⭑ Interval training doesn’t need to be exhausting ✔ try MIIT
⭑ High Intensity or Moderate? ✔ a guide to help you choose
⭑ MIIT is great, but it doesn’t substitute for HIIT ✔ here's why
⭑ Good knees are critical for your healthspan ✔ 3 exercises for knee health

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Hello,

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Knees.

Like many of you, I've started paying more attention to my knees. Now that I'm in the athletics club every week and running in organised competitions, knee health has become a top priority.

It's our muscles that keep the moving parts of our knees in line and flowing smoothly without pain. As they weaken, our knees start to rub in the wrong spots. I found three simple exercises which activate one of the most important muscles to maintain knee alignment and avoid pain. See item #4.

High-intensity interval Training (HIIT) is hard work and doesn't suit most people. Moderate-intensity interval Training (MIIT) has come into vogue, and research supports its value as an alternative to HIIT - see item #1.

If you are physically capable of doing both HIIT and MIIT, how would you choose between the two? Check my guide - see item #2.

Don't be fooled by social media, though; MIIT is an alternative but not a substitute for HIIT - see item #3.

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01 Interval Training Benefits With Gain Without The Pain

High-intensity Interval Training is associated with hard-core fitness folk. There's a reason for that, because exercising at 80 - 95% of your maximum heart rate is hard.

However, recent research into interval training has begun to support the idea that high-intensity efforts may not be necessary for you to achieve significant health benefits.

Overall, these studies suggest that Moderate-Intensity Interval Training can be an effective and possibly more accessible alternative to high-intensity training, especially for those at different stages of fitness or with chronic conditions.

⇒ Both HIIT and MIIT have demonstrated similar improvements in cardiorespiratory fitness, body composition, and metabolic health markers - proportional to the volume of work e.g. effort X time.

What this means for you: I can understand if HIIT is not for you. But rather than just meandering through your exercise program or postponing starting one, consider adding structure by laying out a series of moderate-intensity routines.

Having a structure means that you have to think less about what to do each time you go to the gym and that you also have a framework for measuring your progress. Here's a Moderate Intensity Interval Training structure:

1. Warm-Up Duration: 5-10 minutes
   - Activity: Begin with a light activity, such as walking on a treadmill or gentle cycling, to gradually increase your heart rate and warm up the muscles.
   ​
2. MIIT Repetitions:​
   - Interval Duration: 3-5 minutes of moderate-intensity exercise
   ​- Recovery Duration: 1-2 minutes of light activity or rest
   ​- Repetitions: 4-6 cycles
   - Exertion Level: 55% to 75% of your Maximum Heart Rate (the top of Zone 2 on your Apple Watch).
   ​
   Examples of Moderate-Intensity Activities:
   - Brisk walking or light jogging on a treadmill
   - Cycling at a steady but manageable pace
   - Using an elliptical machine with moderate resistance
   - Rowing at a steady, moderate pace
   ​
3. Cool Down Duration: 5-10 minutes
   ​- Activity: Gradually reduce the intensity of your effort to a gentle walk or slow pedal. Then, do stretching exercises for the best results and recovery.

Mix up your activities and aim for 3 times a week.

Related: Even Very Active Runners Lose Leg Strength Without Resistance Training​

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02 How To Choose Between HIIT and MIIT - A Guide

Regular readers will know that I often say that the best exercises are the ones you'll stick with. How can you determine if HIIT or MIIT might be a good choice for you to start, or to switch between one and the other?

They both offer substantial benefits.

⇒ The best choice will depend on individual circumstances and preferences - your physical capability, health status, personal goals, and lifestyle factors.

What does this mean for you? Here’s a playbook to help you choose between doing HIIT or MIIT, taking into account your current fitness, your goals, the time you have available, the risk of injury, psychological factors and social preferences:

1. Current Health and Fitness Levels​
   - HIIT is best if you are moderately active and have no significant cardiovascular, joint, or other health issues. It can quickly improve your cardiovascular health, strength, and metabolic function.
   - MIIT is more suitable if you are a beginner, less active, or have health issues such as joint pain or chronic conditions like heart disease or diabetes.
   ​
2. Personal Goals​
   - HIIT is ideal for quick fitness improvements, significant weight loss, or metabolic health improvements in a shorter period. It is effective in improving your aerobic capacity and glucose metabolism.
   - MIIT is best if you prefer more steady progress, maintaining health rather than peak fitness, or a less strenuous exercise routine that can be sustained long-term.
   ​
3. Time Availability​
   - HIIT is highly efficient if you have limited time for workouts. Sessions can be as short as 20-30 minutes and still be highly effective—this is the genesis of the F45 fitness franchise.
   - MIIT requires more time for similar health benefits. It is suitable if you have more time to exercise, or you can do it in less time and gain very worthwhile proportional benefits.
   ​
4. Risk of Injury, and Recovery Time​
   HIIT: Higher impact and intensity mean a greater risk of injury and longer recovery times. It is not for you if you have existing injuries or poor recovery ability.
   - MIIT lowers the impact risks of injury and provides a quicker recovery time. Start here if your recovery capacity is low.
   ​
5. Psychological Factors​
   - HIIT provides a challenging routine that can be highly motivating for some but may feel overwhelming for others. There's little time and energy for small talk, but you share the bond of working hard.
   - MIIT can be preferable if you find comfort in routine or are intimidated by high intensity.
   ​
6. Social Preferences​
   - HIIT is conducted in dynamic, high-energy group settings, which might appeal if you enjoy being part of a group of "hardcore" fellow travellers.
   - MIIT: Also often performed in groups, but easy to do solo if you prefer a more solitary exercise experience. In a group setting, there is more time and energy for talking and enjoying the interaction.

⇒ Tip: some research found that people find HIIT more manageable in their schedule and stick with it compared to people who choose MIIT but could not keep up the extra time commitment.​​​​​

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03 MIIT Isn't The New HIIT - It's A Different Option

Some headlines proclaim Moderate Intensity Interval Training as the new HIIT, implying it is almost as effective.

It's not.

It's true to say that MIIT delivers substantial benefits for everyone when done consistently, especially if you have not been so active in the past.

⇒ However, HIIT delivers unique benefits over MIIT - particularly superior cardiovascular and metabolic health improvements.

What this means for you: If HIIT suits you, then you gain the following benefits as compared to MIIT:

1. HIIT significantly increases maximal oxygen uptake (VO2max), which is a key indicator of cardiovascular fitness. Improved VO2max is associated with reduced risks of cardiovascular diseases.
2. HIIT causes greater physiological adaptations in your cardiovascular system than steady-state, moderate-intensity efforts. This includes increased stroke volume (the amount of blood ejected by the heart in each beat) and improved cardiac output (overall blood flow).
3. HIIT leads to more pronounced improvements in insulin sensitivity than MIIT. This benefit is critical as improved insulin sensitivity reduces the risk of type 2 diabetes and can help manage existing diabetes more effectively.
4. The intense exertion in HIIT triggers significant muscle glucose uptake, which is maintained for hours post-exercise, thereby improving overall glucose metabolism. This is a huge benefit for those of us with diabetes.
5. The vigorous intensity of HIIT induces endothelial function improvement (the function of the vascular endothelial cells lining the blood vessels) and increases arterial elasticity. These changes help reduce blood pressure.
6. HIIT is highly effective for fat loss and increasing overall caloric burn. The nature of high-intensity work followed by rest periods increases the body’s metabolic rate after exercise for 24 - 48 hours - known as "the afterburn effect". This results in a calorie burn of approximately 6-15% more than the energy expended during the exercise.

⇒ HIIT is a highly effective training method for improving cardiovascular and metabolic health in less time than MIIT.

Caveat: Doing HIIT once a week is sufficient when we are older, as more often can lead to unnecessary stress, which counteracts the benefits. In other words, more is not better.

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04 Why Quad Activation Matters To Prevent Knee Pain

Our exercise of the week is... targeted for the Vastus Medialis Oblique (VMO) quad.

Activating your Vastus Medialis Oblique muscle means engaging and strengthening a specific part of the quadriceps muscle in your thigh, which is crucial for stabilising your knee.

The VMO is located just above and to the inside of your knee and plays a significant role in keeping your kneecap (patella) properly aligned when you move your leg. A lack of alignment leads to knee pain, exacerbated by walking and running.

⇒ However, with targeted strengthening exercises, you can protect your knees and enjoy pain-free mobility.

What this means for you: The VMO is an integral part of the quadriceps group that plays a pivotal role in stabilising your knee. Strengthening the VMO not only helps in preventing knee injuries but also aids in quicker rehabilitation post-injury.

Here are three effective exercises designed to target this key muscle:

1. VMO Activation Squat: Stand with your feet hip-width apart, toes slightly turned out. Place a small ball between your knees. As you squat, squeeze the ball to engage your VMO. Aim for 3 sets of 10-15 repetitions.
2. Step-Ups: Find a step or a stable platform. Step up with one foot, focusing on pushing through your entire foot and engaging your thigh. Alternate legs and perform 3 sets of 12 steps per leg.
3. Leg Extensions: Sitting on a chair or leg extension machine, slowly extend your knee against resistance. Focus on tightening your quads as you fully extend your leg. Perform 3 sets of 10 repetitions.

Incorporating these exercises into your routine 2-3 times a week will significantly enhance the strength and stability of your knees.

⇒ Keep testing your ability to achieve “terminal knee extension”. This ability helps fully extend the knee and plays a critical role in shielding the cartilage from impacts, thus averting conditions like osteoarthritis. See this short, excellent video.

Related: Avoid Ankle Injuries And Gain Balance Better With These Four Everyday Simple Exercises​​​​​​

Thanks for reading!

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>> My Latest Blog Post: Energise Your Golden Years: Boosting Your Desire to Exercise with Gut-Healthy Foods​

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