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Regular physical activity (PA) can reduce the risk of developing type 2 diabetes, but adherence to time-orientated (150 min week −1  or more) PA guidelines is very poor. A practical and time-efficient PA regime that was equally efficacious at controlling risk factors for cardio-metabolic disease is one solution to this problem. Herein, we evaluate a new time-efficient and genuinely practical high-intensity interval training (HIT) protocol in men and women with pre-existing risk factors for type 2 diabetes.    Materials and methods  One hundred eighty-nine sedentary women ( n  = 101) and men ( n  = 88) with impaired glucose tolerance and/or a body mass index >27 kg m −2  [mean (range) age: 36 (18–53) years] participated in this multi-center study. Each completed a fully supervised 6-week HIT protocol at work-loads equivalent to ~100 or ~125%V  ˙   O   2    max    . Change inV  ˙   O   2    maxwas used to monitor protocol efficacy, while Actiheart™ monitors were used to determine PA during four, weeklong, periods. Mean arterial (blood) pressure (MAP) and fasting insulin resistance [homeostatic model assessment (HOMA)-IR] represent key health biomarker outcomes.    Results  The higher intensity bouts (~125%V  ˙   O   2    max    ) used during a 5-by-1 min HIT protocol resulted in a robust increase inV  ˙   O   2    max(136 participants, +10.0%,  p  < 0.001; large size effect). 5-by-1 HIT reduced MAP (~3%;  p  < 0.001) and HOMA-IR (~16%;  p  < 0.01). Physiological responses were similar in men and women while a sizeable proportion of the training-induced changes inV  ˙   O   2    max    , MAP, and HOMA-IR was retained 3 weeks after cessation of training. The supervised HIT sessions accounted for the entire quantifiable increase in PA, and this equated to 400 metabolic equivalent (MET) min week −1 . Meta-analysis indicated that 5-by-1 HIT matched the efficacy and variability of a time-consuming 30-week PA program onV  ˙   O   2    max    , MAP, and HOMA-IR.    Conclusion  With a total time-commitment of <15 min per session and reliance on a practical ergometer protocol, 5-by-1 HIT offers a new solution to modulate cardio-metabolic risk factors in adults with pre-existing risk factors for type 2 diabetes while approximately meeting the MET min week −1  PA guidelines. Long-term randomized controlled studies will be required to quantify the ability for 5-by-1 HIT to reduce the incidence of type 2 diabetes, while strategies are required to harmonize the adaptations to exercise across individuals.

frontiers in endocrinology

A Practical and Time-Efficient High-Intensity Interval Training Program Modifies Cardio-Metabolic Risk Factors in Adults with Risk Factors for Type II Diabetes