Effects of Diet, Exercise, and Electrical Muscle Stimulation in Overweight and Obese Women

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Overview

This randomized controlled study evaluated the effects of diet, exercise, and electrical muscle stimulation (EMS) on body measurements, blood test results, and appetite in women with overweight or obesity. A total of 75 women aged 19-45 years with a body mass index (BMI) of 25 kg/m² or higher were randomly assigned to one of three groups: diet alone, diet plus exercise, or diet plus EMS. All participants received an individualized energy-restricted diet. Participants in the exercise group also performed at least 30 minutes of moderate-intensity walking daily, while participants in the EMS group received abdominal EMS twice per week for six weeks. Body measurements, selected biochemical parameters, and appetite-related measures, including hunger, satiety, and desire to eat, were assessed before and after the six-week intervention. The study aimed to determine whether adding exercise or EMS to an individualized energy-restricted diet provides additional benefits for body composition, metabolic health, and appetite regulation in women with overweight or obesity.

This randomized controlled study included 75 women aged 19-45 years with overweight or obesity (BMI ≥25 kg/m²). Eligible participants were randomly assigned to three intervention groups, with 25 participants in each group. All participants received an individualized energy-restricted dietary program designed to provide an energy deficit of approximately 500 kcal/day. The dietary plans provided approximately 55-60% of total energy from carbohydrates, 12-15% from protein, and 25-30% from fat, with a target dietary fiber intake of 25-30 g/day. Participants attended weekly follow-up visits throughout the intervention. Participants in the Diet Group received the individualized dietary intervention alone. Participants in the Diet + Exercise Group received the same dietary intervention and were instructed to perform at least 30 minutes of moderate-intensity walking daily throughout the six-week intervention. Participants in the Diet + EMS Group received the dietary intervention together with localized abdominal electrical muscle stimulation. EMS was administered twice weekly on non-consecutive days for six weeks, for a total of 12 sessions. Each EMS session lasted approximately 25 minutes. Anthropometric assessments included body weight, BMI, waist circumference, hip circumference, neck circumference, mid-upper arm circumference, body fat percentage, fat mass, and fat-free mass. Selected biochemical parameters were assessed using fasting blood samples. Appetite-related outcomes, including hunger, satiety, and desire to eat, were evaluated using a Visual Analog Scale (VAS). Measurements were obtained at baseline and after completion of the six-week intervention. The primary objective was to compare changes in anthropometric outcomes among the three intervention groups. Additional evaluations examined changes in biochemical parameters and subjective appetite-related outcomes.

Interventions

Individualized Energy-Restricted DietBEHAVIORAL

Participants received an individualized energy-restricted diet designed to provide an energy deficit of approximately 500 kcal/day. The diet provided 55-60% of total energy from carbohydrates, 12-15% from protein, and 25-30% from fat, with a target fiber intake of 25-30 g/day. Participants attended weekly follow-up visits throughout the 6-week intervention period.

Moderate-Intensity WalkingBEHAVIORAL

Participants were instructed to perform at least 30 minutes of moderate-intensity walking daily throughout the 6-week intervention period. Walking intensity was defined as producing a slight increase in heart rate and breathing while allowing participants to maintain conversation comfortably.

Electrical Muscle Stimulation (EMS)DEVICE

Localized abdominal electrical muscle stimulation was administered twice weekly on non-consecutive days for 6 weeks, for a total of 12 sessions. Each session lasted approximately 25 minutes. Four surface electrodes were positioned symmetrically on the abdominal region. Stimulation was delivered at 85 Hz with a pulse width of approximately 300-400 μs, and intensity was increased according to individual tolerance to achieve visible and palpable muscle contractions without pain or discomfort.

Eligibility

Sex: FEMALEMin age: 19 YearsMax age: 45 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Female participants aged 19-45 years * Body mass index (BMI) ≥25.0 kg/m² * No more than a 5% change in body weight during the previous 3 months * Premenopausal * Not participating in a regular exercise program * Applying to the center for weight management * Willing to participate and providing written informed consent Exclusion Criteria: * History of thrombosis or active thrombotic risk * Diagnosed hypertension * Pregnancy or lactation * Epilepsy * History of abdominal, gastric, or inguinal hernia * Cardiac pacemaker or other implanted electronic device * Metallic prostheses or large implants * Bariatric surgery within the previous 6 months * Use of pharmacological treatments that could affect weight loss, including GLP-1 receptor agonists or corticosteroids * Diabetes mellitus * Malignancy * Advanced renal or hepatic disease * Any medical condition contraindicating EMS application

Outcomes

Primary Outcomes

Change in Body Weight

Body weight was measured in kilograms using a bioelectrical impedance analysis device (InBody 270) at baseline and after completion of the intervention. Change in body weight was evaluated by comparing the post-intervention measurement with the baseline measurement.