Comparing In-Person to Tele-Exercise High-Intensity Interval Training in Adults With Class II/III Obesity

<h2>ABSTRACT</h2><h3>Background</h3> The COVID-19 pandemic accelerated the use of tele-exercise. Providers must now determine the most suitable modality of supervised exercise training for patients. This study compared exercise attendance and intensity during supervised high-intensity interval training (HIIT) between in-person vs. tele-exercise sessions among adults with class II/III obesity. <h3>Methods</h3> We conducted a secondary analysis of a randomized controlled trial of 62 participants examining exercise and surgical weight loss effects on neuropathy. Participants underwent two in-person supervised and one unsupervised HIIT sessions weekly for two years. After the pandemic onset, sessions shifted to tele-exercise. We evaluated associations between session attendance and intensity with pre- vs. post-lockdown timing. <h3>Results</h3> Supervised session attendance increased after switching from in-person to tele-exercise sessions (incident rate ratio[IRR]: 1.50, 95% CI: [1.27, 1.79]). Pre-pandemic follow-up time was associated with decreased attendance (IRR: 0.95, 95% CI: [0.94, 0.97]), but supervised session attendance increased after the COVID-19 shutdown (IRR: 1.05, 95% CI: [1.03, 1.07]). Participants with prediabetes or diabetes showed reduced attendance, while those undergoing bariatric surgery had increased attendance. No change was seen in exercise intensity after switching from in-person to tele-exercise sessions (point estimate: -0.01, 95% CI: [-0.02, -0.01]), but small effects of follow-up time on exercise intensity were seen with increases over time before the pandemic and decreases after the lockdown. <h3>Conclusions</h3> Tele-exercise resulted in improved attendance for HIIT training among adults with class II/III obesity without meaningful differences in exercise intensity, supporting its use for this population.