+ MODEL

Nutrition, Metabolism & Cardiovascular Diseases (2013) xx, 1e6

Available online at www.sciencedirect.com

journal homepage: www.elsevier.com/locate/nmcd

VIEWPOINT

Is high-intensity exercise better than

moderate-intensity exercise for weight loss?
P. De Feo*

Healthy Lifestyle Institute, C.U.R.I.A.MO. (Centro Universitario Ricerca Interdipartimentale Attività

Motoria), University of Perugia, Via G. Bambagioni, 19, 06126 Perugia, Italy

Received 10 April 2013; received in revised form 23 May 2013; accepted 10 June 2013

KEYWORDS Abstract This viewpoint debates the state-of-the-art research focusing on the optimal inten-
Exercise; sity of the exercise programs for inducing a sustained weight or fat-mass loss in overweight/
Obesity; obese people. In our demanding society, the most attractive messages in the popular press
Diabetes; are those promising the best results in a short time. This might explain the emphasis given
Lifestyles; by media to those scientific articles that report the efficacy on weight loss of exercise pro-
Motivation grams by their shorter duration and higher intensity.
However, in the literature on overweight or obese people, there is little conclusive evidence
for more favorable effects with high-intensity training than with continuous moderate-
intensity exercise on body weight or fat mass loss. Since both exercise protocols have been
demonstrated as useful to reduce body weight, the decision on the intensity of exercise pre-
scription should be individualized and based on outcomes different from fat or weight loss. In
this regard, there are pro and contra arguments for the prescription of high-intensity aerobic
exercise in obese people. Among the pro arguments, is the demonstration that, in several
studies, high-intensity training appears to induce superior improvements in aerobic fitness.
Among the contra arguments to prescribe high-intensity exercise is the demonstration that
prescribing a higher-intensity exercise decreases adherence and results in the completion of
less exercise. Thus, a successful exercise program should be proposed at a moderate intensity
and a low perceived effort because obese subjects who have low self-efficacy, poor mood
status, and are not familiar with high-intensity workouts could easily drop out.
ª 2013 Elsevier B.V. All rights reserved.

* Tel.: þ39 075 33320.

E-mail addresses: [email protected], [email protected].

0939-4753/$ - see front matter ª 2013 Elsevier B.V. All rights reserved.
http://dx.doi.org/10.1016/j.numecd.2013.06.002

Please cite this article in press as: De Feo P, Is high-intensity exercise better than moderate-intensity exercise for weight loss?, Nutrition,
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 + MODEL
2 P. De Feo

Introduction range of the exercise effort is used to define moderate- or

high-intensity exercise is sometimes overlapping and not
The pandemic distribution of being overweight and obesity well standardized. This opinion view adopts the definition
has resulted in the growth in interest by the media in of the American College of Sports Medicine, which states
communicating different nutritional and exercise strategies that the intensity for moderate-intensity exercise ranges
to the general population to achieve weight loss. Certainly, between 40% and 60% of maximal capacity, whereas that
regular exercise is an effective way to prevent weight gain for high-intensity exercise is above 65% of the maximal
and promote weight loss [1]. However, in our demanding capacity [12]. However, it should be outlined that in most
society, the most attractive messages in the popular press of studies in which volunteers performed exercise at high-
are those promising the best results in a short time. This intensity, the intensity prescribed was above 80e85% of
might explain the emphasis given by media to those sci- peak power output or maximal velocity. Below 80% of peak
entific articles that report the efficacy on weight loss of power output, we should not consider generally this as
exercise programs by their shorter duration and higher in- high-intensity training.
tensity. This opinion view debates the state-of-the-art
research focusing on the optimal intensity of the exercise
programs for inducing a sustained weight or fat-mass loss in Intensity of aerobic and resistance exercises
overweight/obese people. and weight loss
Theoretically, an optimal exercise program for weight
loss should be feasible and attractive for patients, lead to There is enough evidence that suggests that aerobic and
tangible health outcomes, and consequently be adopted by resistance exercises are beneficial for patients with obesity
patients as definite lifestyle behavior. According to Ban- and related morbidities. For this reason, all scientific
dura’s social learning theory, the major determinants that guidelines recommend that at least 150 min per week of
influence a person in adopting a new behavior are con- moderate aerobic exercise should be combined with three
sciousness and self-esteem [2]. Thus, a sedentary obese weekly sessions of resistance exercise to increase muscle
person before starting a regular exercise program should be strength [5e11]. However, if we limit the discussion to the
convinced that the positive results outweigh his/her nega- outcome “weight loss” or “fat mass loss”, only aerobic
tive expectations and that he/she will be able to perform exercise has solid evidence supporting its efficacy in the
the exercise [3]. Qualitative analysis of obese patients’ literature; whereas conflicting data regarding the effects
views on barriers to start a lifestyle intervention program, of resistance exercise have been produced [13]. Very
in which exercise represents the core strategy, shows that recently, Willis et al. specifically examined the effects of
the decision-making process is strongly influenced by the the type of exercise on body mass and fat mass in over-
expectations of significant weight loss and other health weight adults and, in a randomized approach, compared
outcomes that are counterbalanced by the views of exer- similar amounts of aerobic and resistance training and a
cise as a sacrifice, a time demanding, difficult, or impos- combination of the two [13]. Primary outcomes included
sible task [4]. total body mass, fat mass and lean body mass [13]. The
In the last two decades, a growing number of studies aerobic training and aerobic/resistance training groups
have tested the efficacy of exercise programs with reduced the total body mass (TBM, aerobic 1.8  3.0,
different structures regarding the type (aerobic, resis- aerobic/resistance 1.6  3.1 kg, mean  SD) and fat
tance, and mixed), the weekly frequency, the volume, the mass (FM, aerobic 1.7  2.7, aerobic/resistance
intensity (moderate or high), and the duration. Based on 2.4  3.0 kg) more than that of the resistance training
these results, many national and international health or- (TBM 0.8  2.3, FM 0.3  2.1 kg, p < 0.05), but they were
ganizations or scientific societies have published position not different from each other. Resistance training and
statements and guidelines on the promotion of physical aerobic/resistance training increased the lean body mass
activity or the use of exercise as a therapeutic tool for more than that of the aerobic training (p < 0.05). Thus,
obesity, diabetes, and prevention of cardiovascular dis- while requiring double the time commitment, a program of
eases that take into account the expected health outcomes combined aerobic/resistance training did not result in
and the patients’ compliance [5e11]. In order to better significantly more fat mass or body mass reductions over
clarify the matter of the present opinion view, it is neces- aerobic training alone. The authors conclude that in
sary to clearly distinguish the terms physical activity and balancing time commitments against health benefits, it
exercise, sometimes inaccurately or interchangeably used, appears that aerobic training is the optimal mode of ex-
and to share a definition of exercise intensity (Table 1). ercise for reducing fat mass and body mass while a pro-
Physical activity can be defined as any bodily movement, gram including resistance training is needed for increasing
produced by skeletal muscles, that results in energy lean mass in middle-aged and overweight/obese in-
expenditure beyond resting expenditure [12]. Exercise is a dividuals [13]. In my opinion, these results do not mean
subset of physical activity that is planned, structured, re- that resistance training should be reduced because people
petitive, and purposeful in the sense that improvement or lose muscle mass when they grow older, and stronger
maintenance of physical fitness is the objective [12]. A muscles can prevent possible injuries caused by aerobic
clear differentiation between moderate- and high-intensity exercise. However, owing to the poor efficacy of resistance
exercises is also relevant to discuss the results of the ex- training on fat mass loss, the following discussion will be
ercise studies performed in obese populations because in limited to the effects of high-intensity compared to
the methodological sections of some of these studies the moderate-intensity aerobic exercise on weight loss.

Please cite this article in press as: De Feo P, Is high-intensity exercise better than moderate-intensity exercise for weight loss?, Nutrition,
Metabolism & Cardiovascular Diseases (2013), http://dx.doi.org/10.1016/j.numecd.2013.06.002
 + MODEL
Is high-intensity exercise better than moderate-intensity exercise? 3

Table 1 Definitions of physical activity, exercise, and of moderate or high exercise intensities.
Physical activity can be defined as any bodily movement, produced by skeletal muscles, that results in energy expenditure
beyond resting expenditure.
Exercise is a subset of physical activity that is planned, structured, repetitive, and purposeful in the sense that improvement
or maintenance of physical fitness is the objective.
Moderate-intensity exercise ranges between 40% and 60% of maximal capacity.
High-intensity exercise is above 65% of the maximal capacity.
Generally, high intensity exercise is considered that performed over 80% of maximal power output.

Weight loss and aerobic exercise intensity patients with the metabolic syndrome [23]. The two exer-
cise programs were equally effective at lowering the mean
High-intensity exercise (above 80e85% of peak power arterial blood pressure and reducing fat mass and body
output) can be performed only for few minutes. For this weight (2.3 and 3.6 kg in high-intensity exercise
reason, it is proposed in practice as high-intensity interval and continuous moderate-intensity exercise, respectively)
training (HIIT). HIIT involves exercising repeatedly at a high [23].
intensity for 30 s to several minutes, separated by 1e5 min Thus, at present, it has not been demonstrated that in
of recovery (either no- or low-intensity exercise) [14]. A overweight or obese people HIIT is better than moderate-
particular HIIT intervention used in studies is the Wingate intensity exercise in inducing weight loss. In 2003, Jakicic
protocol developed in the 1970s [15]. This involves 30 s of and coworkers published the results of a randomized trial
cycling at maximum effort (at an intensity of over 90% of that compared the effects of four exercise-training pro-
the maximal oxygen uptake, also known as 90% of VO2 max) grams that differed in terms of intensity and duration, in
separated by 4 min of recovery, repeated 4e6 times per sedentary and overweight women with body weight,
session, with three sessions per week. Wingate tests require cardiorespiratory fitness, and exercise participation as the
a specialized cycle ergometer and the ‘all-out’ maximal main outcome measures [25]. Participants were randomly
effort necessitates an extremely high level of subject assigned to 1 of 4 exercise groups (vigorous intensity/high
motivation. The bout of exercise is until exhaustion, and duration; moderate intensity/high duration; moderate in-
the principle of HIIT is spent a long time at a high per- tensity/moderate duration; or vigorous intensity/moderate
centage of peak VO2, as proposed for athletes by Dupont duration) based on estimated energy expenditure
et al. [16], Millet et al. [17]. Therefore, it may not be safe (1000 kcal/week versus 2000 kcal/week) and exercise in-
or practical to implement this form of training in the gen- tensity (moderate versus vigorous). Vigorous exercise was
eral overweight or obese population. Two weeks of HIIT performed on treadmills and prescribed by using the Borg’s
using Wingate protocol or a more practical model of low- scale (13e15/20 of rate of perceived exertion) and age-
volume HIIT [18] was a sufficient stimulus to increase predicted maximal heart rate. The vigorous-exercise pro-
skeletal muscle oxidative capacity and GLUT4 protein tocol used by Jakicic and coworkers was at about 75% of the
content. At present, no data on the effects on body weight maximal capacity and thus, less demanding in comparison
or fat mass in response to long-term use of HIIT in obese to the maximal effort required by HIIT. The results of this
people has been published. Tremblay and colleagues, in well-conducted randomized study demonstrated that sig-
1994, were the first to explore the impact of exercise in- nificant weight loss and improved cardiorespiratory fitness
tensity by using a 15e20-week ergocycle exercise program were achieved through the combination of exercise and
in two groups of non-obese young adults on body fatness diet during 12 months, although no differences were found
and skeletal muscle metabolism [19]. Body weight did not based on different exercise durations and intensities [25].
change after the moderate or HIIT period, however, a This conclusion has been subsequently confirmed by
significantly greater reduction in subcutaneous fat Chambliss who using a quite similar study design demon-
(measured by skin folds) was observed in the HIIT group strated that sedentary overweight women lost weight and
[19]. More recently, several studies have examined the improved cardiorespiratory fitness in a year-long combined
effects of HIIT for a period of training ranging from 12 to 24 dietary and exercise regimen and that the duration of ex-
weeks [20] and demonstrated significant reductions of ercise (at least 150 min/week of walking) was more
weight or fat mass [21e24]. However, these studies were important than vigorous versus moderate intensity in
not designed to compare the efficacy of HIIT versus mod- achieving these goals [26]. Finally, in 2005, Duncan et al.
erate aerobic-exercise intensity on weight or fat mass loss compared the effects of walking at different intensities on
in obese subjects as the major outcome. Trapp et al. cardiorespiratory fitness and lipid profile in sedentary
compared the effects of HIIT versus steady-state exercise, adults [27]. The four different exercise conditions: mod-
but, in a group of young healthy women with a BMI of erate intensityelow frequency, moderate intensityehigh
23.2  2.0 kg/m2 and demonstrated that HIIT exercise frequency, hard intensityelow frequency, and hard inten-
induced a significant reduction in total body mass, fat mass, sityehigh frequency did not differentially affect body
and trunk fat whereas steady-state exercise had no effect weight (p Z 0.78), which was not an outcome of this ran-
[21]. Tiønna et al. examined the effects of moderate- domized study [27].
versus high-intensity exercise with regard to variables At present, based on the limited number of available
associated with cardiovascular function and prognosis in 32 studies, we can conclude that there is no convincing

Please cite this article in press as: De Feo P, Is high-intensity exercise better than moderate-intensity exercise for weight loss?, Nutrition,
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 + MODEL
4 P. De Feo

evidence of the superiority of high-intensity exercise in might also be influenced by exercise intensity [34]. In this
inducing weight loss in an overweight or obese population. regard, scientific literature reports conflicting results.
Some studies have demonstrated that high-intensity exer-
Exercise intensity and substrate utilization cise favors a negative energy balance to a greater extent
than does low-intensity exercise [34,35]. Another study
performed in normal weight women reached the opposite
The recent availability of stable isotope techniques and of
conclusion that high-intensity exercise increases energy
nuclear magnetic resonance spectroscopy, along with the
intake [36]. In 1990, Kissileff and coworkers compared post-
classic studies made with indirect calorimetry and tissue
exercise food intake in a small number of obese (n Z 9) or
biopsy, has permitted to establish the contribution of
non-obese (n Z 9) women after strenuous or moderate
glucose and FFA to ATP production in exercising humans
exercise [35]. Obese women ingested the same amount of
[28].
the liquid test meal after moderate or strenuous exercise in
A main conclusion that can be drawn from these studies
contrast to non-obese women who ingested fewer calories
is that energy flux is determined by relative exercise in-
after intense exercise [35]. It is hypothesized that the
tensity [29]. At rest, most of energy (about 60%) for non-
absence of an increase in energy intake when increasing
contracting skeletal muscle derives from lipid oxidation
expenditure in obese subjects is based on their excess en-
[29]. During moderate intensity exercise (40e50% of VO2
ergy stores in the form of adipose tissue [35].
max), both fuels lipid and glucose are equally oxidized by
Thus, according to this limited experience high-intensity
working muscles. At greater exercise intensities carbohy-
exercise should not significantly modulate hunger or
drate become the primary energy source whereas FFA flux
appetite in obese people and favor weight loss through a
and oxidation are inversely related to exercise intensity.
better control of food intake.
The rate of FFA utilization declines below the basal values
at high (>80%) exercise intensities; under these conditions
the energy supply of working skeletal muscle becomes Conclusions
strictly dependent on muscle glycogen and blood glucose
[29,30]. Muscle glycogen depleted because of high intensity
In the literature on overweight or obese people, there is
exercise must be restored in the hours following the exer-
little conclusive evidence for more favorable effects with
cise session and this elicits greater lipid oxidation rates in
high-intensity training than with continuous moderate-
the 24 h period following intense exercise in comparison to
intensity exercise on body weight or fat mass loss. Since
moderate exercise [28].
both exercise protocols have been demonstrated as useful
The different rates and types of substrate utilization
to reduce body weight, the decision on the intensity of
during moderate or high intensity exercise have clear im-
exercise prescription should be individualized and based on
plications for exercise mediated fat loss. In theory, high
outcomes different from fat or weight loss. In this regard,
intensity exercise allows patients/subjects to lose more fat
there are pro and contra arguments for the prescription of
mass than moderate intensity exercise, considering that it
high-intensity aerobic exercise in obese people. Among the
induces increased oxidation of lipids after the session. In
pro arguments for high-intensity aerobic exercise, is the
addition, the principal interest of high intensity exercise is
demonstration that, in several studies, high-intensity
the possibility to maintain high-intensity exercise for far
training appears to induce superior improvements in aero-
longer periods than during continuous exercise. Therefore,
bic fitness and similar improvements in some cardio-
high intensity exercise elicits a greater training stimulus,
metabolic risk factors in comparison to continuous
which further increase the total active caloric expenditure
moderate-intensity exercise when performed by healthy
[3]. On the other hand, several obese persons refer that they
subjects or clinical patients for at least 8e12 weeks [37].
do not feel confident with high rates of perceived exertion
Certainly, a greater improvement in cardio-respiratory
and naturally prefer to exercise at moderate intensities [4].
fitness is a valuable outcome because the results of
For these patients the optimal strategy to promote fat loss
several prospective studies have shown a significant inverse
are open air group exercise sessions at moderate intensity
relationship between cardio-respiratory fitness and all
but for many hours, using socialization and pleasant sur-
causes of risk of death in obese or type 2 diabetes subjects
roundings as elements for long term adherence. Under these
[38,39]. In addition, for some patients introducing sub-
conditions trained obese subjects will predominantly use
maximal short repeats in the exercise schedule might
lipid oxidation for their physical activity [28].
represent a mental stimulus that mitigates the boring as-
pects of a constant exercise session and augments the long-
Strenuous exercise and appetite term adherence to regular exercise [40]. The game-like
nature of interval training makes it an attractive alterna-
Exercise-induced weight loss is the result of the balance tive [41]. In theory, it could be incorporated into every
between the effects of exercise on energy expenditure and phase of rehabilitation adjusted according to each sub-
appetite. Exercise is often considered as an unsuccessful ject’s medical history and functional status. Among the
form of weight control because of the possible concomitant contra arguments to prescribe high-intensity exercise is the
compensation of food intake. However, this belief is not consideration that sedentary and obese people usually view
supported by several studies that show that exercise in- exercise as a “sacrifice” or “something impossible” [4].
duces a brief suppression of hunger [31e33], even if this Thus, a successful exercise program should be proposed at
does not necessarily translate into a decrease in subse- a moderate intensity and a low perceived effort because
quent food intake [31,32]. Post-exercise energy intake obese subjects who have low self-efficacy, poor mood

Please cite this article in press as: De Feo P, Is high-intensity exercise better than moderate-intensity exercise for weight loss?, Nutrition,
Metabolism & Cardiovascular Diseases (2013), http://dx.doi.org/10.1016/j.numecd.2013.06.002
 + MODEL
Is high-intensity exercise better than moderate-intensity exercise? 5

status, and are not familiar with high-intensity workouts [9] Marwick TH, Hordern MD, Miller T, Chyun DA, Bertoni AG,
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Nutrition, Physical Activity and Metabolism; Interdisciplinary
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Please cite this article in press as: De Feo P, Is high-intensity exercise better than moderate-intensity exercise for weight loss?, Nutrition,
Metabolism & Cardiovascular Diseases (2013), http://dx.doi.org/10.1016/j.numecd.2013.06.002