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HIIT May Best Moderate Exercise for Poststroke Fitness

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HIIT May Best Moderate Exercise for Poststroke Fitness

Repeated 1-minute bursts of high-intensity interval training (HIIT) are more effective than conventional moderate, continuous exercise for improving aerobic fitness after stroke, according to a multicenter randomized controlled trial.

“We hoped that we would see improvements in cardiovascular fitness after HIIT and anticipated that these improvements would be greater than in the moderate-intensity group, but we were pleasantly surprised by the degree of improvement we observed,” Ada Tang, PT, PhD, associate professor of health sciences at McMaster University in Hamilton, Ontario, Canada, told Medscape Medical News. “The improvements seen in the HIIT group were twofold higher than in the other group.”

Ada Tang, PT, PhD

The results were published on August 7 in Stroke.

Clinically Meaningful

Researchers compared the effects of 12 weeks of short-interval HIIT with those of moderate-intensity continuous training (MICT) on peak oxygen uptake (V̇O2peak), cardiovascular risk factors, and mobility outcomes after stroke.

They randomly assigned participants to receive 3 days per week of HIIT or traditional moderate exercise sessions for 12 weeks. Participants’ mean age was 65 years, and 39% were women. They enrolled at a mean age of 1.8 years after sustaining a mild stroke.

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A total of 42 participants were randomized to HIIT and 40 to MICT. There were no significant differences between the groups at baseline, and both groups exercised on adaptive recumbent steppers, which are suitable for stroke survivors with varying abilities.

The short-interval HIIT protocol involved 10 1-minute intervals of high-intensity exercise, interspersed with nine 1-minute low-intensity intervals, for a total of 19 minutes. HIIT intervals targeted 80% heart rate reserve (HRR) and progressed by 10% every 4 weeks up to 100% HRR. The low-intensity intervals targeted 30% HRR.

The traditional MICT protocol for stroke rehabilitation targeted 40% HRR for 20 minutes and progressed by 10% HRR and 5 minutes every 4 weeks, up to 60% HRR for 30 minutes.

The HIIT group’s cardiorespiratory fitness levels (V̇O2peak) improved twice as much as those of the MICT group: 3.5 mL of oxygen consumed in 1 minute per kg of body weight (mL/kg/min) compared with 1.8 mL/kg/min.

Of note, changes in V̇O2peak from baseline remained above the clinically important threshold of 1.0 mL/kg/min at 8-week follow-up in the HIIT group (1.71 mL/kg/min) but not in the MICT group (0.67 mL/kg/min).

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Both groups increased their 6-minute walk test distances by 8.8 m at 12 weeks and by 18.5 m at 20 weeks. No between-group differences were found for cardiovascular risk or mobility outcomes, and no adverse events occurred in either group.

On average, the HIIT group spent 36% of total training time exercising at intensities > 80% HRR throughout the intervention, while the MICT group spent 42% of time at intensities of 40%-59% HRR.

The study was limited by a small sample size of high-functioning individuals who sustained a mild stroke. Enrollment was halted for 2 years due to the COVID-19 lockdowns, limiting the study’s statistical power.

Nevertheless, the authors concluded, “Given that a lack of time is a significant barrier to the implementation of aerobic exercise in stroke clinical practice, our findings suggest that short-interval HIIT may be an effective alternative to traditional MICT for improving V̇O2peak after stroke, with potential clinically meaningful benefits sustained in the short-term.”

“Our findings show that a short HIIT protocol is possible in people with stroke, which is exciting to see,” said Tang. “But there are different factors that clinicians should consider before recommending this training for their patients, such as their health status and their physical status. Stroke rehabilitation specialists, including stroke physical therapists, can advise on how to proceed to ensure the safety and effectiveness of HIIT.”

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Selected Patients May Benefit

“Broad implementation of this intervention may be premature without further research,” Ryan Glatt, CPT, senior brain health coach and director of the FitBrain Program at Pacific Neuroscience Institute in Santa Monica, California, told Medscape Medical News. “The study focused on relatively high-functioning stroke survivors, which raises questions about the applicability of the results to those with more severe impairments.” Glatt did not participate in the research.

photo of Ryan Glatt
Ryan Glatt, CPT

“Additional studies are needed to confirm whether these findings are applicable to more diverse and severely affected populations and to assess the long-term sustainability of the benefits observed,” he said. “Also, the lack of significant improvements in other critical outcomes, such as mobility, suggests limitations in the broader application of HIIT for stroke rehabilitation.”

“While HIIT shows potential, it should be approached with caution,” Glatt continued. “It may benefit select patients, but replacing traditional exercise protocols with HIIT should not be done in all cases. More robust evidence and careful consideration of individual patient needs are essential.”

This study was funded by an operating grant from the Canadian Institutes of Health Research. Tang reported grants from the Canadian Institutes of Health Research, the Physiotherapy Foundation of Canada, and the Heart and Stroke Foundation of Canada. Glatt declared no relevant financial relationships.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.

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Is This Muscle-Building Protocol All Hype? Here’s What You Need to Know.

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Is This Muscle-Building Protocol All Hype? Here’s What You Need to Know.

IF YOUR MEDIA diet puts you into certain corners of the muscle-obsessed fitness internet, you know about lengthened partials. If you don’t immediately recognize the term, we’ll get you up to speed: Lengthened partials are fractional reps performed with the target muscle in its stretched position. Good examples of this include the lower half of a pullup or biceps curl. Rather than raising the weight (or your body, in the case of the pullup) up through the exercise’s full range of motion, you’ll only go to about halfway to the top. Why? Muscle researchers have found that in many cases, those half-reps can still yield growth.

Anyone plugged-in enough to be familiar with the concept has also likely heard all kinds of wild theories about the protocol: Lengthened partials should be used for any and all exercises, no one should ever do a full rep ever again, your gains will jump by exponential degrees by using this one magic trick—the list goes on. There’s a lot of noise out there about this approach, and MH experts are trying to cut through it in our recent Strong Talk discussion.

“The problems with [the conversation around lengthened partials] right now is everyone’s trying to research every muscle,” said exercise physiologist and strength and conditioning coach Dr. Pat Davidson. Davidson was dismissive of some of the studies surrounding the protocol, as researchers seem to be approaching the topic both broadly in, terms of the muscle groups being tested, and with a limited scope of focus for the experiments. “They don’t give enough time and the stimulus is just kind of weird in some of these things. It’s going completely overboard.”

Does that mean that you should ignore everything you hear about lengthened partials and muscle building? Not quite, according to Davidson. There’s still solid research backing the use of the protocol in basic cases, and it’s not worth disregarding because the hype cycle is spinning out of control.

“There are some really good take-home points. When you stretch a muscle and challenge it, that’s probably the greatest threat you can put on it,” he said, calling back to another salient point in the conversation. “Most of the staple exercises that have been around for the test of time that everybody goes back to feature that naturally.”

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Along with the isolation exercises mentioned above, he’s talking about compound movements like squats and bench presses, which apply heavy stimulus to the target muscles when they’re in the stretched position (the bottom of the squat and the bottom of the bench press, for example).

The real misread of the protocol would be performing your partials in the wrong place. If you’re hitting half-reps when the muscle is in the shortened position, you’re not coming close to doing enough to reap the benefits of your workout. “The things that most people do that never makes progress is they just do quarter squats at the top,” Davidson said. “They use too much weight, and they never go low enough… That’s not doing anything.” That applies to the other big compound movements, too; performing limited-ROM bench or leg press reps won’t get you anything but an empty ego boost.

The most important thing to remember is that the “lengthened” aspect is what’s important, not the “partial.” Davidson was clear about what it takes to really make this type of work useful: the hard stuff, i.e. taking the weight to that bottom portion of the movement, with the muscle in the lengthened position. You can’t completely skip out on ROM and expect muscle growth. “Versus somebody for real where it’s like boom, they bury that thing deep, they hold that stretch, and they drive out of that stretch,” he said, motioning through a bench press rep. “That’s the real deal.”

For more important lessons for growth, check out the MH Definitive Guide to Building More Muscle.

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Brett Williams, NASM-CPT, PES, a senior editor at Men’s Health, is a certified trainer and former pro football player and tech reporter. You can find his work elsewhere at Mashable, Thrillist, and other outlets.

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As a woman, I used to be afraid of lifting weights. Now, I’m proud to be ‘jacked’

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As a woman, I used to be afraid of lifting weights. Now, I’m proud to be ‘jacked’

A childhood with an emphasis on skinnyI have no recollection of the term “strength training” growing up. I entered high school in 2006 and threw myself into cross-country running, where slender was the ideal body type. The petite stars of “The Hills” and “Gossip Girl” covered CosmoGirl and Seventeen next to “get bikini-ready” headlines, and judges on “America’s Next Top Model” scrutinized women’s bodies on national TV.

Instead of weight-lifting, I was focused on squeezing into a pair of low-rise jeans from Delia’s.

The only time I recall lifting a weight as a teen was on a gym date with a guy from school. He showed me how to do a barbell bench press and dripped sweat on me while spotting me.

For the past few years, I’ve taught boxing, HIIT, strength training and more.Tyler Essary / TODAY

If this was a woman’s experience trying to lift weights, I wanted nothing to do with it. Plus, with no resources or role models showcasing the benefits of getting strong, I assumed that it only led to a muscular upper body, the total opposite of what I was seeing in my magazines.

The truth is strength training can improve bone, heart and brain health, boost your metabolism, preserve quality of life as you age, reduce the risk of disease and more. But even if I knew all this when I was younger, I still probably would’ve avoided it, given the mental images strength training conjured.

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One of the first-known female pioneers in weightlifting was Abbye “Pudgy” Stockton, credited for popularizing Santa Monica’s Muscle Beach with her husband in the 1930s and ‘40s, per the Los Angeles Times. But it wasn’t until the ‘80s that women and weightlifting become more mainstream, after Arnold Schwarzenegger put bodybuilding on the map when he appeared in the 1977 documentary “Pumping Iron,” per the New York Times.

From there, Lisa Lyons, Carla Dunlap, Rachel McLish and more bodybuilders emerged in the ’80s, and before long, gyms were turning co-ed.

Fast-forward to the 2000s, and at-home DVD workouts that focused on building strength became bestsellers, like Tony Horton’s P90X and Jillian Michael’s “Shred” workouts. CrossFit also rose to stardom and introduced women and men alike to strength training (with some injuries along the way).

By 2010, when I started college, I still didn’t see myself in strength training. Doing a workout DVD in my dorm room wasn’t practical, and CrossFit felt beyond my skillset. After I gained the freshman 15, I became hawk-eyed on weight loss. My senior year, I picked up running again, and after graduation, I ran my first half marathon.

After the race, when I combed through professional photos, one caught my attention. I thought my arms looked strong. I purchased it and made it my profile picture on Facebook. Years later, friends and family told me that photo concerned them because of how thin I was.

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Nicoletta Richardson.
I used to care only about being skinny. Now, I care about being strong.Tyler Essary / TODAY

In 2017, I started working as a social media editor at a health and fitness magazine, and I wrote a before-and-after about my 40-pound weight loss dating back to college. After it published, I did what all the editors warned me not to: look at the comments. It was a mixed bag, but one that bluntly stated I looked better in the before image burned into my mind.

I got into the New York City Marathon that same year, so I added more miles to my runs. I ignored advice that I should cross-train and stuck to hitting the pavement, with the occasional spin or Barry’s class. I was all in on legs, and that seemed to work for me up until that point — why would I do otherwise?

I kept running, with the perception that beauty and skinny went hand in hand.

A gateway into strength training

When the pandemic hit in March 2020, my now-husband, Sam, and I retreated to his parents’ for a few months. At first, running was my sanctuary, but it became lonely. I turned to social media and joined live workouts led by fitness instructors and studio owners.

In no time, I was doing one or two a day in the basement that became my makeshift gym. I started sharing workout reviews on my Instagram to help others looking for a sense of semi-normalcy.

Nicoletta Richardson.
I used weights for the first time during lockdown in 2020.Tyler Essary / TODAY

Some classes encouraged using weights, and my future father-in-law had a set of adjustable iron-plated dumbbells. “I’ll just use the 5-pounder,” I thought to myself. I never increased the load, but choosing to reach for anything was new for me.

Around the same time, thought of teaching fitness crept into my mind. While we were hunkering down, I yearned to progress forward, so I enrolled in an online course to become a certified group fitness instructor in July 2020. I shared the news on Instagram with a flex.

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Eventually, Sam and I moved back into our own space, where I balanced my classes with 5-pound workouts.

Addressing my fear of being ‘jacked’

In January 2021, I passed my group fitness instructor test from my bedroom. I asked Sam to take a picture, and as he snapped away, a realization struck me as quickly as hips driving a kettlebell into the air: I could no longer be afraid of going heavier — if not for me, for the people I teach. 

I started teaching free HIIT classes on Zoom to friends, family and any Instagram followers who wanted in. A year later, I landed a part-time gig as an instructor at a new boxing and strength studio, where I was demoing exercises, correcting form, navigating lights and music, providing motivational cues and leading by example by grabbing heavier weights.

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Do you know that for every hour you exercise, you can add up to 3 hours to your life? – The Times of India

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Do you know that for every hour you exercise, you can add up to 3 hours to your life? – The Times of India

Enough has been said about the benefits of exercise. 30 minutes of exercising everyday is known to have long-term health effects, including lowering your BP, better cardiovascular health, and even weight loss. However, do you know that for every hour you exercise, you can actually increase your lifespan by three hours? Yes, you heard that right!

Exercise, and live longer
Dr. John Scharffenberg, a professor of nutrition at Loma Linda University in California, shared some tips for living a longer life in a YouTube video. At the remarkable age of 100, the centenarian shared that one of the biggest tools to live longer is exercise, and for every hour you exercise, you add three hours to your life. He also mentioned that while exercise is important at every age, you must definitely exercise between the ages of 40-70, as your body start to degenerate at 40.

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Here are some more tips that he added:
Tobacco: The doctor outlines the dangers of tobacco, known since the 1964 Surgeon General report. He said that when it comes to Alzheimer’s, it has an extremely small percentage of tobacco users. That is because tobacco users do not live long enough to get any chronic disease later on.
Alcohol: Following closely on the heels of tobacco is alcohol. Dr. Scharffenberg said that especially for women, alcohol increases the chances of getting breast cancer. He also added that while earlier studies claim that two drinks a day for men, and one drink a day for women was probably safe, new studies refute that, and add no amount of alcohol is safe.
Exercise: As mentioned earlier, Dr. Scharffenberg is a huge advocate of exercise, and recommends it everyday. He adds that even if someone is obese and exercises everyday, he will still outlive a person who is thin, but does not exercise. And, while a lot of people think that 40 is the age to slow down, on the contrary, one should start exercising the most from this age, upto the age of 70.

Smoking: At one point of life, smoking will kill you, says Dr. John Scharffenberg. It could be at 40 or 60, depending on how long you have been smoking. And unlike alcohol, on which debate is sketchy, there is no debate on smoking – even 1 cigarette is not recommended.

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Diet: Dr. Scharffenberg largely recommends a vegetarian diet, with an occasional lean meat here and there. According to him, “The optimum diet is the vegetarian diet. Everybody should know this. It’s not something unusual.” He notes that top scientists advised the U.S. government in 2015 that a vegetarian diet is among the optimal dietary patterns, as it can help reduce the risk of age-related diseases.
This apart, Dr. Scharffenberg recommends low consumption of sugar, reducing fat intake, and other lifestyle changes that can make you live longer.

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