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Stroke: HIIT may be more effective than steady, moderate exercise

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Stroke: HIIT may be more effective than steady, moderate exercise
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A new study compared HIIT and steady, moderate exercise for stroke recovery. RZCREATIVE/Stocksy
  • Stroke is a condition where blood and oxygen are not able to get to the brain.
  • Exercise is an important part of stroke recovery.
  • Researchers from McMaster University have found that repeated one-minute bursts of high intensity interval training (HIIT) were more effective in improving aerobic fitness after a stroke than traditional, continuous moderate exercise.

Each year, about 15 million people around the world have a stroke — a condition where blood and oxygen is not able to get to the brain.

While stroke is treatable, researchers estimate that more than two-thirds of stroke survivors will require rehabilitation, which depending on the person’s needs can include speech, occupational, and physical therapies.

Previous studies show that exercising after a stroke offers several health benefits, including reduced risk of stroke recurrence and improved overall recovery.

A recent study found that repeated one-minute bursts of high-intensity interval training (HIIT) was more effective in improving aerobic fitness after a stroke than traditional, continuous moderate exercise.

“Stroke is a leading cause of death and disability worldwide, but there is strong evidence to support exercise as a key component of rehabilitation programs to promote recovery and reduce long-term impacts of stroke and lower risk of future recurrent stroke,” said Ada Tang, PT, PhD, physiotherapist, professor, and assistant dean of Rehabilitation Science at McMaster University and corresponding author of the study.

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“Research has shown that aerobic fitness levels are low in people with stroke, often at levels that are inadequate to perform activities we might do every day such as climbing stairs or walking fast,” Tang explained to Medical News Today. “We know that there are challenges to participating in exercise after stroke, however, such as finding time to fit it into their day.”

“We also know that therapists can be hesitant to push patients with stroke to higher intensities of exercise despite research that suggests that more intense exercise may be beneficial. Instead, they are more likely to keep exercise intensities lower. We felt that HIIT would be an important, feasible, and time-efficient option for exercise after stroke,” she added.

The study is published in the journal Stroke.

For this study, researchers recruited 82 stroke survivors who were in the period between six months and five years after a stroke.

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Study participants were randomly grouped to either receive HIIT or moderate exercise sessions for three days of the week over 12 weeks.

“Both groups exercised three times per week on non-consecutive days for 12 weeks,” Tang detailed. “Both groups included three minutes of warm-up and two minutes of cool down. All exercise was performed on a recumbent stepper machine (NuStep).”

“For participants in the HIIT group, the exercise protocol was 10 one-minute intervals of high-intensity exercise (80-100%) interspersed with nine one-minute intervals of lower intensity recovery (30%),” she continued. “Exercise time, not including warm-up and cool-down, was 19 minutes. The moderate-intensity continuous exercise sessions were 40-80% intensity for 20-30 minutes.”

At the study’s conclusion, scientists found that the cardiorespiratory fitness levels — the maximum amount of oxygen a person can take in during exercise — of participants in the HIIT group improved twice as much as those in the moderate exercise group.

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“We expected to observe greater improvements in fitness levels in the HIIT group but were excited to see how much they did improve,” Tang said. “The improvements in fitness levels in the HIIT group were within the range of values associated with lower risk of hospitalization and stroke.”

Additionally, researchers found that this improvement stayed above clinically important thresholds in the HIIT group eight weeks after the end of the study, which was not the same case for the moderate exercise group.

“This finding is important as it means that the gains made after HIIT were maintained to a greater extent than after moderate-intensity continuous training. Nonetheless, it is important that regular exercise becomes part of a lifelong healthy lifestyle after stroke given that people with stroke are at higher risk of having another one in the future.”
— Ada Tang, PT, PhD

“We believe that the higher intensities achieved (are the) key difference. By using an interval training format where bursts of high-intensity exercise is interspersed with recovery intervals of lower intensity, we can achieve the benefits of more intense exercise without risk of over-fatigue.We will continue to examine innovative ways to promote exercise and physical activity after stroke to reduce the global burden of this condition,” Tang said.

After reviewing this study, Christopher Yi, MD, a board certified vascular surgeon at Memorial Orange Coast Medical Center in Fountain Valley, CA, told MNT he found it to be of interest and excitement.

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“This study shows that high-intensity aerobic exercise can significantly improve cardiovascular fitness in stroke patients, which is a substantial long-term benefit for stroke recovery,” Yi explained.

“Patients who [experience] strokes are often severely debilitated, with poor (quality) of life and decreased longevity. Finding better ways to enhance the recovery of strokes will improve the quality of these patient’s lives, reduce the risk of recurrent strokes and cardiovascular events, and ultimately increase survival rates.”
— Christopher Yi, MD

“I would like to see how patients with more severe physical impairments after a stroke perform with HIIT. I would also like to see long-term outcomes of this study beyond eight weeks, including overall quality of life. Lastly, I would like to understand the underlying biological mechanisms from HIIT, including cardiovascular function and neuroplasticity,” he added.

MNT also spoke with Ryan Glatt, CPT, NBC-HWC, senior brain health coach and director of the FitBrain Program at Pacific Neuroscience Institute in Santa Monica, CA, about this study.

“The study is intriguing but raises questions about the generalizability of HIIT benefits for a broader stroke population,” Glatt said. “Improving aerobic fitness is essential to reduce the risk of secondary strokes, but the study’s participant pool limits the broader application of its findings. Future research should include more diverse and severely impaired stroke survivors to truly validate HIIT’s effectiveness and long-term impact.”

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Put the fun back in your fitness routine with this 10-minute follow-along workout from The Curvy Girl Trainer Lacee Green

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Put the fun back in your fitness routine with this 10-minute follow-along workout from The Curvy Girl Trainer Lacee Green

Ever feel like beginner-friendly workouts are anything but?

That’s how BODi Super Trainer Lacee Green felt, so she devised a three-week, entry-level program designed for genuine newcomers to exercise—or those just getting back into it.

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Higher fitness levels linked to lower risk of depression, dementia – Harvard Health

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Higher fitness levels linked to lower risk of depression, dementia – Harvard Health
research review

People with high cardiorespiratory fitness were 36% less likely to experience depression and 39% less likely to develop dementia than those with low cardiorespiratory fitness. Even small improvements in fitness were linked to a lower risk. Experts believe that exercise’s ability to boost blood flow to the brain, reduce bodywide inflammation, and improve stress regulation may explain the connection.

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These 20-Minute Burpee Workouts Replaced His Entire Gym Routine – and Transformed His Physique

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These 20-Minute Burpee Workouts Replaced His Entire Gym Routine – and Transformed His Physique

While many swear by them, most people see burpees as a form of punishment – usually dished out drill sergeant-style by overzealous bootcamp PTs. Often the final blow in an already brutal workout, burpees are designed to test cardiovascular fitness, muscular endurance and mental grit. Love them or loathe them, they deliver every time.

For Max Edwards – aka Busy Dad Training on YouTube – they became a simple but highly effective way to stay fit and lean during lockdown. Once a committed powerlifter, spending upwards of 80 minutes a day in the gym, he was forced to overhaul his approach due to fatherhood, lockdown and a schedule that no longer allowed for long, structured lifting sessions.

‘Even though I was putting in hours and hours into the gym and even though my physique was pretty good, I wasn’t becoming truly excellent at any physical discipline,’ he explained in a YouTube video.

‘I loved the intentionality of training,’ says Edwards. ‘The fact that every session has a point, every rep in every set is helping you get towards a training goal, and I loved that there was a clear way of gauging progression – feeling like I was developing competence and moving towards mastery.’

Why He Walked Away From Powerlifting

Despite that structure, Edwards began to question whether powerlifting was sustainable long-term.

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‘My sessions were very taxing on my central nervous system. I was exhausted between sessions. It felt as if I needed at least nine hours of sleep each night just to function.’

He also noted that his appetite was consistently high.

But the biggest drawback was time.

‘I could not justify taking 80 minutes a day away from my family for what felt like a self-centred pursuit,’ he says.

A Simpler Approach That Stuck

‘Over the course of that year I fixed my relationship with alcohol and I developed, for the first time in my adult life, a relationship with physical training,’ says Edwards.

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With limited time and no access to equipment, he turned to burpees. Just two variations, four times a week, with each session lasting 20 minutes.

‘My approach in each workout was very simple. On a six-count training day I would do as many six-counts as I possibly could within 20 minutes. On a Navy Seal training day I would do as many Navy Seal burpees as I could within 20 minutes – then in the next workout I would simply try to beat the number I had managed previously.’

This style of training is known as AMRAP – as many reps (or rounds) as possible.

The Results

Edwards initially saw the routine as nothing more than a six-month stopgap to stay in shape. But that quickly changed.

‘I remember catching sight of myself in the mirror one morning and I was utterly baffled by the man I saw looking back at me.’

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He found himself in the best shape of his life. His energy levels improved, his resting heart rate dropped and his physique changed in ways that powerlifting hadn’t quite delivered.

‘It has been five years since I have set foot in a gym,’ he says. ‘That six-month training practice has become the defining training practice of my life – and for five years I have trained for no more than 80 minutes per week.’

The Burpee Workouts

1/ 6-Count Burpees

20-minute AMRAP, twice a week

How to do them:

  • Start standing, feet shoulder-width apart
  • Crouch down and place your hands on the floor (count 1)
  • Jump your feet back into a high plank (count 2)
  • Lower into the bottom of a push-up (count 3)
  • Push back up to plank (count 4)
  • Jump your feet forward to your hands (count 5)
  • Stand up straight (count 6)

20-minute AMRAP, twice a week

How to do them:

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  • Start standing, feet shoulder-width apart
  • Crouch down and place your hands on the floor
  • Jump your feet back into a high plank
  • Perform a push-up (chest to floor)
  • At the top, bring your right knee to your right elbow, then return
  • Perform another push-up
  • Bring your left knee to your left elbow, then return
  • Perform a third push-up
  • Jump your feet forward
  • Stand or jump to finish

Headshot of Kate Neudecker

Kate is a fitness writer for Men’s Health UK where she contributes regular workouts, training tips and nutrition guides. She has a post graduate diploma in Sports Performance Nutrition and before joining Men’s Health she was a nutritionist, fitness writer and personal trainer with over 5k hours coaching on the gym floor. Kate has a keen interest in volunteering for animal shelters and when she isn’t lifting weights in her garden, she can be found walking her rescue dog.

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