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643 articles were obtained from the four databases. 207 duplicates were excluded, and 135 articles were excluded based on screening of their title and abstract. Then, the full text of 72 articles was reviewed and an additional 57 studies were excluded for not meeting the inclusion criteria. Finally, this left a total of 15 studies that satisfied the inclusion criteria. All 15 studies were included in the qualitative systematic review, and 12 studies were included in the quantitative systematic review (Fig. 1).
Tables 1 summarize the studies included in the review. The table lists the authors, sample size, a summary of the HIIT program, outcomes, whether the intervention was supervised or unsupervised, and the intervention setting (home-based HIIT, lab-based HIIT, MICT, or non-exercise control) for each study. Summaries of the HIIT or MICT methods include the duration of training, frequency, mode of exercise, and intensity.
Risk of bias assessment
The results of the methodological quality assessment of the studies included in this review are summarized in Fig. 2. The proper procedure for randomly generated sequences was fully described in 15 studies, 1 of which hid the assignments. Performance bias was found in all included trials. Blinding of participants was not possible due to the nature of the exercise interventions, though this does not pose a threat in terms of internal validity. Eight studies blinded outcome assessors and 3 studies did not.
Setting (home- or lab-based HIIT, MICT, and control)
Five studies involved interventions for healthy adults [15, 22, 23, 26, 27] and 10 involved interventions for patients [13, 14, 16,17,18,19,20,21, 24, 25]. The comparison group versus home-based HIIT was lab-based HIIT in 4 studies [13, 15, 26, 27], MICT in 7 [14, 16, 18,19,20,21,22], resistance training in 1 [24], and non-exercise controls in 3 studies [17, 23, 25]. The intervention was supervised in 2 studies [17, 24], unsupervised in 6 [15, 16, 22, 23, 26, 27], and a combination of supervised and unsupervised in 7 [13, 14, 18,19,20,21, 25]. The exercise modality for home-based HIIT included 6 weight-bearing exercise [15, 22, 23, 25,26,27], 6 using stationary cycling or a treadmill [14, 17,18,19, 21, 24], and 3 using outdoor/indoor equipment [13, 16, 20].
Cardiorespiratory fitness: home-based HIIT versus non-exercise controls
Four studies with a total of 100 participants compared home-based HIIT versus non-exercise controls (Fig. 3a) [14, 25,26,27]. Compared with the non-exercise control group, the meta-analytic effects of home-based HIIT appeared to provide a greater benefit in terms of VO2peak (SMD 0.61; 95% CI [0.21, 1.02]; p = 0.003). Egger’s test suggested potential publication bias, though not statistically significant (intercept = -4.239, 95% CI -6.75—-1.73, t = -3.316, p = 0.080). However, a visual examination of the funnel plot showed symmetry, indicating no evident bias.
Cardiorespiratory fitness: home-based HIIT versus lab-based HIIT
Four studies with a total of 110 participants compared home-based HIIT and lab-based HIIT (Fig. 3b) [13, 15, 26, 27]. No significant difference in VO2peak was observed between home-based HIIT and lab-based HIIT (SMD -0.35; 95% CI [-0.73, 0.03]; I2 = 0%; p = 0.07). Egger’s test indicated no significant evidence of publication bias in the meta-analysis (intercept = 2.175, 95% CI 0.07—4.28, t = 2.026, p = 0.180). The funnel plot appeared symmetrical upon visual inspection, aligning with the Egger’s test results.
Cardiorespiratory fitness: home-based HIIT versus MICT
Three studies with a total of 188 participants compared home-based HIIT versus MICT (Fig. 3c) [16, 18, 21]. No significant difference in VO2peak was observed between home-based HIIT and MICT (SMD 0.34; 95% CI [-0.05, 0.73]; I2 = 32%; p = 0.09). Egger’s test did not reveal any statistical evidence of publication bias (intercept = 2.236, 95% CI -0.05—4.53, t = 1.914, p = 0.307). Visual inspection of the funnel plot suggested symmetry, supporting the absence of publication bias.
Patients-reported outcomes
Patient-reported physical activity was analyzed in 3 studies with a total of 198 participants. No significant difference in physical activity was observed between the home-based HIIT group and the non-exercise control group (SMD 0.28; 95% CI [0.00, 0.56]; I2 = 0%; p = 0.05) (Fig. 4a) [17, 25]. Patient-reported fatigue was analyzed in 2 studies with a total of 64 participants. No significant difference in fatigue was observed between the home-based HIIT group and the non-exercise control group (SMD -0.50; 95% CI [-1.00, 0.00]; I2 = 0%; p = 0.05) (Fig. 4b) [14, 25].
Compliance rate and adverse events
All studies (15/15; 100%) reported exercise program compliance rates. The mean rate of exercise program compliance across all studies was 80% (range: 35–100%). Five of the studies also reported heart rate during exercise, with an average value of 87% HRmax.
Of the 15 studies included in this systematic review, all of the Taylor et al. studies (20–22) had the same study participants, so we reviewed what was reported in 13 studies. All trials (13/13; 100%) commented on adverse events in the exercise interventions, but 10 trials did not state that they used a specific protocol for collecting adverse events. No cardiac-related events resulting in death or hospitalization during training occurred in any of the intervention groups among the studies that reported events. The four studies that reported adverse events included exercise-induced shoulder pain [16], hypotension during exercise [18], post-exercise cardiovascular events (obstruction due to bypass graft failure) [21], and serious events occurred in patients with coronary artery disease [20]. No adverse events occurred in the other 10 studies.
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