HIIT or Miss? - Alternative options for when HIIT is tough on your joints.

Introduction

High-Intensity Interval Training (HIIT) is renowned for its effectiveness in improving cardiovascular fitness (1) and burning calories (2). HIIT workouts are usually short in duration (~25mins), and provide an easier method for individuals to increase their physical activity on a weekly basis, especially if they have a limited amount of free time due to other life commitments (3).

However, HIIT can be tough on the joints, especially for firefighters who may already suffer from knee pain. Fortunately, there are several other exercise modalities that can provide similar benefits without the high impact stress of HIIT.

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HIIT Exercise Alternatives

One method to reduce the impact on the joints would be to scale down the exercises in a HIIT workout. Examples of scaled down options are provided below:

Star Jumps ------ Side steps

Burpees----------Bodyweight squat into overhead reach

High Knees------ Standing march

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Alternative physical activity options to HIIT

Listed below are a selection of alternative physical activities to try if you find HIIT tough on your joints or too intense to participate in currently. I have provided options for low impact cardio training, low impact strength training and flexibility and balance training.

1. Low-Impact Cardio

Swimming

Swimming is an excellent full-body workout that places minimal stress on the joints (4). The buoyancy of water supports body weight, reducing the impact on the knees. Swimming laps, water aerobics, and even treading water can significantly improve cardiovascular health, muscular endurance, and overall fitness.

Cycling

Cycling, whether on a stationary bike or outdoors, is another low-impact exercise that provides cardiovascular benefits without stressing the knees. Stationary bikes often have adjustable resistance levels, allowing firefighters to customize the intensity of their workouts. Cycling can help strengthen the quadriceps, hamstrings, and calf muscles, which can provide better knee support (5).

Elliptical Training

Elliptical machines simulate walking or running without the impact. They are particularly beneficial for those with knee pain as they provide a smooth, gliding motion that reduces stress on the joints. Elliptical training can enhance cardiovascular fitness, and many machines allow for varying resistance and incline to increase workout intensity (6).

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2. Strength Training

Bodyweight Exercises

Bodyweight exercises such as push-ups, pull-ups, and planks can build strength and endurance without putting undue stress on the knees. These exercises target multiple muscle groups and can be easily modified to suit individual fitness levels (7).

Resistance Bands

Resistance bands provide a versatile and low-impact way to perform strength training. Exercises like seated leg presses, lateral band walks, and banded squats can strengthen the muscles around the knee, enhancing stability and reducing pain (8).

Weight Machines

Using weight machines can be beneficial because they provide controlled, guided movements that reduce the risk of injury. Machines like the leg press, seated row, and chest press can help build muscle without putting additional pressure on the knees (9).

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3. Flexibility and Balance Training

Yoga

Yoga can improve flexibility, balance, and strength while being gentle on the knees. Poses such as the warrior sequence, bridge pose, and child's pose can help stretch and strengthen the muscles supporting the knee joint. Additionally, yoga can aid in stress reduction, which is beneficial for overall health and well-being (10).

Pilates

Pilates focuses on core strength, flexibility, and overall body awareness. Exercises like leg circles, bridges, and side leg lifts can strengthen the muscles around the knee and improve joint stability. Pilates also emphasizes controlled movements and proper alignment, which can help prevent injuries (11).

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Conclusion

Firefighters with knee pain have a variety of alternatives to HIIT that can help them maintain fitness without exacerbating their condition. Low-impact cardio, strength training, flexibility and balance exercises all provide comprehensive workouts that support overall health and job performance. By incorporating these alternatives, firefighters can stay fit, reduce pain, and enhance their ability to perform their duties effectively.

Dr Liam Noll

P.S. If you found this useful, or know someone who could benefit from low impact physical activity, please share this with them.

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References

1.         Astorino TA, Edmunds RM, Clark A, King L, Gallant RA, Namm S, et al. High-intensity interval training increases cardiac output and VO2max. Med Sci Sports Exerc. 2017;49(2):265-73.

2.         Falcone PH, Tai C-Y, Carson LR, Joy JM, Mosman MM, McCann TR, et al. Caloric expenditure of aerobic, resistance, or combined high-intensity interval training using a hydraulic resistance system in healthy men. The Journal of Strength & Conditioning Research. 2015;29(3):779-85.

3.         Woodworth A, Arumalla S, Gowder C, Hernandez J, Kim A, Moorthy B, et al. Development of a tool for quantifying need-supportive coaching in technology-mediated exercise classes. 2023.

4.         Lo GH, Ikpeama UE, Driban JB, Kriska AM, McAlindon TE, Petersen NJ, et al. Evidence that swimming may be protective of knee osteoarthritis: data from the osteoarthritis initiative. PM&R. 2020;12(6):529-37.

5.         Alkatan M, Baker JR, Machin DR, Park W, Akkari AS, Pasha EP, et al. Improved function and reduced pain after swimming and cycling training in patients with osteoarthritis. The Journal of rheumatology. 2016;43(3):666-72.

6.         Tsai L-C, Lee SJ, Yang AJ, Ren Y, Press JM, Zhang L-Q. Effects of off-axis elliptical training on reducing pain and improving knee function in individuals with patellofemoral pain. Clinical Journal of Sport Medicine. 2015;25(6):487-93.

7.         Hamzah R, Lesmana R, Prasetia R. ROLE OF BODYWEIGHT EXERCISE ON SKELETAL MUSCLE STRENGTH IN ELDERLY. JURNAL ILMU FAAL OLAHRAGA INDONESIA. 2023;4(2):21-31.

8.         Kim G-J, Oh H, Lee S, Lee K, Kim K. Effects of resistance exercise using the elastic band on the pain and function of patients with degenerative knee arthritis. Journal of physical therapy science. 2020;32(1):52-4.

9.         Hasan Z, Kamli MA. A solution for joint pain and body relief through portable exercise machine. International Journal of Design Engineering. 2021;10(2):178-92.

10.       Telang A, Iyer SS, Saoji K, Gawande V. Treating of Joint Pain-Arthritis through YOGA. Journal of Pharmaceutical Research International. 2021;33(37B):283-8.

11.       Korkmaz C, Çalık BB, Kabul EG. Investigation of the effects of clinical Pilates exercises on physical fitness and psychosocial parameters in healthy women. Journal of Exercise Therapy and Rehabilitation. 2022;9(3):153-63.