High-intensity interval training and moderate-intensity continuous training versus usual care in adults with familial hypercholesterolaemia: protocol for the UPPA-FH three-arm randomised trial

Introduction: Familial hypercholesterolaemia (FH) is an inherited disorder associated with lifelong exposure to elevated low-density lipoprotein cholesterol (LDL-c) and substantially increased risk of premature atherosclerotic cardiovascular disease. Although intensive lipid-lowering therapy is the cornerstone of management, many individuals remain at elevated residual cardiovascular risk. Exercise training may improve cardiorespiratory fitness (CRF), vascular function and cardiometabolic health; however, randomised evidence comparing different exercise modalities in adults with FH is lacking. The UPPA-FH trial aims to evaluate the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), compared with usual care, on CRF, subclinical atherosclerosis and cardiometabolic health in adults with FH.