High Intensity Interval Training for Children

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Introduction[edit | edit source]

High-Intensity Interval Training (HIIT) involves short bursts of intense exercise (85% or higher of maximal heart rate) followed by periods of rest or low-intensity exercise[1]. Originally popular among athletes, HIIT has gained recognition for its efficiency in improving cardiovascular fitness, muscle strength, and overall health in various populations, including children. It is a time-efficient training method[1].

HIIT aligns with the physical activity patterns in children and the intermittent style of most sports[2][3], and with lower cardiometabolic risk[4]. It has greater post-exercise enjoyment than continuous exercise[5]. HIIT reduces boredom and gives children a sense of accomplishment after each interval, and thereby enhancing children's motivation[6].

It has been suggested that HIIT not only burns calories during the workout but also triggers additional fat loss mechanisms due to its intense nature. These mechanisms include increased excess post-exercise oxygen consumption (EPOC), reduced appetite following exercise, and elevated catecholamine release, which enhances fat breakdown in tissues[7].

Benefits of HIIT for children[edit | edit source]

  • Cardiovascular health: HIIT has been shown to improve heart health by enhancing cardiovascular endurance and reducing risk factors associated with heart disease[3].
    • Systolic and diastolic blood pressure improvements[3][8][9][10]
    • Cardiac autonomic nervous system improvements[11]
    • Cardiovascular disease biomarker improvements[3][8]:
      • Blood glucose
      • Cholesterol
      • High-density lipoprotein cholesterol
      • Low-density lipoprotein cholesterol
      • Blood triglycerides
  • Cardiorespiratory health: Short, intense bursts of activity help to build muscle strength and endurance, crucial for overall physical development[10].
  • Metabolic health: HIIT can improve metabolic health[8]:
    • Increasing insulin sensitivity[3][8]
    • Reduction in fasted insulin[8]
    • Reduction in insuline resistance[8]
  • Performance:
    • Improvements in neuromuscular performance[14]
    • Improvements in anaerobic performance[14]
    • Improvements in endurance[13][9][15]
  • Body size and composition:
    • Decreasing body weight[8]
    • Reduction in Body Mass Index (BMI)[2][8]
    • Reduction in body fat[2][8]
    • Reduction in waist circumference[2]
  • Mental health: Engaging in HIIT can boost mood, reduce anxiety, and improve cognitive function in children:
    • Improvements in wellbeing[2]
    • Improvements in mental health[16]
    • Improvements in cognitive function:
      • Improvements in executive functions:
      • Academic achievement[19]
  • Time efficiency: HIIT workouts are typically shorter in duration, making them a practical option for children with busy schedules[1].

Target groups for HIIT[edit | edit source]

  • General population[1]
  • Children with obesity[10][20][21]
  • Children with Attention Deficit Hyperactivity Disorder (ADHD)
  • Children with Asthma
  • Children with Type 1 Diabetes
  • Children with Developmental Coordination Disorder (DCD)
  • Children with Cerebral Palsy (CP)[22]
  • Children with physical disabilities
  • Children with special educational needs[23]
  • Athletic children

Children with obesity and HIIT[edit | edit source]

Physical activity is a crucial intervention for reducing adolescent obesity. The WHO advises that children and adolescents should participate in an average of 60 minutes of moderate to high-intensity physical activity (MVPA) daily to achieve health benefits[24]. Despite this, over 80% of adolescents do not meet the minimum recommended level of physical activity[25].

Benefits of HIIT in children with obesity:

  • HIIT results in improvements in body composition in less time than less-intense exercise[20]
  • Improvements in cardiorespiratory fitness[20]:
    • Improvements in VO2max[10][20]
    • Decrease in Systolic blood pressure[10]
  • Improvements in body composition[10]:
    • Decrease in BMI[10]
    • Decrease in fat mass[10]
    • Decrease in visceral fat[10]

Children with ADHD and HIIT[edit | edit source]

Children with Asthma and HIIT[edit | edit source]

Children with type 1 diabetes and HIIT[edit | edit source]

Children with DCD and HIIT[edit | edit source]

Children with CP and HIIT[edit | edit source]

Benefits of HIIT for children with CP:

  • Improvements in aerobic exercise capacity[22]
  • Increasement of energy reserve[22]
  • Improvements in quality of life[22]

Children with physical disabilities and HIIT[edit | edit source]

Children with special educational needs[edit | edit source]

Children and adolescents with special educational needs are less physically active than their peers[26].

Benefits of HIIT for children with special educational needs:

  • Changes in body composition (BMI, waist circumference, body fat percentage, fat mass)[23]
  • Improvements in cardiorespiratory fitness[23]
  • Improvements in anaerobic performance[23]
  • Improvements in functional capacity[23]
  • Improvements in motor proficiency[23]
  • Improvements in mood[23]
  • Improvements in quality of life[23]

Children and adolescents with special educational needs should undergo medical assessments before starting any exercise regimen[27].

Athletic children and HIIT[edit | edit source]

Athletic children reach a significantly higher intensity level during HIIT than other children and are more motivated[15].

HIIT protocol[edit | edit source]

  • Frequency:
    • g
  • Intensity:
    • Intensity ranges from 80% to 100% maximum heart rate[2]
    • 70% to 90% maximum oxygen uptake (VO2max)[8]
    • Rating of Perceived Exertion (RPE) score of 4 or 5[28]
  • Time:
  • Type:
    • Running might have more health benefits than cycling[10].
    • Running/cycling HIIT is better in improving cardiorespiratory fitness than other HIIT modalities (like resistance-based HIIT)[29].

Safety considerations[edit | edit source]

  • Proper Supervision: Ensure that a qualified adult supervises all HIIT sessions to monitor technique and safety. HIIT is typically safe for children and adolescents[30], and it usually results in only minor injuries such as bruises, strains, and dizziness[29].
  • Appropriate Training: Tailor the intensity of the exercises to match the child’s age, fitness level, and physical capabilities.
    • Running may offer greater health benefits compared to cycling. When obese children participate in HIIT, the therapist must be aware that the increased joint torque and ground reaction forces could elevate the risk of joint degeneration[10].
  • Warm-Up and Cool-Down: Incorporate proper warm-up and cool-down routines to prevent injuries.
  • Hydration and Nutrition: Encourage adequate hydration before, during, and after workouts, and ensure a balanced diet to support energy needs.
  • Rest and Recovery: Emphasize the importance of rest days to allow for adequate recovery and prevent overtraining.

Monitoring intensity during the workout and progress[edit | edit source]

  • Assessments: Regularly measure the improvements by using the appropriate tests.
    • Heart rate monitor[29]
    • Rating of perceived exertion (RPE)[29]. RPE is valid for monitoring HIIT in laboratory and school settings[28][31]. The OMNI-cycling scale can be used to estimate the perceived exertion during cycling[32] and the OMNI-walk/run scale for running[33].
    • 20 meter Shuttle run test[10][29][34]
    • Yo-Yo Intermittent Recovery Test Level 1[29]
  • Feedback and adjustment: Use feedback from the children to adjust the intensity and variety of exercises to keep them engaged and motivated.
  • Goal setting: Encourage the children to set achievable fitness goals and celebrate their progress to build confidence and enthusiasm for the activity.

School-based HIIT[edit | edit source]

School-based interventions are frequently considered the most universally applicable and effective method for influencing the health of young individuals[8]. Schools are ideal for promoting physical activity in children[2]. School-based interventions are usually low cost[14][35]. HIIT can be a useful method within schools to promote health[2].

Effects of school-based HIIT:

  • Improvements in VO2 max[8]
  • Reduction in body fat[8]
  • Reduction in waist circumference[8]
  • Improvements in blood pressure[8]
  • Improvements in neuromuscular performance[14]
  • Improvements in anaerobic performance[14]

Barriers for implementing HIIT in schools:

  • Busy curriculum[29]
  • Inconvenient use of equipment[29]
  • Time constraints[29]
  • Lack of space[29]
  • Lack of perceived fitness improvement[29]

Facilitators for implementing HIIT in schools:

  • Training workshops[29]
  • Incentive strategies[29]
  • Theoretical instructions[29]

Practical application for HIIT in schools:

  • Integration with Physical Education (PE) activities[20]:
    • HIIT can be seamlessly integrated into existing PE lessons. This can be done by including HIIT intervals within the structure of regular PE activities.
    • For instance, traditional games or exercises can be adapted to include short bursts of high-intensity activity followed by periods of rest or low-intensity activity.
  • Dedicated HIIT sessions[20]:
    • Alternatively, HIIT sessions can be scheduled during specific periods of the school day, separate from regular PE classes.
    • This can be particularly useful for schools looking to enhance the overall physical activity of students without disrupting the existing curriculum.
  • Session frequency and duration[20]:
    • To ensure the effectiveness of HIIT programs, it is recommended to conduct 2–3 sessions per week.
    • Each session can include intervals of 15–30 seconds of high-intensity activity followed by 15–30 seconds of passive or active rest.
    • Shorter intervals seem to be more motivating[15].
  • Higher volume programs[20]:
    • For programs requiring higher volume, discontinuous games lasting up to 6 minutes of work with 4-minute rest periods can be used.
    • Total session time can be extended to around 40 minutes, providing a comprehensive workout while still fitting within the school schedule.
  • Extra:
    • Variety of training content helps to sustain high intensity levels[15].
    • Use of music can help to sustain high intensity levels[15].

Conclusion[edit | edit source]

HIIT can be a highly effective and enjoyable way for children to improve their fitness and overall health. By focusing on safety, proper supervision, and engaging workouts, HIIT can foster a lifelong love for physical activity and well-being in children.

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Cao M, Quan M, Zhuang J. Effect of High-Intensity Interval Training versus Moderate-Intensity Continuous Training on Cardiorespiratory Fitness in Children and Adolescents: A Meta-Analysis. International Journal of Environmental Research and Public Health. 2019; 16(9): 1533
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Duncombe S, Barker AR, Bond B, Earle R, Varley-Campbell J, Vlachopoulos D, Walker JL, Weston KL, Stylianou M. School-based high-intensity interval training programs in children and adolescents: A systematic review and meta-analysis. PLoS ONE. 2022; 17(5): e0266427
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Eddolls WTB, McNarry MA, Stratton G, Winn CON, Mackintosh KA. High-Intensity Interval Training Interventions in Children and Adolescents: A Systematic Review. Sports Medicine. 2017; 47: 2363-2374
  4. ↑ Tarp J, Child A, White T, Westgate K, Bugge A, Grontved A, Wedderkopp N, Andersen LB, Cardon G, Davey R. Physical activity intensity, bout-duration, and cardiometabolic risk markers in children and adolescents. International Journal of Obesity. 2018; 42(9): 1639-1650
  5. ↑ Malik AA, Williams CA, Weston KL, Barker AR. Perceptual Responses to High- and Moderate-Intensity Interval Exercise in Adolescents. Medicine & Science in Sports & Exercise. 2018; 50(5): 1021-1030
  6. ↑ Stork MJ, Banfield LE, Gibala MJ, Kinis KAM. A scoping review of the psychological responses to interval exercise: is interval exercise a viable alternative to traditional exercise? Health Psychology Review. 2017; 11(4): 324-344
  7. ↑ Irving BA, Davis CK, Brock DW, Weltman JY, Swift D, Barret EJ. Effect of exercise training intensity on abdominal visceral fat and body composition. Medicine & Science in Sports & Exercise. 2008; 40(11): 1863-1872
  8. ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 8.12 8.13 8.14 8.15 Bond B, Weston KL, Williams CA, Barker AR. Perspectives on high-intensity interval exercise for health promotion in children and adolescents. Open Asscess Journal of Sports Medicine. 2017; 8: 243-265
  9. ↑ 9.0 9.1 9.2 Ketelhut S, Kircher E, Ketelhut SR, Wehlan E, Ketelhut K. Effectiveness of Multi-activity, High-intensity Interval Training in School-aged Children. International Journal of Sports Medicine. 2020; 41(4): 227-232
  10. ↑ 10.00 10.01 10.02 10.03 10.04 10.05 10.06 10.07 10.08 10.09 10.10 10.11 10.12 Cao M, Tang Y, Li S, Zou Y. Effects of High-Intensity Interval Training and Moderate-Intensity Continuous Training on Cardiometabolic Risk Factors in Overweight and Obesity Children and Adolescents: A Meta-Analysis of Randomized Controlled Trials. International Journal of Environmental Research and Public Health. 2021; 18(20): 11905
  11. ↑ van Biljon A, McKune AJ, DuBose KD, Kolanisi U, Semple SJ. Short-Term High-Intensity Interval Training Is Superior to Moderate-Intensity Continuous Training in Improving Cardiac Autonomic Function in Children. Cardiology. 2018; 141(1): 1-8
  12. ↑ Yin J, Zhou Z, Lan T. High-Intensity Interval Training versus Moderate-Intensity Continuous Training on Health Outcomes for Children and Adolescents: A Meta-analysis of Randomized Controlled Trials. BioMed Research International. 2020; 9797439
  13. ↑ 13.0 13.1 13.2 Tottori N, Morita N, Ueta K, Fujita S. Effects of High Intensity Interval Training on Executive Function in Children Aged 8-12 Years. International Journal of Environmental Research and Public Health. 2019; 16(21): 4127
  14. ↑ 14.0 14.1 14.2 14.3 14.4 Bauer N, Sperlich B, Holmberg HC. Effects of High-Intensity Interval Training in School on the Physical Performance and Health of Children and Adolescents: A Systematic Review with Meta-Analysis. Sports Medicine - Open. 2022; 8(50)
  15. ↑ 15.0 15.1 15.2 15.3 15.4 Bossmann T, Woll A, Wagner I. Effects of Different Types of High-Intensity Interval Training (HIIT) on Endurance and Strength Parameters in Children and Adolescents. International Journal of Environmental Research and Public Health. 2022; 19(11): 6855
  16. ↑ Leahy AA, Mavilidi MF, Smith JJ, Hillman CH, Eather N, Barker D. Review of High-Intensity Interval Training for Cognitive and Mental Health in Youth. Medicine & Science in Sports & Exercise. 2020; 52(10): 2224-2234
  17. ↑ Reyes-Amigo T, Bezerra A, Gomez-Mazorra M, Boppre G, Martins C, Carrasco-Beltran H, Cordero-Roldan E, Mota J. Effects of high-intensity interval training on executive functions in children and adolescents: A Systematic Review and Meta-analysis. Physical Activity Review. 2022; 10(2): 77-87
  18. ↑ Ai J-Y, Chen F-T, Hsieh S-S, Kao S-C, Chen A-G, Hung T-M, Chang Y-K. The Effect of Acute High-Intensity Interval Training on Executive Function: A Systematic Review. International Journal of Environmental Research and Public Health. 2021; 18(7): 3593
  19. ↑ Takehara K, Togoobaatar G, Kikuchi A, Lkhagvasuren G, Lkhagvasuren A, Aoki A. Exercise Intervention for Academic Achievement Among Children: A Randomized Controlled Trial. Pediatrics. 2021; 148(5): 1-10
  20. ↑ 20.0 20.1 20.2 20.3 20.4 20.5 20.6 20.7 Delgado-Floody P, Latorre-Román P, Jerez-Mayorga D, Caamano-Navarrete F, García-Pinillos F. Feasibility of incorporating high-intensity interval training into physical education programs to improve body composition and cardiorespiratory capacity of overweight and obese children: A systematic review. Journal of Exercise Science & Fitness. 2019; 17(2): 35-40
  21. ↑ Meng C, Yucheng T, Shu L, Yu Z. Effects of school-based high-intensity interval training on body composition, cardiorespiratory fitness and cardiometabolic markers in adolescent boys with obesity: a randomized controlled trial. BMC Pediatrics. 2022; 22(112)
  22. ↑ 22.0 22.1 22.2 22.3 Lauglo R, Vik T, Lamvik T. High-intensity interval training to improve fitness in children with cerebral palsy. BMJ Open Sport & Exercise Medicine. 2016; 2: e000111
  23. ↑ 23.0 23.1 23.2 23.3 23.4 23.5 23.6 23.7 Poon ET-C, Wongpipit W, Sun F, Tse AC-Y, Sit CH-P. High-intensity interval training in children and adolescents with special educational needs: a systematic review and narrative synthesis. International Journal of Behavioral Nutrition and Physical Activity. 2023; 20(13)
  24. ↑ Martin A, Booth JN, Laird Y, Sproule J, Reilly JJ, Saunders DH. Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Cochrane Database Systematic Review. 2018; 3: CD009728
  25. ↑ Cai Y, Zhu X, Wu X. Overweight, obesity, and screen-time viewing among Chinese school-aged children: national prevalence estimates from the 2016 physical activity and fitness in China - the youth study. Journal of Sport and Health Science. 2017; 6(4): 404-409
  26. ↑ Sit CHP, McKenzie TL, Cerin E, Chow BC, Huang WY, Yu J. Physical activity and sedentary time among children with disabilities at school. Medicine & Science in Sports & Exercise. 2017; 49(2): 292-297
  27. ↑ Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine. 2020; 54(24)
  28. ↑ 28.0 28.1 Liu Y, Williams CA, Weston KL, Duncombe SL, Malik AA, Barker AR. Validation and calibration for embedding rating of perceived exertion into high-intensity interval exercise in adolescents: a lab-based study. Pediatric Exercise Science. 2024; 1-7
  29. ↑ 29.00 29.01 29.02 29.03 29.04 29.05 29.06 29.07 29.08 29.09 29.10 29.11 29.12 29.13 Liu Y, Wadey CA, Barker AR, Williams CA. Process evaluation of school-based high-intensity interval training interventions for children and adolescents: a systematic review and meta-analysis of randomized controlled trials. BMC Public Health. 2024; 24: 348
  30. ↑ Eather N, Babic M, Riley N, Costigan SA, Lubans DR. Impact of Embedding High-Intensity Interval Training in Schools and Sports Training on Children and Adolescent's Cardiometabolic Health and Health-Related Fitness: Systematic Review and Meta-Analysis. Journal of Teaching in Physical Education. 2022; 42(2): 243-255
  31. ↑ Duncombe SL, Stylianou M, Price L, Walker JL, Barker AR. Making a HIIT: Methods for quantifying intensity in high-intensity interval training in schools and validity of session rating of perceived exertion. Journal of Sports Sciences. 2023; 41(18): 1678-1686
  32. ↑ Robertson RJ, Goss FL, Boer NF, Peoples JA, Foreman AJ, Dabayebeh IM. Children's OMNI Scale of Perceived Exertion: mixed gender and race validation. Medicine & Science in Sports & Exercise. 2000; 32: 452-458
  33. ↑ Utter AC, Robertson RJ, Nieman DC, Kang J. Children's OMNI Scale of Perceived Exertion: walking/running evaluation. Medicine & Science in Sports & Exercise. 2002; 34: 139-144
  34. ↑ Léger LA, Mercier D, Gacoury C, Lambert J. The multistage 20 metre shuttle run test for aerobic fitness. Journal of Sports & Science. 1988; 6: 93-101
  35. ↑ Lonsdale C, Sanders T, Parker P. Effect of a Scalable School-Based Intervention on Cardiorespiratory Fitness in Children: A Cluster Randomized Clinical Trial. JAMA Pediatrics. 2021; 175(7): 680-688
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