Fitness
Stroke: HIIT may be more effective than steady, moderate exercise
- 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
Previous studies show that
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
“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
For this study, researchers recruited 82 stroke survivors who were in the period between six months and five years after a stroke.
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
“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.
“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.”
Fitness
At 66, Judy Murray swapped skipping for rebounding – here’s why it’s so effective for midlife women
A household name synonymous with tennis, Judy Murray has branched out in recent years when it comes to fitness. While the coach and former player still frequents the court – it’s integral to her day job, after all – she has incorporated several other activities into her routine, including one you might be unfamiliar with: rebounding.
Rebounding
In an interview with The Times, Judy explained that while skipping had been part of her tennis routine for years, she’d decided to replace it with rebounding – jumping on a trampoline – due to the impact skipping started to have on her joints and legs. And she’s onto something – a NASA study found rebounding to be up to 68% more effective at working the muscles and joints than treadmill running – something scientists call mechanical loading, which is crucial for bone, muscle and tendon health.
It doesn’t have to be expensive, either. Judy told The Times that she had bought a mini trampoline for £24.99 and that she used it in one-minute bursts.
‘Rebounding can be a smart swap for women in midlife, particularly if high-impact skipping or plyometric training has started to feel unforgiving on the joints,’ says personal trainer Michael Baah. ‘As oestrogen declines during perimenopause and menopause, we typically see reductions in bone mineral density, muscle mass and tendon elasticity,’ he explains. ‘High-impact ground reaction forces from traditional skipping can be effective for bone health, but they also place substantial load through the knees, hips and Achilles.’ Rebounding, on the other hand, ‘absorbs some of the ground reaction force, reducing peak stress through the joints, while still stimulating muscle activation in the calves, glutes and core.’
It shouldn’t replace strength training, adds Baah, which ‘remains the most effective intervention for combatting age-related sarcopenia and maintaining metabolic health,’ but it’s an incredibly valuable conditioning tool ‘for women who want to protect their joints while maintaining cardiovascular fitness.’
Below, we also look at the other workouts Judy has turned to in recent years to stay strong and active while protecting her joints – and why you should try them, too.
She swims
‘As I get older I have found a lot of things I enjoyed doing really impact my knees and hips, but a lot of things I can do in water…I also realise I have five grandchildren now. I want to be able to run after them and pick them up and put them down with relative ease,’ Judy told The Times. ‘I have a whole routine I do in the swimming pool and there is no impact in the water. It is a better way to do some of the things I used to do.’
Indeed, not only does swimming protect your joints, but it’s also effective for cardio fitness. ‘The biggest advantage of swimming is that it is low impact. The buoyancy of water significantly reduces joint loading, making it an excellent option for people with joint pain or who have a lower tolerance to impact,’ personal trainer and nutritionist Georgia Garlick previously told WH. ‘It is a true full-body exercise, involving the upper body, trunk, hips and legs simultaneously.’ On average, she added that moderate swimming burns 500-700 kcal per hour – typically more than moderate cycling.
She has started playing golf
Judy has also discussed how participating in Strictly Come Dancing back in 2014 instilled in her a desire to continue challenging herself and trying new things – no matter her age. In that vein, ahead of her 65th birthday, she told HELLO!, that she had taken up golf. ‘I’m addicted to it, it is so incredibly relaxing,’ she said. ‘It gets me out in the fresh air and away from my phone and because it’s not as physically demanding as running around a tennis court, it suits me now that my arms aren’t as strong as they once were.
‘As we get older it’s so important to keep trying to find things that stimulate you, make you think and keep you socially connected – and golf ticks all of those boxes.’
A review published in the British Journal of Sports Medicine linked golf to an increased life expectancy, reduced risk of chronic disease and improved mental health.
She plays pickleball
While padel has become hugely popular, it seems that its sibling pickleball – which combines tennis, badminton and table tennis – is more up Judy’s street. After trying the sport herself, she’s since campaigned to get more people involved. ‘It’s just fun and engaging, and it’s incredibly inclusive. And for Scotland, it’s a perfect fit for us. We have terrible weather, we have badminton courts everywhere – in every community centre and sports centre. Even church halls have badminton courts,’ she told The National. ‘In terms of setting up quickly, wherever you are, I think it’s a perfect fit for getting more people more active.’
Judy added that she sees it as a perfect transition from tennis to something that will let her play a similar game for longer.
She stretches regularly
The final touch to Judy’s fitness routine? A dedicated stretching routine. ‘Since I turned 60, I’ve realised how important it is to stretch to stay mobile and flexible if I want to stay active with my grandchildren,’ she told HELLO!.
While we don’t know the specifics of Judy’s stretching routine, even dedicating just a few minutes daily to mobility can supercharge longevity.
There is an ideal routine based on science, though. According to a panel of experts convened by the American College of Sports Medicine, who reviewed a range of studies, you should:
- Do flexibility exercises (stretches, yoga or tai chi) for all major muscle-tendon groups – neck, shoulders, chest, trunk, lower back, hips, legs and ankles – minimum two to three times per week.
- Spend 60 seconds on each exercise. If you can hold a specific stretch for 15 seconds, try repeating it three more times and if you can hold it for 20 seconds, two more repetitions would be ideal.
As Judy regularly says, though, it’s about finding forms of exercise that you enjoy, as you’ll be far more likely to find the time – even if it’s for five minutes – to get stuck in.
Hannah Bradfield is a Senior Health and Fitness Writer for Women’s Health UK. An NCTJ-accredited journalist, Hannah graduated from Loughborough University with a BA in English and Sport Science and an MA in Media and Cultural Analysis. She has been covering sports, health and fitness for the last five years and has created content for outlets including BBC Sport, BBC Sounds, Runner’s World and Stylist. She especially enjoys interviewing those working within the community to improve access to sport, exercise and wellness. Hannah is a 2024 John Schofield Trust Fellow and was also named a 2022 Rising Star in Journalism by The Printing Charity. A keen runner, Hannah was firmly a sprinter growing up (also dabbling in long jump) but has since transitioned to longer-distance running. While 10K is her favoured race distance, she loves running or volunteering at parkrun every Saturday, followed, of course, by pastries. She’s always looking for fun new runs and races to do and brunch spots to try.
In an era where ultramarathons, double training days and weekly Hyroxes have become the norm, the signs of exercise dependency are increasingly blurred. Movement is celebrated as medicine, after all – so how do you know when it’s become something more sinister?
At its core, exercise dependency is a pattern of compulsive exercise where working out stops being a flexible, health-enhancing habit and becomes something you feel driven to do – even when it’s harming your body, mood or life. But since it’s widely seen as a “healthy” habit, the signs are often missed.
In reality, depending on exercise (often to avoid painful or difficult emotions) carries significant physical and psychological consequences – and research shows that among people who regularly exercise, 14-42% of them suffer. Below, dietitian and expert in REDS Renee McGregor shares the signs to watch for, then scroll down for advice on how to restore a healthier relationship with exercise.
Signs of exercise dependency
- Using exercise to manage emotions: Relying on exercise to fix negative moods or feelings of worthlessness.
- Never feeling you’re doing “enough”: Feeling that no matter how much you train, it’s not sufficient.
- Hidden workouts: Hiding the amount of exercise done from others.
- Distorted priorities: Inflexible, obsessive, and compulsive thinking regarding fitness goals.
- Ignoring pain or injury: Continuing to train despite illness, exhaustion or injury.
- Withdrawal symptoms: Feeling anxious, depressed, irritable or restless if a session is missed.
- Compulsive scheduling: Structuring the entire day around workouts and feeling intense anxiety if the schedule is disrupted.
- Increasing intensity/volume: Needing more exercise to achieve the same high or emotional satisfaction.
- Prioritising exercise: Skipping work, school, social events or family obligations to exercise.
How to recover
1.Identify compulsive patterns
Studies show exercise dependence shares features with other addictive behaviours, like tolerance, withdrawal and compulsive use. And McGregor says around 60% of people with exercise dependency also show behaviours linked to a dysfunctional relationship with food. Aim to identify what makes you want to exercise: is it a desire to control your weight? Or to avoid guilt or anxiety? How do you feel when you’re not able to exercise?
2. Reduce wearable tech tracking
Constantly tracking your steps, workout data and fitness scores can inadvertently increase anxiety, guilt and comparison around metrics and goals, potentially reinforcing obsessive exercise behaviour – instead of healthy motivation. Indeed, studies show wearables can exacerbate harmful compulsive exercise behaviour and should be used with caution in people prone to dependence.
3. Find a non-body-based hobby
Language learning, pottery, chess, or volunteering can all help to reduce stress, build identity outside exercise and improve well‑being by activating new reward pathways and providing a sense of purpose. Research on these types of leisure activities shows that engaging in hobbies is linked to better mental health, reduced depression and anxiety and is also protective in recovery from addictive behaviour.
4. Seek professional psychological support
Other research shows various types of therapy can help explore motivations and past experiences that contribute to compulsive exercise, as well as helping to rebuild social functioning outside of exercise routines.
5. Broaden your coping strategies beyond exercise
Multiple studies show that exercise often serves as an emotional coping strategy for stress, anxiety or low mood – not just physical health. Experts say recognising and addressing this in therapy can help you to broaden your emotional toolbox beyond exercise – for example, studies show walking outdoors (without tracking your pace or steps) can help relieve stress and anxiety. Other research shows five-ten minutes of paced breathing, journalling and short guided meditations can also work. Gardening, long baths and reading fiction can also act as a stress release.
6. Structure balanced activity with rest
Establish a structured, weekly schedule focussing on moderate intensity exercise over high intensity, with rest and recovery also formally scheduled in, as per research. It’s not about completely cutting out all exercise, but making it a realistic, sustainable and healthy part of life.
7. Set training boundaries
Experts recommend built-in rest and setting a minimum duration per exercise session to avoid overexercising and to boost physiological recovery and psychological resilience. Aim for at least one rest day between workouts.
If you recognise these signs in yourself, it’s important to seek support from a GP or qualified mental health professional. Exercise dependency and exercise addiction are treatable, and getting help early can make recovery far easier and more sustainable. Contact your GP or use the NHS’ Mental Health Services, or contact BEAT.
As Women’s Health UK’s fitness director and a qualified Pilates and yoga instructor, Bridie Wilkins has been passionately reporting on exercise, health and nutrition since the start of her decade-long career in journalism. She secured her first role at Look Magazine, where her obsession with fitness began and she launched the magazine’s health and fitness column, Look Fit, before going on to become Health and Fitness writer at HELLO!. Since, she has written for Stylist, Glamour, Cosmopolitan, Marie Claire, Elle, The Metro, Runner’s World and Red.Now, she oversees all fitness content across womenshealthmag.com.uk and the print magazine, spearheading leading cross-platform franchises, such as ‘Fit At Any Age’, where we showcase the women proving that age is no barrier to exercise. She has also represented the brand on BBC Radio London, plus various podcasts and Substacks – all with the aim to encourage more women to exercise and show them how.Outside of work, find her trying the latest Pilates studio, testing her VO2 max for fun (TY, Oura), or posting workouts on Instagram.
As running challenges get more and more extreme, it can be easy to assume that unless you’re running seven marathon in seven days in seven different continents, you’re not really a runner. But the truth is that a smaller, manageable amount of exercise can make a big, lasting difference – as a new study in The Lancet proves.
What did the study find?
As with the best studies, the results were taken from a large data pool. Researchers examined existing data from studies conducted in Norway, Sweden, the US and the UK that included more than 100,000 participants.
Another plus for the study is that the date was based on device-measured physical activity and sedentary time, as opposed to self-reported activity data (which is more prone to bias and error).
After crunching the numbers, the researchers estimated how many deaths could have been prevented through small, daily lifestyle changes.
The conclusion? Adding just five minutes of moderate-to-vigorous exercise per day could help to prevent up to 10% of all deaths from any cause.
Another easy came in the form of sitting less. Reducing sitting time by 30 minutes a day could, said the researchers, prevent up to 7% of deaths.
What does this mean for us?
While these figures might look relatively small on paper, they are hugely significant in the context of the global population – and highlight the powerful health benefits of adding just a little bit of physical activity into your day.
When, according to the World Health Organization, 31% of adults and 80% of adolescents don’t meet the recommended levels of physical activity, it’s so important to know that small, daily changes are valid and can make a difference.
‘These results show that small steps can have a large impact,’ the study’s co-author Maria Hagströmer, told Health Management Magazine. ‘You don’t need to run marathons – just a few extra minutes of brisk walking each day can make a difference.’
‘Our study focuses on realistic changes. For many people, reducing sitting time or adding short bouts of activity is more achievable than large lifestyle modifications,’ added co-author Ing-Mari Dohrn.
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Hannah Bradfield is a Senior Health and Fitness Writer for Women’s Health UK. An NCTJ-accredited journalist, Hannah graduated from Loughborough University with a BA in English and Sport Science and an MA in Media and Cultural Analysis. She has been covering sports, health and fitness for the last five years and has created content for outlets including BBC Sport, BBC Sounds, Runner’s World and Stylist. She especially enjoys interviewing those working within the community to improve access to sport, exercise and wellness. Hannah is a 2024 John Schofield Trust Fellow and was also named a 2022 Rising Star in Journalism by The Printing Charity. A keen runner, Hannah was firmly a sprinter growing up (also dabbling in long jump) but has since transitioned to longer-distance running. While 10K is her favoured race distance, she loves running or volunteering at parkrun every Saturday, followed, of course, by pastries. She’s always looking for fun new runs and races to do and brunch spots to try.
Rick Pearson is the senior editor at Runner’s World UK. He’s been with the brand since 2017 and loves testing PB-friendly shoes for on and off road. Rick is a sub-three marathoner, 4-something miler and once completed 100 miles in less than 24 hours. He occasionally likes to remind people of these feats on the Runner’s World podcast, which he co-hosts.
Rick’s running CV also includes racing a steam train over 14 miles (he won, narrowly) and a horse over a marathon (he lost, comfortably).
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