# The Effect of All Extremity High Intensity Interval Training on Athero-Protective Factors and Endothelial Function in Overweight and Obese Women

PMID: 34912517
Journal: International Journal of Preventive Medicine
Published: 2021-10-26
Authors: Hovsepian V, Marandi SM, Esfarjani F, Zavar R, Sadeghi M

## Question

Does non-weight-bearing all-extremity HIIT improve FGF21, adiponectin, nitric oxide, flow-mediated dilation, aerobic fitness, and body composition in overweight and obese women?

## Summary

In sedentary overweight or obese young women, 10 weeks of supervised non-weight-bearing arm-and-leg ergometer HIIT improved flow-mediated dilation, adiponectin, VO2max, weight, body fat, and waist circumference compared with a control group. FGF21 and nitric oxide did not change, and one participant withdrew because of exercise-induced asthma at high intensity.

## Population

- Sedentary overweight or obese female university students.
- Sample size: 26
- Age: 20.53 ± 1.50 years; eligibility age 18-23 years.
- Sex: Female only.
- Fitness level: Sedentary, defined as exercise ≤2 times per week.
- Health status: Overweight or obese with BMI ≥27 kg/m2; free of CVD, diabetes, hormonal complications, medication use, smoking, and restricted diet.

## Methodology

- Semi-experimental controlled pre/post intervention.
- 10 weeks
- University exercise and laboratory setting in Isfahan, Iran.
- Controlled study design.

## Protocol

- All-extremity HIIT.
- Modality: Simultaneous upper-body and lower-body ergometers.
- Work intervals: 4 minutes.
- Recovery: 3 minutes.
- Sets or repetitions: 4 high-intensity intervals with 3 recovery intervals.
- Intensity: 85-90% maximum heart rate during work intervals; 70% maximum heart rate during recovery.
- Session duration: 40 minutes.
- Frequency: 4 sessions per week.
- Program length: 10 weeks.
- Progression: First week familiarization/preconditioning, then intensity and duration increased to reach target peak HR and 40-minute total time.
- Control.
- Modality: No prescribed training.
- Program length: 10 weeks.
- Progression: No exercise progression.

## Outcomes

### FMD
Status: improved
Flow-mediated dilation improved after all-extremity HIIT compared with control.

HIIT 8.83 ± 3.71 to 10.21 ± 3.73%; control 9.27 ± 5.01 to 8.07 ± 4.06%; ANCOVA p < 0.001.

### Adiponectin
Status: improved
Adiponectin increased with HIIT and differed from control.

HIIT 8.37 ± 1.09 to 8.95 ± 0.55 ng/ml; between-group p = 0.01.

### FGF21 and NO
Status: no clear change
FGF21 and nitric oxide did not significantly change.

FGF21 between-group p = 0.93; NO between-group p = 0.84.

### VO2max and body composition
Status: improved
VO2max increased and weight, body fat percentage, and waist circumference decreased after HIIT.

VO2max 28.55 ± 3.75 to 34.19 ± 4.09 ml/kg/min, p < 0.001; body fat 38.83 ± 2.21 to 36.22 ± 3.21%, p < 0.001; weight and waist between-group p < 0.001.

## Practical Insights

- Non-weight-bearing HIIT may be useful when running or walking HIIT is limited by body mass, joint load, or weakness.
- Using both upper and lower limbs can create a large-muscle-mass stimulus without impact loading.
- The protocol needs specialized ergometers and heart-rate supervision, limiting direct home translation.

## Limitations

- Small female-only sample.
- Randomization was not clearly reported.
- Young university students only.
- VO2max was estimated by a submaximal test.
- Diet and physical activity were recorded but not tightly controlled.
- One high-intensity asthma-related dropout.

## Safety And Adherence

- Four of 30 participants did not complete the intervention.
- One withdrawal was due to exercise-induced asthma at high HIIT intensities.
- Three additional withdrawals were due to schedule conflict.
- Authors described the program as feasible and well tolerated based on 86% completion.

## Original Sources

- [PubMed](https://pubmed.ncbi.nlm.nih.gov/34912517/) (pubmed)
- [DOI](https://doi.org/10.4103/ijpvm.IJPVM_248_19) (doi)
- [PMC full text](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8631139/) (full text)

## Agent Guidance

Preserve the paper-level scope of this note. Do not generalize beyond the population, protocol, measured outcomes, and limitations above.