Swing and a Miss or Inside-the-Park Home Run

As we bask in the fading glow of the 2012 Summer Olympics games, it seems apropos to discuss the clinical application of an exercise training regimen that was systematically applied to elite athletes nearly 80 years ago. Then, Drs Woldemar Gerschler and Herbert Reindel, a professor of physical education and a physician, used the scientific method to develop the basic principles of what is referred to today as high-intensity interval training (HIIT).1 The use of HIIT, which consists of a series of repeated bouts of high-intensity exercise intervals alternated with periods of low- to moderate-intensity recovery, remains a mainstay in the training regimen of many of today's athletes, regardless of whether they are our youth participating in middle school track or seasoned veterans competing for Olympic Gold.Article see p 1436However, given the many recently published small-sample studies that incorporated HIIT in patients with stable metabolic or cardiovascular disease, one cannot help but think that this exercise regimen might also represent a potentially new approach to patient care. Truth be told, HIIT was evaluated in the clinical setting in patients with chronic heart failure >25 years ago.2 Although the duration of the work and recovery periods can vary from one study to another, a common model for HIIT prescribes 4 to 5 work bouts of 3 to 4 minutes each, during which exercise intensity is set as high as 85% to 90% of heart rate reserve: (peak heart rate−resting heart rate)× 0.9+resting heart rate (the Figure). Interspersed among these higher-intensity bouts are recovery bouts of similar duration, prescribed at 60% to 70% of heart rate reserve. This approach to exercise training stands in stark contrast to today's guideline-based method of moderate continuous training (MCT),3,4 which maintains exercise intensity between 60% and 80% of heart …