Brief Intense Stair Climbing Improves Cardiorespiratory Fitness

Customizing intense interval exercise training prescription using the "frequency, intensity, time, and type of exercise" (FITT) principle

Intense interval exercise training induces various physiological and metabolic adaptations related to performance and health. For designing a program, the F.I.T.T. principle, referring to frequency, intensity, time, and type of exercise, can be used to manipulate the level of physiological stress in the body, leading to various adaptations. Modifying these four parameters results in a wide range of interval protocols that are safe and effective for different populations including athletes and individuals with chronic diseases. In this review, we present how the manipulation of the F.I.T.T. components can alter the acute and chronic cardiorespiratory, metabolic, perceptual, and affective responses and adaptations to intense interval exercise training. From this evidence, it appears that the duration of the exercise bout and recovery interval are critical parameters for the manipulation of almost all acute responses, enabling periodization of intense interval exercise training, and promoting optimal adaptations and exercise adherence. In addition, a considerable level of adaptations may be achieved with training frequencies as low as once or twice per week and with lower than maximal intensities, adding to the feasibility of this exercise mode. Overall, by varying these parameters, the design of an intense interval exercise training program can be tailored according to the needs and abilities of each individual, and an optimized training prescription may be achieved.

High-intensity functional training modulates oxidative stress and improves physical performance in adolescent male soccer players: a randomized controlled trial

While regular exercise training is known to decrease oxidative stress (OS) and enhance antioxidant functions in adults, limited data exist on OS responses in the pediatric population. This study aimed to investigate the effects of high-intensity functional training (HIFT) on oxidative stress and physical performance in adolescent soccer players. In this randomized controlled trial, 20 well-trained adolescent soccer players were divided into HIFT (n = 10) and moderate-intensity soccer technical training (MITT, n = 10) groups. Both groups trained for 8 weeks (3 days/week). Oxidative stress biomarkers (MDA, 8-OHDG, H2O2, GPx, CAT) and physical performance (VO2peak, vertical jump height [VJH], maximal explosive power [MEP]) were assessed pre- and post-intervention. Repeated measure mixed ANOVA (2 × 2) with a significance level of P < 0.05 was used to determine differences between and within subjects. The main effect of interaction was significant for VO2peak, VJH and MEP (P < 0.05). The main effect of interaction was not significant for CAT, 8-OHDG, GPx, H2O2 and MDA (P > 0.05). Following intervention, VO2peak and VJH performance in the HIFT were significantly higher than MITT (P < 0.05). MDA and H2O2 in the HIFT decreased significantly (P < 0.05), but no significant changes were observed in the MITT (P > 0.05). CAT activity decreased significantly (P < 0.05), while GPx activity increased significantly (P < 0.05) in both groups. 8-OHDG did not show significant changes in both groups (P > 0.05). Eight weeks of HIFT did not cause greater OS compared to MITT, while could improve physical performance parameters. These findings suggest that HIFT is a viable and time-efficient training strategy for enhancing athletic performance in youth sports. Trial registration: The present study was a randomized controlled trial (registration number: IRCT20190530043762N1, 25/09/2019, Iran).

Device-measured vigorous intermittent lifestyle physical activity (VILPA) and major adverse cardiovascular events: evidence of sex differences

BACKGROUND

Vigorous intermittent lifestyle physical activity (VILPA) refers to brief bouts of intense physical activity embedded into daily life.

OBJECTIVE

To examine sex differences in the dose-response association of VILPA with major adverse cardiovascular events (MACE) and its subtypes.

METHODS

Using multivariable-adjusted cubic splines, we examined the associations of daily VILPA duration with overall MACE and its subtypes (incident myocardial infarction, heart failure and stroke) among non-exercisers (individuals self-reporting no leisure-time exercise and no more than one recreational walk per week) in the UK Biobank. We also undertook analogous analyses for vigorous physical activity among exercisers (individuals self-reporting participation in leisure-time exercise and/or recreational walking more than once a week).

RESULTS

Among 13 018 women and 9350 men, there were 331 and 488 all MACE, respectively, over a 7.9-year follow-up. In women, daily VILPA duration exhibited a near-linear dose-response association with all MACE, myocardial infarction and heart failure. In men, dose-reponse curves were less clear with less evidence of statistical signifigance. Compared with women with no VILPA, women's median daily VILPA duration of 3.4 min was associated with hazard ratios (HRs; 95% confidence intervals) of 0.55 (0.41 to 0.75) for all MACE and 0.33 (0.18 to 0.59) for heart failure. Women's minimum doses of 1.2-1.6 min of VILPA per day were associated with HRs of 0.70 (0.58 to 0.86) for all MACE, 0.67 (0.50 to 0.91) for myocardial infarction, and 0.60 (0.45 to 0.81) for heart failure. The equivalent analyses in UK Biobank's accelerometry sub-study exercisers suggested no appreciable sex differences in dose-response.

CONCLUSIONS

Among non-exercising women, small amounts of VILPA were associated with a substantially lower risk of all MACE, myocardial infarction and heart failure. VILPA may be a promising physical activity target for cardiovascular disease prevention, particularly in women unable or not willing to engage in formal exercise.

Effect of brief intense stair climbing on cardiorespiratory fitness and metabolic risk factors in inactive young men with obesity: A randomized controlled trial

BACKGROUND AND AIM

We investigated the effects of brief, intense stair climbing on cardiorespiratory fitness (CRF) and cardiometabolic risk factors in young Korean men with obesity.

METHODS AND RESULTS

Twenty-four healthy men (age: 25.8 ± 2.4 years, BMI: 27.1 ± 2.5 kg/m2) were randomized into either the stair climbing exercise group (n = 12) or the control group (no exercise intervention, n = 12). The stair climbing exercise (5 days per week for 4 weeks) included a 3-min warm-up, followed by three 20-s bouts of vigorous stair climbing [≥80 % of age-predicted maximal heart rate (MHR)], with 2-min of recovery in between. Peak oxygen uptake (VO2peak) and body composition were measured by maximal treadmill test and bioelectrical impedance analysis, respectively. A fasting blood sample was obtained after a 10-h overnight fast to measure cardiometabolic markers. All participants completed the study and attended 97.1 % of all scheduled exercise sessions. There was significant group x time effect on CRF, such that the stair climbing exercise group had significant improvements in VO2peak (pre: 38.7 ± 5.2 versus post: 41.6 ± 5.7 ml/kg/min, P < 0.01) and exercise duration (pre: 10.4 ± 1.8 versus post: 12.1 ± 1.9 min, P < 0.01) during a maximal treadmill test, but with decreases in VO2peak and no change in the exercise duration the control group. Body weight, body fat and metabolic variables were unchanged after stair climbing exercise.

CONCLUSION

Brief, intense stair climbing with a total time commitment of 10 min per day is effective for improving VO2peak in young men with obesity.

CLINICAL TRIAL REGISTRATION

KCT0008139.

Effect of self-paced sprint interval training and low-volume HIIT on cardiorespiratory fitness: the role of heart rate and power output

Aim

The primary aim was to assess the efficacy of self-paced sprint interval training (SIT) with low-volume high-intensity interval training (LV-HIIT) when performed without encouragement on improving cardiorespiratory fitness (CRF). A secondary aim was to explore whether the effort exerted during protocols [power output (PO) and heart rate (HR)] influenced the change in CRF.

Methods

In a randomised cross-over design, 82 previously inactive adults (m/f: 26/56, 28 ± 10 years, BMI 25 ± 3 kg m-2) undertook 6-weeks of self-paced SIT (4-8 × 30 s with 120 s recovery) or LV-HIIT (6-10 × 1 min with 1 min recovery) separated by a 4-week washout period. Sessions were completed 3×/week using WattBikes, and a target of >80% HRmax was suggested during the intervals. Markers of cardio-metabolic health were assessed before and after each intervention.

Results

Training increased VO2peak (SIT +3.1 ± 0.4 mL kg-1 min-1, LV-HIIT +2.7 ± 1.2 mL kg-1 min-1, P < 0.001) and decreased body fat % (P = 0.002), aortic pulse wave velocity (P = 0.002) and glucose tolerance 120 min following an oral glucose tolerance test (P = 0.024), with no difference between protocols (P > 0.05). When grouping participants into tertiles based on HR and PO responses (n = 27), those achieving a low HR had similar changes in VO2peak compared to the high HR group in both interventions (P > 0.05). For LV-HIIT, participants in the highest tertile for peak PO had a greater change in VO2peak compared to all other participants (Low 1.8 ± 4.1 mL kg-1 min-1, Medium 1.9 ± 3.3 mL kg-1 min-1, High 4.3 ± 3.6 ml kg-1 min-1, P = 0.020).

Discussion

Six-weeks of self-paced SIT and LV-HIIT induce comparable improvements in CRF, body composition, arterial stiffness and glucose tolerance. Importantly, higher HR did not elicit superior changes in CRF, but PO achieved during LV-HIIT may influence improvements.

Sex differences in associations of daily stair climbing, genetic predisposition, and risk of cardiovascular disease among 389,973 UK adults

OBJECTIVES

This study aimed to determin the sex differences in associations between daily stair climbing with cardiovascular disease (CVD) risk, and the role of genetic predisposition.

STUDY DESIGN

This study is a prospective cohort study from the UK Biobank.

METHODS

A total of 389,973 adults (mean age of 55.7 years, 45.2 % men) from the UK Biobank were analyzed. The frequency of daily stair climbing was self-reported via questionnaires, and the polygenetic risk score (PRS) of CVD was measured to assess genetic predisposition. Cox proportional hazards regression was used to predict CVD risk.

RESULTS

During a median follow-up of 13.7 years, 57,704 cases were recorded. Compared with the no stair climbing group, both sexes achieved a peak CVD benefit at 11-15 times/day of stair climbing (hazard ratio (HR) 95 % confidence intervals (CI) 0.92 [0.88-0.98] for male, HR 95 % CI 0.86 [0.82-0.90] for female). In the joint analyses, 11-15 times/day of stair climbing was significantly associated with a 12 % lower CVD risk even in the high PRS group of women. For males, 11-15 times/day of stair climbing was significantly associated with CVD risk only in intermediate and high PRS groups, but not in the low PRS group. Results were consistent in subgroup analyses stratified by age.

CONCLUSIONS

Our study demonstrated the negative associations of daily stair climbing with CVD risk were more pronounced in females than in males, and these associations were independent of disease susceptibility to CVD only in females. These findings highlight stair climbing as a low-cost intervention strategy for preventing CVD, especially in females.

Conceptual and Evidence Update on Incidental Physical Activity: A Scoping Review of Experimental and Observational Studies

Promoting incidental physical activity (IPA) can help reduce sedentary lifestyles and physical inactivity levels in the population. However, there is heterogeneity in the definition of IPA, and studies have yet to synthesize the empirical findings on this topic. This review aimed to (1) Synthesize the definitions of the IPA used in the scientific literature, (2) Identify the behaviors part of the IPA, and (3) Synthesize the main findings on IPA. The review followed PRISMA guidelines. A systematic search was performed in July 2023, and an update was made in February 2024 in the CINAHL databases by EBSCOhost, Cochrane Library, Pubmed, ScienceDirect, Scopus, and Web of Science. The search phrase was ("incidental physical activity" OR "incidental physical activity of daily living" OR "incidental movement" OR "vigorous intermittent lifestyle physical activity" OR "VILPA" OR "physical activity of daily living"). Fifty-five studies were included, with non-experimental (40), experimental (12), qualitative studies (2), and mixed design (1). Ten different terms for IPA were identified, and a conceptual definition was included in 33 articles. Behaviors measured as part of the IPA were reported in 41 articles. These definitions describe unstructured, unplanned, and unintentional physical activities of daily living that are performed as a by-product of an activity with a different primary purpose during free or occupational time and without specific fitness, sport, or recreation goals. Include light and vigorous intensities ranging from short sessions of < 1 min to prolonged ones. They include home activities, self-care, gardening, occupation, active transportation, and walking. Furthermore, evidence on IPA suggests an association with a lower risk of all-cause mortality. The findings of this review contribute to the updated study of IPA. Advances in data processing methods are needed to capture the diversity of behaviors and deepen the understanding of IPA.

Time to Elicit Physiological and Exertional Vigorous Responses from Daily Living Activities: Setting Foundations of an Empirical Definition of VILPA

PURPOSE

Vigorous intermittent lifestyle physical activity (VILPA) are bursts of incidental vigorous activity that occur during day-to-day activities outside of the exercise-domain. Vigorous intermittent lifestyle physical activity has shown promise in lowering risk of mortality and chronic disease. However, there is an absence of an empirically derived definition. Using physiological and effort-based metrics commonly used to define vigorous intensity, we investigated the minimum time needed to elicit physiological and perceived exertion responses to standardized activities of daily living.

METHODS

Seventy adults (age = 58.0 ± 9.6 yr; 35 female) completed 9 VILPA activities of daily living in a randomized order, which included fast walking, fast incline walking, stair climbing, stationary cycling, and carrying external weight equal to 5% and 10% of body weight. Metabolic rate (by continuous indirect calorimetry), heart rate (telemetry) and perceived effort (Borg Scale) were measured during exercise. Time to reach VILPA was assessed using %V̇O 2max , %HRmax, and rating of perceived exertion thresholds.

RESULTS

The mean time to elicit VILPA ranged from 65 to 95 s (mean ± sd = 76.7 ± 3.8 s) for %V̇O 2max , 68 to 105 s (mean ± sd = 82.8 ± 6.8 s) for %HRmax, and 20 to 60 s (mean ± sd = 44.6 ± 6.7 s) for rating of perceived exertion. For each of the three indices, there was no difference in the time to elicit VILPA responses by sex or age ( P > 0.08), and times were also consistent between activities of daily living tasks. For example, for females and males, the average time to elicit vigorous responses while walking on a flat surface was 85.8 s (±16.9 s) and 80 s (±13.9 s), respectively, and for stair climbing while carrying 10% of body weight the duration was 78.4 s (±17.6 s) and 76.9 (±17.7 s).

CONCLUSIONS

When participants undertook activities of daily living, VILPA elicited a physiological response at an average of 77 to 83 s for %V̇O 2max and %HRmax, and 45 s for perceived exertion. The absence of a difference in the time to reach VILPA between sex and age suggests that a consistent behavioral VILPA translation can be used in interventions and population-based studies designed to assess the health effects of incidental physical activity.

Effects of Integrating Stair Climbing-Based Exercise Snacks Into the Campus on Feasibility, Perceived Efficacy, and Participation Perspectives in Inactive Young Adults: A Randomized Mixed-Methods Pilot Study

This 6-week pilot study aimed to investigate the feasibility, perceived efficacy, and participation perspectives of a university campus stair climbing-based exercise snack (ES) intervention and to compare it to moderate-intensity continuous training (MICT). Healthy, young, inactive adults (age: 21.6 ± 2.3 years, BMI: 22.5 ± 3.6 kg/m2) were randomly assigned to three groups (ES, MICT, and Control [CON]). ES (n = 14, 6 females) and MICT (n = 13, 9 females) groups performed three sessions per week over 6 weeks, while the control group (n = 15, 9 females) maintained their habitual lifestyle. ES involved 3 × ~30 s 'all-out' stair-climbing (6 flights, total 126 steps and 18.9 m elevation) bouts separated by > 1 h rest, and MICT involved 40 min stationary cycling at 60%-70% HRmax. Mixed linear effect models were used to explore within and between-group differences, and the change in magnitude was determined using mean difference (MD), 95% confidence interval (CI), and Cohen's d effect size. Fourteen participants also completed post-intervention semi-structured interviews. Retention rates of 93% (ES, 14/15), 93% (MICT, 13/14), and 100% (CON, 15/15) were achieved from baseline to post-assessments, with compliance (participants' attendance to scheduled ES sessions) of 97% (733/756 sessions) and 93% (217/234 sessions) in ES and MICT, respectively. No significant differences were found between ES and MICT for future intentions (4.8 ± 1.4 and 5.0 ± 0.9), enjoyment (PACES, 89.0 ± 16.4 and 94.5 ± 11.9), and satisfaction. A significant group × time interaction was found in the quality of life and perceived stress. ES and MICT significantly increased the quality of life by 8% (MD = 5.5 [95% CI = 0.3, 10.7], Cohen's d = 0.64) and 6% (MD = 4.6 [95% CI = 0.9, 8.2], Cohen's d = 0.88) compared to baseline, whereas CON experienced a significant decrease (MD = -7.9 [95% CI = -14.4, -1.6], Cohen's d = 0.56). ES significantly decreased perceived stress by 7% (MD = -4.6 [95% CI = -8.9, -0.3], Cohen's d = 0.58), while MICT (MD = 2.0 [95% CI = -0.1, 4.1], Cohen's d = 0.28) and CON (MD = -2.4 [95% CI = -6.1, 1.3], Cohen's d = 0.22) had no significant effects. The majority (12/14) of participants generally demonstrated positive attitudes toward participation in ES and found it easier than expected while highlighting enablers, barriers, and future recommendations. Stair climbing-based ES could be integrated into the campus setting, appeared feasible, and was similar to MICT regarding future intentions, enjoyment, and satisfaction. Both ES and MICT might induce relevant positive effects on the quality of life, and ES demonstrated greater benefits compared to MICT or CON for reducing perceived stress. Interviews provided positive insights into fostering adherence to ES among university students.

Association of Four Dietary Patterns and Stair Climbing with Major Adverse Cardiovascular Events: A Large Population-Based Prospective Cohort Study

BACKGROUND

The protective effect of a healthy diet combined with stair climbing on cardiovascular health is unclear. We aimed to assess the independent and joint associations of dietary patterns and stair climbing with major adverse cardiovascular events (MACEs).

METHODS

We included 117,384 participants with information on dietary intake and stair climbing from the UK Biobank (UKBB). We excluded participants with MACEs at baseline and death within two years of follow-up. We used restricted cubic spline (RCS) plots describing the linear or nonlinear associations between dietary patterns (the alternate Mediterranean diet score (AMED), dietary approaches to stop hypertension (DASH), the healthful planted-based diet index (HPDI) and the alternate healthy eating index-2010 (AHEI-2010)) and stair climbing and MACEs. COX regressions estimated the hazard ratios (HRs) for incident MACEs associated with dietary patterns combined with stair climbing, and adjusted for sociodemographic, lifestyle and medical factors.

RESULTS

The UKBB documented 9408 MACEs over a median follow-up of 13.3 years. Four dietary patterns were negatively and linearly associated with MACEs (P-nonlinear > 0.05), whereas daily stair climbing was negatively and nonlinearly associated with MACEs (P-nonlinear = 0.011). All of the dietary patterns had significant multiplicative interactions with stair climbing (all p-values < 0.05). The three dietary patterns had the lowest risk ratios for MACEs in the highest tertile (T3) combined with daily stair climbing of 60-100 steps (AMED: 0.78 (0.68, 0.89), DASH: 0.80 (0.70, 0.91) and HPDI: 0.86 (0.75, 0.98)), whereas the AHEI-2010 had the lowest HRs for MACEs in the T1 combined with stair climbing of 110-150 steps (AHEI-2010: 0.81 (0.71, 0.93)).

CONCLUSIONS

Maintaining healthy dietary patterns and adhering to an average of 60-100 steps of stair climbing per day at home can be effective in preventing cardiovascular health-related events.

Lifestyle intervention for metabolic dysfunction-associated fatty liver disease: a 24-h integrated behavior perspective

INTRODUCTION

The prevalence, health and socioeconomic burden of metabolic dysfunction-associated fatty liver disease (MAFLD) is growing, increasing the need for novel evidence-based lifestyle approaches. Lifestyle is the cornerstone for MAFLD management and co-existing cardiometabolic dysfunction. The aim of this review was to evaluate the evidence for lifestyle management of MAFLD, with a specific lens on 24-hour integrated behaviour and provide practical recommendations for implementation of the evidence.

RESULTS

Weight loss ≥ 7-10% is central to lifestyle management; however, liver and cardiometabolic benefits are attainable with improved diet quality and exercise even without weight loss. Lifestyle intervention for MAFLD should consider an integrated '24-h' approach that is cognisant of diet, physical activity/exercise, sedentary behavior, smoking, alcohol intake and sleep. Dietary management emphasises energy deficit and improved diet quality, especially the Mediterranean diet, although sociocultural adaptations to meet preferences should be considered. Increasing physical activity and reducing sedentary behavior can prevent MAFLD, with strongest evidence in MAFLD supporting regular structured moderate-vigorous aerobic exercise for 150-240 min/week. Resistance training in addition to aerobic exercise should be considered and prioritised for those who are losing body mass via diet and/or pharmacological approaches and those with sarcopenia, to minimise bone and lean mass loss. Limited evidence suggests that sleep is important for MAFLD prevention. Emerging novel approaches to diet and exercise may address some of the key barriers to behaviour change (e.g. lack of time, access to resources and social support).

FUTURE DIRECTIONS

Large-scale multidisciplinary trials in people with MAFLD with long-term follow-up, that can be scaled up into mainstream healthcare, are required. Future management guidelines should consider the heterogeneity of MAFLD and specialised models of care that coordinate the health workforce to manage the increased and growing MAFLD population.

Exercise snacks are a time-efficient alternative to moderate-intensity continuous training for improving cardiorespiratory fitness but not maximal fat oxidation in inactive adults: a randomized controlled trial

The aims of this study were (1) to determine how stair-climbing-based exercise snacks (ES) compared to moderate-intensity continuous training (MICT) for improving cardiorespiratory fitness (CRF), and (2) to explore whether ES could improve maximal fat oxidation rate (MFO) in inactive adults. Healthy, young, inactive adults (n: 42, age: 21.6 ± 2.3 years, BMI: 22.5 ± 3.6 kg·m-2, peak oxygen uptake (VO2peak): 33.6 ± 6.3 mL·kg-1·min-1) were randomly assigned to ES, MICT, or Control. ES (n = 14) and MICT (n = 13) groups performed three sessions per week over 6 weeks, while the control group (n = 15) maintained their habitual lifestyle. ES involved 3 × 30 s "all-out" stair-climbing (6 flight, 126 steps, and 18.9 m total height) bouts separated by >1 h rest, and MICT involved 40 min × 60%-70% HRmax stationary cycling. A significant group × time interaction was found for relative VO2peak (p < 0.05) with ES significantly increasing by 7% compared to baseline (MD = 2.5 mL·kg-1·min-1 (95% CI = 1.2, 3.7), Cohen's d = 0.44), while MICT had no significant effects (MD = 1.0 mL·kg-1·min-1 (-1.1, 3.2), Cohen's d = 0.17), and Control experienced a significant decrease (MD = -1.7 mL·kg-1·min-1 (-2.9, -0.4), Cohen's d = 0.26). MFO was unchanged among the three groups (group × time interaction, p > 0.05 for all). Stair climbing-based ES are a time-efficient alternative to MICT for improving CRF among inactive adults, but the tested ES intervention appears to have limited potential to increase MFO.

Reduced-exertion high-intensity interval training (REHIT): a feasible approach for improving health and fitness?

In recent years, research investigating the dose-response to sprint interval training (SIT) has provided evidence that the number and duration of repetitions in a SIT session can be reduced whilst preserving the beneficial health-related adaptations. Together this research has led to the development of protocols involving minimal doses of SIT: regularly performing just two or three 20-30 s all-out sprints in a 10 min training session has been shown to elicit beneficial metabolic and cardiovascular adaptations. These SIT protocols, which we originally termed "reduced-exertion high-intensity interval training" (or REHIT), have the potential to remove many of the common barriers associated with other SIT protocols, as well as with HIT and aerobic exercise. Here, we critically review the evidence on the efficacy, feasibility and acceptability, and effectiveness of REHIT for improving health and fitness.

Relationship of device measured physical activity type and posture with cardiometabolic health markers: pooled dose-response associations from the Prospective Physical Activity, Sitting and Sleep Consortium

AIMS/HYPOTHESIS

The aim of this study was to examine the dose-response associations of device-measured physical activity types and postures (sitting and standing time) with cardiometabolic health.

METHODS

We conducted an individual participant harmonised meta-analysis of 12,095 adults (mean ± SD age 54.5±9.6 years; female participants 54.8%) from six cohorts with thigh-worn accelerometry data from the Prospective Physical Activity, Sitting and Sleep (ProPASS) Consortium. Associations of daily walking, stair climbing, running, standing and sitting time with a composite cardiometabolic health score (based on standardised z scores) and individual cardiometabolic markers (BMI, waist circumference, triglycerides, HDL-cholesterol, HbA1c and total cholesterol) were examined cross-sectionally using generalised linear modelling and cubic splines.

RESULTS

We observed more favourable composite cardiometabolic health (i.e. z score <0) with approximately 64 min/day walking (z score [95% CI] -0.14 [-0.25, -0.02]) and 5 min/day stair climbing (-0.14 [-0.24, -0.03]). We observed an equivalent magnitude of association at 2.6 h/day standing. Any amount of running was associated with better composite cardiometabolic health. We did not observe an upper limit to the magnitude of the dose-response associations for any activity type or standing. There was an inverse dose-response association between sitting time and composite cardiometabolic health that became markedly less favourable when daily durations exceeded 12.1 h/day. Associations for sitting time were no longer significant after excluding participants with prevalent CVD or medication use. The dose-response pattern was generally consistent between activity and posture types and individual cardiometabolic health markers.

CONCLUSIONS/INTERPRETATION

In this first activity type-specific analysis of device-based physical activity, ~64 min/day of walking and ~5.0 min/day of stair climbing were associated with a favourable cardiometabolic risk profile. The deleterious associations of sitting time were fully attenuated after exclusion of participants with prevalent CVD and medication use. Our findings on cardiometabolic health and durations of different activities of daily living and posture may guide future interventions involving lifestyle modification.

A single all-out bout of 30-s sprint-cycle performed on 5 consecutive days per week over 6 weeks does not enhance cardiovascular fitness, maximal strength, and clinical health markers in physically active young adults

BACKGROUND

This study examined the effects of a single all-out bout of 30-s sprint-cycle performed daily for 5 consecutive days per week for 6 weeks, on aerobic fitness, muscle strength and metabolic-health markers in physically active young males and females.

METHODS

Healthy, physically active 20-28 year olds, were randomly assigned to either experimental (EXP, N = 11) or non-training control (CON, N = 8) group. With supervision, the EXP group performed one bout of 30-s sprint-cycle daily, Mondays to Fridays over 6 weeks, while CON group continued with their usual lifestyle. The followings were measured at pre- and post-intervention: maximal aerobic power, peak torque of knee extensors and flexors at velocities 30° s-1 and 300° s-1, resting heart rate, resting blood pressure, body fat percentage, fasting lipid profile, fasting blood glucose, and fasting insulin levels.

RESULTS

There were no significant improvements in the EXP group for all the measured variables (all P > 0.05); except for significant interaction effects in peak torque of knee extensors at 30° s-1 (P = 0.044) and low-density lipoprotein-cholesterol (P = 0.046). Post hoc test indicate that CON group showed decline in their low-density lipo-proteins levels (P = 0.024).

CONCLUSION

Six weeks of one all-out bout of 30-s sprint-cycle per day, for 5 consecutive days per week, was ineffective in improving cardiovascular fitness, maximal strength, and most health markers in physically active young adults. The present results when combined with the previous literature suggest that there is a possibility of a minimum threshold for a number of sprint-cycle bouts needed to be performed before any form of cardio-metabolic-health benefit is accrued.

Motivating factors for physical activity participation among individuals with chronic obstructive pulmonary disease: A qualitative study applying the motivation, opportunity, and ability model

OBJECTIVE

The study aims to explore the driving forces behind physical activity engagement among patients with chronic obstructive pulmonary disease, focusing on motivation, opportunity, and capability.

DESIGN

A phenomenological qualitative study applied the motivation, opportunity, and capability model, conducted in two respiratory units of a Chinese university hospital.

METHODS

Participants, selected by age, gender, and illness duration, included inpatients during the interview sessions and those recently discharged within six months. One-on-one semi-structured interviews were recorded, transcribed, and analyzed by the Colaizzi seven-step method.

RESULTS

Seventeen participants diagnosed with chronic obstructive pulmonary disease for over one year aged between 66 (range: 42-96) participated. Three major themes were identified: Inspiring participation motivation-transitioning from recognizing significance to habit formation; Offering participation opportunities-reiterating demand for personalized strategies and ideal environmental settings; Enhancing participation capability-addressing strategies for overcoming fears, setting goals, ensuring safety, and adjusting activity levels.

CONCLUSIONS

This research underscores the vital role of inspiring participation motivation, offering opportunities, and enhancing the capability for participation in effective engagement. Advocating increased attention from healthcare departments, fostering interdisciplinary collaboration, improving activity guidance and counseling effectiveness, and considering individual preferences can significantly benefit those patients with chronic obstructive pulmonary disease who hesitate or are unable to participate in physical activities, thereby increasing the dose of non-leisure time physical activity.

Effects of acute and chronic stair-climbing exercise on metabolic health: A systematic review

Stair climbing exercise (SE) provides a feasible approach to elevate physical activity, but the effects on metabolic health are unclear. We systematically reviewed the currently available evidence on the effects of SE on fasting and postprandial glycaemia and lipidaemia. Studies were included if they investigated the effects of acute or chronic (at least 2 weeks) SE on fasting and/or postprandial glycaemic (insulin and glucose) and lipidaemic (triacylglycerols and non-esterified fatty acids) responses in healthy, prediabetic or type 2 diabetic adult populations. PubMed, Web of Science and Scopus were searched for eligible studies until July 2022. A total of 25 studies (14 acute and 11 chronic) were eligible for review. Acute bout(s) of SE can reduce postprandial glycaemia in individuals with prediabetes and type 2 diabetes (8 of 9 studies), but not in normoglycemic individuals. The effects of acute SE on postprandial lipidaemic responses and SE training on both fasting and postprandial glycaemia/lipidaemia were unclear. Acute SE may reduce postprandial glucose concentrations in people with impaired glycaemic control, but high-quality studies are needed. More studies are needed to determine the effect of chronic SE training on postprandial glucose and lipid responses, and the acute effects of SE on lipid responses.

Is low-volume high-intensity interval training a time-efficient strategy to improve cardiometabolic health and body composition? A meta-analysis

The present meta-analysis aimed to assess the effects of low-volume high-intensity interval training (LV-HIIT; i.e., ≤5 min high-intensity exercise within a ≤15 min session) on cardiometabolic health and body composition. A systematic search was performed in accordance with PRISMA guidelines to assess the effect of LV-HIIT on cardiometabolic health and body composition. Twenty-one studies (moderate to high quality) with a total of 849 participants were included in this meta-analysis. LV-HIIT increased cardiorespiratory fitness (CRF, SMD = 1.19 [0.87, 1.50]) while lowering systolic blood pressure (SMD = -1.44 [-1.68, -1.20]), diastolic blood pressure (SMD = -1.51 [-1.75, -1.27]), mean arterial pressure (SMD = -1.55 [-1.80, -1.30]), MetS z-score (SMD = -0.76 [-1.02, -0.49]), fat mass (kg) (SMD = -0.22 [-0.44, 0.00]), fat mass (%) (SMD = -0.22 [-0.41, -0.02]), and waist circumference (SMD = -0.53 [-0.75, -0.31]) compared to untrained control (CONTROL). Despite a total time-commitment of LV-HIIT of only 14%-47% and 45%-94% compared to moderate-intensity continuous training and HV-HIIT, respectively, there were no statistically significant differences observed for any outcomes in comparisons between LV-HIIT and moderate-intensity continuous training (MICT) or high-volume HIIT. Significant inverse dose-responses were observed between the change in CRF with LV-HIIT and sprint repetitions (β = -0.52 [-0.76, -0.28]), high-intensity duration (β = -0.21 [-0.39, -0.02]), and total duration (β = -0.19 [-0.36, -0.02]), while higher intensity significantly improved CRF gains. LV-HIIT can improve cardiometabolic health and body composition and represent a time-efficient alternative to MICT and HV-HIIT. Performing LV-HIIT at a higher intensity drives higher CRF gains. More repetitions, longer time at high intensity, and total session duration did not augment gains in CRF.

Joint associations of device-measured physical activity and abdominal obesity with incident cardiovascular disease: a prospective cohort study

OBJECTIVE

To examine the joint associations between physical activity and abdominal obesity with the risk of cardiovascular disease (CVD) events.

METHODS

We included 70 830 UK Biobank participants (mean age±SD=61.6 ± 7.9 years; 56.4% women) with physical activity measured by wrist-worn accelerometers and without major chronic diseases. Participants were jointly categorised into six groups based on their physical activity level (tertiles of total volume and specific intensity levels) and presence or absence of abdominal obesity based on measured waist circumference. Associations with incident CVD (fatal and non-fatal events) were determined using proportional subdistribution hazard models with multivariable adjustment.

RESULTS

After excluding events during the first 2 years of follow-up, participants were followed for a median of 6.8 years, during which 2795 CVD events were recorded. Compared with the low abdominal adiposity and highest tertile of physical activity, abdominal obesity was associated with higher risk of incident CVD, especially in those with low levels of vigorous-intensity physical activity (HR 1.42, 95% CI 1.22 to 1.64). Approximately 500 min per week of moderate-to-vigorous intensity and approximately 30-35 min of vigorous-intensity physical activity offset the association of abdominal obesity and the risk of having a CVD event.

CONCLUSION

Physical activity equivalent to approximately 30-35 min of vigorous intensity per week appears to offset the association between abdominal obesity and incident CVD. About 15 times more physical activity of at least moderate intensity is needed to achieve similar results.

Stair-climbing interventions on cardio-metabolic outcomes in adults: A scoping review

Objective

Physical inactivity is linked with high chronic disease risk; however, only a fraction of the global population meets the recommendations for physical activity. Stair-climbing is a simple and accessible form of physical activity that has been shown to improve cardio-metabolic outcomes in adults. The present scoping review explores the physiological and therapeutic effects of stair-climbing interventions on adult cardio-metabolic disease risk factors.

Methods

This scoping review followed the reporting guidelines of the Arksey & O'Malley framework, which collates evidence in stages. The research question was framed as "What are the effects of stair climbing on cardio-metabolic outcomes in adults?". Eligible articles were identified through an extensive search of four electronic databases, and data from 24 research studies were charted and organized.

Results

Stair climbing improves aerobic capacity (8-33 ml kg/min) and serum biomarkers by ≈9-15 %. A minimum of 4-8 weeks are necessary to alter cardiometabolic risk. Regular stair climbing can improve cardio-metabolic risk indicators, including body composition, blood pressure, cholesterol levels, and insulin sensitivity. The research regarding inflammatory and musculoskeletal changes with stair climbing bouts is still in its infancy.

Conclusion

Stair climbing interventions are a no-cost and feasible form of physical activity for improving cardiometabolic disease risk in adults.

Association of Stair Use With Risk of Major Chronic Diseases

INTRODUCTION

Physical inactivity is associated with a higher risk of chronic diseases. Regular stair use can contribute to increasing physical activity in the population. This study aimed to investigate the association between flights of stairs used daily at home and all-cause mortality and cause-specific incidence and mortality.

METHODS

Of the 502,628 UK Biobank participants recruited between 2007 and 2010, 442,027 (mean age, 56±8 years) had available data and were included in the analyses conducted in 2023. Participants were categorized on the basis of flights of stairs climbed daily (1-5, 6-10, 11-15, >15). The disease-specific outcomes were cardiovascular disease, respiratory disease, cancer, type 2 diabetes, and all-cause dementia. Cox proportional hazard models, adjusted for sociodemographic, lifestyle, and health-related confounding factors, were used to analyze the associations between stair use frequency and health outcomes.

RESULTS

Participants were followed up for a median of 10.9 years. Climbing stairs >15 times per day was associated with a lower risk of 8 of the 9 outcomes analyzed than not using stairs. The magnitude of association ranged from 3% (95% CI=0.94, 0.99) lower risk for all-cause cancer to 51% (95% CI=0.39, 0.60) lower risk of chronic obstructive pulmonary disease. Findings were similar for mortality outcomes, with the hazard ratios ranging from 0.82 (95% CI=0.77, 0.87) for all-cause cancer to 0.46 (95% CI=0.23, 0.92) for chronic obstructive pulmonary disease mortality.

CONCLUSIONS

Stair use was associated with a lower risk of all-cause mortality and cause-specific incidence and mortality independent of confounding factors, including adiposity and multimorbidity.

Exercise in the workplace: examining the receptivity of practical and time-efficient stair-climbing "exercise snacks"

In the workplace, people are often sedentary for prolonged time and do not regularly engage in physical activity-two factors independently linked to premature morbidity and mortality. This study aimed to determine the receptivity of incorporating practical stair-climbing "exercise snacks" (Snacks; three isolated bouts of ascending 53-60 stairs performed sporadically throughout the day) into workplace settings compared to more traditional high-intensity interval training (HIIT; performed as three bouts of 53-60 stairs within a structured HIIT workout) and to explore if these exercise strategies could influence sedentary and physical activity behaviour. Fourteen participants (12 women; Mage = 38.9 ± 10.2 years) completed two supervised exercise trials (Snacks and HIIT) followed by 1 week participating in either form of exercise in their workplace. Ratings of perceived exertion (RPE), affective valence, enjoyment, and self-efficacy were measured at the supervised exercise sessions. During the follow-up period, sedentary behaviour and physical activity were measured with an accelerometer. Affective valence was more positive (p = 0.03; η2 p = 0.21) and there was a lower rise in RPE (p = 0.01; η2 p = 0.29) during Snacks than HIIT. Post-exercise enjoyment of, and self-efficacy towards, Snacks and HIIT were high and similar (ps > 0.05). After the supervised trials, 10/14 of the participants preferred Snacks and 4/14 preferred HIIT (p = 0.18). On days when participants chose to perform either exercise modality, the average number of sit-to-stands in a 24 h period was increased (48.3 ± 8.7 to 52.8 ± 7.8; p = 0.03; Hedge's g = 0.73) and moderate-to-vigorous physical activity tended to increase (21.9 ± 18.2 to 38.1 ± 22.1 min; p = 0.06; Hedge's g = 0.60) compared to days when they chose not to exercise. Stair-climbing exercise snacks may be an attractive approach to implement in the workplace setting and has potential to positively impact sedentary behaviour and physical activity metrics.

Effect of Short Bouts of Vigorous Stair Climbing on Cardiorespiratory Fitness in Women with Overweight and Obesity: A Pilot Feasibility Study

Background

We examined the effect of 4 weeks of a brief vigorous stair climbing exercise on cardiorespiratory fitness (CRF) and body composition in women with overweight or obesity.

Methods

Twenty-six participants (age, 25.4±4.9 years; body mass index [BMI], 25.3±1.8 kg/m2) were randomly assigned to either a stair climbing exercise group (n=13) or a non-exercising control group (n=13). The stair climbing exercise group performed 20 sessions (supervised, five sessions/week over 4 weeks) of brief intermittent stair climbing exercise consisting of a 3-minute warm-up followed by three bouts of 20 seconds of stair climbing (≥80% of age-predicted maximum heart rate) interspersed with 2-minute recovery periods (total exercise duration=10 minutes/session). Peak oxygen uptake (VO2peak) was measured using a graded maximal treadmill test with the use of a standard open-circuit spirometry technique. Body composition was assessed with bioelectrical impedance analysis.

Results

All participants, except one who dropped out due to coronavirus disease 2019 (COVID-19) infection, completed the study with 100% attendance rates. There were significant interaction effects (group×time) on body weight, BMI, waist circumference, and CRF such that the stair climbing exercise group had significant (P≤0.01) reductions in body weight (66.5±4.6 to 65.2±4.6 kg), BMI (24.8±1.2 to 24.4±1.1 kg/m2), and waist circumference (78.0±3.7 to 76.5±4.1 cm) and improvements in VO2peak (31.6±2.5 to 34.9±2.6 mL/kg/min) compared with controls.

Conclusion

Short bouts of vigorous stair climbing is a feasible and time-efficient exercise strategy for improving CRF in previously sedentary, young women with overweight and obesity.

A Perspective on High-Intensity Interval Training for Performance and Health

Interval training is a simple concept that refers to repeated bouts of relatively hard work interspersed with recovery periods of easier work or rest. The method has been used by high-level athletes for over a century to improve performance in endurance-type sports and events such as middle- and long-distance running. The concept of interval training to improve health, including in a rehabilitative context or when practiced by individuals who are relatively inactive or deconditioned, has also been advanced for decades. An important issue that affects the interpretation and application of interval training is the lack of standardized terminology. This particularly relates to the classification of intensity. There is no common definition of the term "high-intensity interval training" (HIIT) despite its widespread use. We contend that in a performance context, HIIT can be characterized as intermittent exercise bouts performed above the heavy-intensity domain. This categorization of HIIT is primarily encompassed by the severe-intensity domain. It is demarcated by indicators that principally include the critical power or critical speed, or other indices, including the second lactate threshold, maximal lactate steady state, or lactate turnpoint. In a health context, we contend that HIIT can be characterized as intermittent exercise bouts performed above moderate intensity. This categorization of HIIT is primarily encompassed by the classification of vigorous intensity. It is demarcated by various indicators related to perceived exertion, oxygen uptake, or heart rate as defined in authoritative public health and exercise prescription guidelines. A particularly intense variant of HIIT commonly termed "sprint interval training" can be distinguished as repeated bouts performed with near-maximal to "all out" effort. This characterization coincides with the highest intensity classification identified in training zone models or exercise prescription guidelines, including the extreme-intensity domain, anaerobic speed reserve, or near-maximal to maximal intensity classification. HIIT is considered an essential training component for the enhancement of athletic performance, but the optimal intensity distribution and specific HIIT prescription for endurance athletes is unclear. HIIT is also a viable method to improve cardiorespiratory fitness and other health-related indices in people who are insufficiently active, including those with cardiometabolic diseases. Research is needed to clarify responses to different HIIT strategies using robust study designs that employ best practices. We offer a perspective on the topic of HIIT for performance and health, including a conceptual framework that builds on the work of others and outlines how the method can be defined and operationalized within each context.

Daily stair climbing, disease susceptibility, and risk of atherosclerotic cardiovascular disease: A prospective cohort study

BACKGROUND AND AIMS

The associations between intensity of stair climbing and atherosclerotic cardiovascular disease (ASCVD) and how these vary by underlying disease susceptibility are not fully understood. We aim to evaluate the intensity of stair climbing and risk of ASCVD types and whether these vary with the presence of ASCVD risk factors.

METHODS

This prospective study used data of 458,860 adult participants from the UK Biobank. Information about stair climbing, sociodemographic, and lifestyle factors was collected at baseline and a resurvey 5 years after baseline. ASCVD was defined as coronary artery disease (CAD), ischemic stroke (IS), or acute complications. Associations between flights of stair climbing and ASCVD were examined as hazard ratios (HRs) from Cox proportional hazards models. The modification role of disease susceptibility on such associations was assessed by analyses stratified by levels of genetic risk score (GRS), 10-year risks of ASCVD, and self-reported family history of ASCVD.

RESULTS

During a median of 12.5 years of follow-up, 39,043 ASCVD, 30,718 CAD, and 10,521 IS cases were recorded. Compared with the reference group (reported climbing stairs 0 times/day at baseline), the multivariable-adjusted HRs for ASCVD were 0.97 (95% CI, 0.93-1.01), 0.84 (0.82-0.87), 0.78 (0.75-0.81), 0.77 (0.73-0.80) and 0.81 (0.77-0.85) for stair climbing of 1-5, 6-10, 11-15, 16-20 and ≥21 times/day, respectively. Comparable results were obtained for CAD and IS. When stratified by different disease susceptibility based on the GRS for CAD/IS, 10-year risk, and family history of ASCVD, the protection association of stair climbing was attenuated by increasing levels of disease susceptibility. Furthermore, compared with people who reported no stair climbing (<5 times/d) at two examinations, those who climbed stairs at baseline and then stopped at resurvey experienced a 32% higher risk of ASCVD (HR 1.32, 95% CI:1.06-1.65).

CONCLUSIONS

Climbing more than five flights of stairs (approx 50 steps) daily was associated with a lower risk of ASCVD types independent of disease susceptibility. Participants who stopped stair climbing between baseline and resurvey had a higher risk of ASCVD compared with those who never climbed stairs.

Rates of compliance and adherence to high-intensity interval training: a systematic review and Meta-analyses

BACKGROUND

To determine rates of compliance (i.e., supervised intervention attendance) and adherence (i.e., unsupervised physical activity completion) to high-intensity interval training (HIIT) among insufficiently active adults and adults with a medical condition, and determine whether compliance and adherence rates were different between HIIT and moderate-intensity continuous training (MICT).

METHODS

Articles on adults in a HIIT intervention and who were either insufficiently active or had a medical condition were included. MEDLINE, EMBASE, PsychINFO, SPORTDiscus, CINAHL, and Web of Science were searched. Article screening and data extraction were completed by two independent reviewers. Risk of bias was assessed using RoB 2.0 or ROBINS-I. Meta-analyses were conducted to discern differences in compliance and adherence between HIIT vs. MICT. Sensitivity analyses, publication bias, sub-group analyses, and quality appraisal were conducted for each meta-analysis.

RESULTS

One hundred eighty-eight unique studies were included (n = 8928 participants). Compliance to HIIT interventions averaged 89.4% (SD:11.8%), while adherence to HIIT averaged 63% (SD: 21.1%). Compliance and adherence to MICT averaged 92.5% (SD:10.6%) and 68.2% (SD:16.2%), respectively. Based on 65 studies included in the meta-analysis, compliance rates were not different between supervised HIIT and MICT interventions [Hedge's g = 0.015 (95%CI: - 0.088-0.118), p = .78]. Results were robust and low risk of publication bias was detected. No differences were detected based on sub-group analyses comparing medical conditions or risk of bias of studies. Quality of the evidence was rated as moderate over concerns in the directness of the evidence. Based on 10 studies, adherence rates were not different between unsupervised HIIT and MICT interventions [Hedge's g = - 0.313 (95%CI: - 0.681-0.056), p = .096]. Sub-group analysis points to differences in adherence rates dependent on the method of outcome measurement. Adherence results should be interpreted with caution due to very low quality of evidence.

CONCLUSIONS

Compliance to HIIT and MICT was high among insufficiently active adults and adults with a medical condition. Adherence to HIIT and MICT was relatively moderate, although there was high heterogeneity and very low quality of evidence. Further research should take into consideration exercise protocols employed, methods of outcome measurement, and measurement timepoints.

REGISTRATION

This review was registered in the PROSPERO database and given the identifier CRD42019103313.

Vigorous Intermittent Lifestyle Physical Activity and Cancer Incidence Among Nonexercising Adults: The UK Biobank Accelerometry Study

Importance

Vigorous physical activity (VPA) is a time-efficient way to achieve recommended physical activity (PA) for cancer prevention, although structured longer bouts of VPA (via traditional exercise) are unappealing or inaccessible to many individuals.

Objectives

To evaluate the dose-response association of device-measured daily vigorous intermittent lifestyle physical activity (VILPA) with incident cancer, and to estimate the minimal dose required for a risk reduction of 50% of the maximum reduction.

Design, Setting, and Participants

This was a prospective cohort analysis of 22 398 self-reported nonexercising adults from the UK Biobank accelerometry subsample. Participants were followed up through October 30, 2021 (mortality and hospitalizations), or June 30, 2021 (cancer registrations).

Exposures

Daily VILPA of up to 1 and up to 2 minutes, assessed by accelerometers worn on participants' dominant wrist.

Main Outcomes and Measures

Incidence of total cancer and PA-related cancer (a composite outcome of 13 cancer sites associated with low PA levels). Hazard ratios and 95% CIs were estimated using cubic splines adjusted for age, sex, education level, smoking status, alcohol consumption, sleep duration, fruit and vegetable consumption, parental cancer history, light- and moderate-intensity PA, and VPA from bouts of more than 1 or 2 minute(s), as appropriate.

Results

The study sample comprised 22 398 participants (mean [SD] age, 62.0 [7.6] years; 10 122 [45.2%] men and 12 276 [54.8%] women; 21 509 [96.0%] White individuals). During a mean (SD) follow-up of 6.7 (1.2) years (149 650 person-years), 2356 total incident cancer events occurred, 1084 owing to PA-related cancer. Almost all (92.3%) of VILPA was accrued in bouts of up to 1 minute. Daily VILPA duration was associated with outcomes in a near-linear manner, with steeper dose-response curves for PA-related cancer than total cancer incidence. Compared with no VILPA, the median daily VILPA duration of bouts up to 1 minute (4.5 minutes per day) was associated with an HR of 0.80 (95% CI, 0.69-0.92) for total cancer and 0.69 (95% CI, 0.55-0.86) for PA-related cancer. The minimal dose was 3.4 minutes per day for total (HR, 0.83; 95% CI, 0.73-0.93) and 3.7 minutes for PA-related (HR, 0.72; 95% CI, 0.59-0.88) cancer incidence. Findings were similar for VILPA bout of up to 2 minutes.

Conclusions and Relevance

The findings of this prospective cohort study indicate that small amounts of VILPA were associated with lower incident cancer risk. Daily VILPA may be a promising intervention for cancer prevention in populations not able or motivated to exercise in leisure time.

Stair climbing, genetic predisposition, and the risk of incident type 2 diabetes: A large population-based prospective cohort study

BACKGROUND

Cross-sectional evidence and small-scale trials suggest positive effects of stair climbing on cardiometabolic disease and glucose regulation. However, few studies have examined the long-term association between stair climbing and the incidence of type 2 diabetes (T2D). We aimed to prospectively evaluate the association of stair climbing with T2D and assess modifications by genetic predisposition to T2D.

METHODS

We included 451,699 adults (mean age = 56.3 ± 8.1 years, mean ± SD; 55.2% females) without T2D at baseline in the UK Biobank and followed up to March 31, 2021. Stair climbing information was collected through the touchscreen questionnaire. Genetic risk score for T2D consisted of 424 single nucleotide polymorphisms.

RESULTS

During a median follow up of 12.1 years, 14,896 T2D cases were documented. Compared with participants who reported no stair climbing, those who climbed stairs regularly had a lower risk of incident T2D (10-50 steps/day: hazard ratio (HR) = 0.95, 95% confidence interval (95%CI): 0.89-1.00; 60-100 steps/day: HR = 0.92, 95%CI: 0.87-0.98; 110-150 steps/day: HR = 0.86, 95%CI: 0.80-0.91; >150 steps/day: HR = 0.93, 95%CI: 0.87-0.99, p for trend = 0.0007). We observed a significant interaction between stair climbing and genetic risk score on the subsequent T2D risk (p for interaction = 0.0004), where the risk of T2D showed a downward trend in subjects with low genetic risk and those who reported stair climbing activity of 110-150 steps/day appeared to have the lowest overall T2D risk among those with intermediate to high genetic risk.

CONCLUSION

A higher number of stairs climbed at home was associated with lower T2D incidence risk, especially among individuals with a low genetic predisposition to T2D. These findings highlight that stair climbing, as incidental physical activity, offers a simple and low-cost complement to public health interventions for T2D prevention.

Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality

Wearable devices can capture unexplored movement patterns such as brief bursts of vigorous intermittent lifestyle physical activity (VILPA) that is embedded into everyday life, rather than being done as leisure time exercise. Here, we examined the association of VILPA with all-cause, cardiovascular disease (CVD) and cancer mortality in 25,241 nonexercisers (mean age 61.8 years, 14,178 women/11,063 men) in the UK Biobank. Over an average follow-up of 6.9 years, during which 852 deaths occurred, VILPA was inversely associated with all three of these outcomes in a near-linear fashion. Compared with participants who engaged in no VILPA, participants who engaged in VILPA at the sample median VILPA frequency of 3 length-standardized bouts per day (lasting 1 or 2 min each) showed a 38%-40% reduction in all-cause and cancer mortality risk and a 48%-49% reduction in CVD mortality risk. Moreover, the sample median VILPA duration of 4.4 min per day was associated with a 26%-30% reduction in all-cause and cancer mortality risk and a 32%-34% reduction in CVD mortality risk. We obtained similar results when repeating the above analyses for vigorous physical activity (VPA) in 62,344 UK Biobank participants who exercised (1,552 deaths, 35,290 women/27,054 men). These results indicate that small amounts of vigorous nonexercise physical activity are associated with substantially lower mortality. VILPA in nonexercisers appears to elicit similar effects to VPA in exercisers, suggesting that VILPA may be a suitable physical activity target, especially in people not able or willing to exercise.

High-Intensity Interval Training (HIIT) in Hypoxia Improves Maximal Aerobic Capacity More Than HIIT in Normoxia: A Systematic Review, Meta-Analysis, and Meta-Regression

The present study aimed to determine the effect of high intensity interval training (HIIT) in hypoxia on maximal oxygen uptake (VO_2max) compared with HIIT in normoxia with a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-accordant meta-analysis and meta-regression. Studies which measured VO_2max following a minimum of 2 weeks intervention featuring HIIT in hypoxia versus HIIT in normoxia were included. From 119 originally identified titles, nine studies were included (n = 194 participants). Meta-analysis was conducted on change in (∆) VO_2max using standardised mean difference (SMD) and a random effects model. Meta-regression examined the relationship between the extent of environmental hypoxia (fractional inspired oxygen [FiO₂]) and ∆VO_2max and intervention duration and ∆VO_2max. The overall SMD for ∆VO_2max following HIIT in hypoxia was 1.14 (95% CI = 0.56-1.72; p < 0.001). Meta-regressions identified no significant relationship between FiO₂ (coefficient estimate = 0.074, p = 0.852) or intervention duration (coefficient estimate = 0.071, p = 0.423) and ∆VO_2max. In conclusion, HIIT in hypoxia improved VO_2max compared to HIIT in normoxia. Neither extent of hypoxia, nor training duration modified this effect, however the range in FiO₂ was small, which limits interpretation of this meta-regression. Moreover, training duration is not the only training variable known to influence ∆VO_2max, and does not appropriately capture total training stress or load. This meta-analysis provides pooled evidence that HIIT in hypoxia may be more efficacious at improving VO_2max than HIIT in normoxia. The application of these data suggest adding a hypoxic stimuli to a period of HIIT may be more effective at improving VO_2max than HIIT alone. Therefore, coaches and athletes with access to altitude (either natural or simulated) should consider implementing HIIT in hypoxia, rather than HIIT in normoxia where possible, assuming no negative side effects.

Vigorous physical activity, incident heart disease, and cancer: how little is enough?

AIMS

Vigorous physical activity (VPA) is a time-efficient way to achieve recommended physical activity levels. There is a very limited understanding of the minimal and optimal amounts of vigorous physical activity in relation to mortality and disease incidence.

METHODS AND RESULTS

A prospective study in 71 893 adults [median age (IQR): 62.5 years (55.3, 67.7); 55.9% female] from the UK Biobank cohort with wrist-worn accelerometry. VPA volume (min/week) and frequency of short VPA bouts (≤2 min) were measured. The dose-response associations of VPA volume and frequency with mortality [all-cause, cardiovascular disease (CVD) and cancer], and CVD and cancer incidence were examined after excluding events occurring in the first year. During a mean post-landmark point follow-up of 5.9 years (SD ± 0.8), the adjusted 5-year absolute mortality risk was 4.17% (95% confidence interval: 3.19%, 5.13%) for no VPA, 2.12% (1.81%, 2.44%) for >0 to <10 min, 1.78% (1.53%, 2.03%) for 10 to <30 min, 1.47% (1.21%, 1.73%) for 30 to <60 min, and 1.10% (0.84%, 1.36%) for ≥60 min. The 'optimal dose' (nadir of the curve) was 53.6 (50.5, 56.7) min/week [hazard ratio (HR): 0.64 (0.54, 0.77)] relative to the 5th percentile reference (2.2 min/week). There was an inverse linear dose-response association of VPA with CVD mortality. The 'minimal' volume dose (50% of the optimal dose) was ∼15 (14.3, 16.3) min/week for all-cause [HR: 0.82 (0.75, 0.89)] and cancer [HR: 0.84 (0.74, 0.95)] mortality, and 19.2 (16.5, 21.9) min/week [HR: 0.60 (0.50, 0.72)] for CVD mortality. These associations were consistent for CVD and cancer incidence. There was an inverse linear association between VPA frequency and CVD mortality. 27 (24, 30) bouts/week was associated with the lowest all-cause mortality [HR: 0.73 (0.62, 0.87)].

CONCLUSION

VPA of 15-20 min/week were associated with a 16-40% lower mortality HR, with further decreases up to 50-57 min/week. These findings suggest reduced health risks may be attainable through relatively modest amounts of VPA accrued in short bouts across the week.

High-intensity circuit training for improving anthropometric parameters for women from low socioeconomic communities of Sikandarabad: A clinical trial

Background

An alarming trend of sustained physical inactivity has been observed among women in socioeconomically disadvantaged areas, mainly due to the lack of time and high cost of gym facilities. Although physical activity essentially contributes to disease prevention, evidence supporting time-efficient exercise on anthropometric measures is limited. This study aimed to identify the effectiveness of interval-based high-intensity circuit training (HICT) on anthropometric measures and the nature of the relationship between these measures.

Methods

A single-group, quasi-experimental study was conducted in the community park of Ziauddin Hospital at Sikandarabad. Sixty women who were overweight and had sedentary lifestyles were recruited for a six-week HICT-based program conducted at 85%–95% maximum heart rate (MHR) on every alternate day. Outcome measures were assessed at baseline and at 6-weeks including anthropometric parameters (body mass index [BMI], body fat percentage [BF%], and waist-to-hip ratio [WHR]).

Results

The six-week HICT-based program demonstrated a significant reduction in BMI (p<0.001), BF% (p<0.001), and WHR (p<0.001). Reductions in the BMI mean from 27.3±1.3 to 25.1±1.4 and BF% mean from 31.9±2.3 to 27.6±2.4 were observed following 18 sessions of HICT. The effect of age on BF% and WHR was linearly significant (p<0.001) with increasing age (BF%) and WHR.

Conclusion

Interval-based HICT was an effective exercise regimen for improving BMI, BF%, and WHR. Furthermore, the exercise protocol was feasible and well tolerated, with no reported adverse events, and it could be easily implemented in real-world community settings. BF% and WHR were significantly influenced by increasing age; therefore, our findings support the importance of exercise implementation, especially with increasing age, for the maintenance of a disease-free healthy lifestyle.

Acute appetite and eating behaviour responses to apparatus-free, high-intensity intermittent exercise in inactive women with excess weight

High-intensity intermittent exercise (HIIE) has been shown to transiently suppress appetite, but such exercise has traditionally required the use of specialist apparatus (e.g., cycle ergometer). This study aimed to determine appetite and eating behaviour responses to acute apparatus-free HIIE in inactive women with excess weight. A preliminary study (n = 18 inactive women, 9 healthy weight, 18.0-24.9 kg∙m^-2; 9 with excess weight, 25.0-34.9 kg∙m^-2) revealed that intervals of 30 s of "all out" star jumping elicited physiological responses akin to intervals of 30 s of "all out" cycling. Twelve women (29.2 ± 2.9kg∙m^-2, 38 ± 7years, 28 ± 39 min MVPA∙week^-1) then completed three trials in a within-subject, randomised cross-over design: 4 × 30 s "all out" star jumping (4 × 30 s); 2 × 30 s "all out" star jumping (2 × 30 s); resting control (CONT). Upon completing each late-morning exercise trial, lunch was provided upon request from the participant. The time from the exercise bout to lunch request - termed eating latency - was recorded, and ad libitum food intake at lunch was measured. Subjective appetite was measured using a visual analogue scale before and after exercise, and at lunch request. Free-living energy intake (EI) and energy expenditure (EE) were recorded for the remainder of the trial day and the three days following. Change-from-baseline in subjective appetite was significantly lower immediately after 4 × 30 s (-9.6 ± 18.4 mm) and 2 × 30 s (-11.5 ± 21.2 mm) vs. CONT (+8.1 ± 9.6 mm), (both p < 0.05, d = 0.905 and 1.027, respectively). Eating latency (4 × 30 s: 32 ± 33 min, 2 × 30 s: 31 ± 26 min, CONT: 27 ± 23 min, p = 0.843; η²_p = 0.017) and lunch EI (4 × 30 s: 662±178 kcal, 2 × 30 sec: 715 ± 237 kcal, CONT: 726 ± 268 kcal, p = 0.451; η²_p = 0.077) did not differ significantly between conditions. No significant differences were observed in trial day EI and EE, or in EI and EE on the three days following exercise (all p > 0.05). Mean trial day relative EI (EI - EE) was 201 ± 370 kcal lower after 4 × 30 s than CONT, but this difference was not statistically significant (p = 0.303, d = 0.585). In conclusion, very low-volume star jumping elicited a transient suppression of appetite without altering eating behaviour. (313 words).

Very Low-Volume, High-Intensity Interval Training Mitigates Negative Health Impacts of COVID-19 Pandemic-Induced Physical Inactivity

Initially, we aimed to investigate the impact of a one-year worksite low-volume, high-intensity interval training (LOW-HIIT) on cardiometabolic health in 114 sedentary office workers. Due to the COVID-19 pandemic outbreak, LOW-HIIT was discontinued after 6 months and participants were followed up for 6 months to analyze physical activity/exercise behavior and outcome changes during lockdown. Health examinations, including cardiopulmonary exercise testing and the assessment of cardiometabolic markers were performed baseline (T-1), after 6 months (T-2, termination of worksite LOW-HIIT) and 12 months (T-3, follow-up). Cycle ergometer LOW-HIIT (5 × 1 min at 85-95% HRmax) was performed 2×/week. For follow-up analyses, participants were classified into three groups: HIIT-group (continued home-based LOW-HIIT), EX-group (continued other home-based exercises), and NO-EX-group (discontinued LOW-HIIT/exercise). At T-2, VO2max (+1.5 mL/kg/min, p = 0.002), mean arterial blood pressure (MAB, -4 mmHg, p < 0.001), HbA1c (-0.2%, p = 0.005) and self-reported quality of life (QoL, +5 points, p < 0.001) were improved. At T-3, HIIT-group maintained VO2max and QoL and further improved MAB. EX-group maintained MAB and QoL but experienced a VO2max decrease. In NON-EX, VO2max, MAB and QoL deteriorated. We conclude that LOW-HIIT can be considered a promising option to improve cardiometabolic health in real-life conditions and to mitigate physical inactivity-related negative health impacts during lockdowns.

Cardiovascular responses to high-intensity stair climbing in individuals with coronary artery disease

Exercise-based cardiac rehabilitation leads to improvements in cardiovascular function in individuals with coronary artery disease. The cardiac effects of coronary artery disease (CAD) can be quantified using clinical echocardiographic measures, such as ejection fraction (EF). Measures of cardiovascular function typically only used in research settings can provide additional information and maybe more sensitive indices to assess changes after exercise-based cardiac rehabilitation. These additional measures include endothelial function (measured by flow-mediated dilation), left ventricular twist, myocardial performance index, and global longitudinal strain. To investigate the cardiovascular response to 12 week of either traditional moderate-intensity (TRAD) or stair climbing-based high-intensity interval (STAIR) exercise-based cardiac rehabilitation using both clinical and additional measures of cardiovascular function in individuals with CAD. Measurements were made at baseline (BL) and after supervised (4wk) and unsupervised (12 week) of training. This study was registered as a clinical trial at clinicaltrials.gov (NCT03235674). Participants were randomized into either TRAD (n = 9, 8M/1F) and STAIR (n = 9, 8M/1F). There was a training-associated increase in one component of left ventricular twist: Cardiac apical rotation (TRAD: BL: 5.6 ± 3.3º, 4 week: 8.0 ± 3.9º, 12 week: 6.2 ± 5.1º and STAIR: BL: 5.1 ± 3.6º, 4 week: 7.4 ± 3.9º, 12 week: 7.8 ± 2.8º, p (time) = 0.03, η2  = 0.20; main effect) and post-hoc analysis revealed a difference between BL and 4 week (p = 0.02). There were no changes in any other clinical or additional measures of cardiovascular function. The small increase in cardiac apical rotation observed after 4 weeks of training may indicate an early change in cardiac function. A larger overall training stimulus may be needed to elicit other cardiovascular function changes.

Effects of low-volume, high-intensity interval training on maximal oxygen consumption, body fat percentage and health-related quality of life in women with overweight: A randomized controlled trial

Background

Several investigations suggest that high-intensity interval training (HIIT) provokes larger changes in VO_2max compared to moderate-intensity continuous training (MICT); other studies associate HIIT with significant decreases in total, abdominal and visceral fat mass. However, some meta-analyses express that the enhancements with HIIT on VO_2max are slightly higher concerning MICT. These studies had low-to-moderate methodological quality, and the exercise protocols were completed mostly on treadmills or cycle ergometers. Thus, the objective of this study was to compare the effect of a low-volume HIIT versus a MICT program on VO_2max, body fat percentage (BFP), and health-related quality of life (HRQoL) in overweight women. It followed a research protocol with high methodological rigor and good reporting quality.

Methods

After two physical adaptation weeks (run-in period), thirty-five volunteers were randomized to HIIT (n = 16) or MICT (n = 19). Both groups performed 24 sessions on a grass sports field (walking, jogging or running). The HIIT group completed 15 bouts of 30 s [90–95%, maximal heart rate (HR_max)], while the MICT group completed 30 min of continuous exercise (65–75% HR_max).

Results

The difference between HIIT and MICT post-intervention on VO_2max was not statistically significant (0.8 ml/kg/min. CI 95%, −1.0 to 2.7, p = 0.37). Similarly, no statistically significant differences were found between groups for BFP and HRQoL.

Conclusions

Low-volume HIIT program has no quantitative advantage compared with that resulting from MICT, in VO2max, BFP, and HRQoL. ClinicalTrials.gov Identifier: NCT03300895.

The Effect of Brief Stair-Climbing on Divergent and Convergent Thinking

Recent studies show that even a brief bout of aerobic exercise may enhance creative thinking. However, few studies have investigated the effect of exercise conducted in natural settings. Here, in a crossover randomized controlled trial, we investigated the effect of a common daily activity, stair-climbing, on creative thinking. As experimental intervention, subjects were asked to walk downstairs from the fourth to the first floor and back at their usual pace. As control intervention, they walked the same path but using the elevator instead. Compared to using the elevator, stair-climbing enhanced subsequent divergent but not convergent thinking in that it increased originality on the Alternate Use Test (d = 0.486). Subjects on average generated 61% more original uses after stair-climbing. This is the first study to investigate the effect of stair-climbing on creative thinking. Our findings suggest that stair-climbing may be a useful strategy for enhancing divergent thinking in everyday life.

Exercise Snacks: A Novel Strategy to Improve Cardiometabolic Health

We define exercise snacks as isolated ≤1-min bouts of vigorous exercise performed periodically throughout the day. We hypothesize that exercise snacks are a feasible, well-tolerated, and time-efficient approach to improve cardiorespiratory fitness and reduce the negative impact of sedentary behavior on cardiometabolic health. Efficacy has been demonstrated in small proof-of-concept studies. Additional research should investigate this novel physical activity strategy.

Psychological Aspects of Stair Use: A Systematic Review

Stair use, a common lifestyle activity, is a moderate-to-vigorous physical activity that, despite often being brief in duration, may contribute to psychological health. A systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) method to summarize psychological aspects related to stair use. Included studies examined at least 1 psychological outcome in relation to either objective measures of stair use, such as time or stair height, or subjective measures of, or measures related to, stair use such as perceived difficulty using stairs. A total of 22 studies met the inclusion criteria; 12 used subjective stair use measures and 10 used objective stair use measures. The limited evidence from studies using self-reports supported that (1) perceived difficulty using stairs was positively associated with increased symptoms of anxiety and depression and (2) stair use was not associated with a reduced incidence of mental illnesses such as depression, suicide, or dementia. Studies using objective measures of stair use supported that (3) elevated symptoms of anxiety and depression are negatively associated with stair use performance. Given the widespread use of stairs, there is surprisingly little data about the extent to which, and for whom, stair use influences psychological health.

Physiological Responses to Low-Volume Interval Training in Women

Interval training is a form of exercise that involves intermittent bouts of relatively intense effort interspersed with periods of rest or lower-intensity exercise for recovery. Low-volume high-intensity interval training (HIIT) and sprint interval training (SIT) induce physiological and health-related adaptations comparable to traditional moderate-intensity continuous training (MICT) in healthy adults and those with chronic disease despite a lower time commitment. However, most studies within the field have been conducted in men, with a relatively limited number of studies conducted in women cohorts across the lifespan. This review summarizes our understanding of physiological responses to low-volume interval training in women, including those with overweight/obesity or type 2 diabetes, with a focus on cardiorespiratory fitness, glycemic control, and skeletal muscle mitochondrial content. We also describe emerging evidence demonstrating similarities and differences in the adaptive response between women and men. Collectively, HIIT and SIT have consistently been demonstrated to improve cardiorespiratory fitness in women, and most sex-based comparisons demonstrate similar improvements in men and women. However, research examining insulin sensitivity and skeletal muscle mitochondrial responses to HIIT and SIT in women is limited and conflicting, with some evidence of blunted improvements in women relative to men. There is a need for additional research that examines physiological adaptations to low-volume interval training in women across the lifespan, including studies that directly compare responses to MICT, evaluate potential mechanisms, and/or assess the influence of sex on the adaptive response. Future work in this area will strengthen the evidence-base for physical activity recommendations in women.

Functional high-intensity interval training is not equivalent when compared to combined training for blood pressure improvements in postmenopausal women: a randomized controlled trial

INTRODUCTION

Low-volume functional high-intensity interval training (F-HIIT) improves cardiorespiratory fitness, body composition, and physical function similarly to combined training (CT, gold standard protocol), however no previous studies have compared the F-HIIT equivalence with CT in reducing blood pressure in older people, particularly in postmenopausal women (PW). Therefore, the aim of this study (trial registration: NCT03200639) was designed to test whether F-HIIT of low volume is an equivalent strategy to CT for improving blood pressure (BP) in PW.

MATERIAL AND METHOD

Forty-nine PW were divided into two groups: F-HIIT and CT. The F-HIIT protocol was composed of 10 sets of 60 seconds of high-intensity exercises interspersed with 60 seconds of low-intensity exercises for recovery. The CT protocol was composed of 30 minutes of moderate-intensity walking, followed by five total body resistance exercises. Both protocols were performed 3-times-a-week for 12 weeks. The BP from rest condition (before exercise) was measured before and after 12 weeks of intervention in both groups, using an automatic blood pressure monitor. The boundaries values for equivalence for systolic and diastolic BP was set at 5.14 and 2.92 mmHg, respectively.

RESULTS

There was only a significant reduction (P < .05) in systolic BP in CT group from baseline (-3.2 (95% CI, -6.2 to -0.2) mmHg). The difference of systolic BP between F-HIIT and CT was 5.8 (95% CI, 1.3-10.4) mmHg, showing non-equivalence (inferiority) for F-HIIT.

CONCLUSION

Thus, these results suggest that low-volume F-HIIT protocol is not an equivalent strategy when compared to CT for BP improvements in PW.

Effects of a Brief Stair-Climbing Intervention on Cognitive Functioning and Mood States in Older Adults: A Randomized Controlled Trial

Despite an abundance of evidence that exercise benefits cognition and mood, physical activity levels among older adults remain low, with time and inaccessibility posing major barriers. Interval stair climbing is an accessible time-efficient form of physical activity demonstrated to benefit cognition and mood in young adults, but effectiveness in older adults remains unknown. To address this, 28 older adults (Mage = 69.78 years, 16 females) undertook cognitive and mood assessments twice, 1 week apart, once preceded by interval stair climbing. A fairly large, albeit only marginally significant, effect size (ηp2=.12) indicated improved cognition following the moderate- to high-intensity intervention; however, rather than improving mood, older adults reported feeling more tired (g = 0.51). These outcomes provide initial indications that this mode of exercise that can easily translate to naturalistic settings offers promise as an intervention strategy, but more research is needed to optimize the protocol to suit aged populations (ACTRN1261900169014).

Using Focus Groups and Interviews to Inform the Design of a Workplace Exercise Programme: An Example From a High-Intensity Interval Training Intervention

OBJECTIVE

Using a formative evaluation of a high-intensity interval training (HIIT) intervention, we illustrate how qualitative data can inform the development of workplace exercise interventions.

METHOD

Eight focus groups and four interviews were conducted with employees (n = 38) and management (n = 4) from six office-based organisations before intervention implementation.

RESULTS

Some participants thought workplace-based HIIT would be practical, given the limited time required. Others perceived it may not be acceptable for all individuals, given the exercise intensity. With consideration of identified barriers (workload/family commitments effecting time availability) and facilitators (flexible working conditions) participants' perspectives were incorporated into the intervention protocol. A short-term group-based intervention was preferred, with a choice of exercise modes (based on stair climbing, stepping or boxing).

CONCLUSION

This study provides a framework to incorporate stakeholders' perspectives into the development of workplace exercise interventions.

Brief Exercise at Work (BE@Work): A Mixed-Methods Pilot Trial of a Workplace High-Intensity Interval Training Intervention

Introduction: The efficacy of high-intensity interval training (HIIT) for improving markers of physical fitness and cardiometabolic health is promising. The workplace is one non-laboratory setting where the effectiveness of HIIT could be explored. The aim of this study was to undertake a mixed-methods exploratory pilot trial of a workplace HIIT intervention named Brief Exercise at Work (BE@Work). Methods: Fifty-four healthy employees (mean ± standard deviation [SD] age 46 ± 10 years) from two workplaces in Northeast England were allocated to 8 weeks of thrice-weekly workplace HIIT based on boxing, stair climbing and stepping, comprising 4-7 60 s high-intensity intervals interspersed with 75 s rest (n = 30), or a no-intervention control (n = 24). The primary outcome was the change SD of predicted maximal oxygen consumption (VO2max). Markers of physical fitness, cardiometabolic health and mental well-being were also measured at baseline and follow-up. Participant perceptions of the intervention were explored in post-intervention focus groups (n = 9). Results: Mean (±SD) session attendance was 82% (±15%). Mean peak heart rate across the intervention was 87% of age-predicted maximal heart rate with a within- and between-subject SD of 5.5% and 3.7%, respectively. The SD of changes in predicted VO2max was 6.6 mL·kg-1·min-1 across both groups, which can be used to inform sample size estimations for a future full trial. The control-adjusted mean increase (95% confidence interval) in predicted VO2max was 3.9 (-0.2 to 8.1) mL·kg-1·min-1, corresponding to a Cohen's D of 0.47. We also observed preliminary evidence of small to moderate effects in favour of the intervention group for non-dominant leg extensor muscle power, markers of health-related quality of life, well-being and perceived stress and small to moderate effects in favour of the controls in perceived pain, physical activity and high-density lipoprotein cholesterol. During HIIT, focus group participants reported physiological responses they perceived as unpleasant or tiring (e.g., breathlessness, local muscular fatigue), but also that they felt alert and energised afterwards. Conclusion: The findings of this exploratory pilot trial support the implementation of a definitive randomised controlled trial to quantify the effectiveness of a workplace HIIT intervention.

Stair climbing and mortality: a prospective cohort study from the UK Biobank

BACKGROUND

Regular stair climbing has the potential to lower the risk of premature death, but current evidence is scarce. We aimed to examine whether daily stair climbing is associated with lower risk of all-cause, cancer, and cardiovascular disease (CVD) mortality.

METHODS

Using the UK Biobank cohort, we extracted information of self-reported daily flights of stairs climbed at home, categorized as none, 1 to 5, 6 to 10, 11 to 15, and ≥16 flights per day. Associations between flights of stair climbed per day and mortality were examined as hazard ratios (HRs) from Cox proportional hazards models adjusted for demographic, clinical, and behavioural covariates including time spent in other physical activities. We calculated the restricted mean survival time as an absolute measure of association. The risk of residual confounding was examined using propensity score matching and by using lung cancer as negative control outcome. Participants were followed from baseline (2006-2010) through 31 March 2020.

RESULTS

A total of 280 423 participants (median follow-up 11.1 years, during which 9445 deaths occurred) were included. Compared with not climbing any stairs, climbing more than five flights of stairs at home per day was associated with lower risk of premature mortality. The lowest risk was found for those climbing 6-10 flights per day: 0.91; 95% confidence interval (CI): 0.85, 0.98, translated to approximately 44 to 55 days of additional survival. A similar pattern was found after applying propensity score matching and for cancer mortality (6-10 flights per day HR: 0.88; 95% CI: 0.80, 0.97), but not for CVD mortality (6-10 flights per day HR: 1.08; 95% CI: 0.91, 1.29). The association between stair climbing and lung cancer was similar to that of all-cause mortality.

CONCLUSIONS

Climbing more than five flights of stairs at home per day was associated with a lower risk of all-cause and cancer mortality, but not CVD mortality, compared with those who did not take the stairs. The magnitude of the association was small and appeared susceptible to residual confounding. It is unlikely that at-home stair climbing is sufficient physical activity stimuli to lower the risk of premature mortality.

Brief Vigorous Stair Climbing Effectively Improves Cardiorespiratory Fitness in Patients With Coronary Artery Disease: A Randomized Trial

Background: Cardiac rehabilitation exercise reduces the risk of secondary cardiovascular disease. Interval training is a time-efficient alternative to traditional cardiac rehabilitation exercise and stair climbing is an accessible means. We aimed to assess the effectiveness of a high-intensity interval stair climbing intervention on improving cardiorespiratory fitness (V˙O2peak) compared to standard cardiac rehabilitation care.

Methods: Twenty participants with coronary artery disease (61 ± 7 years, 18 males, two females) were randomly assigned to either traditional moderate-intensity exercise (TRAD) or high-intensity interval stair climbing (STAIR). V˙O2peak was assessed at baseline, following 4 weeks of six supervised exercise sessions and after 8 weeks of ~24 unsupervised exercise sessions. TRAD involved a minimum of 30 min at 60–80%HR_peak, and STAIR consisted of three bouts of six flights of 12 stairs at a self-selected vigorous intensity (~90 s/bout) separated by recovery periods of walking (~90 s). This study was registered as a clinical trial at clinicaltrials.gov (NCT03235674).

Results: Two participants could not complete the trial due to the time commitment of the testing visits, leaving n = 9 in each group who completed the interventions without any adverse events. V˙O2peak increased after supervised and unsupervised training in comparison to baseline for both TRAD [baseline: 22.9 ± 2.5, 4 weeks (supervised): 25.3 ± 4.4, and 12 weeks (unsupervised): 26.5 ± 4.8 mL/kg/min] and STAIR [baseline: 21.4 ± 4.5, 4 weeks (supervised): 23.4 ± 5.6, and 12 weeks (unsupervised): 25 ± 6.2 mL/kg/min; p (time) = 0.03]. During the first 4 weeks of training (supervised) the STAIR vs. TRAD group had a higher %HR_peak (101 ± 1 vs. 89 ± 1%; p ≤ 0.001), across a shorter total exercise time (7.1 ± 0.1 vs. 36.7 ± 1.1 min; p = 0.009). During the subsequent 8 weeks of unsupervised training, %HR_peak was not different (87 ± 8 vs. 96 ± 8%; p = 0.055, mean ± SD) between groups, however, the STAIR group continued to exercise for less time per session (10.0 ± 3.2 vs. 24.2 ± 17.0 min; p = 0.036).

Conclusions: Both brief, vigorous stair climbing, and traditional moderate-intensity exercise are effective in increasing V˙O2peak, in cardiac rehabilitation exercise programmes.

Home-Based Stair Climbing as an Intervention for Disease Risk in Adult Females; A Controlled Study

Cardiovascular disease and the metabolic syndrome are major contributors to health care expenditure. Increased physical activity reduces disease risk. The study compared effects of walking up and down stairs at home with continuous, gym-based stair climbing on the disease risk factors of aerobic fitness, serum lipids, body composition, fasting blood glucose, and resting cardiovascular variables. Sedentary women (31.7 ± 1.4 years) were randomly assigned to home-based (n = 26) or gym-based (n = 24) climbing for five days.week⁻¹ over an eight-week period. Each ascent required a 32.8-m climb, with home-based climbing matching the vertical displacement in the gym. Participants progressed from two ascents.day⁻¹ to five ascents.day⁻¹ in weeks 7 and 8. Relative to controls, stair climbing improved aerobic fitness (V˙O₂max +1.63 mL.min⁻¹.kg⁻¹, 95% CI = 1.21–2.05), body composition (weight −0.99 kg, 95% CI = 1.38–0.60), and serum lipids (LDL cholesterol −0.20 mmol.L⁻¹, 95% CI = 0.09–0.31; triglycerides −0.21 mmol.L⁻¹, 95% CI = 0.15–0.27), with similar risk reductions for home and gym-based groups. Only the home-based protocol reduced fasting blood glucose. Discussion focuses on stair climbing bouts as time-efficient exercise and the potential benefits of a home-based intervention. Stair use at home offers a low-cost intervention for disease risk reduction to public health.

Metabolic Effect of Breaking Up Prolonged Sitting with Stair Climbing Exercise Snacks

PURPOSE

Prolonged sitting is associated with cardiometabolic complications. The study purpose was to investigate whether breaking up prolonged sitting with brief stair climbing exercise "snacks" could lower postprandial insulin, glucose, and free fatty acids responses.

METHODS

In two separate randomized crossover studies, 12 young healthy-weight men (study 1) and 11 adults with overweight/obesity (OW; study 2) completed two experimental conditions: i) sedentary (SED; 9-h sitting) and ii) stair climbing snacks (SS; 8 × 15-30 s once per hour). The same high-glycemic index meals were consumed at 0, 3, and 6 h at each condition. The primary outcome was total insulin area under the curve (AUC) across 9 h.

RESULTS

In healthy-weight men, there were no significant differences between SS and SED for total (9-h) insulin AUC (P = 0.24, d = 0.4), total glucose AUC (P = 0.17, d = 0.48), total nonesterified fatty acid (NEFA) AUC (P = 0.22, d = 0.4), or total triglyceride AUC (P = 0.72). In adults with OW, total insulin AUC (-16.5%, P = 0.036, d = 0.94) and total NEFA AUC (-21%, P = 0.016, d = 1.2) were significantly lower in SS versus SED. No differences were found for total glucose and triglyceride AUC (all, P > 0.31) in participants with OW.

CONCLUSIONS

Breaking up 9 h of prolonged sitting with hourly brief stair climbing exercise snacks lowered postprandial insulin and NEFA levels in adults with overweight/obesity.

Untapping the Health Enhancing Potential of Vigorous Intermittent Lifestyle Physical Activity (VILPA): Rationale, Scoping Review, and a 4-Pillar Research Framework

Recently revised public health guidelines acknowledge the health benefits of regular intermittent bouts of vigorous intensity incidental physical activity done as part of daily living, such as carrying shopping bags, walking uphill, and stair climbing. Despite this recognition and the advantages such lifestyle physical activity has over continuous vigorous intensity structured exercise, a scoping review we conducted revealed that current research in this area is, at best, rudimentary. Key gaps include the absence of an empirically-derived dose specification (e.g., minimum duration of lifestyle physical activity required to achieve absolute or relative vigorous intensity), lack of acceptable measurement standards, limited understanding of acute and chronic (adaptive) effects of intermittent vigorous bouts on health, and paucity of essential information necessary to develop feasible and scalable interventions (e.g., acceptability of this kind of physical activity by the public). To encourage collaboration and research agenda alignment among groups interested in this field, we propose a research framework to further understanding of vigorous intermittent lifestyle physical activity (VILPA). This framework comprises four pillars aimed at the development of: (a) an empirical definition of VILPA, (b) methods to reliably and accurately measure VILPA, (c) approaches to examine the short and long-term dose-response effects of VILPA, and (d) scalable and acceptable behavioural VILPA-promoting interventions.