medRxiv : the preprint server for health sciences · 2026
Submaximal Exercise Testing to Dose High-Intensity Interval Training After Stroke: The FAST Randomized Clinical Trial.
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Bartsch Bria L, Engler Amanda, Schneider Noah, Britton-Carpenter Amanda J, Baldridge Tyler, Montgomery Robert N, Vidoni Eric D, Moores Alexandra, Vetter Elyse S, Hazen Emily M, Abraham Michael, Billinger Sandra A
Аннотация
IMPORTANCE: High-intensity interval training (HIIT) improves peak oxygen uptake (VO 2 peak) and walking post-stroke. However, previous HIIT trials have primarily implemented maximal exercise testing, limiting clinical implementation.
OBJECTIVE: Evaluate the preliminary efficacy of HIIT, compared to moderate-intensity continuous training (MICT) using a submaximal exercise test. Hypothesis: HIIT will produce greater improvements than MICT in VO 2 peak, vascular measures, and walking outcomes.
DESIGN: This was a randomized preliminary efficacy trial conducted between July 2023 and December 2025.
SETTING: University of Kansas Medical Center.
PARTICIPANTS: Participants with chronic stroke, 20-85 years of age, were randomized to HIIT or MICT.
INTERVENTION: HIIT and MICT were performed on a total-body recumbent stepper 3 times per week for 4 weeks, with intensity prescribed using peak power output (PPO) to achieve target heart rate zones derived from a submaximal exercise test. HIIT was performed for 25 minutes with 1-minute vigorous-intensity intervals (65-95% PPO) interspersed with 1-minute active recovery intervals. MICT was performed continuously at 45-65% PPO for 25 minutes.
MAIN OUTCOMES: The primary outcome was change in predicted VO 2 peak. Secondary outcomes included middle cerebral artery velocity, peripheral vascular function, and arterial stiffness with gait speed and walking endurance as tertiary outcomes.
RESULTS: Forty-nine participants (HIIT: n=25, MICT: n=24) were randomized (62.4(12.5) years, 42.9% female), attended 99.5(2.0)% of sessions, and achieved target intensity zones. No study-related serious adverse events occurred. Our results showed no significant between-group differences (p=0.54) for study outcomes. Both groups significantly improved VO 2 peak (HIIT: +1.13 mL•kg-1•min-1 (95% CI: 0.05-2.21), p=0.04; MICT: +1.58 mL•kg-1•min-1 (95% CI: 0.18-2.97), p=0.03) and with fast gait speed and walking endurance. Peripheral vascular function significantly improved following HIIT.
CONCLUSIONS AND RELEVANCE: HIIT can be safely implemented in individuals with chronic stroke using a submaximal exercise test. Both HIIT and MICT elicited clinically meaningful gains in VO2peak and walking. However, only HIIT led to a significant improvement in peripheral vascular function, suggesting a biologic signal for intensity-dependent vascular adaptation.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05936008.
OBJECTIVE: Evaluate the preliminary efficacy of HIIT, compared to moderate-intensity continuous training (MICT) using a submaximal exercise test. Hypothesis: HIIT will produce greater improvements than MICT in VO 2 peak, vascular measures, and walking outcomes.
DESIGN: This was a randomized preliminary efficacy trial conducted between July 2023 and December 2025.
SETTING: University of Kansas Medical Center.
PARTICIPANTS: Participants with chronic stroke, 20-85 years of age, were randomized to HIIT or MICT.
INTERVENTION: HIIT and MICT were performed on a total-body recumbent stepper 3 times per week for 4 weeks, with intensity prescribed using peak power output (PPO) to achieve target heart rate zones derived from a submaximal exercise test. HIIT was performed for 25 minutes with 1-minute vigorous-intensity intervals (65-95% PPO) interspersed with 1-minute active recovery intervals. MICT was performed continuously at 45-65% PPO for 25 minutes.
MAIN OUTCOMES: The primary outcome was change in predicted VO 2 peak. Secondary outcomes included middle cerebral artery velocity, peripheral vascular function, and arterial stiffness with gait speed and walking endurance as tertiary outcomes.
RESULTS: Forty-nine participants (HIIT: n=25, MICT: n=24) were randomized (62.4(12.5) years, 42.9% female), attended 99.5(2.0)% of sessions, and achieved target intensity zones. No study-related serious adverse events occurred. Our results showed no significant between-group differences (p=0.54) for study outcomes. Both groups significantly improved VO 2 peak (HIIT: +1.13 mL•kg-1•min-1 (95% CI: 0.05-2.21), p=0.04; MICT: +1.58 mL•kg-1•min-1 (95% CI: 0.18-2.97), p=0.03) and with fast gait speed and walking endurance. Peripheral vascular function significantly improved following HIIT.
CONCLUSIONS AND RELEVANCE: HIIT can be safely implemented in individuals with chronic stroke using a submaximal exercise test. Both HIIT and MICT elicited clinically meaningful gains in VO2peak and walking. However, only HIIT led to a significant improvement in peripheral vascular function, suggesting a biologic signal for intensity-dependent vascular adaptation.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05936008.