Rates of compliance and adherence to high-intensity interval training: a systematic review and Meta-analyses

Abstract

Background To determine rates of compliance (i.e., supervised intervention attendance) and adherence (i.e., unsupervised physical activity completion) to high-intensity interval training (HIIT) among insufficiently active adults and adults with a medical condition, and determine whether compliance and adherence rates were different between HIIT and moderate-intensity continuous training (MICT). Methods Articles on adults in a HIIT intervention and who were either insufficiently active or had a medical condition were included. MEDLINE, EMBASE, PsychINFO, SPORTDiscus, CINAHL, and Web of Science were searched. Article screening and data extraction were completed by two independent reviewers. Risk of bias was assessed using RoB 2.0 or ROBINS-I. Meta-analyses were conducted to discern differences in compliance and adherence between HIIT vs. MICT. Sensitivity analyses, publication bias, sub-group analyses, and quality appraisal were conducted for each meta-analysis. Results One hundred eighty-eight unique studies were included (n = 8928 participants). Compliance to HIIT interventions averaged 89.4% (SD:11.8%), while adherence to HIIT averaged 63% (SD: 21.1%). Compliance and adherence to MICT averaged 92.5% (SD:10.6%) and 68.2% (SD:16.2%), respectively. Based on 65 studies included in the meta-analysis, compliance rates were not different between supervised HIIT and MICT interventions [Hedge’s g = 0.015 (95%CI: − 0.088–0.118), p = .78]. Results were robust and low risk of publication bias was detected. No differences were detected based on sub-group analyses comparing medical conditions or risk of bias of studies. Quality of the evidence was rated as moderate over concerns in the directness of the evidence. Based on 10 studies, adherence rates were not different between unsupervised HIIT and MICT interventions [Hedge’s g = − 0.313 (95%CI: − 0.681–0.056), p = .096]. Sub-group analysis points to differences in adherence rates dependent on the method of outcome measurement. Adherence results should be interpreted with caution due to very low quality of evidence. Conclusions Compliance to HIIT and MICT was high among insufficiently active adults and adults with a medical condition. Adherence to HIIT and MICT was relatively moderate, although there was high heterogeneity and very low quality of evidence. Further research should take into consideration exercise protocols employed, methods of outcome measurement, and measurement timepoints. Registration This review was registered in the PROSPERO database and given the identifier CRD42019103313.

High‐intensity interval training and cardiorespiratory fitness in adults: An umbrella review of systematic reviews and meta‐analyses

“…The safety concerns associated with HIIT do not appear to be significantly greater than those associated with MICT. This notion is supported by a recent systematic review that indicated high compliance to HIIT among insufficiently active adults and adults with a medical condition 57 . Among our included reviews that reported compliance, 20,32,35,37,39,41 the compliance level within HIIT programs was also satisfactory (i.e., ≥80%) in general.…”

“…reported four adverse events in the 14 included RCTs analyzed among 429 middle‐aged and older adults, including hip pain, persistent cramps, and myocardial infarction. However, while large‐scale studies with safety outcomes are currently lacking, some clinical studies have suggested that HIIT appears to be safe, well‐tolerated, and attainable, even when applied to relatively high‐risk populations with low initial fitness 53–57 . The safety concerns associated with HIIT do not appear to be significantly greater than those associated with MICT.…”

“…However, while large-scale studies with safety outcomes are currently lacking, some clinical studies have suggested that HIIT appears to be safe, well-tolerated, and attainable, even when applied to relatively high-risk populations with low initial fitness. [53][54][55][56][57] The safety concerns associated with HIIT do not appear to be significantly greater than those associated with MICT. This notion is supported by a recent systematic review that indicated high compliance to HIIT among insufficiently active adults and adults with a medical condition.…”

“…This notion is supported by a recent systematic review that indicated high compliance to HIIT among insufficiently active adults and adults with a medical condition. 57 Among our F I G U R E 3 Results of meta-analyses that compared HIIT with MICT for CRF improvements using (A) standardized mean differences and (B) weighted mean difference. We conducted a re-analysis of the CRF data reported in the original review by Rugbeer et al 17 and identified that the direction of effects comparing SIT versus MICT and HIIT versus MICT was likely mistakenly swapped by the original authors.…”