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Today we're going to be talking about high-intensity interval training. I guess I should also actually remember to mention your name as the second most handsome Dr. Rathamarka. Dr. Austin Baraki, what's going on, man? It is just an honorific that now I think people clearly associate with only me. Maybe you don't need to mention the name. People just know who you're talking about now.
People just know. Also, people assume that I consider myself number one. That's just like all that does is speak to the new audience that we've garnered because they aren't privy to the insider joke that was out of the bag long time ago, hundreds of episodes ago. But I am not number one. Clearly, clearly. I don't think poorly of myself, but just as far as number one, that's not me. So anyway, if you get that joke, if you get that reference, hey, man.
We're really excited to still have you listening to the Barbell Medicine podcast, but I can confirm I'm not number one. Other sort of announcements that we have Barbell Medicine Plus. We have no we announced that a few weeks ago and it's going strong. We're uploading summaries and podcasts actually early access to our podcast ad free listening to our podcast.
In addition to transcripts and some other exclusive content. So if you want to be a Barbell Medicine Plus member that can look that up on our websites, also linked in the description below. We also I did this while I was in France, we released a brand new template power building one generation to and I know what people are thinking they're like, well, don't you guys already have like a power building one template. Yes, we did. It was a three day version.
You couldn't pick your own exercises and the reason why I selected that originally, is because my thought was in the like lifetime of a train, you know, career of a trainee. If you're doing, you know, an entry level template. I don't know if you have enough experience at that point to pick your own exercises.
So the idea was well, I'll do it for you. I've done some tweaks, I've done some modification of our of our template offerings and I figured out a way to make that work where people can pick their own exercises. In addition to giving people not just a three day version of the template, but also a two day and four day versions of the template. It's also got brand new programming that I think is a little bit better suited to folks who will be in the in that sort of.
That market for a for an entry level or like their first four ray into power building and additionally kind of rewrote the entire company in text. It's very specific now to this new template. So it's a completely new sort of template offering and yeah is up on the websites on our app as well.
So you can pick that up if you are interested. All right, well, let's pop into this podcast on high intensity interval training and to start it off, we have to bring back one of our favorite segments. And I think some of our listeners favorite segment is quack watch and Dr.
and Dr. Patrick is added again, and this is a direct quote from a tweet that she published incorporating these evidence based high intensity interval training or hit protocols into your exercise routine can substantially improve your cardiovascular fitness cellular energy production and metabolic health.
And then she recommends that people do a Tabata protocol, which is 20 seconds of all out effort, followed by a 10 second rest period for eight rounds and she says you can do these daily. She then says you can do when gate sprints, when gates that particular type of like exercise bike that people use an exercise physiology labs to test power output.
So you would do 30 seconds of all out efforts, followed by a four minute of light recovery by four to six rounds, you can do that once per week. And you also do a one minute on one minute off, so one minute on of all out effort, followed by one minute rest for 20 minutes, you can do that twice per week.
I should allude to something we'll talk about later. There's a difference between all out versus maximal effort. So all out is basically like as hard as you'll let yourself go, but maximal effort is exactly what it sounds like it's the maximum amount you can do and you cannot repeat that until a much later time. It's kind of like you want a five rep max, for example, it's like, hey, that's a five rep max, you could not repeat that five minutes later by definition.
And then she says you can do a Norwegian four by four, which is where you four minutes of very hard effort, followed by three minutes of light recovery by four rounds, and you can do that twice per week. So daily tabata's once per week, when gate twice per week, one one one minute on one minute off and twice per week Norwegian four by fours.
She's like, yeah, evidence base, baby, let's go. This is an unbelievable. Do you think that either of us could survive one week of doing that? Well, well, exactly, my short answer is yes. And here's why because when doing these, if we knew that that was the weekly prescription, we would just auto regulate it, whether that's conscious or subconscious or otherwise, meaning that we're like, oh, to bottle, I'm not going to send it for 20 seconds.
I'll do it at RP eight. Yeah, we would just do the program. Correct. Yeah, exactly. So it and what happens most of the time with these, we can call these like pop scientists, right? You know, if there's like our airport books, maybe these are airport scientists, you know, just publishing stuff that's not really true, but sounds good if you don't think about it too hard or you don't know anything.
When they published these tweets invariably, there are actual experts that come way in. This is like their pet topic and they're like, no, dummy, you did it wrong. And here's why and you should have asked first. And, and you know, some of these people have dedicated their whole life to the to studying this stuff. And it's it's almost like an egregious error on the person publishing this like, yeah, do this huge platform.
And then these academics are like, hey, look, like, why didn't you just ask, we're happy to share our take on this and we can help you put out better information. Sometimes, you know, oftentimes for free. But you just didn't ask, you didn't even know where to ask, which is problematic. So the first person I saw that weighed in on this was Dr. Steven Siler.
He's an exercise physiologist and easy one of the foremost experts in endurance training. He like created the five zone model, like the first person to publish on this in 2009. So well before Attia was talking about five zone models well before anybody else was talking about zone two stuff.
Like he created it effectively. That's not entirely true. Some like previous sports training guidelines had talked about a five zone model, but he was the first like citation you can find about this. Anyway, he wrote back on a tweet. I've been doing research on elite endurance performance for 30 years. I know you have areas of great expertise. Unfortunately, sustainable endurance training is clearly not one of this is extremely bad advice that can do far more harm than good over time.
But please trust sports scientists and on with on the ground experience working with all types of athletes daily to bought a sessions are a perfect recipe for rapid stagnation and ultimately performance decline. The reasons are myriad both related, but related to both molecular signaling feedback inhibition and systemic stress responses and strain reactions to borrow a term double jeopardy.
I thought that was particularly damning and then Steve Magnus. He's a researcher author of science of running and do hard things, both excellent books. It's also the former assistant coach and scientific advisor for the Nike Oregon project. He wrote back he says you should not do these workouts as written the disconnect between what's done in the real world and what's spread on social media is crazy. Why all out or as hard as you can workouts are rare even in elites.
The intensity is too high and it isn't the right stimulus, especially with the first and third workouts were recovery is short. What should these workouts be instead. Well, the Tavata work he recommends being done at a one mile pace. So basically your fastest one mile, not just 20 seconds of all out effort go crazy. I imagine Kermit the frog like that.
That would be Rhonda Patrick sort of recommendation and meanwhile this actual coach is like now that's probably one mile pace for the wind gate. That's a 30 second sprint. He says well depending on the goal. Those should be done at about 800 meter or 600 meter pace for the one minute on one minute off. Well depending on the goal that should those should be done between a 5K and a one mile pace.
Interval should be purposeful and not all out. He then says be wary when someone says to do this interval quote all out. You want your intensities to be specific to the stimulus and adaptation that you want. The goal isn't to create fatigue. That's easy to do. The goal is to slightly embarrass your body in the right direction.
So then Dr. Rhonda Patrick responds putting aside the wind gates ignoring this. I agree just error. I have putting aside the wind gates is anything done in a total of 10 minutes that big of a deal should be limited harm.
Steve Magnus replies it just keeps getting worse now any workout that is less than 10 minutes equals not a big deal speed endurance 200 to 150 seconds, etc. And your max would like a word from an injury slash over training standpoint very short and intense workouts are often what you have to be the most cautious with.
I've linked to those tweets in the in the description below. But before we move on to the rest of this podcast, Austin, when you saw this train wreck of a tweet thread, what did what did you think?
Yeah, I couldn't look away. I mean, we ended up having some some conversations about it. It reflects my experience, you know, training in a more endurance oriented sport when I was in the pool. I mean, I can think of like we might have had one or two like workouts a year where we're doing like repeats that were actually intended to be all out and they were miserable real fast.
And you did not look forward to doing them again anytime soon. So it was extremely infrequent. And even the benefit of doing it at all was was debatable in terms of the fatigue cost relative to the stimulus you got out of it. Perhaps it was being given more for a mental training kind of aspect.
I can't speak to my coaches mindset at the time, but very, very infrequent. It also reflects what we have talked about even, you know, to translate it a little bit over into the world of strength training like how often we actually go absolute all out like
true max effort lifts is not similarly not frequent because at the same kind of argument, the fatigue cost that it typically generates is not worth the benefit. And so, you know, I think that for Dr. Patrick here who was, you know, making a lot of these claims, she clearly does not have knowledge of or experience of like what that training actually is like she clearly doesn't do it herself.
If she does she is as you say, like internally auto regulating she's pacing herself while telling herself she's going all out, but not actually doing it. And this is not something that I would necessarily blame someone for. So I think back to like my swimming days in the pool.
And early on like when I was quite young and I was racing and I thought I was sprinting and I vividly remember a day where I had like my biggest rival at the time when I was like, I don't know 13 or something like that. And we had been racing going back and forth all year and that day I unleashed a new gear because I had this like additional motivation to race this this guy who had been my rival for like the whole season.
And I vividly remember I was like, oh, that's what sprinting is actually like right. So so I once I learned that my entire like sprint performance changed once I kind of learned and access that gear. And so there's some value in learning where that gear is and how to access it. But it should be done very sparingly and especially in the context of training if ever I suspect she never has.
And then these experts are clearly, you know, indicating indicating that to her. And so I suspect she's talking to like Gen Pop people who've never access that gear. And so all out quote unquote to them is really like 50 or 60% of max effort. Like that, you know, yeah, yeah, I think, you know, if you want to be charitable about this take, it's like, hey, you can you can do these things and improve your cardiovascular fitness.
And I wouldn't really be able to like say, well, that's wrong because certainly if you do this compared to nothing, your cardiovascular fitness is likely to improve. So like, I guess that's true. If taken just literally like that, I, but the insinuation is no do this instead of something else. Yeah.
And if we're talking about like optimization, even though that's a word, neither was really, really love. But if you're talking about this about maybe like your best return on investment from training clearly, this is not the right way to go about it as as not only reflective of the broader body of evidence on how to improve endurance performance, but also markers there
and stuff whether it's VO 2 max or whatever the claim about cellular energy production is also we're going to get into that a little bit, you know, assuming we're talking about like mitochondrial density and capitalization and whatever. So like you can do all of that through a number of different ways of training, the idea that doing this specific protocol or combination of protocols is like the best.
Again, that's a different claim that like this could improve that or would improve that compared to doing nothing. I guess, you know, again, you can be charitable as charitable as you want to this take. I just am like if somebody's willing would be otherwise willing to do this lot of very hard efforts very, very frequently. I suspect they'd also be on board with doing something a little bit more moderate intensity that's more planned out and progressively loaded over time.
That's the other thing here is like, OK, well, this is just like a prescription. How does this dynamically evolve over time? You can't put that into tweet, which is why most experts don't do this shit. Like if you're you know, I'm saying that's like you publishing a program like, Hey, just do this for lifting and you're like, it's incomplete. I don't feel great about publishing that. Is that that kind of jive with how you think about exercise prescription.
I agree. I think that there's just a big disconnect in terms of either her own training and the types of people that she might, you know, communicate with and then these coaches and experts who are actually quite familiar with high level training on this. I mean, we see the same thing in other contexts like I think about, you know, our former colleagues in the strength training space who would, you know, advise all beginners to just like continuously add weight and grind and grind and grind.
And then once we get a little bit of experience coaching and actually programming for people were like, that doesn't really work very well. People tend to burn out really quickly. It's a pipeline to our pain and rehab, you know, service a lot of the time and just pulling back a tiny bit from that, just like, you know, quote unquote all out level of effort.
You get the vast majority of the benefits with a lot better kind of like, you know, fatigue and risk profile and things like that. And so it just translates pretty broadly, but when there's a disconnect between, you know, the expertise and the experience and the type of person that you're that you're training and trying to communicate to. And perhaps how it's received, you know, the person who's actually doing the training.
Like you were saying, maybe they ought to regulate and the people that she's talking to who who claim to be doing this, maybe they're actually doing their tabata is at one mile pace. So it ends up being kind of like a moderate intensity interval thing. But if it's truly, truly high intensity, it should smoke you and you should not be able to do it daily, much less multiple times a week like she's advising for some of these things.
Yeah, yeah. And again, I think it will cover this in the actual substance of this podcast, but it's like, if this were the best method or one of the best methods for improving cardiovascular fitness endurance performance and so on and so forth. We people would have stumbled upon it and and incorporated it as as described here, or at least closely described this, but almost universally people have rejected this, which I think speaks to the veracity of the statement overall.
And I just wouldn't take exercise advice from people who don't exercise at a high level and have experienced coaching exercise or prescribing exercise at a high level. That's not your area of expertise. Why opine on it? That's like me opine on like how to get a rocket to launch. I'm like, I don't know, man, you know, I took some physics courses, right? And like, I know how to make motors work, but like I can't speak to to, you know, launching a rocket.
So that's why I don't talk about it. But I suppose if I did, maybe we could expand our barbell medicine plus membership base, you know, maybe we could write a book on it. Maybe we could, you know, come up with a protocol. The old barbell medicine rocket launch protocol. There we go. To the moon to the moon. All right. Well, with that in mind, today we're going to talk about hit or high intensity interval training.
Now in an athletic context, hit is build as a way to accumulate a greater amount of higher intensity work that would subsequently generate unique adaptations that are helpful in sport. In the health context, high intensity interval training is often said to improve weight loss, body composition, cardiress, Tory fitness and more better than modern intensity, continuous conditioning while reducing the time commitment. So that in mind, let's start off some definitions here.
So when we define high intensity interval trainer, when we try to define this, I think broadly speaking, we're talking about interval training as a simple concept referring to repeated bouts of relatively hard work, interspersed with recovery periods of easier work or rest in some cases.
So when we said there's no common definition of quote high intensity interval training that is, you know, consensus or otherwise well accepted, despite its widespread use and that's problematic with not only like looking at the research, but also even trying to characterize a particular protocol like was this actually high intensity interval training was this sprint intensity interval training was this some other type of, you know, not quite moderate but not quite high intensity like something somewhere between.
And it depends on how you define it. High intensity probably means greater than moderate intensity and in this case, it's not continuous work, but rather interval work, I think that's reasonable. And then sprint intensity training, so s it is that of h i it is a particular type of hit training, though many think of hit training only as sprint intensity training, a sprint interval training, which makes again data analysis tough because hit is not universally sprint intensity training, although.
All sprint intensity training is by definition hit provided you do more than one interval, I suppose, if you just do one sprint, I don't know that sprint interval training, I think that's just you did one sprint, but leave that to some some other nerds to figure out.
Now as a reminder, there are many different ways to describe exercise intensity, although they all center around two major landmarks, so the first landmark is this aerobic threshold or aerobic lactate threshold also known as ventilatory threshold one or lactate threshold one. There are other metrics here involved and right around here is when there's the first sort of increase in blood lactate above baseline, so that's sort of the first landmark.
Second landmark is called the anaerobic threshold or lactate turn point or maximal lactate steady state, there's a bunch of different terms that all refer to the same thing.
And that's basically when your lactate starts going nuts like goes up to the roof, some people talk about four millimoles per liter of lactate as like an actual measurement, although again that varies by support and by individuals, so it's hard to put a specific number on this, but those are the two major landmarks this aerobic threshold that's when your lactate starts to go up above baseline, and then there's this anaerobic threshold and that's when lactate starts going up much faster than then you would otherwise expect because you just can't clear it quickly enough.
So using this definition, you can do aerobic intervals done at various intensities above the aerobic threshold, so that's above like zone two using the five zone model, so you could do zone three, you know high intensity interval training, hit training, these are tempo intervals, you could do zone four type high intensity interval training, those would be threshold intervals also aerobic.
So at the zone five, so at VO to max, that's kind of a blend of aerobic anaerobic mostly dip in an anaerobic, you could do sprint intensity intervals that's zone six or zone seven as described by Dr. Siler that we talked about earlier.
So as far as an operational definition of high intensity interval training or hit for this podcast, we can say that hit training is a target intensity or has a target intensity between 80 to 100% of maximum heart rate, whereas sprint sprint intensity training or sit has a target intensity greater than 100% of your VO to max. And again, this bears another repeating that this intensity is could be classified as either maximal or all out depending on how many times you're doing it.
Again, this is kind of an important point to recognize. So if I have to put zones on this and I refer the listeners back to our conditioning podcast series, if they really want to dive into three zone models, five zone models, et cetera for high intensity interval training, we think about those mostly as being zone three and zone four, where zone three is like this tempo type work that's 75 to like 90% of your max heart rate.
Again, this varies wildly, between individuals also different modalities and then zone four would be like a threshold type intensity about 85% to 95% of your max heart rate. And then zone five or higher would be like a sprint intensity training that would be like VO to max level 95% or higher of your maximum heart rate, those would all be different types of hit, right, but then there's two broad categories within hit broadly speaking one is just high.
And the other one is sprint intensity, yes, there are other physiological biomarkers we could use to like make up different definitions, so things like VO to max or heart rate associated with via to max blood lactate could also be used, but again, that means people are instrumented while they're doing these sort of efforts and I don't know that those are practical practically.
You could use those practically with our audience and then also you could use things like tempo targets like oh, I'm going to do it a one mile pace, for example, if I pay 800 meter pace, which is really derived from functional testing it's probably the best for sport. But yeah, all out efforts like just do it maximally or whatever is most likely reserved for non sport applications, basically it's general population, hey, just go as hard as you can.
And that's fine, but for sports, you'd want to do it as specific intensity to get a specific adaptation will talk more about that later. Also, does that seem like a workable definition for you if you're like, all right, all high intensity interval training is just non continuous training above like zone two, so everything above that. And then you can fractionate that into sprint intensity a little bit further by by demarcating that at like zone five or higher.
Yeah, I think it's a more useful definition. The problem that I see with it is that this is not the general populations understanding of what high intensity interval training is. I think that when they envision it, they envision quote unquote all out and that's whatever maximum gear that they feel they have the capacity for. They see, you know, they might throw back to seeing, you know, TV commercials for back when like P90 X and those other types of training programs were very popular.
So they might default to that thought without really realizing that something that, you know, might be a high end tempo effort to tie in tempo run, you know, we used to do these, I would say that most of our pool training was like repeated efforts and like an aerobic range. So you could you could call that kind of like a high intensity interval training by this definition, even though it doesn't look like what a lot of people envision as high intensity.
I think if we could get more people to realize this, it could be useful. It's not unlike, you know, when we talk about strength training and we stratify different intensity ranges and you can do sets in the 70 to 75% range.
And then you know 80 to 85% range or in the, you know, 90% plus range, those are different levels of intensity. They're all quote unquote high, but they're selecting for slightly different adaptations and they have different pros and different cons in terms of the fatigue cost and other things like that that you have to consider when you're programming it. Yeah, but I think if you tell somebody, I'm lifting at high intensity, they probably do assume like near one or at max.
Yep, or more. Yeah, in fact, you probably have a meme associated with that. And that face that that level of effort. Again, that comes out maybe once a year like the frequency with which I truly make that level of effort in the context of strength training, which is, you know, important. Yeah, all right. Well, let's move further. Let's talk about high intensity interval training for health. Now with respect to health and exercise, there are a number of important outcomes we want to program for.
Specifically, when we're talking about conditioning exercise, the main ones here are cardiovascular fitness weight loss or weight management and body composition, those would be the three main sort of health related outcomes we'd be searching for from conditioning. Yes, things like mitochondrial content or muscle capitalization, others up, those are neat proxies, but you know, it's hard to make heads or tails of those things without some more.
I would say clinically relevant outcome, whether it's VO2 max, I could use that, whether it's like reduction in cardiovascular disease or change in resting blood pressure, those are things that you care about far more than like, dude, you got tons of mitochondrial density. Congratulations. Yeah, have you ever tested somebody's mitochondria in the hospital? Just curious.
I'm trying to think if I, I mean, the answer is no, I'm trying to think is there ever a situation where I was suspicious for one of those like mitochondria that we learned about in med school, but that's still pediatric land. So no, just not. Okay, fair enough. So when we start here with cardiovascular fitness or cardio, now this is defined as the capacity of the heart, lungs and circulatory systems, those are your blood vessels to support energy production during physical activity and exercise.
And cardiovascular fitness improves the delivery of oxygen and energy, along with the removal of waste products and other related processes to maintain muscular force production during sustained efforts. There are many different ways to measure cardiovascular fitness, such as maximal oxygen uptake, that's VO2 max peak oxygen uptake that's VO2 peak direct functional testing, such as a six or 12 minute walk run test and more.
And body of data has demonstrated that fitness level powerfully predicts the risk for adverse events across the spectrum of health and disease. In many studies, fitness has been shown to outperform the traditional risk factors in terms of health outcomes.
Recent meta analysis based on 37 studies with objective measures of cardiovascular fitness and over two million adults found the relative risk for all cause mortality was reduced 11% for every one met increase. That's about 3.5 on a VO2 max in cardiovascular fitness independent of age biological sex and duration of follow up.
That's just a fancy way of saying that as your cardiovascular fitness increases, you reduce your risk of all cause mortality, which that would be another one of those clinically important outcomes that we would care about far more than mitochondrial density, muscle capitalization, protein signatures that you can otherwise test for. Yeah, did you die?
Did you die? Yeah, too long didn't read or didn't listen in this case. Well, VO2 max is an indicator of the body's ability to deliver oxygen to active muscle and increasing it tends to improve health. So the question is does high intensity interval training improve VO2 max better than other methods of conditioning and if so, is it more efficient?
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That's I-N-C-O-G-N-I dot com slash barbell to get 60 percent off your annual plan to protect your privacy. Go incognito with incogni. Some research, mostly in untrained individuals, show that high intensity interval training can elicit larger improvements in selected physiological markers related to oxygen delivery and utilization as compared to a matched volume of moderate intensity continuous training.
Some other studies will use like match workload with a different way to try and match the amount of training load, but still the story is the same. So for example, with respect to mitochondrial activity and mitochondrial density, sprint intensity training is more effective than high intensity training, and that's more effective, both are more effective than moderate intensity continuous training per hour. So from a time efficiency standpoint for these mitochondrial markers.
So like how many mitochondria do you have per unit area, how active are they, for example, again, the importance of these outcomes in isolation is up for debate because again, Austin and I would both do the same thing it'd be a shoulder shrug with someone said look, my mitochondrial, you know, density is is higher now because I'm doing sprint interval training like great did your VO2 max go up.
Oh, like did your endurance performance and something you actually care about go up did your hemoglobin A1 sego down stuff like that anyway that does seem to be true, particularly untrained individuals. Now when it comes to VO2 max, there are a number of studies tried to compare various types of high intensity interval training to moderate intensity continuous training also comparing moderate intensity continuous training to sprint interval training.
And the data here is much less clear. So for example, this one studies eight weeks long, there's 24 total sessions done all on a treadmill, the high intensity interval training group completed 15 bouts of 30 seconds sprints at about 90 to 95% maximum heart rate. And that really sprint interval training that's more just that upper end of high intensity interval training while the moderate intensity group completed 40 minutes of continuous exercise at about 65 to 75% of their maximum heart rate.
Both increase the VO2 max about the same whereas only the moderate intensity continuous training lowered the systolic blood pressure a notable amount eight millimeters of mercury. Another study showing that high intensity interval training can lower resting blood pressure. So I'm not trying to say that that's not a decent way to lower your resting blood pressure. Just not the findings aren't universal aren't universally in favor of high intensity interval training.
And the study that actually showed that high intensity interval training and sprint intensity intensity training had a greater improvement in VO2 max when the work was matched over eight weeks. So again, on both sides of things you're going to find a different result. And I could go on for hours on this legitimately hours.
And then actually what's more useful instead of just citing study after study after study and letting you make the decision using a meta analysis and stuff like this actually tends to be better when you get to pull all these studies together. It kind of gives you a better sense of the totality of the evidence.
Not always the case because if you don't know a lot about the subject matter and you just look at a meta analysis, you might be missing some actual difference because meta analyses as you pointed out number of times Dr. Baraki. It sets you yourself up for like, oh, there's no difference between two things. Why is that just to like remind the audience like why do meta analyses on average tend to lead to maybe a smaller than expected difference or like eliminating differences.
Well, there's a lot of different limitations to them potentially and what you're alluding to is something that we've talked about more specifically in the nutrition context as it relates to dietary saturated fat intake and effect on lipids and cardiovascular disease. That's a more specific scenario where the limitations in terms of what you're comparing and when you pull those things that can basically bias your meta analysis towards what we'll call the null towards showing no effect.
And so if the studies that you include are biased in that direction or are kind of erasing out some of the some of the relevant variation there, then you can end up with a a meta analysis that'll falsely lead you in that direction. But at the same time, they can be biased in other directions. And the ultimate point here to distill it down is something more clear is the output of a meta analysis depends quite heavily on the inputs to it.
And that what that means is which studies you select which studies you exclude. And then there are also really interesting data that we haven't talked a ton about, but that we might get into another time on, you know, all of the different potential statistical methods that you can use to analyze data.
And there's some really interesting, you know, a research where they take a data set and they just like feed it to a bunch of different groups and let them use different statistical methods and they can come to all sorts of different conclusions. And so neither of us are statisticians to have that level of expertise to really dissect where the particular methods used appropriate, but these are just a couple of the potential limitations that we can come across here.
The output depends heavily on the input and then on the statistical method used to do the analysis. Yeah, that's that was one of the actually do think that the nutritional, the nutrition science comparison is warranted here because when you're comparing like high intensity interval training to modern intensity continuous training the heterogeneity.
So the differences in actual protocols used would, you know, very easily sway the results one way or the other are we talking about sprint intensity training are we talking about high intensity interval training in zone three or zone four and like what they work matched are they volume matched are they all sorts of things right only an untrained verse trained all sorts of stuff.
In any case, I tried to limit my meta analysis selection only to what I would consider higher quality meta analyses, particularly those that did a bunch of subgroup analysis comparing specific types of high intensity or sprint interval training to modern intensity continuous training that was matched on some level.
The first one, this was a meta analysis of 22 studies and it showed that both modern intensity continuous training and high intensity interval training improved VO2 max about the same, especially when intervals were shorter than two minutes effectively showing that going to an intensity that was high enough that you could not do them for longer than two minutes.
Well, there wasn't really an advantage at improving VO2 max on the other hand, if you did include interval training and they were longer than two minutes so now you're decidedly in that aerobic sort of range so we're talking zone three or zone four for doing these types of intervals at that length you can't do a zone five interval or zone six interval sprint interval training at more than two minutes.
You really can't even sprint for a minute so that's another another sort of issue here, but if you increase the intervals to longer than two minutes it may work better than modern intensity continuous training alone with when you have only a limited amount of volume that you can do meaning that you're pressed for time for example.
You can't do hours and hours and hours of conditioning every week, but again that's kind of a very specialized scenario which is like a look I've only got a hundred minutes per week to do conditioning should it be all modern intensity continuous training or should I do some aerobic intervals at a slightly higher intensity to about my VO2 max and I think that be a more reasonable take if dr. Patrick if that was her tweet.
They would be on quack watch but instead she said look you can do daily to bodice you can do wind gates a couple times a week whatever and then anything under 10 minutes doesn't matter I'm like well you could go out and do a few sprints on the track and you know that could be very significant particularly depending on your how prepared your hamstrings your Achilles and everything else are for that task.
Yeah the thought here was that if you're doing these longer intervals these aerobic intervals two minutes are longer effectively you're keeping the cardiovascular system working at a higher intensity compared to sprint interval training where you don't really have enough time to keep the cardiac respiratory system working at that threshold or above.
Another meta analysis found the same thing and they actually the authors interpreted as follows to maximize the training effects on VO2 max longer intervals greater than two minutes higher volume intervals so greater than 15 minutes and moderate to long term training go figure four to 12 weeks or more for high intensity interval training are recommended.
There's also a study specifically limiting the comparison between high intensity interval training and moderate intensity continuous training in those with type two diabetes this is a meta analysis of 20 studies high intensity interval training was found to increase VO2 max 1.9 milliliters per kilogram per minute more than moderate intensity continuous training I know what people are thinking they're like. There's a lot of people are thinking they're like.
See there you go hits better than then low intensity steady state the like smallest detectable difference that you can find in VO2 max has been estimated to be around 1.5 so like 1.9 I'm like to me that's kind of like not a big difference that's just like weight loss studies at show if you go low carb you you lose on average 1 kilogram more over a year I'm like 1 kilo like that.
That easily could just be an artificial difference particularly related to water and even so even it was truly 1 kilogram like who cares it's 1 kilo that kind of jive with with your interpretation of that it's you know a lot of the results of these kind of studies similar to the ones that you describe with respect to weight loss it might show a bit of a difference and there's a common refrain when analyzing studies in medicine of contrasting what is a clinically significant difference from a statistically significant difference and
one that would get you more excited is with where the difference is much larger and more consistent across the population when it's relatively smaller and if it's more heterogeneous then that means that hey these are probably mostly similar there might be a slight bias in favor of one or the other but both can probably work for a certain type of person and so what that ends up doing is when we prescribe things it might be like well maybe we'll start out maybe our starting prescription might be for the thing that is slightly favored on average but if that doesn't go great we have no qualms with like switch into the other thing and try to do it.
So we're switching to the other thing and trying that because maybe the person that's in front of us might be one of the people in the other group that did better with a different strategy and that's common for nutrition stuff for exercise stuff you know for even for a lot of medical treatments as well.
Yeah exactly as far as body composition goes so just a some background information exercise is not awesome for weight loss in particular meaning that it's not that we're not recommending against exercise in for individuals who want to lose weight it's just that it tends not to produce a lot of weight loss.
We think that it increases people's sensitivity to satiety signals we think that including exercise produces a better body composition with people who are losing weight compared to those who don't exercise so they tend to have they tend to lose more fat mass and preserve more muscle mass if they're exercising then if they don't all those things are true it's just that exercise in and of itself doesn't seem to cause a lot more weight loss and particularly improve like sustained weight loss more than just an energy deficit because again this is more complicated.
The body comes up with a lot of different ways to sort of work against you particularly in some unfortunate individuals so with that background in mind a meta analysis of 54 studies looking at high intensity interval training versus moderate intensity continuous training and their effects on body composition the authors found this our findings provide compelling evidence that the pattern of intensity of effort and volume during endurance exercise i.e.
interval training versus moderate intensity continuous training has minimal influence on longitudinal changes in fat mass and fat free mass which are likely to be minimal anyway savage just absolutely savage that that paper is actually pretty interesting it's by steel I was posted in 2021 and I'll link that in the show notes below.
The last thing I'll say here is that most of these studies certainly not all of them most of these studies are done in untrained individuals and the differences in not only body composition weight management but also things like the two max are likely to be different in well trained individuals we'll discuss more of this when we talk about high intensity interval training for performance and sport but the idea that we can use the same sort of mechanistic you know prediction that things are going to happen in trained for untrained individuals I don't think that's that's something we can we can do.
Or know that we should do anyway. Last thing I wanted to comment on is efficiency because you hear this all the time well just do high intensity interval training because you less time less time now to be fair there is some good evidence that interventions requiring a total time commitment of less than 15 minutes per bout including warm up and cool down and performed at least three times a week for six weeks can increase your VO to max by about one met many of these studies have employed sprint intensity training though not always again.
Again same caveat supply these are short term studies talking about six weeks that's not really a lifetime of exercise for example or lifetime related effects usually untrained population again and is you know yet increasing one met on your VO to max that's not nothing but I want more yeah and to get more you're going to probably have to do more so yeah this is better than nothing but I don't know that that's the complete story so yes you can increase VO to max you can improve health trajectory by doing some high intensity interval training.
I just don't think that's the only thing you should do and in addition the total time commitment of most of the classic high intensity interval training protocols including warm up the recovery intervals and cool down is typically more than 20 minutes anyway it's not like you're getting this done in 10 minutes although if you listen to dr Patrick shit all you got to do is to bada every day it's only you know four minutes.
Not enough I think yeah reminds me of I mean I keep finding comparisons to the strength training world and the you know there are studies where they just do daily one or I'm training and that would probably be the absolute fastest and most efficient way to make your one rep max go up can how long can you do that for.
Yeah yeah and some of that is like acclimatization just like get better at the thing that you're testing and I find that most people particularly coming from what I would consider maybe more traditional or historical like strength training backgrounds are not really well adept at doing a one rep effort they just haven't practiced them that much and so yeah I could see a situation we're doing one rep maxes or near maxes daily for a series of weeks my one rep max went through the roof.
It's like great but you can't really do that for you know years and years and years and years for focus periods time sure and then the last thing I'll say here is that strong motivation is required due to this like high exertion nature of these interval training models which can be very fatiguing and too strenuous for previously under active or inactive individuals so like it takes the right type of person and I don't want people to think that I don't like high intensity interval training or sprint intensity training I just think that it's not for everyone and if it is for you to do that.
I think it should be programmed cautiously and if you wanted to end the podcast you wanted to click off right there fine you got my synopsis but I think that's that's how we feel about programming this for for health related purposes anything else you wanted to add to that Dr. Baraki.
I think for health the great thing is that you have so many different ways that you could train towards a health related outcome that do not need to be terribly specific for performance related outcomes so you just have a lot of different options you don't need to limit yourself too much and so as a result that opens up a lot of doors and strategies to make it enjoyable and sustainable for people not entirely independent of the outcome because you would still prefer to see improvement in people but it does not need to force a very specific particular improvement in order to get health benefits out of it.
Yeah, I agree. All right, so let's pivot we'll talk about high intensity interval training for performance and so just to start all training intensities ranging from prolonged continuous sessions in the moderate domain to repeated quote all out sprint interval sessions all of these things can improve endurance performance provided the training is balanced within a wider program specific to the demands of sport.
And again, if you wanted to click off right there great I think you got it, but that pertains that applies to resistance training to it's like look there are so many different training intensities that can work it just house the whole program set up and is this specific to your needs so yeah, well that's a good way to start this discussion on performance now there is likely no single optimal training intensity distribution for all endurance sports and events but rather determination of the optimal individualized and sport specific periodization.
Of intensity distribution maybe the next step for people who are programming endurance for their athletes. Currently high level endurance athletes typically employ a training intensity distribution that involves somewhere between 70 to 90% of their training volume in the moderate intensity domain and about 10 to 30% of the training volume at higher intensities in the heavy or quote extreme or severe intensity domains that's like the 80 20 rule we talked about during the pod.
And again, I refer you back to earlier discussion on like what dr. Patrick was saying like if there was something to doing all this high intensity interval training on a regular basis there are so many different endurance sports where there's so much money and prestige and incentive to be awesome that people would do it and intensity high intensity interval trainings had been around for almost a hundred years now at least as far as our formal understanding of them so like why aren't people doing this.
If there's got to be a reason and like they still include some of it in their programming so it's not like they're just throwing it all the way they're just saying we need to a little bit less of it and it needs to be program specifically so I don't understand why somebody would say no do only this and do a ton of it when that's not really like modeled in any anywhere else on the planet by people who are actually good at the stuff.
Yeah, I agree and there are certainly people who have tried this over time and I think that even if we were to point to people who did use it to great success there is given how much of a minority they would be in there is still likely a pretty strong argument for more of a survivorship bias meaning that like they were the only person who could manage to handle that kind of work for long enough to get to that level and everybody else got would get fried by then so one example this is again extrapolating to my knowledge of the swimming world.
There are there's there's folks there's a kind of a bit of a small movement I would say and one guy who was actually an Olympian who popularized a very particular form of training they called it ultra short race pace training where all of his training was done ideally at race pace now I will still point out that that does not mean that it was all all out maximum effort it was just race pace he didn't do like sub race aerobic type threshold work it was just repeated ultra short training.
He did ultra short intervals over and over and over again trying to maintain race pace and for him it worked quite well to get him to a high level of the sport and to you know qualifying for the Olympics in a few events now any time he tried to swim even like a mid distance type event he would flame out by the end of the race and he ended up getting beat he was good at the super short stuff and so it like it's still
quite quite a bit of a critical in terms of how well it's worked out for him and he is sense to some extent like moved on from that that training paradigm but that's like I'm trying to think of like of all the different you know sporting context that I'm aware of people who have had any degree of success and I'm coming up with like one in that world in powerlifting
anybody who's just a fan of just like, you know, max effort all the time, like, you know, especially if they're raw and tested, things like that. Like, not too many people who we can think of who are successful in that realm. And then, you know, in other endurance contexts, same thing, we don't really see this work out. Yeah. Yeah. I mean, there are examples of people using what you would call unconventional training methods that have had varying levels of success.
Yeah. All that speaks to you to me is the inter individual differences and not only preferences, but also responsiveness. But by and large, when you see like, not a lot of people are doing this and not a lot of people have been successful using this method, whatever, if there is a specific method there that kind of speaks against like using that method preferentially. Yes. Because probably, realistically speaking, it's probably not going to work for you.
Just, you know, it's a numbers numbers game. So if we think about this like 80, 20 kind of split, right? 80% being like low to moderate intensity and 20% being what you can call high intensity stuff. And maybe some of that is interval training.
It's contested as to whether the 20% of higher intensity training should be done in like this pyramidal fashion where there's decreasing training volume attributed to higher and higher intensities, meaning that maybe you do 10% of your high intensity work in zone three, 5% in zone two, you know, and then another 5% in zone five or something like that.
You just get like decreased mountain, you form a pyramid up that way or in a polarized fashion with the remaining 20% is performed primarily at the highest domain. So you don't maybe have anything in the zone three or tempo work. And maybe a little bit in zone four that threshold work, everything's like zone five, zone six or higher.
A systematic review of highly trained elite distance runners found that most training phases involve this pyramidal approach that is the overwhelming majority of training is done in the low to moderate zone. And a small amount is dedicated to high intensity work that gradually gets smaller and smaller and smaller as intensity increases. That's probably a more traditional model.
And again, to make the parallel to resistance trainings like you do most of your work in maybe that 65 to 75% or even if you would call it 70 to 80, I think we could both be convinced that that's fine. And then the amount of work that you do in the 80 to 85% range is probably greater than the amount of work you do in the 90 to 95% range. So maybe it does look pyramidal on that approach. But again, I think it's the extent of that comparison.
Nonetheless, sprint intensity training, particularly all out efforts is majorly understudied. In fact, when you look at like what high level elite endurance athletes are doing, the majority of what you would consider their sprint intensity work is not done all out or maximal.
It's done in particular pace involved tempo or target a heart rate, VO2 max, something like that power output mainly because they're trying to develop specific adaptations, not just like again, Kermit on the monarch barcule. Crazy. Just, you know, some of the most interesting studies I've read on this, they're using short sprints for like queuing.
Like so people don't get lazy on the bike, for example, the like what are there's peddling efficiency, cadence, etc. Or even for like to wake them up in the middle of like a long, you know, about so they stay vigilant or for fun or even just training high velocity movements in general. So I think there's got to be a specific purpose for why you're programming these things, which again, I think is programming 101 that shouldn't surprise anybody.
And so I think that's a nice segue into like how would you program high intensity interval training? And we go back to that 80 20 rule for like volume distribution. So you can split that up with a number different by a number of different ways. It could be minutes.
So if somebody's just trying to meet the current physical activity guidelines at 150 minutes per week, that means that 120 minutes or two hours per week is in that low to moderate zone, maybe mostly towards zone two and 30 minutes of it is higher intensity of that higher intensity work. It's kind of pick your poison. I think for health, I'd have a really difficult time making a case for like, you know, it should be mostly zone five or zone four or zone three.
As like for me, from a health perspective, if we're just talking about 150 minutes per week, I'm just happy that you're doing it. What an interesting average, what are you doing in today's 25 year period, do you have a different take on that or do you agree? Yeah, no I agree. And I would actually for health purposes. I see no reason to really proscribe that absolute maximum all out, unless the person like specifically asks for it.
And that reflects what we would suggest for strength training too. If we're strength training general population, especially for health outcomes, and they don't care for like absolute maximum strength performance, if they're getting most of their strength work in and their reps, and that what we're going to call a high intensity mistake, we
definitely into the 70 to 80% range. That's great. I don't care if I ever program somebody who's starting training for General Health to touch anything of well over 90% because it's just unnecessary. Cool. Yeah. I agreed. The other way that you could think about this if you wanted to use like a met minute sort of prescription because again, just minutes, you know, if 30 minutes of zone three tempo work is going to be different than 30 minutes of sprint interval training
per week, right? And you're like, I don't suspect that's going to be equivalent sort of training loads. Maybe met minutes, this would actually be a good use case for those. So the, I mean, if you had to pick something else anyway. So the current guidelines suggest somewhere between 500 to 1000 met minutes per week. So if we say that 500 met minutes per week of conditioning is the target here. And we're doing this 80, 20 distribution. Well, that
means you have 100 met minutes per week of higher intensity work. That might be a nice way to prevent somebody from doing too much silly stuff, meaning like running at a super fast pace is going to have a higher met cost, for example, then running at a tempo pace, for example. So that might be useful. But again, 80% of the work, the bulk of the work that you're doing should probably be zone one, zone two, maybe pushing a closer to zone
two if I had to like weigh in on that. And then the other 20% spread out based on goals, preferences and, you know, needs. I still think though that high intensity interval work of any variety should be programmed at a specific intensity for specific adaptations. So do you want to drive up your view to max and be able to work more there? Well, then you need to program it at the heart rate associated with your view to max or the lactate level
associated with your view to max. So for example, the wind gate instead of doing 30 seconds all out and a four minute active recovery for four to six sort of sets, you could do 30 seconds at your 800 meter pace if you know that. That would be for a runner. For a cyclist, it would probably be about double that length. So whatever, you know, I don't know that cyclists know their mile time, for example, but some other pace that's analogous to an
800 meter pace. For the one minute on, one minute off, if you were doing that type of setup, that should be at like a one mile or five K pace. And I think you could use that like a row or your running pace for like a five by five. So doing five, that's not five reps five and five sets. It's five sets of five minute intervals with three minute rest or
similar in between. That would be like zone four, the second lactate threshold. And there's actually a study where they kind of compared different setups within this five by five minute intervals. One, they did a constant speed the whole time. And another one, they actually had surges programmed in there. They do these 40 seconds surges at maximum sort of aerobic speed. And effectively using those surges in there got them at the, they spent more time
closer to their VO2 max and seem to actually help them do a little bit better. And lastly, the last thing I'll say about this is that sprint intensity training should be use sparingly, if at all, especially in those who are not prepared for it. I think again, people romanticize sprinting because they look at a sprinter and the Olympics just happened. They're like, look at these sprinters. They're jacked, right? Super, you know, and lean and
fast and athletic. So I need to sprint in order to achieve those goals. And it's like, well, one, that person genetics and opportunity that got them there in addition to the hard work, of course, just because you start doing sprints, I don't know that it's going to improve your body composition. In fact, I'd say probably not compared to other types of conditioning
and exercise. And further, I think there are real risks there just due to the high velocity movements, the greater force of zordic round reactive forces and, and sort of muscular forces that you're exposing these untrained or unacustomed muscles to. I think if you and I had to go out and do like 20 meter sprints, repeats, and somebody was like, gun the head, you better go all out on this. I see a hamstring thing coming at one of us. Maybe both of us. I don't know.
Yeah, I mean, I'm imagining somebody who say they look at us and they're like, oh, I want to be like that. So they did lift 700 pounds. I'm going to go deadlift 700 pounds. Most people would recognize that that is unlikely to work out well for you. Yet nobody bats an eye on them like I'm going to go sprint just because it's unloaded, but your body is similarly unprepared for the actual demands of that task.
Yeah. Yeah. For people who want to start sprinting, particularly running sprints, I tend to start people out with on a jump rope because that sort of bounding and rebound and stuff like that and getting used to those sort of forces, I think is a good sort of on ramp.
And then I try to move to uphill sort of runs, tempo runs, and gradually increasing intensity there over weeks, agree, until somebody can tolerate maybe on all out sort of uphill sprint for 20 seconds or something like that with long recovery periods in between. And then after that, I'll put them on flat and I'll have them do it at a sub maximal intensity again to sort of make sure that they're accustomed to that. None of that is as sexy as saying. Yeah, you could do Tavata sprints every day.
The other thing I was curious about with Dr. Patrick's original claims is that like the Tavata's were daily. The wing gates were also once a week. The one on one off was twice a week. And the Norwegian 4x4 was also twice a week. And I'm wondering if this is like collectively all of these things because then you're going to end up with some days. Obviously where you're doing both, you're doing both like the Norwegian thing as well as a Tavata on that same day. And like this is absolute insanity.
But yeah, imagine if the tweet just re rewrite it and if it's like if you want to improve your cardiovascular fitness, cellular energy production and metabolic health, just do 20 to 30 minutes of modern intensity conditioning daily. Pick whatever you want, make sure it's not too hard or too easy. Enjoy it. Like that would be like a very reasonable tweet, but that would be the most the most tepid take I can think. Yeah, hey, hey, you should be
active pretty regularly in a way that's not too stressful. Very risky. Yeah. Nice. All right. Well, let's wrap this up. High intensity interval training has no generalized definition. We propose a working definition where high intensity interval training is a target intensity between 80% and 100% of maximum heart rate. So that zone three or zone four, like 75 to 95% of your max heart rate. Whereas sprint intensity training has a target intensity
above your VO2 max. So that's like zone five or higher, which would be like 95% or higher of your maximum heart rate. With respect to weight loss, conditioning exercise is not very helpful in this regard directly with little to no differences between high intensity interval
training and moderate intensity continuous training. Instead, exercise can improve weight management indirectly via increases in sensitivity to satiety signals, some ability to improve the retention of muscle mass and counter some of the metabolic adaptation that results from low energy availability. With respect to cardiovascular fitness, both high intensity interval training and moderate intensity continuous training, improve metrics of fitness
with unclear differences between the two long term. Admittedly, most data on this are short term and an untrained individuals limiting its generalized ability. High intensity interval training appears to be very safe and may be the preferred type of conditioning by some. However, maximal cardiovascular fitness is unlikely to be achieved by hit alone, particularly sprint intensity training and short intervals. Trained endurance athletes practices may be
instructive. From a coaching perspective, we recommend first achieving and then exceeding the current guideline recommendations for conditioning through any combination of exercise that is palatable to the individual. Then we recommended 80-20 distribution, where 80% is in the zone 1 to zone 2 range, favoring more zone 2, and 20% is of higher intensity, which should ideally be programmed added intensity specific to the individual's goals and needs. Often, anything you want to add to this?
I think we covered it. We've hit in a nice crack watch segue into a solid episode. So, hopefully that was useful. Yeah, love it. Alright, well that's a wrap here on the hit episode of the Barbell Medicine podcast. We'll be bringing modern medicine to strengthen conditioning and strengthen conditioning to modern medicine. Again, I'm Dr. Jordan Vagamom. Shout out to Dr. Austin Barocki for joining us on this podcast before you guys go anywhere, though. Leave us a
five star rating and a review. It really helps drive traffic to our podcast so we can keep bringing you all the latest nuance and health and fitness. From everyone here at Barbell Medicine, we'll catch you next week and every week by here on the Barbell Medicine podcast.
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