This Exercise shrinks PLAQUE in your arteries (!) | New trial

[@NutritionMadeSimple]

Dear all: Just a quick clarification regarding the "peak heart rate" mentioned in the video. Multiple viewers asked if several minutes at 85-95% "peak heart rate" isn´t too strenuous, especially for patients with heart disease. Although the study Methods aren't entirely clear, it seems they performed a ramp test prior to the study to determine each participant´s exertion limit. This test started at a comfortable intensity, which was gradually increased every minute until the participant stopped due to exertion (or until VO2max was achieved). It seems, then, that "peak HR" refers to the highest HR recorded during this test before the participant chose to stop it. In HIIT, it is customary to calculate "maxHR" by subtracting age from 220. It appears "peak HR" used in this study is unrelated to this calculation, and is instead a personalized measure obtained empirically. In other words, two participants with the same age could have wildly different "peak HRs" depending on their condition. This allowed them to tailor the exercise to each person's ability and tolerance. Finally, the main takeaway from this study is that physical activity has the potential to deliver some plaque regression. The specifics (type and exact protocol used) may or may not be important (more work will be required to establish this). Hope this makes sense and thanks to the attentive viewers for the inquisitiveness of bringing this to our attention. Gil

[@atmas1337]

Thanks for clarification

[@cyberfunk3793]

I'm no expert, but I have started doing this kind of 4x4 intervals and some even shorter intervals like 20s sprints. With shorter interval after recovery, it's not even possible at least for me to get average heart rate close to my max because the heart doesn't ramp up in 2 seconds but the heart rate gradually rises. So even with all out effort, average heart rate might just be for example 145. At least the instructions I have seen is, you run the 4 minutes as fast you can or at the fastest steady pace you can do the 4 minutes instead of any heart rate target. With longer steady pace runs like 5k it's when I really see the heart rate climb over 170 to the max if I'm pushing and I'm typically not able to hold that pace very long and either have to slow down or even walk.

[@Noegzit]

The 220-age formula is an approximation (a bad one) that will never suit everyone. The HR Max varies to greatly between people. For my part my HR Max is now a little above 190. I read 192 on my watch during a training on the track. When I did my VO2 Max test in a lab a few years ago it was estimated to 196. The 220-age formula would give me only 156 (I'm 64) a value that is obviously very underestimated. Anyway we shouldn't trust too much a formula where we substract an age in years (dimension = TIME) to a cardiac frequency in beats per minute (dimension = 1/TIME).

[@henrikmadsen2176]

I really wonder how they measure plaque-buildup this precise !!?? CAN I HAVE MY PLAQUE-BUILDUP MEASURED ???

[@henrikmadsen2176]

@@cyberfunk3793 I very much agree to "just ran as fast as you can" for your target duration (wether it be 20 seconds or 4 minutes). It will take 30-60 seconds before one reach 90% (especially it will take some time in the first bout) Running a full 4 minutes at an AVERAGE of 85-95% - is that even possible? Certainly brutal and VERY taxing!

[@StevenBrener]

Love how you really analyze the results and ask questions rather than just giving a surface analysis of the findings which could miss important nuances

[@michaeljuliano5716]

Just remember, HIIT should be prescribed in moderation. Daily HIIT is no only unnecessary but it’s not sustainable. 4 sets of 4:4 (4 min max effort, 4 min recovery) twice a week is plenty and gives enough space for recovery while allowing you to participate in other activities like zone 2 cardio, sports, hobbies, and strength training 😊

[@MeredithDomzalski]

What is Zone 2?

[@stevewise1656]

Agreed! HIIT also causes CNS severe fatigue. People don't understand HIIT should be done within seconds or maybe a minute of active rest then another round. Olympic level distance runners don't run to the point of 95 percent of max heart rate over a four minute interval. This is one study. Also, if someone/me lifts weights four plus days a week and also performed lHIIT, I would be overtrained and need to take weeks off to stabilize my CNS.

[@michaeljuliano5716]

@@MeredithDomzalski zone 2 is just a term for any cardiovascular activity where your heart rate falls within a certain range, (70ish % of your max, I believe). It’s more of a steady-state endurance based form of cardio performed for much longer in duration (45-90 minutes), low-moderate in intensity, and easy to recover from.

[@nguyen2]

@@MeredithDomzalski Similar to what michaeljuliano said. another way to put it is exercise where you can sustain full paragraph conversation. someone on the phone with you can tell you are doing some physical activity from your voice pattern.

[@ukispargitus970]

@michaeljuliano5716 Could you please list an example of exercises based on 4 sets of 4:4? Thank you.

[@peterbedford2610]

Of all the various health related activities, foods, supplements, etc.that I've done over the years, HIIT gives me the most immediate and positive feedback. My energy level feels great the next day. 3 times a week for about 30 minutes.

[@michaelbluejay]

Dr. C., fantastic channel, I learn a lot. I think you'd want to know this: At 2:37, the reduction from 49.5% to 48.3% is not "a 1.2% drop", it's a 1.2 percentage POINT drop". The actual percentage drop is 1.2 ÷ 49.5 = 2.4%. Seeing the numbers on the screen it's clear to see what you meant, but what about if someone quotes you and doesn't use the before and after figures?

[@glendahopp]

So happy to learn how statins reverses plaque. My ldl-c is 28 and my cardiologist is thrilled. Now I know why!

[@davidbuckland5976]

As a child of the 70's HIIT would have been running for the bus. I have to say though, these videos are really informative and very well presented. I live in North Wales, so any cycling I do has a bit of HIIT with the hills 😊

[@jungtarcph]

What country is North Wales?

[@kedabro1957]

​@@jungtarcph Either a part of Britain or a town in the USA. Towns are too small to have well-known geography, so he probably meant the part of Britain.

[@LDUB250]

Thank you for this video Gil, Six months ago, I was diagnosed with Moyamoya disease after having a TIA while watching a movie with my family. At 42 years old I have had to make major lifestyle changes to try slow the progression. The last few months of MRIs and CTs show my condition is stable. I like to think it is because of a combination of mediterranean diet, intermitting fasting, walking, HIT training and medications together. This information on those studies gives me hope I can reverse things even a little to reduce my risk.

[@kerrymeadows]

My brother in law was diagnosed with Moyamoya and had to have brain surgery. This was 10 years ago. Have they decided lifestyle changes such as yours is enough? Just wondering as his surgery was brutal.

[@watcherworld5873]

I exercised pretty much daily until last month when I did no exercise because of work. This is what happened. 1. I lost my sleep regularity. 2. I lost at least 3 points from my VO2MAX. 3. My resting blood pressure went up by at least 10 points on both my systolic and diastolic. 4. My fasting blood glucose went up by at least 10 points. 5. My body fat ran up by about 3%. 6. I believe my vision has deteriorated. It was only about 33 days of inactivity. Yeah, it was a really bad idea to stop exercising. I guess what surprised me was how quickly my health deteriorated. I think it will take at least until the end of this year to recover from this lapse of judgment. Never again!

[@clownbackpainrick6581]

Do not forget the other factors. Maybe you had huge stress from your work. And maybe your food intake was not ideal either...

[@DavitGiorgadze]

Return and made your body happy!

[@azmilezzuanzubad9527]

How do you measure your VO2 MAX?

[@DavitGiorgadze]

Smart Watches @@azmilezzuanzubad9527

[@watcherworld5873]

@@azmilezzuanzubad9527 It is estimated by my Garmin running watch. If you ran sufficiently long, it will use your pace and heart rate data to estimate your VO2MAX. According to net wisdom, it is supposed to be accurate.

[@Itsme-e5j]

Thank you! You are one of the few credible sources on the internet.

[@FakYuhGoogel]

I always have doubts with small sample size groups, here its two groups of 30 - but I also didn't know that it's possible to actually shrink plaque size instead of just maintaining it. So it would be great to have a follow-up where: - the control group then gets supervised non-HIIT exercise to see if the improvements in the other group were exclusive to HIIT - the HIIT-group continuing supervision to see if their plaque levels decrease further

[@shadowgirl11]

30 is actually pretty good sample size.

[@drott150]

There is other evidence relating to shrinking plaque with lipid lowering strategies, including diet and statins. That's what the graphic is Dr Gil posted in the video at 6:55 . Various large studies (with much larger cohorts than 60 people) showing plaque regression when LDL goes below 80 mg/dL. HIIT exercise, or exercise in general, probably has an additive effect.

[@AnneMB955]

I totally agree - not enough people in the study for me to run to the gym. Would be interested in reading the paper.

[@DavidM2002]

I would view a small sample size the way you do. However, if a large enough % of that group had a similar change and if that change was significant, it would sway me to place less doubt on the size of the group. But, like you and others, a new study with a larger group would certainly be warranted to remove that group size doubt.

[@thebigpicture2032]

A 1% reduction doesn’t seem statistically significant. Would like to see follow-up studies with larger groups.

[@dvdmon]

I apologize if this comment is going to be really long, but it's right up my alley as I have a lot of personal related experience: I have heart disease, had a stent placed in a "diagonal" (smaller side-branching) artery when I was 45 due to angina symptoms, then a NSTEMI when I was 49 due to that stent (according to the cardiologist) - the stent was protruding into the LAD and caused buildup there that might otherwise not have happened, and created a 90% blockage which was stented. In that stenting procedure, the plaque was pushed into the same diagonal artery (I believe this process is sometimes called "jailing"?), then the diagonal is reopened via a stent or balloon. In my case, since there was already a stent in there, they went with a balloon. This all went great until 5 months later I started getting angina again. What they found was that the angioplasty (balloon) had at least partially failed in the diagonal and it had close back up, at least partially. The lack of blood flow was still considered to be minor and so they suggested anti-anginal medication, which I tried maybe 5 different kinds and the only one that worked in any noticeable way had horrible side effects. At that point, my cardiologist recommended a specific type of exercise that reminds me a lot of HIIT. The way he prescribed it, and the way that I have done it since, is to exercise in a way that brings on the angina symptoms. Once I notice them, I have to keep going for another 1-2 minutes, then I rest for as long as it takes to where I'm not longer feeling the angina anymore (which at least initially is 30-60 seconds). Then I go back to exercising until I trigger the angina again. He suggested I do this daily, or as close to daily as possible for 30 minutes per day. He said that this was to increase collateral blood vessels so that more blood could get to the heart tissue around the diagonal that was not getting enough due to the blockage. So it wasn't specifically for "decreasing" plaque. I've been doing this now for over 4 years and I haven't experienced any other cardiac issues, thankfully, so it's kept me out of the hospital at least, but it also increases my overall quality of life, since when I first started getting the angina, I was having it just walking on relatively level ground at a normal (not too slow but also not very fast) pace. What I've found with the exercise is that the more consistently I do it, the less angina I feel in general, and my exercise capacity goes up. My current routine is to hop on my treadmill and go a few minutes at 3.5mph at an incline of 7.5 (although in the past I'd gone as high as 10.5). I keep it on the lower side because if I go higher, then over the course of 30 minutes, my heart rate can get over my max (peak?), and then I have to either make the intervals shorter or go down in incline. With 7.5 right now, I can do 40 minutes with only getting to about 85% of that peak heart rate. When I am really consistent about it, this can actually be increased because my exercise capacity increases. So basically, I start by doing about 4 minutes because the initial onset of angina takes a bit longer. After that initial interval, I do a few 3-minute intervals separated by 1 minute rests, as I do this, the onset of angina gets to be later in the interval, so that by the time I'm on the 4th interval or so, I can increase it to 4 minutes of walking. And soon after that, the angina is so subtle that I end up going 5-10 minutes per interval. The longer the interval, the higher my heart rate eventually climbs, so I will often stop simply to "reset" so that it doesn't get too close to my peak heart rate. So, if this is indeed decreasing my plaque, that would be fantastic, but I'm happy with stable plaque and simply keeping my angina at bay. To give you a sense of where I am outside of exercise, as I mentioned, I eat a WFPB diet that is very low in saturated fat, and have been doin so for 6.5 years. I'm also on 10mg of Rosuvastatin (been on it for almost 5 years), and my LDL over the last 5 years has kind of gone up and down between 35 and 55. I've been at a normal BMI for about 6 years. I'm 55 right now. I'm curious about similar exercise routines in terms of outcomes as well, but also in terms of anginal symptoms, exercise capacity, and general quality of life. I'm assuming that if done mindfully, exercise can only be beneficial for most people, but that of course I don't have all the studies to back it up, just get that general sense from everything I've read and heard about it. The caveat being of course that you can overdo anything!

[@Wudang56-56]

tks for taking the trouble of detailing your experience and sharing it. I think you know your body more than anyone else so if it works by all means keep on with it. From the scientific explanation point of view could it also be due at least partly to angiogenesis whereby your heart has buillt micro capillaries in response to the increase in blood demand induced by the exercise routine ?

[@dvdmon]

@@Wudang56-56 Yes, I mean that's what I think I always understood it to be, not about plaque reduction, but just angiogenesis. I would be great if plaque were being reduced as well, since that would also potentially improve things...

[@richgl31]

Very interesting. I’m 49 , had MI at 42 and 5 stents. 3 circumflex , 1 in each of the others. Been ok, 5 km runs , weights etc.recent treadmill stress test though had to be stopped at 9 min, slight ST depression; returned to normal quickly though. I could have run on, but was stopped. So now waiting for angiogram (4 months time). Interestingly had just started walking a lot with new dog rather than running. I am also not sure I feel angina… I also apparently have a slight hernia- so hard to differentiate!. I am pescatarian mainly/ going low sugar now though to reduce inflammation and so reducing carbs too. I am building my fitness back for long runs- but chosen indoor bike now as you can warm up more gradually. Hopefully I can copy you in getting the heart going without issue again. Sure it is because I had a stressful patch and did not do the regular higher heart rate exercise🧐.

[@dvdmon]

@@richgl31 Just be careful with "low carb" - that's a big part of what landed me in trouble to begin with. I bought all the low-carb rhetoric and just ate mostly meat and cheese and low-carb veggies, a very high-saturated diet for 12 years and after 12 years ended up needing a stent (at 45). If I could go back in time I would have stuck to my older pescatarian diet but made it only moderate amounts of fish with mostly whole plants. I've been eating a diet of only whole plants for the last 6.5 years and so far so good.

[@DanielForrester]

This was eye opening. I am 47. One nstemi mi and stent in the ole lad. I walk 30 minutes 3-5 times a week and try for three bodyweight workouts a week with lots of static holds and a couple inversions. Cardiologist is always more optimistic than I am. I am copying your coment here to unpack bit by bit.

[@supercal333]

4 min at 95% peak heart rate is brutal.

[@kpsig]

In a cyclocross race it can be that you hit an average of 90% for max HR for 40 mins…

[@bengt_axle]

All is relative to fitness. I'm almost 57 and I can cycle at 160 BPM for 40 minutes continuously. My max would probably be 173, which I can hold only for a few seconds.

[@karakoram_]

@@jsherrier1196 I haven't heard of such a long HIIT intervals. Typical interval length 20-40s, rarely 60s, and a rest for half of the interval length. For example in tabata: 20s/10s *6 (3min) with MAXIMUM performance during interval. 4min at 95% doesn't seem reasonable. Maybe it was 4min of series including intervals and rests.

[@seanwhitehall4652]

I takes time for HR to rise...does the beginning count?

[@jozefwoo8079]

@@seanwhitehall4652it also takes time to drop so if you just aim to keep your heart rate at the target level until the 3 or 4 minutes are up, you should be doing fine. The most important is to actually do the exercise 😊

[@lost_boy]

this makes me very happy - I've been doing HIIT routines for the past few years!

[@brucefranken4615]

Dr. Gil, you continue to be my go to source on lipidology. Always unbiased, with the rare ability to take a mass of information and reduce it to digestible portions. Keep up the good work!

[@drott150]

Can you explain whether it was hard plaque or soft plaque or some combination they measured before and after? I see in the study it says _"multivessel intravascular imaging was performed when feasible by a combination IVUS- and near-infrared spectroscopy (NIRS) catheter using an automated pullback system (TVC-MC8 model system with a 3.2Fr 40 MHz catheter, Infraredx, Burlington, Massachusetts). Following administration of intracoronary nitroglycerine, the NIRS-IVUS catheter was positioned as distally as possible in the coronary artery. To ensure matching coronary segments at baseline and follow-up, the distal starting points of the pullbacks were recorded angiographically to assist in registration of the corresponding segments at follow-up."_ I am only familiar with CAC and CIMT (which I'm not even sure is a widely accepted method) for measuring plaque thickness. This sounds like a sort of roto-rooter camera method that would measure the diameter of a partially occluded artery. How can it see and measure the thickness of plaque through the walls? How does it know the entire artery hasn't simply slightly expanded because of the HIIT?

[@MarilynMayaMendoza]

I wonder how old these participants were. HIIT is quite vigorous, so I guess having the instructor there was also a safety measure. Thanks to your videos, at 73 with a very low, lipid, lowering drug, I started the isometric exercise to lower my blood pressure. I really appreciate your videos because I think they’re the most truthful and realistic on the Internet. Thank you so much. Aloha.

[@avoycendeether8869]

Mean age 58.7 years in the control group & 57.3 years in the exercise group.

[@MarilynMayaMendoza]

@@avoycendeether8869 I wonder how I can tweak it for my limited mobility. Thank you

[@TurKishsoulja]

@@avoycendeether8869 I doubt anyone that old with those risk factors can even complete that exercise routine.

[@optimismrules2512]

Isometric (held positions) is usually contraindicated for high BP 🤔

[@lisapet160]

@@optimismrules2512 Totally opposite. Check recent data with side to side comparison.

[@urstandingonmyfoot]

This has been known for a long time but has recently been re-branded as HIIT. The California Longshoreman study showed very similar results in 1951. As a former track coach, we used FARTLEKS which was first used in 1930, where we used brief high intensity runs followed by brief walks or jogs and were very effective in improving running performance. This is all history re-visited.

[@datacipher]

Hey dullard, of course anaerobic intervals have been used since the beginning of time to improve performance. Food gravy. BTennis players were using them in 30’s too. The POINT is whether it can affect plaque size!

[@randeepwalia1507]

But I would assume you weren't doing fartleks to reduce the size of arterial plaque 😊

[@jrennickemd]

Love the Nuance Gil! I’m really glad you emphasized the point that their LDL was essentially at the threshold for stagnation, which I think is a key point. Great video!

[@sandrabentley8111]

They were all on statin drugs.

[@stevensauvageau8827]

Important news for me, TY. I'm 45, but want to be thinking about it now. The most encouraging takeaway for me from this video, is it is possible to lower plaque levels. TY much.

[@carinaekstrom1]

With the help of exercise, you can lower plaque levels when your LDL/ApoB is around 80 or lower. And you can lower your LDL/ApoB with diet and/or statins.

[@jimcrockett9296]

Agreed! Most things I've seen up until now said that plaque was permanent and unalterable.

[@RandomHuTaoSimp]

@@jimcrockett9296 The most POWERFUL way to reverse plaque even more than this is prolonged fasting. At least 14 days of water fasting to significantly reduce arterial plaque

[@AnTalk_blog]

@@jimcrockett9296 In this study it went down from 49% to 48% in 6 months with statins and HIIT training. Honestly, for me, someone with constantly high LDL and low HDL levels, it's not very encouraging.

[@brucemoose926]

When plaque is reduce, where does it go? What is the mechanism of plaque removal? I have never heard a biochemical explanation so I suspect they don't know. Please enlighten me.

[@junaid6220]

Please let me know if you ever get an answer for this. Cheers

[@brandonloyd8852]

Is decipates into the body in the same way Puss from an infection goes away. Also the same way a bruise does. Good HDL Cholesterol will also take tge LDL Cholesterol back to the Liver to be eliminated. Plant based diet, Antiplatelets and Statins can damn near make you Completely Stable.

[@Nicksonian]

WOW! Great information! As a 66-year-old with a strong heart but needed several stents due to angina, this is important stuff. In recent years, I’ve ramped up resistance training but only stuck my toe into the HIIT pool. Some studies have shown that training at lower intensities can have more benefits than at high intensities. But it seems to depend upon your goals. I’m going to try this routine on my rowing machine in a couple minutes. Great video today with Dr. Gil on Physionic!

[@richgl31]

Do you think HIIT is suitable?. I had an MI and 5 stents (at age 42 unfortunately)and cardio rehab highlighted I should not do competitive sports anymore… due to stop/start intensity. Just wonder if HIIT is potentially dangerous for us?. PS. I am running 5k’s and resistance work just fine. Walking loads etc. good diet etc.

[@vroomgc]

@@richgl31 Totally agree, for older ppl HIIT is not recommended because of the stress it can put on the heart

[@padmeshsethuraman5617]

I’m 66 year old Indian male living in south India. I have reduced my weight by 11kgs in the last 4.5 years after retiring. I go to the gym six days a week. 3 days I do cardio (Norwegian protocol) and 3 days of strength training. I have been working out in the gym since I was 50. My BMI is 23.5. My tummy is flat. My LDL C is 149. HDL 63, TGL 52. HbA1C 5.6%. Fasting sugar in 90’s. PP 112. I have my dinner by 5.30pm. Mostly vegetarian. I do take an egg most days. Never undergone any surgery nor admitted in hospital. I do my annual check ups since my mid 40’s. Not taking any medication. Don’t drink alcohol nor do I smoke.

[@akhilvijaykumar7064]

Some doctors in India say that high levels of HIIT can cause the plaque in the artery to rupture and cause heart attack. This was in the background of many fit young people dieing from sudden cardiac arrests .Could you please share what the current literature says about this?

[@AD-in6qp]

That’s because after people received a certain shot they started dropping dead and now they are trying to normalize kids and young people having heart attacks and cardiac events

[@zerrodefex]

Yeah totally nothing else that those athletes might have taken in the past couple years that could be a factor.

[@mz4987]

Those Indian doctors are full of it. Show us the clinical data!

[@rockbrd1]

This is why it's not healthy to just go into HIIT training of someone who is not healthy. Start slow cardio for for a while and work your way up to HIIT and switch it up .

[@EdwardsNH]

@@rockbrd1 The two are unrelated, but yeah... whatever

[@gerrysecure5874]

4x4min hiit is standard vo2max training session. In endurance training a ratio of 1:4 of hiit : steady state low intensity is often recommended to be sustainable and optimal performance wise. Twice a week is doable for a limited time, but long term it requires a good athletic level with many training sessions per week.

[@Skiskiski]

My version of it: 5 repeats of 4 minutes 7 miles an hour with 4 intervals of 4 minutes 3 to 3.7 miles an hour. I do not warm up. I just do it. The total time is 36 minutes plus, some times, "cool down" at 3 miles an hour. This is also close to 35 minuets of walking or walking and running that alleviates already existing peripheral artery disease or may even help to prevent it. No warm up means that I must necessarily exercise in the afternoon or evening. If I warmed up, after the warmup, I would just go home.

[@carolinemarie44]

I am 55 years young and Im going start sprinting tomorrow. This is HIIT. Feeling great!

[@remko4112]

How's it going so far?

[@Guishan_Lingyou]

Very interesting. HIIT is effective, but I think it's tough for a lot of people to stick with.

[@vroomgc]

Yes and some studies have show HIIT to be a potential problem for older people because of the stress on the heart. Also any HIIT exercises done in cold temperatures can also be more of an issue

[@jenjen789]

I love HIIT. I do it everyday. But if I were to do 4 cycles of 4 minutes, I wonder if it would give me a heart attack right on the treadmill.

[@NutritionMadeSimple]

haha it is intense. gotta ramp on to it :)

[@cybervoid8442]

It's not HIIT if you can do it everyday. You Clearly have capacity to push much harder if you are able to deal with the intensity everyday. Food for thought!

[@Nicksonian]

Last year, I tried some HIIT a few times. At my favorite park, I’d jog a loop that included an incline. I’d sprint up the hill, and jog back down, repeating six or eight times. Not fun. Stopped doing it.

[@drott150]

@@cybervoid8442 Tell that to Jim Fixx or Bob Harper. You can be fabulously fit and achieve very high levels of athletic performance, yet have large, fragile, soft plaque filled pustules lying inside your arteries just waiting for enough physical stress to pop them. Intense exercise stretches and dilates arteries. It also greatly increases both blood pressure and the shear forces of blood rapidly rushing past the fragile pustules. Put it all together and one day one of the pustules pops and it dumps its contents directly into the bloodstream, resulting in a massive clot.

[@jenjen789]

@@Nicksonian perhaps doing fewer reps is better than doing none. Whenever I see stairs, I try to run up the stairs as fast as I can. Whenever I am at a crosswalk, I run as fast as I can. Just short bursts of extreme efforts. I have lost more weight and have a much higher energy level now.

[@VTVT1306]

Thnx, I have angina and this gives me a little hope. I think boxing is a HIIT like training and I start feeling better with it.

[@jelambertson]

Coincidentally that’s exactly what I’m doing. After 2 stents with no mi 1 yr ago I started slow. Now I’m up to walking @ 3.4 for 2 min and running @ 4.4 for 3 min. For 2 hrs on treadmill. My cardiologist hasn’t done a full follow up exam with a CAT yet but I’m looking forward to it and impressing the techs when I do my next stress test (I’m 67 now). Impressing the doc and the techs is rewarding after busting your but at the gym for months.

[@Eduardolluvioso]

Who knew my high school track coach in 1980 was a pioneer. We did intervals for 60% of our training. I kept the habit into adulthood and this makes me happy.

[@PhilWhelanNow]

HIIT has been around since the 1930’s, pioneered in Sweden.. look up Fartlek methods. en.wikipedia.org/wiki/Fartlek

[@1ACL]

I was a competitive swimmer in the 70s, and our coach started us on this. It was cutting edge training, and it was brutal.

[@reallyanotheruser7290]

Hey Gil, first of thanks for the video and the work youre doing, you helped me tremendously on getting to a healthier diet! I wanted to give some general feedback. I really hope i dont come across as bashing your vids, i just dont know how to say this better cause im not a native english speaker: What i heared from alot of big youtubers, and what i agree with, is that audio quality is the most important thing about youtube videos, because alot of people tend to click away when the audio isnt great. Also it can mess with headphone users if they have to turn up the volume on your videos and then the next video from some other youtuber plays (or your outro music) and blows their ears out. I think your gear is absolutely fine, but imo there is some audio processing missing that would improve it quite a bit. I have no experience in audio processing for podcasts, so take this with a grain of salt, but due to being a musician i can give you a general direction (should be doable in any video and/or audio editing software): Normalize the audio, then do some equalizing (comes down to personal taste, i tried low cut at 130Hz, +3db at 550Hz 2oct bw, -5db at 1.4khz 0.6oct bw, -8db high shelf at 6khz 2oct bw, just to boost some important frequencys and cut out unpleasant or unessential ones for the next step), then a audio compressor (-21db threshold, 5:1 ratio, 50ms release, 6db makeup gain). Maybe you can play around with this a little, or better, look through some youtube tutorials, or even better, find someone who knows exactly what he is doing. Again, i love your vids and your work, so please dont read this as "your audio sucks, do exactly as i say", but rather like "hey i noticed this might be something you can improve, here is a rough idea".

[@NutritionMadeSimple]

thanks!!! feedback always appreciated!

[@reallyanotheruser7290]

​@@NutritionMadeSimple forgot to mention 6db makeup gain after compression 😅

[@sO_RoNerY]

Dude many KZbinrs hint the video is close to ending soon. Listen out for that. Also check how many more minutes is left of the video. I do this all the time. Get into the habit.

[@UpsideDown853]

Awesome overview! For me the question would be whether HIIT reliably reduces plaque or if the high blood pressure simply “blasts” plaque away for it to accumulate somewhere else in another form. I think lipid reduction is smart because the approach is to lower the building blocks which are used for plaques. That being said, I believe HIIT or any exercise is a good idea and should be incorporated into daily routines.

[@truth-Hurts375]

Whahooooo !!! Who would have ever thought about that ????must be new discovery !!!!👍👍👍

[@tomthumb753]

I drove my LDL to 55 with weight loss and diet. I do work out three times per week.

[@guestguest747]

Curious about the specifics. Care to share diet-related changes?

[@tomthumb753]

@@guestguest747 stopped eating the shit. Lots of fruit, veggies, nuts, no processed. food.

[@cyberfunk3793]

LDL can drop while losing weight, but it doesn't mean it will stay low permanently. I would be surprised if your LDL stays at 55 without drugs, unless you are very young, genetically lucky or a vegan.

[@fabianstec]

well its a nutrition channel but I love your videos on exercise

[@ewu2030]

the HIIT exercise you explain is basically a VO2MAX session which is probably one of the best way actually live longer. And to VO2MAX 2 times a week and 3 times of Z2 and you are set for a great cardiovascular health

[@napnap609]

Great video as usual Gil. I'm a little confused or should I say surprised when you said it's been proven that lipid lowering meds, statins etc., shrink plaque size. I had no idea statins did that and though that it was the opposite; that statins increase your plaques by stabilizing soft plaques and reinforcing the calcified plaques, and in doing so, your CAC scores would actually go up from a CAC score prior to taking meds. How do statins shrink plaques? Also, wondering when plaques shrink is that always a good thing? I could see the benefit to shrinking the height of a plaque but shrinking the width would make me think the damaged party of the artery is being exposed again, unless the previously area covered with plaque has actually restored itself.

[@NutritionMadeSimple]

yes, they can reduce plaque thickness (likely through lipid reduction, PCSK9 inhibitors have the same effect) and also raise CAC. but the bottomline is that the rate of events (heart attacks etc) is reduced

[@reydelagarza2953]

Yea, I agree. I think only Repatha has shown a small reduction in plaque, and not "significant," so he confused me here, too. I've never seen anything about "height" or "width", so I'm gonna look further at that. For starters, guess "width" means from edge of inner artery wall? maybe you mean depth?

[@NutritionMadeSimple]

​@@reydelagarza2953 hi. the figure shown in the video at 7:00 (figure 5 from academic.oup.com/eurheartj/article/38/32/2459/3745109) compiles many of these trials, you can see on screen they include some trials of statin alone, some of statin+ezetimibe. the key seems to be how low the LDL-C/ApoB gets, more so than what method or drug is used

[@DrAshoriMD]

I consider plaque regression an important but third-teer consideration. As you mentioned clearly, halting progression is already a major win. And a first-teer goal is to ensure stabilization of existing unstable plaque and making sure that plenty of peripheral, smaller vessels are built to supply the rest of the heart muscle in case of any blockage due to ruptured plaque.

[@nimblegoat]

The main point is neither group plague grew - so if you are starting to get in the danger zone - pressurize your Dr for some drugs - suitable for you - plus exercise Also this means if you start earlier - at say 25% plaque - you stabilise it there . Also if this HIIT exercise continued - it should lower overall mortality - more efficient body , more plasticity in your veins and arteries Just hold out till they get micro cleaning bots to safely remove plaque - most plaque. biofilms in nature are tough to remove - even with a scrub brush- say in bathroom on mold that is mature , or with teeth not brushed enough ( normally need a hygienist with ultra sound ) The other hope is new techs that can produced effects deep under skin at very targeted points -just tech now starting to be used for brain surgery I believe - ie a 3D generated waves that only work where various paths meet up - so not invasive surgury

[@magaman6353]

There have already been studies on this at Toronto Western Hospital. I'll try to find the link later. A 1% reduction after 6 months isn't much - and not everyone got a reduction - but for every 1% reduction, blood flow increases 2 or 3%. Things only start getting dangerous after 50% blockage though, particularly in the left descending artery (aka "the widow maker.")

[@f.austin]

great video - presentation and summation done well and thoughtfully - thanks for sharing!

[@joeordinary209]

Braking hit interwall to shorter bursts and also recovery periods is as efficient but IMHO more mangable. I used to do 45 sec+45 sec and did many repeats. At the end of the session the heartbeat remains constant high also during the recovery period:) Bu resting pulse went below 40 Bpm

[@jimmagwojo2718]

A very good video doc. Very nuanced. Made me realise like everything they are not as absolute as they seem.

[@scottsutoob]

An interesting topic that I don't know if you have covered yet is non-nutrition causes of higher LDL and other markers. I have been eating low saturated fat mostly plant based diet for over 40 years. My cholesterol levels reflected that until a few years ago when work and life became very stressful. Diet and exercise stayed the same, but cholesterol especially LDL shot up significantly.

[@Nicksonian]

Consider 80/20 training. Just watched a new running video from Coach Parry. The presenter, having read 100 running books, says that the best training for even elite runners is 80 percent at LOW INTENSITY, and 20 percent HIGH INTENSITY. Another recommendation is interspersing walking with running. Indeed, walking has lately been touted as being as beneficial as more intense workouts. Recovery is also very important.

[@TheMaryConway]

How are the measuring the plaque?

Damn wish they also had VO2 max scores from the start and the end of the trial. Would be really interesting to see.

[@PH-dm8ew]

Love your high info and scientific based approach. Do you have a video about heart health and plaques as they relate to low carb keto diets? What does the science show?

[@pyroliquid_]

He has a number of videos on this. The key is quality of fat you eat. High-saturated fat diet (more than 10% of your calories) isn't good for your cardiovascular health, but keto rich in unsaturated fat is good for your heart

[@aquamarine99911]

When I do resistance training wearing my HR monitor, the HR curves look exactly like they do when I do cardio HIIT. So would just doing the RT along with cardio on off days accomplish the same thing as HIIT. In other words, does it matter HOW you get your HR up?

[@Derek_1111]

Is your RT structured in a HIIT type session or are you doing more of a standard style of resting 1.5 to 3m between heavy sets? I personally quit lifting heavy but when I did, the big compounds like squatting, dead lifts, and bent over rows were intense enough that they jacked my heart rate up like you mentioned. Either way sounds like you're consistent with your exercise routine so you're doing just fine. If anything doing what you're doing to get your heart rate up is probably better since you're building more muscle mass in the process...

[@baz1184]

I wonder the same thing.

[@my4cars528]

I wonder if other fitness routines have a significant impact.

[@ScrapPalletMan]

Super good info. Thanks man

[@RacerX1971]

I do HIIT on my bike. Pedal fast for 30 sec, then coast for 10 sec, do it again like 8 times. When i get home, my blood sugar is 80. Ive been doing this for 3 mos, combined with walking and push ups 3x a week. My average blood sugar is 113 now compared to 130 without HIIT.

[@vincec727]

That’s closer to the “intervals “ that i’ve seen

[@scottk1525]

Good stuff. Bums me out that they only studied HIIT. Maybe lower intensity exercise is just as effective.

[@joerenner8334]

Where is the link to the study?

[@NutritionMadeSimple]

hi, see the description

[@masher1042]

Thanks! Very helpful to know. Will target to add 1 or 2 interval per week to my zone 2 rides.

[@robertdaymouse3784]

The problem with exercise studies on old people with serious health challenges is that no one wants the subjects to have a heart attack while doing the exercise. None of these people were running like in your graphic. There is no way these people were doing 85%-95% actual max heart rate for 4 minutes. All the exercises were watered down to the point where is was just 43 minutes of them walking on a treadmill alternating between a 4% and a 0% grade. Love your channel, keep up the good work.

[@NutritionMadeSimple]

yes, the "peak HR" they used in the study is quite different from the "max HR" commonly used in HIIT. no doubt this was much milder or these patients wouldn't tolerate it :)

[@waynegolding14]

I like that you're doing videos looking at research on exercise now Gil. It would be great if you could look at research on sleep as well! Personally, I see diet, exercise and sleep as the big 3 to DO well

[@RandomHuTaoSimp]

The number 1 to prioritize is prolonged fasting. At least 14 days or more. That's far more powerful than diet, sleep and exercise. Well maybe a combination of sleep and prolonged fasting.

[@waynegolding14]

@@RandomHuTaoSimp I strongly disagree.

[@jrennickemd]

Agree with you in that sleep, diet, and exercise are the big three!

[@AndersWelander]

Clearly there are many ways to do HIIT judging by the comments. 🙂 I'm definitely going to do it now. I will build up to an intensity that feels right.

[@karlschmied6218]

Question: Is the illustration of an artery 2:36 with plaque correct? I thought that the plaque is not in direct contact with the lumen, but is still under a layer of endothelial cells. The picture looks like my drainpipes, which I recently had to clean.

[@stargazerbird]

Been doing intervals for a while now. One session a week and one session sprints. Intervals is harder. Start out with 3 minutes and a longer wait between. Build up to 4 minutes. Definitely feel the improvement in stress, fitness and sleep compared with endless base slow runs.

[@OneFunPierre]

Happy Thanksgiving Gil!

[@NutritionMadeSimple]

happy TG!

[@tridoc99]

Thanks for the interesting info. Most people just call it Hit workout and don’t say each letter.

[@ambramari118]

Does the exercise low even further (on top of statin) the LDL ApoB ?

[@newyorkguy158]

This is a great question. Dr. Carvalho has said previously that exercise doesn't lower ApoB, but this study may suggest otherwise. I don't know if the authors addressed this question.

[@esvedra2419]

Interesting. I used to love HIIT but lost condition over time switching to just weights/no cardio

[@ThePoitivient]

Great stuff! Do you know if high A1C causes high LDL numbers? Do the numbers tend to follow each other?

[@NutritionMadeSimple]

people with insulin resistance and/or type 2 diabetes tend to have higher ApoB and LDL particle numbers (though not necessarily LDL cholesterol). see our recent series with dr. Cromwell for details

[@esotericsolitaire]

A doctor told me once that if I bring my A1C down, the triglycerides would come down too. This turned out to be patently untrue in my case. The only things that lower my triglycerides are alcohol and fast food abstention. I have never taken meds.

[@jimdaikh9381]

​@@NutritionMadeSimpleCorrect me if I'm wrong, looking at it the other way, having low A1C doesn't mean you will have low APOB because I'm in that group. I assume A1C is and indicator of Insulin Resistance so IR isn't always a factor?

[@rexwine]

Is the plaque shrinking or just the arteries increasing in size due to exercise?

[@avoycendeether8869]

@rexwine GOOD QUESTION! I'm not an imaging expert but if I look at the results, before/after Vessel, Lumen, and Atheroma volume all went down for the exercise group. For the control group Vessel & Atheroma volume both went up, Lumen volume was almost unchanged. Hmmm...so that's some stuff to think about...

[@RandomHuTaoSimp]

arteries don't expand 2.4% in a 6 month span. This is impossible. The plaque literally decreased thanks to calcium needs for the bones. Meaning through autophagy (Wasnt a lot) Plaque was removed from the arteries and placed in the bones. This is what I think is happening. Makes sense because 21 day fasts seem to significantly reduce arterial calcification.

[@DemeterN]

Wonderful news! Thank you.

[@brenttuttle7268]

It took several months after my MI before I felt comfortable doing HIIT again. Agree with other comments about being worried about having another heart attack

[@avoycendeether8869]

Awesome commentary, interesting study! Maybe the hardest thing to believe is the level of compliance the authors achieved from the exercise group! Ha! I note that they mention this level of compliance would be unlikely outside the boundaries of a study. No kidding! Also, the authors though 60 participants was limited...I'll just say when I read 60 participants I thought it was a very good level of participation for this sort of study. Especially when the first thing you ask your 58 year-old CV patients to do is a GXT until they very nearly feel like they're gonna die. Well done Vesterbekkmo, Madsen, et al.

[@JessicaTPeterson]

A drop from 49.5% to 48.3% is not a 1.2 percentage difference. It's a 2.454% difference.

[@vaska1999]

?

[@JessicaTPeterson]

@@vaska1999 If plaque filled 100% of the artery lumen, then dropped to 98.8% after the HIIT program, that would be a 1.2 percentage difference in plaque volume. If plaque filled 2% of the lumen, then dropped to 0.8% after the HIIT program (still 1.2% less), that would be an 85.7 percentage difference. The percentage difference between 49.5% and 48.3% is 2.454.

[@lotembenatar7163]

Interesting, thank you, Gil, for the content

[@adim00lah]

I do kettlebells about 4 times a week, which is hiit training, so I guess I'm on the right track. Thanks doc.

[@jm08050]

Sorry, but kettlebells are not HIIT at all.

[@adoboFosho]

​@jm08050 that's bs how much swings can you do straight then 😂

[@thefisherking78]

Very interesting news! I'm 45 with some risk factors but doing some things right. Weights, lots of low-intensity cardio, but usually at least a couple of HIIT sessions a week. I'll have to make a point of including more.

[@optimismrules2512]

You don't need to include more HIIT if you're doing it at actual high intensity as there are some downsides to TOO much (joint pain, overtrainjng, etc). Add more traditional intervals vs trying to overdo HIIT.

[@carvedwood1953]

Can you please does a video about nattokinase?

[@tablameister]

Thanks for the video. Several Canadian University studies show the benefit of HIIT.

[@vickyverma6852]

If you have never done any high intensity exercise before, don't jump into HIIT right away. Start slow and progress over time.

[@Ultimatefitness360]

How can a person do 4 min high intensity training without break ?? Is it possible to sprint for 4 min continuously ??

[@doctormarazanvose4373]

Try cycling up a big hill with a gradient >10% you'll think 4 minutes is a breeze.

[@colincowie2547]

30 secounds. Is ideal.. then rest 90secounds

[@OttoBoy]

Your question is one of the most frequently asked on HIIT videos. I asked the same when I first saw a HIIT video. The content creators seem to never clarify the intensity level for a given time sequence unless an interviewer asks to clarify. The pace and level of intensity correlates with the time duration. If you’re doing 30 second HIIT intervals, the pace and intensity for many will be a solid sprint - what most could sustain for around 200 meters. If you’re doing 4 minute intervals, the pace and intensity will be more measured - probably similar to attempting a steady pace for a 800 meter PR. Obviously, the pace and intensity will widely vary with each person. The pace of a world class marathon runner will obviously be much faster than a weekend warrior whose main goal is to just finish the 26.2. That same weekend warrior is a probably going to cover a little over 200 meters that an Olympic runner can probably cover 300 meters in 30 seconds. Doing HIIT can be injurious in a lot of ways if one is overreaching, particularly if one is not in the physical condition to perform it. A reputable medical professional is the best first step in assessing one’s ability to perform HIIT.

[@nichtsistkostenlos6565]

This is interesting, this is similar to what I do to train VO2 max, so might be another reason why VO2 max tracks so well with longevity.

[@MT-sq3jo]

I agree with you. My view is, VO2 max is merely a bio marker that you are already doing a lot of exercise which gives you the benefits.

[@owambocontrol4218]

Thanks for the great video. Appreciate it!

[@jtiasgaard155]

Let me say first of all, I truly appreciate your contributions to this space. I am a physician as well. I noted that you said "statins have been shown to reduce plaque." I do not believe this is correct. I believe they have been shown to stabilize and stop progression, but not actually reduce damage already done. Please correct me if I am wrong. Thanks.

[@NutritionMadeSimple]

hi, depending on the degree of LDL-C lowering, plaque progression is stopped with LLT and at even lower values some regression has been reported, this seems to be dose-dependent. Regression is generally seen under 60-80mg/dL LDL-C. See the references linked in the description for details on all this

[@heatherh.946]

Excellent content as usual! I'm enjoying the shorter videos. I save your longer ones for when I'm on the treadmill lol

[@middleearthltd]

Last Great content as always Thank You 🙏

[@s3anuk]

another great video, but please buy a 4k camera as 1080 looks really outdated on a monitor

[@MiKraThe]

Even though I think excercise is a wonderful tool for improving health I have some questions about the methodology. There was a significant difference in VO2max between groups after intervention. Is it possible that the vo2max changed the arteries in a way that could not be accounted for by the calculations they used to determine the TAV and resulting %? Lets say a change in dimensions of arteries?

[@drott150]

One nit of the study is that they should have supervised whatever type of exercise that supposedly took place in the control group. By "supervising" anything you are watching it and therefore changing its behavior (Heisenberg). The other group should have been "supervised" in the sense they were simply witnessed and verified to do whatever level of exercise they would normally do. Total physical activity levels should have been recorded for both groups as a comparator. I suspect the relatively small plaque difference between the two groups would have shrunk, because I would bet my LAD that unverified exercise compliance rates for already unhealthy people is not good.

[@pfdavidz]

This is great. More studies will be positive news.

[@JackFalltrades]

This goes back to something I read half a century ago. Something I think was mentioned in Dr. Cooper's, _Aerobics _ . A doctor had a patient with heart disease who improved vastly within several months. It turned out the patient had set himself the task of chopping wood every day. His endurance gradually increased, and his symptoms improved. If you've ever chopped wood, you know it's kind of HIIT. You swing the axe until you get tired, rest, and then continue swinging

[@700317]

What about an interview with Ford Brewer from Prev Med Health? Would be a good conversation. Love this channel!

[@johnsmith-zf1fd]

Have there been any studies on following a plant based diet and plaque reduction?

[@Reewnat]

Is it realistic to do actual HIIT for 4min straight? My understanding is that a full on sprint level workout is realistically 60-90sec. Is this a lower level HIIT/high level cardio?

[@windar2390]

There is a 30sec HIIT where you go as hard as you can. Of course you cant do that for 4min. So, at the start you have to choose an intensity, that you can hold for 4min, but after 4min, you cant add another minute. Choosing and holding an intensity, is the second hardest thing of the HIIT training. ;-) Unless you have an ergometer, where you can define a constant power output.

[@newyorkguy158]

I wonder how long it took these people with significantly occluded arteries to get to the level of fitness where they could do HIIT?

[@jacko.6625]

@@windar2390 I run on a track. Use a timer. How far do you get in 4 minutes? Try to run at least that distance. I started out running 2 laps, walking one lap, 4 times. I don't think that 4 minutes is sacred. It took me longer. I'm now running the intervals in 4 minutes 15 seconds.

[@windar2390]

@@jacko.6625 I dont run, I cycle. When I train indoor, I can setup my ergometer at 360watt, which is the power I can hold for exactly 4min. However, 4min is not the holy grail. Anything between 30sec and 8min is fine as long as you are at your limit. It might even be beneficial when you do some variations, so the body doesnt get used to it.

[@duppy9012]

Just to confirm this is actual reduction of plaque? vs like extra dilation in the arteries? this is incredible

[@WalkingDday]

I see many videos on the importance of NO on plaque reduction and other benefits.

[@MarcoMeile]

thanks for the great explanation! And i like your microphone :D

[@RedPillVegan]

1% change doesn’t sound statistically significant, but when you are talking about a reduction in plaque size with an exercise intervention i’m thinking about implications of additional improved vasodilation and vo2 max too if they keep up their exercise program

[@nichtsistkostenlos6565]

It is absolutely statistically significant, go read the study. He also explained why it's significant in terms of risk.

[@bedrosgesaratsi1099]

It usually takes decades to clog arteries, so it still makes sense... I think 1% decrease can still make a huge difference, especially when combined with other "heart friendly" practices. Had the only effect of vigorous exercise been stopping plaque growth, it would have still been a great benefit.

[@dafringe]

It wasn't a 1.2 "percent" drop. It was a 1.2 "point" drop, which is about 2.43%.

[@datacipher]

@@nichtsistkostenlos6565NO. He said it MIGHT make a difference since a 1% reduction in drug therapy equated to a 20% reduction. We have no idea how much that 20% was directly due to the 1% reduction in size. One would suspect it almost certainly was not - very implausible! Most likely other effects from the drugs were in play as well.

[@datacipher]

@@dafringeNO. It was a 1.2% drop in blockage (which is the standard metric). If you want to talk about percentage of plague loss, then sure.. 2.4… If you’re going to try to obnoxiously correct people, it certainly does not help to even further conflate meanings with undefined expressions.

[@mikesmicroshop4385]

Which of the studies listed show that Plack is related to cholesterol levels?

[@TheCyclingCardio]

4x4 is classic VO2 max interval..and twice a week is the go to recommendation for majority of endurance athletes training program, so the regiment is very applicable..and 49% plaque burden is most probably not ischemic inducing, so combined with the Statin and Antiplatelet, this whole regiment is relatively safe and doable… 1% might clinically insignificant, BUT, it’s only for 6 months..as both cardiologist and endurance sports enthusiasts at 39 yrs old, I’m really excited to see where this goes, both for me and my patient

[@roguemedic]

Unfortunately, the study is using secondary endpoints, but has not adjusted the p value for significance, although that is important with assessment of secondary endpoints. This is interesting, but the results seem as if they would be statistically significant - if the end points were appropriately adjusted. Often adjustment to p < 0.03 accounts for the multiple end points, but since the researchers do not provide that adjustment, we do not know if it should be something else, like p < 0.01. "In the present article, results from the analyses of the predefined secondary endpoints assessing atheroma volumes using grey-scale IVUS are presented." "Normally distributed continuous variables were compared using the Student t-test and categorical variables were compared by the Chi-square test or Fisher’s exact test. P-values

[@johnzabroski5396]

The study you cite is reporting a secondary endpoint, so it was not designed to be powered to study this effect. In terms of measuring plaque size, they are using IVUS. I thought this was not the gold standard for measuring arterial health. I get it... It may be "good enough" but what changes are we actually seeing?

[@robjones3482]

Did the study include calcium scores before and after? Was age or gender a factor in this study?