To HITT or not to HITT?

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There is little doubt that exercise is good for you and is a form of disease modification. However, there is a big debate about whether high-intensity interval (HIIT) or moderate continuous training (MCT) (aerobic) is best for you. This study below suggests HIIT is best. 

Positive changes in cardiorespiratory fitness were larger and the non-response less with HIIT compared to MCT. Younger age and lower starting or baseline fitness predicted a higher absolute improvement following the exercise intervention. 

The problem with HIIT and even MCT is that pwMS who are disabled may have difficulty exercising. Saying this, many of my patients who are even wheelchair-bound have found ways to work out using upper limb exercises. What is not addressed is how to get pwMS to start exercising; it is easy to prescribe exercise, but long term adherence with exercise and other lifestyle interventions is very poor. 

If you have been successful in maintaining an exercise program can you let your fellow pwMS know your secret? Thanks. 

Schlagheck et al.  VO2peak Response Heterogeneity in Persons with Multiple Sclerosis: To HIIT or Not to HIIT? Int J Sports Med . 2021 Jul 1. doi: 10.1055/a-1481-8639.

Exercise is described to provoke enhancements of cardiorespiratory fitness in persons with Multiple Sclerosis (pwMS). However, a high inter-individual variability in training responses has been observed. This analysis investigates response heterogeneity in cardiorespiratory fitness following high intensity interval (HIIT) and moderate continuous training (MCT) and analyzes potential predictors of cardiorespiratory training effects in pwMS. 131 pwMS performed HIIT or MCT 3-5x/ week on a cycle ergometer for three weeks. Individual responses were classified. Finally, a multiple linear regression was conducted to examine potential associations between changes of absolute peak oxygen consumption (absolute ∆V̇O2peak/kg), training modality and participant’s characteristics. Results show a time and interaction effect for ∆V̇O2peak/kg. Absolute changes of cardiorespiratory responses were larger and the non-response proportions smaller in HIIT vs. MCT. The model accounting for 8.6% of the variance of ∆V̇O2peak/kg suggests that HIIT, younger age and lower baseline fitness predict a higher absolute ∆V̇O2peak/kg following an exercise intervention. Thus, this work implements a novel approach that investigates potential determinants of cardiorespiratory response heterogeneity within a clinical setting and analyzes a remarkable bigger sample. Further predictors need to be identified to increase the knowledge about response heterogeneity, thereby supporting the development of individualized training recommendations for pwMS.

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General Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice. 

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

12 comments

  • I have been going to physio weekly for some 10 years and I believe it has helped me enormously. I go once a week to MS Action in Walthamstow and I have a personal trainer who visits me weekly, so two sessions.
    Expensive yes but worthwhile, not only for the work out but also structures my week and gives me the satisfaction that I am doing something positive.
    I know that my MS has progressed but I know I’m doing as much as I can to slow it.

  • I work out virtually daily and HIIT training is incorporated into my full program for MS (The MS Gym).

    Past the intro program, there is HIIT training from either a chair then eventually standing.

    Between remapping and vestibular work, strength training along with emphasis on correct breathing, tension and relaxation and other key points (we really have to understand our bodies to learn to move them again) and with the addition of the HIIT training, it’s a good daily workout especially when we have limitations. HIIT doesn’t necessarily look like HIIT to start – we have to train to get there. But even if you start slow, it’s more than you were doing before!

    (If you would like to learn more, Prof G, it could be arranged :))

  • If possible, I would do HIIT (without going to Tabatha style extreme though) over regular cardio but it is harder to pull off, especially after running is not an option anymore.

    Stationary bike can work for HIIT but it needs baseline fitness to be reasonable.

    Right now doing cardio with rowing Ergometer as current living arrangements don’t really have space for a bike.

    Also physiotherapy and bodyweight exercise, pre covid resistance strength training.

  • Exercise lowers neurofilament light chain levels., however doesn’t HIIT lower it more and for longer?

    Exercise has to be classed as a DMT

    Get moving people!!

  • Duh. It’s well-known that HIIT improves VO2max more than other forms of exercise in the general population, why would it be any different in MS? They didn’t measure any MS-specific outcomes, so what exactly was the point of this study…?

  • The best exercise program is living in a place like nyc where you walk as much as you’re able.

    It’s not hiit but something. We got a peloton recently and have been working up to doing that at once a week

  • I am a pwMS who excercises very regularly and I think its important to recognize that its not a single thing that gets me doing it every day. I have a whole basket of tools that I use.
    1. I’ve built a habit.
    2. Part of building the habit is strategy 2. Every day I go out with a goal but if I’m feeling terrible then its just getting my shoes on and getting around the block. I nearly always manage to keep going and do more but don’t beat myself up if I only do the minimum.
    3. I go first thing i the morning. This is the only time of day I’ve been able to set that I don’t make excuses of being too tired or … This time will probably be different for different people.
    4. On bad days I remind myself that exercise spurs genesis of neurons and oligodendrocytes plus wiring of new connections. For me knowing why its important helps. Right around the time of my diagnosis I read Norman Doidge’s book, the brain’s way of healing. The story of the man who got Parkinson’s at a relatively young age and how he walked to keep ahead of it had a significant impact on me.
    5. I got a dog who needs to go out and reminds me in a happy way to do so.
    6. For me getting out in nature is a happy place so all my excercise is outdoors and things that I enjoy. Picking the right activities is key.
    7. I’m at a place where I clearly feel worse if I have not excercised for a couple of days. This may be a tough thing to discover for those new to exercise but for me the brain fog rolls in and I can clearly relate it to when I have not exercised.

    Its all nice to say that this or that type of excercise is ‘best’ but if its not something you will stick to then its not the best for you.

  • For me the key was finding something I enjoyed.

    On top of MS I have hEDS. I had a lifetime of any exercise causing pain, so I was put off trying anything much. During a career break in my 20s (I finally ditched my legal career) I had a job involving a lot of walking, and this led rather inevitably to hip pain which almost stopped me from walking at all. My employer wanted to extend my contract and I had to say no. By that time I had moved to the UK and was able to access physio on the NHS – magic! Someone tells you what to do, you do it, you feel better, you keep doing it and feel better still! My new workplace had a running group. I always thought running was one of the things I shouldn’t do with my condition but my physio said there was no reason why I shouldn’t.

    It was the social, group nature of the runs and the accountability of sitting next to the group leader that got me along each week. It took at least six months before I actually enjoyed running for its own sake.

    Now that my habit is set, I can take myself off on my own all day on the trails, though I sell enjoy running in a group. I also find having a goal to aim for a motivating factor, and races are good for that. Shame they keep getting cancelled! Hopefully parkrun can go ahead this month.

  • I have always enjoyed sport and exercise which makes it a lot easier to continue with it post-diagnosis. I really, really wanted to get back to the activities I loved, despite having all sorts of difficulties and feeling awful, and that gave me motivation. So, in general terms, I think the secret has got to be finding something you genuinely enjoy. With or without MS, a lot of people give up on exercise because they are not enjoying it and just doing it because they feel they should. Having a go, in whatever way you can, at something that genuinely appeals, would seem to be the best way to start exercising. The finer details of HIIT and MCT are less important than just being active and out in the fresh air as much as possible, particularly if exercise is completely alien.

  • Do what you enjoy. Do only what you can manage and that way you stand a good chance of sustaining it. So if it’s a short walk, that’s much better than not doing anything. Don’t get upset if you can’t manage it one day, but do set aside a little time to do something most days. I am lucky that I have the time and live near a beach, a running track, a gym and my neighbour has a swimming pool. I was always rubbish at sport but I just keep trying. Don’t worry about being laughed at or pitied. Ignore any negativity. It’s probably all in the mind anyway. It’s the most neuro-protective activity I do.

By Prof G

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