Affective and enjoyment responses to 12 weeks of high intensity interval training and moderate continuous training in adults with Crohn’s disease

Authors: Lindsay Bottoms aff001;  Dean Leighton aff002;  Roger Carpenter aff003;  Simon Anderson aff004;  Louise Langmead aff005;  John Ramage aff006;  James Faulkner aff007;  Elizabeth Coleman aff008;  Caroline Fairhurst aff008;  Michael Seed aff003;  Garry Tew aff009
Authors place of work: Department of Psychology and Sports Science, University of Hertfordshire, Life and Medical Sciences, Hatfield, United Kingdom aff001;  Centre for Immunobiology, Queen Mary University of London, Whitechapel, London aff002;  School of Health, Sport and Bioscience, University of East London, Stratford Campus, London, United Kingdom aff003;  Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom aff004;  Digestive Diseases Clinical Academic Unit, Barts and the London NHS Trust, London, United Kingdom aff005;  Hampshire Hospitals NHS Foundation Trust, Hampshire, United Kingdom aff006;  Department of Sport, Exercise and Health, University of Winchester, Winchester, United Kingdom aff007;  York Trials Unit, University of York, Heslington, York aff008;  Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, United Kingdom aff009
Published in the journal: PLoS ONE 14(9)
Category: Research Article
doi: 10.1371/journal.pone.0222060


The aim was to undertake secondary data analysis from a three-arm randomised feasibility trial of high intensity interval training (HIIT), moderate intensity continuous training (MICT), and usual care control in adults with Crohn’s disease (CD; n = 36), with a primary focus on exploring affective and enjoyment responses. Twenty-five participants with quiescent or mildly-active CD were randomised to one of the two exercise groups: HIIT (n = 13) and MICT (n = 12). Both groups were offered thrice weekly sessions for 12 weeks. MICT consisted of cycling for 30 minutes at 35% peak power (Wpeak), whereas HIIT involved ten 1-minute bouts at 90% Wpeak, interspersed with 1-minute bouts at 15% Wpeak. Heart rate (HR), differentiated ratings of perceived exertion for legs (RPE-L) and central (RPE-C), along with feeling state (Feeling Scale; FS) were measured at 92.5% of each session. Enjoyment was measured at the end of training using the Physical Activity Enjoyment Scale (PACES). Post-hoc exploratory analysis involved a mixed-model two-way ANOVA to compare HR, RPE-L, RPE-C and FS for the exercise sessions in weeks 1, 6 and 12 between groups. Overall, HR was greater (p < 0.01) during HIIT (173 ± 8 bpm) compared with MICT (128 ± 6 bpm). Similarly, RPE-L and RPE-C responses were greater overall (p = 0.03 and p = 0.03, respectively) during HIIT (5.5 ± 1.6 and 5.1 ± 1.7, respectively) compared to MICT (3.3 ± 1.5 and 2.9 ± 1.5, respectively). Overall, FS was 2.2 ± 1.9 for HIIT and 2.1 ± 1.4 for MICT with no effect of treatment group (p = 0.25) or time (p = 0.94). There was also no significant difference in PACES scores between HIIT (99.4 ± 12.9) and MICT (101.3 ± 17.4; p = 0.78). The findings suggest HIIT and MICT protocols elicited similar enjoyment and affect in adults with quiescent or mildly-active CD.


Medicine and health sciences – Public and occupational health – Physical activity – Physical fitness – Cardiology – Heart rate – Clinical medicine – Clinical immunology – Autoimmune diseases – Crohn's disease – Immunology – Gastroenterology and hepatology – Inflammatory bowel disease – Bone – Bone density – Diagnostic medicine – Signs and symptoms – Fatigue – Pathology and laboratory medicine – Biology and life sciences – Sports science – Sports and exercise medicine – Exercise – Anatomy – Biological tissue – Connective tissue – Research and analysis methods – Mathematical and statistical techniques – Statistical methods – Analysis of variance – Physical sciences – Mathematics – Statistics


Crohn’s Disease (CD) is a type of inflammatory bowel disease which can affect a patient anywhere from the mouth to the anus. Patients often suffer with symptoms of fatigue, pain and diarrhoea [1]. Due to the inflammation of the gut wall it can also lead to malabsorption and this can lead to side effects such as low bone mineral density and loss of muscle mass [1]. Such effects can reduce quality of life in a patient [2, 3]. Other extraintestinal manifestations include large joint arthritis, uveitis, iritis, episcleritis, erythema nodosum and pyroderma gangernosum [4]. In 2006, it was observed that treatment for inflammatory bowel disease costs the United Kingdom’s National Health Service (NHS) approximately £720 million per annum [5] and with numbers of patients increasing annually the economic burden will have risen and will continue to rise.

The main goals of treatment for CD are to achieve mucosal healing and deep remission [4] and prevent the need for surgery. The treatment for CD involves an induction and maintenance regimen [6]. The choice of medication is dependent on disease severity and response to previous therapies. The most widely used drugs in CD are corticosteroids, immunosuppressants and biologics [6] with the aim to induce remission and mucosal healing and prevent the need for surgery. As mentioned, there are often extraintestinal manifestations such as fatigue, low bone mineral density and loss of muscle mass which the prescribed medications often do not treat. Therefore, exercise could be a potential adjunct therapy to help reduce these symptoms and improve quality of life, as it has been shown to help in other health conditions [7]. It therefore seems a logical progression to investigate exercise efficacy in relation to CD.

Most of the information currently known about exercise and CD is based on studies of low-moderate intensity exercise with small sample sizes, which demonstrated an improvement in quality of life without apparent adverse events [810]. However, results from a UK-based survey indicated that 83% of adults with IBD do not engage in levels of activity commensurate with the public health guidelines (17) of 150 minutes of moderate aerobic physical activity a week [11]. Health related research in the last decade has started to focus on the benefits of high intensity interval training (HIIT) which consists of repeated, intense exercise bouts separated by passive or active recovery and can be performed in less time for the same energy expenditure [12]. Data from 6 to 12 weeks of exercise training demonstrates similar to greater improvements in maximal oxygen uptake (V˙O2max) with HIIT (~10–14%) compared to MICT (~7–10%)[13, 14]. This could make HIIT appealing to recommend when encouraging sedentary individuals to become more physically active. However, HIIT can produce symptoms of shortness of breath, leg pain and dramatic fatigue in comparison to MICT [15] and may therefore be less enjoyable. Currently, little information is known on HIIT in adults with CD despite it appearing as a time-efficient approach to improve cardiorespiratory fitness and cardio-metabolic health in general populations [16] and other clinical populations [17, 18]. Previous authors have suggested high-intensity exercise may potentially be detrimental to health due to possible negative side effects in IBD, such as gastrointestinal distress [8] which could exacerbate symptoms. This might be an old-fashioned reservation about high-intensity exercise and IBD as there are several examples of elite athletes who suffer with IBD such as Sir Steve Redgrave (a 5 times Olympic Champion) and Ali Jawad (a Paralympic power lifter) who have still managed to compete at an international standard. A greater understanding of the safety and efficacy of different types of exercise training is needed to support the development of evidence-based exercise guidelines and promotion strategies that are specific to CD.

Acceptability and enjoyment are also important when developing and exploring exercise training for clinical populations. Considering that the affective response may be a predictor for exercise adherence [19], it is important to prescribe exercise sessions which result in positive affective responses. More intensive exercise might result in more negative affective responses which in turn might contribute to poor exercise adherence [19]. There is a trade-off between higher intensities generally providing more cardiorespiratory fitness benefit but less favourable affective responses. HIIT becomes a viable exercise programming option because the rest intervals between intense work intervals may contribute to reduced discomfort and inducing a more positive affective response. Studies comparing affective responses of HIIT and MICT have produced mixed results [2023] and no studies have been published in CD. Therefore, we conducted a feasibility study to determine the acceptability and potential benefits and harms of HIIT and MICT in adults with quiescent or mildly-active CD, and the feasibility of conducting a full-scale trial (see Tew et al. [24] for full discussion). However, as enjoyment is a potential barrier for participating in exercise we focus here on secondary analysis to explore differences in affect and enjoyment following 12 weeks of either HIIT or MICT training in CD patients.

Materials and methods

Experimental design

This is a secondary analysis of data collected in a three-arm, parallel-group, feasibility randomised controlled trial, which had a 12-week intervention period and follow-up assessments at 13 and 26 weeks after randomisation. Following enrolment, all participants underwent a baseline cardiopulmonary exercise test (CPET) on a cycle ergometer and were asked for their preference to a specific group allocation prior to randomisation. After baseline assessments, participants were randomly assigned to HIIT, MICT or control, with each group receiving usual NHS care. Data on affect and enjoyment was not collected in the control group, so the focus here is on data from the HIIT and MICT groups only. Further details on the trial design have been published previously [25]. Ethics approval was granted by the Camden and Kings Cross Research Ethics Committee (reference 15/LO/1804), and all participants provided written informed consent before enrolment. The trial was registered prospectively (ISRCTN13021107).

Participants and setting

We included male and female patients between 16 and 65 years of age with a clinical diagnosis of CD. Patients had to have a stool calprotectin of <250 μg/g, stable medication (>4 weeks), and quiescent or mildly-active disease, as indicated by a Crohn’s Disease Activity Index (CDAI) of <150 or 150–219, respectively. Exclusion criteria were: contraindication to exercise testing or training [26], coexistent serious autoimmune disease (e.g. rheumatoid arthritis or systemic sclerosis), pregnant, planned pregnancy or major surgery within the first 3 months after randomisation, poor tolerability of venepuncture or inadequate access for venous blood sampling, and current participation in >90 min/week of purposeful exercise (e.g. cycling, swimming or running) or another clinical trial. Recruitment was from three hospital trusts in England: Guy’s and St Thomas’ NHS Foundation Trust, Barts Health NHS Trust, and Hampshire Hospitals NHS Foundation Trust. The exercise programmes were delivered in the exercise science facilities of the University of East London and the University of Winchester.

Exercise intervention

Participants were invited to complete three supervised exercise sessions per week for 12 consecutive weeks, commencing the week following their baseline assessment and randomisation. Reimbursement was provided for travel expenses. All exercise was undertaken on a cycle ergometer (Lode Corival or SRM Ergometer), with each session comprising a 5-minute warm-up at 15% of peak power output (Wpeak; determined during the baseline CPET), a main conditioning phase, and then a 3-minute cool-down at 15% Wpeak. For HIIT, the conditioning phase involved ten 1-minute bouts at 90% Wpeak, interspersed with 1-minute bouts at 15% Wpeak, whereas for MICT it involved 30 minutes at 35% Wpeak. The MICT programme was selected because it has been shown to elicit a similar energy expenditure compared with the HIIT programme [27].

Differential ratings for breathlessness (RPE-C) and leg exertion (RPE-L) were assessed using Borg’s CR-10 scale [28] before exercise, immediately post, and 10-minutes post-exercise. In addition, participants were asked to rate their breathlessness and leg exertion at 2.5%, 7.5%, 42.5%, 47.5%, 92.5% and 97.5% of exercise completed. These time points were chosen to incorporate both interval and recovery periods during the HIIT protocol [21]. Participants' heart rate was also recorded using Polar heart-rate monitors at 2.5%, 42.5%, and 92.5% of exercise completed. The one item Feeling Scale (FS; [29]) was used to measure general affective valence (i.e., pleasure and displeasure). Participants were prompted at the beginning of each exercise visit with the following instructions: “While participating in exercise, it is common to experience changes in mood. Some individuals find exercise pleasurable, whereas others find it to be unpleasant. Additionally, feeling may fluctuate across time. That is, one might feel good and bad a number of times during exercise. When asked please tell me how you feel at that current moment using the scale below”. The feeling scale is scored on an 11-point bipolar scale ranging from -5 (very bad) to +5 (very good). The FS was administered pre-, immediately post and 10-minutes post-exercise. To assess in-task affect, the FS was also administered at 2.5%, 42.5%, and 92.5% of exercise completed. In addition, enjoyment was measured during the follow up assessment in week 13 using the Physical Activity Enjoyment Scale (PACES). Incremental cycle exercise testing to maximum volitional exertion was performed in the final sessions of weeks 4 and 8 to re-calculate Wpeak and determine if the power output of the upcoming exercise sessions needed to be changed.

Statistical analysis

Statistical analyses were performed using SPSS v25.0 (IBM, Chicago, USA). Data are presented as means ± standard deviation (SD) and, where appropriate, individual responses are presented in a dot plot graph. Post-hoc exploratory analysis involved a mixed-model two-way ANOVA to compare exercise training data for RPE-C, RPE-L and FS on data averaged across the 3 weekly sessions at 92.5% of exercise completed (at the end of the 10th interval for HIIT and 27th minute for MICT) for weeks 1, 6 and 12 (time) and between groups (condition). In addition, a mixed-model two-way ANOVA to compare exercise testing data for peak power and HR at baseline and weeks 4, 8 and 12 (time) and between groups (condition). Main effects for time, main effects for condition and the interaction between time and condition were calculated and where appropriate Bonferonni post-hoc corrections for multiple comparisons were conducted. Mean differences are presented with standard error when comparisons are made. Data normality was checked using a Shapiro-Wilk test; upon moderate violation of the normality assumption, analysis of variance (ANOVA) was still conducted as the model is sufficiently robust to detect statistically significant differences between means, in terms of type 1 error [30]. There was homogeneity of variances, as assessed by Levene’s test of homogeneity of variance (p > 0.05). There was homogeneity of covariances, as assessed by Box's test of equality of covariance matrices (p >0.05). Greenhouse-Geisser correction was applied upon violation of Mauchly’s test of sphericity for ANOVAs. An independent t-test was used to assess between-group differences in PACES scores. Significance was determined by a p value of <0.05. Effect sizes were calculated using partial eta squared (ηp2) and defined as trivial (<0.10), small (0.10–0.29), moderate (0.30–0.49), or large (≥0.50) [31].


Participant characteristics at baseline

A total of 13 participants, of which 7 (54%) were male (mean ± SD age: 37.0 ± 11.1 yrs; body mass: 76.2 ± 13.5 kg; CDAI: 74 ± 48), were randomised to HIIT and 12 were randomised to MICT (male: n = 3, 25%; mean ± SD age: 38.5 ± 13.0 yrs; body mass: 63.8 ± 12.5 kg; CDAI: 55 ± 47). The mean baseline peak oxygen consumption (V˙O2peak) were 27.3 ± 7.7 and 28.7 ± 8.6 ml/kg/min for HIIT and MICT, respectively. Mean recorded baseline peak power output on the CPET was 169 ± 25 W for HIIT and 153 ± 11 W for MICT. When participants were asked for their preference to a specific group allocation prior to randomisation 74% preferred HIIT, 22% MICT, and 4% control.

Exercise testing data

Table 1 depicts the exercise testing data during the exercise tests at baseline and weeks 4, 8 and 12 for both HIIT and MICT. There was a significant interaction between time and condition for peak power (F(3,60) = 5.27; p <0.01; ηp2 = 0.21). There was a significant effect of time on peak power for HIIT (F(3,27) = 27.81; p <0.01; ηp2 = 0.76). For HIIT peak power significantly increased from baseline to week 4 (mean ± SD, 20.5 ± 10.8W, p = 0.03). Peak power was not significantly different between weeks 4 and 8 (mean difference ± SE; 10.00 ±8.94W, p = 0.31), but power was significantly greater in week 12 compared to 4 (mean difference ± SE; 12.30 ±6.32, p = 0.02). There was no significant difference between weeks 8 and 12 (mean difference ± SE; 2.30 ±7.16W, p = 1.00). There was no significant effect of time on peak power for MICT (F(1.69,18.56) = 3.62; p = 0.05; ηp2 = 0.25). There were no statistically significant differences between HIIT and MICT for peak power at baseline, weeks 4, 8 and 12 (p >0.05). Peak HR was similar between conditions throughout the training with no main effect for condition (F(1,19) = 0.09; p = 0.77; ηp2 = 0.01) and no main effect for time (F(3,57) = 0.35; p = 0.79; ηp2 = 0.02) nor an interaction between time and training (F(3,57) = 1.16; p = 0.33; ηp2 = 0.06).

Tab. 1.

Mean ± SD peak power and HR during the exercise tests at baseline and weeks 4, 8 and 12 for HIIT and MICT.

<h2>Mean ± SD peak power and HR during the exercise tests at baseline and weeks 4, 8 and 12 for HIIT and MICT.</h2>

Exercise training data


Participants attended 62% of HIIT sessions offered and 75% of MICT sessions. The median (range) number of sessions attended was 25 (0–36) and 25 (18–34) for the HIIT and MICT groups, respectively. Eight (62%) of the HIIT participants and eight (67%) of the MICT participants achieved the pre-specified minimum attendance criterion of at least 24 sessions. Two HIIT participants did not attend a single exercise session: one due to illness, and the other due to work and holiday commitments. Another HIIT participant withdrew from the intervention after completing 5 sessions due to moving abroad. The main reasons for sessions being missed were work commitments (25%, 72/286), illness (25%, 71/286 [only two of which were CD-related]) and holiday (14%, 40/286) (data from both exercise groups combined).

Heart rate responses

There was no significant interaction between time and condition for HR during training (F(2,26) = 0.12; p = 0.89; ηp2 = 0.01; Fig 1). There was a main effect of time (F(2,26) = 9.60; p <0.01; ηp2 = 0.43) which showed HR to be significantly lower at week 6 (149 ± 6 bpm) and week 12 (148 ± 6 bpm) compared to 1 (155 ± 8 bpm; p = 0.03 and p <0.01, respectively). However, there was no significant difference between weeks 6 and 12 (1 ± 2 bpm, p = 1.00). There was also a main effect of condition with HR being significantly higher overall during HIIT (173 ± 8 bpm) compared to MICT (128 ±6 bpm, p <0.001).

<h2>Mean (SD) HR at week 1, 6 and 12.</h2>
Fig. 1.

Mean (SD) HR at week 1, 6 and 12.

* denotes significant difference from week 1 (p <0.05).

RPE and affective responses

There was no significant interaction for time and condition for RPE-L (F(2,26) = 0.65; p = 0.51; ηp2 = 0.05 or RPE-C (F(2,26) = 0.12; p = 0.09; ηp2 = 0.01). There was a main effect of condition for RPE-L (F(1,13) = 6.37; p = 0.03; ηp2 = 0.33) and RPE-C (F(1,13) = 5.91; p = 0.03; ηp2 = 0.31), with RPE-L and RPE-C being significantly greater during HIIT (5.5 ±1.6 and 5.1 ±1.7 i.e. ‘hard’, respectively) compared to MICT (3.3 ± 1.5 and 2.9 ± 1.5 i.e. ‘moderate’, respectively; Fig 2). A main effect of time was demonstrated for both RPE-L (F(2,26) = 7.61; p <0.01; ηp2 = 0.37) and RPE-C (F(2,26) = 5.66; p = 0.01; ηp2 = 0.30), with values lower at week 12 (3.3 ± 1.7) compared to 1 (4.5 ± 0.76) and 6 (4.1 ± 1.1).

<h2>Mean (SD) RPE for central (RPE-C: panel A) and legs (RPE-L: panel B) at week 1, 6 and 12.</h2>
Fig. 2.

Mean (SD) RPE for central (RPE-C: panel A) and legs (RPE-L: panel B) at week 1, 6 and 12.

* denotes significant difference from MICT (p <0.05). # denotes significant difference from week 12 (p <0.05).

There was no significant interaction between time and condition for FS (F(2,26) = 1.17; p = 0.32; ηp2 = 0.08). There was also no main effect of condition (F(1,8) = 1.51; p = 0.25; ηp2 = 0.03) with FS being 2.2 ± 1.9 (i.e. fairly good) for HIIT and 2.1 ± 1.4 (i.e. fairly good) for MICT (Fig 3). Nor was there a main effect of time (F(3,24) = 0.13; p = 0.94; ηp2 = 0.04).

<h2>Mean (SD) feeling scale at the end of exercise at weeks 1, 6 and 12.</h2>
Fig. 3.

Mean (SD) feeling scale at the end of exercise at weeks 1, 6 and 12.

Exercise enjoyment (PACES)

As can be seen in Fig 4 both HIIT and MICT produced high exercise enjoyment scores (mean ± SD 99.4 ± 12.9 and 101.3 ± 17.4, respectively) demonstrating a high level of enjoyment (max score 126), with no significant differences between conditions (t(20) = -0.29; p = 0.78; δ = 0.06). When comparing the single item score on PACES between HIIT and MICT (Fig 5) there was no significant interaction between question and condition (F(5.5,110.8) = 0.57; p = 0.74; ηp2 = 0.03). There was a main effect of question (F(5.5,110.8) = 3.61; p < 0.01; ηp2 = 0.15), but there was no main effect of condition (F(1,20) = 0.08; p = 0.78; ηp2 = 0.01).

<h2>Dot plot of individual exercise enjoyment scores (PACES) and mean (± SD) PACES score post 12 weeks of training for both HIIT and MICT.</h2>
Fig. 4.

Dot plot of individual exercise enjoyment scores (PACES) and mean (± SD) PACES score post 12 weeks of training for both HIIT and MICT.

<h2>Mean (SD) single item scores (from 1 to 7) for PACES for both HIIT and MICT conditions.</h2>
Fig. 5.

Mean (SD) single item scores (from 1 to 7) for PACES for both HIIT and MICT conditions.


The present study is the first to compare the enjoyment and affective responses to HIIT and MICT in adults with quiescent or mildly active CD. Despite significantly greater HR and RPE responses during HIIT compared to MICT, these methods of training elicited similar enjoyment and affective responses. Attendance rates were also similar between groups. The enjoyment and affective responses were also generally high, suggesting that adults with quiescent or mildly active CD can find both forms of aerobic exercise training to be acceptable and enjoyable.

Previous research by Tew et al. [32] demonstrated that adults with IBD did not meet the physical activity guidelines of the general population. Often a major barrier for participation in physical activity is lack of enjoyment in particular when considering high intensity exercise [15, 20, 21]. As mentioned earlier, high intensity exercise has been suggested to potentially be detrimental to health in adults with IBD due to possible negative side effects, such as gastrointestinal distress [8] which could exacerbate symptoms. Therefore, it was surprising that when participants were asked for their preference to a specific group allocation prior to randomisation 74% preferred HIIT, 22% MICT, and 4% control. This suggests that patients are interested in performing HIIT if they are willing to participate in an exercise clinical trial. As can be seen from the results of this study, not only did participants in both arms of the study enjoy their exercise intervention (either HIIT or MICT) they also felt ‘fairly good’ towards the end of the exercise sessions. We have previously reported that very few exercise-related adverse events occurred during this trial [24]. These results suggest that participants with quiescent or mildly active CD feel ‘fairly good’ when performing both MICT and HIIT.

Along with the barriers to exercise, adhering to an exercise programme can also bring challenges. Demonstrating similar enjoyment between MICT and HIIT suggests both modes of exercise could be employed in a training programme for patients with quiescent or mildly active CD. For participants to maintain a training programme they need to have positive affect responses during exercise as observed in the present study. Mean FS in the present study was 2.2 (SD 1.8; i.e. fairly good) for HIIT and 2.1 (SD 1.3, i.e. fairly good) for MICT at 92.5% of the exercise completed. A meta-analysis by Oliveira et al. (19) found that for FS, only six out of 12 comparisons showed beneficial effects for HIIT involving normal weight and overweight-to-obese populations. The authors found no relationship of FS to the fitness characteristics of the participants and therefore suggest that the FS scores were related to the exercise characteristics [19]. When comparing the FS scores in the present study with previous research by Oliveira et al. (23) who measured FS pre, every 20% of exercise completed and post exercise for both HIIT and MICT it is apparent that CD patients demonstrated a greater positive FS compared to young healthy adults. The mean ± SD values at the final 20% of exercise in Oliveira et al. (23) were -2.7 ± 2.6 for HIIT and 0.8 ± 2.5 for MICT. Differences between our study and Oliveira et al. (23) could be a result of the exercise intensity being lower in the present study (90% HRpeak) for 60 seconds compared to 100% VO2peak for 120 seconds. Rhodes and Kates [33] have demonstrated that affective responses during moderate intensity exercise linked positively to future exercise behaviour. Suggesting that participants who feel good during exercise are more likely to continue to perform exercise.

As mentioned previously, HIIT and MICT were matched for energy expenditure although the HIIT main conditioning phase (i.e. excluding warm-up and cool-down) duration was significantly shorter lasting 20 minutes compared to 30 minutes for MICT. HR and RPE were significantly greater for the HIIT sessions compared to the MICT showing a greater exercise intensity. This resulted in greater increases in peak power in the HIIT group compared to the MICT group, suggesting that HIIT could produce greater cardiovascular improvements and ultimately greater cardiometabolic benefits. The exercise intensity and rest intervals of HIIT is important when considering affective and enjoyment responses. There is no universally accepted approach to HIIT and therefore studies often employ different exercise/rest intervals. Research has demonstrated that exercise intervals at 120 seconds produced significantly lower affective responses compared to 60 second intervals [19]. Insufficient rest between intervals can also negatively affect enjoyment and ultimately exercise adherence suggesting a stimulus—recovery ratio of 1:1 produces the best affective responses [19]. The HIIT protocol used in the present study employed a 1:1 ratio of 60 seconds, designed to provide positive affect responses based on research with young sedentary adults [34]. As there are many different methods of HIIT, it may not be appropriate to generalise the findings of the present study to different HIIT approaches e.g. sprint interval training or high volume HIIT (4 minute intervals with recovery of a similar duration) [35].

Mean enjoyment levels based on PACES in the present study were 99.4 (± 12.9) and 101.3 (± 17.4) for HIIT and MICT, respectively. These results are similar in terms of HIIT to Thum et al. (15) who found scores of 103.8 ± 9.4 for HIIT (8 x 60s at 85% Wmax followed by 60s at 25% Wmax) in recreationally active participants. In the same study by Thum et al. (15) their MICT protocol (20 minutes at 45% Wmax) produced slightly lower levels of enjoyment compared to the present study (84.2 ±19.1). Similarly, Oliveira et al. (23) observed values of 97.8 ± 17.3 for HIIT (6 x 120s at 100% VO2peak, 120s at 0% for recovery) and 96.2 ± 16.7 for MICT (20min at 85% VO2peak) in University students. Vella et al. [36] observed PACES scores between 74 and 125 for both HIIT (10 x 1 minute at 75–80% of heart rate reserve followed by 1 minute at 35–40%) and MICT (20 minutes at 55–59% of heart rate reserve) in sedentary obese adults. In a clinical population of patients waiting for an elective abdominal aortic aneurysm repair they observed PACES values of 98 (18) with HIIT training (either 8 x 2 minutes or 4 x 4 minutes, 3 x a week for 4 weeks) [37]. Therefore, it appears that patients with quiescent or mildly active CD have similar levels of enjoyment towards both HIIT and MICT exercise in comparison to healthy and clinical adult populations [15, 23, 36, 37].

Previous authors have suggested there is a need to report individual PACES items to signify which items are responsible for high levels of enjoyment [38]. There were no differences in scores for any item of PACES. Each item is scored out of 7, with a higher score demonstrating a greater level of enjoyment. There was a mean score of 5 on every item of the scale for both conditions. To the author’s knowledge the only published study investigating differences on the individual items of the PACES is Malik et al. [39] and they found higher levels in items “I got something out of it”, “It’s very exciting” and “It gave me a strong feeling of success” with HIIT compared to MICT. In contrast, the authors observed higher levels of “I feel bored” and “It’s not at all interesting” in the MICT compared to HIIT. They suggest the differences are due to participants perceiving a greater sense of reward, excitement and success following HIIT compared to MICT. The results of the research by Malik et al. (39) may differ to the current study due to the fact their participants were aged 12–15 year olds, whereas our study recruited 16–65 year olds.

The study did have some limitations, this was a feasibility trial and as such, with a relatively small sample size, is likely underpowered for these exploratory analyses. Being a small study increases the likelihood of a chance imbalance between groups in the responses to HIIT and MICT throughout the training intervention. Other studies have used a crossover design so participants experience the different exercise protocols, but this is difficult to do when using a 12-week intervention. Another limitation was that enjoyment was only measured at one timepoint. In the study of Heisz et al. [34], PACES was assessed at the end of every week in a 6-week intervention with PACES scores increasing every week in the HIIT arm. However, as the present study measured one time point these changes were not detectable if they existed.

In conclusion, both HIIT and MICT produced high levels of enjoyment as well as feeling ‘fairly good’ suggesting that future exercise trials could include either/both modes as an exercise intervention. One of the major barriers to exercise participation is enjoyment and this study demonstrates that patients with quiescent or mildly active CD appear to enjoy high intensity interval and moderate continuous cycling exercise.


1. Bilski J, Brzozowski B, Mazur-Bialy A, Sliwowski Z, Brzozowski T. The role of physical exercise in inflammatory bowel disease. Biomed Res Int. 2014;2014:429031. doi: 10.1155/2014/429031 24877092.

2. Wiroth JB, Filippi J, Schneider SM, Al-Jaouni R, Horvais N, Gavarry O, et al. Muscle performance in patients with Crohn's disease in clinical remission. Inflamm Bowel Dis. 2005;11(3):296–303. doi: 10.1097/01.mib.0000160810.76729.9c 15735436.

3. Schneider SM, Al-Jaouni R, Filippi J, Wiroth JB, Zeanandin G, Arab K, et al. Sarcopenia is prevalent in patients with Crohn's disease in clinical remission. Inflamm Bowel Dis. 2008;14(11):1562–8. doi: 10.1002/ibd.20504 18478564.

4. Gajendran M, Loganathan P, Catinella AP, Hashash JG. A comprehensive review and update on Crohn's disease. Disease-a-month: DM. 2018;64(2):20–57. doi: 10.1016/j.disamonth.2017.07.001 28826742.

5. Luces C, Bodger K. Economic burden of inflammatory bowel disease: a UK perspective. Expert review of pharmacoeconomics & outcomes research. 2006;6(4):471–82. doi: 10.1586/14737167.6.4.471 20528516.

6. Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L. Crohn's disease. Lancet. 2017;389(10080):1741–55. doi: 10.1016/S0140-6736(16)31711-1 27914655.

7. Pedersen BK, Saltin B. Evidence for prescribing exercise as therapy in chronic disease. Scandinavian journal of medicine & science in sports. 2006;16 Suppl 1:3–63. doi: 10.1111/j.1600-0838.2006.00520.x 16451303.

8. Ng V, Millard W, Lebrun C, Howard J. Low-intensity exercise improves quality of life in patients with Crohn's disease. Clin J Sport Med. 2007;17(5):384–8. 17873551.

9. Loudon CP, Corroll V, Butcher J, Rawsthorne P, Bernstein CN. The effects of physical exercise on patients with Crohn's disease. Am J Gastroenterol. 1999;94(3):697–703. doi: 10.1111/j.1572-0241.1999.00939.x 10086654.

10. Klare P, Nigg J, Nold J, Haller B, Krug AB, Mair S, et al. The impact of a ten-week physical exercise program on health-related quality of life in patients with inflammatory bowel disease: a prospective randomized controlled trial. Digestion. 2015;91(3):239–47. doi: 10.1159/000371795 25823689.

11. Health Do. Start active, stay active: a report on physical activity from the four home countries. London: Department of Health: 2011.

12. Gibala MJ, Little JP, Macdonald MJ, Hawley JA. Physiological adaptations to low-volume, high-intensity interval training in health and disease. J Physiol. 2012;590(Pt 5):1077–84. doi: 10.1113/jphysiol.2011.224725 22289907.

13. Nybo L, Sundstrup E, Jakobsen MD, Mohr M, Hornstrup T, Simonsen L, et al. High-intensity training versus traditional exercise interventions for promoting health. Med Sci Sports Exerc. 2010;42(10):1951–8. doi: 10.1249/MSS.0b013e3181d99203 20195181.

14. Burgomaster KA, Howarth KR, Phillips SM, Rakobowchuk M, Macdonald MJ, McGee SL, et al. Similar metabolic adaptations during exercise after low volume sprint interval and traditional endurance training in humans. J Physiol. 2008;586(1):151–60. doi: 10.1113/jphysiol.2007.142109 17991697.

15. Thum JS, Parsons G, Whittle T, Astorino TA. High-Intensity Interval Training Elicits Higher Enjoyment than Moderate Intensity Continuous Exercise. PLoS One. 2017;12(1):e0166299. doi: 10.1371/journal.pone.0166299 28076352.

16. Weston M, Taylor KL, Batterham AM, Hopkins WG. Effects of low-volume high-intensity interval training (HIT) on fitness in adults: a meta-analysis of controlled and non-controlled trials. Sports Med. 2014;44(7):1005–17. doi: 10.1007/s40279-014-0180-z 24743927.

17. Mijwel S, Jervaeus A, Bolam KA, Norrbom J, Bergh J, Rundqvist H, et al. High-intensity exercise during chemotherapy induces beneficial effects 12 months into breast cancer survivorship. Journal of cancer survivorship: research and practice. 2019. doi: 10.1007/s11764-019-00747-z 30912010.

18. Minghetti A, Faude O, Hanssen H, Zahner L, Gerber M, Donath L. Sprint interval training (SIT) substantially reduces depressive symptoms in major depressive disorder (MDD): A randomized controlled trial. Psychiatry research. 2018;265:292–7. doi: 10.1016/j.psychres.2018.04.053 29775886.

19. Oliveira BRR, Santos TM, Kilpatrick M, Pires FO, Deslandes AC. Affective and enjoyment responses in high intensity interval training and continuous training: A systematic review and meta-analysis. PLoS One. 2018;13(6):e0197124. doi: 10.1371/journal.pone.0197124 29874256.

20. Bartlett JD, Close GL, MacLaren DP, Gregson W, Drust B, Morton JP. High-intensity interval running is perceived to be more enjoyable than moderate-intensity continuous exercise: implications for exercise adherence. Journal of sports sciences. 2011;29(6):547–53. doi: 10.1080/02640414.2010.545427 21360405.

21. Jung ME, Bourne JE, Little JP. Where does HIT fit? An examination of the affective response to high-intensity intervals in comparison to continuous moderate- and continuous vigorous-intensity exercise in the exercise intensity-affect continuum. PLoS One. 2014;9(12):e114541. doi: 10.1371/journal.pone.0114541 25486273.

22. Kong Z, Fan X, Sun S, Song L, Shi Q, Nie J. Comparison of High-Intensity Interval Training and Moderate-to-Vigorous Continuous Training for Cardiometabolic Health and Exercise Enjoyment in Obese Young Women: A Randomized Controlled Trial. PLoS One. 2016;11(7):e0158589. doi: 10.1371/journal.pone.0158589 27368057.

23. Oliveira BR, Slama FA, Deslandes AC, Furtado ES, Santos TM. Continuous and high-intensity interval training: which promotes higher pleasure? PLoS One. 2013;8(11):e79965. doi: 10.1371/journal.pone.0079965 24302993.

24. Tew GA, Leighton D, Carpenter R, Anderson S, Langmead L, Ramage J, et al. High-intensity interval training and moderate-intensity continuous training in adults with Crohn's disease: a pilot randomised controlled trial. BMC gastroenterology. 2019;19(1):19. doi: 10.1186/s12876-019-0936-x 30696423.

25. Tew GA, Carpenter R, Seed M, Anderson S, Langmead L, Fairhurst C, et al. Feasibility of high-intensity interval training and moderate-intensity continuous training in adults with inactive or mildly active Crohn's disease: study protocol for a randomised controlled trial. Pilot Feasibility Stud. 2017;3:17. Epub 2017/04/03. doi: 10.1186/s40814-017-0133-z 28373911.

26. ACSM. ACSM's guidelines for exercise testing and prescription. Eighth ed. Philadelphia: Lippincott Williams & Wilkins:; 2009.

27. Little JP, Jung ME, Wright AE, Wright W, Manders RJ. Effects of high-intensity interval exercise versus continuous moderate-intensity exercise on postprandial glycemic control assessed by continuous glucose monitoring in obese adults. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. 2014;39(7):835–41. doi: 10.1139/apnm-2013-0512 24773254.

28. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–81. Epub 1982/01/01. 7154893.

29. Hardy C, Rejeski W. Not what, but how one feels: the measurement of affect during exercise. Journal of Sport and Exercise Psychology. 1989;11:304–17.

30. Blanca MJ, Alarcon R, Arnau J, Bono R, Bendayan R. Non-normal data: Is ANOVA still a valid option? Psicothema. 2017;29(4):552–7. doi: 10.7334/psicothema2016.383 29048317.

31. Hopkins WG, Marshall SW, Batterham AM, Hanin J. Progressive statistics for studies in sports medicine and exercise science. Med Sci Sports Exerc. 2009;41(1):3–13. doi: 10.1249/MSS.0b013e31818cb278 19092709.

32. Tew GA, Jones K, Mikocka-Walus A. Physical Activity Habits, Limitations, and Predictors in People with Inflammatory Bowel Disease: A Large Cross-sectional Online Survey. Inflamm Bowel Dis. 2016;22(12):2933–42. doi: 10.1097/MIB.0000000000000962 27824653.

33. Rhodes RE, Kates A. Can the Affective Response to Exercise Predict Future Motives and Physical Activity Behavior? A Systematic Review of Published Evidence. Annals of behavioral medicine: a publication of the Society of Behavioral Medicine. 2015;49(5):715–31. doi: 10.1007/s12160-015-9704-5 25921307.

34. Heisz JJ, Tejada MG, Paolucci EM, Muir C. Enjoyment for High-Intensity Interval Exercise Increases during the First Six Weeks of Training: Implications for Promoting Exercise Adherence in Sedentary Adults. PLoS One. 2016;11(12):e0168534. doi: 10.1371/journal.pone.0168534 27973594.

35. Wisloff U, Ellingsen O, Kemi OJ. High-intensity interval training to maximize cardiac benefits of exercise training? Exercise and sport sciences reviews. 2009;37(3):139–46. doi: 10.1097/JES.0b013e3181aa65fc 19550205.

36. Vella CA, Taylor K, Drummer D. High-intensity interval and moderate-intensity continuous training elicit similar enjoyment and adherence levels in overweight and obese adults. European journal of sport science. 2017;17(9):1203–11. doi: 10.1080/17461391.2017.1359679 28792851.

37. Tew GA, Batterham AM, Colling K, Gray J, Kerr K, Kothmann E, et al. Randomized feasibility trial of high-intensity interval training before elective abdominal aortic aneurysm repair. Br J Surg. 2017;104(13):1791–801. Epub 2017/10/09. doi: 10.1002/bjs.10669 28990651.

38. Biddle SJ, Batterham AM. High-intensity interval exercise training for public health: a big HIT or shall we HIT it on the head? Int J Behav Nutr Phys Act. 2015;12:95. doi: 10.1186/s12966-015-0254-9 26187579.

39. Malik AA, Williams CA, Bond B, Weston KL, Barker AR. Acute cardiorespiratory, perceptual and enjoyment responses to high-intensity interval exercise in adolescents. European journal of sport science. 2017;17(10):1335–42. doi: 10.1080/17461391.2017.1364300 28859545.

Článok vyšiel v časopise


2019 Číslo 9

Najčítanejšie v tomto čísle

Tejto téme sa ďalej venujú…