ -18 10 -6§ vs -4§ -7§ vs -1 6§ vs 1
Participant and training characteristics are displayed in Table 34.2
a HIIT vs other training and/or habitual control
b All fasting: Glu – glucose, Ins – insulin, TAG – triacylglycerol, HDL & LDL – high & low density lipoprotein cholesterol, TC – total cholesterol
* plasma metabolites presented to only one decimal place, which may have led to inflated %∆ estimations
§ Significant within HIIT group change
† Top row of results (n=20) 3 months of HIIT; bottom row of results (n=13) 12 months of HIIT