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Eur J Sport Sci. Author manuscript; available in PMC 2018 October 01.
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Published in final edited form as:

Eur J Sport Sci. 2017 October ; 17(9): 1203–1211. doi:10.1080/17461391.2017.1359679.

High-intensity Interval and Moderate-intensity Continuous

Training Elicit Similar Enjoyment and Adherence Levels in
Overweight and Obese Adults
Chantal A. Vella1, Katrina Taylor2, and Devin Drummer3

1Department of Movement Sciences and WWAMI Medical Education Program, University of

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Idaho, 875 Perimeter Drive MS 2401, Moscow ID 83844-2401, cvella@uidaho.edu 2Department

of Physical Education, Health and Recreation, Eastern Washington University, 200 PEB, Cheney,
WA 99004, ktaylor31@ewu.edu 3Department of Movement Sciences, University of Idaho, 875
Perimeter Drive MS 2401, Moscow ID 83844-2401, drum0056@vandals.uidaho.edu

Abstract
BACKGROUND: High-intensity interval training (HIIT) has been shown to improve
cardiometabolic health during supervised lab-based studies but adherence, enjoyment and health
benefits of HIIT performed independently are yet to be understood. We compared adherence,
enjoyment and cardiometabolic outcomes after 8-weeks of HIIT or moderate-intensity continuous
training (MICT), matched for energy expenditure, in overweight and obese young adults.
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METHODS: 17 adults were randomized to HIIT or MICT. After completing 12 sessions of

supervised training over 3 weeks, participants were asked to independently perform HIIT or MICT
for 30 minutes, 4 times/week for 5 weeks. Cardiometabolic outcomes included cardiorespiratory
fitness (VO2peak), lipids, and inflammatory markers. Exercise enjoyment was measured by the
validated Physical Activity Enjoyment Scale. RESULTS: Exercise adherence (93.4±3.1% vs
93.1±3.7%, respectively) and mean enjoyment across the intervention (100.1±4.3 vs 100.3±4.4,
respectively) were high, with no differences between HIIT and MICT (p>0.05). Similarly,
enjoyment levels did not change over time in either group (p>0.05). After training, HIIT exhibited
a greater decrease in low-density lipoprotein cholesterol than MICT (−0.66 mmol·L−1 vs. −0.03
mmol·L−1, respectively) and a greater increase in VO2peak than MICT (p<0.05, +2.6 ml·kg.min−1
vs. +0.4 ml·kg.min−1, respectively). Interleukin-6 and C-reactive protein increased in HIIT (+0.5
pg·mL−1 and +31.4 nmol·L−1, respectively) and decreased in MICT (−0.6 pg·mL−1 and −6.7
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nmol·L−1, respectively, p<0.05).

Corresponding Author: Chantal A Vella, PhD, Department of Movement Sciences and WWAMI Medical Education Program,
University of Idaho, 875 Perimeter Drive MS 2401, Moscow, ID 83844-2401, TEL: 208-885-2189, FAX: 208-885-5929,
cvella@uidaho.edu.
Disclosure of Interests
The authors declare that they have no conflicts of interest.
All procedures performed were in accordance with the ethical standards of the institutional ethics review board and conformed to the
policies established by the U.S. Department of Health, Education, and Welfare and the American Physiological Society. The study had
prior approval by the University ethics review board and all participants provided informed consent.
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CONCLUSIONS: Our novel findings suggest that HIIT is enjoyable and has high unsupervised
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adherence rates in overweight and obese adults. However, HIIT may be associated with an
increase in inflammation with short-term exercise in this population.

Keywords
C-reactive protein; cardiorespiratory fitness; interleukin-6; cardiovascular disease; obesity;
Physical activity; inflammation

Introduction
It is well established that physical activity is associated with decreased morbidity and
mortality from cardiometabolic disease. Despite this evidence, only 20% of US adults meet
current physical activity guidelines and 25% report no leisure-time physical activity (Centres
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for Disease Control and Prevention, 2014). One of the most common barriers to engaging in
regular exercise is a lack of time (Burgess, Hassmen, & Pumpa, 2017; Trost, Owen,
Bauman, Sallis, & Brown, 2002), with current research focusing on time-efficient strategies
to promote exercise adherence and cardiometabolic health. Recently, high intensity interval
training (HIIT) has gained popularity as a novel, time-efficient exercise strategy that has
been shown to improve cardiometabolic disease risk factors in a variety of populations.

The majority of studies on HIIT have been supervised, laboratory-based interventions with
only one mode of exercise (Elmer, Laird, Barberio, & Pascoe, 2015; Fex, Leduc-Gaudet,
Filion, Karelis, & Aubertin-Leheudre, 2015; Fisher et al., 2015; Higgins, Baker, Evans,
Adams, & Cobbold, 2015; Saanijoki et al., 2015), which limits the generalizability of the
findings to free-living conditions. While these studies provide important information on the
effects of HIIT on specific cardiometabolic outcomes in the short term, they do not address
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enjoyment of and adherence to HIIT under unsupervised conditions. Enjoyment is an

important motive for engaging in and adhering to exercise (Aaltonen et al., 2012) yet there is
a paucity of data on this topic related to HIIT. Most studies on enjoyment of HIIT have
measured enjoyment after acute or short-term exercise in a laboratory environment, with
conflicting findings (Bartlett et al., 2011; Jung, Bourne, & Little, 2014; Martinez, Kilpatrick,
Salomon, Jung, & Little, 2015; Saanijoki et al., 2015). Research has yet to adequately
evaluate HIIT as an exercise strategy that can be sustained independently, over a meaningful
period of time. To our knowledge only one study to date has investigated the adherence to
HIIT using multiple modes of exercise and during unsupervised conditions (Jung, Bourne,
Beauchamp, Robinson, & Little, 2015). This intervention study was six weeks in duration,
with two weeks of supervised conditions, in participants with prediabetes. Further studies
are needed to determine adherence to longer term HIIT and enjoyment of this type of
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exercise in previously sedentary adults. The purpose of this study was to compare adherence
to and enjoyment of unsupervised HIIT and moderate-intensity continuous training (MICT)
in sedentary, overweight and obese young adults. A secondary purpose of this study was to
compare cardiometabolic outcomes post intervention between HIIT and MICT.

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Methods
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Seventeen sedentary, overweight or obese adults aged 18–44 years (7 males, 10 females)
participated in the study. Participants were recruited from a university and its surrounding
community in the Pacific Northwest via flyers with a quick response code to the study
website, word-of-mouth, university email advertisements and local newspaper
advertisements. Interested participants were screened for inclusion and exclusion criteria via
phone and participants were provided a gift card to the university bookstore after completing
the study. Exclusion criteria included diagnosed cardiovascular, metabolic, or pulmonary
disease; currently using antihypertensive or lipid-lowering medications; currently pregnant
or breast feeding; irregular menstrual cycles; current smoker or smoked within past 6
months; or unable to perform exercise. The study protocols were submitted to and approved
by the University’s Institutional Review Board for ethical testing of human subjects.
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After consent, all participants completed baseline testing at week 0 and post testing at week
9 of the study. Testing at all time points was similar and described below. Participants were
instructed to abstain from exercise for at least 12h, caffeine for at least 4h, and food for at
least 2h, prior to each visit for testing. Participants were asked to fast for 12h prior to blood
draws.

Following baseline testing (including fasting blood draw, anthropometrics, blood pressure,
dietary recall, and cardiorespiratory fitness), participants were randomized to HIIT or MICT
for 4 days per week for 8 weeks. The first 3 weeks of the 8-week intervention included one-
on-one supervised training, specific to the group assignment, on 3 sessions per week. The
fourth session was unsupervised and designed to increase participant autonomy. The last 5
weeks of the 8-week intervention was unsupervised.
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The exercise modes included treadmill, cycle ergometer, and elliptical in a university gym-
based setting where all participants had free access. Participants were instructed to use one
mode for each exercise session and rotate modes such that all modes were used each week.
For the fourth exercise session each week, participants self-selected their preferred exercise
modality from the three they had been prescribed. Participants were also given the
opportunity to jog or cycle outdoors on the days that the treadmill and cycle ergometer were
prescribed, as long as heart rate was monitored and the prescribed intensities were
achievable. Only one participant engaged in exercise outdoors during the study. The exercise
prescription was progressive over the first 3 to 4 weeks of the intervention and groups were
matched for energy expenditure.

Exercise training
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Training intensities were derived from a VO2peak test at week 0 and 4, allowing for a
progressive workload adjustment, and were prescribed as heart rate reserve (HRR), as
recommended by the American College of Sports Medicine (ACSM, 2017). Participants
randomized to MICT performed 20-min of continuous exercise at 55–59% HRR, with a 5-
minute warm-up and cool down at 35–40% HRR for a 30-minute exercise session.
Participants randomized to HIIT performed ten 1-minute bouts of high intensity exercise at
75–80% HRR, separated by ten 1-minute recovery bouts at 35–40% HRR. The high-

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intensity intervals were equivalent to 84 to 87% HR max in this sample, consistent with the
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intensities used in the HIIT literature. Warm-up and cool down periods were matched to
MICT.

Participants wore a heart rate monitor (Polar FT7, Polar Electro Inc, New York, USA) during
each exercise session to monitor exercise intensity. Participants also completed a log book
for each training session, logging exercise heart rate data and session summary data (heart
rate and energy expenditure) from the heart rate monitor. The heart rate monitors stored all
exercise session data and were used to confirm exercise adherence, target heart rates and
energy expenditure against the log books.

Anthropometric, blood pressure, and body composition measurements

Height and weight were measured to the nearest 0.1 cm and 0.5 kg, respectively. Waist
circumference was measured to the nearest 0.1 cm, in duplicate, at the level of the iliac crest.
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Overweight and obese were defined as body mass index of 25.0–29.9 and ≥30.0 kg·m−2,
respectively (National Heart Lung and Blood Institute, 1998). After five minutes of seated
rest two readings of blood pressure, within 5 mmHg, were averaged (Omron HEM-907XL;
Kyoto, Japan). Body composition was estimated via air displacement plethysmography with
measured thoracic gas volume (BOD POD®; COSMED, Rome, Italy) using standard
procedures from the manufacturer.

Fasting blood samples

Fasting blood draws (12h fast) were performed at least 48h after the final exercise session
for the determination of glucose, insulin, lipids, and inflammatory markers (C-reactive
protein [CRP], interleukin-6 (IL-6), interleukin-8 (IL-8), tumour necrosis factor alpha (TNF-
α), leptin, and adiponectin). Blood samples for glucose and lipids were processed in
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duplicate by a local CLIA certified laboratory. Glucose, high-density lipoprotein (HDL),

low-density lipoprotein (LDL), total cholesterol, and triglycerides were measured using a
Dimension RxL Max Integrated Chemistry System (Siemens; Erlangen, Germany). Glucose
was measured using the hexokinase method with a minimum sensitivity of 0.0 mmol·L−1
and an intra-assay coefficient of variation (CV) of 0.6%. HDL cholesterol was assessed
using the polyethylene glycol direct method with a minimum sensitivity of 0.3 mmol·L−1
and an intra-assay CV of 0.9%. LDL cholesterol was measured using the direct method with
a minimum sensitivity of 0.13 mmol·L−1 and an intra-assay CV of 1.4%. Total cholesterol
was measured via cholesterol oxidase, esterase, and peroxidase, and had a minimum
sensitivity of 0.39 mmol·L−1 and an intra-assay CV of 1.1%. Triglycerides were measured
using the enzymatic endpoint method and had a minimum sensitivity of 0.6 mmol·L−1 and
an intra-assay CV of 1.2%.
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Serum samples for insulin and inflammatory markers were sent to the University of
Alabama Centre for Clinical and Translational Sciences Core Laboratory for analysis.
Insulin was measured using an immunoenzymatic method (TOSOH AIA-600 II; TOSOH
Bioscience, South San Francisco, CA, USA). This assay had a minimum sensitivity of 0.5
uU·mL−1 and intra-assay CV of 1.49%. Adiponectin and leptin were measured by
radioimmunoassay (Millipore RIA kit, EMD Millipore, Billerica, MA) with a minimum

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sensitivity (90% bound) of 1.07 ug·mL−1 and 0.88 ng·mL−1, respectively and intra-assay CV
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of 6.79% and 5.70%, respectively. High sensitivity CRP was measured using an
immunoturbidimetric assay (Pointe Scientific, Canton, MI, USA). This assay had a
minimum sensitivity of 0.5 mg·L−1 and intra-assay CV of 7.49%. TNF-a, IL-6 and IL-8
were measured using 7-plex pro-inflammatory kits (Meso Scale Diagnostics, Rockville,
MD) with a minimum sensitivity of 0.055 pg·mL−1, 0.137 pg·mL−1, and 0.06 pg·mL−1,
respectively and intra-assay CV of 6.28%, 4.75%, and 1.97%, respectively.

Cardiorespiratory fitness measurements

VO2peak and maximal heart rate were measured using a continuous incremental exercise
test to exhaustion on a treadmill and computerized metabolic system (TrueOne 2400;
ParvoMedics, Salt Lake City, UT, USA). Resting expired gases were measured for 2 minutes
followed by a 2 minute warm up performed at 2.5 to 3.5 mph, 0% grade. The treadmill
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speed was then increased to a comfortable but challenging walking or jogging pace (3–5
mph) for 2 minutes with the grade remaining at 0%. The treadmill grade was then increased
by 1% each minute, with participants encouraged to continue until volitional fatigue.
Standard criteria of respiratory exchange ratio greater than or equal to 1.10 and failure of
heart rate to increase with increases in workload were used to confirm that a maximal effort
was reached (ACSM, 2017). For all analyses of oxygen consumption, data were smoothed
with a 15-breath moving average and the highest value obtained during the last minute of
exercise was recorded (Robergs, Dwyer, & Astorino, 2010).

Exercise enjoyment
To assess exercise enjoyment, participants were asked to complete the 18-item Physical
Activity Enjoyment Scale (Kendzierski & DeCarlo, 1991) during the first, fourth, and final
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week of exercise training. The questionnaires were completed immediately after the third
exercise session of the week. This instrument consists of questions relating to enjoyment
immediately after exercise with the instruction “Please rate how you feel at the moment
about the physical activity you have been doing”. This 18-item survey is scored on a 7-point
bipolar scale. Example items include “I enjoy it/I hate it”, “I find it energizing/I find it
tiring”, “It gives me a strong sense of accomplishment/It does not give me any sense of
accomplishment at all”. Scores range from 18–126 with higher scores indicating higher
levels of enjoyment. Previous research has shown good internal consistency of this
instrument (Cronbach’s alpha=0.96; Kendzierski & DeCarlo, 1991).

Dietary Intake
Daily intakes of energy and macronutrients were analysed using 24-h dietary recalls (2 week
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days and 1 weekend day) over a 1-week period at pre and post testing (Nutrition Data
System for Research software, University of Minnesota, Minneapolis, MN; Version 2013).
Participants were asked to maintain their current diet throughout the duration of the study.

Statistics
Sample size estimates were generated with an ANOVA repeated measures within-between
interaction design using GPower version 3.1.9.2 (Universitat Kiel, Germany). Our primary

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outcome variable was enjoyment of exercise, with a minimum important difference of 18

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between MICT (48±14) and HIIT (66±10; Kong et al., 2016) and a correlation of 0.6
between repeated measures (Kendzierski and DeCarlo, 1991). Based on data from Kong et
al. (2016) we calculated the pooled variance (12.1), effect size f (0.75), Cohen’s d (1.5) and
eta squared (0.36) to use for the sample size estimation. Using an ANOVA, repeated
measures within-between interaction design, a sample size of 8 participants per group was
required for an alpha of 0.05 and 95% power.

Data were analysed using SPSS Statistical Software (IBM SPSS Statistics for Windows
22.0, Armonk, NY, USA). The Shapiro–Wilk test was used to check the assumption of
normality, and non-normally distributed variables were log transformed. Multivariate
analysis of variance (ANOVA) was used to compare mean characteristics and exercise
variables (e.g., enjoyment) between groups at baseline. Repeated measures ANOVA was
used to evaluate changes in exercise enjoyment and dietary intake from pre to post
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intervention.

Analysis of covariance (ANCOVA) was used to test differences between the groups while
controlling for baseline values (Rausch, Maxwell, & Kelley, 2003). This statistical approach
tests whether groups are different on the post-test while controlling for pretest values and
whether groups change differently from pre to post test. We used this approach because it is
generally more powerful than a repeated-measures ANOVA (group main effect and time by
group interaction) when interest lies in group differences in the change from pre-test to post-
test within the context of a randomized pre-to-post design (Rausch et al 2003). Variables that
were significantly associated with the outcome variable were used as covariates. Covariates
for lipids and inflammatory markers included baseline value, age, and body fat. Covariates
for VO2peak and blood pressure included baseline value and sex. An alpha value of p<0.05
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was accepted as the minimal level of significance.

Results
Ten participants were randomized into MICT (6 men and 4 women) and 9 were randomized
into HIIT (2 men and 7 women) exercise groups. Seventeen participants completed the 8-
week intervention (Figure 1). There were no adverse events during testing or training in
MICT or HIIT. Baseline characteristics by training group are shown in Tables 1 and 2. All
participants were overweight or obese, with an average body mass index of 31.6±5.0 kg·m2
(range 25.6–43.5 kg·m2) and average body fat percentage of 35.2±6.8% (range 19.1–43.6%).

Macronutrient and energy intake (p>0.05) were similar across the 8-week study, indicating
diet did not change with adoption of the exercise program. Additionally, there were no
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changes in body composition, body weight, or body mass index across the 8-week study
(p>0.05).

Exercise adherence to the 8-week program was similar between MICT and HIIT (p>0.05,
Table 1). Both exercise deliveries were enjoyable with enjoyment scores ranging from 74 to
125 and no differences in enjoyment between groups or over time (p>0.05, Figure 2).

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Average daily exercise energy expenditure was similar between MICT and HIIT groups
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(295.0±67.5 vs. 284.3±30.9 kcals, respectively) indicating both groups were able to perform
the prescribed exercise protocol and maintain heart rate targets when exercising on their
own.

Table 2 displays cardiometabolic baseline and post-intervention values for MICT and HIIT
groups. There was a significant difference in LDL cholesterol post-intervention between
groups with HIIT exhibiting a significantly greater decrease from pre to post intervention
than MICT, when controlling for baseline values, age and body fat (p<0.05). There were no
group differences in HDL cholesterol, triglycerides, total cholesterol, glucose, insulin, blood
pressure, or waist circumference following the 8-week study. There was a significant
difference in VO2peak post-intervention between groups with HIIT showing a significantly
greater increase in relative VO2peak than MICT (p=0.04), when controlling for covariates.
Results were similar when absolute VO2peak was used in the model.
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Mean values of IL-6 and CRP were significantly different at post intervention between
groups when controlling for baseline values, age, and body fat (p<0.05, Table 2). Over the 8-
week intervention, levels of IL-6 and CRP decreased in MICT and increased in HIIT
(p<0.05). There were no group differences in IL-8, TNF-α, leptin, or adiponectin following
the 8-week intervention.

Discussion
Our novel findings provide preliminary evidence that adherence to and enjoyment of HIIT,
carried out in a free-living environment, in overweight and obese adults is high and similar
to that of MICT matched for time and energy expenditure. These findings suggest that
overweight and obese participants can adhere to a HIIT program independently and that
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enjoyment of exercise was high throughout the intervention. Our results also suggest that 8
weeks of HIIT improves low-density lipoprotein and VO2peak levels in previously sedentary
overweight and obese adults when compared to MICT, despite a similar energy expenditure.
Further, these positive health changes were evident despite the exercise program not meeting
current guidelines for physical activity and no change in body mass or body fat percentage.

A unique finding in the study was that adherence to and enjoyment of HIIT was similar to
that of MICT. Enjoyment is important for long term adherence to exercise (Aaltonen et al.,
2012). Yet few studies investigate enjoyment of HIIT after an intervention lasting more than
2 weeks (Foster et al., 2015). Moreover, there is debate over the value and practicality of
HIIT relative to MICT and whether adherence to HIIT would be high enough to promote
positive health outcomes and be used as a public health strategy (Biddle & Batterham,
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2015). We show that enjoyment was high and stayed high throughout the 8-week
intervention. This is in contrast to Foster et al. (2015) who showed enjoyment of HIIT
decreased over 8 weeks in untrained college-aged subjects. The study by Foster et al. (2015)
employed intervals that were at a higher intensity and shorter duration than the current study
and participants performed exercise on a cycle ergometer in a laboratory, which may have
contributed to the decreased enjoyment over the course of the study. Our study had
participants exercise using 3 modes of exercise in a gym setting or outside, which may have

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increased enjoyment levels. Our adherence levels of 93.4% and 93.1% for HIIT and MICT,
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respectively was similar to that reported from laboratory-based studies (Keating et al., 2014).

Recent studies have reported mixed results regarding the effects of HIIT on lipid levels.
Elmer et al. (2015) reported that 8 weeks of laboratory-based HIIT, similar to the protocol in
the current study but in men only, showed a significant decrease in triglycerides in HIIT
when compared to moderate-intensity endurance training. Fisher et al. (2015) reported that 6
weeks of laboratory based HIIT significantly reduced total cholesterol and triglycerides in
overweight and obese young men but there was no difference between HIIT and moderate-
intensity exercise training. Others have shown little impact of HIIT on lipid levels (Ciolac et
al., 2010; Higgins et al., 2014; Kessler, Sisson, & Short, 2012). Our results extend these
findings by demonstrating greater improvements in LDL cholesterol following unsupervised
HIIT in overweight and obese men and women when compared to MICT of similar energy
expenditure. Our participants maintained the same diet throughout the 8-week intervention
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and did not lose body mass or fat mass, suggesting that the changes were due to the exercise
program. We did not see significant changes in other lipids with either exercise program,
which is consistent with previous studies.

Numerous studies have established a strong association between low cardiorespiratory

fitness and cardiovascular disease morbidity and mortality. We found that an 8-week HIIT
program significantly increased VO2peak by 7.5% in young overweight and obese adults,
but this change was not evident in the MICT program despite a similar energy expenditure.
This improvement in VO2peak may be clinically significant, translating to about a 14%
reduction in cardiovascular disease mortality (Lee et al., 2011). Our findings are consistent
with the majority of the literature showing improvements in VO2peak in the ranges of 7–
24% after 4–16 weeks of HIIT in a variety of healthy and at-risk populations. A limitation in
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the literature includes the inability to directly compare the results of HIIT interventions
because the interventions are vastly different. HIIT protocols can vary in interval intensity,
length, duration, and number of intervals as well as the ratio of intervals to recovery periods
and type of recovery. Moreover, some of these protocols may not be achievable or
sustainable in an overweight or obese population, particularly the supramaximal protocols.
Our study adds to the literature by demonstrating this change in cardiorespiratory fitness in
overweight and obese adults engaging in the intervention under free-living conditions.

Our results suggest that HIIT and MICT may elicit different effects on markers of
inflammation in overweight and obese adults. Levels of CRP and IL-6 increased in HIIT and
decreased in MICT. The majority of studies on exercise and inflammation have investigated
the effects of moderate-intensity aerobic training with equivocal results. Some studies show
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decreases in CRP and IL-6 with 6 to 12 months of aerobic training in healthy and diseased
samples, whereas others show no change in inflammation with training (Beavers, Brinkley,
& Nicklas, 2010). To our knowledge, only four studies have examined the effects of HIIT on
inflammation with conflicting findings (Elmer et al., 2015; Gerosa-Neto et al., 2016;
Keating et al., 2014; Robinson, Durrer, Simtchouk, Jung, Bourne, Voth, & Little 2015).
Three of the four studies report no changes in CRP, IL-6, IL-8, or TNF-α, whereas Gerosa-
Neto et al. (2016) report favourable changes in IL-6 and unfavourable changes in TNF-α and
adiponectin with HIIT. It is important to note that although IL-6 levels were increased in

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HIIT in the present study, IL-6 can be anti-inflammatory by acting to stimulate production of
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anti-inflammatory cytokines IL-1 receptor antagonist and IL-10, and supressing TNF-α
through IL-6 dependent and independent pathways (Pederson and Pederson, 2005). No
changes in adiponectin levels were observed in the present study, supporting the findings of
previous research (Arikawa, Thomas, Schmitz, & Kurzer, 2011; Marcell, McAuley,
Traustadottir, & Reaven, 2005). A review on exercise and adiponectin levels indicated that
moderate-to-vigorous exercise lasting at least 90 minutes may be necessary to increase
adiponectin levels in adults (Simpson & Singh, 2008). Our findings should be confirmed in
larger samples to determine whether HIIT may be more likely to produce an inflammatory
response than MICT in certain samples, particularly obese individuals, or whether longer
term exercise (i.e., greater than 8 weeks) is needed to show decreases in inflammation.

This study has several strengths including investigating enjoyment of exercise under free-
living conditions, using accurate and reliable measures of cardiorespiratory fitness and body
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composition, having participants maintain a similar diet throughout the study, matching
energy expenditure between groups, and employing a randomized study design that included
unsupervised exercise in a free-living environment. Limitations of the study included lack of
a no-exercise control group and determination of the minimum important difference for
enjoyment of exercise with the Physical Activity Enjoyment Scale. Currently there is no
consensus in the literature on the minimum important difference in enjoyment of exercise,
which may have implications for sample size calculations. Thus, estimated sample size for
this study was based on group differences reported in the literature (Kong et al., 2016).

In summary, our findings suggest that HIIT is enjoyable and has high unsupervised
adherence rates in a free-living environment in overweight and obese adults. Our results also
suggest that 8 weeks of HIIT improves LDL cholesterol and VO2peak levels in previously
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sedentary overweight and obese adults when compared to MICT, despite a similar energy
expenditure. However, HIIT may be associated with an increase in inflammation with short-
term exercise in this population.

Acknowledgments
This research was funded by CTR-IN NIH NIGMS #1U54GM104944–01A1. This publication was made possible
by an Institutional Development Award from NIH NIGMS under grant P20GM103408.

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Figure 1.
Flow of participants through the intervention.
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Figure 2.
Physical activity enjoyment scale during the intervention (mean±SD). Closed circles MICT,
open circles HIIT, p>0.05.
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Table 1.

Participant characteristics (mean±SD), p>0.05 for all.

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Variable MICT (n=9) HIIT (n=8) ALL (N=17)

Age (years) 28.9±8.1 23.1±6.6 26.2±7.8
Sex (female [%]) 4 [44%] 6 [75%] 10 [59%]
Body mass (kg) 99.5±7.1 86.6±4.1 93.4±18.2
Body mass index (kg·m−2) 33.1±6.0 29.9±3.3 31.6±5.0
Fat (%) 35.3±7.2 35.2±6.8 35.2±6.8
Fat mass (kg) 35.7±13.1 30.4±9.0 33.2±11.3
Fat free mass (kg) 63.6±11.0 54.8±6.5 59.5±10.0
Exercise Enjoyment (end of week 1) 97.6±10.7 99.9±15.7 98.7±12.9
Exercise adherence (%) 93.1±10.6 93.4±8.3 93.2±9.3
Average daily exercise 295.0±67.5 284.3±30.9 290.0±52.2
energy expenditure (kcals)
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Average weekly exercise 1086.1±242.1 1048.3±150.5 1068.3±199.0

energy expenditure (kcals)

p>0.05 for all

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Table 2.

Cardiometabolic and fitness outcomes in MICT and HIIT at baseline and post-intervention (mean±SE).
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MICT (n=9) HIIT (n=8)

Variable Baseline Post- Baseline Post- Effect size

† † (power)
intervention intervention
(95% CI) (95% CI)
a 34.5±2.1 34.9±0.8 34.8±2.9 * 0.27 (52%)
VO2peak (mL/kg·min−1) (33.3, 36.6) 37.4±0.8
(35.7, 39.2)
a 117.0±3.9 116.2±2.2 114.0±1.7 118.3±2.3 0.03 (9%)
SBP (mmHg) (111.4, 121.0) (113.2, 123.3)
a 74.0±3.5 71.5±2.0 72.0±2.9 71.1±2.1 0.01 (5%)
DBP (mmHg) (67.3, 75.7) (66.6, 75.5)
b 108.1±4.9 106.1±1.4 101.3±3.2 104.5±1.5 0.04 (10%)
Waist (cm) (103.1, 109.0) (101.2, 107.6)
b 5.2±0.1 5.1±0.1 4.9±0.2 5.3±0.1 0.13 (23%)
Glucose (mmol·L−1)
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(5.0, 5.3) (5.1, 5.5)

b 21.5±5.0 16.6±3.0 12.5±3.1 17.1±3.0 0.01 (5%)
Insulin (μU·mL−1) (10.4, 22.8) (10.5, 23.7)
Lipids
b 1.0±0.1 1.2±0.1 * 1.1±0.1 0.05 (11%)
HDL (mmol·L−1) (1.1, 1.3) 1.4±0.1 (1.0, 1.2)
b 2.9±0.3 2.9±0.1 3.0±0.4 * 0.41 (76%)
LDL (mmol·L−1) (2.7, 3.2) 2.4±0.1
(2.1, 2.6)
b 1.1±0.1 1.2±0.2 1.0±0.2 1.1±0.2 0.01 (6%)
Triglycerides (mmol·L−1) (0.8, 1.6) (0.7, 1.5)
b 4.2±0.3 4.1±0.2 4.5±0.4 3.8±0.2 0.09 (17%)
Total chol (mmol·L−1) (3.7, 4.5) (3.4, 4.2)
Inflammatory Markers
b 21.9±5.7 14.9±5.4 14.3±3.8 * 0.41 (71%)
CRP (nmol·L−1) (2.9, 26.7) 37.6±5.4
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(25.7, 49.5)
b 1.0±0.3 0.4±0.2 0.5±0.1 * 0.30 (55%)
IL-6 (pg·mL−1) (<0.01, 0.7) 1.0±0.2
(0.6, 1.3)
b 8.2±1.0 11.7±0.9 10.7±1.0 8.6±1.0 0.28 (51%)
IL-8 (pg·mL−1) (9.8, 13.6) (6.5, 10.6)
b 2.0±0.1 2.1±0.1 2.1±0.2 2.1±0.1 0.01 (7%)
TNFα (pg·mL−1) (2.0, 2.3) (1.9, 2.2)
b 26.7±4.2 27.8±1.7 26.3±4.5 30.3±1.8 0.07 (14%)
Leptin (ng·mL−1) (24.1, 31.4) (26.3, 34.9)
b 6.7±1.5 6.4±0.3 7.9±1.3 6.9±0.3 0.07 (14%)
Adiponectin (μg·mL−1) (5.7, 7.1) (6.2, 7.7)

CI, confidence interval; VO2peak, peak oxygen consumption; SBP, systolic blood pressure; DBP, diastolic blood pressure; HDL, high density
lipoprotein cholesterol; LDL, low density lipoprotein cholesterol; Total chol, total cholesterol; CRP, C-reactive protein; IL, interleukin; TNFα,
tumour necrosis factor alpha
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†
marginal means from ANCOVA
*
p≤0.05 compared to MICT
a
Covariates included baseline value and sex
b
Covariates included baseline value, age, and body fat mass

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