Eur J Appl Physiol (2013) 113:25312540
DOI 10.1007/s00421-013-2689-5
ORIGINAL ARTICLE
Effects of high vs. moderate exercise intensity during interval
training on lipids and adiponectin levels in obese young females
G. Racil O. Ben Ounis O. Hammouda A. Kallel
H. Zouhal K. Chamari M. Amri
Received: 8 April 2013 / Accepted: 21 June 2013 / Published online: 4 July 2013
Springer-Verlag Berlin Heidelberg 2013
Abstract
Purpose We investigate the effects of 12-week interval
training of moderate- or high-intensity exercise on blood
lipids and plasma levels of adiponectin.
Methods Thirty-four obese adolescent females [age =
15.9 0.3 years; BMI and BMI-Z-score = 30.8 1.6
kg/m2 and 3 0.3, respectively], were randomized to
high-intensity interval training (HIIT, n = 11), moderate-
intensity interval training (MIIT, n = 11), or a control
:
group (CG, n = 12). Maximal oxygen uptake (V O2peak ),
Communicated by Jean-Rene Lacour.
G. Racil (&)  M. Amri
Department of Biological Sciences, Faculty of Science of Tunis,
University Tunis el Manar, Tunis, Tunisia
e-mail: ghazi_racil@yahoo.fr
O. Ben Ounis  O. Hammouda  K. Chamari
Higher Institute of Sport and Physical Education, Ksar Said in
Tunis, University of Manouba, Tunis, Tunisia
O. Hammouda
Research Laboratory Sport Performance Optimization,
National Center of Medicine and Sciences in Sport (CNMSS),
Tunis, Tunisia
A. Kallel
Biochemistry Laboratory, CHU Rabta,
University of Tunis El Manar, Tunis, Tunisia
H. Zouhal
Laboratoire Mouvement Sport Sante (M2S), UFR APS,
Universite Rennes 2-ENS Cachan, Campus la Harpe,
35044 Rennes Cedex, France
K. Chamari
Research and Education Centre, Aspetar, Qatar Orthopaedic and
Sports Medicine Hospital, Doha, Qatar
maximal aerobic speed (MAS), plasma lipids and adipo-
nectin levels were measured in all subjects before and
after training.
Results Following the training program, in both training
groups, body mass, BMI-Z-score, and percentage body fat
:
(% BF) decreased, while V O2peak and MAS increased.
Low-density lipoprotein cholesterol, high-density lipopro-
tein cholesterol, and adiponectin levels were positively
altered (-12.6 and -7.4 %; 6.3 and 8.0 %; 35.8 and
16.2 %; high to moderate training program, respectively).
Waist circumference, triglyceride and total cholesterol
decreased only in HIIT group (-3.5; -5.3 and -7.0 %,
respectively, in all P \ 0.05). Significant decrease in the
usual index of insulin resistance (HOMA-IR) occurred in
HIIT and MIIT groups (-29.2 5.3 and -18.4 8.6 %,
respectively; P \ 0.01).
Conclusion The results show that HIIT positively chan-
ges blood lipids and adiponectin variables in obese ado-
lescent girls, resulting in improved insulin sensitivity, as
attested by a lower HOMA-IR, and achieving better results
compared to moderate-intensity exercise.
Keywords Training intensity  Intermittent exercise 
Adipose tissue  Insulin resistance  Adolescent
Introduction
The increase of obesity among both children and adults is
associated with the development of several chronic dis-
eases, including metabolic syndrome, type-2 diabetes,
cardiovascular diseases, cancer, and arthritis (Guh et al.
2009). In this context, a number of well-established blood
markers, such as blood glucose, total cholesterol (TC),
123
2532
triglycerides (TG), low (LDL-C), and high-density lipo-
protein cholesterol (HDL-C), and insulin resistance are
used as complements to the health risk assessment
(Murakami et al. 2007).
Additionally, unlike other adipose-derived hormones,
adiponectin (a protein that is secreted by adipose tissue)
levels decrease with increasing body mass index (BMI) and
is thus lower in obese individuals (Balagopal et al. 2005). In
fact, high levels of adiponectin could stimulate glucose uti-
lization, fat oxidation in skeletal muscle and is inversely
related to insulin resistance (Punthakee et al. 2006). Several
studies investigated the effects of combined exercise and diet
on lipids and lipoproteins but few have looked at the effects
of physical exercise alone (Crouse et al. 1997). In this con-
text, physical exercise may significantly increase adiponec-
tin levels (Balagopal et al. 2005) suggesting a positive role of
physical activity on adiponectin concentrations in youth (Dai
et al. 2009). Therefore, emerging literature highlights the
need to incorporate physical activity into every strategy
intended to prevent body mass gain as well as to maintain
body mass loss overtime (Coker et al. 2009) (Fig. 1).
The ideal exercise prescription for achieving body mass
loss and thereby decreasing body fat for the obese has not yet
been identified. Previously, moderate-intensity exercise has
been recommended as the primary exercise method for body
mass and body fat loss (Atkinson and Walberg-Rankin 1994).
However, recent findings suggested that high-intensity inter-
val training (HIIT) has the potential to be an economical and
effective exercise protocol for reducing fatness of overweight
and obese individuals, and has been shown to favor a negative
energy balance (Talanian et al. 2007). On the other hand, when
compared to other intensities, HIIT induced significantly
greater improvements in cardio-respiratory fitness and other
physiological parameters (Cornish et al. 2011). In this context,
a recent study, investigated the effects of 2 weeks of low-
volume HIIT on metabolic health in a group of individuals
with type-2 diabetes resulting in subjects significantly
Fig. 1 Percentage changes in % fat mass levels in the three groups
after the intervention. Values are mean SD (*P \ 0.05)
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Eur J Appl Physiol (2013) 113:25312540
improving their blood glucose profile (Little et al. 2011).
Furthermore, other research has also shown HIIT to be ben-
eficial for cholesterol management and/or prevention (Wil-
liams and Franklin 2008). Some recent studies have even
shown that high-density lipoprotein cholesterol (HDL-C)
could be well enhanced with HIIT (Lamina and Okoye 2012;
Metcalfe et al. 2011). Regular HIIT has also been shown to
significantly increase both aerobic and anaerobic fitness, to
decrease insulin resistance (Boutcher 2011) and to promote a
number of skeletal muscle adaptations that result in enhanced
fat oxidative capacity and improved glucose tolerance
(Boutcher 2011). Indeed, HIIT increases maximal activity and
protein content of mitochondrial enzymes such as citrate
synthase, cytochrome oxidase, and enhances b hydroxyacyl
coenzyme A dehydrogenase and phosphofructokinase activ-
ities (Gibala 2009; Talanian et al. 2007). The notion that HIIT
can be performed by anybody (Metcalfe et al. 2011) needs to
be proved, especially in obese subjects whose exercise
capacity is reduced.
Interestingly, Bouassida et al. (2008) reported that
training, which increases the physical fitness of the indi-
viduals and modifies their body composition, also increases
plasma adiponectin. However, in this context, contradic-
tory results have been published in obese girls (Nassis et al.
2005), and experiments studying the effects of supra-
maximal interval training programs on blood lipids profile
and plasma adiponectin are still lacking, especially in
obese adolescent girls. Therefore, the aim of this study was
to examine the effects of 12-week HIIT (supra-maximal)
on body composition as well as plasma lipids and adipo-
nectin levels in obese adolescent girls.
Methods
Participants
This study was approved by the Research Ethics Committee
of the Faculty of Sciences of Tunis, Tunisia. Before the
involvement in the study, each participant and parents signed
an informed consent in accordance with the international
ethical standards and more specifically, the Declaration of
Helsinki (Harriss and Atkinson 2011). Thirty-four obese
Tunisian girls (age 15.9 0.3 years) participated in the
study. None of the participants was involved for more than
3 h per week in any structured program of physical activity.
Individuals were recruited from three schools and pre-
sented a BMI [97th percentiles according to the French
standards, because Tunisian norms are still lacking (Cole
et al. 2000). None of the girls used drugs or therapies for
obesity, or presented chronic diseases, endocrine disorders
or diabetes mellitus, which may prohibit the study progress
and testing.
Eur J Appl Physiol (2013) 113:25312540
During the intervention period, all participants were
asked to maintain their normal diet and not to consume any
medications during the week prior to blood sampling.
Dietary intervention
To establish daily energy intake and composition of the
subjects habitual diet, 4-day-diet records were carried out
by all subjects (3 weekdays and 1 weekend day). All food
intake and beverages were weighed and recorded, and
energy intake and composition of the diets were calculated
with a computer database using the Bilnut 4 software
package (SCDA Nutrisoft, Cerelles, France) and the food
composition tables published by the Tunisian National
Institute of Statistics in 1978. Subjects were helped to
estimate portion sizes and the dietary survey was con-
ducted by a specialized dietician.
Anthropometric measures
Body mass (BM) was assessed to the nearest 0.1 kg with a
digital scale (Tanita, Tokyo, Japan), body height was
measured in centimeters with no shoes, heels together, and
the back of the subject parallel to the stadiometer (Model
214 height rod; Seca, Hamburg, Germany). Waist cir-
cumference (WC) in cm, used as a marker of central body
fat (Pouliot et al. 1994), was measured with a non-
deformable tape ruler between the lower rib margin and the
iliac crest, at the end gentle-expiration (as recommended
by international guidelines). Percentage body fat (% BF)
was assessed for each participant by bioelectrical imped-
ance analysis (BIA) (Tanita Body Composition Analyzer
Mode TBF-300, Tokyo, Japan).
Body mass index (BMI = Mass [kg]/(Height [m])2) was
determined and subjects BMI-Z-score was calculated
according to Rolland-Cachera et al. (1991) with the fol-
lowing formula:
Z Q=M L  1=LS pant at the end of the test. HRpeak was considered as the
with Q = BMI, M = median, L = power, S = coefficient
of variation.
Pubertal stage was evaluated according to the Tanner
classification (Tanner and Whitehouse 1976) by a trained
pediatrician: pubertal children comprised children who
were in Tanner stage IIIII and post-pubertal children in
Tanner stage IVV (refer to Table 2).
Testing procedure
All participants performed a maximal graded test (Chtara
: week on non-consecutive days (on Monday, Wednesday,
et al. 2005) until exhaustion to measure their V O2peak and
:
speed associated with V O2peak (MAS) before and after the
2533
12-week training program. The tests took place in the
morning after a standardized breakfast (10 kcal kg-1,
*55 %, of which came from carbohydrates, *33 % from
lipids and *12 % from proteins, as determined by an
experienced nutritionist) and under similar environmental
conditions. During each session, temperature, humidity,
and wind speed were continuously measured (temperature
ranged from 18 to 22 C, and humidity from 50 to 70 %
with wind speed \2 m s-1). During the maximal graded
test, respiratory gas exchange was measured breath-by-
breath using a calibrated portable telemetric system to
:
measure V O2peak (Cosmed K4b2, Rome, Italy)
(McLaughlin et al. 2001). To be accustomed with the test
and the materials, all subjects computed a familiarization
session before baseline testing.
The maximal test (Chtara et al. 2005) was carried out on
200-m outdoor track calibrated with cones. Blue cones
were set at 20 m intervals along the track (inside the inner
track corridor line), while red cones were set 2 m behind
the blue cones. The running pace was set by an examiner,
equipped with a listing table containing the lap-times, a
chronometer and a whistle. The examiner emitted short
sound when the subject had to pass by a blue cone to be
able to maintain a constant speed for each test stage. At
each sound, the subject had to be within 2 m of the blue
cones. When subjects were behind a red cone two con-
secutive times or when the subjects stopped the exercise,
judging themselves exhausted, the test was ended. The
initial speed was set at 8 km h-1 and was increased by
0.5 km h-1 every minute. The sustained speed during the
last completed stage corresponds to the maximal aerobic
speed (MAS). If the last stage was not run for a full minute,
the MAS was then calculated according to Kuipers et al.
(1985).
HR was continuously monitored during the maximal test
with a heart rate monitor (Polar Electro S-610 i, Kempele,
Finland), to note peak heart rate (HRpeak) of each partici-
highest value on the basis of 5-s averaged HR values.
Training program
Participants were randomly assigned to a HIIT group
(n = 11), exercising at 100 to 110 % of MAS (or the speed
:
associated with V O2peak ) (Table 1); a moderate-intensity
interval training (MIIT) group (n = 11), exercising at
7080 % of MAS (Table 1) and a non-exercising control
group (CG) (n = 12). Training groups (HIIT and MIIT)
participated in an interval training program 3 times per
and Friday) during 12 weeks (Table 1). Two subjects were
unable to complete the training program for personal
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2534 Eur J Appl Physiol (2013) 113:25312540

Table 1 Training program for the trained groups: high-intensity interval training (HIIT) and moderate-intensity interval training (MIIT)
Weeks 14 Weeks 58 Weeks 912

Training programs HIIT 29 29 29

(6 9 30 s/30 s) (8 9 30 s/30 s) (8 9 30 s/30 s)
100 %/50 % MAS 105 %/50 % MAS 110 %/50 % MAS
R = 4 min R = 4 min R = 4 min
MHR = 194.2 b min-1 MHR = 191.9 b min-1 MHR = 192.3 b min-1
TL: 450 ATU TL: 620 ATU TL: 640 ATU
MIIT 29 29 29
(6 9 30 s/30 s) (8 9 30 s/30 s) (8 9 30 s/30 s)
70 %/50 % MAS 75 %/50 % MAS 80 %/50 % MAS
R = 4 min R = 4 min R = 4 min
MHR = 182 b min-1 MHR = 178 b min-1 MHR = 184.7 b min-1
TL: 360 ATU TL: 500 ATU TL: 520 ATU
Example (2 9 (6 9 30 s/30 s) 7550 % MAS. R = 4 min) it means that the subject had to run 2 series of 6 repetitions of 30 s/30 s, composed
:
of 30 s running at 75 % of MAS (the speed associated with V O2peak ) and 30 s active recovery at 50 % of MAS. The subject recovered passively
4 min between series. Each session is repeated 3 times a week, each period lasting 4 weeks; MHR mean heart rate of training, TL training load.
Example of training load calculation for HIIT during the first period: [[(100 ? 50)/2] 9 3 9 2] = 450 ATU
MAS maximal aerobic speed, ATU arbitrary training units

reasons: one from (HIIT group) and the other from (MIIT
group), and their data are thus excluded from all analyses.
Therefore, results of only 11 subjects in each experimental
group are presented in this work.
Training sessions were composed of interval exercises
with active recovery and were performed on an outside
200 m track. All sessions included three different periods:
the sessions were started by a standardized warm-up, which
consisted of 10-min continuous jogging at moderate inten-
sity (50 % of MAS), followed by 5 min dynamic stretching
exercises and 5 short bursts of *20 m accelerations on the
track. Then, the subjects performed their training program.
During intervals of high-intensity (e.g., 100 % MAS)
and moderate-intensity (e.g., 70 % MAS) exercises, the
speed was controlled with individualized distances
according to each subjects MAS. Subjects had to run in
30 s, a given distance, marked by two cones (cones 1, 2), in
relation to the speed requested. An acoustic signal was
given at start (cone 1) and at the end of 30 s (cone 2).
During the interval of active recovery, speed (50 % MAS)
was also controlled with a distance according to each
subjects MAS and according to the groups intensity (e.g.,
high or moderate). To get from the arrival cone (cone 2), to
the starting cone (cone 1), the subject had to go through a
yellow cone located at mid-distance from the cones (1 and
2) and it was not placed in the same running direction. To
help the participant to manage the recovery speed, a signal
was given at half recovery (after 15 s) to indicate the split-
time near the yellow cone.
At the end of the training session, subjects cooled down
for about 10 min, running at low intensity and performing
static stretching. Two members of our laboratory super-
vised all interval training program sessions.
During the training period (weeks 4 and 8), a maximal
graded test was performed in the same conditions as the
first one to assess the new MAS to update the training
speed of each subject. All the training sessions were con-
trolled and monitored using a heart rate monitor (Polar
Electro S-610 i, Kempele, Finland) to make sure that par-
ticipants were in the normal heart range and did not
undergo any complications.
Biochemical analysis
Blood samples have been obtained from 7:00 a.m. to
8:00 a.m. after an overnight fasting (*12 h). Samples
have been collected in lithium-heparinized tubes and
immediately centrifuged at 4 C. Samples were kept on ice
during experiments and were freezed at -80 C.
Total cholesterol (TC), triglycerides (TG), and HDL-C
levels have been measured for all subjects before and after
the interventional program using enzymatic methods. The
inter-assay coefficients of variation (CV) were of: 1.7, 2.2,
and 2.0 %, respectively. LDL-C was calculated using the
Friedewald et al. (1972) formula.
Plasma glucose concentrations were measured using an
automated device (AU2700, Olympus, France). The inter-
assay coefficient of variation (CV) was 1.7 %. Plasma
insulin was assayed by an IRMA Insulin kit (Immunotech,
France). The intra- and inter-assay coefficients of varia-
tions were of 3.34 and 3.74.8 %, respectively. Insulin
resistance was assessed using the homeostatic model

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Eur J Appl Physiol (2013) 113:25312540
assessment for insulin resistance (HOMA-IR) which has
been computed as follows:
HOMA-IR Fasting insulin lU/ml
 Fasting glucose mmol/l=22:5:
Plasma adiponectin was determined using an ELISA kit
(B-Bridge international, Inc.). The intra- and inter-assay
coefficients of variation were 4.1 and 7.4 %, respectively.
Statistical analysis
Means and standard deviations were calculated for each
observation point. ShapiroWilk test was applied to con-
firm normality, whereas homogeneity of variance was
assessed using Levenes test. For normally distributed data,
a two-way analysis of variance (ANOVA) with repeated
measures was used to compare values within each group
(HIIT, MIIT, control) at the two data collection points,
whereas a one-way ANOVA was used to test differences
between groups at the two data collection points. Where
residuals were not normally distributed, the nonparametric
KruskalWallis test (H values) was used. Bonferroni
adjustments for multiple comparisons were used. For sig-
nificant H values, a Bonferroni adjusted MannWhitney
U test was applied. Analysis of covariance (ANCOVA)
was performed to assess the role of Tanner stages on the
significant differences within the group and between
groups. In addition, post hoc, effect size statistics (ES) for
all the statistically significant t ratios were also established.
These calculations were based on Cohens classification
and knowledge of the ES enabled estimating the magnitude
of the difference (i.e., trivial: ES \0.2, small:
0.2 B ES \ 0.5, moderate: 0.5 B ES \ 0.8, and large: ES
C0.8). The level of significance was set at P \ 0.05. Sta-
tistical analysis was performed using SPSS version 18.0
(SPSS Inc., Chicago, IL, USA).
Results
Anthropometric and physiological characteristics
The physical, physiological, and blood variables of the
three groups at the beginning and at the end of the 12-week
period are summarized in Tables 2 and 3. Comparisons of
the three groups showed that they were matched for
anthropometric parameters, age, and pubertal stage before
the commencement of the training program. There were no
significant differences in energy intake between tests.
At the post-intervention, we noted a significant decrease
(P \ 0.05) in the BM of both training groups (HIIT and
MIIT). Similarly, the Z-scores of BMI decreased
2535
significantly in HIIT group (P \ 0.01, ES = 0.75) and in
MIIT group (P \ 0.05, ES = 0.68). In the between groups
comparison, BMI-Z-score and %BF in HIIT group were
significantly different (P \ 0.05) from the two other
groups (MIIT and CG). Conversely, in post-intervention,
the HIIT subjects WC decreased significantly (P \ 0.05,
ES = 0.59), as did %BF in the same group (P \ 0.01,
ES = 0.72).
In MIIT group, the %BF was also significantly
decreased (P \ 0.05, ES = 0.66). At the end of the train-
ing period, a significant increase was observed in MAS of
both trained groups (P \ 0.01 and P \ 0.05 for HIIT and
MIIT, respectively), but a higher increase was noted in
HIIT group (10.3 0.8 to 11.5 0.7 km h-1).
:
HIIT group increased significantly V O2peak by 7.7 %
(P \ 0.01, ES = 0.68) and MIIT group increased signifi-
:
cantly V O2peak by 5.2 % (P \ 0.05, ES = 0.57). In the
between groups difference, HIIT group noted a significant
:
increase (P \ 0.05) in V O2peak , when compared to the CG.
Blood analysis
Table 3 shows that the HIIT group experienced significant
positive modifications (P \ 0.05) for all: in TC
(ES = 0.62), TG (ES = 0.47), HDL-C (ES = 0.59) and
adiponectin (ES = 0.69). Whilst significant decreases
(P \ 0.01) also occurred in HIIT group for all: in LDL-C
(ES = 0.75), insulin (ES = 0.79) and HOMA-IR
(ES = 0.80). For the in-between groups difference, HIIT
group was significantly higher (P \ 0.05) in TC, LDL-C,
and insulin, when compared to MIIT or control groups.
Concerning adiponectin levels, both training groups (HIIT
and MIIT) were significantly different from the CG
(P \ 0.05) (Fig. 2).
The MIIT group experienced a significant increase in the
HDL-C and adiponectin (P \ 0.05) (ES = 0.65 and
ES = 0.69, respectively) in the post-training test, whereas
a decrease has occurred in the same group in LDL-C,
insulin, and the HOMA-IR (P \ 0.05, ES = 0.62,
ES = 0.77 and ES = 0.79, respectively). For the in-
between groups difference, MIIT group showed signifi-
cantly different levels than the CG in TG and adiponectin
(P \ 0.05). When all parameters were adjusted for Tanner
stages, significant differences remained unchanged
(Fig. 3).
Discussion
The main focus of this study was to compare the effects of
HIIT versus MIIT on health-related parameters in obese
young girls. The present study results demonstrated for the
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Table 2 Physical and physiological variables (mean SD) before (pre) and after (post) the interventions
HIIT (n = 11) MIIT (n = 11) CG (n = 12)
Pre Post Pre Post Pre Post

PS (IIIII/IVV) 6/5 5/6 6/6

Age (years) 15.6 0.7 16.3 0.52 15.9 1.2
BM (kg) 83.5 5.9 80.3 6.2* 84.4 6.6 82.7 6.8* 82.7 5.7 82.2 5.5
Height (cm) 163.4 4.4 163.7 4.4 162.9 4.7 163.0 4.6 164.3 5.1 164.5 5.0
BMI-Z-sc 2.9 0.2 2.5 0.3#, 3.1 0.4 2.8 0.3* 2.9 0.2 2.9 0.2
WC (cm) 93.7 4.8 90.3 6.7* 94.0 3.9 91.0 4.6 93.1 3.9 92.8 3.7
% Body fat 37.2 1.2 34.30 1.7*, 38.2 1.4 36.2 1.0* 35.8 1.5 35.4 1.2
:
V O2peak (ml mn
-1
kg) 36.9 1.8 39.7 1.8 #, 37.0 2.1 38.9 2.2* 38.1 1.5 38.6 1.4
MAS (km h-1) 10.3 0.8 11.5 0.7*, 9.8 1.2 10.9 0.6* 10.4 0.6 10.7 0.8
-1
EI (kcal day ) 2,975 118 2,883 94 3,015 123 2,912 113 2,930 95 2,895 92
Data are means (SD)
:
PS pubertal stage, BMI-Z-sc Z-score of body mass index, %BF percentage of body fat, WC waist circumference, V O2peak peak oxygen
consumption, MAS maximal aerobic speed, EI daily energy intake
Significantly different within each group before vs after program: * P \ 0.05, #P \ 0.01

Significantly different from the other groups: P \ 0.05

Significantly different from control: P \ 0.05

Table 3 Blood variables (mean SD) before (pre) and after (post) the interventions
HIIT (n = 11) MIIT (n = 11) CG (n = 12)
Pre Post Pre Post Pre Post

TC (mmol l-1) 3.8 0.32 3.53 0.31*, 4.05 0.29 3.90 0.32 3.9 0.23 3.86 0.16
-1
TG (mmol l ) 1.4 0.06 1.3 0.05* 1.37 0.07 1.34 0.09 1.26 0.12 1.23 0.1
HDL-C (mmol l-1) 1.02 0.06 1.08 0.08* 1.01 0.08 1.09 0.07* 0.99 0.05 1.0 0.03
LDL-C (mmol l-1) 2.49 0.32 2.18 0.4#, 2.77 0.3 2.55 0.32* 2.64 0.24 2.62 0.18
, ,
Adiponectin (lg ml) 7.4 1.49 9.9 1.46* 6.7 1.05 7.7 1.21* 6.7 1.03 7.2 0.79
Glucose (mmol l-1) 4.6 0.54 4.5 0.47 4.5 0.40 4.4 0.34 4.7 0.44 4.6 0.32
Insulin (lU ml-1) 21.3 2.41 15.5 1.19#, 21.8 1.85 17.9 1.45* 19.6 2.09 18.8 1.95
HOMA-IR 4.4 0.73 3.1 0.43# 4.4 0.62 3.6 0.43* 4.1 0.57 3.81 0.52
Data are means (SD)
TC Total cholesterol, TG triglyceride, HDL-C high-density lipoprotein cholesterol, LDL-C low-density lipoprotein cholesterol, HOMA-IR
homoeostasis model assessment index for insulin resistance
Significantly different within each group before VS after program: * P \ 0.05, #P \ 0.01

Significantly different from the other groups: P \ 0.05

Significantly different from control: P \ 0.05

first time that both types of training were effective in
improving Z-score of BMI, aerobic fitness, and metabolic
parameters in this sample. Moreover, this study showed
that better modifications in plasma lipids and plasma
adiponectin levels were achieved through high compared to
moderate exercise training intensity.
Both groups underwent a significant decrease in body
mass after training (P \ 0.05), associated with a significant
decrease in BMI-Z-score. Furthermore, three sessions per
week of HIIT during 12-week period were sufficient to
decrease the WC (-3.58 % that was accompanied by a
higher decrease in BM compared to the MIIT group) but
this did not occur in the other training group. Despite
reports that supra-maximal HIIT may not be safe, tolerable,
or appealing for some individuals (Gibala et al. 2012;
Gayda et al. 2012), it has been shown to be more enjoyable
than other types of exercise at moderate intensity (Bartlett
et al. 2011), and it has been reported to be perceived as less
difficult in obese women (Coquart et al. 2008a). In this
context, it has to be mentioned that during the intervention,
subjects enjoyed the training sessions on the track and were
motivated to the challenge of reaching the cones at the

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Fig. 2 Percentage changes of LDL-C, insulin and HOMA-IR levels
in the three groups after the intervention. Values are mean SD
(*P \ 0.05, #P \ 0.01)
Fig. 3 Percentage changes of HDL-C and adiponectin levels in the
three groups after the intervention. Values are mean SD
(*P \ 0.05)
requested time independently of the exercise intensity.
This, has to be considered in designing training protocols
for obese young women, probably contributing to lower
drop-out rates for larger samples of subjects compared to
classical boring continuous running. This has of course
to be experimented.
Reduction in %BF has also been observed in both
training groups. This is consistent with the findings of Woo
et al. (2004), who reported that exercise training decreased
fat mass substantially compared with dietary changes in
overweight or obese subjects, even when the exercise
intensities were low. Therefore, the present study shows
that body composition improvements can also be reached
with interval training of both moderate and high exercise
intensity. In this context, when training volumes were
equalized between groups, HIIT appeared to be the most
2537
effective training method to reduce BM in adolescents
(Gutin et al. 2005). Of note, HIIT had more favorable
effects with regard to improving anthropometric parame-
ters. The results support the notion that HIIT is effective in
getting a more favorable body composition. However, the
results reported in this study were similar to those reported
by (Coquart et al. 2008a) where intermittent exercises were
appropriate and was observed to provide significant
improvements in BM and BF. In contrast, when the exer-
cise modality was different, based on constant velocity
walk or an intermittent walk, the same author (Coquart
et al. 2008b) reported contradictory results in obese
women. These authors concluded that intermittent walk
could not be proposed to reduce the BM or BF but to
maintain those two parameters to improve the physical
fitness and quality of life and thus avoid the progression of
obesity.
However, in the case of different training modes, some
previous studies (DeBusk et al. 1990; Haskell et al. 2007)
showed that exercising with intervals was considered to be
more effective than continuous training; therefore, it has
been observed that MIIT provided cardiovascular benefits
and improvement in blood lipids. It should be noted, how-
ever, that young generally dislike prolonged physical activ-
ity with little variation in intensity (e.g., continuous running),
which is considered less enjoyable than HIIT through a lower
ratings of perceived enjoyment (Bartlett et al. 2011). Con-
versely, the young tend to spontaneously engage in short
bursts of intense physical activity interspersed with periods
of less intensity (Ratel et al. 2004); this could stimulate the
cardio-respiratory system and could present greater ability to
recover after short periods of high-intensity exercise
(Bangsbo et al. 1994). According to other studies, HIIT was
an effective alternative to continuous training, which
induced equivalent or superior improvements when they
were compared at BMI (Tjonna et al. 2009, Buchan et al.
2011) and at body weight (Tjonna et al. 2008). In contrast, a
recent study (Koubaa et al. 2013) demonstrated that con-
tinuous training was more beneficial in reducing BM and BF
while intermittent training remained greater for the
improvement of cardio-respiratory fitness.
On the other hand, it has been shown that lipid contribu-
tion to energetic metabolism is dependent on exercise
intensity and duration (Garrigue et al. 2006). The role of
post-exercise lipolysis has also to be considered in that
regard, contributing to body composition remodeling (Gar-
rigue et al. 2006). Literature shows that high-intensity
exercise requires glucose catabolism and in consequence the
glucose metabolism is turned away to restore muscle gly-
cogen stocks, while low intensity exercise needs lipid oxi-
dation as a principal source of energy (Brooks and Mercier
1994). In this context, Kiens and Richter (1998) have shown
that, even in the post-exercise recovery period, muscle
123
2538
glycogen resynthesis was the high metabolic priority,
inducing post-exercise lipid combustion. These authors have
thus suggested that muscle triacylglycerols, and probably
very low-density lipoprotein triacylglycerols, were impor-
tant providers of fuel for post-exercise muscle metabolism
and recovery processes.
After the intervention, participants improved several
risk factors and aerobic fitness variables. Of all established
:
risk factors, is the increase of V O2peak which was higher in
HIIT compared to MIIT. However, it appears that the
duration of the intervention period (12 weeks) was
important to induce central physiological adaptations.
Indeed, the rationale of intense interval training is to
challenge the hearts pumping ability so that work may be
completed at higher intensities over shorter periods
(Tjonna et al. 2009). Based on HR responses (Table 1), it is
evident that both training programs challenged the hearts
pumping ability throughout the intervention period. Indeed,
it is likely that the increase in MAS is ensured by regular
aerobic training, which induced several cardiovascular and
metabolic adaptations (Saltin and Gollnick 1983). How-
ever, all subjects completed a familiarization session
before baseline testing, and no difference was observed
between familiarization and baseline measurements of
: several diseases. Nevertheless, we assume that the signifi-
V O2peak . Of note, all the subjects have provided a true
maximal effort during the baseline test and the maximal
heart rate achieved during graded tests did not significantly
differ between the baseline and post-intervention mea-
surement. In this context, it has to be stressed that even of
equal training volume, the training load was higher in the
HIIT compared to the MIIT (see Table 1). This could
explain the higher improvements of some physiological
: exercise protocol, it may be doubtful that the general
variables as V O2peak .
The present study results showed that adiponectin levels
increased significantly post-intervention in both training
groups (Table 3). Higher circulating adiponectin would be
beneficial during exercise, since adiponectin favors fat
oxidation and uptake of glucose into skeletal muscle
(Punthakee et al. 2006). In the present experiment, the
changes in adiponectin levels were related to the reductions
in %BF, which also decreased fasting insulin concentra-
tions in both training groups, but with larger changes in
HIIT group after the training program.
Researchers noted that in sedentary overweight popula-
tion, six sessions of HIIT over 2 weeks could yet improve
aerobic capacity, insulin sensitivity (Whyte et al. 2010) and
increase muscle oxidative capacity as well as GLUT-4
protein content (Hood et al. 2011). It is also well known that
GLUT-4 increases in proportion to increased insulin sen-
sitivity after endurance training, which also probably con-
tributes to the reduction of blood glucose (Host et al. 1998).
From another side, neither the plasma concentrations of
123
Eur J Appl Physiol (2013) 113:25312540
glucose and insulin nor the lipid profile differed across the
three groups before the training program (Table 2). After
the training program of both groups, changes in glucose
metabolism were still in the normal range and did not
change much from the pre-intervention. In humans, a higher
risk of atherosclerosis has been found with high concen-
trations of TC and LDL-C, and low concentrations of HDL-
C (Koro et al. 2006). In the post-test, the subjects altered
positively and significantly TG, TC, LDL-C after HIIT and
a significant increase was noted in HDL-C. In contrast, the
only significant increase in MIIT group occurred in the
HDL-C and the LDL-C. Indeed, the significant decrease of
LDL-C in both training groups was associated with an
improvement in the overall fat metabolism and significant
improvements in insulin resistance. The CG did not undergo
any significant alteration of any of the cited variables.
The present study results demonstrated that both interval
training types at moderate and high intensity were benefi-
cial to body mass loss and could decrease the total fat mass
of young obese women. Since the two forms of training
program reflected an increase in cardio-respiratory system
efficiency, the present data allow concluding that both
intensities (HIIT and MIIT) may be used as an efficient and
safe strategy to prevent obese youth from being affected by
cant decrease in the TG concentration that have occurred
after training at supra-maximal intensity (100110 % of
MAS), as well as the decrease in the WC, may induce
better health benefits compared to training at sub-maximal
intensity (7080 % of MAS).
Some limitation, however, should be noted in this
research study design. Given the extreme nature of the
population could safely or practically adopt the model of
high-intensity training and some displeasure could occur
for the overweight/obese adults and some other clinical
populations.
Conclusion
The most important findings of the present study were that
improvements of body composition and lipid profile were
associated with cardiovascular adaptations and increased
plasma adiponectin, resulting in a decreased HOMA-IR in
young obese women. In this context, HIIT seems to be a
better approach for the prevention and management of the
adolescent obesity and the metabolic, cardiovascular, and
hormonal disorders observed in this population than does
MIIT. Therefore, those findings provide an important first
step toward an evidence basis for the utilization of HIIT as
an exercise strategy for the young obese women. Further
studies must experiment with the optimal training protocol
Eur J Appl Physiol (2013) 113:25312540
designs to optimize health status variables improvement
and the enjoyment of the interval exercise. In this regard,
alternating short distances in fast runs and other types of
exercise (e.g., aerobics) could possibly increase the sub-
jects motivation to stick to the training program, inducing
a clear reduction in training drop-out in the obese.
Acknowledgments The present study was supported by the Min-
istry of Higher Education, Scientific Research and Technology of
Tunisia. The authors are grateful to all of the adolescents for their
cooperation; we also thank Dr. Kaabachi N., Dr. Jemaa R., Dr. Garbi
A. and the dietician Miss Mrad for their medical assistance.
Conflict of interest The authors declare that they have no conflict
of interest related to the publication of this article.
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