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Systematic Review Article, Physiology • Rev Bras Med Esporte 26 (6) • Nov-Dec 2020 • https://doi.org/10.1590/1517-869220202606201837 copy

HIIT, RESISTANCE TRAINING, AND RISK FACTORS IN ADOLESCENTS: A SYSTEMATIC REVIEW

HIIT, TREINAMENTO RESISTIDO E FATORES DE RISCO EM ADOLESCENTES: UMA REVISÃO SISTEMÁTICA

HIIT, ENTRENAMIENTO RESISTIDO Y FACTORES DE RIESGO EN ADOLESCENTES: UNA REVISIÓN SISTEMÁTICA

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

It has been shown that combined physical exercise is an efficient non-pharmacological approach in the context of public health, since it has demonstrated satisfactory results in the prevention, treatment and control of various morbidities. Therefore, it is essential to systematize current knowledge to enable professionals involved in the prescription of physical exercise to do so based on evidence. Thus, the objective of this study was to perform a systematic review of randomized clinical trials to verify changes in cardiometabolic risk factors induced by high-intensity interval training (HIIT) and resistance training (RT) in adolescents. The systematic search was performed in the following databases: Pubmed, ScienceDirect, Cochrane, LILACS and Scielo. Initially 933 studies were identified, then two researchers eliminated duplications and manuscripts that did not meet the eligibility criteria. Thus, two articles were included that met these criteria: a randomized clinical trial conducted with adolescents (10 to 19 years) of both sexes, an intervention lasting for at least four weeks, which prescribed HIIT and RT in the same session or not, and evaluation of at least one cardiometabolic risk factor. The results demonstrated that eight to 12 weeks of HIIT and RT without nutritional intervention were effective in significantly reducing waist circumference and body fat percentage. However, data pertinent to the efficacy of this combination on risk of developing type 2 diabetes mellitus and arterial hypertension are controversial. In view of the above, it is ascertained from the included studies that the combination of HIIT and RT has the potential to reduce cardiometabolic risk factors in adolescents; therefore, further studies should be conducted to determine the effectiveness of this prescription of physical exercise. Level of Evidence II; Systematic review of Level II or Level I Studies with discrepant results.

Keywords:
Exercise; High-intensity interval training; Adolescent health

Author	Reason for exclusion
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Ackel-D’Elia et al. (2014)²⁵25. Ackel-D’Elia C, Carnier J, Bueno Jr CR, Campos RMS, Sanches PL, Clemente APG, et al. Effects of different physical exercises on leptin concentration in obese adolescents. Int J Sports Med. 2014;35(2):164–71.	The modalities of the physical exercises of interest in this review were high-intensity interval training (HIIT) and resistance training. The studies in this group performed continuous aerobic exercise in combination with resistance training.
Alberga et al. (2012)²⁶26. Alberga AS, Goldfield GS, Kenny GP, Hadjiyannakis S, Phillips P, Prud'homme D, et al. Healthy eating, aerobic and resistance training in youth (HEARTY): study rationale, design and methods. Contemp Clin Trials. 2012;33(4):839–47.
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Campos et al. (2014)³³33. Campos RMS, Mello MT, Tock L, Silva PL, Masquio DL, Piano A, et al. Aerobic plus resistance training improves bone metabolism and inflammation in adolescents who are obese. J Strength Cond Res. 2014;28(33):758–66.
Dâmaso et al. (2014)¹²12. Dâmaso AR, Campos RMS, Caranti DA, Piano A, Fisberg M, Foschini D, et al. Aerobic plus resistance training was more effective in improving the visceral adiposity, metabolic profile and inflammatory markers than aerobic training in obese adolescents. J Sport Sci. 2014;32(15):1435–45.
Davis et al. (2011)³⁴34. Davis JN, Gyllenhammer LE, Vanni AA, Meija M, Tung A, Schroeder ET, et al. Startup circuit training program reduces metabolic risk in latino adolescents. Med Sci Sports Exerc. 2011;43(11):2195–203.
Foschini et al. (2010)³⁵35. Foschini D, Araújo RC, Bacurau RFP, Piano A, Almeida SS, Carnier J, et al. Treatment of obese adolescents: the influence of periodization models and ace genotype. Obesity. 2010;18(4):766–72.
Gow et al. (2016)³⁶36. Gow ML, Doorn NV, Broderick CR, Hardy LL, Ho M, Baur LA, et al. Sustained improvements in fitness and exercise tolerance in obese adolescents after a 12 week exercise intervention. Obes Res Clin Pract.2016;10(2):178–88.
Inoue et al. (2015)³⁷37. Inoue DS, Mello MT, Foschini D, Lira FS, Ganen AP, Campos RMS, et al. Linear and undulating periodized strength plus aerobic training promote similar benefits and lead to improvement of insulin resistance on obese adolescents. J Diabetes Complications. 2015;29(2):258–64.
Mello et al. (2011)³⁸38. Mello MT, Piano A, Carnier J, Sanches PL, Corrêa FA, Tock L, et al. Long-term effects of aerobic plus resistance training on the metabolic syndrome and adiponectinemia in obese adolescents. J Clin Hypertens. 2011;13(5):343–50
Mendelson et al. (2015)³⁹39. Mendelson M, Michallet AS, Monneret D, Perrin C, Estève F, Lombard PR, et al. Impact of exercise training without caloric restriction on inflammation, insulin resistance and visceral fat mass in obese adolescents. Pediatr Obes. 2015;10(4):311–9.
Monteiro et al. (2015)⁴⁰40. Monteiro PA, Chen KY, Lira FS, Thamyres B, Saraiva C, Moura B, et al. Concurrent and aerobic exercise training promote similar benefits in body composition and metabolic profiles in obese adolescents. Lipids Health Dis. 2015;14(153):1–9.
Piano et al. (2012)⁴¹41. Piano A, Mello MT, Sanches PL, Silva PL, Campos RMS, Carnier J, et al. Long-term effects of aerobic plus resistance training on the adipokines and neuropeptides in nonalcoholic fatty liver disease obese adolescents. Eur J Gastroenterol Hepatol. 2012;24(11):1313–24.
Sigal et al. (2014)⁴²42. Sigal RJ, Alberga AS, Goldfield GS, Prud'homme D, Hadjiyannakis S, Gougeon R, et al. Effects of aerobic training, resistance training, or both on percentage body fat and cardiometabolic risk markers in obese adolescents: the healthy eating aerobic and resistance training in youth randomized clinical trial. JAMA Pediatr. 2014;168(11):1006–14.
Son et al. (2017)⁴³43. Son W, Sung K, Bharath LP, Choi K, Park SY. Combined exercise training reduces blood pressure, arterial stiffness, and insulin resistance in obese prehypertensive adolescent girls. Clin Exp Hypertens. 2017;39(6):546–52.
Calcaterra et al. (2013)⁴⁴44. Calcaterra V, Larizza D, Codrons E, Silvestri A, Brambilla P, Abela S, et al. Improved metabolic and cardiorespiratory fitness during a recreational training program in obese children. J Pediatr Endocrinol Metab. 2013;26(3–4):271–6.	Prescription of sports activities only
Reinehr et al. (2011)⁴⁵45. Reinehr T, Schaefer A, Winkel K, Finne E, Kolip P. Development and evaluation of the lifestyle intervention “Obeldicks light” for overweight children and adolescents. J Public Health. 2011;19(4):377–84.	Prescription of sports activities only
Carrel et al. (2005)⁴⁶46. Carrel A, Meinen A, Garry C, Storandt R. Effects of nutrition education and exercise in obese children: the ho-chunk youth fitness program. Wis Med J. 2005;104(5):44–8.	Resistance training and sports activities Continuous aerobic training only Circuit-strength training only HIIT and sports activities Continuous aerobic training only Continuous aerobic training only Continuous aerobic training and sport activities Walking and jogging training Continuous aerobic training and exercises in Wii Fit Combined training and sports activities
Fayh et al. (2013)⁴⁷47. Fayh APT, Lopes AL, Silva AMV, Reischak-Oliveira A, Friedman R. Effects of 5 % weight loss through diet or diet plus exercise on cardiovascular parameters of obese: a randomized clinical trial. Eur J Nutr. 2013;52(5):1443–50. Giannaki et al. (2016)⁴⁸48. Giannaki CD, Aphamis G, Tsouloupas CN, Ioannou Y, Hadjicharalambous M. An eight week school-based intervention with circuit training improves physical fitness and reduces body fat in male adolescents. J Sports Med Phys Fitness. 2016;56(7–8):894–900.
Gueugnon et al. (2012)⁴⁹49. Gueugnon C, Mougin F, Nguyen NU, Bouhaddi M, Nicolet-Guénat M, Dumoulin G. Ghrelin and PYY levels in adolescents with severe obesity: effects of weight loss induced by long-term exercise training and modified food habits. Eur J Appl Physiol. 2012;112(5):1797–805.
Huang et al. (2015)⁵⁰50. Huang C, Kwok ÞC, Chou ÞC, Chou Y, Ho LT, Shih KC. The effect of exercise on lipid profiles and inflammatory markers in lean male adolescents: a prospective interventional study effects of exercise on body composition. J Investig Med. 2015;63(1):29–34.
Kamal & Ragy. (2012)⁵¹51. Kelishadi R, Hashemipour M, Mohammadifard N, Alikhassy H, Adeli K. Short- and long-term relationships of serum ghrelin with changes in body composition and the metabolic syndrome in prepubescent obese children following two different weight loss programmes. Clin Endocrinol (Oxf). 2008;69(5):721–9.
Kelishadi et al. (2008)⁵²52. Kamal NN, Ragy MM. The effects of exercise on C-reactive protein, insulin, leptin and some cardiometabolic risk factors in Egyptian children with or without metabolic syndrome. Diabetol Metab Syndr. 2012;4(1):1–7.
Knox et al. (2012)⁵³53. Knox G, Baker JS, Davies B, Faulkner S, Rance J, Rees A, et al. Effects of a novel school-based cross-curricular physical activity intervention on cardiovascular disease risk factors in 11- to 14-year-olds: the activity knowledge circuit. Am J Heal Promot. 2012;27(2):75–83.
Mccormack et al. (2014)⁵⁴54. McCormack SE, McCarthy MA, Harrington SG, Farilla L, Hrovat MI, Systrom DM, et al. Effects of exercise and lifestyle modification on fitness, insulin resistance, skeletal muscle oxidative phosphorylation and intramyocellular lipid content in obese children and adolescents. Pediatr Obes. 2014;9(4):281–91.
Vrablík et al. (2014)⁵⁵55. Vrablík M, Dobiášová M, Zlatohlávek L, Urbanová Z, Ceška RČ. Biomarkers of cardiometabolic risk in obese/overweight children: effect of lifestyle intervention. Physiol Res. 2014;63(6):743–52.

Author	Subjects	Intervention	Outcome	Results (Mean percentage [range])	Conclusion
Logan et al. (2016)¹⁹19. Logan GRM, Harris N, Duncan S, Plank LD, Merien F, Schofield G. Low-active male adolescents: a dose response to high-intensity interval training. Med Sci Sports Exerc. 2016;48(3):481–90.	- n = 26 non-active male adolescents who did not participate in structured physical activities (16.0 ± 1.0 years) - They were randomized into five groups (HIIT + TR, HIIT + TR, HIIT + TR, HIIT + TR, and HIIT + TR). - HIIT + RT 1: n = 5 - HIIT + RT 2: n = 5 - HIIT + RT 3: n = 6 - HIIT + RT 4: n = 5 - HIIT + RT 5: n = 5	- 8 weeks of high-intensity interval training and endurance training - HIIT 2 times per week/RT 1 time per week with 48-h intervals between the sessions - HIIT prescription The HIIT was prescribed in the premises of a college. All groups performed 3 min of heating and final recovery (50–60% HR_max) HIIT + RT 1: 4 sequences × 20 s (90–100% CF_max) interspersed with 10-s passive recovery HIIT + RT 2: 2 blocks × 2 sequences × 20 s (90–100% FC_max) interspersed with 10-s passive recovery HIIT + RT 3: 3 blocks × 3 sequences × 20 s (90–100% FC_max) interspersed with 10-s passive recovery HIIT + RT 4: 4 blocks × 4 sequences × 20 s (90–100% FC_max) interspersed with 10-s passive recovery HIIT + RT 5: 5 blocks × 5 sequences × 20 s (90–100% FC_max) interspersed with 10-s passive recovery At each block of 4 sequences an interval of 2 min of passive recovery was performed. - RT prescription RT for all groups: 3 sets, 8–12 repetitions (70% of 1RM) in exercises: supine, seated paddling, leg press, dumbbells, and squats.	- Percentage of fat estimated with radiological densitometry of double energy (DXA) - Waist circumference: in the erect position at expiration, the waist circumference was measured with a measuring tape at the point of greatest protuberance between the iliac crest and the last floating rib - Glucose and insulin: Blood was collected after 12 hours of fasting. Analysis of glucose and insulin were performed with specific tests (Roche Modular E170) - Blood pressure at rest: after 5 minutes in the sitting position, blood pressure was checked with an automatic monitor	- Fat percentage (p < 0,05) HIIT + RT 1: −0.9 −4.0 to −2.3) HIIT + RT 2: −4.3 −8.1 to −0.4) HIIT + RT 3: −6.2 (−9.1 to −4.2) HIIT + RT 4: −1.7 (−4.5 to 2.0) HIIT + TR 5: −5.5 (−10.0 to −0.3) - Waist circumference (p < 0.05) IIT + RT 1: −2.2 (−4.2 to −0.6) HIIT + RT 2: −3.0 (−8.4 to −1.0) HIIT + RT 3: −3.3 (−4.9 to −1,7) HIIT + RT 4: −0.9 (−8.0 to 4.6) HIIT + RT 5: −2.6 (−6.6 to −0.7) - Fasting glucose (p = 0.837) HIIT + RT 1: 8.2 (4.0–15.5); HIIT + RT 2: 1.4 (−9.5 to 14.5); HIIT + RT 3: 9.9 (−5.3 to 34.5) HIIT + RT 4: −12.4 (−18.9 to −8.4) HIIT + RT 5: 4.3 (−10.0 to 23.2) - Fasting insulin (p = 0.716) HIIT + RT 1: −11.8 (−33.4 to 8.5) HIIT + RT 2: 21.1 (−19.5 to 70.6) HIIT + RT 3: −7.1 (−29.4 to 22.8) HIIT + RT 4: 53.2 (−32,6 to 167.6) HIIT + RT 5: 81.13 (−22.0 to 196.7) - Systolic blood pressure (p = 0.183) HIIT + RT 1: −6.3 (−9.5 to −3.1) HIIT + RT 2: −5.7 (−19.1 to 7.7) HIIT + TR 3: 4.5 (0.6 to 4.9) HIIT + RT 4: −4.3 (−11.3 to 3.5) HIIT + RT 5: −2.8 (−7.0 to 0.3) - Diastolic blood pressure (p < 0.05) HIIT + RT 1: 0.8 (−5.4 to 6.7) HIIT + RT 2: −2.7 (−10.4 to 3.5) HIIT + RT 3: 2.6 (−4.8 to 11.0) HIIT + RT 4: −13.1 (−21.4 to −4.4) HIIT + RT 5: −9.9 (−13.1 to −6.5)	Eight weeks of HIIT and weight training induced significant reductions in fat percentage, waist circumference, and diastolic blood pressure. Execution of additional HIIT sequences promoted small improvements in male adolescents
Racil et al. (2016)²⁰20. Racil G, Zouhal H, Elmontassar W, Ben A, Sousa MV, Chamari K, et al. Plyometric exercise combined with high-intensity interval training improves metabolic abnormalities in young obese females more so than interval training alone. Appl Physiol Nutr Metab. 2016;41(1):303–9.	- n = 68 obese female adolescents (16.6 ± 1.3 years) - They were randomized into three groups (HIIT + RT, HIIT, and control) - HIIT + RT: n = 26 - HIIT: n = 23 - Control: n = 19	- 12 weeks of high-intensity interval training and endurance training on the same day, 3 times per week with a 48-hour interval between sessions. - HIIT Prescription 10 min of heating and recovery (50% VO_2peak). HIIT was prescribed on a 200-m runway. 2 blocks × 6 to 8 sequences × 30 s (100% VO_2peak) interspersed with 30 s of active recovery (50% VO_2peak). At each block from 6 to 8 sequences, a 4-min passive recovery interval was performed. - RT prescription first to fourth week: 2 blocks × 4 sequences × 15 s in exercises: jumping with both legs, throwing the medicine ball above the head, and diving in the medicine ball with one leg fifth to eighth week: 2 blocks × 4 sequences × 15 s of exercises, including jumps with obstacles, zigzag jumps, and throwing a medicine ball on one's back. ninth to 12th week without: 2 blocks × 4 sequences × 15 s of exercises, including jumping over the cone with one leg, zig-zag with one leg, and throwing a medicine ball to a partner. For each new block or fiscal year, an interval of 1.5 min was executed. Inspection: Lack of training.	- Fat percentage: estimated by bioimpedance (TBF-300) - Waist circumference: in the erect position, the waist circumference was measured with a measuring tape at the point of greatest protuberance between the iliac crest and the last floating rib. - Fasting glucose: blood was collected after 12 hours of fasting. Blood glucose analysis was performed using an automatic device (Architect c8000) - Fasting insulin: blood was collected after a 12-h fast. Insulin analysis was performed using the method (RIA) (Immunotech A)	- Fat percentage HIIT + RT: −7.2 ± 1.8 (p < 0.05) Control: 0.6 ± 0.9 - Waist circumference HIIT + RT: −4.0 ± 1.0 (p < 0.05) Control: −0.6 ± 0.6 - Fasting glucose level HIIT + RT: −11.0 ± 4,7 (p < 0.05) Control: 1.3 ± 3.5 - Fasting insulin level HIIT + RT: −29.5 ± 5.6 (p < 0,05) Control: −3.2 ± 3.2	Twelve weeks of HIIT and resistance training through plyometric exercises induced significant reductions in the percentage of fat, waist circumference, glucose and insulin concentrations in adolescents with obesity

	Risk of bias
Author	Randomization	Allocation secrecy	Blinding of participants and team	Blinding in the evaluation of outcomes	Incomplete outcome data	Selective reporting of outcomes	Other sources of biases
Logan et al. (2016)	Low	High	High	Uncertain	Low	Low	Low
Racil et al. (2016)	Low	High	High	Uncertain	Low	Low	Low

	Author
Questions	Logan et al. (2016)	Racil et al. (2016)
1. The eligibility criteria have been specified^* * Question 1 does not contribute to the total score. .	Yes	Yes
2. The subjects were randomly distributed into groups.	Yes	Yes
3. The distribution of participants was blind.	No	No
4. Initially, the groups were similar in terms of the most important prognostic indicators.	Yes	Yes
5. All the subjects participated blindly in the study.	No	No
6. All the professionals who administered the intervention did so blindly.	No	No
7. All evaluators who measured at least one key outcome did so blindly.	No	No
8. Measurements of at least one key outcome were obtained from >85% of the subjects initially assigned to the groups.	Yes	Yes
9. All the subjects from whom measurements of results were taken were either treated or controlled according to distribution, or where this was not the case, the data were analyzed for at least one of the key results by “intended treatment.”	Yes	Yes
10. The results of intergroup statistical comparisons have been described for at least one key outcome.	Yes	Yes
11. The study presents both precision and variability measures for at least one key outcome.	Yes	Yes
Total score	6	6

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