This review considers the physiological basis of brief vigorous exercise to improve health, with a focus on cardiorespiratory fitness (CRF) and glycaemic control, and the potential underlying mechanisms involved. We defined 'brief' as a protocol lasting ࣘ15 min including warm-up, cool-down and recovery, and involving a total of ࣘ5 min of 'vigorous' exercise, which was classified as meeting or exceeding the lower end of the range for this relative intensity as per the criteria from the American College of Sports Medicine. The physiological mechanisms responsible for the increase in CRF, as measured by maximal oxygen update (V O 2 max ), after brief vigorous exercise are unclear and likely depend on various factors including the specific nature of the intervention as well as the time course of the response. Limited available evidence suggests the potential for an increased oxygen extraction by active muscle (i.e. greater arterio-venous oxygen difference), since an increase inV O 2 max has been reported after several weeks of brief vigorous exercise despite no measurable change in cardiac output. Emerging evidence indicates that brief vigorous exercise can improve glycaemic control, suggesting that this type of exercise could potentially play a role in the prevention and management of type 2 diabetes. The acute Martin Gibala is a professor and chair of the Department of Kinesiology at McMaster University in Hamilton, Canada. He is an integrative physiologist who studies the mechanistic basis of exercise responses in humans, and associated health impacts. His research on the topic of interval training has helped to establish the efficacy of brief, intense exercise to enhance physical fitness in both healthy and diseased states. His knowledge translation efforts include a book for the general public on the science of time-efficient exercise, response is not well characterized but several studies have shown that several weeks of vigorous exercise improves estimates of insulin sensitivity as determined by various methods including by hyperinsulinaemic-euglycaemic clamp. The physiological mechanisms underlying improved CRF and glycaemic control after brief vigorous exercise, and the broader impact on health, remain fruitful areas of investigation.Abstract figure legend Potential for brief vigorous exercise to reduce cardiometabolic disease risk