High-Intensity Interval Training, Solutions To The Programming Puzzle Part I Cardiopulmonary Emphasis

REVI EW ARTI CLE
High-Intensity Interval Training, Solutions

to the Programming Puzzle
Part I: Cardiopulmonary Emphasis
Martin Buchheit

Paul B. Laursen
Published online: 29 March 2013
Springer International Publishing Switzerland 2013
Abstract High-intensity interval training (HIT), in a
variety of forms, is today one of the most effective means
of improving cardiorespiratory and metabolic function and,
in turn, the physical performance of athletes. HIT involves
repeated short-to-long bouts of rather high-intensity exer-
cise interspersed with recovery periods. For team and
racquet sport players, the inclusion of sprints and all-out
efforts into HIT programmes has also been shown to be an
effective practice. It is believed that an optimal stimulus to
elicit both maximal cardiovascular and peripheral adapta-
tions is one where athletes spend at least several minutes
per session in their red zone, which generally means
reaching at least 90 % of their maximal oxygen uptake
(
_
VO
2max
). While use of HIT is not the only approach to
improve physiological parameters and performance, there
has been a growth in interest by the sport science com-
munity for characterizing training protocols that allow
athletes to maintain long periods of time above 90 % of
_
VO
2max
(T@
_
VO
2max
). In addition to T@
_
VO
2max
, other
physiological variables should also be considered to fully
characterize the training stimulus when programming HIT,
including cardiovascular work, anaerobic glycolytic energy
contribution and acute neuromuscular load and musculo-
skeletal strain. Prescription for HIT consists of the
manipulation of up to nine variables, which include the
work interval intensity and duration, relief interval inten-
sity and duration, exercise modality, number of repetitions,
number of series, as well as the between-series recovery
duration and intensity. The manipulation of any of these
variables can affect the acute physiological responses to
HIT. This article is Part I of a subsequent II-part review
and will discuss the different aspects of HIT programming,
from work/relief interval manipulation to the selection
of exercise mode, using different examples of training
cycles from different sports, with continued reference to
T@
_
VO
2max
and cardiovascular responses. Additional pro-
gramming and periodization considerations will also be
discussed with respect to other variables such as anaerobic
glycolytic system contribution (as inferred from blood
lactate accumulation), neuromuscular load and musculo-
skeletal strain (Part II).
1 Introduction
With respect to prescribing training that improves perfor-
mance, coaches know that theres more than one way to
skin the cat.[1] Recent reviews [1, 2] have highlighted the
potential of varying quantities of both high-intensity
interval training (HIT) and continuous high-volume, low-
intensity training on performance in highly trained athletes.
While there is no doubt that both types of training can
effectively improve cardiac and skeletal muscle metabolic
function, and that a dose of both types of training are
important constitutes of an athletes training programme,
M. Buchheit
ASPIRE, Football Performance & Science Department,
Academy for Sports Excellence, Doha, Qatar
M. Buchheit (&)
Physiology Unit, Sport Science Department, ASPIRE,
Academy for Sports Excellence, P.O. Box 22287, Doha, Qatar
e-mail: [email protected]; [email protected]
P. B. Laursen
High Performance Sport New Zealand,
Auckland, New Zealand
P. B. Laursen
Sport Performance Research Institute New Zealand (SPRINZ),
Auckland University of Technology, Auckland, New Zealand
Sports Med (2013) 43:313338
DOI 10.1007/s40279-013-0029-x
this review will focus solely on the topic of HIT. Indeed, a
number of studies in this area have emerged over the last
decade, and it is perhaps not surprising that running- or
cycling-based HIT is today considered one of the most
effective forms of exercise for improving physical perfor-
mance in athletes [36]. HIT involves repeated short-to-
long bouts of rather high-intensity exercise interspersed
with recovery periods [3], and has been used by athletes
for almost a century now. For example, in 1920, Paavo
Nurmi, one of the best middle- and long-distance runners in
the world at that time, was already using some form of HIT
in his training routines. Emil Zatopek contributed later in
the 1950s to the popularization of this specic training
format (see Billat [3] for a detailed history of HIT). The
progressive emergence of this training method amongst
elite athletes is the rst evidence of its effectiveness (i.e.
best practice theory [2]). More recently, the use of sprints
and all-out efforts has also emerged, both from the applied
(team sport) eld and the laboratory [79]. These particu-
larly intense forms of HIT include repeated-sprint training
(RST; sprints lasting from 3 to 7 s, interspersed with
recovery periods lasting generally less than 60 s) or sprint
interval training (SIT; 30 s all-out efforts interspersed with
24 min passive recovery periods).
Following pioneering experiments by Hill in the 1920s
(Hill included intermittent exercises in his rst studies [2]),
Astrand and co-workers published several classical papers
in the 1960s on the acute physiological responses to HIT,
which created the rst scientic basis for long [10] and
short [11, 12] duration intervals. Studies by Balsom et al.
followed in the 1990s, emphasizing all-out efforts [13]. As
will be detailed in the review, most of the scientic work
that followed these studies over the past 2050 years has
been an extension of these ndings using new technology
in the eld (i.e. more accurate and portable devices).
However, the important responses and mechanisms of HIT
had already been demonstrated [1012].
It has been suggested that HIT protocols that elicit
maximal oxygen uptake (
_
VO
2max
), or at least a very high
percentage of
_
VO
2max
, maximally stress the oxygen trans-
port and utilization systems and may therefore provide the
most effective stimulus for enhancing
_
VO
2max
[5, 14, 15].
While evidence to justify the need to exercise at such an
intensity remains unclear, it can be argued that only exer-
cise intensities near
_
VO
2max
allow for both large motor unit
recruitment (i.e. type II muscle bres) [16, 17] and
attainment of near-to-maximal cardiac output (see Sect.
3.2), which, in turn, jointly signals for oxidative muscle
bre adaptation and myocardium enlargement (and hence,
_
VO
2max
). For an optimal stimulus (and forthcoming car-
diovascular and peripheral adaptations), it is believed that
athletes should spend at least several minutes per HIT
session in their red zone, which generally means attaining
an intensity greater than 90 % of
_
VO
2max
[3, 5, 15, 18].
Consequently, despite our limited understanding of the
dose-response relationship between the training load and
training-induced changes in physical capacities and per-
formance (which generally shows large inter-individual
responses [19, 20]), there has been a growing interest by
the sport science community for characterizing training
protocols that allow athletes to maintain the longest time
[90 %
_
VO
2max
(T@
_
VO
2max
; see Midgley and McNaugh-
ton [14] for review). In addition to T@
_
VO
2max
, however,
other physiological variables should also be considered to
fully characterize the training stimulus when programming
HIT [2123]. Any exercise training session will challenge,
at different respective levels relative to the training content,
both the metabolic and the neuromuscular/musculoskeletal
systems [21, 22]. The metabolic system refer to three dis-
tinct yet closely related integrated processes, including (1)
the splitting of the stored phosphagens (adenosine tri-
phosphate [ATP] and phosphocreatine [PCr]); (2) the
nonaerobic breakdown of carbohydrate (anaerobic glyco-
lytic energy production); and (3) the combustion of car-
bohydrates and fats in the presence of oxygen (oxidative
metabolism, or aerobic system) [184]. It is therefore pos-
sible to precisely characterize the acute physiological
responses of any HIT session, based on (a) the respective
contribution of these three metabolic processes; (b) the
neuromuscular load; and (c) the musculoskeletal strain
(Fig. 1, Part I). Under these assumptions, we consider the
cardiorespiratory (i.e. oxygen uptake;
_
VO
2
) data, but also
cardiovascular work [2427]), stored energy [28, 29] and
cardiac autonomic stress [3033] responses as the primary
variables of interest when programming HIT sessions
(review Part I). By logic, anaerobic glycolytic energy
contribution and neuromuscular load/musculoskeletal
strain are therefore likely the more important secondary
variables to consider when designing a given HIT session
(Part II).
Several factors determine the desired acute physiological
response to an HIT session (and the likely forthcoming
adaptations) [Fig. 1]. The sport that the athlete is involved
in (i.e. training specicity) and the athletes prole or sport
specialty (e.g. an 800 m runner will likely favour a greater
proportion of anaerobic-based HIT compared with a
marathon runner [6]) should rst be considered in relation to
the desired long-term training adaptations. Second, and
more importantly on a short-term basis, training periodi-
zation has probably the greatest impact on the HIT pre-
scription. Many of the desired training adaptations are
likely training cycle dependent (e.g. generic aerobic power
development in the initial phase of the preseason vs. sport-
specic and more anaerobic-like HIT sessions towards the
314 M. Buchheit, P. B. Laursen
start of the competitive season in team sports). Additionally,
for athletes training twice a day, and/or in team sport
players training a myriad of metabolic and neuromuscular
systems simultaneously [34], the physiological strain
associated with a given HIT session needs to be considered
in relation to the demands of other physical and technical/
tactical sessions to avoid overload and enable appropriate
adaptation (i.e. maximize a given training stimulus and
minimize musculoskeletal injury risk). There are likely
several approaches (i.e. HIT format) that, considered in
isolation, will achieve a similar metabolic and/or neuro-
muscular training adaptation outcome. However, the ability
of the coach to understand the isolated acute responses to
various HIT formats may assist with selection of the most
appropriate HIT session to apply, at the right place and time.
At least nine variables can be manipulated to prescribe
different HIT sessions (Fig. 2 [35]). The intensity and
duration of work and relief intervals are the key inuencing
factors [10, 12]. Then, the number of intervals, the number
of series and between-series recovery durations and
intensities determine the total work performed. Exercise
modality (i.e. running vs. cycling or rowing, or straight line
vs. uphill or change of direction running) has to date
received limited scientic interest, but it is clear that it
represents a key variable to consider when programming
HIT, especially for team and racquet sport athletes. The
manipulation of each variable in isolation likely has a
direct impact on metabolic, cardiopulmonary and/or neu-
romuscular responses. When more than one variable is
manipulated simultaneously, responses are more difcult to
Fig. 1 Decision process for selecting an HIT format based on the
expected acute physiological response/strain. The six different types
of acute responses are categorized as (1) metabolic, but eliciting
essentially large requirements from the O
2
transport and utilization
systems, i.e. cardiopulmonary system and oxidative muscle bres; (2)
metabolic as for (1) but with a certain degree of neuromuscular strain;
(3) metabolic as for (1) but with a large anaerobic glycolytic energy
contribution; (4) metabolic as for (3) plus a certain degree of
neuromuscular load; (5) metabolic with essentially an important
anaerobic glycolytic energy contribution and a large neuromuscular
load; and (6) eliciting a high predominant neuromuscular strain.
While some HIT formats can be used to match different response
categories (e.g. short intervals when properly manipulated can match
into categories 14), SIT for example can only match category 5.
Category 6 is not detailed in the present review since it does not t
into any particular type of HIT. HIT high-intensity interval training,
[La] blood lactate accumulation; surrogate of anaerobic glycolytic
energy release RST repeated-sprint training, SIT spring interval
training
HIT Programming: Cardiopulmonary Emphasis 315
predict, since the factors are inter-related. While our
understanding of how to manipulate these variables is
progressing with respect to T@
_
VO
2max
[14], it remains
unclear which combination of work-interval duration and
intensity, if any, is most effective at allowing an individual
to spend prolonged T@
_
VO
2max
while controlling for the
level of anaerobic engagement [3] and/or neuromuscular
load (review Part II).
Considering that long-term physiological and perfor-
mance adaptations to HIT are highly variable and likely
population-dependent (age, gender, training status and
background) [19, 20], providing general recommendations
for the more efcient HIT format is difcult. We provide,
however, in Part I of this review, the different aspects of
HIT programming, from work/relief interval manipulation
to the selection of exercise modality, with continued ref-
erence to T@
_
VO
2max
(i.e. time spent C90 %
_
VO
2max
,
otherwise stated), which may assist to individualize HIT
prescription for different types of athletes. Additional
programming considerations will also be discussed with
respect to other variables, such as cardiovascular responses.
Different examples of training cycles from different sports
will be provided in Part II of the present review. As this
was a narrative, and not a systematic review, our methods
included a selection of the papers we believed to be most
relevant in the area. Since the main goal of HIT sessions is
to improve the determinants of
_
VO
2max
, only HIT sessions
performed in the severe intensity domain (i.e. greater than
the second ventilatory threshold or maximal lactate steady
state) were considered. Acute responses to running-based
HIT were given priority focus, since the largest quantity of
literature has used this exercise mode. It is likely, however,
that the manipulation of these same HIT variables has
comparable effects in other sports (or exercise modes, e.g.
cycling, rowing, etc.), with the exception of under-water
activities that may require a specic programming
approach [36]. Finally, we believe that the present rec-
ommendations are essentially appropriate for moderately
trained to elite athletes. For special populations (e.g. sed-
entary or cardiac patients), the reader is referred to recent
reviews [37] and original investigations [3840]. Stan-
dardized differences (or effect sizes; ES [41]) have been
calculated where possible to examine the respective effects
of the manipulation of each HIT variable, and interpreted
using Hopkins categorization criteria, where 0.2, 0.6, 1.2
and[2 are considered small, medium, large and very
large effects, respectively [42].
2 Prescribing Interval Training for Athletes
in the Field
To prescribe HIT and ensure that athletes reach the
required intensity, several approaches exist to control and
individualize exercise speed/power accordingly. We will
discuss these points and illustrate why, in our opinion,
using incremental test parameters is far more objective,
practical, and likely more accurate and effective at
achieving desired performance outcomes.
2.1 The Track-and-Field Approach
To programme HIT for endurance runners, coaches have
traditionally used specic running speeds based on set
times for distances ranging from 800 m to 5000 m, but
without using physiological markers such as the speeds
Work
Relief
Duration
Duration
I
n
t
e
n
s
i
t
y
I
n
t
e
n
s
i
t
y
Series
Series duration
Time between series
# of series
Work modality
Between-series
recovery intensity
Fig. 2 Schematic illustration of
the nine variables dening a
HIT session adapted from
Buchheit [35]. HIT high-
intensity interval training
associated with
_
VO
2max
, lactate or ventilatory thresholds
[3]. It is worth mentioning, however, that coaches and
athletes have been, and still are, highly successful using
this approach; an observation that should humble the
exercise physiologist. The attraction of this method is that
the entire locomotor prole (i.e. both maximal sprinting
and aerobic speeds, Fig. 3) of the athlete can be used to
shape the HIT session, so that each run can be performed
in accordance with the athletes (maximal) potential. While
for short intervals (i.e. 1060 s) the reference running time
will be a percentage of the time measured over a maximal
100400 m sprint, the speed maintained over 8001,500 m
to 2,0003,000 m can be used to calibrate longer intervals
(e.g. 24 to 68 min). The disadvantage of this approach,
however, is that it does not allow the coach to consciously
manipulate the acute physiological load of the HIT session,
and precisely target a specic adaptation (i.e. Fig. 1, when
there is a need to improve a physiological quality and not
just to prepare for a race). Additionally, this approach tends
to be reserved for highly experienced coaches and well
trained athletes, for whom best running times on several set
distances are known. The translation and application of the
track-and-eld method to other sports is, however, difcult.
For example, how might a coach determine the expected
800-m run time for a 2.10-m tall basketball player that has
never run more that 40 s continuously on a court before?
Thus, using the track-and-eld approach for non-track-and-
eld athletes is unlikely to be appropriate, practical or
effective.
2.2 The Team Sport Approach
Due to the technical/tactical requirements of team sports,
and following the important principle of training specic-
ity, game- (i.e. so-called small sided games, SSG) [4346]
or skill-based [47, 48] conditioning has received an expo-
nential growth in interest [49]. While understanding of the
_
VO
2
responses to SSG is limited [44, 50, 51], T@
_
VO
2max
during an SSG in national-level handball players was
achieved for 70 % of the session (i.e. 5 min 30 s of the 8-
min game) [50]. Although the effectiveness of such an
approach has been shown [43, 46, 52, 53], SSGs have
limitations that support the use of less specic (i.e. run
based) but more controlled HIT formats at certain times of
the season or for specic player needs. The acute physio-
logical load of an SSG session can be manipulated by
changing the technical rules [54], the number of players
and pitch size [55], but the overall load cannot, by default,
be precisely standardized. Within-player responses to SSG
are highly variable (poor reproducibility for blood lactate
[coefcient of variation (CV): 1530 %] and high-intensity
running responses [CV: 3050 %] [56, 57]), and the
between-player variability in the (cardiovascular) respon-
ses is higher than more specic run-based HIT [49]. During
an SSG in handball, average
_
VO
2
was shown to be inver-
sely related to
_
VO
2max
[50], suggesting a possible ceiling
effect for
_
VO
2max
development in tter players. Addition-
ally, reaching and maintaining an elevated cardiac lling is
believed to be necessary to improve maximal cardiac
Fig. 3 Intensity range used for
the various run-based HIT
formats. ASR anaerobic speed
reserve, MLSS maximal lactate
steady state, MSS maximal
sprinting speed, RST repeated-
sprint training, SIT sprint
interval training,
_
VO
2max
maximal oxygen uptake,
v
_
VO
2max
minimal running speed
required to elicit
_
VO
2max
, VD50
speed half way between
v
_
VO
2max
and MLSS, V
crit
critical velocity, V
IFT
peak
speed reached at the end of the
3015 Intermittent Fitness Test,
V
Inc.Test
peak incremental test
speed
function [58, 59]. The repeated changes in movement
patterns and the alternating work and rest periods during an
SSG might therefore induce variations in muscular venous
pump action, which can, in turn, limit the maintenance of a
high stroke volume (SV) throughout the exercise and
compromise long term adaptations [60] (see Sect. 3.2).
Compared with generic run-based exercises, the
_
VO
2
/heart
rate (HR) ratio (which can be used with caution as a sur-
rogate of changes in SV during constant exercise when the
arteriovenous O
2
difference is deemed constant [61]) is
also likely lower during an SSG [44, 50, 51]. While this
ratio is generally close to 1 during run-based long intervals
(i.e.
_
VO
2
at 95 %
_
VO
2max
for HR at 95 % of maximal HR
(HR
max
) [21, 62]), authors have reported values at 79 %
_
VO
2max
and 92 % HR
max
during basketball drills [44] and
at 52 %
_
VO
2max
and 72 % HR
max
during a ve-a-side
indoor soccer game [51]. This conrms the aforementioned
possible limitations with respect to SV enlargement, and
suggests that assessment of cardiopulmonary responses
during an SSG (and competitive games) using HR may be
misleading [63]. Finally, the
_
VO
2
/speed [50] (and HR/
speed [63]) relationship also tends to be higher during an
SSG compared with generic running, possibly due to
higher muscle mass involvement. While this method of
training is often considered to be highly specic, this is not
always the case, since during competitive games players
have often more space to run and reach higher running
speeds (up to 8590 % of maximal sprinting speed [64
66]) for likely similar metabolic demands.
2.3 Heart Rate-Based Prescription
Heart rate has become the most commonly measured
physiological marker for controlling exercise intensity in
the eld [67]. Setting exercise intensity using HR zones is
well suited to prolonged and submaximal exercise bouts;
however, its effectiveness for controlling or adjusting the
intensity of an HIT session may be limited. HR cannot
inform the intensity of physical work performed above the
speed/power associated with
_
VO
2max
, which represents a
large proportion of HIT prescriptions [35]. Additionally,
while HR is expected to reach maximal values ([9095 %
HR
max
) for exercise at or below the speed/power associated
with
_
VO
2max
, this is not always the case, especially for very
short (\30 s) [68] and medium-long (i.e. 12 min) [69]
intervals. This is related to the well-known HR lag at
exercise onset, which is much slower to respond compared
with the
_
VO
2
response [70]. Further, HR inertia at exercise
cessation (i.e. HR recovery) can also be problematic in this
context, since this can create an overestimation of the
actual work/physiological load that occurs during recovery
periods [69]. It has also been shown that substantially
different exercise sessions (as assessed by accumulated
blood lactate levels during run-based HIT [71] and by
running speed during an SSG [63]) can have a relatively
similar mean HR response. Thus, the temporal dissociation
between HR,
_
VO
2
, blood lactate levels and work output
during HIT limits our ability to accurately estimate inten-
sity during HIT sessions using HR alone. Further, it is
difcult to imagine how an athlete would practically con-
trol or adjust exercise intensity during an interval, espe-
cially for athletes running at high speed, where viewing HR
from a watch is difcult.
2.4 Rating of Perceived Exertion-Based Prescription
Prescribing the intensity of HIT bouts using the rating of
perceived exertion (RPE) method [72] is highly attractive
because of its simplicity (no need to monitor HR) and
versatility. Using this approach, coaches generally pre-
scribe independent variables such as the duration or dis-
tance of work and relief intervals [71]. In return, the
athlete can self-regulate their exercise intensity. The
intensity selected is typically the maximal intensity of
exercise perceived as sustainable (hard to very hard,
i.e. C6 on a CR-10 Borg scale and C15 on a 620 scale)
and is based on the athletes experience, the session goal
and external considerations related to training periodiza-
tion. While the specic roles (or contributions) played by
varying biological afferents and other neurocognitive
processes involved with the selection of exercise pace
based on effort are still debated (see viewpoint/counter-
point [73]), RPE responses may reect a conscious sen-
sation of how hard, heavy, and strenuous exercise is [74],
relative to the combined physiological [75], biomechanical
and psychological [76] stress/fatigue imposed on the body
during exercise [77]. RPE responses are gender-indepen-
dent [78] and comparable during free versus constant pace
exercise [79]. In practice, the rst benet of RPE-guided
HIT sessions [69, 71] is that they do not require any
knowledge of the athletes tness level (no test results
needed). Finally, RPE is a universal exercise regulator,
irrespective of locomotor mode and variations in terrain
and environmental conditions. While more research in
trained athletes is needed to conrm the efcacy of RPE-
guided training sessions, it has been shown to promote the
same physiological adaptations as an HR-based pro-
gramme over 6 weeks in young women [80]. The RPE
method does have limitations, however, since it does not
allow for the precise manipulation of the physiological
response to a given HIT session. This could limit the
ability to target a specic adaptation (i.e. Fig. 1), and
might also be problematic in a team sport setting (as
discussed in the three preceding sections). There is also
some evidence to suggest that the ability to adjust/evaluate
exercise intensity based on RPE may be age- [81], tness-
[82, 83], exercise-intensity- and pleasure-[84] dependent.
2.5 Velocity/Power Associated with Maximal Oxygen
Uptake (
_
VO
2max
)
Following early works in the 1970s and 1980s [8588], the
physiologists V.L. Billat and D.W. Hill popularized the
speed (or power) associated with
_
VO
2max
(so-called
v/p
_
VO
2max
or maximal aerobic speed/power [MAS/MAP]
[89, 90]) as a useful reference intensity to programme HIT
[35]. The attractiveness of the v/p
_
VO
2max
method is that it
represents an integrated measure of both
_
VO
2max
and the
energetic cost of running/cycling into a single factor;
hence, being directly representative of an athletes loco-
motor ability [89]. Since v/p
_
VO
2max
is theoretically the
lowest speed/power needed to elicit
_
VO
2max
, it makes
intuitive sense for this marker to represent an ideal refer-
ence for training [5, 15, 89].
v/p
_
VO
2max
can be determined, or estimated, a number of
different ways. Methods include using the following:
1) The linear relationship between
_
VO
2
and running
speed established at submaximal speeds [88].
2) The individual cost of running to calculate a theoret-
ical running speed for a given
_
VO
2max
, either with [91]
or without [92] resting
_
VO
2
values.
3) Direct measurement (i.e. pulmonary gas exchange
[93]) during ramp-like incremental running/cycling
tests to exhaustion, either on the track, on a treadmill
or using an ergometer. On the track, the University of
Montreal Track Test (UM-TT [87]) is the protocol
most commonly used with athletes [94, 95], although
the Vam-Eval [96], which only differs from the UM-
TT due to its smoother speed increments and shorter
intercones distances, has also received growing inter-
est since it is easier to administer in young populations
and/or non-distance running specialists [97, 98]. Since
the true v/p
_
VO
2max
during incremental tests requires
_
VO
2
measures to determine the lowest speed/power
that elicits
_
VO
2max
(generally dened as a plateau in
_
VO
2
or an increase less than 2.1 mL/min/kg despite an
increase in running speed of 1 km/h [93]), the nal
(peak) incremental test speed/power reached at the end
of these tests (V/p
Inc.Test
) is only an approximation of
v/p
_
VO
2max
. These two distinct speeds/powers are
strongly correlated (r [0.90 [87]), but V/p
Inc.Test
can
be 510 % greater than v/p
_
VO
2max
, with individuals
possessing greater anaerobic reserves presenting gen-
erally a greater v/p
_
VO
2max
- V/p
Inc.Test
difference.
Measurement of V
Inc.Test
is, however, very practical in
the eld since it is largely correlated with distance
running performance [99] and match running capacity
in team sports (but for some positions only) [98, 100].
4) A 5-min exhaustive run [101], since the average time
to exhaustion at v
_
VO
2max
has been reported to range
from 4 to 8 min [89, 102]. The v
_
VO
2max
calculated
from this test has been shown to be largely correlated
with the V
Inc.Test
reached in the UM-TT (r = 0.94)
and on a ramp treadmill test (r = 0.97) [101], while
being slightly (i.e. 1 km/h range) slower and faster
than these velocities, respectively. The v
_
VO
2max
estimated via the 5-min test is, however, likely
inuenced by pacing strategies, and may only be valid
for trained runners able to run at v
_
VO
2max
for &5 min.
v
_
VO
2max
is also method-[90] and protocol-dependent
[103]. A mathematically estimated v
_
VO
2max
[88, 91] is
likely to be lower than a measured v
_
VO
2max
[93] that is
also lower than V
Inc.Test
[89, 104]. Additionally, irrespec-
tive of the method used to determine v
_
VO
2max
, protocols
with longer-stage durations tend to elicit lower speed/
power values [103], while larger speed/power increments
result in higher-speed/power values. Similarly, v
_
VO
2max
also appears to be inversely related to the terrain or
treadmill slope [105]. Endurance-trained athletes are likely
able to tolerate longer stages and therefore, less likely to
present impairments in v
_
VO
2max
with variations in proto-
col. These differences must be acknowledged since small
differences in the prescribed work intensity have sub-
stantial effects on acute HIT responses.
The reliability of v
_
VO
2max
and V
Inc.Test
(as examined
using CVs) has been shown to be good: 3 % for v
_
VO
2max
in moderately trained middle- and long-distance runners
[68], 3.5 % for UM-TT V
Inc.Test
in moderately trained
athletes [87], 3.5 % (90 % condence limits: 3.0, 4.1
[Buchheit M, unpublished results]) for Vam-Eval V
Inc.Test
in 65 highly trained young football players, 2.5 % and 3 %
for treadmill V
Inc.Test
in well trained male distance runners
[106] and recreational runners [104], respectively, and
nally, 12 % for the 5-min test in a heterogeneous
sporting population [107].
For training prescription, V
Inc.Test
, as determined in the
eld with the UM-TT [87] or the Vam-Eval [96], is
probably the preferred method, since, in addition to not
requiring sophisticated apparatus, the tests account for the
anaerobic contribution necessary to elicit
_
VO
2max
[108]. It
is, however, worth noting that using v
_
VO
2max
or V
Inc.Test
as
the reference running speed is essentially suitable for long
(26 min) intervals ran around v
_
VO
2max
(90105 %). For
sub- and supramaximal training intensities, however, the
importance of other physiological attributes should be
considered. For instance, endurance capacity (or the
capacity to sustain a given percentage of v
_
VO
2max
over
time [109]) and anaerobic power/capacity [110] are likely
to inuence time to exhaustion and, in turn, the physio-
logical responses. The following section highlights the
different options available for the prescription of supra-
maximal training (i.e. training at intensities [v
_
VO
2max
).
2.6 Anaerobic Speed Reserve
Consideration for an individuals anaerobic speed reserve
(ASR; the difference between maximal sprinting speed
(MSS) and v
_
VO
2max
, Fig. 3) is often not fully taken into
account by coaches and scientists in their training pre-
scription. While track-and-eld (running) coaches have
indirectly used this concept for years to set the work
interval intensity (as discussed in Sect. 2.1), its scientic
basis and interest was only brought forth merely a decade
ago, when Billat and co-workers [110] showed that time to
exhaustion at intensities above v
_
VO
2max
were better related
to the ASR and/or MSS, than to v
_
VO
2max
. Bundle et al.
[111113] demonstrated, using an empirical prediction
model, that the proportion of ASR used could determine
performance during all-out efforts lasting between a few
seconds and several minutes. While these studies have used
continuous exercise, ASR has only recently been consid-
ered in relation to repeated-sprint performance [114, 115].
In practice, two athletes can present with clearly different
MSS ability, despite a similar v
_
VO
2max
(Fig. 4 [116]). If
during an HIT session they exercise at a similar percentage
of v
_
VO
2max
, as is generally implemented in the eld (e.g.
see [117]), the exercise will actually involve a different
proportion of their ASR, which results in a different
physiological demand, and in turn, a different exercise
tolerance [116]. Therefore, it appears that, in addition to
v
_
VO
2max
, the measurement of MSS (and ASR) should be
considered for individualizing training intensity during
supramaximal HIT [110, 116].
2.7 Peak Speed in the 3015 Intermittent Fitness Test
While using the ASR to individualize exercise intensity for
supramaximal runs might represent an improved alterna-
tive over that of v
_
VO
2max
or V
Inc.Test
, it still does not
capture an overall picture of the different physiological
variables of importance during team- or racquet-based
specic HIT sessions. In many sports, HIT is performed
indoors and includes repeated very short work intervals
(\45 s). This implies that, in addition to the proportion
of the ASR used, the responses to these forms of HIT
appear related to an individuals (1) metabolic inertia (e.g.
_
VO
2
kinetics) at the onset of each short interval; (2)
physiological recovery capacities during each relief inter-
val; and (3) change of direction ability (since indoor HIT is
often performed in shuttles) [94, 116]. Programming HIT
without taking these variables into consideration may result
in sessions with different aerobic and anaerobic energy
demands, which prevents the standardization of training
load, and likely limits the ability to target specic physi-
ological adaptations [94]. To overcome the aforementioned
limitations inherent with the measurement of v
_
VO
2max
and
ASR, the 3015 Intermittent Fitness Test (3015
IFT
) was
developed for intermittent exercise and change of direction
(COD)-based HIT prescription [35, 94, 116]. The 3015
IFT
was designed to elicit maximal HR and
_
VO
2
, but addi-
tionally provide measures of ASR, repeated effort ability,
acceleration, deceleration, and COD abilities [94, 118,
119]. The nal speed reached during the 3015
IFT
, V
IFT
, is
therefore a product of those above-mentioned abilities. In
other words, the 3015
IFT
is highly specic, not to a spe-
cic sport, but to the training sessions commonly per-
formed in intermittent sports [116]. While the peak speeds
reached in the different Yo-Yo tests [120] (e.g. vYo-YoIR1
for the Yo-Yo Intermittent Recovery Level 1) and V
IFT
have likely similar physiological requirements [221], only
the V
IFT
can be used accurately for training prescription.
For instance, vYo-YoIR1 cannot be directly used for
training prescription since, in contrast to V
IFT
[35], its
relationship with V
Inc.Test
(and v
_
VO
2max
) is speed-depen-
dent [121], Fig. 5). When running at vYo-YoIR1, slow and
unt athletes use a greater proportion of their ASR, while
tter athletes run below their v
_
VO
2max
(Fig. 5). Finally,
V
IFT
has been shown to be more accurate than V
Inc.Test
for
individualizing HIT with COD in well trained team sport
players [94], and its reliability is good, with the typical
Fig. 4 Illustration of the importance of ASR for two athletes
possessing similar running speeds associated with v
_
VO
2max
, but
different maximal sprinting speeds. During an HIT session, Athlete B
with a greater ASR will work at a lower percentage of his ASR, and
will therefore achieve a lower exercise load compared with Athlete A
[116]. ASR anaerobic speed reserve, HIT high-intensity interval
training, v
_
VO
2max
minimal running speeds associated with maximal
oxygen uptake
error of measurement (expressed as CV) shown to be 1.6 %
(95 % CL 1.4, 1.8) [122]. Also of note, since V
IFT
is
25 km/h (1525 %) faster than v
_
VO
2max
and/or V
Inc.Test
[35, 116, 119], it is necessary to adjust the percentage of
V
IFT
used when programming. While HIT is generally
performed around v
_
VO
2max
(i.e. 100120 % [3, 4], Fig. 3),
V
IFT
constitutes the upper limit for these exercises (except
for very short intervals and all-out repeated-sprint training).
Thus, the 3015
IFT
permits improved precision of pro-
gramming by individualizing the intensity of the prescribed
interval bouts around intensities ranging from 85 % to
105 % of V
IFT
[43, 50, 123125].
2.8 All-Out Sprint Training
Repeated all-out sprinting efforts have received a marked
growth in research interest lately [9, 126]. In practical terms,
these sessions can be divided into either short (310 s, RST)
or long (3045 s sprints, SIT) duration sprints. Since such
exercise is consistently performed all-out, they can be
prescribed without the need to pre-test the individual (i.e.
v/p
_
VO
2max
is not specically needed to calibrate the intensity).
3 Acute Responses to Variations of Interval Training
3.1 Maximizing the Time Spent at or Near
_
VO
2max
We lead off this review with data related to T@
_
VO
2max
(reviewed previously [14]), since pulmonary
_
VO
2
respon-
ses may actually integrate both cardiovascular and muscle
metabolic (oxidative) responses to HIT sessions. In the
present review, we integrate recently published work and
provide a comprehensive analysis of the
_
VO
2
responses to
different forms of HIT, from long intervals to SIT sessions,
through short intervals and repeated-sprint sequences
(RSS, Fig. 3). Figure 6 illustrates the
_
VO
2
responses of
four distinct HIT sessions, including long intervals, and
highlights how changes in HIT variables can impact the
T@
_
VO
2max
[21, 50, 127, 128]. There are, however,
numerous methodological limitations that need to be con-
sidered to interpret the ndings shown from the different
studies [68, 103, 129]. In addition to methodological con-
siderations between studies (treadmill vs. overground run-
ning, determination criteria for both
_
VO
2max
and v
_
VO
2max
,
data analysis [averaging, smoothing technique], threshold
for minimal
_
VO
2
values considered as maximal [90 %,
95 %,
_
VO
2max
minus 2.1 ml/min/kg, 100 %]), differences
in the reliability level of analysers and intra-day subject
variation in
_
VO
2max
,
_
VO
2
kinetics and times to exhaustion,
make comparison between studies difcult. The within-
study effects of HIT variable manipulation on the observed
T@
_
VO
2max
can, however, provide insight towards under-
standing how best to manipulate HIT variables.
3.1.1 Oxygen Uptake (
_
VO
2
) Responses to Long Intervals
3.1.1.1 Exercise Intensity during Long Intervals During
a single constant-speed or power exercise, work intensity
close to v/p
_
VO
2max
is required to elicit maximal
_
VO
2
responses. In an attempt to determine the velocity associ-
ated with the longest T@
_
VO
2max
during a run to exhaus-
tion, six physical-education students performed four
separate runs at 90 %, 100 %, 120 % and 140 % of their
v
_
VO
2max
(17 km/h) [130]. Not surprisingly, time to
exhaustion was inversely related to running intensity.
T@
_
VO
2max
during the 90 % and 140 % conditions was
trivial (i.e. \20 s on average), but reached substantially
y = x
All pooled
n = 141
r = 0.84 (0.79, 0.88)
y = 0.8x + 6
V
Inc.Test
(km/h)
v
Y
o
-
Y
o

I
R
1

(
k
m
/
h
)
12
13
14
15
16
17
18
19
20
b
Male
n = 14
r = 0.79 (0.57, 0.86)
y = 0.4x + 9.8
y = x
V
Inc.Test
(km/h)
12 13 14 15 16 17 18 19 20
10 12 14 16 18 20 22 24
V
I
F
T

(
k
m
/
h
)
10
12
14
16
18
20
22
24
a
Male
Female
Fig. 5 Relationships (90 % condence limits) between the V
IFT
,
upper panel (Buchheit M, personal data [35]), vYo-YoIR1, lower
panel [121] and V
Inc.Test
. V
IFT
speed reached at the end of the 3015
Intermittent Fitness Test
,
V
Inc.Test
peak incremental test speed, vYo-
YoIR1 peak running speed reached at the end of the Yo-Yo
intermittent recovery level 1 test
larger values at 100 % and 120 %: mean standard
deviation 190 87 (57 % of time to exhaustion,
ES[?2.8) and 73 29 s (59 %, ES[?1.7). In another
study, middle-distance runners did not manage to reach
_
VO
2max
while running at 92 % of v
_
VO
2max
[131]. The
ability to reach
_
VO
2max
during a single run at the velocity
between the maximal lactate steady state and v
_
VO
2max
(i.e.
vD50, &9293 % of v
_
VO
2max
[130]) via the development
of a
_
VO
2
slow component [10] is likely tness-dependent
[132] (with highly trained runners unlikely to reach
_
VO
2max
). In addition, as the determination of vD50 is
impractical in the eld, work intensities of C95 %
v/p
_
VO
2max
are therefore recommended for maximizing
T@
_
VO
2max
during single isolated runs. However, in prac-
tice, athletes do not exercise to exhaustion, but use inter-
vals or sets. Slightly lower intensities (C90 % v/p
_
VO
2max
)
can also be used when considering repeated exercise bouts
(as during HIT sessions), since interval
_
VO
2
is likely to
increase with repetitions with the development of a
_
VO
2
slow component [10]. As suggested by Astrand in the
1960s [10], exercise intensity does not need to be maximal
during an HIT session to elicit
_
VO
2max
.
3.1.1.2 Time-to-Reach
_
VO
2max
and Maximizing Long-
Interval Duration If
_
VO
2max
is to be reached during the
rst interval of a sequence, its interval duration must at
least be equal to the time needed to reach
_
VO
2max
. Thus,
with short intervals, as during typical HIT sessions (work
interval duration \time needed to reach
_
VO
2max
),
_
VO
2max
is usually not reached on the rst interval.
_
VO
2max
values
can, however, be reached during consecutive intervals,
through the priming effect of an adequate warm-up and/or
the rst intervals (that accelerates
_
VO
2
kinetics [133, 134])
and the development of a
_
VO
2
slow component [10]. The
time needed to reach
_
VO
2max
during constant-speed exer-
cise to exhaustion has received considerable debate in the
past [104, 131, 135138]. The variable has been shown to
range from 97 s [138] to 299 s [131] and has a high in-
tersubject variability (2030 % [131, 135, 137] to 40 %
[104]). While methodological differences could explain
some of these dissimilarities (whether 95 % or 100 % of
_
VO
2max
is considered, the presence and type of pretrial
warm-up), the variability is consistent with those shown in
_
VO
2
kinetics at exercise onset.
_
VO
2
kinetics are generally
affected by exercise intensity [139], accelerated during
running compared with cycling exercise [140] and faster in
trained individuals [141]. The relationship between
_
VO
2
kinetics at exercise onset and
_
VO
2max
, however, is less
clear, with some studies reporting relationships [141143],
and others showing no correlation [144146], suggesting
that the
_
VO
2
kinetics at exercise onset is more related to
training status [141, 147] than
_
VO
2max
per se.
T
i
m
e

(
m
i
n
)
0
5
10
15
20
25
30
35
40
45
Session time
T@VO
2max
(90%)
43(13)%
26(15)%
24(9)%
70(9)%
D
i
s
t
a
n
c
e

(
m
)
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
Total distance
Distance >90% vVO
100%
83(55)%
67(30)%
N/A
RPE:13.5(2)
[La]: 5.7(1.8)
[La]: 6.5(2.2)
RPE:15.8(2.4)
[La]: 8.9(2.2)
RPE:16.5(2.2)
5x(3min[90% vVO
2max
]/90s[0%]) 1
5x(5min[92% vVO
2max
]/2.5min[46% vVO
2max
]) 2 3min45[SSG]/30s[0%]/3min45[SSG] 4
3x(2x(2min[100% vVO
2max
]/2min[50% vVO
2max
])) 3
T@VO
2max
(95%)
43(13)%
38(21)%
20(14)%
70(19)%
34(12)%
2max
Fig. 6 Mean SD of total session time, T@
_
VO
2max
, total distance
and distance ran above 90 % of v
_
VO
max
during four different HIT
sessions including long intervals. Percentages (mean SD) refer to
T@
_
VO
2max
relative to the total session time, and distance ran above
90 % of v
_
VO
2max
relative to the total distance ran. RPE and [La],
mmol/L) are provided as mean SD when available. References: 1
[21]; 2 [127]; 3 [128] and 4 [50]. HIT high-intensity interval training,
[La] blood lactate concentration, N/A not available, RPE rating of
perceived exertion, SSG small-sided games (handball),
_
VO
2max
maximal oxygen uptake, T@
_
VO
2max
time spent above 90 % or
95 % of
_
VO
2max
, v
_
VO
2max
minimal running speed associated with
_
VO
2max
As an alternative to using xed long-interval durations,
using 5070 % of time to exhaustion at v
_
VO
2max
has been
suggested by the scientic community as an alternative to
individualizing interval training [3, 5, 137, 148150].
However, to our knowledge, prescribing training based on
time to exhaustion is very rare compared with how
endurance athletes actually train. Additionally, while the
rationale of this approach is sound (5070 % is the average
proportion of time to exhaustion needed to reach
_
VO
2max
),
this is not a practical method to apply in the eld. First, in
addition to v
_
VO
2max
, time to exhaustion at v
_
VO
2max
must
be determined, which is only a moderately reliable measure
(CV = 12 % [68] to 25 % [93]), is exhaustive by nature
and highly dependent on the accuracy of the v
_
VO
2max
determination [103]. Second, the time required to reach
_
VO
2max
has frequently been reported to be longer than
75 % of time to exhaustion in some participants [131, 135,
136]. Intervals lasting 70 % of time to exhaustion have also
been reported as very difcult to perform, likely due to the
high anaerobic energy contribution this requires [150]. For
athletes presenting with exceptionally long time to
exhaustion, repeating sets of 60 % of time to exhaustion is
typically not attainable [137]. Finally, there is no link
between the time needed to reach
_
VO
2max
and time to
exhaustion [135, 137]. Therefore, since a given percentage
of time to exhaustion results in very different amounts of
T@
_
VO
2max
, it appears more logical to use the time needed
to reach
_
VO
2max
to individualize interval length [135] (e.g.
time needed to reach
_
VO
2max
? 1 or 2 min). If the time
needed to reach
_
VO
2max
cannot be determined (as is often
the case in the eld), we would therefore recommend using
xed intervals durations C23 min that could be further
adjusted in accordance with the athletes training status
(with the less trained performing lower training loads, but
longer intervals) and the exercise mode. Indeed, if we
consider that the time constant of the primary phase of the
_
VO
2
kinetics at exercise onset (s) in the severe intensity
domain is generally in the range of 20 s to 35 s [131, 140,
146], and that a steady-state (C95 %
_
VO
2max
) is reached
after exercise onset within &4 s,
_
VO
2max
should then be
reached from within 1 min 20 s to 2 min 20 s (at least
when intervals are repeated), irrespective of training status
and exercise mode. This is consistent with the data shown
by Vuorimaa et al. in national level runners
(v
_
VO
2max
= mean SD 19.1 1 km/h), where
_
VO
2max
values were reached during 2-min work/2-min rest inter-
vals, but not during 1 min/1 min [22]. Similarly, in
the study by Seiler and Sjursen [71] in well trained run-
ners (v
_
VO
2max
= 19.7 1 km/h), peak
_
VO
2
was only
82 5 % of
_
VO
2max
during 1-min intervals, while it
reached 92 4 during 2-min intervals; extending the work
duration did not modify these peak values (93 5 and
92 3 % for 4- and 6-min intervals, respectively).
Although performed on an inclined treadmill (5 %), these
latter sessions were performed at submaximal self-selected
velocities (i.e. 91 %, 83 %, 76 % and 70 % v
_
VO
2max
for 1-
, 2-, 4- and 6-min intervals, respectively [71]), which
probably explains why
_
VO
2max
was not reached [130] (see
Sect. 3.1.1.4 below with respect to uphill running).
3.1.1.3 Relief Interval Characteristics during Long-Inter-
val High-Intensity Interval Training (HIT) When pro-
gramming HIT, both the duration and intensity of the relief
interval are important [152]. These two variables must be
considered in light of (1) maximizing work capacity during
subsequent intervals (by increasing blood ow to acceler-
ate muscle metabolic recovery, e.g. PCr resynthesis, H
?
ion buffering, regulation of inorganic phosphate (Pi) con-
centration and K
?
transport, muscle lactate oxidation) and;
(2) maintaining a minimal level of
_
VO
2
to reduce the time
needed to reach
_
VO
2max
during subsequent intervals (i.e.
starting from an elevated baseline) [3, 14]. While per-
forming active recovery between interval bouts is appeal-
ing to accelerate the time needed to reach
_
VO
2max
and in
turn, induce a higher fractional contribution of aerobic
metabolism to total energy turnover [134], its effects on
performance capacity (time to exhaustion), and hence,
T@
_
VO
2max
are not straightforward. The benet of active
recovery has often been assessed via changes in blood
lactate concentration [153, 154], which has little to do with
muscle lactate concentration [155]. Additionally, neither
blood [156, 157] nor muscle [155] lactate has a direct (nor
linear) relationship with performance capacity. The current
understanding is that active recovery can lower muscle
oxygenation [158, 159], impair PCr resynthesis (O
2
com-
petition) and trigger anaerobic system engagement during
the following effort [160]. Additionally, while a benecial
performance effect on subsequent intervals can be expected
with long recovery periods (C3 min [134, 161, 162], when
the possible wash out effects overcome that of the likely
reduced PCr resynthesis), active recovery performed dur-
ing this period may negate subsequent interval perfor-
mance using both long periods at high intensities ([45 %
v/p
_
VO
2max
) [153] and short periods of varying intensity
[159, 163]. In the context of long interval HIT, passive
recovery is therefore recommended when the relief interval
is less than 23 min in duration. If an active recovery is
chosen for the above-mentioned reasons (i.e. [3, 14, 134].),
relief intervals should last at least 34 min at a submaximal
intensity [153] to allow the maintenance of high-exercise
intensity during the following interval.
In practice, active recovery is psychologically difcult
to apply for the majority of athletes, especially for non-
endurance athletes. When moderately trained runners
(v
_
VO
2max
= 17.6 km/h) were asked to self-select the nat-
ure of their relief intervals during an HIT session
(6 9 4 min running at 85 % v
_
VO
2max
on a treadmill with
5 % incline), they chose a walking recovery mode of about
2 min [69]. Compared with 1-min recovery intervals, the 2-
min recovery duration enabled runners to maintain higher
running speeds; extending passive recovery to 4 min did
not provide further benets with respect to running speeds.
The low T@
_
VO
2max
/total exercise time ratio shown
by Millet et al. [128] (34 % when considering time[90 %
_
VO
2max
; Fig. 6) in well trained triathletes (v
_
VO
2max
=
19.9 0.9 km/h) was likely related to the introduction of
5-min passive pauses every second interval. With intervals
performed successively (no passive pauses, no blocks
but active recoveries \50 % v
_
VO
2max
between runs),
Demarie et al. [127] reported a longer T@
_
VO
2max
in senior
long-distance runners (v
_
VO
2max
= 16.6 1.1 km/h). More
recently, Buchheit et al. showed, in highly trained young
runners (v
_
VO
2max
= 18.6 0.3 km/h), that even shorter
recovery periods (i.e. 90 s), despite a passive recovery
intensity (walk), enabled athletes to spend a relatively high
proportion of the session at [90 % of
_
VO
2max
(43 %) [21].
This particular high efciency was also likely related to
both the young age [222] and the training status [141] of
the runners (since both are generally associated with
accelerated
_
VO
2
kinetics).
Finally, in an attempt to individualize between-run
recovery duration, the return of HR to a xed value or
percentage of HR
max
is sometime used in the eld and in
the scientic literature [165, 166]. The present under-
standing of the determinants of HR recovery suggest,
nevertheless, that this practice is not very relevant [69].
During recovery, HR is neither related to systemic O
2
demand nor muscular energy turnover [142, 167], but
rather to the magnitude of the central command and
metaboreex stimulations [168].
3.1.1.4 Uphill Running during HIT with Long Inter-
vals Despite its common practice [169], the cardiorespi-
ratory responses to eld-based HIT sessions involving
uphill or staircase running has received little attention.
Laboratory studies in trained runners (V
Inc.Test
C 20 km/h)
[170, 171] have shown that, for a given running speed,
_
VO
2
is higher during uphill compared with level running after a
couple of minutes, probably due to the increased forces
needed to move against gravity, the subsequently larger
motor units recruited and the greater reliance on concentric
contractions; all of which are believed initiators of the
_
VO
2
slow component [172]. However, in practice, athletes
generally run slower on hills versus the track [173]. Gajer
et al. [174] found in elite French middle-distance runners
(v
_
VO
2max
= mean SD 21.2 0.6 km/h,
_
VO
2max
=
78 4 ml/min/kg) that T@
_
VO
2max
observed during a hill
HIT session (6 9 500 m [1 min 40 s] 45 % slope [85 %
v
_
VO
2max
]/1 min 40 s [0 %]) was lower compared with a
reference track session (6600 m [1 min 40 s] {102 %
v
_
VO
2max
}/1 min 40 s [0 %]). While
_
VO
2
reached 99 %
and 105 %
_
VO
2max
during the hill and track sessions,
respectively, the T@
_
VO
2max
/exercise time ratio was
moderately lower during the hill HIT (27 % vs. 44 %,
ES & - 1.0). The reason for the lower T@
_
VO
2max
during
the hill HIT is unclear. Despite the expected higher muscle
force requirement during hill running [173], this is unlikely
enough to compensate for the reduction in absolute running
speed. If we consider that running uphill at 85 % v
_
VO
2max
with a grade of 5 % has likely the same (theoretical) energy
requirement as level running (or treadmill running with a
1 % grade to compensate for wind resistance [105])
at & 105 %; [175] the differences observed by Gajer et al.
could have been even greater if the at condition was ran at
a faster (and possibly better matched) speed (105 % vs.
102 % [174]). As well, intervals in these sessions might not
have been long enough to observe the additional slow
component generally witnessed with uphill running
(& 2 min [172]). More research is required, however, to
clarify the cardiorespiratory responses to uphill running at
higher gradients ([10 %) or to staircase running that may
require very high
_
VO
2
values due to participation of upper
body limbs (back muscles and arms when pushing down or
grabbing handrails).
3.1.1.5 Volume of HIT with Long Intervals Another
variable that can be used to maximize T@
_
VO
2max
is the
number of long-interval repetitions. It is worth noting,
however, that very few authors have examined HIT ses-
sions/programmes that are consistent with the sessions that
athletes actually perform, and that research on the optimal
T@
_
VO
2max
per session is limited. Cumulated high-
intensity ([90 % v/p
_
VO
2max
) exercise time during typical
sessions in well trained athletes has been reported to
be 12 min (6 9 2 min or 6 9 &600 m [128]), 15 min
(5 9 3 min or 5 9 &8001,000 m [21]), 16 min (4 9
4 min or 4 9 &1,0001,250 m [46]), 24 min (6 9 4 min
or 6 9 &1,0001,250 m [69]; 4 9 6 min or 4 9
& 1,500 m [71]) and 30 min (6 9 5 min or 5 9 &1,300
1,700 m [127]), which enabled athletes to accumulate,
depending on the HIT format, from 10 min[90 % [21, 128]
to 410 min [95 % [127, 128] at
_
VO
2max
. Anecdotal evi-
dences suggest that elite athletes tend to accumulate greater
T@
_
VO
2max
per session at some point of the season. In
recreationally trained cyclists (
_
VO
2max
: *52 ml/min/kg),
Seiler et al. showed that larger volumes of HIT performed
at a lower intensity (i.e. 4 9 8 min = 32 min at 90 %
HR
max
) may be more effective than more traditional HIT
sessions (e.g. 4 9 4 min) [176]. Further research examin-
ing the inuence of these particular sessions in more highly
trained athletes are, however, required to conrm these
ndings.
3.1.2
_
VO
2
Responses to HIT with Short Intervals
For short interval HIT runs to exhaustion, T@
_
VO
2max
is
largely correlated with total exercise time (i.e. time to
exhaustion) [14]. Hence, the rst approach to maximizing
T@
_
VO
2max
during such sessions should be to focus on the
most effective adjustments to work/relief intervals (intensity
and duration) that increase time to exhaustion. In practice,
however, coaches do not prescribe HIT sessions to exhaus-
tion; they prescribe a series or set of HIT [50, 128, 177, 178].
In this context, it is important to consider the strategies
needed to maximize T@
_
VO
2max
within a given time period,
or to dene time-efcient HIT formats with respect to the
T@
_
VO
2max
/exercise time ratio (i.e. T@
_
VO
2max
in relation to
the total duration of the HIT session, warm-up excluded).
3.1.2.1 Effect of Work Interval Intensity on
T@
_
VO
2max
Billat et al. [23] were the rst to show the
effect of exercise intensity on T@
_
VO
2max
during HIT with
short intervals (15 s/15 s) in a group of senior (average age:
52 years) distance runners (v
_
VO
2max
= 15.9 1.8 km/h).
While the concurrent manipulation of the relief interval
intensity (6080 % of v
_
VO
2max
, to maintain an average
HIT intensity of 85 %) might partially have inuenced the
_
VO
2
responses, the authors did show that increasing work
interval intensity from 90 % to 100 % of v
_
VO
2max
was
associated with a small improvement in the T@
_
VO
2max
/
exercise time ratio (81 % vs. 68 %, ES = ? 0.5). How-
ever, the T@
_
VO
2max
/exercise time ratio (85 %) was not
substantially greater using a work interval xed at 110
compared with 100 % of v
_
VO
2max
(ES = ?0.2). Using a
xed relief interval intensity (Fig. 7a, [117, 177, 179]),
increasing work intensity from 100 % to 110 % of
v
_
VO
2max
during a 30 s/30 s format in trained young run-
ners (v
_
VO
2max
= 17.7 0.9 km/h) induced a moderate
increase in the T@
_
VO
2max
/exercise time ratio
(ES = ? 0.6), despite very large and moderate reduc-
tions in time to exhaustion (ES = -4.4) and T@
_
VO
2max
(ES = -0.7), respectively [179]. A slight increase in work
intensity from 100 % to 105 % of v
_
VO
2max
during a
30 s/30 s HIT format in well trained triathletes
(v
_
VO
2max
= 19.8 0.93 km/h) was associated with a
large improvement in the T@
_
VO
2max
(ES = ?1.2) [177]. The twofold magnitude difference in
Millet et al. [177] compared with Thevenet et als. study
[179] (ES: ?1.2 vs. ?0.6) is likely due to the fact that
Millet et als. runs were not performed to exhaustion, but
implemented with pre-determined sets. It is therefore
possible that if the runs at 100 % had been performed to
exhaustion [177], this would have compensated for the
lower efciency of the protocol and decreased the differ-
ence in T@
_
VO
2max
observed. Similarly, increasing the
work intensity from 110 % to 120 % of v
_
VO
2max
during a
15 s/15 s format in physical education students
(v
_
VO
2max
= 16.7 1.3 km/h) lead to a large improve-
ment in the T@
_
VO
2max
/exercise time ratio (ES = ?1.8)
[117]. Interestingly, in the study by Millet et al. [177],
individual improvements in T@
_
VO
2
with the increase in
work intensity were inversely correlated with the athletes
primary time constant for
_
VO
2
kinetics at exercise onset
(r = 0.91; 90 % CI 0.61, 0.98), suggesting that the time
constant could be an important variable to consider when
selecting HIT variables [116, 177]. Practically speaking,
this data implies that coaches should programme HIT at
slightly greater exercise intensities for athletes presenting
with slow
_
VO
2
kinetics (i.e. older/less trained [141]), or for
athletes exercising on a bike [140]. However, since
increasing exercise intensity has other implications (e.g.
greater anaerobic energy contribution, higher neuromus-
cular load, see Part II), such programming manipulations
need to use a cost/benet approach.
With respect to the use of very-high-exercise intensities
([102/120 % V
IFT
/v
_
VO
2max
) for HIT, while the
T@
_
VO
2max
/exercise time ratio is high (81 % and 77 % at
130 % and 140 % of v
_
VO
2max
, respectively), exercise
capacity is typically impaired and, hence, total T@
_
VO
2max
for a given HIT series is usually low [117] (i.e. 5 min 47 s
at 120 % v
_
VO
2max
[117]). Nevertheless, the use of repeated
sets of such training can allow the accumulation of a suf-
cient T@
_
VO
2max
. Additionally, well trained athletes are
generally able to perform HIT at this intensity for longer
periods (i.e. [8 min [43, 50, 95, 180], especially when
V
IFT
, instead of v
_
VO
2max
, is used [94]). To conclude, it
appears that during HIT that involves short work intervals,
selection of a work bout intensity that ranges between
100 % and 120 % of v
_
VO
2max
([89 % and 105 % of V
IFT
)
may be optimal.
3.1.2.2 Effect of Work Interval Duration on T@
_
VO
2max
The effect of work interval duration on systemic
_
VO
2
responses during HIT involving repeated short intervals
was one of the rst parameters examined in the HIT lit-
erature [11, 12]. Surprisingly, there is little data available
on repeated efforts lasting less than 15 s, despite the
common approach used by coaches (e.g. 10 s/10 s, 10 s/
20 s) [181, 182]. During very short runs (\10 s), ATP
requirements in working muscle are met predominantly by
oxidative phosphorylation, with more than 50 % of the O
2
used derived from oxymyoglobin stores [11]. During the
recovery periods, oxymyoglobin stores are rapidly restored
and then available for the following interval [11]. As a
result, the cardiopulmonary responses of such efforts are
relatively low [183], unless exercise intensity is set at a
very high level (as detailed in Sect. 3.1.4) and/or relief
intervals are short/intense enough so that they limit com-
plete myoglobin resaturation. Therefore, in the context of
HIT involving short intervals (100120 % v
_
VO
2max
or 89/
105 % V
IFT
), work intervals C10 s appears to be required
to elicit high
_
VO
2
responses. Surprisingly, the specic
effect of work interval duration, using a xed work/rest
ratio in the same group of subjects, has not been investi-
gated thus far; whether, for example, a 15 s/15 s HIT
session enables a greater T@
_
VO
2max
than a 30 s/30 s session is unknown.
What is known of course is that prolonging exercise
duration increases the relative aerobic energy requirements
[184]. Increasing the work interval duration, while keeping
work relief intervals constant, also increases T@
_
VO
2max
(Fig. 7b, [128, 185, 186]). For example, extending work
interval duration from 30 s to 60 s using a xed-relief
duration of 30 s in well trained triathletes (v
_
VO
2max
=
19.9 0.9 km/h) induced very large increases in
T@
_
VO
2max
(9 vs. 1.5 min, ES = ? 2.4), despite a shorter
total session time (28 vs. 34 min, ES = -0.9; change in
the T@
_
VO
2max
/exercise ratio, ES = ?2.8) [128]. Simi-
larly, in wrestlers (v
_
VO
2max
= 16.3 1.1 km/h), increas-
ing running work interval duration from 15 s to 30 s lead to
very large increase in T@
_
VO
2max
(4 vs. 0 min,
ES = 2.9); [185] a further increase in the interval duration
to 60 s extended T@
_
VO
2max
to 5.5 min (ES = 0.5 vs. the
30-s condition). Considering the importance of
_
VO
2
kinetics for extending T@
_
VO
2max
[177], these data suggest
that longer work intervals (e.g. 30 s/30 s vs. 15 s/15 s) are
preferred for individuals with slow
_
VO
2
kinetics (i.e. older/
less trained [141]), or for exercising on a bike [140].
3.1.2.3 Characteristics of the Relief Interval and
T@
_
VO
2max
The intensity of the relief interval also plays a
major role in the
_
VO
2
response during HIT involving short
intervals, since it affects both the actual
_
VO
2
during the
sets and exercise capacity (and, hence, indirectly time to
exhaustion and T@
_
VO
2max
; Fig. 7c, [164, 187, 188]).
Compared with passive recovery, runs to exhaustion
T
i
m
e

(
m
i
n
)
0
10
20
30
40
50 0% vVO
2max
50% vVO
2max
/41% V
IFT
67% vVO
2max
/56% V
IFT
84% vVO
2max
/71% V
IFT
T@ VO
2max
(90%)
15s[120% vVO
2max
]/15s[--]% 7 30s[105% vVO
2max
]/30s[--]% 89
42(17)%
24(19)%
63(26)%
68(19)%
84(10)%
77(12)%
[La]: 10.7(2)
[La]: 11.7(2)
[La]: 6(2)
[La]: 9.6(2)
[La]: 8.1(2)
[La]: 12.8(2)
T
i
m
e

(
s
)
0
5
10
15
20
25
30
35
40
45
50
55
60
65 15s
20s
25s
30s
60s
T@%VO
2max
(90%)
T@%VO
2
7(7)%
32(11)%
0%
31(22)%
50(18)%
1(1)%
2(1)%
6(4)%
1(1)%
2(2)%
7(5)%
--s[100% vVO
2max
]/30s[50]% 4
--s[100% vVO
2max
]/15s[50%] 5
--s[105% vVO
2max
]/20s[0] 6
--s[115% vVO
2max
]/20s[0] 6
T
i
m
e

(
m
i
n
)
0
5
10
15
20
25
30
a
100% vVO
2max
/85% V
IFT
105% vVO
2
110% vVO
2
120% vVO
2
130% vVO
2
140% vVO
2
T@VO
2max
(90%)
55(20)%
93(23)%
81(48)%
77(53)%
23(18)% 46(20)%
23(10)%
32(22)%
15s[--%]/15s[0] 1
30s[--%]/30s[50% vVO
2max
] 2
30s[--%]/30s[50% vVO
2max
] 3
*
[La]: 7.3(2)
[La]: 11.5(2)
[La]: 12.5(2)
[La]: 11.1(3)
[La]: 13.1(4)
[La]: 14.7(5)
[La]: 13.5(3)
[La]: 8.2(1)
[La]: 11.0(3)
max
/89% V
IFT
max
/94% V
IFT
max
/102% V
IFT
max
/111% V
IFT
max
/120% V
IFT
max
(95%)
b
c
Fig. 7 Mean SD total time and T@
_
VO
2max
during different forms
of HIT, including short intervals, as a function of changes in work
interval intensity (a: references 1 [117]; 2 [179] and 3 [177]), work
interval duration (b: references 4 [128], 5 [185] and 6 [186]) and relief
interval intensity (c: references: 7 [190]; 8 [188] and 9 [164]).
-- indicates the variable that was manipulated. Percentages refer to the
mean SD T@
_
VO
2max
relative to total session time. Mean SD
[La] mmol/L is provided when available (values for study 6 [186]
were all \6 mmol/L and are therefore not provided). HIT high-
intensity interval training,
_
VO
2max
maximal oxygen uptake,
T@
_
VO
2max
time spent at 90 % or 95 % of
_
VO
2max
, V
IFT
running
speed reached at the end of the 3015 Intermittent Fitness Test,
v
_
VO
2max
minimal running speed associated with
_
VO
2max
, * indicates
HIT not performed to exhaustion
involving active recovery are consistently reported to be
4080 % shorter [164, 187190]. Therefore, when con-
sidering runs to exhaustion during 15 s/15 s exercises, the
absolute T@
_
VO
2max
might not differ between active and
passive recovery conditions [190] (ES = -0.3), but the
T@
_
VO
2max
/exercise time ratio is substantially greater
when active recovery is implemented (ES = ?0.9); a
factor of obvious importance when implementing pre-
determined sets of HIT [50, 128, 178]. During a 30 s/30 s
exercise model, compared with passive recovery, recovery
intensities of 50 % and 67 % of v
_
VO
2max
were associated
with small and very large improvements in T@
_
VO
2max
(ES = ?0.4 and ?0.1, respectively) and the T@
_
VO
2max
/
exercise time ratio (ES = ?2.3 and ?4.1, respectively)
[164, 188]. Increasing the recovery intensity to 84 %
reduced moderately T@
_
VO
2max
(ES = -0.6), but
increased very largely the T@
_
VO
2max
(ES = ?3.4). Taken together, these studies suggest that,
for the short HIT formats examined thus far, relief interval
intensities around &70 % v
_
VO
2max
should be recom-
mended to increase both T@
_
VO
2max
and the T@
_
VO
2max
/
exercise time ratio [23]. The fact that active recovery had a
likely greater impact on T@
_
VO
2max
during the 30 s/30 s
[164, 188] compared with the 15 s/15 s [190] exercise
model is related to the fact that
_
VO
2
reaches lower values
during 30 s of passive rest, which directly affects
_
VO
2
levels during the following effort. For this reason, we
recommend programming passive recovery B1520 s for
non-endurance sport athletes not familiar with performing
active recovery, and/or performing active recovery during
longer-relief interval durations (C20 s). In general, the
characteristic of the relief interval intensity can be adjusted
in alignment with the work intensity, with higher-relief
interval intensities used for lower-work interval intensities
[23], and lower-relief exercise intensities used for higher-
work interval intensities and durations [117, 177, 179].
3.1.2.4 Series Duration, Sets and T@
_
VO
2max
Dividing
HIT sessions into sets has consistently been shown to
reduce the total T@
_
VO
2max
[50, 128, 178]. For example,
in endurance-trained young runners (v
_
VO
2max
= 17.7
0.3 km/h), performing 4-min recoveries (30 s rest, 3 min at
50 % v
_
VO
2max
, 30 s rest) every 6 repetitions (30 s/30 s)
was associated with a moderately lower T@
_
VO
2max
(ES = -0.8) despite very large increases in time to
exhaustion (ES = ?4.3); the T@
_
VO
2max
/exercise time
ratio was therefore very largely reduced (ES = -2.3)
[178]. This is likely related to the time athletes needed to
return to high
_
VO
2
levels after each recovery period, irre-
spective of the active recovery used. While it could be
advised to consistently recommend HIT runs to exhaustion
to optimize T@
_
VO
2max
, this would likely be challenging,
psychologically speaking, for both coaches and athletes
alike; this is likely why HIT sessions to exhaustion are not
often practiced by athletes.
In practice, the number of intervals programmed should
be related to the goals of the session (total load or total
T@
_
VO
2max
expected), as well as to the time needed to
reach
_
VO
2max
and the estimated T@
_
VO
2max
/exercise time
ratio of the session. The time needed to reach
_
VO
2max
during different work- and relief-interval intensities
involving short HIT (30 s/30 s) was recently examined in
young endurance-trained athletes [164, 179, 188]. Not
surprisingly, these studies showed shorter time needed to
reach
_
VO
2max
values for work intensities C105 % v
_
VO
2max
and relief intensities C60 % v
_
VO
2max
. Conversely, using
slightly lower work- and/or relief-interval intensities (i.e.
work: 100 % and relief: 50 % v
_
VO
2max
) the runners nee-
ded more than 7 min to reach
_
VO
2max
. Despite a lack of
statistical differences [164, 179, 188], all ES between the
different work/relief ratios examined were small to very
large. In the eld then, time needed to reach
_
VO
2max
might
be accelerated by manipulating HIT variables during the
rst repetitions of the session, i.e. using more intense work-
and/or relief-interval intensities during the rst two to three
intervals, or using longer work intervals and/or shorter
relief intervals.
If we consider that a goal T@
_
VO
2max
of &10 min per
session is appropriate to elicit important cardiopulmonary
adaptations (Sect. 3.1.1.5), athletes should expect to exer-
cise for a total of 30 min using a 30 s [110 % v
_
VO
2max
]/
30 s [50 % v
_
VO
2max
] format, since the T@
_
VO
2max
/total
exercise time ratio is approximately 30 % (Fig. 7a). Since
it is unrealistic to perform a single 30-min session, it is
possible for it to be broken into three sets of 1012 min
(adding 12 min per set to compensate for the time needed
to regain
_
VO
2max
during the second and third set). Such a
session is typical to that used regularly by elite distance
runners in the eld. A lower volume (shorter series or less
sets) may be used for other sports (i.e. in team sports, a
T@
_
VO
2max
of 57 min is likely sufcient [116]) and/or for
maintenance during unloading or recovery periods in an
endurance athletes programme. In elite handball, for
example, 2 9 (20 9 10 s [110 % V
IFT
]/20 s [0]) is com-
mon practice, and might enable players to spend &7 min
at
_
VO
2max
(considering a T@
_
VO
2max
/exercise time ratio of
35 %; Buchheit M, unpublished data). In football (soccer),
HIT sessions such as 2 9 (1215 9 15 s [120 % V
Inc.Test
]/
15 s [0]) are often implemented [95], which corresponds to
&6 min at
_
VO
2max
(14 min with a T@
_
VO
2max
/exercise
time ratio of &45 % [190]).
3.1.3 Short versus Long Intervals and T@
_
VO
2max
A direct comparison between long and short HIT sessions,
with respect to T@
_
VO
2max
, has only been reported twice in
highly-trained athletes. Gajer et al. [174] compared
T@
_
VO
2max
between 6 9 600 m (track session, 102 %
v
_
VO
2max
, ran in &1 min 40 s) and 10 repetitions of a
30 s/30 s HIT session (work/relief intensity: 105/50 %
v
_
VO
2max
) in elite middle-distance runners (v
_
VO
2max
=
21.2 0.6 km/h). While
_
VO
2
reached 105 %
_
VO
2max
during the track session,
_
VO
2max
was not actually attained
during the 30 s/30 s session. If the track session is con-
sidered as the reference session (T@
_
VO
2max
/exercise
time ratio: 44 %), T@
_
VO
2max
was very largely lower
during the 30 s/30 s intervals (10 %, ES & -2.6). Simi-
larly, Millet et al. [128] showed that performing 2 min/
2 min intervals enabled triathletes to attain a very largely
longer T@
_
VO
2max
compared with a 30 s/30 s session
(ES = ?2.2, T@
_
VO
2max
/exercise time ratio = ?2.2).
Long intervals were however moderately less efcient
than a 60 s/30 s effort model (T@
_
VO
2max
/exercise time
ratio, ES = -0.8) [128]. Taken together, these data sug-
gest that long intervals and/or short intervals with a work/
relief ratio [1 should be preferred due to the greater
T@
_
VO
2max
/exercise time ratio.
3.1.4
_
VO
2
Responses to Repeated-Sprint Sequences
Compared with the extensive data available on cardiore-
spiratory responses to long and short HIT, relatively little
has been presented on the acute responses to RSS. An RSS
is generally dened as the repetition of [two short (B10 s)
all-out sprints interspersed with a short recovery period
(\60 s) [191]. Early in the 1990s, Balsom et al. [13]
demonstrated that RSS were aerobically demanding (i.e.
[65 %
_
VO
2max
). In addition, Dupont et al. have shown
that footballers can reach
_
VO
2max
during repeated sprinting
[192]. To our knowledge, however, T@
_
VO
2max
during RSS
has not been reported. For the purpose of the present
review, we have reanalysed data from previous studies [30,
158, 193, 194] to provide T@
_
VO
2max
values for several
forms of RSS (Fig. 8, upper panel [13, 30, 158, 192195]).
When manipulating key variables already described (Fig. 2
[35]),
_
VO
2max
is often reached and sustained for 1040 %
of the entire RSS duration (i.e. 1060 s; Fig. 8 a). If RSS
are repeated two to three times per session, as is often done
in practice [180, 196, 197], the majority of athletes may
spend up to 23 min at
_
VO
2max
during the repeated sprints.
To increase T@
_
VO
2max
during an RSS, it appears that
sprints/efforts should last at least 4 s, and that the recovery
should be active and less than 20 s (Fig. 8, lower panel [13,
30, 158, 192195]). The introduction of jumps following
the sprints [193], and/or changes in direction [194], are also
of interest, since these may increase systemic O
2
demand
without the need for increasing sprint distance, which could
increase muscular load and/or injury risk (see review Part
II). Nevertheless, with very short passive recovery periods
(i.e. 17 s), some athletes can reach
_
VO
2max
by repeating 3 s
sprints only (15 m). It is worth noting, however, that during
all RSS examined here (Fig. 8, except for Dupont et als.
study [192]), a number of players did not reach
_
VO
2max
,
and T@
_
VO
2max
showed high interindividual variations
(CV = 30100 %). More precisely, when considering the
four different forms of RSS performed by the same group
of 13 athletes [193, 194], it was observed that six (45 %) of
them reached
_
VO
2max
on four occasions, one (8 %) on
three, four (31 %) on two, with two (15 %) never reaching
_
VO
2max
during any of the RSS. When the data from the
four RSS were pooled, the number of times that
_
VO
2max
was reached was inversely related to
_
VO
2max
(r = -0.61,
90 % CL -0.84, -0.19). Similarly, the total T@
_
VO
2max
over the four different RSS was inversely correlated with
_
VO
2max
(r = -0.55; 90 % CL -0.85, 0.00). There was,
however, no relationship between the number of times that
_
VO
2max
was reached or the T@
_
VO
2max
and
_
VO
2
kinetics at
exercise onset, as measured during submaximal exercise
[144]. These data show that, with respect to T@
_
VO
2max
,
using RSS may be questionable to apply in some athletes,
especially those of high tness.
3.1.5
_
VO
2
Responses to Sprint Interval Sessions
The important research showing the benets of SIT [126],
notwithstanding, there is, to date, few data available
showing the acute physiological responses to typical SIT
sessions that might be implemented in practice. Tabata
et al. [198] showed that
_
VO
2max
was not reached (peak of
87 %
_
VO
2max
) during repeated 30 s cycling efforts (200 %
of p
_
VO
2max
and therefore not actually all-out) inter-
spersed by 2-min passive recovery. In contrast, we recently
showed [142] that during a true all-out SIT session, most
subjects reached values close to (or above) 90 % of their
_
VO
2max
and HR. Nevertheless, T@
_
VO
2max
was only 22 s
on average (range 060 s, with two subjects showing no
values [90 %
_
VO
2max
) [142], and
_
VO
2max
was reached by
ve (50 %) subjects only. These important individual
_
VO
2
responses to SIT sessions were partly explained by
variations in cardiorespiratory tness (i.e. there was a
negative correlation between T@
_
VO
2max
and both
_
VO
2max
(r = -0.68; 90 % CL -0.90, -0.20) and
_
VO
2
kinetics at
(submaximal) exercise cessation (r = 0.68; 90 % CL 0.20,
0.90). As with RSS, there was no link between T@
_
VO
2max
and
_
VO
2
kinetics at exercise onset. Finally, it is worth
noting that although pulmonary
_
VO
2
is not high during
SIT, muscle O
2
demand likely is, especially as the number
of sprint repetitions increase. It has been shown that there
is a progressive shift in energy metabolism during a SIT
session, with a greater reliance on oxidative metabolism
when sprints are repeated [199, 200]. Along these same
lines, muscle deoxygenation levels and post-sprint reoxy-
genation rates have been shown to become lower and
slower, respectively, with increasing sprint repetition
number. This response implies a greater O
2
demand in the
muscle with increasing sprint repetition (since O
2
delivery
is likely improved with exercise-induced hyperaemia)
[142].
3.1.6 Summary
In this section of the review, we have highlighted the
_
VO
2
responses to various forms of HIT. It appears that most HIT
formats, when properly manipulated, can enable athletes to
reach
_
VO
2max
. However, important between-athlete and
between-HIT format differences exist with respect to
T@
_
VO
2max
. RSS and SIT sessions allow for a limited
T@
_
VO
2max
compared with HIT that involve long and short
intervals. Combined, data from high-level athletes [128,
174] suggest that long intervals and/or short intervals with
a work/relief ratio [1 should enable a greater T@
_
VO
2max
/
exercise time ratio during HIT sessions. The methods of
maximizing long-term
_
VO
2max
development and perfor-
mance adaptations using different forms of HIT sessions
that involve varying quantities of T@
_
VO
2max
, as well as
the most efcient way of accumulating a given T@
_
VO
2max
in an HIT session (i.e. intermittently vs. continuously), is
still to be determined.
3.2 Cardiac Response with HIT and Repeated-Sprint
Efforts
Due to the varying temporal aspects [70] and possible
dissociation between
_
VO
2
and cardiac output (Qc) during
intense exercise [201, 202], T@
_
VO
2max
might not be the
sole criteria of importance for examining when assessing
the cardiopulmonary response of a given HIT session.
Since reaching and maintaining an elevated cardiac lling
is believed to be necessary for improving maximal cardiac
function [58, 59, 203], training at the intensity associated
with maximal SV may be important [201]. Dening this
key intensity, however, remains difcult, since this requires
the continuous monitoring of SV during exercise (e.g
[2527, 201, 204]). Interestingly, whether SV is maximal at
v/p
_
VO
2max
, or prior to their occurrences, is still debated
[205207]. SV behaviour during an incremental test is
Sprint duration (s)
0 1 2 3 4 5 6 7
R
e
c
o
v
e
r
y

t
i
m
e

(
L
o
g

[
s
]
)
10
20
30
40
60
120
VO
2
>50%VO
2max
VO
2
>55%VO
2max
VO
2
>65%VO
2max
VO
2
>75%VO
2max
VO
2
>80%VO
2max
VO
2
>85%VO
2max
1
5
x

(
4
0
m
/
1
2
0
s
[
0
%
]
)

1
4
0
x

(
1
5
m
/
2
7
.
4
s
[
0
%
]
)

2
1
5
x

(
4
0
m
/
6
0
s
[
0
%
]
)

1
6
x

(
4
s

W
d
w
/
2
1
s
[
0
%
]
)

3
2
0
x

(
3
0
m
/
2
5
.
5
s
[
0
%
]
)

2
1
5
x

(
4
0
m
/
3
0
s
[
0
%
]
)

1
1
5
x

(
4
0
m
/
2
4
.
4
s
[
0
%
]
)

2
6
x

(
2
5
m
/
2
1
s
[
4
5
%
]
)

4
1
5
x

(
4
0
m
/
2
5
s
[
5
0
%
]
)

5
2
0
x

(
1
5
m
/
1
7
s
[
0
%
]
)

6
6
x

(
2
5
m

C
O
D
9
0
/
2
1
s
[
4
5
%
]
)

4
6
x

(
4
s

W
d
w
/
2
1
s
[
4
5
%
]
)

3
6
x

(
2
5
m
+
J
u
m
p
/
2
1
s
[
4
5
%
]
)

7
6
x

(
2
5
m

C
O
D
9
0
+
J
u
m
p
/
2
1
s
[
4
5
%
]
)

7
V
O
2

(
%

V
O
2
m
a
x
)
40
50
60
70
80
90
100 69%
15(13)%
100%
35%*
46%
9(10)%
53%
19(27)%
69%
29(25)%
100%
41(14)%
50%
8(6)%
90COD +Jump +Jump
Wdw
Fig. 8 a Mean SD
_
VO
2
responses during selected repeated-sprint
sequences. The intensity of the relief interval (i.e. [percentage]) is
expressed as a fraction of the v
_
VO
2max
. When available, both the
percentage of participants that reached
_
VO
2max
(runner) and the
mean SD time spent above 90 % of
_
VO
2max
(clock) are provided.
b The mean
_
VO
2
responses during the repeated-sprint sequences
presented in section a are categorized into six colour-coded families
(based in the % of
_
VO
2max
elicited) and then plotted as a function of
sprint and recovery duration. The dashed lines represent the shorter
sprint and recovery durations likely needed to achieve at least 80 % of
_
VO
2max
. Circles indicate active recovery. Note (see arrow) that 75 %
of
_
VO
2max
can be achieved with very short sprints (i.e. 15 m) with
passive recovery when sprints are interspersed with very short pauses
(i.e. 17 s). References: 1 [13]; 2 [195];3 [158]; 4 [194]; 5 [192]; 6 [30]
and 7 [193]. COD changes of direction,
_
VO
2
oxygen uptake,
_
VO
2max
maximal
_
VO
2
, v
_
VO
2max
minimal running speed required to elicit
maximal
_
VO
2
, Wdw refers to sprints performed on a non-motorized
treadmill
likely protocol-dependent [202] and affected by training
status (e.g. ventricular lling partly depends on blood
volume, which tends to be higher in trained athletes) [206],
although this is not always the case [207]. In addition, the
nature of exercise, i.e. constant power vs. incremental vs.
intermittent, as well as body position (more supine during
rowing or swimming vs. more upright during running and
cycling), might also affect the SV reached and maintained
throughout the exercise bout. In fact, there is limited data
on cardiac function during exercises resembling those
prescribed during eld-based HIT sessions, i.e. constant-
power bouts at high intensity. In these studies, SV reached
maximal values within &1 min [26],] &2 min [24, 25,
204] and &4 min [27], and then decreased [24, 26, 204] or
remained stable [25, 27] prior to fatigue. Inconsistencies in
exercise intensities, individual training background and
particular haemodynamic behaviours (e.g. presence of a
HR deection at high intensities [208]), as well as meth-
odological considerations in the measurement of SV may
explain these differences [205207]. As discussed in
Sect. 2.2, alternating work and rest periods during HIT with
short intervals might also induce variations in the action of
the venous muscle pump, which can, in turn, limit the
maintenance of a high SV [60].
Following the beliefs of German coach, Woldemar
Gerschler, in the 1930s, Cumming reported, in 1972, that
maximal SV values were reached during the exercise
recovery period, and not during exercise, irrespective of the
exercise intensity [209]. Although these results were
obtained during supine exercise in untrained patients, and
despite contradictory claims [210], they contributed to the
widespread belief that the repeated recovery periods and
their associated high SV accounted for the effectiveness of
HIT on cardiocirculatory function [211]. In partial support
of this, Takahashi et al. [212] also reported in untrained
males that during the rst 80 s of an active recovery (20 %
_
VO
2max
), SV values were 10 % greater than during a pre-
ceding submaximal cycling exercise (60 %
_
VO
2max
). Sur-
prisingly, these particular and still hypothetical changes in
SV during recovery had never before been examined dur-
ing typical HIT sessions in athletes. We recently collected
haemodynamic data in well trained cyclists that partly
conrmed Cummings ndings (Buchheit M, et al.,
unpublished data, Fig. 9). Irrespective of the exercise, i.e.
incremental test, 3 min at p
_
VO
2max
or repeated 15-s sprints
(30 % of the anaerobic power reserve, APR), the SV of a
well trained cyclist (peak power output = 450 W,
_
VO
2max
= 69 ml/min/kg, training volume = 10 h/week)
showed its highest values consistently during the recovery
periods (upright position on the bike). While we
acknowledge the limitations inherent to the impedance
method used (PhysioFlow, Manaetec, France [213, 214]),
and while further analysis on a greater number of subjects
is needed, these preliminary data lend support to the belief
that despite its supramaximal nature, HIT sessions might
trigger cardiocirculatory adaptation via cardiovascular
adjustments occurring specically during the recovery
periods. Take for example an HIT session involving three
sets of eight repetitions of a 15 s sprint (30 % APR)
interspersed with 45 s of passive recovery (long enough for
peak SV to be reached). Such a format would allow such
athletes to maintain their peak SV for 24 9 20 s = 480 s,
which is similar to what can be sustained during a constant-
power exercise performed to exhaustion [25]. Interestingly,
Fontana et al. [215] also observed, using a rebreathing
method in untrained men, largely greater SV values at the
end of a 30 s all-out sprint compared with an incremental
test to exhaustion (127 37 vs. 94 15 ml, ES =
? 1.3). HR
max
was nevertheless very largely lower
(149 26 vs. 190 12 beats/min, ES = -2.2), so there
was no substantial difference in maximal cardiac output
(Qc
max
) [18.2 3.3 vs. 17.9 2.6 L/min, ES = -0.1].
To conclude, the optimal nature and intensity of exercise
needed to produce the greatest SV adaptations is not
known. In acquiring the answer to this question, one needs
to take into account individual characteristics, such as t-
ness level, training status and various individual haemo-
dynamic behaviours to different exercise modes. In a
practical way, on the basis of the limited data available, it
might be recommended to prescribe a variety of different
training methods to gain the adaptation advantages of each
exercise format. HIT sessions, including near-to-maximal
long intervals with long recovery durations (e.g. [34 min/
[2 min) might allow athletes to reach a high SV during the
work (and possibly the relief intervals). Along these same
lines, 4-min intervals &9095 % v/p
_
VO
2max
appear to be
receiving the greatest interest to improve cardiopulmonary
function (e.g [46, 59, 216]). Alternatively, repeated short
supramaximal work intervals (e.g. 1530 s) with long
recovery periods ([45 s) might also be effective at reach-
ing high values both during exercise [215] and possibly, in
recovery (Fig. 9). However, whether Qc
max
adaptations are
comparable following long- and short-interval sessions (i.e.
continuous vs. intermittent), or whether achieving a certain
quantity of time at Qc
max
(T@Qc
max
) is needed to maxi-
mize its adaptation, is still unknown. In the only longitu-
dinal study to date comparing the effect of short versus
long HIT on maximal cardiovascular function in university
students (
_
VO
2max
: 5560 ml/min/kg) [59], there was a
small trend for greater improvement in Qc
max
for the long
interval protocol (ES = ?1 vs. ?0.7 for 4 9 4 min vs. 15/15,
respectively). It is worth noting that Seiler et al. [176]
showed, in recreational cyclists (
_
VO
2max
: *52 ml/min/kg),
that accumulating 32 min of work at 90 % HR
max
may
actually induce greater adaptive gains than 16 min of work
at *95 % HR
max
[176]. While SV was not measured, these
results contrast with the idea that exercise intensity directly
determines the training responses [59]. Rather, they show
that both exercise intensity and accumulated duration of
interval training may act in an integrated way to stimulate
physiological adaptations in this population [176]. In this
latter case [176], the decrease in exercise intensity may
have allowed for a greater T@Qc
max
(or near Qc
max
), and,
in turn, a greater adaptation. Whether similar results would
be observed in highly trained athletes who are more likely
to require greater levels of exercise stress for further
adaptations, is still unknown. Finally, since T@Qc
max
has
been shown to be largely correlated with time to exhaustion
during severe exercise (r ranging from 0.79; 90 % CL 0.45,
0.93 to r 0.98; 90 % CL 0.94, 0.99) [25], pacing strategies
that can increase time to exhaustion but that sustain a high
cardiorespiratory demand may also be of interest. For
instance, adjusting work intensity based on
_
VO
2
responses
(constant-
_
VO
2
exercise at 77 %
_
VO
2max
on average)
instead of power (constant-power exercise at 87 %
p
_
VO
2max
) led to moderate increases in time to exhaustion
(20 min 10 min vs. 15 min 5 min, ES = ?1.0) and,
in turn, T@Qc
max
(16 min 8 min vs. 14 min 4 min,
ES = ?0.9) [25].
4 Conclusions
In Part I of this review, the different aspects of HIT pro-
gramming have been discussed with respect to T@
_
VO
2max
and cardiopulmonary function. Important between-athlete
and between-HIT format differences exist, so that precise
recommendations are difcult to offer. Most HIT formats,
if properly manipulated, can enable athletes to reach
_
VO
2max
, but RSS and SIT sessions allow limited
T@
_
VO
2max
compared with HIT sessions involving long
and short intervals. The
_
VO
2
responses during RSS and SIT
appear to be tness-dependent, with the tter athletes less
able to reach
_
VO
2max
during such training. Based on the
current review, the following general recommendations can
be made:
1. To individualize exercise intensity and target specic
acute physiological responses (Fig. 1), v/p
_
VO
2max
and
ASR/APR or V
IFT
are likely the more accurate
references needed to design HIT with long
(C12 min) and short (B45 s) intervals, respectively.
For run-based HIT sessions, compared with the ASR,
V
IFT
integrates between-effort recovery abilities and
COD capacities that make V
IFT
especially relevant for
programming short, supramaximal intermittent runs
Time (s)
H
R

(
b
p
m
)
,

S
V

(
m
l
)

a
n
d

m
u
s
c
l
e

T
S
I

(
%
)
40
60
80
100
120
140
160
180
200
HR
SV
TSI
V
O
2

(
m
l
/
m
i
n
/
k
g
)
0
20
40
60
80
VO
2
Time (s)
H
R

(
b
p
m
)
,

S
V

(
m
l
)

a
n
d

m
u
s
c
l
e

T
S
I

(
%
)
40
60
80
100
120
140
160
180
200
a
HR
SV
TSI
V
O
2

(
m
l
/
m
i
n
/
k
g
)
0
20
40
60
80
VO
2
Time (s)
0 50 100 150 200 250 300 350
0 500 1000 1500 2000 2500
0 100 200 300 400 500 600 700
H
R

(
b
p
m
)
,

S
V

(
m
l
)

a
n
d

m
u
s
c
l
e

T
S
I

(
%
)
40
60
80
100
120
140
160
180
200
HR
SV
TSI
V
O
2

(
m
l
/
m
i
n
/
k
g
)
0
20
40
60
80
VO
2
b
c
Fig. 9 a
_
VO
2
, HR, SV and muscle oxygenation (TSI) during an
incremental test followed by two sets of three supramaximal 15-s
sprints (35 % APR); b 5-min bout at 50 % of p
_
VO
2max
immediately
followed by 3 min at p
_
VO
2max
; and (c) the early phase of an HIT
session (i.e. rst four exercise bouts (15-s [35 % APR]/45 s [passive];
in a well trained cyclist. Note the reductions in SV for intensities
above [50 % of
_
VO
2max
during both the incremental and constant
power tests, which is associated with a greater muscle deoxygenation
during the incremental test. In contrast, maximal SV values are
consistently observed during the post-exercise periods, either follow-
ing incremental, maximal or supramaximal exercises. APR anaerobic
power reserve, HIT high-intensity interval training, HR heart rate,
_
VO
2max
maximal oxygen uptake, p
_
VO
2max
minimal power associated
with
_
VO
2max
, SV stroke volume, TSI tissue saturation index
performed with COD, as implemented in the majority
of team and racket sports.
2. Especially in well trained athletes that perform exer-
cises involving large muscle groups, and assuming the
accumulation of T@
_
VO
2max
may maximize the train-
ing stimulus to improving performance, we recom-
mend long- and short-bout HIT with a work/relief ratio
[1 (see Part II, Table 1 for practical programming
suggestions). Additionally:
a. There should be little delay between the warm-up
and the start of the HIT session so that the time
needed to reach
_
VO
2max
is accelerated. Warm-up
intensity can be B6070 % v/p
_
VO
2max
, or game
based (moderate intensity) for team and racket
sport athletes.
b. Total session volume should enable athletes to
spend between &5 (team and racket sports) and
&10 (endurance sports) min at
_
VO
2max
.
3. Until new evidence is provided, the importance of
continuous versus repeated ventricular lling at high
rates for developing cardiovascular adaptations is not
known. Near-to-maximal and prolonged work intervals
currently appear to be the preferred HIT option (i.e.
[4 min at 9095 % v/p
_
VO
2max
, with likely decreasing
external load with increasing fatigue to prolong
T@Qc
max
).
5 Perspective
Further research is required to specify the acute cardio-
pulmonary responses to HIT/RST/SIT in particular popu-
lations such as youth and female athletes, as well as the
inuence that training status and cardiorespiratory tness
have on these responses. Further research is also needed to
improve our understanding of how to optimally manipulate
HIT variables, in particular, environmental conditions (e.g.
altitude [21], heat [217]), where typical HIT sessions, as
suggested for programming in the present review, cannot
be performed. The impact of time of day, timing within a
session, and external training contents should also be
examined, as typically most studies are conducted with
fresh participants in controlled environments, while in
practice, HIT sessions are often performed in a state of
accumulated fatigue (end of a team-sport session or in
the afternoon following an exhaustive morning training
session). Understanding the physiological responses to
technical/tactical training sessions is also likely an impor-
tant aspect of successful training in team sport athletes, so
that the optimal HIT sessions can be programmed as sup-
plemental sessions (i.e. how does one best solve the
programming puzzle, while adding what is missed
during the technical/tactical sessions [151], since physio-
logical and performance adaptations have been shown to
occur in relation to the accumulated training load com-
pleted at high intensities [218]). Finally, since in team
sports improvements in physical tness might not have a
similar impact on match running performance for all
players (inuence of playing positions, systems of play,
individual playing styles) [63, 98, 219, 220], the imple-
mentation of HIT sessions should be individualized and
considered using a cost-benet approach. As will be dis-
cussed in Part II, consideration for other important aspects
of HIT programming, such as glycolytic anaerobic energy
contribution, neuromuscular load and musculoskeletal
strain, should also be considered. Further studies are also
needed to examine the long-term adaptations to all forms
of HIT/repeated all-out efforts presented in the present
review with respect to gender, age and training status/
background.
Acknowledgments No sources of funding were used to assist in the
preparation of this review. The authors have no conicts of interest
that are directly relevant to the content of this review.
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