PURPOSE: The 2018 Physical Activity Guidelines Advisory Committee systematically searched existing literature reviews to assess the relationship between high-intensity interval training (HIIT) and reduction in cardiometabolic disease risk. METHODS: Duplicate independent screenings of 260 articles identified from PubMed®, Cochrane Library, and CINAHL databases yielded suitable data from one systematic review and two meta-analyses. Search terms included a combination of "high intensity" "physical activity/exercise" and "interval training" and outcome-specific terms. The quality of the included reviews was assessed using a tailored version of the AMSTARExBP report on quality. Exposure Subcommittee members graded scientific evidence strength based on a five-criteria rubric and assigned one of four grades: strong, moderate, limited, or not assignable. RESULTS: Moderate evidence indicates that HIIT can improve insulin sensitivity, blood pressure, and body composition in adults with group mean ages ranging from ~20 to ~77 yr. These HIIT-induced improvements in cardiometabolic disease risk factors are comparable with those resulting from moderate-intensity continuous training, and they are more likely to occur in adults at higher risk of cardiovascular disease and diabetes than in healthy adults. Moderate evidence also indicates that adults with overweight or obesity classification are more responsive than adults with normal weight to HIIT-related improvements in insulin sensitivity, blood pressure, and body composition. Insufficient evidence was available to determine whether a dose-response relationship exists between the quantity of HIIT performed and several risk factors for cardiovascular disease and diabetes, or whether the effects of HIIT on cardiometabolic disease risk factors are influenced by age, sex, race/ethnicity, or socioeconomic status. CONCLUSIONS: HIIT by adults, especially those with overweight and obesity classification, can improve insulin sensitivity, blood pressure, and body composition, comparable with those resulting from moderate-intensity continuous training.