I recently attended a seminar delivered by Prof John Forbes (a colleague here in the business school at UL) entitled ‘Personalised health: a new role for one-person trials’. John neatly made a convincing argument for the powerful role of n=1 (single participant) trials in identifying the most effective treatment specific to an individual patient. During the seminar I was reminded of how this applied to exercise for both and health and performance and of a recent contribution we made to the literature on this topic.
Last year my PhD supervisor, Dr Donal O’Gorman, and I contributed to one of the Journal of Physiology’s excellent CrossTalk series on “High intensity interval training does/does not have a role in risk reduction or treatment of disease”. Leading the proposal in the case for High Intensity Interval Training (HIIT) were Ulrik Wisløff, Jeff Coombes and Øivind Rognmo who outlined a clear case for a role for HIIT in prevention and treatment of several chronic diseases including cardiovascular disease and Type 2 Diabetes citing epidemiological evidence and intervention studies. Tanya Holloway and Lawrence Spriet led the opposing view, citing the safety and beneficial effects of moderate intensity endurance training, evidence that it is equivalent to HIIT and the lack of positive outcomes for HIIT in diseased populations, particularly hypertension induced heart failure.
We put forward our argument that there was a clear benefit of exercise in the prevention and treatment of chronic disease, however, the comparison of HIIT vs moderate intensity endurance training outcomes for several different diseases with alternate underlying pathologies and mechanisms was futile. Dr O’Gorman and I debated for the adoption of a Personalised Exercise Treatment (PET) approach as a strategy to stratify patients and optimise treatment outcomes in specific to the disease and to the patient. For example, the debate around ‘non-responders’ to certain types of exercise rages on. My belief is there are no ‘non-responders’ to exercise and I prefer to use the terms high and low sensitivity to exercise. A PET approach could mitigate against this and could be informed by the type, severity and duration of disease, pharmacological treatment and the high degree of inter-individual sensitivity to exercise. This would enable us to tailor the treatment, including the exercise regimen, specific to the patient to result in the best clinical outcome. When it comes to exercise and treatment in general, it is not one size (or HIIT!) that fits all…
If you’d like to check out the debate and our contribution please see the below links…
New Comment from Carson et al. on Journal of Physiology Crosstalk 26: High intensity interval training does/does not have a role in risk reduction or treatment of disease (SEE PAGE 11)
CrossTalk proposal: High intensity interval training does have a role in risk reduction or treatment of disease, Ulrik Wisløff, Jeff S. Coombes and Øivind Rognmo http://onlinelibrary.wiley.com/doi/10.1113/JP271041/full
CrossTalk opposing view: High intensity interval training does not have a role in risk reduction or treatment of disease, Tanya M. Holloway and Lawrence L. Spriet http://onlinelibrary.wiley.com/doi/10.1113/JP271039/full
Comment from Carson & O’Gorman
Carson, B.P, O’Gorman, D.J. (2016) Not one HIIT fits all! J Physiol 000.0 1–15
Investigating the impact of exercise on whole body or cellular responses is both challenging and stimulating given the complexity and variety of factors involved (Egan et al. 2010; 2013). This is compounded further when homeostasis and cellular function is disrupted in chronic disease states. It is widely accepted that exercise of varying duration, intensity and frequency mitigates this maladaptation (Booth & Laye 2010) but in most instances a generalised (Colberg et al. 2010) rather than personalised approach to exercise is adopted. This Crosstalk, debating whether HIIT has a role in the management of heterogenous (pre-) clinical populations, serves as an exemplar to argue for a ‘Personalised Exercise Treatment’ (PET) approach to disease management. Instead of a somewhat futile justification for/against HIIT, a strategy to stratify patients and optimise treatment outcomes in sub-groups needs to be developed. As evidenced in this CrossTalk, heterogeneous clinical phenotypes and physiological adaptations have high and low sensitivity to HITT, as with other forms of exercise. A PET approach would be informed by the type, severity and duration of disease in addition to the clinical phenotype, pharmacological treatment and the high degree of inter-individual sensitivity to exercise. Good examples of disease specific exercise training strategies exist (Praet & van Loon 2007) but there is scope for further personalisation and diversification. The primary clinical outcome targets for disease management can be optimised if the heterogeneous response to exercise, including HIIT, can be harnessed to identify the right exercise dependent on the patient’s individual circumstances, access and preferences.
Dr. Brian Carson is a Lecturer in Exercise Physiology and is Course Director for the BSc. Sport and Exercise Sciences. View Brian’s profile here
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