The intensity paradox:A systematic review and meta‐analysis of its impact on the cardiorespiratory fitness of older adults

Aim: The present systematic review and meta‐analysis aimed to compare the effect of moderate‐ versus high‐intensity aerobic exercise on cardiorespiratory fitness (CRF) in older adults, taking into account the volume of exercise completed. Methods: The databases MEDLINE (Ovid), EMBASE (Ovid), and CENTRAL (Cochrane Library) were searched to identify randomized controlled trials (RCTs). Two reviewers extracted data and assessed bias. Comprehensive Meta‐Analysis software calculated overall effect size, intensity differences, and performed meta‐regression analyses using pre‐to‐post intervention or change scores of peak oxygen uptake (V̇O2peak). The review included 23 RCTs with 1332 older adults (intervention group: n = 932; control group: n = 400), divided into moderate‐intensity (435 older adults) and high‐intensity (476 older adults) groups. Results: Meta‐regression analysis showed a moderate, but not significant, relationship between exercise intensity and improvements in V̇O2peak after accounting for the completed exercise volume (β = 0.31, 95% CI = [−0.04; 0.67]). Additionally, studies comparing moderate‐ versus high‐intensity revealed a small, but not significant, effect in favor of high‐intensity (Hedges' g = 0.20, 95% CI = [−0.02; 0.41]). Finally, no significant differences in V̇O2peak improvements were found across exercise groups employing various methods, modalities, and intensity monitoring strategies. Conclusion: Findings challenge the notion that high‐intensity exercise is inherently superior and indicate that regular aerobic exercise, irrespective of the specific approach and intensity, provides the primary benefits to CRF in older adults. Future RCTs should prioritize valid and reliable methodologies for monitoring and reporting exercise volume and adherence among older adults

HIIT at Home:Enhancing Cardiorespiratory Fitness in Older Adults—A Randomized Controlled Trial

Background: This study aimed to investigate the effectiveness of a 6‐month home‐based high‐intensity interval training (HIIT) intervention to improve peak oxygen consumption (V̇O2peak) and lactate threshold (LT) in older adults. Methods: Two hundred thirty‐three healthy older adults (60–84 years; 54% females) were randomly assigned to either 6‐month, thrice‐weekly home‐based HIIT (once‐weekly circuit training and twice‐weekly interval training) or a passive control group. Exercise sessions were monitored using a Polar watch and a logbook for objective and subjective data, respectively, and guided by a personal coach. The outcomes were assessed using a modified Balke protocol combining V̇O2peak and LT measures. General linear regression models assessed between‐group differences in change and within‐group changes for each outcome. Results: There was a significant between‐group difference in the pre‐to‐post change in V̇O2peak (difference: 1.8 [1.2; 2.3] mL/kg/min; exercise: +1.4 [1.0; 1.7] mL/kg/min [~5%]; control: −0.4 [−0.8; −0.0] mL/kg/min [approximately −1.5%]; effect size [ES]: 0.35). Compared with controls, the exercise group had lower blood lactate concentration (−0.7 [−0.9; −0.4] mmol/L, ES: 0.61), % of peak heart rate (−4.4 [−5.7; −3.0], ES: 0.64), and % of V̇O2peak (−4.5 [−6.1; −2.9], ES: 0.60) at the intensity corresponding to preintervention LT and achieved a higher treadmill stage (% incline) at LT (0.6 [0.3; 0.8]; ES: 0.47), following the intervention. Conclusion: This study highlights the effectiveness of a home‐based HIIT intervention as an accessible and equipment‐minimal strategy to induce clinically meaningful improvements in cardiorespiratory fitness in older adults. Over 6 months, the exercise group showed larger improvements in all outcomes compared with the control group. Notably, the LT outcome exhibited a more pronounced magnitude of change than V̇O2peak