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Changes in Cardiorespiratory Fitness Following Exercise Training Prescribed

Relative to Traditional Intensity Anchors and Physiological Thresholds: A
Systematic Review with Meta-an...

Article in Sports Medicine · November 2024

DOI: 10.1007/s40279-024-02125-x

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Sports Medicine
https://doi.org/10.1007/s40279-024-02125-x

SYSTEMATIC REVIEW

Changes in Cardiorespiratory Fitness Following Exercise Training

Prescribed Relative to Traditional Intensity Anchors and Physiological
Thresholds: A Systematic Review with Meta‑analysis of Individual
Participant Data
Samuel J. R. Meyler1 · Paul A. Swinton2 · Lindsay Bottoms1 · Lance C. Dalleck3 · Ben Hunter4 · Mark A. Sarzynski5 ·
David Wellsted1 · Camilla J. Williams6 · Daniel Muniz‑Pumares1

Accepted: 17 September 2024

© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2024

Abstract
Background It is unknown whether there are differences in maximal oxygen uptake (V O2max) response when prescribing
intensity relative to traditional (TRAD) anchors or to physiological thresholds (THR).
Objectives The present meta-analysis sought to compare: (a) mean change in V O2max, (b) proportion of individuals increas-
ing V O2max beyond a minimum important difference (MID) and (c) response variability in V O2max between TRAD and THR.
Methods Electronic databases were searched, yielding data for 1544 individuals from 42 studies. Two datasets were created,
comprising studies with a control group (‘controlled’ studies), and without a control group (‘non-controlled’ studies). A
Bayesian approach with multi-level distributional models was used to separately analyse V O2max change scores from the two
datasets and inferences were made using Bayes factors (BF). The MID was predefined as one metabolic equivalent (MET;
3.5 mL ­kg−1 ­min−1).
Results In controlled studies, mean V O2max change was greater in the THR group compared with TRAD (4.1 versus 1.8
mL ­kg−1 ­min−1, BF > 100), with 64% of individuals in the THR group experiencing an increase in V O2max > MID, compared
with 16% of individuals taking part in TRAD. Evidence indicated no difference in standard deviation of change between THR
and TRAD (1.5 versus 1.7 mL ­kg−1 ­min−1, BF = 0.55), and greater variation in exercise groups relative to non-exercising
controls (1.9 versus 1.3 mL ­kg−1 ­min−1, BF = 12.4). In non-controlled studies, mean V O2max change was greater in the THR
group versus the TRAD group (4.4 versus 3.4 mL ­kg−1 ­min−1, BF = 35.1), with no difference in standard deviation of change
(3.0 versus 3.2 mL ­kg−1 ­min−1, BF = 0.41).
Conclusion Prescribing exercise intensity using THR approaches elicited superior mean changes in V O2max and increased
the likelihood of increasing V O2max beyond the MID compared with TRAD. Researchers designing future exercise training
studies should thus consider the use of THR approaches to prescribe exercise intensity where possible. Analysis compar-
ing interventions with controls suggested the existence of intervention response heterogeneity; however, evidence was not
obtained for a difference in response variability between THR and TRAD. Future primary research should be conducted
with adequate power to investigate the scope of inter-individual differences in V O2max trainability, and if meaningful, the
causative factors.

1 Introduction highest V̇ O2max values ever recorded [3, 4]. Additionally, V̇

O2max is an important marker of cardiovascular health [5–7],
Cardiorespiratory fitness, measured as maximum oxygen and low levels of V̇ O2max are a strong risk factor for all-cause
uptake (V̇ O2max), represents the upper limit of cardiopulmo- and disease-specific mortality [5]. Despite being the only
nary-muscle oxidative function [1], quantifying the body’s major risk factor not routinely assessed in clinical practice,
ability to transport and utilise oxygen [2]. As such, V̇ O2max is growing epidemiological and clinical evidence suggests
recognised as a key determinant of endurance performance, that V̇ O2max may be a stronger predictor of mortality than
with elite endurance athletes demonstrating some of the traditionally assessed risk factors such as smoking, type 2
diabetes mellitus and obesity [7]. Increasing V̇ O2max is thus
Extended author information available on the last page of the article
a commonly sought-after phenotypic change across different

Vol.:(0123456789)
 S. J. R. Meyler et al.

the number of individuals attaining a change in V̇ O2max

Key Points surpassing a predefined threshold, interventions commonly
adopt ‘additive’ approaches (for a review see [21]). For
Prescribing exercise training relative to physiological example, augmenting the exercise stimulus (i.e. increasing
thresholds, rather than traditional intensity anchors, training volume, frequency, and/or intensity) often proves
elicited superior changes in cardiorespiratory fitness and effective in increasing response rate as a result of greater
increased the proportion of individuals increasing cardi- group mean increases in V̇ O2max [22–25]. Aiming to elicit
orespiratory fitness by at least one metabolic equivalent. superior changes in V̇ O2max and reduce response variability
No difference in cardiorespiratory response variability to the initial stimulus, an example of a ‘subtractive’ approach
was observed between exercise groups. Comparisons [21], may be achieved through changing the method used
with controls, however, provided evidence of inter- to prescribe exercise intensity [19]. However, the effects of
individual response variability that warrants further using different means of exercise prescription to do so are
investigation. unclear.
Exercise intensity is commonly prescribed relative to tra-
Considering the link between cardiorespiratory fitness ditional (TRAD) intensity anchors (Table 1) [15], whereby
and both health and performance outcomes, future stud- recommended percentages of such values are used to pre-
ies should aim to prescribe exercise relative to physi- scribe exercise in a given intensity domain. It is worth noting
ological thresholds where possible. that, whilst varying nomenclature is used to describe the dif-
ferent intensity domains in performance and health settings
[26], the three-domain classification (moderate-, heavy- and
severe-intensity exercise) will be referred to in the present
populations. Evidence indicates that increasing V̇ O2max by study. Notably, TRAD approaches are evidenced to elicit
one metabolic equivalent (MET; 3.5 mL ­kg−1 ­min−1) can marked variation in acute physiological responses and exer-
reduce mortality risk by ~ 10–30% [5, 8] and health care cise tolerance [27–33]. As changes in V̇ O2max manifest in
costs by ~ 5% [9, 10]. In turn, a value of one MET can be response to specific exercise-induced adaptive stimuli [34],
used as a minimum important difference (MID) when evalu- when different stimuli are experienced by individuals over
ating changes in V̇ O2max following a period of exercise train- time, it is plausible that this may contribute to a portion of
ing [7, 11]. V̇ O2max response variability [19, 31, 35].
Changes in V̇ O2max can be explained by the Fick principle, However, using physiological thresholds that demarcate
where V̇ O2max is the product of maximum cardiac output and the intensity domains as intensity anchors (Table 2) has
arteriovenous oxygen difference [12, 13]. Adaptations caus- been shown to elicit more homogeneous acute physiological
ing changes in cardiac output (i.e. the product of heart rate responses to an exercise bout [29, 32, 33, 36]. It is of interest
and stroke volume) represent ‘central’ adaptations whereby to explore whether this has a positive impact on longer-term
phenotypic modifications alter convective oxygen delivery, responses (i.e. training-induced changes in V̇ O2max) regarding
whereas adaptations causing changes in arteriovenous oxy- their magnitude and variability. If the magnitude of training-
gen difference reflect ‘peripheral’ adaptations, comprising induced changes in V̇ O2max can be increased among a larger
changes in oxygen extraction and utilisation [14]. The most proportion of individuals, and the number of individuals expe-
effective means of increasing V̇ O2max is through endurance riencing negligible changes in their V̇ O2max is reduced, this
training, typically in the form of constant load continuous could have profound implications for improving health out-
training and/or interval-based training, which are shown to comes and approaches to exercise prescription.
increase V̇ O2max by ~ 5.5 and ~ 4.9 mL ­kg−1 ­min−1, respec-
tively [15]. However, V̇ O2max is markedly reduced by periods 1.1 Objectives
of inactivity (e.g. bed rest) [16]. Whilst both approaches of
exercise training have been demonstrated to be efficacious at Examining differences between physiological threshold (THR)
the group level [15], the individual effect of exercise training and TRAD exercise programmes [and using non-exercising
on V̇ O2max appears to exhibit a heterogenous distribution [17, control groups (CON) where applicable], we sought to: (a)
18], suggesting that some individuals do not attain some of compare the mean change scores in V̇ O2max and the proportion
the benefits of exercise. of individuals expected to attain increases in V̇ O2max beyond
Several biological and methodological factors underpin a MID of one MET (3.5 mL ­kg−1 ­min−1) between THR and
this apparent ‘response variability’ (for a review see [19]), TRAD and (b) test the hypothesis that V̇ O2max response vari-
as well as measurement error and day-to-day biological vari- ability is lower in the THR group compared with the TRAD
ability [20]. To tackle response variability, and specifically group.
Cardiorespiratory Fitness and Exercise Intensity Prescription

Table 1  ‘Traditional’ anchors of exercise intensity

Intensity anchor Abbreviation Description

Maximum oxygen uptake V̇ O2max Maximum oxygen uptake attained during maximal exercise
despite increases in external workload
Oxygen uptake reserve V̇ O2R Difference between maximum and resting oxygen uptake
Maximum heart rate HRmax Maximum heart rate reached during maximal exercise despite
increases in external workload
Heart rate reserve HRR Difference between maximum and resting heart rate
Maximum work rate WRmax Maximum work rate achieved during an incremental exercise test

Table 2  Physiological thresholds delineating the boundaries of the moderate- and heavy-intensity domains and the heavy- and severe-intensity
domains
Physiological threshold Description

Boundary between the moderate- and heavy-intensity domains

Lactate threshold (LT) Blood lactate concentration rises above baseline levels
Gas exchange threshold (GET) First breakpoint at which V̇ CO2 increases disproportionately to V̇ O2
First ventilatory threshold ­(VT1) An increase in V̇ E/V̇ O2 with no concurrent increase in V̇ E/V̇ CO2
Boundary between the heavy- and severe-intensity domains
Maximum lactate steady-state (MLSS) Highest constant workload that leads to a balance between lactate
production and elimination
Respiratory compensation point (RCP) Second breakpoint at which V̇ E increases disproportionately to V̇ O2
Second ventilatory threshold ­(VT2) A simultaneous increase in both V̇ E/V̇ O2 and V̇ E/V̇ CO2
Critical power (CP) Asymptote of the power–duration relationship

V̇ ̇CO2 Carbon dioxide production, V̇ E minute ventilation, V̇ O2 oxygen uptake

2 Methods 2.2.3 Type of Interventions

2.1 Protocol and Registration Training interventions had to meet the following criteria:
(a) exercise training lasted ≥ 3 weeks; (b) consisted of either
This review was pre-registered on the International Pro- continuous training, interval training or a combination of
spective Register of Systematic Reviews (PROSPERO; both; (c) exercise was either walking, running or cycling;
id: CRD42021226644), and the present protocol has been (d) V̇ O2max was directly measured pre- and post-intervention
conducted in accordance with the Preferred Reporting via indirect calorimetry during an incremental test to task
Items for Systematic Review and Meta-analysis of Individ- failure; and (e) individuals were either allocated to tradition-
ual Participant Data guidelines [37] (Supplementary file). ally prescribed exercise training (TRAD), whereby exercise
intensity was prescribed relative to a physiological value,
2.2 Eligibility Criteria as outlined in Table 1, and/or to a physiological threshold
(THR) as outlined in Table 2. The latter included studies
2.2.1 Type of Study using the delta method (∆), whereby intensity is prescribed
using a physiological threshold and physiological value (i.e.
Randomised controlled and non-controlled training studies, 50% ∆ = gas exchange threshold + [0.5 × (critical power-gas
written in English, and published before October 2023, were exchange threshold)]). Exercise groups involving additional
used. interventional manipulations, such as nutritional supplemen-
tation and/or environmental manipulation, were excluded.
2.2.2 Type of Participants Two datasets were created from eligible studies, one con-
taining ‘controlled’ studies, where studies included volume-
Participants were healthy males and females ≥ 18 years of matched THR and TRAD exercise group and a non-exer-
age with a body mass index (BMI) ≤ 30 kg ­m2, and not suf- cising control group (CON), and ‘non-controlled’ studies,
fering from any acute or chronic disease(s).
 S. J. R. Meyler et al.

where data from any single THR and TRAD exercise group 2.6 Risk of Bias
were included.
Risk of bias was assessed in each individual study by two
2.3 Identifying Studies for Systematic Review— reviewers (S.M. and D.M.P.). For randomised trials, the
Information Sources and Search Strategy Cochrane risk-of-bias tool for randomised trials (RoB2)
was used [38]. The ROBINS-I tool was used for assessing
The electronic databases PubMed and Scopus were searched risk of bias in non-randomised and uncontrolled intervention
initially in 2021 and updated in 2023 such that papers pub- studies [39]. An inter-reviewer reliability analysis using the
lished before October 2023 were included. Databases were kappa statistic ( k ) was performed to determine consistency
searched using the following terms: ‘high-intensity inter- between reviewers (Supplementary file).
val training’, ‘continuous training’, ‘endurance training’,
‘maximum oxygen uptake’, ‘peak oxygen uptake’, ‘V̇ O2max’, 2.7 Specification of Outcomes and Effect Measures
‘cardiorespiratory fitness’ and ‘healthy adults’. Additional
resources were sought via the scrutinisation of reference A l l a n a ly s e s we r e c o n d u c t e d u s i n g V̇ O 2 m a x
lists, review articles and contact with research teams of rel- (mL ­kg−1 ­min−1) change scores, calculated for each indi-
evant papers. The literature search and study selection pro- vidual as the post-intervention value minus the baseline
cess was carried out independently by two authors (S.M. and value. Measures of effect were based on group differences
B.H.) using a systematic review software (Covidence, Veri- according to this absolute scale and percentage expected
tas Health Innovation, Australia). A third reviewer (author to exceed the MID.
D.M.) resolved any disagreements regarding study eligibil-
ity. The title and abstracts were extracted from the database
searches and duplicates were removed automatically by the 2.8 Synthesis Methods
Covidence software. Papers that were not relevant based on
the title were removed. Title and abstracts were screened to Across all analyses, one-stage IPD meta-analysis mod-
identify studies that appeared to meet the predefined eligibil- els were developed. All models were conducted within
ity criteria. Full texts of studies passing the title and abstract a Bayesian framework with random intercepts to account
screening were then scrutinised to determine their eligibility for systematic variation across individual studies. Change
for inclusion in the review. scores relative to baseline were calculated for each par-
ticipant on an absolute scale (mL ­kg−1 ­min−1), and distri-
2.4 Data Collection Processes butional models were used to estimate both the mean dif-
ference and standard deviation of the difference. A group
Corresponding authors of eligible studies were contacted term (TRAD versus THR, or exercise versus control) was
via email or by other means of contact (e.g. ResearchGate added as a predictor for the mean and standard deviation,
and social media). Authors were provided with a brief sum- with a log link used for the latter. Posterior distributions
mary of the aims of the present study and invited to share were summarised by reporting the median and 95% credi-
anonymised individual participant data (IPD). Anonymised ble intervals (CrI) for the mean and 75% CrIs for the stand-
IPD included age, sex, height (cm), pre- and post-interven- ard deviation. Separate Bayes factors were estimated com-
tion mass (kg), V̇ O2max (mL ­kg−1 ­min−1 and L ­min−1) and paring models with and without the group predictor for
BMI for all individuals. Lead authors were contacted in the the mean and standard deviation. A Bayes factor greater
same manner if corresponding authors were unreachable. A than 1.0 provided evidence supporting a group difference,
follow-up email containing a deadline for response was sent whereas values less than 1.0 provided evidence support-
to authors in the absence of a reply. ing no group difference. The overall strength of evidence
in favour of the different models was evaluated accord-
2.5 IPD Integrity ing to a previously defined scale [40], with non-neutral
descriptions ranging from anecdotal to extreme evidential
Once IPD were received, data were checked for consist- strength (Table 3).
ency with the published report, at the individual level for To investigate the proportion of individuals exceeding
inconsistencies and missing data. Only individuals with a the MID, we used the posterior samples from the distribu-
complete data set were included in the review, and individ- tional model to generate posterior predictions (n = 10,000)
ual data not meeting the participant eligibility criteria were and calculated the proportion that exceeded the threshold
excluded. Any discrepancies between IPD and published in each group. Default weakly informative priors were
reports were discussed with the study authors. used, including student-t and half-t priors with 3 degrees
of freedom. All analyses were performed using the R
Cardiorespiratory Fitness and Exercise Intensity Prescription

wrapper package brms interfaced with Stan to perform 3.4 Results of Syntheses

sampling [41] and the R package bridgesampling to cal-
culate Bayes factors. Convergence of parameter estimates 3.4.1 Changes in Maximum Oxygen Uptake
was obtained for all models with Gelman–Rubin R-hat
values below 1.1 [42]. Controlled studies ‘Extreme’ evidence (BF > 100) was
identified in support of a greater improvement in V̇ O2max
for THR [4.1 (95% CrI: 3.1–5.0 mL ­kg−1 ­m in−1)] com-
3 Results pared with TRAD [1.8 (95% CrI: 0.9–2.8 mL ­kg−1 ­min−1);
Fig. 2]. Individuals were estimated to be approximately
3.1 Study Selection and IPD Obtained four times more likely to experience an increase in V̇
O2max greater than the MID with THR (64%) compared
See Fig. 1 for the flow diagram pertaining to study identifi- with TRAD (16%). There was ‘anecdotal’ evidence
cation and screening, and the amount of IPD obtained. (BF = 0.55) in support of no difference in variation of V̇
O2max change scores between THR [1.5 (75% CrI: 1.2–1.8
mL ­k g −1 ­m in −1 )] and TRAD [1.7 (75% CrI: 1.4–2.1
3.2 IPD integrity and Risk of Bias Within Studies mL ­kg −1 ­m in −1); Fig. 2]. When THR and TRAD were
combined, ‘strong’ evidence (BF = 12.4) was identi-
There were no issues that needed to be raised following the fied in support of a greater variation in V̇ O 2max change
checking of IPD. Risk of bias assessments for individual scores in the training groups [1.9 (75% CrI: 1.7–2.2)
studies are included in the Supplementary file. There was no mL ­k g −1 ­m in −1)] compared with CON [1.3 (75% CrI:
need for any weighting adjustments prior to the subsequent 1.1–1.6) mL ­kg−1 ­min−1); Fig. 3].
analyses. Risk was determined to be as follows: Domain 1: Non-controlled studies In general, similar findings to
low risk 87%, some concerns 3%, high risk 10%; Domain those obtained for controlled studies were observed in non-
2: low risk 100%; Domain 3: low risk 100%; Domain 4: controlled studies. ‘Very strong’ evidence (BF = 35.1) was
low risk 100%; Domain 5: low risk 10%, high risk 90%; identified in support of a greater improvement in V̇ O2max
and Overall: low risk 10%, some concerns 80%, high risk for THR [4.4 (95% CrI: 3.7–5.2 mL ­kg−1 ­m in−1)] com-
10% (Supplementary file). Of note, IPD from the HERIT- pared with TRAD [3.4 (95% CrI: 2.8–4.1 mL ­kg−1 ­min−1);
AGE study [17] were included in the current analyses. Due Fig. 4]. Predictions using the fitted model estimated 60%
to the large amount of HERITAGE IPD analysed (n = 562) of individuals in the THR group should be expected to
compared with that of the other eligible studies combined increase V̇ O2max beyond the MID, with 47% expected in
(n = 953), the analyses were run with and without its inclu- the TRAD group. ‘Anecdotal’ evidence (BF = 0.41) was
sion. There was, however, no difference between the pri- identified in support of no difference in variation of V̇
mary results in either case, and thus, the results are reported O2max change scores between THR [3.0 (75% CrI: 2.7–3.3
including the HERITAGE IPD. mL ­k g −1 ­m in −1 )] and TRAD [3.2 (75% CrI: 2.9–3.5
mL ­kg−1 ­min−1); Fig. 4].

3.3 Study Characteristics
4 Discussion
Individual study characteristics are presented in Table 4,
and summary characteristics of THR and TRAD studies are This is the first IPD meta-analysis to explore the magnitude
presented in Table 5. and variation in V̇ O2max change scores elicited by training
programmes using THR and TRAD approaches. The main
findings were (1) prescribing exercise intensity using THR
approaches elicited superior mean changes in V̇ O2max and
Table 3  Category of evidence for Bayes factor interpretation increased the likelihood of an individual increasing V̇ O2max
Bayes factor Strength of evidence beyond the MID, and (2) there appeared to be no difference
in response variability between THR and TRAD.
≥ 100 Extreme
30–100 Very strong
10–30 Strong
4.1 Mean Changes in V̇ O2max
3–10 Moderate
1–3 Anecdotal
Superior increases in V̇ O2max were observed in the THR
1 No evidence
group compared with the TRAD group in both the controlled
 S. J. R. Meyler et al.

Fig. 1  Flow diagram of the study identification and screening process

and non-controlled analyses. In the controlled studies, it was findings agree with previous literature whereby increased V̇
estimated that individuals were approximately four times as O2max response rates are typically explained by greater mean
likely to experience an increase in V̇ O2max beyond the MID. change scores as opposed to reductions in inter-individual
This estimate was based on the statistical model indicating variability [25]. In turn, using THR approaches represents
64% of participants undergoing THR would experience an a viable approach in increasing response rates, and thus,
increase of ≥ 3.5 mL ­kg−1 ­min−1 compared with 16% of par- increasing the likelihood of individuals attaining the health-
ticipants undergoing TRAD. In the non-controlled studies, and performance-related benefits of exercise training. Impor-
greater variability was observed across the larger data set; tantly, instead of requiring increases in training dose follow-
however, it was estimated that, on average, 60% and 47% of ing TRAD (i.e. by increasing training intensity, frequency
individuals would experience changes beyond the MID in and/or duration), using THR approaches appears to be an
the THR and TRAD groups, respectively. effective method to increase the proportion of individuals
Regarding the notion of increasing ‘response rates’, attaining increases in V̇ O2max beyond a predefined threshold
herein defined as the proportion of individuals improving a in response to the initial exercise stimulus.
given parameter beyond a predefined threshold, the present
Table 4  Participant characteristics, sample size, training characteristics and V̇ O2max change scores for studies included in the present individual participant data meta-analysis

Study Year Participants Sex Number (n) Method Type Mode (ses- Protocol V̇ O2max (mL ­kg−1 ­min−1) Change Change
(age) sions)
Pre Post Percentage (%) mL ­kg−1 ­min−1
Mean ± SD Mean ± SD Mean ± SD Mean ± SD

Arboleda 2019 Sedentary M 18 TRAD INT Running (24) 15 × 30 s @ 40.1 ± 6.2 43.7 ± 6.2 9.7 ± 9.8 3.6 ± 3.5
et al. [43] (29 ± 8) 90–95%
­HRmax
20 TRAD CT Running (24) 40 min @ 43.5 ± 8.6 44.9 ± 8.7 4.3 ± 15.4 1.4 ± 6.7
65–75%
­HRmax
Astorino 2018 Active M/F 14 THR INT Cycling (9) 8–10 × 1 min 38.8 ± 4.3 41 ± 4.6 5.7 ± 3.9 2.2 ± 1.6
et al. [44] (27 ± 8) @ 130%
VT
Astorino 2013 Sedentary F 4 TRAD INT Cycling (33) 6–10 × 1 min 31.7 ± 4.4 36.4 ± 4.2 15.4 ± 9.1 4.7 ± 2.5
et al. [45] (24 ± 7) @ 80–90%
Cardiorespiratory Fitness and Exercise Intensity Prescription

Wmax
8 TRAD INT Cycling (33) 6–10 × 1 min 30.6 ± 4.2 37.1 ± 3.4 22.1 ± 8.1 6.5 ± 1.6
@ 60–80%
Wmax
Berger et al. 2006 Active M 8 TRAD CT Cycling 30 min @ 33.7 ± 3.8 39.8 ± 6 18 ± 7.7 6.1 ± 3
[46] (23 ± 4) (18–24) 60% V̇ O2max
8 TRAD INT Cycling 20 × 1 min 34.6 ± 6.8 43 ± 8.3 24.3 ± 5.1 8.4 ± 2.1
(18–24) @ 90% V̇
O2max
Bonafiglia 2016 Active M/F 21 TRAD CT Cycling (12) 30 min @ 42.2 ± 6.5 43.9 ± 6.5 4.4 ± 7.9 1.7 ± 3.2
et al. [47] (20 ± 1) 65% V̇ O2max
Bouchard 1999 Sedentary M/F 562 TRAD CT Cycling (60) 30–50 min @ 33.1 ± 8.6 38.7 ± 9.1 18 ± 9.9 5.6 ± 2.9
et al. [17] (35 ± 14) 55–75% V̇
O2max
Branch et al. 1997, 1999 Sedentary F 8 TRAD CT Running (40) 150–375 36.2 ± 4.9 38.8 ± 7.5 6.8 ± 8.8 2.6 ± 3.8
[48, 49] (32 ± 5) kcal/ses-
sion @ 80%
­HRmax
10 TRAD CT Cycling (40) 150–375 29.2 ± 7.9 35.5 ± 7 24.6 ± 13.7 6.3 ± 2.6
kcal/ses-
sion @ 80%
­HRmax
Table 4  (continued)
Study Year Participants Sex Number (n) Method Type Mode (ses- Protocol V̇ O2max (mL ­kg−1 ­min−1) Change Change
(age) sions)
Pre Post Percentage (%) mL ­kg−1 ­min−1
Mean ± SD Mean ± SD Mean ± SD Mean ± SD

8 TRAD CT Cycling (40) 150–375 29.8 ± 4.6 34.1 ± 6.6 16.5 ± 25.3 4.3 ± 7.9
kcal/ses-
sion @ 40%
­HRmax
Byrd et al. 2019 Sedentary M/F 11 THR INT + CT Cycling + Run- CT: 30–50 33.6 ± 4 38.4 ± 4.4 14.3 ± 3.6 4.8 ± 1.1
[50] (32 ± 9) ning (30) min
@ < VT1
to > VT2;
INT:
8–12 × 60 s
@ 100% V̇
O2max
11 TRAD INT + CT Cycling + Run- CT: 30–50 30.4 ± 6.2 33 ± 7.2 8.1 ± 3.3 2.5 ± 1.2
ning (30) min @
40–65%
HRR
Casaburi 1987 Sedentary M/F 9 THR CT Cycling (40) 45 min @ 34.5 ± 4.1 40.3 ± 4.1 17.3 ± 8 5.8 ± 2.5
et al. [51] (23 ± 1) 50–75% ∆
Dalleck et al. 2008 Sedentary F 13 TRAD CT Walking (~ 180 min) 35.5 ± 5.9 37.9 ± 4.5 7.8 ± 8 2.5 ± 2.3
[52] (37 ± 6) (30–40) 250–1000
kcal/week
@ 50% V̇
O2R
Dalleck et al. 2016 Sedentary M/F 10 THR CT Aerobic exer- 25–50 min 25.9 ± 3.8 29.7 ± 4.9 14.7 ± 7.8 3.8 ± 2.2
[53] (68 ± 8) cise (21) @ < VT1
to > VT2
9 TRAD CT Aerobic exer- 25–50 min 24.1 ± 12.3 26.3 ± 11.9 11.4 ± 9.5 2.2 ± 1.5
cise (21) @ 40–65%
HRR
Daussin 2008 Sedentary M/F 13 THR CT Cycling (24) 20–35 min 29.1 ± 5.9 31.9 ± 6.4 9.8 ± 8.7 2.8 ± 2.5
et al. [54] (46 ± 8) rep 5 min (4
min @ LT,
1 min @
90% Pmax)
13 THR INT Cycling (24) Work 27.5 ± 5.3 32.3 ± 6.5 18.5 ± 16.7 4.8 ± 4.9
matched
with INT
S. J. R. Meyler et al.
Table 4  (continued)
Study Year Participants Sex Number (n) Method Type Mode (ses- Protocol V̇ O2max (mL ­kg−1 ­min−1) Change Change
(age) sions)
Pre Post Percentage (%) mL ­kg−1 ­min−1
Mean ± SD Mean ± SD Mean ± SD Mean ± SD

Fiorenza 2019 Sedentary M 12 TRAD INT Cycling (18) 10–15 min of 36.6 ± 8.4 39.4 ± 4.8 7.8 ± 7.8 2.8 ± 2.7
et al. [55] (57 ± 8) ‘10–20–30
training’,
3 min rec
between 5
min bouts
@ 30%,
50%, and
100% max
intensity
Ghiarone 2019 Active M 8 THR INT + CT Cycling (18) Train twice 36 ± 4.3 39.3 ± 5.4 9±7 3.3 ± 2.5
et al. [56] (26 ± 5) daily (3
Cardiorespiratory Fitness and Exercise Intensity Prescription

days/
week) CT:
5 min @
LT1 + 100
min @ 50%
∆ (LT1 and
LT2), INT:
10 × 2 min
@ 20% ∆
(LT2 and
PPO)
7 THR INT + CT Cycling (18) Train once 37.9 ± 7.9 40.2 ± 6.6 8.6 ± 21.9 2.3 ± 5.8
daily
(6 day/
week) CT:
5 min @
LT1 + 100
min @ 50%
∆ (LT1 and
LT2), INT:
10 × 2 min
@ 20% ∆
(LT2 and
PPO)
Table 4  (continued)
Study Year Participants Sex Number (n) Method Type Mode (ses- Protocol V̇ O2max (mL ­kg−1 ­min−1) Change Change
(age) sions)
Pre Post Percentage (%) mL ­kg−1 ­min−1
Mean ± SD Mean ± SD Mean ± SD Mean ± SD

Gormley 2008 Active M/F 14 TRAD CT Cycling (22) 30–40 min 34.5 ± 8.6 39.1 ± 9 13.9 ± 10.3 4.6 ± 3.3
et al. [57] (22 ± 3) @ 50–75%
HRR
12 TRAD INT Cycling (18) Weeks 1 and 36.5 ± 5.8 43 ± 7.6 17.7 ± 10.2 6.5 ± 3.8
2: 30–40
min @
50–75%
HRR,
Weeks 3–6:
5 × 5 min @
95% HRR
14 TRAD CT Cycling (23) 30–60 min @ 35.5 ± 7.9 38.8 ± 9.1 10 ± 10.9 3.4 ± 4
50% HRR
Granata 2016 Active M 10 THR INT Cycling (52) 4–7 × 4 min 45.1 ± 7.6 52.2 ± 7.8 16.2 ± 6.6 7.1 ± 2.8
et al. [58] (21 ± 2) @ 35–75%
∆ (LT and
­WRpeak);
5–12 × 4
min @
30–80% ∆;
8–20 × 2
min @
50–80% ∆
Hov et al. 2022 Healthy M 10 TRAD INT Running (24) 4 × 4 min @ 62.1 ± 4.8 66 ± 5 6.3 ± 2.4 3.9 ± 1.5
[59] (23 ± 2) 90–95%
­HRmax
Jacques et al. 2021 Moderately M 15 THR INT Cycling (36) 6–14 × 2 min 52.3 ± 9.8 56.5 ± 10 8.8 ± 12.6 4.2 ± 6.2
[60] trained @ 40–70%
(35 ± 10) ∆
Landen et al. 2021 Moderately F 18 THR INT Cycling (12) 6–14 × 2 min 44.5 ± 9 45.9 ± 8.1 3.9 ± 5.2 1.5 ± 2.1
[61] trained @ 40–70%
(35 ± 7) ∆
Litleskare 2020 Active M/F 12 TRAD CT Running (24) 30–60 min 47.9 ± 5.9 49.7 ± 6.2 3.9 ± 5.6 1.8 ± 2.6
et al. [62] (25 ± 4) @ 70–80%
­HRpeak
S. J. R. Meyler et al.
Table 4  (continued)
Study Year Participants Sex Number (n) Method Type Mode (ses- Protocol V̇ O2max (mL ­kg−1 ­min−1) Change Change
(age) sions)
Pre Post Percentage (%) mL ­kg−1 ­min−1
Mean ± SD Mean ± SD Mean ± SD Mean ± SD

Maturana 2021 Sedentary M/F 21 THR CT Cycling (18) 60 min @ 30.4 ± 4.3 32.7 ± 4.2 7.9 ± 8.6 2.3 ± 2.6
et al. [63] (27 ± 6) LTP1
21 TRAD INT Cycling (18) 4 × 4 min @ 31.9 ± 4.1 37.2 ± 4.1 17 ± 7.9 5.3 ± 2.1
90% ­HRmax
Maunder 2021 Active M 8 THR INT + CT Cycling (15) 4–6 × 8 min 52.5 ± 6.4 53.4 ± 6.9 1.7 ± 3.5 0.9 ± 1.8
et al. [64] (32 ± 7) @ VT2; 90
min @ 95%
VT1; 3 × 25
min @ 50%
∆ (VT1
and VT2);
Cardiorespiratory Fitness and Exercise Intensity Prescription

6–10 × 3
min
McNicol 2009 Active M/F 14 THR CT Running (18) 20 min @ 44 ± 5.5 47.6 ± 6.5 8.7 ± 12.2 3.6 ± 5.1
et al. [65] (21 ± 5) 0.8 km/h
less than
LTv + 0.1
km/h per
session
13 THR CT Running (18) 20 min @ 0.8 44 ± 6.9 45.3 ± 7 3 ± 2.4 1.3 ± 1
km/h less
than LTv
Mendes 2013 Untrained M 13 THR CT Cycling (18) 24–39 min @ 44.9 ± 4.8 49.8 ± 4.5 11.2 ± 7.2 4.9 ± 3.1
et al. [66] (23 ± 2) MLSS
Myrkos et al. 2023 Young adults M/F 13 TRAD INT Running (14) Running 57.7 ± 8 61.4 ± 9.23 6.5 ± 5.7 3.8 ± 3.4
[67] (21 ± 3) bouts @
90% PTV
11 THR CT Running (14) − 2.5% of CV 58.2 ± 7.5 61.1 ± 6.4 5.6 ± 6.7 3 ± 3.7
Nicolini 2019 Sedentary M 15 TRAD INT Cycling (18) 5 × 1 min @ 35.5 ± 4.8 40 ± 5.1 12.9 ± 7 4.5 ± 2.2
et al. [68] (23 ± 4) 105–135%
­WRpeak
Nio et al. 2020 Untrained F 25 TRAD INT Cycling (36) 4 × 4 min @ 29.4 ± 5.3 35.4 ± 5.4 21.6 ± 11.4 6.1 ± 2.9
[69] (52 ± 4) 90–95%
­HRmax
O’Leary 2017 Untrained M/F 10 THR CT Cycling (18) 90% LT 43.5 ± 5.9 47.4 ± 8 8.6 ± 8.4 3.9 ± 3.8
et al. [70] (26 ± 5) matched to
work (KJ)
done in INT
Table 4  (continued)
Study Year Participants Sex Number (n) Method Type Mode (ses- Protocol V̇ O2max (mL ­kg−1 ­min−1) Change Change
(age) sions)
Pre Post Percentage (%) mL ­kg−1 ­min−1
Mean ± SD Mean ± SD Mean ± SD Mean ± SD

8 THR INT Cycling (18) 6–8 × 5 min 44.8 ± 4.2 48.8 ± 5.4 8.8 ± 7.3 4 ± 3.1
@ 50% ∆
Pothier et al. 2021 Untrained M/F 21 TRAD INT + CT Cycling (36) INT: 20 × 15 22.2 ± 6.2 24.3 ± 7 10.4 ± 16.6 2.1 ± 3.4
[71] (69 ± 5) s @ 100–
110% MAP,
CT: 20 min
@ 65–75%
MAP
Preobrazen- 2019 Active M 14 TRAD CT Cycling (15) 30 min @ 46 ± 6.7 49.7 ± 5.2 8.7 ± 7.3 3.7 ± 3.1
ski et al. (21 ± 2) 65% ­WRpeak
[72]
14 THR CT Cycling (15) 30 min @ 45.8 ± 5.9 51.2 ± 6.1 12.2 ± 7.1 5.4 ± 3
‘NEG’
talk–test
stage
Reuter et al. 2023 Untrained M/F 16 TRAD CT Running/ 50 min @ 34.5 ± 3.8 35.3 ± 4 2.6 ± 9.1 0.8 ± 3.1
[73] (46 ± 8) walking (78) 55% HRR
15 TRAD CT + INT Running/ CT: 50 min 33.9 ± 5.3 37.3 ± 4.9 10.7 ± 8 3.4 ± 2.7
walking (78) @ 55%
HRR, INT:
4 × 4 min @
95% ­HRmax
Schaun et al. 2018 Healthy M 14 TRAD INT Running (48) 8 × 20 s @ 46.8 ± 7.1 57.7 ± 6.7 24.9 ± 15.6 11 ± 6.2
[74] (23 ± 4) 130% vV̇
O2max
14 THR CT Running (48) 30 min @ 47.9 ± 7.5 56.6 ± 7.9 19.6 ± 15.6 8.8 ± 6
90–95% HR
at VT2
Schubert 2017 Active M/F 11 TRAD INT Cycling (12) 6–8 × 90% 31.4 ± 9.7 33.1 ± 9.8 6.1 ± 5.2 1.8 ± 1.7
et al. [75] (30 ± 9) PPO
Scharhag- 2012 Untrained M/F 20 TRAD CT Running/ 45 min @ 37.8 ± 5.3 43.1 ± 7.1 14.2 ± 11.7 5.3 ± 4.2
Rosen- (41 ± 6) walking (156) 60% HRR
berger
et al. [76]
Stensvold 2015 (72 ± 2) M/F 77 TRAD CT Aerobic 50 min @ 31.1 ± 5.9 32.6 ± 6.1 5.5 ± 10.7 1.5 ± 3.4
et al. [77] exercise (156) 70% ­HRpeak
S. J. R. Meyler et al.
Table 4  (continued)
Study Year Participants Sex Number (n) Method Type Mode (ses- Protocol V̇ O2max (mL ­kg−1 ­min−1) Change Change
(age) sions)
Pre Post Percentage (%) mL ­kg−1 ­min−1
Mean ± SD Mean ± SD Mean ± SD Mean ± SD

M/F 49 TRAD INT Aerobic Repetitions 31.8 ± 6.9 35.7 ± 6.7 13.7 ± 14.6 3.9 ± 4.3
exercise (156) of 4 min
intervals
with 3 min
recovery
periods
85–95%
­HRpeak
Tarumi et al. 2022 Older adults M/F 28 TRAD CT + INT Running/ CT: 25–40 22.5 ± 4 25.1 ± 4.1 15 ± 28.4 2.6 ± 5.5
[78] (70 ± 6) walking (156) min @
75–85% and
85–90%
Cardiorespiratory Fitness and Exercise Intensity Prescription

­HRmax
Tjønna et al. 2013 Inactive M 10 TRAD INT Running/ 1 × 4 min @ 39.2 ± 5.3 44.1 ± 5.6 12.9 ± 7.7 4.9 ± 2.7
[79] (42 ± 3) walking (30) 90% ­HRmax
12 TRAD INT Running/ 4 × 4 min @ 44.8 ± 5.3 51 ± 4.6 14.4 ± 8.9 6.2 ± 3.6
walking (30) 90% ­HRmax
Vanhatalo 2008 Habitually M/F 9 THR INT Cycling (12) 2 × p/week 6 × 5 50.7 ± 5.4 56 ± 6 10.5 ± 5.3 5.3 ± 2.7
et al. [80] active min at 105%
(29 ± 6) EP + 1 × p/
week 10 × 2
min @
50% WEP
expenditure
during the
first 2 min
period
Vollaard 2009 Healthy M 23 TRAD CT Cycling (24) 45 min 49.2 ± 5.2 55.6 ± 7.1 13.1 ± 10.8 6.4 ± 4.9
et al. [81] (24 ± 2) @70% V̇
O2max
Weatherwax 2019 Sedentary M/F 16 THR CT Aerobic exer- Energy 30.5 ± 6.6 34 ± 7.7 11.4 ± 3.9 3.5 ± 1.5
et al. [82] (46 ± 11) cise (33) expenditure
of 5.6–15.4
kcal/kg/
week @
HR < VT1
to > VT2
Table 4  (continued)
Study Year Participants Sex Number (n) Method Type Mode (ses- Protocol V̇ O2max (mL ­kg−1 ­min−1) Change Change
(age) sions)
Pre Post Percentage (%) mL ­kg−1 ­min−1
Mean ± SD Mean ± SD Mean ± SD Mean ± SD
13 TRAD CT Aerobic exer- Energy 25.2 ± 4.7 26.5 ± 4.2 6.1 ± 7.7 1.4 ± 1.9
cise (33) expenditure
of 5.6–15.4
kcal/kg/
week @
40–65%
HRR
Wolpern 2015 Sedentary M/F 9 THR CT Running (31) 20–30 min @ 35.4 ± 8.8 39.5 ± 8.8 12.2 ± 5.2 4.1 ± 0.9
et al. [83] (33 ± 10) HR < VT1
to > VT2
11 TRAD CT Running (31) 20–30 min 35.1 ± 5.5 36.4 ± 5.7 4 ± 5.4 1.4 ± 1.8
@ 40–65%
HRR
Yan et al. 2017 Moderately M 66 THR INT Cycling (12) 6–14 × 2 min 49.2 ± 8 50.5 ± 7.7 3.2 ± 9.4 1.3 ± 4.3
[84] trained @ 40–70%
(32 ± 8) ∆

THR exercise prescribed relative to physiological thresholds, TRAD exercise prescribed relative to a traditional intensity anchor, CT continuous exercise, INT interval exercise, HRmax maximum
heart rate, HRpeak peak heart rate, HRR heart rate reserve, V̇ O2max maximum oxygen uptake, V̇ O2R oxygen uptake reserve, VT ventilatory threshold, WEP work above end power during a 3 min
all out test, PPO peak power output, vV̇ O2max velocity at V̇ O2max, WRpeak peak work rate, MAP maximum aerobic power, LT lactate threshold, ∆ delta method, MLSS maximum lactate steady
state, LTv velocity at LT, CV critical velocity, PTV peak treadmill velocity, LTP lactate turn point, Pmax maximum power, M males, F females
S. J. R. Meyler et al.
Cardiorespiratory Fitness and Exercise Intensity Prescription

Table 5  Summary characteristics of controlled and non-controlled homogeneous acute physiological responses [29, 32, 33, 36].
THR and TRAD studies included in the present individual participant On the basis of the acute data presented in these studies, it
data meta-analysis
was hypothesised that repeated performance of THR would
Study group manifest in a more consistent chronic stimulus across par-
ticipants, resulting in reduced variation in change scores.
Controlled studies THR TRAD CON
Previous studies have reported increased V̇ O2max response
Studies (n) 4 4 4
rates following exercise training prescribed using THR com-
Individuals (n) 46 44 49
pared with TRAD [50, 53, 82, 90]; however, in such studies
Sex (M; F) 18; 28 16; 28 20; 29
it was unclear whether the increased response rates were
Age (year) 43 ± 17 46 ± 17 44 ± 14
the product of a reduction in response variability or simply
Body mass (kg) 72 ± 11 73 ± 11 75 ± 10
increased group mean changes in V̇ O2max, or both. On the
Baseline V̇ O2max (mL ­kg−1 ­min−1) 31 ± 7 29 ± 5 29 ± 6
basis of the present findings and a lack of evidence support-
Training duration (weeks) 13 ± 1 13 ± 1
ing a difference in the variability in V̇ O2max change scores
Training sessions (n) 29 ± 5 29 ± 5
following THR, it appears that increased response rates are
Continuous exercise 3 3
primarily explained by greater mean V̇ O2max change scores.
Interval exercise 0 0
Typically, THR studies implemented continuous training
Combination 1 1
[51, 53, 65–67, 70, 72, 74, 82, 90, 91]. It is plausible that the
Non-controlled studies THR TRAD
prescribed intensities were low enough that acute metabolic
Studies (n) 18 25
responses to THR and TRAD exercise were not markedly
Individuals (n) 354 1190
different, despite what may have been large differences in
Sex (M; F) 239; 115 565; 622
external work rate among individuals [33]. Notably, when
Age (year) 31 ± 12 38 ± 18
intensities approach or exceed the boundary between the
Body mass (kg) 75 ± 13 71 ± 13
heavy- and severe-intensity domains, marked differences in
Baseline V̇ O2max (mL ­kg−1 ­min−1) 42 ± 10 34 ± 9
exercise durations and responses can be observed despite
Training duration (weeks) 7±4 14 ± 14
only minimal differences in external work rate [33, 92–94].
Training sessions (n) 23 ± 11 43 ± 39
Using physiological thresholds to prescribe and control exer-
Continuous exercise 13 19
cise around this transition may be where such approaches
Interval exercise 8 16
hold their value. Furthermore, the activation of signalling
Combination 4 4
pathways associated with key physiological changes promot-
Data are presented as means or mean ± standard deviation ing increases in V̇ O2max (e.g. mitochondrial biogenesis) has
V̇ O2max maximum oxygen uptake been shown to increase at intensities within the severe-inten-
sity domain compared with the moderate- and heavy-inten-
sity domains [95]. Thus, having the ability to prescribe exer-
4.2 Variability in V̇ O2maxChange Scores cise accurately both above and below the boundary between
the heavy- and severe-intensity domains, as is shown when
An interesting finding of the current analysis was that greater using THR approaches, might have beneficial implications
variability in V̇ O2max change scores was observed in exercis- for the manifestation of subsequent adaptation.
ing groups compared with the non-exercising control group Various approaches are used to determine and apply
(Fig. 3). Whilst the magnitude of this evidence was small, physiological thresholds for training purposes [96, 97].
this provides evidence of inter-individual differences in V̇ Whilst they all aim to approximate the transition between
O2max trainability [18, 19, 85–87]. This warrants further the moderate- and heavy-intensity domains or the heavy- and
investigation, as currently, differences in inter-individual severe-intensity domains, they are not identical [98]. Critical
variability are often found to be attributable to measurement power is often considered the most accurate representation
error and biological variability as opposed to differences in of the latter boundary [93] and as aforementioned is shown
trainability [20, 88, 89]. to better control exercise intensity than when using TRAD
However, contrary to our hypothesis, weak evidence approaches. This is likely explained by the fact that using
was obtained in support of no difference in the variability TRAD approaches does not account for the relative position-
of V̇ O2max change scores between THR and TRAD in both ing of an individual’s critical power relative to a maximum
analyses. It has been shown that using THR approaches physiological value, such as V̇ O2max or H ­ Rmax [33]. Using
more effectively normalises exercise intensity among indi- critical power as a tool for exercise prescription, however,
viduals compared with when using TRAD anchors, reduc- appears to be limited in exercise-related research, with only
ing the variability in exercise tolerance and eliciting more one study in the present dataset [80] using the concept for
training purposes. An advantage of using critical power is
 S. J. R. Meyler et al.

Fig. 2  Modelled changes in V̇ O2max (mL ­kg−1 ­min−1) from controlled exercise training prescribed relative to physiological thresholds (n = 46),
studies comparing exercise prescription using traditional intensity anchors TRAD exercise training prescribed relative to traditional intensity anchors
or physiological thresholds. MID minimum important difference, THR (n = 44), SD standard deviation; CrI credible interval

Fig. 3  Modelled changes in V̇ O2max (mL ­kg−1 ­min−1) from con- physiological thresholds (n = 90), and ‘Control’ comprises data from
trolled studies comparing pooled data from all training groups and non-exercising control groups (n = 49). MID minimum important dif-
control. ‘Train’ comprises data from groups where exercise training ference, SD standard deviation, CrI credible interval
is prescribed using either traditional intensity anchors or relative to
Cardiorespiratory Fitness and Exercise Intensity Prescription

Fig. 4  Forest plot of modelled mean (left) and standard deviation median value and 95% credible intervals for the shrunken estimates.
(right) change in V̇ O2max (mL ­kg−1 ­min−1) across non-controlled Pooled estimates across conditions are presented in the centre of
studies comprising exercise prescription using either traditional the plot. The red line illustrates the minimum important difference
intensity anchors or physiological thresholds. Distributions repre- threshold. THR exercise training prescribed relative to physiological
sent ‘shrunken estimates’ based on all relevant effect sizes, the ran- thresholds, TRAD exercise training prescribed relative to traditional
dom effects model fitted, and borrowing of information across studies intensity anchors
to reduce uncertainty. Circles and connected intervals represent the

that a given work rate can be used to define the exercise exercise using a traditional intensity anchor, as this is where
session(s), negating the need to adjust exercise intensity to we may expect to see a more profound difference in response
match a given heart rate or V̇ O2 response. In the HERITAGE variability.
study, the fluctuation in the training work rate was the third It is worth noting that the relative intensity of exercise is
most impactful factor (6%) on V̇ O2max response variability, consistently shown to influence the magnitude of training-
despite overall adherence being greater than 95% [99]. It induced adaptations [15, 54, 57, 65, 100–102] and that simi-
would thus be interesting to investigate whether a reduction lar adaptations can be observed following a small volume of
in response variability is observed to a higher degree were exercise performed at very high intensities and a large vol-
critical power used as an intensity anchor, particularly when ume of exercise performed at lower intensities [103–107]. In
comparing studies prescribing heavy- and/or severe-intensity a recent study by Inglis et al. [102], 84 healthy participants
 S. J. R. Meyler et al.

performed moderate-, heavy-, severe- or extreme- intensity intensity; however, further studies are warranted to confirm
exercise training where exercise intensity was prescribed this notion [101].
using a ‘domain-based’ approach (i.e. THR) using the LT
and the maximum metabolic steady state (based on blood 4.3 Limitations
lactate and V̇ O2 responses) to determine the boundaries
between the moderate-to-heavy- and heavy-to-severe-inten- A limitation of the present study was the limited amount
sity domains, respectively. Interestingly, all exercise groups, of IPD obtained from those meeting the inclusion criteria.
bar the moderate-intensity exercise group, increased V̇ O2max, Whilst 236 studies met the predefined criteria (Fig. 1), the
the power output at the LT and the power output at the maxi- response rate of IPD obtained was 18% (N = 42). Addition-
mum metabolic steady state. Such results further support ally, THR IPD (n = 354) were limited compared with those
the notion that exercise intensity is a key determinant of of TRAD IPD (n = 1190). Exercise training programmes
training-induced changes in training-induced adaptations. are still routinely prescribed at intensities anchored rela-
All in all, exercise intensity demonstrates a clear influence tive to traditional parameters (i.e. V̇ O2max and H
­ Rmax) [15,
on the magnitude of subsequent changes in markers such 18, 85, 110, 111]. Understandably, using HR-based param-
as V̇ O2max. eters can negate the need for laboratory or field testing,
Such findings incite the argument that the method used making this an attractive approach, albeit not the most
to prescribe exercise intensity is in fact irrelevant and accurate. However, the continued use of V̇ O 2max as an
that, irrespective of whether a THR or TRAD approach is intensity anchor is surprising given its known inaccuracy
used, whichever approach elicits the highest relative exer- in controlling exercise intensity among individuals [29,
cise intensity will likely induce the largest increases in V̇ 31, 33, 36, 112, 113]. Moreover, if measuring V̇ O2max, data
O2max thereafter. On this point, it is important to consider used to determine given physiological thresholds (e.g. gas
the findings of Collins et al. [101], who conducted a train- exchange threshold) are readily available. Alternatively,
ing intervention comprising continuous exercise (CT) pre- self-assessed threshold tools such as rating of perceived
scribed at 44% of the maximum power output achieved in a exertion (RPE) can be used as surrogates for physiologi-
graded exercise testing (­ PGXT) and interval exercise (INT) cal thresholds and provide an easily accessible means
prescribed at 80% P ­ GXT. Of note, there were instances where of prescribing and controlling exercise intensity based
exercise intensity, when expressed relative to critical power, on a threshold-based approach [114–116]. For example,
was higher in the CT group compared with the INT group, using the 6–20 Borg scale, moderate-, heavy-, and severe-
and as a result, these individuals experienced superior intensity exercise can be prescribed at approximately ≤ 13,
changes in critical power post-training. At first glance, this 14–16, and ≥ 17, respectively [115]. Lehtonen et al. [115]
contradicts the argument that high-intensity INT is superior also note that pairing RPE with external work (e.g. run-
to lower-intensity CT [15, 54, 57, 65, 100–102]; however, it ning pace or power output) and internal physiological
instead supports the notion that, when prescribing exercise response (e.g. heart rate) would add a further element of
intensity, whether that be for CT or INT, anchoring intensity sophistication to the prescription and monitoring of exer-
relative to a maximum physiological value such as V̇ O2max cise training. There is also evidence demonstrating that
is not appropriate [31, 33, 35, 108]. Overall, the authors critical power and the running equivalent critical speed
concluded that the higher the training intensity is when can be derived from habitual training data and/or a series
expressed relative to critical power, instead of relative to V̇ of time trials [117–119]. This allows for a more accessible
O2max, the greater the training-induced changes thereafter means of critical speed and/or critical power determina-
[101]. Therefore, whilst the argument may be presented that tion, negating the need for laboratory-based testing [119].
the method used to prescribe exercise intensity is inconse- The results presented herein will hopefully encourage
quential so long as high-intensity exercise is prescribed, a greater consideration of using THR approaches, where
THR-based approach should be used to ensure that exercise possible, when designing future exercise research studies.
intensity is in fact ‘high’ for a given individual based on their Another limitation of the present study is that, compared
unique intensity domains and not just intended to be ‘high’ with the controlled dataset, the non-controlled dataset con-
based on a generalised approach to exercise intensity pre- tained IPD from studies with marked differences in study
scription. Additionally, in the instance that an individual has characteristics. For example, studies adopted various train-
not achieved a change in V̇ O2max, for example, above a given ing doses, populations, modes of exercise and training types
‘response’ threshold, the possibility exists that the intensity (Table 3). Effects of these differences were easily observed
elicited when using a TRAD-based approach was simply too when comparing the range in mean V̇ O2max improvements
low when expressed relative to critical power [19, 33, 101, estimated across the different studies (Fig. 4). Despite dif-
109]. Using critical power, or an alternative threshold, would ferences in study characteristics, overall findings from both
negate this issue of heterogeneity in the prescribed exercise analyses were consistent. As such, the two datasets and
Cardiorespiratory Fitness and Exercise Intensity Prescription

analyses complement each other and help account for their Author Contributions All authors: (1) made substantial contributions
individual limitations; for example, the controlled studies to the conception or design of the work or to the acquisition, analysis,
or interpretation of data and (2) drafted the work or revised it critically
comprise similar study characteristics but are small in sam- for important intellectual content. All authors read and approved the
ple size, whereas the non-controlled studies express a much final version of the manuscript.
larger sample size but marked differences in study charac-
teristics. If enough data were available, stricter eligibility
criteria could have been used such that a more homogeneous
non-controlled dataset could have been analysed. This would
have allowed a more robust comparison between THR and
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Authors and Affiliations

Samuel J. R. Meyler1 · Paul A. Swinton2 · Lindsay Bottoms1 · Lance C. Dalleck3 · Ben Hunter4 · Mark A. Sarzynski5 ·
David Wellsted1 · Camilla J. Williams6 · Daniel Muniz‑Pumares1

4
* Daniel Muniz‑Pumares School of Human Sciences, London Metropolitan University,
[email protected] London, UK
5
1 Department of Exercise Science, University of South
School of Life and Medical Sciences, University
Carolina, Columbia, SC, USA
of Hertfordshire, Hatfield, England, UK
6
2 School of Human Movement and Nutrition Sciences, The
School of Health Sciences, Robert Gordon University,
University of Queensland, Brisbane, QLD, Australia
Aberdeen, Scotland, UK
3
Recreation, Exercise and Sport Science Department, Western
Colorado University, Gunnison, CO, USA

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