COPYRIGHT EDIZIONI MINERVA MEDICA Muscular morphological adaptations of two whole-body high intensity interval training (HIIT) configurations ‘Masoud Moghaddam ', Carlos A. Estrad: mothy Baghurst *, Bert H. Jacobson ! 1. Oklahoma State University, Stillwater, OK, USA 2. Aurora University, Aurora, IL, USA 3, Florida State University, Tallahassee, FL, USA Corresponding author: Masoud Moghaddam Department of Health and Human Performance Oklahoma State University 198 Colvin Recreation Center Stillwater, OK 74074 Phone: (469)623-7078 Email: masoud moghaddam@okstate.edu Manuscript word count: 3,349 words (excluding abstract and references) Abstract word count: 238 words Number of Tables: 1 Number of Figures: 2 aa SSIs ss ere ane inreioere poe ne ne ein ae ma omeeh ears a [Bat ofthe arin cry Commacial se nat uemoe. Ihe anche tks rome aoe rot serra psauelan 2 epi ex pewonal or connmarccture net Bagi Sen katt ter cee antennas eran end aera kar me eT EETCOPYRIGHT EDIZIONI MINERVA MEDICA Muscular morphological adaptations of two whole-body high intensity interval training configurations Abstract BACKGROUND: High-intensity intermittent training (HITT) has increased in popularity due to being, time-efficient mode of exercise, Previous HIIT studies have mainly focused on percentage of fat loss, fat mass loss, and weight loss. However, enhancing muscle protein synthesis induced by HIIT that results in muscular morphological adaptations is a potential benefit of HIIT. This study compared the effects of two HIIT protocols on muscular morphological adaptations METHODS: Thirty-four recreationally active participants were randomly assigned to 10-5-HIIT and 20- 10-HIIT to complete 6 sets of 6 intervals. The 10-5-HIIT and 20-10-HIT protocols were performed with 108:5s and 20s: 10s exercise-to-rest ratios and provided with 1- and 2-min recovery periods between sets, respectively. Muscle cross-sectional area (mCSA) and echo intensity (El) of the rectus femoris (RF) and vastus lateralis (VL) were assessed via B-mode ultrasonography before and after intervention. Two-way mixed factorial ANOVAs were used for analyses. RESULTS: The 10-5-HIIT and 20-10-HIIT groups significantly (p< 0.05) increased RF mCSA (change vo) and VL mCSA (A= 1.2 1.6 em’, 9.0%; A= 2.204 1.4 cm’, 10.4%), respectively. No significant (p > 0.05) change was observed for the El of the RF and VL. CONCLUSION: Whole-body HITT can be a time-efficient exercise modality to elicit muscular morphological adaptations in the RF and VL muscles. The 10-5-HIIT protocol induced benefits comparable to those of the 20-10-HIIT, while it reduced the total exercise time by 50%. Keywords: Intermittent exercise, muscle size, muscle quality, cross-sectional area 2 cere elated emai ete rte Ahaha in te dabei aks ‘palecrere! fac fie Gace euch crnaienat ced teenie Rem stere Sacre moms crchy oarisarsuneh may los 3 te Ace una ory Datel ne hi ery Commerc ea pers ne cose of tre wos rom fs acelin parted The esto oer er pena Barri ct pearito oreioe cone, rey, ti Bog o cage oy capt ok fue wich ha Pir cy Don ec Bet parfiadCOPYRIGHT® EDIZIONI MINERVA MEDICA Muscular morphological adaptations of two whole-body high intensity interval training configurati Introduction The prevalence of obesity and overweight has become one of the significant public health concerns in the United States [1]. The percentages of U.S. adults (aged 18 and over) participating in aerobic exercise or combining aerobic and resi 1 training are 51.7% and 21.7%, respectively [2]. The American College of Sports Medicine (ACSM) recommends that adults aged 18 to 65 should perform at least 150 minutes of moderate-intensity exercise at 64%-76% of maximal heart rate (HRmas) per week, exercise at 77% approximately 75 minutes of vigorous-intensit 95% of HRs each week, or a combination of both moderate- and vigorous-intensity exercise [3]. However, achieving these targe be affected by personal and environmental barriers with “lack of me" reported as the main bactier of exercise participation [4] Recently, high-intensity intermittent training (HIIT) has increased in popularity due to being time-efficient mode of exercise. Generally, HIIT refers to a group of short bouts of exercise separated by short rest periods. There is growing evidence that HIIT may be an alternative to traditional endurance trai ing due to lower exercise volume and duration but with similar cardiorespiratory adaptations [5] Previous studies have reported HIIT as a fast-paced exercise method to inerease maximal oxygen uptake [5], enhance body composition [6], and improve insulin sensitivity [7]. In spite of these significant health benefits, few studies have been conducted to determine muscular morphological adaptations. ‘The previous study has shown that high intensity interval exercise is associated with significant reductions in total body fat, subcutaneous leg and trunk fat, and insulin resistance compared to the same frequency of steady-state exercise [7]. However, enhancing muscle protein synthesis induced by HIIT that results in muscular morphological adaptations is a potential benefit of HIIT [8]. Moreover, the majority of previous studies implemented HIIT protocols as ergometer-based modes of exercise, which has been suggested as an efficient method to improve physical fitness [9]. However, functional HIIT based on 3 Reever are cet peta orks atone opts er ese of ema terse eect] eins ae kr uae Ph futsering eS fey merc erecta oom Smarr enerre tem ee ee eens Bere sechar trans cor ee gestae oceans pet re etareas akan eo ante ese BEUELI ee cies ene Pn cena ee aaaCOPYRIGHT® EDIZIONI MINERVA MEDICA, Muscular morphological adaptations of two whole-body high intensity interval training configurations whole-body training has been recently shown as effective as ergometer-based HIIT [9, 10]. Whole-body training can be more practical because it has the potential to be performed by a wide-range of populations, including those without access to gym facilities or equipment. Therefore, the present study implemented HIIT based on whole-body training for its applicability to the general population. Muscular morphology has been reported to be associated with muscular power [11], muscular strength [12, 13] and cardiovascular fitness [11]. Furthermore, ultrasonography has been determined to be an accurate and reliable technique to measure muscle morphology [14]. Ultrasonography is a popular tool to determine muscle cross-sectional area (mCSA) and echo intensity (El), which indicate the quantity and quality of muscle mass, respectively [12, 13]. Muscle quality can be assessed by El, which estimates the amount of contractile (i.e., musele fibers) and non-contraetile (ic., adipose, connective tisstie) components of muscle jon, several studies have demonstrated the effects of sue [15, 16]. In ad resistance training on mCSA [17, 18] and EI [12, 18], but few studies have investigated the muscular morphologi adaptations of HIIT. Although HIIT protocols of various intensities and durations have been found to be effective training methods, no optimum HIIT protocol has been established to determine the most efficient intensity and duration. It has been suggested that a 2:1 exereise-to-rest ratio elicits a higher accumulated oxygen deficit than other ratios (i.e., 1:1, 1:2) [19], whieh is associated with anaerobic metabolism [20]. During a high intensity exercise, when the working muscle fibers are fatigued, more muscle fibers must be activated to maintain the desired levels of force production [21]. Therefore, performing a high intensity exercise, such as HIIT, can result in inereasing motor unit recruitment, and thereby activation of more muscle fibers, which may develop muscle si e and quality. Furthermore, the shortest-duration HIT. interval studied used a 20s:10s exercise-to-rest ratio (i.e., 20-10-HIIT) [19], However, the present study. implemented a shorter protocol of 10s:5s exe se-to-rest ratio (i.e., 10-S-HIIT) to establish a shorter yet, potentially effective 2:1 interval duration [22]. {eco met blac non copy oxen ouch adhe pera taped ato elariond ne oor tend tone Fete sane hace petted irc colton ayo surah etter cr qlactone| ote Aig cry cee Fe piper dvs False ag one aae HroRt oa total cists viene Tesig ine cache ah OU a ofal oaTswhes ne dba deems ine AICS Neuse Berry Peli Ae crrie een hap oe eee manera ater eae er eee Te ee aves" ence an/ aerate Goo or che erode mma ce coe . eeCOPYRIGHT® EDIZIONI MINERVA MEDICA, Muscular morphological adaptations of two whole-body high intensity interval training configurations Therefore, the purpose of this study was to compare the effects of 10-5-HIT versus 20-10-HIT protocols in conjunction with whole-body training on muscular morphological adaptations of rectus femoris (RF) and vastus lateral was hypothesized that employing whole- (VL). In the present study, body training during HILT interventions would improve musele size and quality similar to ergometer based HIIT protocols, Furthermore, it was hypothesized that the 10-5-HIIT using 10s:5s exercise-to-rest ratio would elicit similar muscular morphological adaptations compared to the 20-10-HIIT protocol at 20s:10s exercise-to-rest ratio, despite the 50% shorter exercise duration. Materials and Methods Experimental Design This study utilized a randomized, between-subjects, pre-post experimental design to assess adaptations before and after intervention. A 4-week training intervention was implemented to compare the effects of the HIIT protocols, The testing process involved ultrasonography measurements, including the mCSA and der (ie., males = 16, EL of the RF and VL muscles. The participants were initially separated by females = 18) before being randomly assigned by a drawing to either the 10-5-HIIT (i.e., 8 males, 9 females) or 20-10-HIIT (i.e., 8 males, females) group. ‘Thirty-four recreationally active college students volunteered to participate (Table 1). Recreationally active was defined as performing planned, structured physical activity for at least 30 min at moderate intensity on at least 3 days per week for at least the previous 3 months [23]. The study was approved by and carried out in accordance with the recommendations of the Institutional Review Board (IRB) for the protection of human subjects, Before starting the investigation, participants were asked to complete an IRB approved informed consent form as well as an Exercise Pre-Participation Health Screening Process and the Physical Activity Readiness Questionnaire (PAR-Q & You) to evaluate their {is cocarert protected by Hematona conyigtans No deena ecroducten& uord 8 pened prone ve to coyote save ont ore fe od pt oan rt ae a a AT BEES Tear et ease eee erin oe aene eee ree emae uae Batted fn taro torerw, cov, Say, osc back ofceangs oy cepy ois ome ous wk ho Pubes hy bos Po i ES paidCOPYRIGHT® EDIZIONI MINERVA MEDICA Muscular morphological adaptations of two whole-body high intensity interval training configurations h th status and ability to participate. Afterwards, they were familiarized with the testing and training procedures and techniques. The nature of the post-testing procedure was identical in all respects to the $ did not have to re- pre-testing (i.e, 72 hours after the last training session), accept that participan complete the informed consent and health history questionnaire, Procedures: i, Ultrasonography Since the quadriceps muscle was one of the activate muscles during the training protocols, the RF and VL. were scanned to investigate the effects of whole-body HIT on muscle size and quality. Following the completion of the familiarization phase, participants’ mCSA and El of the RF and VL muscles were assessed using a brightness mode (B-mode) of the ultrasound imaging system (General Electric LOGIQ 8, Wauwatosa, WI, USA) and multi-frequency linear-array probe (Model ML6-15-D 4-15 MHz, 50- mm field of view), All ultrasonic scans were conducted on the participants” right leg to measure the mCSA and El of the RF and VL. For the assessment of the RF, they were asked to lay supine on a padded plinth, Ultrasonic images were taken on the transverse plane at 50% of the distance from the anterior superior iliae spine (ASIS) to the superior edge of the patella. To sean the VL muscle, participants were instructed to position on their left side at a knee angle of 10°, The VL measurements were obtained from their right leg at 66% of the distance between the ASIS and lateral edge of patella, Locations of measurements were marked with indelible ink to ensure seans were taken at the same area for both RF and VL muscles, A high-density padding foam was placed on the skin to facilitate moving the probe perpendicular to the limb and along the transverse plane. During every scan, water-soluble gel was applied on the skin and ultrasound probe to maximize acoustic coupling and reduce near-field artifacts. To limit compression of the muscle, the probe was carefully placed on the skin surface and consistent minimal pressure was 6 ‘ident toca yrmatona copy No akan coaucten ashe I pomtad penal eo loa a noo cre food tore eyorieanie repel penas trace aidan ck eer avec ors sematcal eth cerioacr dostone] ole Ata i cy eure Pe poten saat Faidecrrt’cacy ofse ote Hou cane rioral cdl tieret ib testers coctercrarou cry re mearswennen abe secee he Mice Reued aera) ise anes ery Cormarsa lish nemmPon Ine ncn of datvtre wens rome ance a pared The eeucian errr pena sf commerectusa srt aed func terfos treror, cova, Src, cb back afchangy ry copa wis ame om wich ho Babies roy bosch Pe hk for paid ©COPYRIGHT® EDIZIONI MINERVA MEDICA Muscular morphological adaptations of two whole-body high intensity interval training configurations applied. The system setting for image gain was set at 50 decibels (dB), the dynamic range was set at 72 AB, and the image depth was set at « range of 5 to 7 cm based on the tissue thickness of each participants’ thigh. All ultrasound scans were taken by the same, experienced individu with appropriate intra-class correlation coefficient (ICC) and standard error of the measurement (SEM) for both mCSA (RF: ICC = 0.99, SEM = 0.37 en VL: ICC = 0.97, SEM = 1.02 em?) and El (RF: ICC = 0.98, SEM = 15 arbitrary unit [au]; VL: ICC = 0.98, SEM = 1.02 au). ii, Ultrasound Image Analysis, All ultrasonic measurements were conducted by one experienced individual using image analysis software (Imagel, version 1.50i) provided by the National Institutes of Health (NIH, Bethesda, Maryland). The Image} software displayed every sean with the greatest visual contrast to define borders for analysis. To determine mCSA, every image was assessed by selecting the borders of muscle tissue without including any surrounding fascia by the polygon function of the Imagel software (Figure 1). However, the EI measurement of each scan was computed by analyzing the gray-scale of the selected area of mCSA through the standard histogram function of ImageJ. The average EI was calculated as an lack; 2: arbitrary unit (au) value between 0 and 255 (0 white). i, Training Interventions ‘Training sessions involved a warm up of S-min self-paced jog, the assigned HIIT protocol, and a S-min jogging to cool down, The HIIT protocols consisted of 6 sets of 6 whole-body exercises, consisting, of burpees, high knees, kettlebell snatches, step-up jumps, jumping jacks, and goblet squats. The 10-5- HIIT protocol was completed at a 10s:5s exercise-to-rest ratio followed by a I-minute recovery after each sel, and the 20-10-HIIT protocol was accomplished at a 20s:10s exercise-to-rest ratio, and a 2-minute recovery between sets (Figure 2). The total exercise time of the 10-5-HIT was 6 minutes, while the 20- 10-HIIT protocol was 12 minutes, Participants were asked to perform continuously at their maximal effort Tisdoosrert tected by nmalona cong ms No adalona ects ported penal ue odo ne oy cre fo ond fr tere Poeker eae sce pared ert ana canes reac iether octane] ote Ase ig cry eure Pe potest ae feidecreresmy o/he oats Hou ettroiieral cada Niello hemp seme cocrerk pak oaay sta naaswictmay don setae bie nice faye dala arp ‘Bret a farcry commu Uns nebo ne cischon 6 ame was roms ance ho aie The eceten oes er pensna cormmarcchrs oct are {tno arto lovenve cove cvaay, br boc of cheng oy copa rok are um wikh ha Pb roy pon ec Ee partedCOPYRIGHTO EDIZIONI MINERVA MEDICA Muscular morphological adaptations of two whole-body high intensity interval training configurations as quickly as possible during each bout of exercise. Light kettlebells (males: 20 or 25 Ibs., females: 10 or 15 Ibs.) were used for the kettlebell snatch and goblet squat to allow participants to perform the movement as fast as possible. Training sessions were performed 3 days a week (i.e., Monday, Wednesday, and Friday) for 4 weeks, Since the primary objective during each bout was to perform exercise at maximal effort, each participant's heart rate was monitored continuously by using heart rate monitor (Polar Electro, Inc., Port Washington, NY, USA) after each bout. The whole-body exercises were required to be performed explosively. Thus, the participants’ heart rates were approximately at 90% of their maximal heart rate, using the Karvonen method, during each bout, which slightly decreased during the rest periods. In addition, strong verbal encouragement was given throughout training sessions. Furthermore, the training sessions were monitored by a certified strength and conditioning specialist to provide technical feedback. Statistical Analyses Prior to analyzing the data, variables were tested for normality through the Shapiro-Wilk’s test. In addition, Mauchly’s test was used to evaluate the assumption of sphericity for repeated measures analysis of variance (ANOVA). A two-way repeated measures ANOVA with factors of group (i.e., 10-5- HIIT and 20-10-HIIT) and time (ie., pre-and post) was applied to compare the two HIIT protocols on muscular morphological adaptations. Main effects were analyzed for the variables that showed no significant interaction effects, as determined by partial eta squared (1,2), and were interpreted as small (0.01), medium (0.06), and large (0.14) [24]. Statistical analyses were completed using IBM SPSS Statistics 24,0 (IBM Corp., Armonk, New York, USA). The level of significance was set at p < 0.05, while the results were presented as mean + standard deviation (SD). Results, 8 Tiscocrert hole by nemating copy avs No sena eeoduelen& ahared pera pase we to omen or save oer te on on ene Teevette ante eu merrier aoatone czy tahwr trac fosemateah tracers aectonel olte ane i ery aust Pe futeemreate ars Redgcmrtteony she tle hoch cotoriora aula rivratl her genure couurierufuacy cra negawich nen don sccm: bhaaice fousd aaa ‘Bares As trary orm st cers ne scion ens ors ron hs ase Ho arte he eccaen Seer er penta carmmmrcehrs eect ani {tno pearitod orenve, cow vay, ts. oc o change oy capi rok fe rus wikh ha Pana oy Don ea FE patedCOPYRIGHT® EDIZIONI MINERVA MEDICA Muscular morphological adaptations of two whole-body high intensity interval training configurations From 34 pre-to-post scans of the RF muscle, 3 (2 from 10-5-HIIT; 1 from 20-10-HIIT) were not usable, as the entire borders of the contractile and non-contractile components of the muscles were not identifiable. Therefore, 31 pre-to-post scans of the RF muscle (10-5-HIT = 15; 20-10-HIIT = 16) were used for analysis, Pairwise comparison was used to determine the difference between two training groups. Table | presents the pre- and post-intervention values of the mCSA (10-5-HIIT: Pre = 12.1 4.2, Post = 13.044. %A = 8.0: 11,0; 20-10-HIIT: Pre = 11.5 3.1, Post = 12.1 + 3.2, %A = 5.58.2) and EI (10-5 HIT: Pre = 45.1 + 7.3, Post = 44.8 + 7.8, %A = -0.3 + 11.5; 20-10-HIIT: Pre = 41.6 + 9.8, Post = 40.24 10.4, %A = -3.8 £8.7) of the RF muscle for the 10-5-HIT and 20-10-HIIT protocols. Overall, similar changes were obtained for all dependent variables in both groups, and therefore, no significant between-group interactions were observed in the mCSA (F (1, 29) = 0.534, p > 0.05, n° = 0.019) and the EL(F (1,29) 0.020) of the RF muscle. However, a significant main effect of time was observed in mCSA (F (1, 29) = 16.348, p< 0.05, ny? 377), The significant increases of the RF MCSA were observed in the 10-5-HIIT group (8.0 11.0%) and 20-10-HIIT group (5.5 + 8.2%). Similar to the RF ultrasonography results, 3 pre-to-post scans of the VL muscle (2 from 10-5- HIIT; | from 20-10-HIIT) were excluded from the analysis since they did not show the entire borders of the muscles, which resulted in 31 usable s “ans Table 1 summarizes the pre-and post-results of the mCSA (10-5-HIIT: Pre = 26.2 + 6.6, Post = 28.4 + 7.0, %A = 9.0 + 7.3; 20-10-HIIT: Pre = 24.6 + 5.2, Post = 27.04 5.2,% 10.4 6.6) and El (10- S-HIIT: Pre 1.3 + 10.9, Post 0.59.1, YA = 0.4 + 9.3; 20-10-HIIT: Pre = 47.4 + 8.8, Post = 47.4 + 10.2, %A=-0.1 + 10.4) of the VL muscle, Statistical analysis indicated no significant time x group interactions in mCSA (F (1, 29) = 0.129, p > 0.05, ny? = 0.005) and El (F (1, 29) = 0.142, p > 0.05, ny? = 0.005) of the VL muscle. However, a significant main effect of time was observed in the VL mCSA (F (1, 9 [ie docrrert protect by Hematond copylgt ave No acral ecroducten& autorsed i pemrted x perenel e tocynoat ard save ont cre fe ret oon Faegelanee ha pence rnta long cape les cca oy tralcah tte prio! decinc| ite Ace cy ou cl gotag a te re coy oa base rue caine ls tare hargosine woot amy ay Sls nea weir abro.toe he ce Raut ray atta anes fcr Cormarca ist a nemo Ihe reckon demote rs rom tie anaes na pared The pesucton opr er penn ox cormarestur ot ated Fenc period toremove cove rev, cou buck of charge Oy copa Notes tee fe wikh ie Pules Moy boson Pe Nels er! period 1 ‘am ce orescence Rose Gon & Sur ose erie ot he SeCOPYRIGHT EDIZIONI MINERVA MEDICA Muscular morphological adaptations of two whole-body high intensity interval training configurations 29) = 81.726, p < 0.05, ny? ).752), Additionally, the mCSA of the VL muscle was significantly improved for both the 10-5-HIIT group (9.0 + 7.3%) and 20-10-HIIT group (10.4 + 6.6%). Discussion The present study aimed to investigate the effects of two HIIT configurations, 10s:5s versus 20s:10s exercise-to-rest ratios, on muscular size and quality of the RF and VL muscles. Results indicate that both 10-5-HIIT and 20-10-HIIT protocols have the potential to improve mCSA of the RF and VL. muscles as measured by the B-mode of the ultrasound imaging system. HIT intervals in a 2:1 exereise- to-rest ratio demonstrated a significant increase in mCSA of the RF and VL, suggesting that both groups benefited from the whole-body training. Additionally, both training protocols yielded no significant effects on muscular quality based on no change in the EI. The post-intervention measurements were taken 72 hours after the last training session for adequate recovery tine and to avoid post-exereise muscle swelling. High intensity interval training may induce similar or even greater physiological adaptations in a shorter time when compared to traditional endurance training [5]. Hence, HIIT can be considered as a time-efficient mode of exereise [25], which may mitigate the “lack of time” excuse, known as the most common barrier to physical activity [4]. While HIIT y ds cardiovascular adaptations, few studies have sought to determine skeletal muscle remodeling as a result of HITT, particularly in conjunction with, whole-body training. The majority of previous HIIT protocols have used a cycling exercise modality, which loads lower extremity rather than whole-body musculature [26]. For example, one previous study reported a 14% increase in mCSA of the VL muscle fler 3 weeks of HIIT on a cycle ergometer, by implementing 10 bouts of I-minute cycling and a I-minute recovery between the bouts, 3 times per week [26]. The longer duration of each bout or specific stress on lower limbs may explain the increase of MCSA afier 3 weeks. The present study implemented whole-body training during HIIT by combi 10 Teche potency toteng cope Noreen meric oan spent pre snto ctae natn oe tnd cet arone Meee ee ee a ee SE oeay aig prime geet cee Game eo EBON ST SO Here ence SU SIS eg Oe COCKS AS ce Su ny aoa Ease Ha ae Bares fence parkacioterae cove Sey ce ba or chao eepiy holes re ase wih We RTS Ma sen Pe as FETS pando [ne ts hart tclicues gene or Fooeriok bon hs Useelan Rcmen the Pe fonCOPYRIGHT® EDIZIONI MINERVA MEDICA Muscular morphological adaptations of two whole-body high intensity interval training configurat various total body exercises and found that both 10-5-HIIT and 20-10-HIIT protocols improved the MCSA of the RF (by 8.0% and 5.5%, respectively) and VL (by 9.0% and 10.4%, respectively) muscles. The “time-efficieney” due to lower exercise volume and duration makes both 10-5-HIIT and 20-10-HUT. protocols efficient protocols to induce muscular morphological adaptations, However, due to shorter time commitment, performing 10-S-HIIT at 10s:5s exercise-to-rest ratio with (otal exercise time of 6 minutes (ie., 14 minutes total time commitment of each session) may offer a shorter and equally efficient interval compared to the 20-10-HILT with total exercise time of 12 minutes (i.e., 28 minutes total time commitment of each session). Generally, muscular size is determined by increasing the ratio of myofibrillar protein synthesis and breakdown [27]. One study demonstrated increased protein synthesis and mitochondrial biogenesis of the VL muscle after 9 sessions of HITT, performing 4 to 8 bouts of 30-second cycling [22]. Moreover, it has been found that mitochondrial and myofibrillar protein synthesis increased 24 to 28 hours after a higher intensity exercise (at 60% of maximal power) compared to lower intensity bouts (at 30% of maximal power) [28]. Furthermore, a significant correlation between protein synthesis and muscular size has been reported during early stages of resistance training after 3 weeks [29]. Therefore, ine mCSA of the RF and VL muscles after 4 weeks of training can be associated with increased protein synthesis and eventually muscle size. However, the present study supports further investigations to study the other factors that contribute to increased muscle size [30]. On the other hand, it has been demonstrated that Elis indicated by the amounts of fibrous and adipose tissue of skeletal muscles, as well as the architectural features of muscle fascicles [31]. Since no change was observed in EI of either RF or VL muscles, results suggest that a 4-week HIIT in conjunction with whole-body training may be insufficient to change intramuscular fibrous and adipose tissues in recreationally active individuals. While muscle swelling due to exercise-induced edema simultaneously ul Tisdoouret loca by htmotona copy No adnan asd th pemedpesnal eto deg neo cr feat fr tore ES Re Anne eared arnt alata cath raat ose Febdecacretcopy oneal Hout cone rierat dls neret is fesmg terns sacsersc rir net trary orn a a nema re ctnctan seni ons rons ace so ere eee eae ani fa earitog oreve cov ray, toc o cng oy opt rok: rus wih he Pane oy Deo ea FE partedCOPYRIGHT® EDIZIONI MINERVA MEDICA Muscular morphological adaptations of two whole-body high intensity interval training configurations increases mCSA and EI during the first 3 weeks of resistance training protocol [29], our findings after a 4-week intervention indicate that the changes in mCSA were not the result of muscle inflammation or damage. Since the EI values did not change, it can be assumed that there was limited acute exercise- induced muscle swelling and inflammation during ultrasonography measurements. In addition, males tend to have higher muscle quality indicated by EI than females due to differences in fibrous and adipose tissue content and distribution [31]. To date, increased musele quality indicated by EI has been reported only after resistance training protocols [12], and any improved muscle quality as measured by EI has not been previously reported following HIIT protocols. Different factors, such as reereationally active participants or insufficient duration of the study (4-week intervention), may have attenuated changes of mu le quality in the present study. Thus, future studies may warrant investigating the effects of longer HIIT interventions on musele quality. Gender was not included as a factor for analysis, which may have induced variability in our data. Future studies may be needed to examine the differential effect of these protocols on muscular morphological adaptations of males versus females. Additionally, control group can particularly be an important factor toi cestigate muscular morphological adaptations. Hence, lack of control group may be considered as a limitation in the present study. The participants’ diet and lifestyle were not controlled, which may influence the results of the present study. However, the participants were asked to maintain their amounts of physical activity. Moreover, there are limitations of ultrasonography with respect to depth and brightness. Specifically, variations in muscle and subcutaneous fat thickness among the participants required changing the depth to capture the full muscle belly within the image. Therefore, the depth setting of the ultrasound imaging system was varied across the participants to observe the entire muscle, Generally, increasing the adjustments in the depth setting is associated with decreasing normative values across the samples, especially regarding muscle quality indicated by El measurements. It has been. suggested that training type may determine which muscles, and what parts of muscle adapt favorably 12 "ees rteces by mote corte. No oxeren mere saat perpen pceelnte cover ona ie ore crs taro Seiati at el pared eins alata cpl dhe ce yield erred decane] ct Ace key eucn 8 ful cem tasty ate PERE rae siheleioe Harfinne ere og hue tong gene cath nungu chy recreate obras bie mice Neve wordy it cine Al cry Camaroon he oacon ol arcs vats fame Ace of sred ne enuch esr ft penant cotati ‘ams ore eri rcnaven'a ence or ager Bria te Soares een ee _ =COPYRIGHT® EDIZIONI MINERVA MEDICA Muscular morphological adaptations of two whole-body high intensity interval training configurations [32], which was not considered in the current study. Furthermore, the ultrasonic scans were taken only from the RF and VL muscles, and caution is warranted when generalizing the findings of this study. Conclusions High intensity interval training may serve as an effective exercise modality to influence muscle size in active young individuals. In this study, whole-body HIIT with 2:1 exercise-to-rest ratio was a safe and well-tolerated HIIT protocol, which elicited an increase in mCSA of the RF and VL muscles. The findings of the present study showed no significant difference between the groups. Both groups similarly increased the mCSA of RF and VL, while there was no significant change in the EI of these muscles. Further studies should investigate the effects of HITT interventions using various protocols on muscle size and quality in different populations and age groups. Therefore, further investigations are suggested to evaluate the validity and feasibility of using ultrasonic imaging to track muscular morphological adaptations in response to exercise interventions. Practical Implications © Whole-body HITT may be a time-efficient and effective method to stimulate muscle size uals, adaptations in healthy young indi . Performing HIIT at 10s:5s exereise-to-rest ratio offers a shorter and equally efficient interval to enhance muscle size compared to other 2:1 exercise-to-rest ratios, + Whole-body training at maximal effort during HIIT may have potentials to improve musck especially for those who have limited or no access to fitness equipment and facilities, 13 {is docrert sce by nlematong copia. 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Go, oF ther tary nfrmation of te PLDI me =COPYRIGHT® EDIZIONI MINERVA MEDICA cord Cr Ties Figure I: Selecting th boxes of the ects Simons (A B) ant vastas lates (C, D)rmscles by Images oftane fo rvaasie rele cros-sec onal nea (mS A) mel echo ifety (ED,COPYRIGHT® EDIZIONI MINERVA MEDICA Musealar nerphological adaptation: of wrowhae-body high intensity interval taining eonfiguations BE] g [2 | sso i |) atte ‘wren soe Hr set 3 cantieatn ae Figme 2: The HIIT protocol consisted of 6 et of 6 whole-body excises, The 10-S-HIIT protocol (A) ras completed at 10:53 wonkto-est tio fllowed by a T-nite covery bebreen the ss, nd the 20:10-HIIT protocol @®)orae accomplished ata20: 10 wontons to, and a Paiste recoreny Debreen sets "cosinor recast conta nN eaten craton kool pert pel down oo Bon ee oe alasohort copy af wares Rrougrorine Fiera srr tare Rercmgoysene crank rang tomer mars enh may cea doen ve Ake Wee Achy Dat ofta dre any Carraroe tered. re crscir et deve was fone slesor panied he oa. ean pana corner we 6° Bate ft eortad crore, con uy ob tccheago oy copy rat fare cure wc be Pry or on he A Bn Bord 2 fun Rane wacker t9 wisi oy ee Mk Gas a her Brton Morrane ot he AC