Home-based HIIT and traditional MICT prescriptions improve cardiorespiratory fitness to a similar extent within an exercise referral scheme for at-risk individuals

Exercise referral schemes (ERS) are used to promote physical activity within primary care. Traditionally, ERS are conducted in a gym or leisure-center setting, with exercise prescriptions based on moderate-intensity continuous training (MICT). Home-based high-intensity interval training (Home-HIIT) has the potential to reduce perceived barriers to exercise, including lack of time and access to facilities, compared to traditional MICT prescription used with ERS and improve health related outcomes. We hypothesized that Home-HIIT would mediate greater improvement in cardiorespiratory fitness (CRF) by virtue of greater adherence and compliance to the exercise prescription, compared to MICT. Methods: Patients enrolled on an ERS (Liverpool, United Kingdom) were recruited for a pragmatic trial. Participants self-selected either 12 weeks of MICT (45–135 min/week at 50–70% HRmax) or Home-HIIT (4–9 min × 1 min intervals at ≥80% of HRmax, interspersed with 1 min rest). The primary outcome was the change in CRF (VO2peak) at post-intervention (12 weeks) and follow-up (3-month post intervention), using intention-to-treat analysis. Results: 154 participants (age 48 ± 10y; BMI 30.5 ± 6.1 kg/m2 ) were recruited between October 2017 and March 2019, 87 (56%) participants chose Home-HIIT and 67 (44%) MICT. VO2peak increased post-intervention in both groups (MICT 3.9 ± 6.0 ml.kg−1 .min−1 , Home-HIIT 2.8 ± 4.5 ml.kg−1 .min−1 , P < 0.001), and was maintained at follow-up (P < 0.001). Fat mass was only reduced post MICT (MICT −1.5 ± 6.3 kg, P < 0.05, Home-HIIT −0.2 ± 2.0 kg, P = 1.00), but the reduction was not maintained at follow-up (MICT −0.6 ± 5.1 kg, Home-HIIT 0.0 ± 2.2 kg, P > 0.05). Adherence to the prescribed programs was similar (MICT 48 ± 35%, Home-HIIT 39 ± 36%, P = 0.77). Conclusion: This is the first study to evaluate the use of Home-HIIT for individuals in a primary care setting. Contrary to our hypothesis, adherence to both exercise prescriptions was poor, and CRF improved to a similar extent in both groups with improvements maintained at 3-month follow-up. We provide evidence that, although not superior, Home-HIIT could be an effective and popular additional exercise choice for patients within primary care based ERS

Additional file 2: of The outcomes of Perthes’ disease of the hip: a study protocol for the development of a core outcome set

Appendix S2. Children’s booklet. (DOCX 242 kb

Additional file 1: of The outcomes of Perthes’ disease of the hip: a study protocol for the development of a core outcome set

Appendix S1. Systematic review data extraction form. (DOCX 20 kb

(A) The HPMA-DMAEMA copolymer used for DNA delivery in both <i>in vitro</i> and <i>in vivo</i> studies. (B) Maps of the CMV-eGFP and Trophoblast-specific plasmids.

<p>(A) The HPMA-DMAEMA copolymer used for DNA delivery in both <i>in vitro</i> and <i>in vivo</i> studies. (B) Maps of the CMV-eGFP and Trophoblast-specific plasmids.</p

Offspring birthweights at delivery were the same in Sham-operated, Internal control and UABL + PLAC1-HuIGF-1 nanoparticle treated group, however the Uterine Artery Branch Ligation, and Cyp19a-HuIGF-1 nanoparticle treated groups had significantly lower birthweights.

<p>N>6 dams per group, ANOVA<0.001, post-hoc Tukeys *<0.05, **<0.01.</p

Representative images of (A) GFP expression following transfection of BeWo with plasmid alone or (B) CMV-eGFP nanoparticles demonstrate greater transgene expression following complex formation than plasmid alone. (C) GFP expression in BeWo cells after transfection with nanoparticles containing PLAC1-GFP or (D) CyP19a-923-GFP for 4 days, resulted in comparable transgene expression to the global CMV promoter, similar results were seen on 4 different passages. Cell nuclei are stained with Dapi (blue). Proliferation levels (E) and apoptosis levels (F) in BeWo cells were not changed when cells were incubated with nanocomplexes for 48 hours compared to BeWo cells incubated with eGFP plasmid alone for the same time period, mean +/- SEM, n>4 passages per treatment.

<p>Representative images of (A) GFP expression following transfection of BeWo with plasmid alone or (B) CMV-eGFP nanoparticles demonstrate greater transgene expression following complex formation than plasmid alone. (C) GFP expression in BeWo cells after transfection with nanoparticles containing PLAC1-GFP or (D) CyP19a-923-GFP for 4 days, resulted in comparable transgene expression to the global CMV promoter, similar results were seen on 4 different passages. Cell nuclei are stained with Dapi (blue). Proliferation levels (E) and apoptosis levels (F) in BeWo cells were not changed when cells were incubated with nanocomplexes for 48 hours compared to BeWo cells incubated with eGFP plasmid alone for the same time period, mean +/- SEM, n>4 passages per treatment.</p

Oligonucleotide primers for RTqPCR.

<p>Oligonucleotide primers for RTqPCR.</p

Placental morphology in the Labyrinthine (L) zone in (A) Sham, (B) UABL,(C) NP-PLAC1-hIGF-1treated groups is similar whereas differences in morphology can be seen in the NP-Cyp19a-hIGF-1 (D) treated group. (Magnification 40X). (E) The ratio of placental Junctional zone (Jz) area to Labyrinthine zone (Lz) area demonstrates significant expansion of the junctional zone in placentas treated with NP-Cyp19a-hIGF-1.

<p>Placental morphology in the Labyrinthine (L) zone in (A) Sham, (B) UABL,(C) NP-PLAC1-hIGF-1treated groups is similar whereas differences in morphology can be seen in the NP-Cyp19a-hIGF-1 (D) treated group. (Magnification 40X). (E) The ratio of placental Junctional zone (Jz) area to Labyrinthine zone (Lz) area demonstrates significant expansion of the junctional zone in placentas treated with NP-Cyp19a-hIGF-1.</p

GFP expression in Human uterine fibroblasts after transfection with nanoparticles containing (A) CMV-GFP, (B) PLAC1-GFP or (C) CyP19a-923-GFP. HEK293 cells transfected with (D) CMV-GFP, (E) PLAC1-GFP or (F) CyP19a-923-GFP demonstrated low but visible transgene expression under the CMV promoter but no GFP expression with the trophoblast-specific promoters. GFP expression in HPMVECs cells after transfection with nanoparticles containing (G) CMV-GFP, (H) PLAC1-GFP or (I) CyP19a-923-GFP. Representative images seen on 4 different passages for each cell type.

<p>Cell nuclei are stained with Dapi (blue).</p

PRISMA flow diagram of the literature review process.

<p>PRISMA flow diagram of the literature review process.</p