In my medical practice over many years, I have focused on helping people find strategies and tools to increase physical activity and to find ways to work within whatever limitations they may have. I have found that regardless of severe limitations, even people whose legs are paralyzed, there is always something we can design to increase their physical activity.
That is part of the reason we have been offering Workouts with Kathy videos each week – regimens like chair yoga can be done by the majority of people regardless of age or level of physical conditioning.
I used to run/jog 2-3 miles 4-5 times a week, swim laps, go roller-blading and do regular high impact aerobic dance, but four spine surgeries since I was 33 years old (two for lumbar laminectomy/diskectomy, two cervical laminectomy/diskectomy and cervical fusion) put an end to the high-impact types of aerobic exercise I loved. So I have sought experienced physical therapists and sports medicine specialists for unique—and sometimes strange—approaches to exercise strength and aerobic conditioning as part of the recovery from my spine surgeries and my ongoing fitness routine. Right after my cervical fusion, I was in a steel 4-poster neck brace for 8 months, and was required to keep a “neutral spine” for any exercise – drastically limiting my options. My very creative physical therapist had me lie on the floor behind an exercise bike and pedal while lying down to build back my leg strength and flexibility. I was embarrassed at the gym with my totally unorthodox and strange appearing workout – but it accomplished my goals! When I started, I could only walk few yards without support. By the end of a month I was striding along briskly, my legs much stronger and balance improved. I soon was able to do powerwalking for a mile or two without difficulty.
After other surgeries, I did water exercises for a full body cardio and resistance workouts, as I still do 5-6 times a week to this day. I would not be able to function without all this strength and cardio and flexibility workouts consistently for all these years. So that life experience has taught me well just how critical a sound, balanced, and consistent workout regimen is for our total body-mind-spirit health and resilience.
But there is another common complaint I hear from patients all the time: “Dr. Vliet, I am doing everything right with my meal plans and exercise, but I haven’t been able to lose that excess fat around my middle. What can I do to help my weight (fat) loss?” I often recommend an individual consult with our exercise physiologist, Kathy, who has worked with my medical practice since 1995 to help patients with individualized exercise workouts and nutrition plans. Kathy is also the Director of Health and Resilience for the Foundation, and she has written today’s Health Tip on High-Intensity Interval Training (HIIT), just one of many techniques she uses to help patients struggling with losing excess body fat and wanting to take their exercise regimen to a higher level so they can achieve their health goals.
Walking is a pretty simple and low-cost way to get your exercise—outdoors or indoors in bad weather. You do not need any expensive equipment or workout gear. Just a pair of comfortable shoes. It is estimated, however, that only about 47% of American adults meet the basic activity guideline of 30 minutes walking 5 days a week, or about 10,000 steps a day. If we consider the full activity recommendations of both the aerobic exercise and muscle-strengthening activities (twice per week), only about 23-24% of adults meet the full guidelines according to 2020 CDC reports on physical activity in the U.S. population.
Thirty minutes of walking 5 days a week translates into 150 minutes of moderate aerobic exercise each week, the minimum level for significant health benefits recommended by physicians and many health organizations. This is the level of weekly physical activity that studies who reduces risk of chronic diseases and death, promotes cardiovascular health, and improves metabolic and psychological health wand sense of wellbeing. Organizations endorsing this recommendation include:
- U.S. Department of Health and Human Services: Their Physical Activity Guidelines for Americans
- American College of Sports Medicine (ACSM
- American Heart Association (AHA)
- American Cancer Society (ACS) to improve health outcomes and quality of life during and after treatment.
- Centers for Disease Control and Prevention (CDC)and World Health Organization (WHO)
If you are among the 53% of Americans not achieving this basic goal, I encourage you to just get out and start walking a few times a week. Start with 5-10 minutes a day and work up at a pace right for you, with the goal of reaching the 30 minutes daily. Then increase the frequency of your walks until you are walking at least five days a week.
Consistency is the key to establishing a habit. I personally try to walk daily, at the same time every day, so it is just routine, and I don’t even have to give it much thought. The more you walk, the more you will be able to walk, both in duration and frequency. Add a few minutes each walk until you are comfortably walking for 30 minutes at least 5 times a week. And this goes for walking outside or inside on a treadmill. Before you know it, you will see additional health improvements. Voila!
For those of you already meeting the recommended minimum amount of activity per week for basic health goals, this health tip is for you. Perhaps you’re walking daily, doing some resistance training, stretching, staying active, but as you get older you are having trouble maintaining your weight. Perhaps you just can lose that last 5 or 10 pounds or 1-2 inches off your waist.
High Intensity Interval Training (HITT) is a tool that may do the trick. This is really nothing new, but there are a few techniques that are getting a lot of attention lately because they work so well!) I want to talk more about these techniques, especially The Norwegian 4 x 4 HIIT workout and The Japanese 3×3 HIIT workout program.
First, what exactly is HIIT?
High-Intensity Interval Training (HIIT) is a time-efficient, versatile training method of cardiovascular exercise characterized by:
- repeated short bursts of intense activity, usually at near maximal effort, but at least at a higher effort than your “moderate” aerobic activities. These intense intervals push the body to a high heart rate, sometimes at or above 90% of maximum heart rate depending upon your fitness level,
- intense bursts then alternate with periods of low-intensity recovery or rest. These brief recovery phases allow partial recuperation before the next effort.
The combination of high-intensity efforts alternating with recovery serve to maximize physical fitness, metabolic health, and cardiovascular improvements in less time than traditional moderate exercise.
Key benefits of HIIT include:
- Enhanced fat loss through higher calorie burns and post-exercise metabolic boost
- Improved insulin sensitivity and blood sugar regulation
- Improved cardiovascular health such as increased VO2 max and reduced blood pressure
- Increased endurance and muscle conditioning
- Mental health benefits, including mood enhancement and cognitive improvements.
HIIT Techniques
- Walk/Jog Conditioning –The original HIIT is a technique, which has been around for ages, is a gradual way to move from a walking program to a jogging program. A typical walk/jog conditioning program involves alternating periods of walking and jogging within the same workout session. For example, you might walk for 2-3 minutes followed by jogging for 30 seconds to 2 minutes, gradually increasing jogging intervals over time while maintaining walking breaks. You can also alternate walking and jogging between each mailbox or telephone pole until you are able to jog more and walk less. It is designed to safely build cardiovascular fitness and endurance, especially for beginners or those returning from inactivity. It is low-impact relative to continuous running, which helps reduce injury risk and muscle fatigue.
- The Japanese 3×3 HIIT workout program, also known as Interval Walking Training (IWT), is a simple, structured workout consisting of alternating 3 minutes of slow or moderate-intensity walking (about 40% of peak aerobic capacity) with 3 minutes of brisk or high-intensity walking (about 70%+ of peak aerobic capacity). This cycle is repeated 5 times, totaling approximately 30 minutes of exercise.
- The Japanese 3×3 boosts cardiovascular fitness by mixing higher and lower intensity efforts, increases fat burning and aerobic capacity more effectively than steady-state walking, is joint-friendly and accessible for older adults or beginners due to its walking-based approach, improves endurance, muscle strength, and helps in weight management, while also balances effort and recovery, making it sustainable and motivating.
- The Norwegian 4 x 4 HIIT workout program is a structured interval training method developed by Norwegian exercise scientists to improve cardiovascular fitness and maximize VO2 max. It consists of four high-intensity (race walking) intervals, each lasting 4 minutes, performed at 85-95% of maximum heart rate, followed by 4 minutes of active recovery at a very low intensity, slow walking. This cycle is repeated four times, typically after a 5-10 minute warm-up and followed by a cool-down period. The total workout time, including warm-up and cool-down, is about 30-35 minutes.
This protocol is one of the gold standards for HIIT, balancing intense workload with manageable recovery, making it effective and sustainable for fitness gains and cardiovascular improvement.
Key features of the Norwegian 4×4 program:
- High-intensity intervals are sustained efforts close to maximal aerobic capacity.
- Active recovery intervals allow partial recuperation while maintaining light activity.
- The program is adaptable, suitable for beginners with fewer intervals, and scalable for advanced fitness levels.
- Ideal frequency is 2-3 times per week with adequate recovery between sessions.
Benefits of the Norwegian 4×4 include:
- Increased fat burning and metabolic efficiency.
- Significant improvement in VO2 max, which reflects the body’s efficiency in utilizing oxygen during exercise.
- Enhanced cardiovascular health and endurance.
- Better overall aerobic and anaerobic fitness.
- Reduced risk of chronic diseases and improved longevity.
IN SUMMARY: The 3×3 and 4×4 methods support sustainable fitness improvement, aids fat loss, enhances stamina, and lowers blood pressure, making it an effective yet manageable HIIT alternative primarily based on walking intervals.
I recommend adding high intensity interval training sessions to your workout routine at least once a week and optimally twice a week. That’s all. Dr. Vliet and I are NOT recommending that you do HITT for all of your aerobic workouts! Why? HIIT is beneficial as I explained, but it is also a stressor for the body and it increases cortisol levels on a short term basis. The short rise in cortisol does not outweigh the overall metabolic benefits.
For your other aerobic exercise sessions each week, continue your cardiovascular (aerobic) activities using zone one or zone two, steady-state moderate walking pace) Performing HIIT twice per week offers maximal intensity conditioning, while steady-state zone 1 or zone 2 exercise provides crucial aerobic endurance and recovery benefits, creating a well-rounded, sustainable fitness routine that balances intensity, recovery, and metabolic health. HIIT provides the quick, intense workouts that maximize calorie burn and metabolic improvements, while steady-state cardio is ideal for building endurance, fat metabolism, and reducing exercise-related stress.
Comparison of HIIT and STEADY STATE Cardiovascular Training:
- Recovery and Injury Risk: HIIT is very demanding on the cardiovascular, muscular, and nervous systems. It creates substantial physiological stress that requires ample recovery time to avoid overtraining, injury, and burnout. Limiting HIIT sessions to about two per week allows the body to repair and adapt effectively.
- Sustainable Training Volume: HIIT sessions, due to their intensity, are shorter but more taxing. To maintain a balanced weekly exercise volume without excessive fatigue, lower intensity steady-state workouts at zone 1 or zone 2 are recommended for other days. These promote endurance, fat metabolism, and cardiovascular base building while being less taxing.
- Optimal Fat Oxidation and Aerobic Base: Zone 1 and 2 aerobic exercise predominantly uses fat for fuel and enhances mitochondrial function and capillary density. These adaptations create a strong aerobic base critical for overall metabolic health, insulin sensitivity, and performance. HIIT alone does not optimize these slower, sustainable energy systems.
- Longevity and Injury Prevention: Steady-state aerobic exercise supports joint health, circulation, and recovery without the high impact or fatigue associated with frequent HIIT. This approach lowers the risk of chronic injuries and supports long-term exercise adherence.
For most people a mixed approach incorporating both HIIT and steady-state cardio is ideal for well-rounded fitness and health benefits. You can incorporate the original walk-jog interval training into your walks a couple times a week or try the Japanese 3 x 3 or the Norwegian 4 x 4 or maybe you can come up with your own. The key point is to keep challenging yourself so your body must respond and learn to adapt, and in that adaptation is where the magic happens and health and fitness goals are achieved. So, walk on!
On a personal note, I like to walk in the mornings, before breakfast (but after hydrating and having a cup of coffee) about an hour after sunrise. I add HIIT to my walk on Mondays and Fridays. I like to think that it is a strong way to start my week as well as finish it. I think weekend walks should be nice and leisurely, savoring being outdoors in nature, while getting all the health benefits.
I also find that it helps prevent interference by other demands that crop up during the day if I do my exercise first thing in the morning. That helps prevent the problem of your being tired, hungry, and not wanting to face the dark, and now colder weather outside. When you work out first thing in the morning you start your day with an accomplishment and that sets a wonderful positive “feel-good” tone for the rest of your day!
I have also incorporated another technique to maximize the beneficial effects of my exercise on muscles. I mix our TruAmino™ Complex in water and drink it prior to my workout to support my lean body mass and provide muscles with fuel and protect against breakdown. Amino acids taken before workouts also help the body burn fat for fuel and improve exercise performance and recovery.
This is a useful strategy especially when working out in a fasted or low-glycogen state in the morning. In addition, I make sure to eat a high protein balanced breakfast after my walk so that I have better blood sugar control for the rest of the day.
CAUTION: As always, we urge you to avoid supplements without checking knowledgeable sources to evaluate your medical situation, proper lab tests to verify what is needed, and to make sure to avoid adverse interactions with prescription medicines and other supplements you take.
All Truth for Health Foundation Products Meet or Exceed cGMP Quality Standards, the highest quality standard for supplements sold in the USA.
For more information, references from studies are listed in the Product Data Sheets for each product, available on our website. Under medical practice regulations, we are unable to answer individual medical questions or make specific individual supplement recommendations for people who are not established patients of Dr. Vliet’s independent medical practice.
I encourage you to consider our other natural medicines with our top quality, cGMP-compliant professional formulas for TruImmune™Boost, TruNAC™, TruImmunoglobulin,™ TruC with BioFlav™ (Vitamin C with complete Bioflavonoids), Tru BioD3™, TruZinc™, TruMitochondrial ™Boost and TruProBiotic™ Daily to replenish critical bifidobacteria depleted by COVID shots, viral illnesses, and antibiotic therapy.
To Your good health and improving resilience!
Elizabeth Lee Vliet, MD |
