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. 2023 Aug 4;102(31):e34626. doi: 10.1097/MD.0000000000034626

Effects of high-intensity interval training with an eccentric hamstring exercise program in futsal players: A randomized controlled trial

Elena Muñoz Gómez a, Hady Atef b,c, Shereen Hamed Elsayed d,*, Hoda M Zakaria e, Miguel Pérez Navarro a, Elena Marqués Sulé f
PMCID: PMC10402967  PMID: 37543767

Background:

Physiotherapy protocols based on high-intensity interval training (HIIT) or eccentric hamstring exercises like Nordic Curl (NC) have been scarcely studied in futsal players. The objective of this study was to compare the effectiveness of a HIIT combined with an NC exercise program versus a HIIT-only program in futsal players.

Methods:

Twenty-one futsal players were divided into (1) HIIT + NC group (n = 11, mean age = 21.55 [4.25]); and (2) HIIT group (n = 10, mean age = 20.90 [1.29]). The HIIT + NC group performed a HIIT circuit combined with 3 sets of 10 NC repetitions for 4 weeks, while the HIIT group performed the same protocol without NC exercise. Body mass index, intermittent work performance, vertical jump performance without and with arms, isometric strength of quadriceps and hamstrings, and the isometric hamstrings/quadriceps (H/Q) ratio, were assessed before and after the interventions.

Results:

The HIIT + NC group and the HIIT group showed a significant improvement in intermittent work performance after the intervention (P = .04 and P = .01, respectively). Also, both groups showed a trend of increasing quadriceps and hamstring isometric strength, although no significant changes were found (P > .05). In addition, neither the HIIT + NC protocol nor the HIIT protocol was sufficient to yield changes in body mass index nor to improve the vertical jump performance (P > .05).

Conclusion:

Both an isolated HIIT protocol and HIIT in combination with NC exercise improved intermittent work performance in futsal players. The present study’s findings may guide futsal players’ physical preparation and injury prevention programs.

Keywords: futsal, high-intensity interval training, jump, strength

1. Introduction

Futsal teams focus primarily on physical preparation to reduce the risk of injury and improve the performance of the players.[1] This is of importance since futsal teams perceive strength deficits as one of the major injury risks in noncontact situations,[1] with hamstring muscle injuries being the most common and recurrent ones.[2,3] A possible explanation may be that futsal players tend to have imbalances in the hamstring/quadriceps strength ratio (H/Q ratio).[4,5] In addition, lack of muscular endurance and strength,[6] as well as the lack of eccentric strength in the hamstring muscles[7] are also strongly related to the risk of musculoskeletal injury.

High-intensity interval training (HIIT) is an appropriate training by providing improvements in aerobic and anaerobic fitness in young soccer players.[8] In fact, HIIT improves performance responses in terms of the 1000-m running time and repeated sprint test ability in young soccer players.[9] In addition, in youth soccer players after a detraining period, HIIT may be beneficial for the recovery of body composition and physical fitness qualities.[10] Furthermore, HIIT is effective in improving VO2max and muscular endurance in moderately trained participants.[11]

Furthermore, training with eccentric resistance has shown a greater increase in total and eccentric muscle strength compared to training with concentric resistance,[12–15] being more specific in terms of improvements in speed and muscle contraction.[12] In addition, it increases muscle cross-sectional area,[12,13,15,16] increases the size of Type II fibers,[13,15] and shows both qualitative and quantitative changes in tendon tissue.[13] Likewise, the inclusion of eccentric hamstring exercises in injury prevention programs has been shown to cause positive modifications in risk factors related to the hamstring musculature and anterior cruciate ligament in noncontact situations.[17] In this line, Nordic Curl (NC) is an exercise that activates all the hamstring muscles eccentrically[18,19] and it has been shown to be effective in decreasing the risk of hamstring injury.[20,21]

Therefore, the aim of this study was to compare the effectiveness of a HIIT combined with NC exercise program versus a HIIT-only program in futsal players on body composition, intermittent work performance, vertical jump performance, and maximal isometric quadriceps and hamstring strength.

2. Methods

2.1. Trial design

A randomized clinical trial was performed from January to April 2021. All procedures were performed in accordance with the Declaration of Helsinki. The participants involved were informed by means of informed consent and their rights were protected. The study protocol was approved by the University of Valencia Experimental Research Ethics Committee (registration number: IE1541414). This study was registered in clinicaltrials.gov (NCT05854459).

2.2. Participants

The subjects were federated futsal players, over 18 years of age and belonging to El Pilar Sports Society (Valencia, Spain). Those who had a medical condition that prevented them from performing any of the evaluations and those who declined to participate in the study were excluded.

2.3. Interventions

Participants were randomly assigned to 2 groups: (1) HIIT and NC exercise group (HIIT + NC group, n = 11); or (2) HIIT-only program group (HIIT group, n = 10). Both groups completed a weekly session for 4 weeks.

2.3.1. HIIT and Nordic Curl exercise program.

The training program in the HIIT + NC group was divided into the following parts:

  • Warm-up. For 10 minutes, the participants warmed up with the exercises running at a speed of 3 km/h, global active joint mobility of the lower limbs, and a 20-m run with mobility exercises for the lower and upper limbs.

  • HIIT. A circuit of 8 exercises was performed for 25 minutes. Each exercise was performed for 40 seconds with 15 seconds rest between exercises so that the circuit was completed 3 times. The exercises were: (i) Squat combined with vertical press using a 10 kg barbell; (ii) 3 seconds of front plank combined with 3 pushups with elbow flexion-extension in prone position; (iii) 3 seconds of front plank combined with 3 pushups with elbow flexion-extension in prone position; (iv) squat with back support on the wall combined with horizontal press using a 5 kg disc; (v) sprint for 5 m with forward run followed by 5 m with backward run; (vi) lateral plank; (vii) jumping Jacks with load (5 kg ballast); (viii) lumbar rotation with load (5 kg ballast); and (ix) global lower limb coordination exercises holding a 5 kg disc with shoulder flexion at 180°.

  • NC exercise. Eccentric exercises of the hamstring muscles were performed for 10 minutes (3 series of 10 repetitions with 1 minute rest between series). For this exercise, the participants were positioned resting their knees on the floor, with their feet fixed, with their shoulders in 90° of abduction and let their body fall forward until contacting the floor with his hands. At that point, returned to the initial position to repeat the exercise again.

  • Stretching. For 5 minutes, hamstring, quadriceps, gastrocnemius and soleus stretches were performed (10 seconds each).

2.3.2. HIIT-only program.

The HIIT group performed the same exercises as the program performed by the HIIT + NC group, however, they did not perform the NC eccentric exercises.

2.4. Outcomes

All the assessments were conducted twice, once before the intervention and the other after the 4-week intervention. The outcomes were as follows:

  1. The anthropometric parameters weight, height, as well as body mass index (BMI) (kg/m2) were recorded.

  2. Intermittent work performance (km/h) was assessed with the 30 × 15 Intermittence Test (30 × 15IFT). In this test, the participant must run between 2 lines 40 m apart for 30 seconds with 15 seconds of passive recovery. The test starts with a speed of 8 km/h and is increased by 0.5 km/h at each 30-second run.[22] The test was ended when the subject decided to stop due to accumulated fatigue or when he/she did not reach the line of the last 3 m at the beep on 3 successive occasions. The speed of the last completed level was selected. The 30 × 15IFT shows an intraclass correlation coefficient (ICC) > 0.90.[22,23]

  3. Vertical jump performance without arm impulse (cm) was measured with the Counter Movement Jumping Test (CMJ). In this test, starting from an initial position with lower limbs in hip extension and knees and hands on the waist, the knees were flexed to 90° and then a vertical jump was performed with knees in extension.[24] The test was performed 3 times, leaving 1 minute of recovery between each attempt, and the highest value was selected. The CMJ is a validated test with a Cronbach Alpha = 0.98, ICC = 0.98.[25–27] The jump height was calculated using the My Jump 2 program (My Jump Lab, Madrid, Spain) (R = 0.995).[28]

  4. Vertical jump performance with arm impulse (cm) was measured using the Counter Movement Jumping Abalakov Test. It was performed in the same way as the CMJ but using the arms to assist in the performance of the jump, by flexing, extending, or abducting them.[24] The test was performed 3 times, allowing 1 minute of recovery between each attempt, and the highest value was selected. The CMJ is a validated test with a Cronbach Alpha = 0.94, ICC = 0.94.[25,27,29] The jump height was calculated using the My Jump 2 program (My Jump Lab, Madrid, Spain).

  5. Maximal quadriceps and hamstring isometric strength (mm Hg) were measured using the Adapted Quadriceps Sphygmomanometer Test.[30] The Logiko Visual sphygmomanometer (Moretti Ibérica, Barcelona, Spain) was inflated to 20 mm Hg before placing the subject’s foot. For the maximal quadriceps isometric strength test, the participant was positioned in a unipodal position and placed the foot on top of the sphygmomanometer that was on a chair behind the subject. 90-degree knee flexion and full knee extension of the contralateral leg were maintained to avoid compensations. In this position the subject was asked to perform a maximal quadriceps contraction on 3 occasions and the highest value obtained was selected. For the maximum hamstring isometric strength (mm Hg) the participant was positioned in the supine position and placed the heel of the foot of the leg to be tested on top of the sphygmomanometer. 90-degree knee flexion and full extension of the contralateral leg were maintained to avoid compensations. In this position, a maximum isometric hamstring contraction was requested on 3 occasions and the highest value obtained was selected. The sphygmomanometer test adapted for quadriceps and hamstrings is validated with an ICC = 0.88 to 0.98.[30–32]

  6. The isometric H/Q ratio was calculated by dividing the values obtained previously in the maximal hamstring isometric strength test by those obtained in the maximal quadriceps isometric strength test of the same limb.

2.5. Randomization and blinding

An online randomization tool was used to perform the randomized allocation by an external investigator who was not involved in the assessment or treatment of the participants. In addition, the participants and the outcome assessor were blinded to the treatment allocation.

2.6. Statistical methods

Statistical analysis was performed using SPSS 24.0 version. The distribution of all outcome variables was verified using the Shapiro–Wilk test. At baseline, independent t-test and chi-square test were used to examine differences in the general features of the experimental group and the control group. A 2-factor mixed multivariate analysis of variance (MANOVA) having a between-subjects factor “intervention group” with 2 categories (HIIT + NC group and HIIT group) and a within-subject factor “time measurements” with 2 categories (T1 and T2) was performed. post hoc analyses were requested using the Bonferroni correction. The assumption of homoscedasticity using Levene test and the sphericity using Mauchly test was evaluated. The level of significance was set at P < .05.

3. Results

Twenty-one participants were randomly assigned to the HIIT + NC group and the HIIT group (n = 11 and n = 10, respectively) and all of them completed the study (Fig. 1). The mean age of the participants was 21.24 (3.14) years. There were no significant differences between groups at baseline in any variable (Table 1). No incidents were reported during the intervention.

Figure 1.

Figure 1.

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Flowchart according to CONSORT Statement for the Report of randomized trials. HIIT = high intensity interval training; HIIT + NC = HIIT and NC exercise, NC = Nordic Curl.

Table 1.

Baseline demographic characteristics.

HIIT + NC group N = 11 HIIT group N = 10 Total N = 21
Age (years)* 21.55 (4.25) 20.90 (1.29) 21.24 (3.14)
Weight (kg)* 72.94 (8.77) 75.97 (9.65) 74.39 (9.10)
BMI (kg/m2)* 23.50 (2.34) 24.46 (3.47) 23.95 (2.90)
Dominant foot†
 Right 8 (72.70 %) 7 (70.00 %) 15 (71.40 %)
 Left 3 (27.30 %) 3 (30.00 %) 6 (28.60 %)
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BMI = body mass index, HIIT = high intensity interval training, HIIT + NC = HIIT and Nordic Curl exercise.

*

Mean (standard deviation).

†

Absolute frequency (percentage).

As shown in Table 2, there were no significant changes in BMI in either group or between groups after the intervention (P > .05). Compared to baseline, both the HIIT + NC and the HIIT groups improved intermittent work performance at the end of the intervention (P = .01 and P = .04, respectively). However, there were no significant improvements in the vertical jump performance with and without arms (P > .05).

Table 2.

Effect of the intervention on body mass index, intermittent work performance, vertical jump performance and quadriceps and hamstrings isometric strength.

HIIT + NC group (n = 11) HIIT group (n = 10)
T1 T2 T1 T2
IMC (kg/m2) 23.50 (2.34) 23.47 (2.28) 24.46 (3.47) 24.45 (3.48)
Intermittent work performance (km/h) 17.59 (2.21) 18.09 (2.73)* 16.05 (0.83) 16.45 (0.72)*
Vertical jump performance without arm impulse (cm) 33.61 (8.09) 33.72 (8.09) 35.67 (6.01) 35.68 (6.06)
Vertical jump performance with arm impulse (cm) 43.60 (8.62) 43.84 (8.69) 42.49 (6.68) 42.58 (6.56)
Maximal quadriceps isometric strength R (mm Hg) 174.55 (32.36) 175.45 (31.42) 159.00 (39.85) 161.00 (30.71)
Maximal hamstrings isometric strength R (mm Hg) 160.91 (19.21) 162.73 (13.48) 169.00 (50.43) 170.00 (42.69)
Maximal quadriceps isometric strength L (mm Hg) 162.27 (33.72) 162.73 (34.09) 167.50 (28.21) 168.00 (24.40)
Maximal hamstrings isometric strength L (mm Hg) 160.91 (33.60) 161.82 (29.60) 165.00 (49.72) 165.00 (46.96)
Isometric H/Q ratio R 0.95 (0.18) 0.95 (0.18) 1.09 (0.32) 1.07 (0.24)
Isometric H/Q ratio L 1.02 (0.25) 1.01 (0.16) 1.01 (0.32) 1.00 (0.30)
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Data shown as mean (standard deviation).

H/Q ratio = hamstrings and quadriceps ratio, HIIT = high intensity interval training, HIIT + NC = HIIT and Nordic Curl exercise, L = left leg, R = right leg, T1 = pre-intervention; T2 = Post-intervention.

*

P < .05 compared to baseline.

In terms of quadriceps and hamstring isometric strength, although there was a trend towards improvement, there were no significant differences between measurement times or between groups, as well as in the isometric H/Q ratio (P > .05).

4. Discussion

Our results showed that futsal players who performed the HIIT + NC and HIIT-only interventions significantly improved intermittent work performance. However, even though the HIIT + NC group obtained greater improvements in most of the variables, these were not statistically significant compared to the HIIT-only program, so it cannot be affirmed that the addition of NC provides additional benefits to HIIT in the variables studied in futsal players.

The futsal players in the sample presented BMI values within the normal range (between 18.5 and 24.9), and no noteworthy modifications were found throughout the study. This is in accordance with Menz et al[11]’s study in which body composition was unaffected by HIIT intervention in moderately trained participants. A recent meta-analysis concluded that HIIT has no significant effects on body composition in individuals with normal weight,[33] whereas greater changes may be observed in overweight and obese participants.[34]

The improvements in 30 × 15IFT demonstrate that a weekly HIIT session for 4 weeks has beneficial effects on the intermittent work performance of futsal players. This might be interesting since in a futsal match, most efforts last between 1 and 30 seconds with pause intervals ranging from 1 to 15 seconds.[35] These results are similar to those presented in the study by Campos et al[36] in which a HIIT protocol based on a series of sprints was carried out for 10 weeks and obtained improvements in the ability to repeat sprints in young futsal players. However, in these studies NC exercise was not added, whose combination with HIIT has shown a 2.84% improvement in intermittent work performance in our study. In this regard, the effect of NC with sprint improvements (‐0.068 s over 5 m and ‐0.078 s over 10 m) has been studied with 3 sessions per week for 10 weeks in soccer players.[37] Since eccentric contractions may increase the size of Type II fibers[13,15] and improve the speed and muscle contraction[12] it would be interesting to carry out studies with longer interventions combining HIIT and NC exercise to check the impact of that on the intermittent work performance of futsal players.

Regarding vertical jumps, the interventions were not enough to yield significant changes. The main reason may be the short duration of the intervention since previous studies on the isolated application of HIIT[36] and NC exercise[37] for 10 weeks did show significant changes in futsal and soccer players. The effects of NC exercise are promising as it is known to target the hamstrings and improve lower limb strength and power,[12–15] which are important factors for vertical jump performance.[38] Additionally, HIIT involves short bursts of intense exercise followed by periods of rest or low-intensity exercise, and it has been found to be an effective training method for improving both aerobic and anaerobic fitness as well as power and explosive strength,[8] which are important for vertical jump performance. Therefore, further studies are needed to analyze the effects of the combination of HIIT and NC exercise in longer interventions in futsal players.

Regarding lower limb strength, there was a trend towards improvement especially in the HIIT + NC group in the right quadriceps (0.52%) and right hamstrings (1.13%). Considering that a lack of muscle strength is related to the risk of musculoskeletal injuries,[6,7] injury prevention programs based on HIIT and NC may be recommended in futsal players. The lack of statistically significant differences may be due to the high standard deviation of the results. Unfortunately, the findings of the present study cannot be compared with previous studies, since this is the first study that analyses the effects of the combination of HIIT and NC on muscle strength. However, previous studies with NC training show increases in eccentric (+13%) and isometric (+9%) hamstring strength in active young adults,[39] as well as structural changes in the muscle.[39,40] Likewise, the application of NC exercise decreases 51% of the long-term hamstring injury risk ratio with injury prevention programs.[20]

Regarding the isometric H/Q ratio, there were no significant changes in this variable, possibly because in the sample of this study, the H/Q ratio values were close to 1, which indicates a good balance between the quadriceps and hamstrings. Normally, futsal players present imbalances in this variable, thus increasing the risk of injury,[4] but to a greater extent during the preseason.[5] Since our study took place once the regular season had already started, a good balance of the H/Q ratio can be explained. Therefore, the options for improvement in this parameter were limited.

4.1. Limitations

The present study has some limitations. The sample was from a single center in 1 country therefore it seems difficult to extrapolate the results to other countries. Also, the sample size was small thus these conclusions should be carefully interpreted when generalizing the results. It should be noted that the exercise programs in this study were limited to 1 d/wk for 4 weeks only due to the search for the least effective durations of training. The impact of a similar program with 2 to 3 d/wk of training and lasting 6 months or longer is important to evaluate the long-term impact and sustainability of the dosing and duration of a combined HIIT and NC exercise program in this population. Also, the effects of HIIT combined with concentric hamstrings training or the comparison with a control group could have been performed, although it was not the purpose of this study. As strengths, this is the first study that evaluated the effects of a combined program including HIIT and NC in futsal players. Also, several outcomes not usually measured in futsal players, such as intermittent work performance and vertical jump performance were analyzed in this study. Future studies should be performed to establish the long-term efficacy of each intervention. Our study can serve as a starting point for investigating this line of work. These limitations should be taken into account in designing future trials.

5. Conclusions

Both an isolated HIIT training program and HIIT in combination with NC exercise improved intermittent work performance in futsal players. In addition, there was a trend towards improvement in quadriceps and hamstring isometric strength. The findings of the present study may guide physical preparation and injury prevention programs in futsal players.

Acknowledgments

We thank all participants that participated in the study and the Sports Society El Pilar.

Author contributions

Conceptualization: Elena Muñoz Gómez, Hady Atef, Shereen Hamed Elsayed, Hoda M. Zakaria, Miguel Pérez Navarro, Elena Marqués Sulé.

Data curation: Hady Atef, Hoda M. Zakaria, Miguel Pérez Navarro, Elena Marqués Sulé.

Formal analysis: Elena Muñoz Gómez, Hady Atef, Hoda M. Zakaria, Miguel Pérez Navarro, Elena Marqués Sulé.

Funding acquisition: Shereen Hamed Elsayed.

Investigation: Elena Muñoz Gómez, Hady Atef.

Methodology: Elena Muñoz Gómez, Hady Atef, Shereen Hamed ElSayed, Hoda M. Zakaria, Elena Marqués Sulé.

Resources: Hoda M. Zakaria, Miguel Pérez Navarro, Elena Marqués Sulé.

Supervision: Hoda M. Zakaria.

Validation: Miguel Pérez Navarro.

Visualization: Miguel Pérez Navarro.

Writing – original draft: Elena Muñoz Gómez, Hady Atef, Shereen Hamed Elsayed, Hoda M. Zakaria, Miguel Pérez Navarro, Elena Marqués Sulé.

Writing – review & editing: Elena Muñoz Gómez, Hady Atef, Shereen Hamed Elsayed, Hoda M. Zakaria, Miguel Pérez Navarro, Elena Marqués Sulé.

Abbreviations:

30x15IFT
30x15 Intermittence Test
BMI
body mass index
CMJ
Counter Movement Jumping Test
H/Q ratio
hamstring/quadriceps strength ratio
HIIT
high-intensity interval training
ICC
intraclass correlation coefficient
NC
Nordic Curl

This research was funded by Princess Nourah Bint Abdulrahman University Researchers Supporting Project number (PNURSP2023R99), Princess Nourah Bint Abdulrahman University, Riyadh, P.O. Box 84428. Riyadh 11671, Saudi Arabia.

The authors have no conflicts of interest to disclose.

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

How to cite this article: Gómez EM, Atef H, Elsayed SH, Zakaria HM, Navarro MP, Sulé EM. Effects of high-intensity interval training with an eccentric hamstring exercise program in futsal players: A randomized controlled trial. Medicine 2023;102:31(e34626).

Clinical Trials gov identifier (NCT05854459).

Contributor Information

Elena Muñoz Gómez, Email: elena.munoz-gomez@uv.es.

Hoda M. Zakaria, Email: dr.hodazakaria@cu.edu.eg.

Miguel Pérez Navarro, Email: miguelpn98@gmail.com.

Elena Marqués Sulé, Email: elena.marques@uv.es.

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