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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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Very difficult and extremely cool: how to start doing pull-ups

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Very difficult and extremely cool: how to start doing pull-ups

The pull-up has long been seen as an important fitness metric. From 1966 to 2013, public middle and high school students in the US were required to do pull-ups as part of the presidential fitness test (an evaluation Donald Trump has considered reinstating). US Marine Corps members were long required to perform pull-ups as part of their regular physical fitness test, and prospective UK Royal Marines must complete a minimum of three to four pull-ups before they are eligible to join.

There is no definitive data on how many adults can perform a proper pull-up, but two things are clear: they are very difficult and look extremely cool.

“When a new client comes to see me, the most common exercise they say they’d like to be able to do is the pull-up,” says Emily Schofield, a certified personal trainer at the training company Ultimate Performance. “Achieving that first proper rep is one of the most satisfying milestones you can reach in the gym, because it’s a genuine, hard-earned display of strength, coordination and control.”

Do you want to literally and figuratively flex on others at the gym? Here’s how to start doing pull-ups.

What is a pull-up?

To perform a pull-up, a person starts by hanging from a bar with their arms fully extended and feet off the ground; this is also known as a dead hang. From there, they pull themselves up until their chin is over the bar, and then lower with control.

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“Done well, it’s a controlled, deliberate movement,” says Schofield. “There’s no kicking, jerking or relying on momentum.”

What are the benefits of pull-ups?

Pull-ups build upper body strength, particularly in the back, says Mathew Forzaglia, certified personal trainer and founder of Forzag Fitness. “It also helps develop core stability, which prevents the body from swaying during consecutive reps, and improves grip strength,” he says.

The muscles most engaged by the exercise, according to the Cleveland Clinic, are the latissimus dorsi (or “lats”) – the large, broad, fan-shaped muscles which stretch from the bottom of the back to below the shoulder blades – and the trapezius (or “traps”) – the triangle-shaped muscles that run from the neck to the mid-back. They also engage shoulders, forearms, biceps, triceps and abdominal muscles.

When Schofield performs a pull-up, she says she focuses on not just using her arms: “Putting too much emphasis on your biceps to execute the move will make you tire quickly and diminish how effectively you’re targeting the lower back,” she explains, adding that the lats should be doing the heavy lifting.

In addition to looking impressive at the gym, pull-ups also help with functional strength. Because pull-ups force the body to work as a single unit, they improve “strength, coordination and neuromuscular control”, as well as helping with posture, improved performance on other lifts, and a more balanced physique overall, Schofield says.

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Can anyone do a pull-up?

For the most part, yes.

Many women in particular seem to doubt this. And can you blame them, when the New York Times once published an article titled, Why Women Can’t Do Pull-Ups? (Granted, the article was controversial at the time, and several outlets and blogs published rebuttals.)

Schofield says many women she works with “instantly dismiss the idea they’ll ever be strong enough to perform a pull-up”. But she emphasizes that neither age nor gender should be considered a barrier to the exercise.

“I train a client who is in her 70s and she can perform a full set of eight pull-ups with greater strength and control than people half her age,” Schofield says.

Some people need to be especially careful when performing pull-ups, Schofield says – specifically those with shoulder injuries, elbow painor any type of upper-body joint issue.

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“In those cases, I’d always prioritize rehab and strengthening work before attempting the exercise,” she says.

How do you do a pull-up?

One of the most common mistakes people make when it comes to pull-ups is jumping straight on to the bar, Schofield says. Most people will need to build up a base of strength before they can successfully perform the exercise.

To do this, prioritize exercises that strengthen the muscles you will need to perform a pull up. These include:

Forzaglia also recommends inverted rows using TRX straps or a barbell set up in a squat rack. “This helps build the foundational pulling strength needed to progress,” he says.

Even if you can’t complete a pull-up, it’s worth spending time on the bar, Schofield says: “That might mean attempting partial reps, holding the top position, or controlling the lowering phase.” All of these help the body learn how to coordinate the movement, she explains.

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Regardless of gender, building to a full pull-up can be a slow process. Countless programs claim to be able to teach people how to do a pull-up in 30 days. That might be possible for some. But achieving a pull-up depends on a number of factors, including baseline fitness, bodyweight and physical build. Although the above exercises are all relatively safe, it is a good idea to work with a certified personal trainer who can offer the best personalized guidance. And encouragement.

“Because pull-ups are difficult, people tend to avoid them when they struggle. But that’s exactly when they should practice them the most,” Schofield says. “The key is to practice, practice, practice.”

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Strengthen your lower abs with this unusual but beginner-friendly core exercise

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Strengthen your lower abs with this unusual but beginner-friendly core exercise

We’re always on the lookout for new core exercises to add to our fitness routines, especially ones that help improve form and control. Midlife trainer Dr Won Dolegowski created the barbell back-supported knee raise with exactly this in mind, saying the movement ‘trains your lower abs without stressing your lower back’ while also teaching core control by reducing momentum and swinging.

‘A strong core goes beyond aesthetics. You need it for better posture, to protect your back and to carry you through life,’ she says.

Sarah Campus, PT, instructor, nutrition coach and founder of LDN MUMS FITNESS, explains how to perform the exercise with proper form, why it’s so effective and the key muscles it works.


How to do the barbell back-supported knee raise

  • Set up a barbell on a rack so it sits at lower-back height when you’re positioned beneath it. Add a hip-thrust pad for comfort.
  • Lean your lower back against the bar for support and stability, keeping your core engaged throughout.
  • Raise your knees towards your chest by curling your pelvis upwards, rather than simply lifting your legs.
  • Slowly lower your legs back down with control, avoiding swinging or arching through the lower back.

Muscles worked

The movement mainly targets the core muscles, says Campus, including:

  • Rectus abdominis – particularly during the lifting phase of the knee raise
  • Hip flexors – which help lift the knees
  • Obliques – which assist with stability and pelvic control
  • Transverse abdominals – for deep core stabilisation

Other muscles involved include:

  • Quadriceps – which help maintain leg position
  • Forearm and grip muscles – which help support your hold on the bar
  • Shoulders and upper back – which stabilise the torso against the support

Benefits of the barbell back-supported knee raise

Campus says the exercise offers several key benefits:

  • The core stays under constant tension throughout the movement, as the back support reduces momentum and swinging.
  • It helps stabilise the spine and pelvis, reducing strain on the lower back and making the exercise feel safer and more comfortable.
  • Because the torso stays in a fixed position, it’s easier to perform a proper pelvic curl at the top of the movement, helping improve lower-ab engagement and control.
  • It can also help strengthen grip, adds Dolegowski.

Modifications of the barbell back-supported knee raise

1. Reverse crunches

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  • Lie on your back with your legs extended and arms by your sides, palms facing down. For extra support, place your hands underneath your hips.
  • Press your lower back into the floor and brace your core by pulling your belly button towards your spine.
  • Engage your lower abs to lift your legs and curl your knees towards your chest, allowing your hips to lift slightly off the floor at the top of the movement.
  • Slowly lower your hips back down with control before extending your legs back to the starting position.

2. Hanging knee raises

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  • Hang from a bar with your hands slightly wider than shoulder-width apart. Pull your shoulder blades down and brace your core.
  • Bend your knees and raise them towards your chest using your core muscles, aiming to bring them up to hip height without swinging.
  • Pause briefly at the top of the movement while keeping your torso stable.
  • Slowly lower your legs back to the starting position with control.

3. Captain’s chair leg raises

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  • Position yourself in a captain’s chair with your back against the support pad and your forearms resting on the arm pads. Let your legs hang straight down.
  • Brace your core and slowly raise your straight legs until they reach hip height or slightly higher.
  • Pause briefly at the top while keeping your torso steady and avoiding swinging.
  • Lower your legs back down slowly and with control before repeating.

Having a strong core is about far more than sporting a six-pack. Build functional mid-section strength – while also improving your power, posture, coordination and balance – with WH COLLECTIVE coach Izy George’s 4-week core challenge. Download the Women’s Health UK app to access the full training plan today.

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Headshot of Sarah Campus

Sarah Campus is a highly qualified women’s PT, Nutrition Coach, Running Coach, Distance Runner, mum of 3 and founder of LDN MUMS FITNESS.

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She’s the host of the Soho House Run Club in Chiswick and a STRAVA and TOMMY’s marathon coach and ambassador. She specialises helping non-runners get into competitive distance running.

As a fitness and holistic wellness expert, Sarah regularly features on TV and in Magazines, offering tips and advice to keep the whole family healthy and active.

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What is Americans’ favorite exercise? New study reveals a surprising trend in fitness habits

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What is Americans’ favorite exercise? New study reveals a surprising trend in fitness habits
Walking is often treated as the simplest, most sustainable way to stay active and for good reason. It requires no equipment, no gym membership, and it fits easily into daily life. But a large new analysis suggests that while walking is extremely popular, it may not be enough on its own for most people to meet widely recommended fitness benchmarks.

A study published in the open-access journal PLOS ONE analyzed data from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System, drawing on survey responses from almost 400,000 U.S. adults. The objective was to know which leisure-time physical activities people prefer and whether those options align with federal activity guidelines.

Walking is most popular but not the most effective for fitness goals

The results were notable. Walking appeared as the most frequently reported leisure-time physical activity across both urban and rural groups. In fact, roughly 44.1% of adults indicated that walking was their main form of exercise.

However, popularity did not translate into achieving recommended health standards. Based on the analysis, individuals who primarily walked had the highest likelihood of not meeting either aerobic or muscle-strengthening guidelines compared with other exercise categories. Even more significant, only about one in four walkers (25%) satisfied both recommended benchmarks, while approximately 22% failed to meet either requirement at all. In contrast, participants who reported running, resistance training, or conditioning workouts as their primary activities were considerably more likely to achieve federal physical activity targets.

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What the guidelines actually require

The American College of Sports Medicine recommends that adults get:

  • At least 150 minutes per week of moderate-intensity aerobic activity
  • Plus muscle-strengthening exercises on two to three days per week

While walking can contribute to aerobic activity mainly if done briskly, it generally does not fulfill the strength-training requirement on its own.

Rural vs urban differences in activity patterns

The study also revealed geographic variations in exercise behavior. Rural residents were more likely to participate in activities such as gardening, hunting, and fishing, whereas urban residents showed higher engagement in running, cycling, dancing, and weight training. Despite differing preferences, urban participants were overall more likely to meet both aerobic and strength-based guidelines compared to rural populations. Researchers suggest that access to facilities, infrastructure availability, and cultural influences may contribute to these differences.

Why this matters: muscle is a key part of health

A key takeaway from the study is that physical activity guidelines are not just about movement, but about different types of movement. Walking supports cardiovascular fitness and daily activity levels, but it does not significantly develop or preserve muscle mass. This distinction is important because muscle deterioration begins gradually with age. Research indicates that adults may lose around 3% to 8% of muscle mass per decade after age 30, a condition known as sarcopenia. This decline is associated with slower metabolism, increased fat storage, reduced mobility, and higher risk of falls and fractures in later life.

Resistance training helps counteract this decline. Studies show it can increase lean muscle mass, boost resting metabolic rate by approximately 7%, and reduce body fat. A large meta-analysis also found resistance training linked to:

  • 15% lower risk of all-cause mortality
  • 19% lower cardiovascular disease mortality
  • 14% lower cancer mortality

The most notable benefits were observed with around 60 minutes per week of resistance exercise, making it a time-efficient health strategy. Additionally, resistance training supports mental well-being by improving mood and increasing BDNF (brain-derived neurotrophic factor), which promotes brain health and neural growth.

What truly makes the difference

The study aligns with broader longevity research suggesting that higher-effort activities tend to deliver stronger physiological benefits.

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Running, weight training, and conditioning workouts share a common feature: they sufficiently challenge the body to trigger adaptation. Walking, although beneficial, generally remains in a lower-intensity range that may not fully satisfy all fitness requirements on its own.

In practical terms:

  • Walking supports general cardiovascular health, mental well-being, and daily movement
  • Resistance training builds and preserves muscle, supports metabolism, and reduces age-related decline
  • Higher-intensity cardio (running, cycling, HIIT) improves cardiovascular fitness more efficiently and helps meet aerobic goals faster

Expert perspective from the study

The researchers emphasized that the findings are not meant to discourage walking but to emphasize gaps between perception and results.

As lead researcher Christiaan Abildso explained:

“We expected to see that walking would continue to be the most common physical activity. However, it was surprising to see that nearly one in four adults who walk as their main activity did not meet either of the physical activity guidelines. That is, they reported less than the recommended 150 minutes per week of moderate-intensity aerobic activity and fewer than the recommended two days per week of muscle-strengthening activity, such as yoga or exercises with resistance bands,”

He also pointed to wider environmental and structural elements influencing activity levels:

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“What we might be seeing in these rural–urban differences in preferences may just reflect what people have access to or what is culturally supported. In our work, we see a need to continue to support our partners in small towns and rural places by creating physical, social, and cultural conditions that support physical activity. This could mean creating a wide shoulder on a country road for running and cycling, helping a senior centre with their chair exercise programming, creating or improving park spaces, expanding the national network of rail trails, renovating abandoned and dilapidated structures (brownfields) into viable activity centres, keeping school facilities open to the public, and many other strategies. Everyone needs to ask, ‘how does what we’re doing affect physical activity?’, in order to help get people more active, more often, in more places,”

FAQs:

1. Is walking good for health?
Yes, walking supports heart health and general well-being. It is a low-impact activity suitable for most people.

2. Can walking replace all exercise?
Not entirely, because it does not build muscle strength effectively. A balanced routine usually includes strength training.

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