A Comparison of High-intensity Interval Training Protocols on Health and Fitness
Condition: Healthy
Study type: Interventional

Summary: 
      Recently, it has been demonstrated that multimodal high-intensity interval training (MM-HIIT)
      (utilizing resistance-based and functional movements) can produce similar aerobic adaptations
      compared to high-intensity interval training (HIIT) using rowing but with greater muscle
      performance in females. In addition, HIIT has been shown to be more enjoyable than continuous
      training, and this may lead to enhanced self-efficacy and increased physical activity. To the
      investigators' knowledge, however, the cardiometabolic effects (blood pressure,
      abdominal/visceral fat, blood sugar, blood lipids/fats) of MM-HIIT have not been reported.
      The investigators aim to compare MM-HIIT with HIIT using a traditional aerobic fitness
      exercise (rowing) for the degree of cardiometabolic, physical performance (strength,
      endurance, power), and psychosocial (self-efficacy and enjoyment) adaptations. They will also
      determined sustained effects of the intervention by completing a 9-month follow-up.
    

Detailed description: 
      The PI will verify age with a drivers license or other form of identification to ensure that
      the study participants are at least 18 years of age to participate. After obtaining consent,
      the PI will then administer a pre-exercise screening tool, the Physical Activity Readiness
      Questionnaire for Everyone, to the participant for them to complete in order to aid in
      determining study eligibility. If the participant is deemed eligible, 3 other questionnaires
      will be emailed to participants for completion: Physical Activity Enjoyment Scale, Exercise
      Self-efficacy Scale, and the International Physical Activity Questionnaire (IPAQ) short form.
      Given that the participants will be instructed to not change any physical activity habits
      outside of the study, the IPAQ will be used to control for this pre- and post-intervention
      and weekly throughout the duration of the intervention. All forms must be completed and
      submitted to the PI prior to further data collection. Data collection will consist of a (1)
      blood collection visit, (2) exercise testing and abdominal/visceral fat measurement session,
      (3) three exercise/movement familiarization sessions (only conducted pre-intervention), (4)
      three strength, muscular endurance, and muscular power testing sessions before and after the
      intervention, and 12 weeks of training three times per week as described below. Excluding the
      consent obtaining meeting, participants will attend 8 sessions prior to beginning the
      intervention as detailed below. During the intervention, participants will be wearing heart
      rate monitors in order to monitor their training intensity. The PI will lead all data
      collection procedures with the assistance of School of Health Science students and Dr. Myung
      Choi except for the blood collection and analysis which will be supervised by Dr. Kristen
      Landis-Piwowar. All measures will be assessed pre- and post-intervention. Blind copy emails
      will be sent to remind the participants about upcoming data collection sessions and to
      schedule a data collection appointment.

      Day 1: Prevention Research Center (blood collection visit)

      Following 12-hr fast, assessments include:

        -  weight, height, waist circumference

        -  resting heart rate

        -  blood pressure

        -  venipuncture (blood sugar and fat)

        -  blood analysis

      Day 2: Prevention Research Center (exercise testing and visceral fat visit)

      Assessments include:

        -  dual-x-ray absorptiometry (DXA) to measure visceral adipose tissue

        -  bicycle VO2max test with standard warm-up and clinical monitoring to assess aerobic
           endurance

        -  Physical Activity Enjoyment Scale and Exercise Self-efficacy Scale (post-intervention)

      Days 3-5: Oakland University (OU) Recreation Center (familiarization visits)

      Familiarization sessions include:

        -  teaching movements used in subsequent testing and training

        -  assessment of musculoskeletal limitations

        -  intervention leader and assistants will attend sessions as part of training

      Days 6-8: OU Recreation Center (performance testing visits)

      Assessments include:

        -  Day 6: one repetition maximum (1 RM) testing for back squat (muscular strength); 70% 1RM
           back squat for max effort repetitions unbroken (muscular endurance)

        -  Day 7: 1 RM overhead press (muscular strength)

        -  Day 8: 1 RM deadlift (muscular strength) and max broad jump (muscular power)

        -  standardized warm-up prior to cool-down following each session

        -  at least 48 hours of rest between each session

      Pre- and post-intervention health measurements: Prevention Research Center Anthropometrics
      and vital sign measures such as height (using a stadiometer), weight (using an eye-level beam
      scale), heart rate and blood pressure (sitting with a sphygmomanometer) will be obtained.

      Pre- and post-intervention endurance measurements: Prevention Research Center Aerobic fitness
      will be directly assessed by a VO2max bicycle test. Each participant will be allowed to
      warm-up on the bicycle for 5 minutes at a low intensity. The VO2max bicycle test will include
      3 minute stages with increasing intensity each stage of 30 - 60 watts. The required cadence
      will be maintained at 60 revolutions per minute (RPM) for each stage. The test will be
      terminated at volitional fatigue defined as the participant no longer able to maintain 60
      RPMs for 20 seconds after encouragement from the testers. For most people, the test will take
      approximately 10 minutes.

      Pre- and post-intervention strength measurements: OU Recreation Center Prior to strength
      testing, three familiarization sessions will be conducted whereby participants will be taught
      and given a chance to practice the movements to be used for testing and training. During
      these sessions, participants will be assessed for any musculoskeletal limitations such as a
      lack of hip and ankle mobility that may require movement/exercise modifications to ensure
      safe technique. Following the familiarization sessions, each participant will complete three
      further days of testing, with at least 48 hours between testing days. These testing sessions
      will occur at OU Recreation Center. Each of these test sessions will be preceded by a
      standardized warmup and instruction regarding the upcoming session. On separate days, muscle
      strength will be assessed using 1-repetition maximum (1RM) testing for back squat, press, and
      deadlift using standardized protocols. The back squat will be performed to below parallel
      (hip crease below the apex of the patella), the press will be initiated with the bar on the
      clavicles, and the deadlift will performed in the conventional stance. All testing days will
      be repeated following training.

      Pre- and post-intervention muscle endurance and muscle power: OU Recreation Center Muscle
      endurance will be assessed by repetitive back squats to voluntary exhaustion. The load will
      be set at 70% of the pre-training

      1RM back squat for both pre- and post-training tests. This test will be conducted immediately
      after the 1 RM testing for back squat. Movement standards will be the same as those for the
      1RM test, and the total number of successful repetitions achieved without a rest will be
      recorded. Muscle power will be assessed using a static broad jump. The best horizontal
      distance achieved out of 3 trials will be recorded. This test will be conducted immediately
      after the 1 RM testing for the deadlift.

      Pre- and post-intervention biochemistry measurements: Prevention Research Center Following a
      12-hour fast, participants will complete venipuncture collection procedures. Two invasive
      needle sticks will be performed during this investigation (one needle stick pre-intervention
      and another needle stick post-intervention). Four milliliters (mL) of blood will be collected
      both pre- and post-intervention for measurement of: total cholesterol, high-density
      lipoprotein cholesterol, triglycerides, alanine aminotransferase, aspartate aminotransferase,
      glucose, and low-density lipoprotein cholesterol. This total amount of blood (8mL) collected
      during this trial will equate to 1.6 teaspoons of blood (5mL = 1 teaspoon). The risks of
      blood draw may include: infection, delayed healing, bruising and/or inflammation at the site
      of vein puncture, physical discomfort, mental discomfort, fainting and feeling faint and
      injury to a nerve or vessel. These risks will be minimized by the use of a trained
      professional (Dr. Kristen Landis-Piwowar) experienced with performing the blood draws,
      sterile technique and single use, disposable, materials who will be supervising the blood
      draw and analysis. Study participants may refuse to participate at any time and withdraw from
      the study without penalty.

      Pre- and post-intervention visceral fat measurement using dual x-ray absorptiometry (DXA)
      scan: Prevention Research Center For this measurement of visceral fat, each participant will
      be asked to lie flat on a special table below the DXA scan. A trained technician (Elise
      Brown, Ryan Tyler, Myung Choi, or Samantha Orr) will position each participant's body under
      the scan and then perform the scan, which will only take < 5 minutes.

      Pre- and post-intervention psychosocial questionnaires The purpose of including these
      psychosocial assessments in the proposed study is to assess changes in physical activity
      enjoyment and exercise self-efficacy. High-intensity interval training has been shown to be
      more enjoyable than continuous training, and this may lead to enhanced self-efficacy. These
      questionnaires will be emailed to participants for completion: Physical Activity Enjoyment
      Scale and Exercise Self-efficacy Scale.

      Nine months following the intervention, participants will complete all assessments again.

      The intervention will be led by students (one leader and at least 2 assistants) who will be
      trained by the PI, and exercise protocols are as follows:

      MM-HIIT Group: This group will train using multimodal exercises for 5 sets of 60 seconds of
      all out work, followed by 3 minutes of rest (a total of 20 minutes each session). Each
      session will have the same exercises within each set, but every session will be different
      than the others for movements utilized. There will be three movements used in each set. The
      first movement will be a strength movement (such as overhead press, squat, deadlift) for 4-6
      repetitions. The second movement follows the first immediately and is a faster body weight or
      light implement power movement such as lunges, body weight squats, or push ups for 6-8
      repetitions. The third movement follows the second immediately and is a very fast,
      sprint-like movement such as box jumps, ball slams, or jump rope for the remainder of the 60
      seconds. The intent of each set is to be completed with as much effort as possible across the
      full 60 seconds. The intervention leader will record weight used for each exercise and will
      instruct participants to increase intensity (up to 110% of previous intensity used) at
      subsequent session once maximum prescribed repetitions have been.

      R-HIIT Group: This group will train using a rowing ergometer for 5 sets of 60 seconds of all
      out work, followed by 3 minutes of rest (a total of 20 minutes each session). Each training
      session will be the same across the 12 weeks. The intent of each set is to be completed with
      as much effort as possible across the full 60 seconds.

      Control Group: This group will be instructed to continue with any activity they were involved
      in prior to the study and to not begin any new exercise programs during the course of the
      study. To incentive participation in this group, the control group will be offered the
      MM-HIIT intervention the following semester at no cost.
    

Intervention name(s): Multimodal High-Intensity Interval Training Intervention
Intervention type(s): Other
Intervention description(s): The intervention will occur 3 times per week for 12 weeks and include a warm-up, MM-HIIT or R-HIIT training protocol, and a cool down.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A parallel-group randomized controlled trial with 9-month follow-up will be conducted. Once initial screening is completed, participants will be randomized into one of three arms: 1) MM-HIIT, 2) R-HIIT, and 3) control.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: High-intensity interval training; cardiometabolic; physical performance; psychosocial adaptation