# Aerobic high-intensity interval training and maximal strength training in patients with unspecific musculoskeletal disorders improve V̇O(2peak) and maximal strength more than moderate training PMID: 38956785 Journal: European Journal of Sport Science Published: 2024-07 Authors: Hov H, Eithun G, Wang E, Helgerud J ## Question Can HIIT plus maximal strength training improve VO2peak and maximal strength more than usual moderate-intensity rehabilitation exercise without worsening feasibility or quality of life in patients with unspecific musculoskeletal disorders? ## Summary In a 4-week multidisciplinary rehabilitation program for people with long-standing unspecific musculoskeletal disorders, replacing standard moderate exercise with 4 x 4 minute HIIT plus maximal strength training produced larger gains in VO2peak and leg-press strength. Dropout, compliance, quality of life, and adverse-event reporting did not suggest worse feasibility for the higher-intensity program in this supervised rehab setting. ## Population - Adults in multidisciplinary rehabilitation for long-standing unspecific musculoskeletal disorders, commonly low back pain, multilocational pain, or fibromyalgia-like presentations. - Sample size: 73 - Age: 45 +/- 10 years - Sex: Mixed sex; exact distribution not extracted from the text read - Fitness level: Mostly not regular exercisers - Health status: Clinical musculoskeletal-disorder rehabilitation population, often on sick leave or unemployed ## Methodology - Randomized clinical rehabilitation intervention - 4 weeks - Public multidisciplinary rehabilitation center - Randomized and controlled study design. ## Protocol - HIIT plus maximal strength training. - Modality: Aerobic HIIT using spinning, walking, running, treadmill, or outdoor modalities plus horizontal leg press. - Work intervals: 4 minutes. - Recovery: 3 minutes active recovery. - Sets or repetitions: Aerobic: 4 x 4 minutes; strength: 4 sets x 4 reps leg press. - Intensity: HIIT at 85-95% HRmax with recovery around 70% HRmax; leg press around 90% 1RM with maximal intended concentric velocity. - Session duration: Part of 4-week rehab schedule; exact session duration varied by rehab day. - Frequency: 15 aerobic endurance sessions and 10 strength sessions across 4 weeks. - Program length: 4 weeks. - Progression: Leg press increased by 4.5 kg if more than 4 reps were achieved in the final set; aerobic intensity HR-guided. - Moderate training rehabilitation exercise. - Modality: Moderate cycling, walking, running, and leg press. - Work intervals: Mostly continuous or moderate exercise; one weekly spinning interval session used 4-5 intervals of 4-5 minutes. - Recovery: 3-minute active recoveries in the weekly spinning interval session. - Sets or repetitions: Leg press 3 sets of 8-10 reps. - Intensity: Aerobic training around 70-80% HRmax; leg press around 75% 1RM without maximal intended velocity. - Session duration: Part of the same 4-week rehab schedule. - Frequency: 15 aerobic endurance sessions and 10 strength sessions across 4 weeks. - Program length: 4 weeks. - Progression: Moderate rehabilitation progression; exact progression less structured than high-intensity group. ## Outcomes ### VO2peak Status: improved HIIT plus maximal strength training improved VO2peak more than moderate training. HG 33.8 +/- 8.1 to 37.3 +/- 8.4 ml/kg/min (10.7 +/- 6.9%) vs MG 33.0 +/- 7.0 to 34.6 +/- 7.5 (4.8 +/- 6.1%); interaction p<.001. ### Leg press 1RM Status: improved Maximal strength improved more in the high-intensity group. HG 92.9 +/- 25.6 to 127.2 +/- 28.0 kg (42.5 +/- 33.6%) vs MG 108.0 +/- 37.7 to 125.8 +/- 39.1 kg (19.1 +/- 18.3%); interaction p<.001. ### Walking economy and blood pressure Status: improved Walking economy and resting blood pressure improved in both groups without a clear between-group difference. ### Quality of life Status: improved SF-36 quality-of-life domains improved in both groups without between-group differences. ### Feasibility and safety Status: no clear change High-intensity training did not worsen dropout, compliance, quality of life, or adverse-event reporting compared with moderate training. No adverse events; dropout p=.386 and compliance p=.229. ## Practical Insights - High-intensity aerobic and strength work can be feasible in a supported rehab environment for some musculoskeletal-disorder patients. - For users with pain or fear of movement, reassurance, supervision, and controlled strength technique likely matter as much as the interval structure. - The evidence supports clinician-supervised high-intensity options, not unsupervised high-intensity prescriptions for pain populations. ## Limitations - Short 4-week intervention with no long-term follow-up. - Moderate comparator was less standardized, limiting precise replication. - Clinical rehab environment was intensive and supportive, so results may not translate to home app use. - No cost-benefit analysis. ## Safety And Adherence - No adverse events were reported. - High-intensity training was delivered inside a multidisciplinary rehab program with professional support. ## Original Sources - [PubMed](https://pubmed.ncbi.nlm.nih.gov/38956785/) (pubmed) - [DOI](https://doi.org/10.1002/ejsc.12126) (doi) - [PMC full text](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11235885/) (full text) ## Agent Guidance Preserve the paper-level scope of this note. Do not generalize beyond the population, protocol, measured outcomes, and limitations above.