Review articleHigh intensity interval training for people with multiple sclerosis: A systematic review
Introduction
Exercise is a safe and feasible intervention for people with multiple sclerosis (MS) (Heine et al., 2015) and is recommended for increasing cardiovascular fitness and muscular strength (Latimer-Cheung et al., 2013). Cardiovascular fitness in people with MS is lower compared to healthy individuals (Langeskov-Christensen et al., 2015) and is inversely correlated with disease severity and impairment, with fitness decreasing as disability and fatigue rise (Heine et al., 2014Heine et al., 2016, Kuspinar et al., 2010, Marrie and Horwitz, 2010, Motl and Fernhall, 2012, Valet et al., 2016). Reviews of trials evaluating the effects of exercise in people with MS have indicated that exercise training is beneficial for increasing and maintaining cardiovascular fitness (Dalgas et al., 2008, Rietberg et al., 2005).
Traditionally, continuous moderate intensity training programmes, to increase fitness and reduce cardiovascular disease risk factors in healthy adults, last 30–60 min at 40–85% of maximal intensity, with higher intensities producing a greater increase in fitness (Garber et al., 2011). High intensity interval training (HIIT), however, involves short bursts of exercise at very high intensity with either a complete or working rest in between bursts. Total time for training sessions typically last around 20 min, have 4–6 cycles of 80–95% of maximal effort for 1–4 min with a similar time of working recovery or rest (Cassidy et al., 2017, Kessler et al., 2012).
Compared to continuous moderate intensity training, HIIT is more efficient in improving VO2 max in healthy individuals (Milanovic et al., 2015), people with coronary artery disease (Elliott et al., 2015), increased cardio-metabolic risk (Weston et al., 2014), and heart failure (Haykowsky et al., 2013, Ismail et al., 2013, Smart et al., 2013, Wisloff et al., 2007). HIIT also produces greater or equal effects, to continuous moderate intensity training, in improving cardiovascular risk factors such as high blood pressure and altered glucose metabolism (Fleg, 2016). The main advantage of HIIT over continuous moderate intensity training is the shorter time required to achieve similar energy expenditure, and comparable, or greater benefits (Fleg, 2016). This is due to an increase in oxygen consumption after acute strenuous exercise known as Excess Post-exercise Oxygen Consumption (Gaesser and Brooks, 1984). Furthermore, shorter exercise intervals of 2 min or less have been found to be more enjoyable than continuous moderate intensity training by participants due to the shorter duration of each burst at high intensity (Cassidy et al., 2017).
Previous work examining the effect of HIIT in people with Parkinson's found an increase in Brain Derived Neurotrophic Factor (BDNF) production, decrease parkinsonian rigidity and muscle tone (Marusiak et al., 2015), improved gait parameters (Pohl et al., 2003) and cognitive performance (Alves et al., 2014). In addition there is limited but positive evidence for using HIIT to improve walking endurance in stroke survivors (Boyne et al., 20152016). However, given that only one of five studies compared HIIT to another form of aerobic exercise (Boyne et al., 2016) indicates that HIIT is an emerging modality in these conditions.
High intensity interval training has been recommended as a possible effective intervention for people with MS as it can allow people to exercise at higher intensities while avoiding thermosensitive reactions (Dalgas et al., 2008). Over the past several years there has been increasing interest in HIIT in MS and several interventional trials published; however no systematic review of HIIT in people with MS has been undertaken. Therefore the aim of this review was to establish the efficacy and safety of HIIT in people with MS.
Section snippets
Methods
An electronic search was undertaken of the following databases in September 2017: EMBASE, MEDline, PEDro, CENTRAL and Web of Science Core collections. The search terms used can be seen in Table 1. The Boolean operators ‘AND’ and ‘OR’ were used to combine searches as appropriate. No limits were placed on time of publication. The reference lists of included articles were also searched.
Articles were eligible for inclusion if they were clinical trials that consisted of an aerobic intervention of
Results
The electronic search identified 935 potential articles and hand searching of relevant reference lists provided one additional article. After the removal of 264 duplicates, the remaining 671 articles were screened by title and abstract. From titles alone, 575 were excluded. Following this, another 58 were excluded by abstract. The full text of 38 articles were read for eligibility by at least two members of the research team and 27 were subsequently excluded (Fig. 1). Eleven articles, which
Discussion
This was the first systematic review for the use of HIIT in MS. Overall, the seven studies included in the review provided positive evidence for the use of HIIT in people with MS. All studies except one (Skjerbæk et al., 2014) found improvements in multiple outcome measures. Predominantly improvements were observed in outcome measures relating to fitness. It should however, be noted that fitness outcome measures were not primary outcomes in any of the studies included. High intensity interval
Conclusion
The evidence presented in this review suggests that HIIT, via cycle ergometry, is a safe and effective way of improving fitness in people with MS and requires fewer, shorter training sessions compared to a moderate intensity, continuous training mode to gain benefits. Further investigation of HIIT is required in people with progressive MS and/or those with a moderate and severe level of disability. In addition, future research should examine the possible benefits of HIIT in people with MS,
Acknowledgements
This project was part of Mr. Evan Campbell's PhD which was funded by the Bevan Scholarship from NHS Ayrshire & Arran, United Kingdom.
Conflict of interest statement
The authors declare that there are no conflicts of interest.
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