Skip to main content
Log in

The Impact of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training on Vascular Function: a Systematic Review and Meta-Analysis

Sports Medicine Aims and scope Submit manuscript

Abstract

Background

Vascular dysfunction is a precursor to the atherosclerotic cascade, significantly increasing susceptibility to cardiovascular events such as myocardial infarction or stroke. Previous studies have revealed a strong relationship between vascular function and cardiorespiratory fitness (CRF). Thus, since high-intensity interval training (HIIT) is a potent method of improving CRF, several small randomized trials have investigated the impact on vascular function of HIIT relative to moderate-intensity continuous training (MICT).

Objective

The aim of this study was to systematically review the evidence and quantify the impact on vascular function of HIIT compared with MICT.

Methods

Three electronic databases (PubMed, Embase, and MEDLINE) were searched (until May 2014) for randomized trials comparing the effect of at least 2 weeks of HIIT and MICT on vascular function. HIIT protocols involved predominantly aerobic exercise at a high intensity, interspersed with active or passive recovery periods. We performed a meta-analysis to compare the mean difference in the change in vascular function assessed via brachial artery flow-mediated dilation (FMD) from baseline to post-intervention between HIIT and MICT. The impact of HIIT versus MICT on CRF, traditional cardiovascular disease (CVD) risk factors, and biomarkers associated with vascular function (oxidative stress, inflammation, and insulin resistance) was also reviewed across included studies.

Results

Seven randomized trials, including 182 patients, met the eligibility criteria and were included in the meta-analysis. A commonly used HIIT prescription was four intervals of 4 min (4 × 4 HIIT) at 85–95 % of maximum or peak heart rate (HRmax/peak), interspersed with 3 min of active recovery at 60–70 % HRmax/peak, three times per week for 12–16 weeks. Brachial artery FMD improved by 4.31 and 2.15 % following HIIT and MICT, respectively. This resulted in a significant (p < 0.05) mean difference of 2.26 %. HIIT also had a greater tendency than MICT to induce positive effects on secondary outcome measures, including CRF, traditional CVD risk factors, oxidative stress, inflammation, and insulin sensitivity.

Conclusion

HIIT is more effective at improving brachial artery vascular function than MICT, perhaps due to its tendency to positively influence CRF, traditional CVD risk factors, oxidative stress, inflammation, and insulin sensitivity. However, the variability in the secondary outcome measures, coupled with the small sample sizes in these studies, limits this finding. Nonetheless, this review suggests that 4 × 4 HIIT, three times per week for at least 12 weeks, is a powerful form of exercise to enhance vascular function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Vita JA, Keaney JF Jr. Endothelial function: a barometer for cardiovascular risk? Circulation. 2002;106(6):640–2.

    Article  PubMed  Google Scholar 

  2. Suwaidi JA, Hamasaki S, Higano ST, et al. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation. 2000;101(9):948–54.

    Article  CAS  PubMed  Google Scholar 

  3. Vane JR, Anggard EE, Botting RM. Regulatory functions of the vascular endothelium. N Engl J Med. 1990;323(1):27–36.

    Article  CAS  PubMed  Google Scholar 

  4. Endemann DH, Schiffrin EL. Endothelial dysfunction. J Am Soc Nephrol. 2004;15(8):1983–92.

    Article  CAS  PubMed  Google Scholar 

  5. Tousoulis D, Kampoli AM, Tentolouris C, et al. The role of nitric oxide on endothelial function. Curr Vasc Pharmacol. 2012;10(1):4–18.

    Article  CAS  PubMed  Google Scholar 

  6. Corretti MC, Anderson TJ, Benjamin EJ, et al. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol. 2002;39(2):257–65.

    Article  PubMed  Google Scholar 

  7. Barac A, Campia U, Panza JA. Methods for evaluating endothelial function in humans. Hypertension. 2007;49(4):748–60.

    Article  CAS  PubMed  Google Scholar 

  8. Celermajer DS, Sorensen KE, Gooch VM, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992;340(8828):1111–5.

    Article  CAS  PubMed  Google Scholar 

  9. Raitakari OT, Celermajer DS. Flow-mediated dilatation. Br J Clin Pharmacol. 2000;50(5):397–404.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Michel T, Vanhoutte PM. Cellular signaling and NO production. Pflugers Arch. 2010;459(6):807–16.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Fornoni A, Raij L. Metabolic syndrome and endothelial dysfunction. Curr Hypertens Rep. 2005;7(2):88–95.

    Article  CAS  PubMed  Google Scholar 

  12. Muniyappa R, Sowers JR. Role of insulin resistance in endothelial dysfunction. Rev Endocr Metab Disord. 2013;14(1):5–12.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Gokce N, Vita JA, Bader DS, et al. Effect of exercise on upper and lower extremity endothelial function in patients with coronary artery disease. Am J Cardiol. 2002;90(2):124–7.

    Article  PubMed  Google Scholar 

  14. Edwards DG, Schofield RS, Lennon SL, et al. Effect of exercise training on endothelial function in men with coronary artery disease. Am J Cardiol. 2004;93(5):617–20.

    Article  CAS  PubMed  Google Scholar 

  15. Higashi Y, Sasaki S, Kurisu S, et al. Regular aerobic exercise augments endothelium-dependent vascular relaxation in normotensive as well as hypertensive subjects: role of endothelium-derived nitric oxide. Circulation. 1999;100(11):1194–202.

    Article  CAS  PubMed  Google Scholar 

  16. Moriguchi J, Itoh H, Harada S, et al. Low frequency regular exercise improves flow-mediated dilatation of subjects with mild hypertension. Hypertens Res. 2005;28(4):315–21.

    Article  PubMed  Google Scholar 

  17. Lewis TV, Dart AM, Chin-Dusting JP, et al. Exercise training increases basal nitric oxide production from the forearm in hypercholesterolemic patients. Arterioscler Thromb Vasc Biol. 1999;19(11):2782–7.

    Article  CAS  PubMed  Google Scholar 

  18. Walsh JH, Yong G, Cheetham C, et al. Effects of exercise training on conduit and resistance vessel function in treated and untreated hypercholesterolaemic subjects. Eur Heart J. 2003;24(18):1681–9.

    Article  PubMed  Google Scholar 

  19. Sciacqua A, Candigliota M, Ceravolo R, et al. Weight loss in combination with physical activity improves endothelial dysfunction in human obesity. Diabetes Care. 2003;26(6):1673–8.

    Article  PubMed  Google Scholar 

  20. Lavrencic A, Salobir BG, Keber I. Physical training improves flow-mediated dilation in patients with the polymetabolic syndrome. Arterioscler Thromb Vasc Biol. 2000;20(2):551–5.

    Article  CAS  PubMed  Google Scholar 

  21. Maiorana A, O’Driscoll G, Cheetham C, et al. The effect of combined aerobic and resistance exercise training on vascular function in type 2 diabetes. J Am Coll Cardiol. 2001;38(3):860–6.

    Article  CAS  PubMed  Google Scholar 

  22. Black MA, Green DJ, Cable NT. Exercise prevents age-related decline in nitric-oxide-mediated vasodilator function in cutaneous microvessels. J Physiol. 2008;586(14):3511–24.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Mora S, Cook N, Buring JE, et al. Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms. Circulation. 2007;116(19):2110–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Joyner MJ, Green DJ. Exercise protects the cardiovascular system: effects beyond traditional risk factors. J Physiol. 2009;587(Pt 23):5551–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Ignarro LJ. Nitric oxide as a unique signaling molecule in the vascular system: a historical overview. J Physiol Pharmacol. 2002;53(4 Pt 1):503–14.

    CAS  PubMed  Google Scholar 

  26. Barone Gibbs B, Dobrosielski DA, Bonekamp S, et al. A randomized trial of exercise for blood pressure reduction in type 2 diabetes: effect on flow-mediated dilation and circulating biomarkers of endothelial function. Atherosclerosis. 2012;224(2):446–53.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Kwon HR, Min KW, Ahn HJ, et al. Effects of aerobic exercise vs. resistance training on endothelial function in women with type 2 diabetes mellitus. Diabetes Metab J. 2011;35(4):364–73.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Okada S, Hiuge A, Makino H, et al. Effect of exercise intervention on endothelial function and incidence of cardiovascular disease in patients with type 2 diabetes. J Atheroscler Thromb. 2010;17(8):828–33.

    Article  CAS  PubMed  Google Scholar 

  29. Maiorana A, O’Driscoll G, Dembo L, et al. Exercise training, vascular function, and functional capacity in middle-aged subjects. Med Sci Sports Exerc. 2001;33(12):2022–8.

    Article  CAS  PubMed  Google Scholar 

  30. Montero D, Walther G, Benamo E, et al. Effects of exercise training on arterial function in type 2 diabetes mellitus: a systematic review and meta-analysis. Sports Med (Auckland, NZ). 2013;43(11):1191–9.

    Article  Google Scholar 

  31. Currie KD, Dubberley JB, McKelvie RS, et al. Low-volume, high-intensity interval training in patients with CAD. Med Sci Sports Exerc. 2013;45(8):1436–42.

    Article  PubMed  Google Scholar 

  32. Wisloff U, Stoylen A, Loennechen JP, et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation. 2007;115(24):3086–94.

    Article  PubMed  Google Scholar 

  33. Molmen-Hansen HE, Stolen T, Tjonna AE, et al. Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients. Eur J Prev Cardiol. 2012;19(2):151–60.

    Article  PubMed  Google Scholar 

  34. Tjonna AE, Lee SJ, Rognmo O, et al. Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome: a pilot study. Circulation. 2008;118(4):346–54.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Schjerve IE, Tyldum GA, Tjonna AE, et al. Both aerobic endurance and strength training programmes improve cardiovascular health in obese adults. Clin Sci (London, England: 1979). 2008;115(9):283–93.

    Article  Google Scholar 

  36. Mitranun W, Deerochanawong C, Tanaka H, et al. Continuous vs interval training on glycemic control and macro- and microvascular reactivity in type 2 diabetic patients. Scand J Med Sci Sports. 2014;24(2):e69–76.

    Article  CAS  PubMed  Google Scholar 

  37. Klonizakis M, Moss J, Gilbert S, et al. Low-volume high-intensity interval training rapidly improves cardiopulmonary function in postmenopausal women. Menopause (New York, NY). 2014;21(10):1099–105.

    Article  Google Scholar 

  38. de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55(2):129–33.

    Article  PubMed  Google Scholar 

  39. Thijssen DH, Black MA, Pyke KE, et al. Assessment of flow-mediated dilation in humans: a methodological and physiological guideline. Am J Physiol Heart Circ Physiol. 2011;300(1):H2–12.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  40. Pyke KE, Tschakovsky ME. The relationship between shear stress and flow-mediated dilatation: implications for the assessment of endothelial function. J Physiol. 2005;568(Pt2):357–69.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  41. Inaba Y, Chen JA, Bergmann SR. Prediction of future cardiovascular outcomes by flow-mediated vasodilatation of brachial artery: a meta-analysis. Int J Cardiovasc Imaging. 2010;26(6):631–40.

    Article  PubMed  Google Scholar 

  42. Goto C, Higashi Y, Kimura M, et al. Effect of different intensities of exercise on endothelium-dependent vasodilation in humans: role of endothelium-dependent nitric oxide and oxidative stress. Circulation. 2003;108(5):530–5.

    Article  PubMed  Google Scholar 

  43. Davies KJ, Quintanilha AT, Brooks GA, et al. Free radicals and tissue damage produced by exercise. Biochem Biophys Res Commun. 1982;107(4):1198–205.

    Article  CAS  PubMed  Google Scholar 

  44. Bergholm R, Makimattila S, Valkonen M, et al. Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilatation in vivo. Atherosclerosis. 1999;145(2):341–9.

    Article  CAS  PubMed  Google Scholar 

  45. Buscemi S, Canino B, Batsis JA, et al. Relationships between maximal oxygen uptake and endothelial function in healthy male adults: a preliminary study. Acta Diabetol. 2013;50(2):135–41.

    Article  CAS  PubMed  Google Scholar 

  46. Davison K, Bircher S, Hill A, et al. Relationships between obesity, cardiorespiratory fitness, and cardiovascular function. J Obes. 2010;2010:191253.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Weston KS, Wisloff U, Coombes JS. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med. 2014;48(16):1227–34.

    Article  PubMed  Google Scholar 

  48. Blair SN, Kampert JB, Kohl HW 3rd, et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA. 1996;276(3):205–10.

    Article  CAS  PubMed  Google Scholar 

  49. Myers J, Prakash M, Froelicher V, et al. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346(11):793–801.

    Article  PubMed  Google Scholar 

  50. Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301(19):2024–35.

    Article  CAS  PubMed  Google Scholar 

  51. Thijssen DH, Dawson EA, Black MA, et al. Brachial artery blood flow responses to different modalities of lower limb exercise. Med Sci Sports Exerc. 2009;41(5):1072–9.

    Article  PubMed  Google Scholar 

  52. Mohan S, Koyoma K, Thangasamy A, et al. Low shear stress preferentially enhances IKK activity through selective sources of ROS for persistent activation of NF-kappaB in endothelial cells. Am J Physiol Cell Physiol. 2007;292(1):C362–71.

    Article  CAS  PubMed  Google Scholar 

  53. Vion AC, Ramkhelawon B, Loyer X, et al. Shear stress regulates endothelial microparticle release. Circ Res. 2013;112(10):1323–33.

    Article  CAS  PubMed  Google Scholar 

  54. Wang JS, Liao CH. Moderate-intensity exercise suppresses platelet activation and polymorphonuclear leukocyte interaction with surface-adherent platelets under shear flow in men. Thromb Haemost. 2004;91(3):587–94.

    CAS  PubMed  Google Scholar 

  55. Inoue N, Ramasamy S, Fukai T, et al. Shear stress modulates expression of Cu/Zn superoxide dismutase in human aortic endothelial cells. Circ Res. 1996;79(1):32–7.

    Article  CAS  PubMed  Google Scholar 

  56. Laughlin MH, Newcomer SC, Bender SB. Importance of hemodynamic forces as signals for exercise-induced changes in endothelial cell phenotype. J Appl Physiol (Bethesda, Md: 1985). 2008;104(3):588–600.

    Article  Google Scholar 

  57. Busse R, Mulsch A. Induction of nitric oxide synthase by cytokines in vascular smooth muscle cells. FEBS Lett. 1990;275(1–2):87–90.

    Article  CAS  PubMed  Google Scholar 

  58. Forstermann U. Nitric oxide and oxidative stress in vascular disease. Pflugers Arch. 2010;459(6):923–39.

    Article  PubMed  Google Scholar 

  59. Korshunov SS, Skulachev VP, Starkov AA. High protonic potential actuates a mechanism of production of reactive oxygen species in mitochondria. FEBS Lett. 1997;416(1):15–8.

    Article  CAS  PubMed  Google Scholar 

  60. Valle I, Alvarez-Barrientos A, Arza E, et al. PGC-1alpha regulates the mitochondrial antioxidant defense system in vascular endothelial cells. Cardiovasc Res. 2005;66(3):562–73.

    Article  CAS  PubMed  Google Scholar 

  61. Hood MS, Little JP, Tarnopolsky MA, et al. Low-volume interval training improves muscle oxidative capacity in sedentary adults. Med Sci Sports Exerc. 2011;43(10):1849–56.

    Article  CAS  PubMed  Google Scholar 

  62. Little JP, Gillen JB, Percival ME, et al. Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type 2 diabetes. J Appl Physiol (Bethesda, Md: 1985). 2011;111(6):1554–60.

    Article  CAS  Google Scholar 

  63. Cersosimo E, DeFronzo RA. Insulin resistance and endothelial dysfunction: the road map to cardiovascular diseases. Diabetes Metab Res Rev. 2006;22(6):423–36.

    Article  CAS  PubMed  Google Scholar 

  64. Wendelhag I, Fagerberg B, Hulthe J, et al. Endothelium-dependent flow-mediated vasodilatation, insulin resistance and the metabolic syndrome in 60-year-old men. J Intern Med. 2002;252(4):305–13.

    Article  CAS  PubMed  Google Scholar 

  65. Lind L. Endothelium-dependent vasodilation, insulin resistance and the metabolic syndrome in an elderly cohort: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Atherosclerosis. 2008;196(2):795–802.

    Article  CAS  PubMed  Google Scholar 

  66. Earnest CP, Lupo M, Thibodaux J, et al. Interval training in men at risk for insulin resistance. Int J Sports Med. 2013;34(4):355–63.

    CAS  PubMed  Google Scholar 

  67. Nybo L, Sundstrup E, Jakobsen MD, et al. High-intensity training versus traditional exercise interventions for promoting health. Med Sci Sports Exerc. 2010;42(10):1951–8.

    Article  PubMed  Google Scholar 

  68. Iellamo F, Caminiti G, Sposato B, et al. Effect of high-intensity interval training versus moderate continuous training on 24-h blood pressure profile and insulin resistance in patients with chronic heart failure. Intern Emerg Med. 2014;9(5):547–52.

    Article  PubMed  Google Scholar 

  69. Stensvold D, Slordahl SA, Wisloff U. Effect of exercise training on inflammation status among people with metabolic syndrome. Metab Syndr Relat Disord. 2012;10(4):267–72.

    Article  CAS  PubMed  Google Scholar 

  70. Taddei S, Ghiadoni L, Salvetti G, et al. Obesity and endothelial dysfunction. G Ital Cardiol. 2006;7(11):715–23.

    Google Scholar 

  71. Cinti S, Mitchell G, Barbatelli G, et al. Adipocyte death defines macrophage localization and function in adipose tissue of obese mice and humans. J Lipid Res. 2005;46(11):2347–55.

    Article  CAS  PubMed  Google Scholar 

  72. Pasarica M, Sereda OR, Redman LM, et al. Reduced adipose tissue oxygenation in human obesity: evidence for rarefaction, macrophage chemotaxis, and inflammation without an angiogenic response. Diabetes. 2009;58(3):718–25.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  73. Trayhurn P, Wood IS. Adipokines: inflammation and the pleiotropic role of white adipose tissue. Br J Nutr. 2004;92(3):347–55.

    Article  CAS  PubMed  Google Scholar 

  74. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352(16):1685–95.

    Article  CAS  PubMed  Google Scholar 

  75. Kessler HS, Sisson SB, Short KR. The potential for high-intensity interval training to reduce cardiometabolic disease risk. Sports Med (Auckland, NZ). 2012;42(6):489–509.

    Article  Google Scholar 

  76. Tjonna AE, Rognmo O, Bye A, et al. Time course of endothelial adaptation after acute and chronic exercise in patients with metabolic syndrome. J Strength Cond Res. 2011;25(9):2552–8.

    Article  PubMed  Google Scholar 

  77. Black MA, Cable NT, Thijssen DH, et al. Importance of measuring the time course of flow-mediated dilatation in humans. Hypertension. 2008;51(2):203–10.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Jeff S. Coombes and Lance C. Dalleck assisted in the design of the search criteria, statistical analysis, revised the drafted paper, and approved the final draft. Arnt Erik Tjonna and Kassia S. Beetham also interpreted the data, revised the drafted paper, and approved the final draft. Jeff S. Coombes is the guarantor of this study. No other sources of funding were used to assist in the preparation of this review. The authors have no potential conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jeff S. Coombes.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ramos, J.S., Dalleck, L.C., Tjonna, A.E. et al. The Impact of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training on Vascular Function: a Systematic Review and Meta-Analysis. Sports Med 45, 679–692 (2015). https://doi.org/10.1007/s40279-015-0321-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40279-015-0321-z

Keywords

Navigation