Training, detraining and retraining effects of moderate vs. high intensity exercise training programme on cardiovascular risk factors

INTRODUCTION

Cardiovascular disease (CVD) remains the most common cause of death worldwide, accounting for nearly half of all noncommunicable disease deaths [1]. Almost half of deaths are due to acute myocardial infarction and one-third of them are due to cerebrovascular accident worldwide [1]. Therefore, reducing the prevalence of cardiovascular risk factors implies reducing the number of deaths due to CVD, and this fact is of great importance for public health. Especially interesting is the reduction of modifiable lifestyle factors, such as smoking, physical inactivity, unhealthy diet and high alcohol consumption [2]. In this way, a sedentary lifestyle is prevalent in most industrialized countries [3]. Over the last six decades, accumulating epidemiological evidence has shown that being physically active is beneficial for health, particularly for the cardiovascular system [3,4]. Physical inactivity ranks fourth among the leading risk factors for mortality worldwide [5]. The role of physical activity in the primary prevention of CVD appears to be established.

Continuous moderate aerobic training is the most common type of training programme to treat cardiovascular risk factors. This type of exercise increases cardiorespiratory fitness and enhances endothelial function, insulin signalling and skeletal muscle biogenesis, as well as decreases blood pressure and reduces body weight and fat [6]. However, during the last years, the application of training programmes that include high-intensity aerobic interval training has grown. Accordingly, high-intensity aerobic interval training programmes reduce blood pressure [7], improve cardiorespiratory fitness [8] and heart function [9], induce mitochondrial biogenesis [10] and improve insulin sensitivity [11]. Although the two training programmes (moderate training [MT] and high-intensity training [HIT]) are effective to reduce cardiovascular risk factors, previous studies have demonstrated that HIT is superior to MT in reversing risk factors [6]. Therefore, exercise intensity is an important factor in the optimization of aerobic capacity improvements and reversing cardiovascular risk factors.

Some previous studies have analysed the effects of exercise discontinuity, inserting training and detraining periods [12–14], in patients with cardiovascular risk factors. In this way, some training adaptations rapidly return to basal values (fat oxidation, cardiorespiratory fitness and triglycerides), whereas others are retained during 1 month of detraining (body composition and high-density lipoprotein [HDL] cholesterol). In addition, a previous study has analysed the effect of consecutive years of 4-month aerobic interval training and concluded that, to chronically improve cardiovascular risk factors, at least two training periods are required. In this way, the blood pressure does not fully return to pretraining values, allowing a cumulative improvement [12]. However, the effects of detraining and retraining according to the training intensity (MT or HIT) are not fully understood. Therefore, the aim of the present study was to analyse the effect of 12 weeks of training, 7 weeks of detraining and 16 weeks of a second period of training using a MT or HIT programme on body composition, blood pressure, strength, cardiorespiratory fitness and fasting blood glucose and lipid profile variables in hypertensive patients treated with antihypertensive therapy. Based on the previous research, our hypothesis was that HIT and MT would significantly improve cardiorespiratory fitness, strength and biochemical and body composition markers in hypertensive patients. In addition, it was hypothesized that HIT would induce greater adaptations and would reduce the detraining effect in these variables when compared to MT.

METHODS Design

We developed a prospective observational study to analyse the effect of 12 weeks of training, 7 weeks of detraining and 16 weeks of a second period of retraining using a MT or HIT programme on body composition, blood pressure, cardiorespiratory fitness, strength and fasting blood glucose and lipid profile variables in hypertensive patients following antihypertensive therapy (Fig. 1). Prior to the study, participants read and signed a form to provide informed consent. In addition, the study conforms to the Declaration of Helsinki and was approved by the Catholic University of Murcia's Science Ethics Committee (C231111).

F1FIGURE 1:

Experimental design.

Participants

All participants included in the study were referred by their primary care physicians who prescribed physical exercise as a healthy lifestyle intervention added to pharmacological treatment in the framework of a behavioural and healthy lifestyle programme (i.e. ‘ACTIVA-Murcia Programme’). Patients went to the sports centre closest to their home. The inclusion criteria were: men or women aged from 40 to 65 years; hypertensive patients receiving antihypertensive therapy (one or more drugs) for at least 1 year; and patients without experience in regular physical exercise. On the other hand, the exclusion criteria were: patients with terminal disease, ischaemic cardiopathy, cerebrovascular disease or cardiovascular pathology (i.e. peripherical arterial disease); participants with a pathology which limited aerobic or resistance training (i.e. muscle disorders, pulmonary obstructive disease, arrhythmia…); or participants were excluded from the analysis if they did not fulfil a minimum compliance of 66% of attendance of the training sessions.

Testing protocol

As Fig. 1 shows, testing sessions were carried out four times: at baseline (T1), at the end of the first training period of 12 weeks duration (T2), after 7 weeks of detraining (T3) and at the end of the study after 16 weeks of a second retraining period (T4). All the tests were measured in one visit to the laboratory. Moreover, a familiarization session was included 48–72 h before the training session where participants performed the isokinetic tests. During the testing session, blood pressure, biochemical blood analysis, body composition tests, isokinetic tests and cardiorespiratory tests were performed.

Two days after the last training session, in all of the testing moments, the blood pressure profile was measured using an oscillometric device (SpaceLabs 90217; Spacelabs Healthcare, Snoqualmie, Washington, USA). Blood pressure was assessed every 30 min during the day and every 60 min during the night. Mean daytime, awake and sleep values of the systolic blood pressure (SBP) and diastolic blood pressure (DBP) were extracted.

A blood sample (2.5 ml) was withdrawn from the antecubital vein using a sterile technique to analyse haematological variables. Blood samples were taken before breakfast after an overnight fast. Blood extraction was performed with the participant seated. The haematological variables of total cholesterol (mg/dl), LDH (mg/dl), HDL (mg/dl), blood glucose (mg/dl), glycosylated haemoglobin (%) and triglycerides (mg/dl) were analysed using an automatic haematology analyser (Pentra 80-HORIBA ABX; Horiba Medical, Northampton, UK).

Body composition was assessed with a segmental multifrequency bioimpedance analyser (Tanita BC-601; TanitaCorp., Tokyo, Japan). We conducted the test at the same time, in the same participant order, and in the same place, with a constant temperature and humidity. To carry out the tests, the participants stood upright on foot electrodes on the instrument platform, with legs and thighs apart and arms not touching the torso. They were barefoot and without excess clothing. Body height was measured using a stadiometer (Seca 700; Seca Ltd, Germany). Body mass (kg), body mass index (kg/m2), fat mass (%) and fat free mass (kg) were analysed. In addition, waist circumference (cm) was assessed.

Regarding isokinetic tests, following a standardized warm-up consisting of 10 min of submaximal stationary cycling and dynamic stretching, an isokinetic dynamometer (Biodex 3; Biodex Corporation, Shirley, New York, USA) was used to measure peak torque values and the torque angle of right leg during knee flexion and extension. The motor axis was visually aligned with the axis of the knee. The participant was seated and stabilized by straps so that only the knee to be tested was moving with a single degree of freedom. The dynamometer was calibrated, using the protocol from the Biodex 6000 manual, at the beginning of the test session. All participants performed five continuous maximum effort concentric contractions of the knee flexors and extensors at the angular velocities of 60°/s and 270°/s. Before the trial set, a specific warm-up consisting of two series at 50 and 80% of the perceived maximum effort of the participant were carried out. The test started 5 min after the warm-up trials had been completed to prevent fatigue. The first and last repetitions were excluded from the data analysis. The second, third and fourth contractions were averaged for the determination of the optimum angle by fitting a fourth order polynomial curve. Only the highest peak torque values of the fitted curve of the flexors and extensors of each velocity were used in the analysis.

After 15 min of rest, aerobic exercise testing on a treadmill following a modification of the Balke–Ware protocol [15], but using the same protocol for men and women, was carried out. Warm-up exercises were developed previous to the test during 2 min: the first minute at a speed of 3 km/h and 1.5% slope and the second minute at 4 km/h and 4% slope. The test was divided into 15 phases of 1 min each with increments of speed (0.2 km/h) and slope (1%), starting at a speed of 5 km/h and 5% slope. All participants were monitored by a gas analyser (Jaeger Oxicom Pro; Jaeger, Wuerzburg, Germany). Maximal oxygen uptake (VO2 max) and time to exhaustion were analysed. Based on previous studies [16], criteria to assume that maximal effort was reached were at least two of the following: a levelling-off of oxygen uptake, maximal respiratory exchange ratio ≥1.10, age predicted HRmax ≥90% and maximal rate of perceived exertion ≥19. Moreover, capillary blood samples (5 μl) for blood lactate concentration ([Lac]) analysis were collected from a finger pick 2 min after the end of the test and analysed using a Lactate Pro analyser (Arkay, Inc., Kyoto, Japan). After the test, second ventilatory threshold was determined in the second increase in ventilation (VE) with a concomitant rapid increase in VE/VO2 and VE/VCO2 and decrease of end-tidal CO2 tension. Maximum oxygen consumption (min/kg per min), second ventilatory threshold (min/kg per min), time to exhaustion (min), time to second ventilatory threshold (min) and blood lactate concentration were analysed.

Training programme

The training programme characteristics were similar in both groups, but the intensity was moderate or high in each group (MT vs. HIT). The training programme included two training periods separated by a 7-week detraining period, which was coincident with a vacation period: 12 weeks duration (from September to December) and 16 weeks duration (from February to June). The frequency of training was 3 days per week in sessions of 60 min duration, with at least 48 h of rest between sessions. The physical training programme was focused on basic exercises of endurance (global bodily activities), strength (specific muscle regions) and flexibility. Specifically, sessions were developed using circuit-based training that provided a dynamic combination of exercises and included the following phases: a warm-up with muscular activation, articular mobility and dynamic exercises; main part that included an aerobic interval exercise at 80–90% of the maximum heart rate for the HIT group and at 50–70% of the maximum heart rate for the MT group; and a cool down based on stretching exercises. Heart rate (HR) was monitored using a pulsometer (Polar RS400; Polar Electro Oy, Kempele, Finland) and recorded. Later, HR data were analysed to determine if the participants fulfilled the intensity programmed into each training programme. Moreover, the rating of perceived exertion (RPE) was also used for intensity monitoring. During the training programme, training intensity was progressively increased according to HR and RPE. All sessions were monitored and supervised by the same researcher, who graduated in Sports Sciences and specialized in strength and conditioning training.

Statistical analysis

Data collection, treatment and analysis were performed using the SPSS for Windows statistical package (version 25.0; IBM, Armonk, New York, USA). Descriptive statistics with measures of central tendency and dispersion were used. The assumption of normality and homoscedasticity were verified using the Shapiro–Wilk W and Levene test. In addition, a two-way analysis (training group × time) of variance with repeated measures and Bonferroni post hoc test were used to investigate differences between study variables. The effect size was calculated using eta-squared (η2). For all procedures, a level of significance of P ≤0.05 was established.

RESULTS

Based on previous studies [17], a total of 18 participants per group would be needed to be able of establishing statistical differences between programs (MT vs. HIT) in systolic blood pressure (80% statistical power; α = 0.05). Physicians prescribed physical exercise to 41 individuals. On the first day, 37 (90.2%) patients showed up at the sports centre. The study population included 37 hypertensive individuals: 17 started the HIT programme and 20 started the MT programme. However, 34 (91.9%) participants (15 men, 19 women; mean age 56.0 ± 5.5 years) completed the programme (minimum compliance of 66% of training sessions during the programmed sessions): the HIT group (n = 15; 8 (53.3%) women; 55.1 ± 5.9 years; 77.0 ± 12.8 kg; 163.0 ± 8.0 cm) and MT group (n = 19; 11 (57.9%) women; 56.7 ± 5.1 years; 81.5 ± 14.4 kg; 162.7 ± 7.0 cm). Three participants did not finish the program and they were excluded for the analysis (MT group: n = 1; man; 50.0 years; 81.0 kg; 162.9 cm; HIT group: n = 2; 1 (50%) woman; 49.5 ± 9.2 years; 90.6 ± 13.2 kg; 171.6 ± 4.0 cm).

There were no statistically significant differences in age (T = 0.421; P = 0.421), BMI (T = 1.229; P = 0.228), fat body mass (T = 1.229; P = 0.217), SBP (T = 0.275; P = 0.785) or DBP (T = 0.032; P = 0.974) when baseline values were compared (between-group differences). Antihypertensive pharmacological treatment included angiotensin receptor blockers in 52.9% of patients, diuretics in 23.5% of patients, beta-blockers in 17.6% of patients, calcium antagonists in 11.8% of patients, angiotensin-converting enzyme inhibitors in 26.5% of patients and alpha-blockers in 2.9% of patients. In one patient assigned to the HIT group, the dose of beta-blocker was reduced by their primary care physician during the study; 26% of the patients were on lipid-lowering drugs and none of them changed their dosage during the programme.

With respect to the ambulatory blood pressure variables (Table 1), a significant effect was observed on the mean daytime SBP (F= 6.664; P= 0.001; η2 = 0.172) and on the awake SBP (F= 4.268; P= 0.007; η2 = 0.118), showing a decrease after the second retraining period of the HIT programme in comparison with the other testing sessions (baseline, after the first training period and after 7 weeks of detraining). Similarly, a significant effect was observed on the mean daytime DBP (F= 26.352; P < 0.001; η2 = 0.279), awake DBP (F= 3.139; P = 0.033; η2 = 0.089) and sleep DBP (F= 3.304; P= 0.024; η2 = 0.094), showing the same behaviour of the HIT programme at the end of the programme in comparison with the other three testing sessions and detecting a significant difference between the two types of exercise (MT vs. HIT) at the end of the second retraining period (P = 0.011). No significant main effect was observed in sleep SBP.

TABLE 1 - Ambulatory blood pressure variables in the four testing points after HIT and MT programmes Baseline [1] After 1st training period (12 weeks) [2] After 7 weeks of detraining [3] After 2nd training period (16 weeks) [4] Variable Mean SD Mean SD Mean SD Mean SD F P η 2 Pairwise comparison Mean daytime systolic blood pressure in 24 h (mmHg) MT
HIT 130.3
131.3 9.7
11.9 130.3
132.1 9.0
11.1 131.6
134.5 11.0
12.3 127.8
121.9 9.6
11.9 6.664 0.001 0.172 HIT: 1 vs. 4 (P < 0.001); 2 vs. 4 (P < 0.001); 3 vs. 4 (P < 0.001) Mean daytime diastolic blood pressure in 24 h (mmHg) MT
HIT 80.3
80.4 6.2
9.0 81.1
81.3 5.5
8.1 81.8
83.7
6.2
9.2 79.6
73.1 6.6
7.6 26.352 <0.001 0.279 MT vs. HIT: 4 (P = 0.011); HIT: 1 vs. 4 (P < 0.001); 1 vs. 3 (P = 0.044); 2 vs. 4 (P < 0.001); 3 vs. 4 (P < 0.001) Awake systolic blood pressure (mmHg) MT
HIT 136.3
131.9 10.2
10.6 135.6
132.8 12.1
9.4 137.4
134.6 12.5
11.6 135.0
125.5 11.2
11.1 4.268 0.007 0.118 MT vs. HIT: 4 (P = 0.02); HIT: 1 vs. 4 (P = 0.001); 2 vs. 4 (P = 0.004); 3 vs. 4 (P < 0.001) Awake diastolic blood pressure (mmHg) MT
HIT 83.3
84.3 1.8
2.0 83.1
85.0 1.6
1.8 84.6
86.7 1.9
2.1 82.5
80.2 1.7
1.9 3.139 0.033 0.089 HIT: 1 vs. 4 (P = 0.016); 2 vs. 4 (P = 0.006); 3 vs. 4 (P < 0.001) Sleep Systolic blood pressure (mmHg) MT
HIT 127.4
121.9 12.6
10.7 127.5
122.6 14.0
11.2 128.9
125.7 10.4
11.1 126.3
117.8 14.2
11.3 1.892 0.136 0.056 HIT: 3 vs. 4 (P < 0.001) Sleep diastolic blood pressure (mmHg) MT
HIT 73.8
73.6 10.1
6.3 74.1
75.1 12.1
5.7 75.0
75.3 9.8
5.4 73.4
68.8 9.7
6.6 3.304 0.024 0.094 HIT: 1 vs. 4 (P = 0.006); 2 vs. 4 (P = 0.003); 3 vs. 4 (P < 0.001)

HIT, high-intensity training; MT, moderate training; SD, standard deviation.

No main effect was observed in body composition variables (i.e. body mass, BMI, fat mass and fat free mass) (Table 2). However, a significant decrease of fat mass was observed from baseline to the end of the second period of retraining in the HIT programme. Conversely, a significant main effect was found on waist circumference (F= 3.029; P= 0.038; η2 = 0.151) seeing a significant decrease at the end of the retraining period in HIT group. On the other hand, a significant effect was observed on total cholesterol (F= 3.031; P= 0.033; η2 = 0.087), showing a significant difference between groups after the first period of training (P = 0.02) and decreasing significantly at the end of the second training programme in the HIT group (P = 0.006). In this way, a significant effect was found in HDL (F= 2.879; P= 0.04; η2 = 0.083), LDL (F= 4.583; P= 0.005; η2 = 0.125). Both the HIT and MT programmes significantly increased HDL after the first and second training periods, without differences between training programmes. Furthermore, LDL decreased significantly after the second training period in the HIT programme, but no change was observed in the MT programme at this point. Finally, no main effect was observed in blood glucose, glycosylated haemoglobin and triglycerides.

TABLE 2 - Body composition and biochemical variables in the four testing points after HIT and MT programmes Baseline [1] After 1st training period (12 weeks) [2] After 7 weeks of detraining [3] After 2nd training period (16 weeks) [4] Variable Mean SD Mean SD Mean SD Mean SD F P η 2 Pairwise comparison Body mass (kg) MT
HIT 81.5
77.0 14.4
12.8 81.1
76.9 14.7
13.2 81.4
76.4 14.3
13.3 80.9
75.3 13.8
13.3 2.480 0.066 0.072 HIT: 1 vs. 4 (P = 0.008); 2 vs. 4 (P = 0.017) BMI (kg/m2) MT
HIT 30.6
29.0 3.8
4.1 30.4
28.9 3.9
4.2 30.6
28.7 3.8
4.2 30.4
28.3 3.5
4.1 2.645 0.054 0.076 HIT: 1 vs. 4 (P = 0.007); 2 vs. 4 (P = 0.017) Fat mass (%) MT
HIT 32.7
28.9 9.3
8.0 31.9
27.8 9.7
7.4 31.6
27.6 9.6
7.6 31.4
26.8 8.5
7.1 0.442 0.723 0.014 HIT: 1 vs. 2 (P = 0.041); 1 vs. 4 (P = 0.006) Fat free mass (kg) MT
HIT 48.8
48.1 10.4
11.3 49.2
49.1 10.5
11.1 49.8
48.9 10.3
12.0 49.6
48.5 10.7
11.9 1.231 0.303 0.037 Waist circumference (cm) MT
HIT 87.8
86.0 5.3
6.0 87.8
85.7 5.3
5.8 87.7
85.5 5.0
5.7 87.3
84.2 4.5
5.7 3.029 0.038 0.151 HIT: 1 vs. 4 (P = 0.001); 2 vs. 4 (P = 0.004); 3 vs. 4 (P = 0.004) Total cholesterol (mg/dl) MT 198.2 25.8 190.3 22.2 200.8 30.3 191.5 20.1 3.031 0.033 0.087 MT vs. HIT: 2 (P = 0.02); HIT: 1 vs. 4 (P = 0.006); 2 vs. 4 (P = 0.002); 3 vs. 4 (P = 0.003) HIT 208.9 29.7 208.8 21.7 213.2 26.9 191.1 25.8 HDL (mg/dl) MT
HIT 60.8
58.7 11.6
9.0 66.2
65.1 11.9
8.3 54.8
52.6 9.5
6.9 59.4
62.3 8.7
5.9 2.879 0.040 0.083 HIT: 1 vs. 2 (P < 0.001); 1 vs. 3 (P = 0.009); 2 vs. 3 (P < 0.001); 2 vs. 4 (P < 0.001); 3 vs. 4 (P < 0.001); MT: 1 vs. 2 (P < 0.001); 1 vs. 3 (P = 0.003); 2 vs. 3 (P < 0.001); 2 vs. 4 (P < 0.001); 3 vs. 4 (P = 0.011) LDL (mg/dL) MT
HIT 109.3
117.6 22.6
28.7 98.5
113.1 22.9
21.0 118.3
127.1 22.4
25.8 107.3
100.2 17.3
24.2 4.583 0.005 0.125 HIT: 1 vs. 4 (P = 0.009); 2 vs. 3 (P = 0.011); 2 vs. 4 (P = 0.039); 3 vs. 4 (P < 0.001); MT: 2 vs. 3 (P < 0.001) Triglycerides (mg/dl) MT
HIT 140.6
162.9 71.9
69.0 127.7
153.3 53.3
66.9 138.7
167.4 68.6
67.4 123.9
142.7 53.1
61.0 0.406 0.749 0.013 HIT: 3 vs. 4 (P = 0.009) Blood glucose (mg/dl) MT
HIT 102.1
106.5 17.4
10.9 104.1
106.4 17.3
14.2 106.5
110.8 17.6
14.3 99.8
97.3 16.38.7 2.194 0.094 0.219 HIT: 1 vs. 4 (P < 0.001); 2 vs. 4 (P = 0.012); 3 vs. 4 (P < 0.001); MT: 3 vs. 4 (P = 0.045) Glycosylated haemoglobin (%) MT
HIT 6.0
6.2 0.3
0.6 5.8
6.0 0.5
0.6 6.0
6.2 0.5
0.7 6.0
5.9 0.4
0.5 1.760 0.160 0.052 HIT: 1 vs. 2 (P = 0.026); MT: 1 vs. 2 (P = 0.002); 2 vs. 3 (P = 0.017)

BMI, body mass index; HDL, high-density lipoprotein; HIT, high-intensity training; LDL, low-density lipoprotein; MT, moderate training; SD, standard deviation.

Regarding cardiorespiratory fitness variables, no main effect was observed in time to exhaustion and time to second ventilatory threshold, VO2max or lactate variables (Table 2). However, a significant effect was observed on the second ventilatory threshold (F= 3.085; P= 0.031; η2 = 0.088), showing a significant difference between MT and HIT at the end of the retraining period (P = 0.007). In this way, both the HIT and MT programmes improved second ventilatory threshold in the first training period and in the second retraining period but HIT produced greater improvements. On the other hand, no main effect was observed in isokinetic strength variables (Table 3).

TABLE 3 - Cardiorespiratory fitness and isokinetic strength variables in the four testing points after HIT and MT programmes Baseline [1] After 1st training period (12 weeks) [2] After 7 weeks of detraining [3] After 2nd training period (16 weeks) [4] Variable Mean SD Mean SD Mean SD Mean SD F P η 2 Pairwise comparison VO2max (ml/kg per min) MT
HIT 27.7
29.3 4.3
5.1 29.7
31.6 4.5
4.7 27.3
28.7 4.3
4.5 30.2
33.3 4.2
5.5 2.118 0.103 0.062 HIT: 1 vs. 2 (P = 0.002); 1 vs. 4 (P < 0.001); 2 vs. 3 (P < 0.001); 3 vs. 4 (P < 0.001); MT: 1 vs. 2 (P = 0.002); 1 vs. 4 (P < 0.001); 2 vs. 3 (P = 0.001); 3 vs. 4 (P < 0.001) Second ventilatory threshold (ml/kg per min) MT
HIT 23.3
24.6 3.7
5.1 25.6
27.5 4.2
3.9 23.9
25.5 3.7
4.1 26.4
30.4 4.0
4.1 3.085 0.031 0.088 MT vs. HIT: 4 (P = 0.007); HIT: 1 vs. 2 (P = 0.004); 1 vs. 4 (P < 0.001); 2 vs. 3 (P = 0.007); 2 vs. 4 (P < 0.001); 3 vs. 4 (P < 0.001); MT: 1 vs. 2 (P = 0.011); 1 vs. 4 (P = 0.006); 2 vs. 3 (P = 0.006); 3 vs. 4 (P = 0.006) Lactate (mmol/l) MT
HIT 7.2
8.0 1.8
1.7 8.4
8.8 2.5
2.3 8.1
8.9 2.1
1.9 9.0
9.8 2.5
1.7 0.507 0.679 0.016 HIT: 1 vs. 4 (P = 0.001); 3 vs. 4 (P = 0.016); MT: 1 vs. 2 (P = 0.014); 1 vs. 4 (P < 0.001); 3 vs. 4 (P = 0.001) Time to second ventilatory threshold (min) MT
HIT 5.6
6.1 2.7
2.5 7.9
7.6 1.4
2.1 6.3
6.8 1.9
2.2 7.7
9.0 1.9
2.2 2.474 0.066 0.072 HIT: 1 vs. 4 (P < 0.001); 2 vs. 4 (P = 0.019); 3 vs. 4 (P < 0.001); MT: 1 vs. 2 (P < 0.001); 1 vs. 4 (P < 0.001); 2 vs. 3 (P = 0.001); 3 vs. 4 (P = 0.001) Time to exhaustion (min) MT
HIT 7.7
8.4 2.8
2.6 9.0
10.0 2.6
2.6 8.9
10.3 2.5
2.4 10.11
11.7 1.8
2.8 1.433 0.238 0.043 HIT: 1 vs. 2 (P = 0.001); 1 vs. 3 (P < 0.001); 1 vs. 4 (P < 0.001); 2 vs. 4 (P < 0.001); 3 vs. 4 (P < 0.001); MT: 1 vs. 2 (P = 0.003); 1 vs. 3 (P = 0.006); 1 vs. 4 (P < 0.001); 2 vs. 4 (P = 0.001); 3 vs. 4 (P < 0.001) Peak torque knee extension 60°/s (N/m) MT
HIT 113.4
127.6 38.9
42.6 119.8
136.7 40.3
41.7 125.5
149.3 47.3
133.4 133.1
165.6 52.2
140.8

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