{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T08:38:45Z","timestamp":1787992725491,"version":"build-2784847793"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T00:00:00Z","timestamp":1692230400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Introduction and aims<\/jats:title><jats:p>High intensity interval training (HIIT) is considered as an alternative exercise modality to moderate intensity continuous training (MICT) for heart failure (HF) patients. Yet a growing number of trials demonstrated inconsistent findings about the effectiveness of HIIT versus MICT until SMARTEX study and OptimEx-Clin study have made a consistent negative conclusion that HIIT was not superior to MICT. The aim of this study was to conduct a meta-analysis involving a subgroup analysis of total exercise time (TET) and disease categories of HF to investigate if TET could affect the superiority of HIIT when compared with MICT.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods and results<\/jats:title><jats:p>An electronic literature search of Pubmed, Embase, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov was performed for this review. 16 studies of 661 patients were finally pooled into quantitative synthesis. The weighted mean difference (WMD) and standard mean difference (SMD) with 95% confidence interval (CI) were calculated for quantitative synthesis of outcomes. HIIT was superior to MICT in improving peak oxygen consumption (Peak VO<jats:sub>2<\/jats:sub>) (WMD: 1.68 ml \u00b7 kg<jats:sup>-1<\/jats:sup>\u00b7 min<jats:sup>-1<\/jats:sup>95% CI: 0.81 to 2.55 n = 661). The subgroup analysis of TET showed that HIIT was superior to MICT in improving Peak VO<jats:sub>2<\/jats:sub>in \u201cshort time\u201d subgroup (WMD: 1.61 ml \u00b7 kg<jats:sup>-1<\/jats:sup>\u00b7 min<jats:sup>-1<\/jats:sup>95% CI: 0.45 to 2.77 n = 166) and in \u201cmedium time\u201d subgroup (WMD: 1.74 ml \u00b7 kg<jats:sup>-1<\/jats:sup>\u00b7 min<jats:sup>-1<\/jats:sup>95% CI: 0.53 to 2.95 n = 420), and that there was no significant difference between HIIT and MICT in improving Peak VO<jats:sub>2<\/jats:sub>in \u201clong time\u201d subgroup (WMD: 0.62 ml \u00b7 kg<jats:sup>-1<\/jats:sup>\u00b7 min<jats:sup>-1<\/jats:sup>95% CI: -1.34 to 2.58 n = 75).<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Conclusions<\/jats:title><jats:p>The superiority of HIIT to MICT in improving Peak VO<jats:sub>2<\/jats:sub>arose in a short to medium length of TET whereas it was effaced by an increment of TET. This \u201cparadox\u201d of TET on HIIT versus MICT might be due to the increasing poor adherence to target exercise intensity over time.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Trial registration<\/jats:title><jats:p><jats:bold>PROSPERO registration number:<\/jats:bold><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42022375076\" xlink:type=\"simple\">CRD42022375076<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0290362","type":"journal-article","created":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T17:45:22Z","timestamp":1692294322000},"page":"e0290362","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["Effects of high intensity interval training versus moderate intensity continuous training on exercise capacity and quality of life in 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