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Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Sedentary behaviour alters metabolic and cardiovascular biomarkers and increases the risk of cardiometabolic diseases. [1] Exercise is a critical factor to improve cardiometabolic health. Health benefits are associated with following at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity per week.[2] Furthermore, the prevention of weight gain is prominent when physical activity is performed at ≥ three metabolic equivalents for >150 minutes per week.[3] However, the optimal duration and intensity of exercise required to improve cardiometabolic health warrants further investigation in the current day and age of limited time and escalating work and family commitments. High-intensity interval training (HIIT) has recently gained popularity as a time-efficient exercise intervention aimed at improving cardiometabolic health in different population groups. A randomised controlled trial reported that HIIT (9x4 minute intervals at ∼90% peak oxygen consumption with three minutes rest) was superior at improving insulin sensitivity compared with moderate-intensity continuous exercise (MICE) in overweight women.[4] A contemporary meta-analysis showed that HIIT provided similar benefits to those undertaking MICE for improving body composition and total cholesterol in overweight or obese adults.[5] Thus research seems inconsistent concerning the optimal duration, intensity and type of exercise aimed at improving cardiometabolic health in overweight or obese adults. A meta-review of 33 systematic reviews reported that HIIT improved some inflammatory markers, cardiac and vascular functions, blood glucose, glycaemic control, cardiorespiratory fitness, heart rate, weight and percentage body fat variables.[6] However, traditional HIIT with repeated sprints may result in undue stress on the cardiovascular system.[7] A close investigation of high-intensity training reveals that it is not a time-efficient intervention considering the repeated highintensity bouts followed by rest intervals during the exercise session.[8] A brief bout of exercise during different periods of the day will drastically minimise the time commitment of training.[8] Mind-body exercise interventions improve general mental and physical health due to the direct influence of the nervous system on immune and endocrine functions.[9] The ‘Gear’ exercise programme uses visualisation to enable participants to cognitively construct the increase and decrease of gears in a car to represent an increase and decrease in speed and intensity before and during the exercise session. The ‘Gear’ exercise programme is new and this is the first study to test the principles of this exercise programme. Therefore, the current study aimed to investigate the effect of the novel ‘Gear’ exercise programme on cardiometabolic risk factors in persons with an elevated risk of cardiovascular disease. Background: High-intensity interval training has recently gained popularity at improving cardiometabolic health. However, a close investigation of high-intensity interval training reveals that the exercise duration is similar to moderate-intensity continuous exercise. Objective: To compare the effect of the time-efficient ‘Gear’ exercise programmes to traditional exercise on cardiometabolic risk factors in persons with an elevated risk of cardiovascular disease. Methods: The study implemented a six-week, randomised controlled trial. The variables were low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, total cholesterol, glycated haemoglobin (HbA1c), blood pressure and body composition. Forty-eight participants completed the study. Participants were randomly assigned to either the ‘Gear’ exercise programme repeated at different times during the day (GEP-DT): cycled for 90 seconds, repeated three times/day, for three days/week (n = 12); ‘Gear’ exercise programme at one point in time (GEP-OT): cycled for 90 seconds followed by 4 minutes and 30 seconds rest, repeated three times at one point in time, for three days/week (n = 14); 30 minutes of moderate-intensity continuous cycling repeated three days/week at 55-69% HRmax (n = 11); and the controls, who were encouraged not to exercise (n = 11). Results: The 90-second GEP-DT intervention reduced HbA1c post six-weeks of training (MD = ­0.1±0.4, % Δ = -1.3%, d = ˗0.70). The GEP-OT group decreased blood triglycerides with a large effect size (MD = ­0.6±1.3, % Δ = ˗31.9%, d = ˗0.83). Conclusion: The novel 90-second ‘Gear’ exercise programme moderately reduced HbA1c and the 18-minute GEP-OT lowered blood triglycerides. ‘Gear’ exercise programmes will encourage future research in persons with non-communicable diseases, and it should be considered as a public health initiative to promote exercise in clinical, home and work environments.

Effect of the 90-second ‘Gear’ exercise programme on cardiometabolic risk factors in persons with an elevated risk of cardiovascular disease