Savonia Article Pro: The Effect of High-Intensity Interval Training on Exercise Tolerance in Patients with Respiratory Diseases
Savonia Article Pro is a collection of multidisciplinary Savonia expertise on various topics.
This work is licensed under CC BY-SA 4.0
Introduction
Evidence-Based Physical Therapy (EBP) uses the best research evidence with clinical expertise and user’s preferences to produce the most appropriate and effective care. At week 44 in 2025, we had International Course in Spain, A Coruna, in the Faculty of Physiotherapy at University of Coruña about EBP. The program was opened with welcome words of the president of The European Network of Physiotherapy in Higher Education (ENPHE) and followed with the basis of EBP and teachers who highlighted the main challenges at different Physical Therapy fields. More than 30 physiotherapy students and 9 teachers from six universities (Savonia University of Applied Sciences, Finland, Universidade da Coruña, Spain, Charles University Czech Republic, CERRFF and École D´Assas, France, and Escola de Santa María de O Porto, Portugal), actively participated this week and shared experiential group dynamics and social activities. The students collaborated and wrote articles on a range of topics, including evidence-based neurology, respiratory and musculoskeletal disorders, geriatric and pediatric care, as well as sports injuries and related issues. This blog article presents the work of the respiratory group.
Background
Chronic respiratory diseases such as COPD, asthma and post-COVID-19 conditions are among the main causes of physical disability and reduced quality of life worldwide (Global Burden of Chronic Respiratory Diseases Collaborators, 2023). Rehabilitation and physical activity play an essential role in improving respiratory function and exercise capacity. Recent studies have shown that exercise training improves tolerance to physical effort and enhances quality of life in patients with respiratory conditions (Ahmed et al., 2022; Martinez-Pozas et al. 2024). However, the most effective type of exercise program is still under discussion. High-Intensity Interval Training (HIIT) has been proposed as a more efficient method compared to traditional continuous training, but research protocols vary.
The aim of this work was to explore the available evidence about the effects of HIIT on exercise tolerance in adults with respiratory diseases and to identify which intervention methods seem to work best.
Methods
We used the PICO system to search for relevant articles. We focused on randomized controlled trials that included adults with chronic respiratory diseases, such as COPD, asthma or post-COVID-19 conditions. The intervention was High-Intensity Interval Training (HIIT) as part of a rehabilitation program. The control group included moderate-intensity continuous training, modified exercise protocols (for example, with supplemental oxygen), usual care or no training. The outcome was exercise tolerance, secondary outcomes included pulmonary and cardiac function, and quality of life.
Moreover, we used the methodological quality of the included randomized controlled trials was assessed using the Physiotherapy Evidence Database (PEDro) scale. This 11-item tool evaluates key aspects of internal validity and the interpretability of study results. The scale examines whether the trial specifies eligibility criteria, uses random and concealed allocation, ensures baseline comparability between groups, and applies blinding of subjects, therapists, and assessors. It also considers whether more than 85% of participants completed follow-up, whether an intention-to-treat analysis was performed, whether appropriate between-group statistical comparisons were reported, and whether point estimates with measures of variability were provided. Except for the eligibility criterion, each item contributes one point, resulting in a total score ranging from 0 to 10, with higher scores indicating stronger methodological quality. The PEDro ratings for each study are presented in the results table. Articles not written in English and those published more than 15 years ago were excluded. At least two reviewers screened all identified studies using the PubMed and PEDro databases with the following search terms: (respiratory diseases OR COPD OR asthma OR COVID-19) AND (High-Intensity Interval Training OR HIIT) AND (exercise tolerance OR rehabilitation). The search was limited to randomized controlled trials published between 2010 and 2025 and available as full text.
Results
From the literature search, four studies were included in our review. In the study by Türk et al. (2020), obese patients with asthma took part in a short-term HIIT rehabilitation programme. Their ability to walk longer distances, measured with the 6-minute walk test, improved clearly more than in the control group. Participants also reported better quality of life after the intervention. Neunhäuserer et al. (2021) studied patients with COPD who trained either with HIIT while using additional oxygen or with regular training. Their endurance and lung function, measured with a cycling test and oxygen uptake levels, improved the most in the HIIT plus oxygen group.
In Rasmussen et al. (2023), people recovering from COVID-19 followed a 12-week HIIT programme. Tests using heart scans and fitness measurements showed that their heart function and exercise capacity improved compared to the moderate training group. Finally, Batajrobeh et al. (2021) looked at miners with COPD who trained either with HIIT or moderate intensity. Both groups improved, but the HIIT group made bigger gains in breathing tests and walking distance. In general, all of them showed that exercise helps people with respiratory diseases to move better and feel better in daily life. However, the improvements were usually greater when the training was done as High-Intensity Interval Training (HIIT) instead of moderate, continuous exercise.
Discussion
Every study found positive effects of exercise, and HIIT seemed to produce the fastest and most noticeable improvements. The reviewed studies consistently demonstrated positive effects of HIIT on exercise tolerance and cardiopulmonary function among patients with chronic respiratory diseases. Nevertheless, the variability in training protocols, including exercise intensity, interval duration and frequency, limits the ability to compare results directly. Additionally, the small number of databases used, and the limited availability of high-quality randomized controlled trials may have restricted the evidence base.
Despite these limitations, HIIT appears to be a safe, feasible, and time-efficient rehabilitation method for this population. Future research should focus on standardizing HIIT protocols, unifying measurement tools, and evaluating long-term outcomes such as adherence, relapse prevention and overall cardiovascular health.
Conclusion
Despite the limitations of our research, we can conclude that HIIT is a safe, effective and time-efficient training method for patients with chronic respiratory diseases. HIIT improves exercise tolerance, pulmonary function and quality of life more than moderate continuous training. Future research should aim to standardize HIIT protocols and study their long-term effects.
Authors:
Milla Saastamoinen, Bachelor’s degree student, Physiotherapy degree programme, Savonia University of Applied Sciences, Finland.
Renáta Šimoníčková, Bachelor’s degree student, Physiotherapy degree programme, Univerzita Karlova / Charles University, Czech Republic.
Leo Vandamme, Bachelor’s degree student, Physiotherapy degree programme, Univerzita Karlova / Charles University, Czech Republic.
Juliette Duault, Bachelor’s degree student, Physiotherapy degree programme, CEERRF, France
Dagmar Pavlu, PT. Assoc. Prof. Charles University, Czech Republic.
Ivana Vláčilová, PhD., PT. Charles University, Czech Republic.
Marja Äijö, PT, PhD Principal Lecturer of gerontology and rehabilitation, Savonia, University of Applied Sciences, Kuopio, Finland.
Veronica Robles García, PhD. PT. OT. Associate Professor, University of A Coruña, A Coruña, Spain.
Zeltia Naia Entonado, PhD. PT. University of A Coruña, A Coruña, Spain.
María Vilanova Pereira, PhD., PT. University of A Coruña, A Coruña, Spain.
Adrien Pallot, PT, MSc, Lecturer at École D´Assas, France.
Aurel Bellaïche, PT, Lecturer at CEERRF, France.
References:
Ahmed, I., Mustafaoglu, R., Yeldan, İ., Yasaci, Z., & Erhan, B. (2022). Effect of pulmonary rehabilitation approaches on dyspnea, exercise capacity, fatigue, lung functions, and quality of life in patients with COVID‑19: A systematic review and meta‑analysis. Archives of Physical Medicine and Rehabilitation, 103(10), 2051–2062. https://doi.org/10.1016/j.apmr.2022.06.007
Batajrobeh, A., Ahmadi, M. M., & Mogharnasi, M. (2021). Effects of High and Moderate-Intensity Interval Training on Pulmonary and Performance Parameters in Miners Suffering From Chronic Obstructive Pulmonary Diseases. Journal of occupational and environmental medicine, 63(10), e673–e678. https://doi.org/10.1097/JOM.0000000000002329
Global Burden of Chronic Respiratory Diseases Collaborators. (2023). Updated estimates on the global burden of chronic respiratory diseases and their risk factors, 1990–2019. eClinicalMedicine, 59, 101936. https://doi.org/10.1016/j.eclinm.2023.101936
Martínez‑Pozas, O., Meléndez‑Oliva, E., Martínez Rolando, L., Quesada Rico, J. A., Corbellini, C., & Sánchez Romero, E. A. (2024). The pulmonary rehabilitation effect on long COVID‑19 syndrome: A systematic review and meta‑analysis. Physiotherapy Research International, 29(2), e2077. https://doi.org/10.1002/pri.2077
Neunhäuserer, D., Reich, B., Mayr, B., Kaiser, B., Lamprecht, B., Niederseer, D., Ermolao, A., Studnicka, M., & Niebauer, J. (2021). Impact of exercise training and supplemental oxygen on submaximal exercise performance in patients with COPD. Scandinavian journal of medicine & science in sports, 31(3), 710–719. https://doi.org/10.1111/sms.13870
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Rasmussen, I. E., Løk, M., Durrer, C. G., Foged, F., Schelde, V. G., Budde, J. B., Rasmussen, R. S., Høvighoff, E. F., Rasmussen, V., Lyngbæk, M., Jønck, S., Krogh-Madsen, R., Lindegaard, B., Jørgensen, P. G., Køber, L., Vejlstrup, N., Klarlund Pedersen, B., Ried-Larsen, M., Lund, M. A. V., Christensen, R. H., … Berg, R. M. G. (2023). Impact of high-intensity interval training on cardiac structure and function after COVID-19: an investigator-blinded randomized controlled trial. Journal of applied physiology (Bethesda, Md.: 1985), 135(2), 421–435. https://doi.org/10.1152/japplphysiol.00078.2023
Türk, Y., Theel, W., van Huisstede, A., van de Geijn, G. M., Birnie, E., Hiemstra, P. S., Sont, J. K., Taube, C., & Braunstahl, G. J. (2020). Short-term and long-term effect of a high-intensity pulmonary rehabilitation programme in obese patients with asthma: a randomised controlled trial. The European respiratory journal, 56(1), 1901820. https://doi.org/10.1183/13993003.01820-2019