Effect of six weeks of Whole-body Electromyostimulation on resistin and adiponectin levels in overweight individuals

doi:10.21203/rs.3.rs-5030972/v1

Background

Electrical muscle stimulation is a new training technique that enhances physical fitness. Due to economic problems, everyone is looking for ways to get the most benefits in the shortest time. This study examines the effectiveness of 20-minute whole-body electromyostimulation (EMS) on the levels of certain adipokines and lipid profiles in sedentary individuals.

Methods

Thirty-eight volunteers were randomly divided into three groups (traditional exercise (TE), EMS, and control groups). The EMS consisted of 10 minutes of resistance stimulation (30 Hz, 350 µs, 4 s of strain 6 s rest) and 10 minutes of endurance stimulation (85 Hz, 350 µs, 6 s of strain, 4 s of rest). The TE group performed 10 minutes of traditional resistance training (2 sets, 10 repetitions, 50–60% of one maximum repetition) and 10 minutes of running on a treadmill.

Results

The ANCOVA indicated that after the intervention, the EMS group had significant improvements in body mass (ηp²=0.53), BMI (ηp²=0.54), fat percentage (ηp²=0.62), aerobic fitness (ηp²=0.46) and adiponectin levels (ηp²=0.60) levels compared to the other two groups. In addition, in comparison to the C group, both training groups demonstrated substantial improvements in subcutaneous fat (arm: ηp²=0.58 and abdomen ηp²=0.55), sit-ups (ηp²=0.38) push-ups (ηp²=0.55), resistin level (ηp²=0.42) and in lipid profiles (cholesterol (ηp²=0.31), triglyceride (ηp²=0.49), LDL (ηp²=0.31) and HDL (ηp²=0.49) levels).

Conclusion

20-minute EMS is more effective in improving lipid profile, adipokines levels, and physical fitness than traditional exercise training. Therefore, this exercise model is time-saving and recommended for overweight individuals.

Electrical muscle stimulation (EMS)

Resistance training

Adipokine

Lipid profiles

Industrialization and economic problems in families have caused people's lifestyles to shift towards inactivity, leading to weight gain and obesity. Statistics indicate that over 2.1 billion people worldwide are overweight or obese (1). Obesity and its complications are the primary problems of societies, as obese individuals are more susceptible to metabolic and cardiovascular diseases (2). Lifestyle modification is the most important way to manage weight.

Adipose tissue is not considered an energy-storing tissue, but it releases particles that affect other tissues and can lead to certain diseases. White adipocytes secrete a cysteine-rich hormone called resistin that is expressed in macrophages in humans (3). It has pro-inflammatory effects is involved in insulin resistance and can link obesity to metabolic diseases such as diabetes and cardiovascular diseases (4). It has the potential to exacerbate metabolic complications. Resistin, by increasing sympathetic nerve activity, could lead to hypertension (5). In addition, plasma resistin levels correlate with obesity (6). Adiponectin is a well-recognized positive adipokine that regulates glucose levels, lipid metabolism, and insulin sensitivity through its anti-inflammatory and antioxidant properties (7). Loss of adipose tissues is associated with increased levels of adiponectin. Adiponectin could improve insulin sensitivity by modifying glucose and lipid metabolisms (7). It activates AMP-activated protein kinase (AMPK) and facilitates the catabolism of fatty acids and glucose (8). Furthermore, adiponectin lowers the plasma level of free fatty acids and boosts the transfer of fatty acids to muscle cells. Hence, weight loss interventions, such as regular exercise training, can improve the body's inflammatory state by altering the levels of adipokines.

The effectiveness of exercise training in weight loss is well-known. Most individuals are searching for innovative ways of exercising that can provide the same benefits as long-term exercise while requiring less time. Whole-body electromyostimulation (EMS) is a new training method. It was claimed that 20-minute stimulation has the effect of approximately one hour of exercise (9). EMS involves simultaneous stimulation of multiple major muscle groups through electrodes embedded in a special cloth. EMS is believed to be an effective and safe training method for older adults who are not able or unwilling to perform dynamic strength training. It is suggested that it should be an efficient and joint-compatible method. This is a suitable way to maintain a lean body mass and strength (10, 11). In this regard, it was reported that whole-body EMS is comparable to high-intensity resistance training in terms of hypertrophy, muscle strength, and fat loss (12). In addition, Park et al. (2021) reported that isometric exercise combined with EMS significantly reduced body weight, fat mass, fat percentage, and inflammatory cytokine levels (13). It can also increase muscle strength, especially in sedentary individuals (13, 14). Kemmler et al. (2016) compared 16 weeks of EMS training with high-intensity resistance training (HIT) (two sessions per week). They reported that both training models were equally effective in improving leg extensor strength, fat mass, and lean body mass (12). Hence, they stated that EMS is a time-efficient but pricy option for individuals aiming at the improvement of muscle strength and body composition.

Given the social and economic problems and the limited opportunities for people to exercise, everyone is looking for an exercise that will provide more benefits in the shortest possible time. Thus, this research aims to determine whether 20-minute whole-body EMS performed for three months can cause a change in lipid profiles and also in serum levels of resistin and adiponectin compared to equal volume resistance training. We hypothesized that 18 sessions of 20-minute EMS training, with higher pressure during training, can result in significant changes in lipid profile, body composition, and adipokine release compared to traditional training with the same duration.

Study design

A randomized study, with a control group, two parallel experimental groups, and a single-blind design (the laboratory expert was blind), was performed on sedentary adults. The goal of the study was to investigate the effects of 18 sessions of EMS training on the physical and some adipokines serum of overweight individuals. At first, the participants were introduced to the research implementation process. They were informed about the benefits and potential risks of the study, signed a consent form, and pre-tests including anthropometric and performance tests were taken. By using the block randomization way (size 6), the participants were allocated to three groups. Subsequently, the subjects were engaged in 18 training sessions and the post-tests were repeated.

Participants

Sedentary and overweight adults (25-40 years) who were eligible to participate in this study were recruited by distributing leaflets in two areas of Tehran, Iran. The inclusion criteria were overweight individuals aged 25-40 years, having no acute and chronic cardiovascular or orthopedic diseases; and having not received drugs or medication. The exclusion criteria were the absence in more than three consecutive sessions, the unwillingness to continue training, and not taking post-tests. A sample size calculation was conducted using G*Power Software version 3.1.9.6 (15) for analysis of covariance (ANCOVA), using a rejection criterion of 0.05 and 0.8 (1-beta) power, and large effect (f=0.5), 42 participants needed. Forty-four eligible adults volunteered to attend this study, but the data of 38 individuals (age: 31.7 ±4.7 years; height: 171.1 ± 9.2 cm, body mass: 86.1 ± 14.9 kg) was analyzed finally. Using the block randomization method, a third person who was not in the research team, randomly assigned participants into three groups, including the EMS group (EMS, n=13), the traditional exercise group (TE, n=13), and the control group (C, n=12). Six participants were excluded due to not being interested in continuing the intervention and did not complete the post-test.

Training protocol

The training protocol lasted six weeks, three sessions per week (18 workouts). Each session was around 30 minutes, including 5 minutes of warm-up with dynamic movements, 20 minutes of main exercises, and five minutes for cool down with stretching movements. The EMS group performed dynamic exercises while receiving electrical stimulation with endurance and resistance frequencies (XBody PRO, Hungary). They received 10 minutes of resistance stimulation (30 Hz, 350 μs, 4 s of strain 6 s rest) and 10 minutes of endurance stimulation (85 Hz, 350 μs, 6 s of strain, 4 s of rest) (16). At first, the subjects were instructed to wear an ensemble that included a black T-shirt and shorts. Then, they wore the special vest, which contained electrodes in the areas of the arms, backs, chests, abdomens, thighs, and gluteal. The electrodes were previously wet with water to facilitate the conduction of the electric current. The electrodes are capable of simultaneously activating 18 regions or 10 muscle groups. The intensity level was adjusted for specific muscle groups and gradually increased throughout the intervention, which was recorded on a device for the next session. The EMS protocol was carried out without external loads, performing dynamic exercises (such as squats, trunk flexion, lunges, lateral raises, arm curls, isometric abdominal contractions, and …). All movements were performed at low intensity in the standing position to allow a voluntary contraction simultaneously with the electrical stimulation.

The TE group also performed traditional exercises for 20 minutes (plus 10 minutes for warming up and cooling down). Ten minutes of traditional resistance training was performed in two sets, 10 repetitions, with 50-60% of one maximum repetition with 20 seconds of rest between sets. The movements for large muscle groups were chest press, leg press, shoulder press, leg curl, lat down, and crunches. Then, they ran on the treadmill for 10 minutes at a speed of 7-7.5 and 10-11 km/h alternately, based on their fitness. The training intensity was monitored using the Borg scale, a 10-point scale. The C group did not attend any exercise training and continued their routine life; they participated in the pre and post-tests.

Measurements

Anthropometric indices

Anthropometric and performance indices were taken before and after the training protocol. Height and body mass were measured using a standard stadiometer (Seca 213, Germany) and a calibrated digital scale (Seca 769, Germany). Body mass index (BMI) was determined by the body mass divided by the square of the body height and is expressed in units of kg/m². Abdominal and arm subcutaneous fat was measured using a caliper (Harpenden, USA) according to the standard protocol on the right side.

Aerobic test

Subjects performed a researcher-designed aerobic incremental test on a treadmill. They started at a speed of 5 km/h and every 2 minutes, one kilometer was added to the speed until the subjects were exhausted. The running time was recorded and used to perform statistical tasks.

Muscle endurance

The push-up is a test for the assessment of upper body endurance. The starting position was with the hands and toes touching the floor, the body and legs in a straight line, feet slightly apart, and the arms at shoulder-width apart. In this position, by keeping the back and knees straight, the subject lowers the body to make a 90-degree angle at the elbows, then returns to the starting position with the arms extended. The number of complete movements during one minute was counted.

The endurance of the abdominal muscles was measured by a sit-up test. Subjects lay on a mattress while their knees bent at approximately right angles. The hands touched the shoulders crosswise. Then, with the contraction of the abdominal muscles, they raised to touch their elbows to their knees and returned to the starting position. The number of correct movements during one minute was recorded.

Blood sampling

Blood samples were collected from the antecubital venous after a night of fasting at 8-8:30 am before and after the interventions. Blood samples were centrifuged at 3000 rpm for 15 minutes, and serum was separated from the blood samples using a suspension technique and stored at a –20 °C freezer. Serum resistin and adiponectin were measured using an enzyme-linked immunosorbent assay (ELISA) kit (RK00139, ZwllBio, Germany). The enzyme colorimetric method using an automatic analyzer (Abbott, Model Alcyon 300, and USA) with Pars-Azmoon Kit was used to measure fat profile (HDL, and triglyceride). Total cholesterol (TC) levels were determined by the enzymatic spectrophotometric method using an auto-analyzer with Pars-Azmoon Kit (Tehran, Iran). LDL was calculated by the Friedewald formula (LDL=TC− (TG/5 + HDL).

Statistical analysis

Data presented in mean ± standard deviation (SD). The post-intervention values between groups were compared using a one-way analysis of covariance (ANCOVA) with pre-test values included as covariates. First, the assumptions of the normal distribution of data using Shapiro-Wilk’s test, homogeneity of variance by box plot test, and homogeneity of regression slopes were confirmed. When significant differences were found in the intergroup, Bonferroni posthoc tests were performed. The effect size (ES) was calculated by partial Eta Squared (ηp²). ES was considered as a small <0.20; a moderate ES was between 0.21-0.50; a large ES was 0.51-0.8 and a very large ES was >0.80. The significance level was set at p≤0.05 for all statistical analyses and we used the Statistical Package of Social Sciences (SPSS, IBM, v19) to analyze data.

Anthropometric indices

We observed no significant differences between groups at anthropometric factors at baseline (p>0.05). Table 1 presents the descriptive statistics of anthropometric and physical performance parameters, pre- and post-intervention. (p>0.05). The ANCOVA indicated that there was a statistically significant difference between groups after the intervention in body mass (F_2,34=19.51, p=0.001, ηp²=0.53), BMI (F_2,34=20.60, p=0.001, ηp²=0.54), and fat percentage (F_2,34=28.13, p=0.001, ηp²=0.62). The Bonferroni post-hoc tests revealed in these three parameters, there was a significant difference between the EMS group with other groups. In addition, there was a significant difference between groups in subcutaneous fat in the arm (F_2,34=23.75, p=0.001, ηp²=0.58) and abdomen (F_2,34=20.35, p=0.001, ηp²=0.55). The Bonferroni post-hoc tests showed there was a significant difference between the two experimental groups and the control group (p<0.05), as well as between the EMS group and the TE (P<0.05).

Table 1: Anthropometric and physical parameters of participants before and after the intervention

Variable	Group	Pre	Post	% change	P between
Body mass (kg)	EMS	82.21 ± 14.76	78.71 ± 13.83	-4.16	0.001
	TE	90.37 ± 14.74	89.27 ± 14.06*	-1.09
	C	85.76 ± 15.27	86.33 ± 15.37*	0.67
BMI (kg/m2)	EMS	29.08 ± 3.15	27.86 ± 3.13	-0.4.21	0.001
	TE	29.44 ± 3.25	29.35 ± 3.40*	-0.32
	C	29.17 ± 2.97	29.37 ± 3.04*	0.67
Body fat percentage (%)	EMS	29.58 ± 3.83	25.49 ± 4.19	-13.81	0.001
	TE	29.61 ± 3.02	28.70 ± 3.59 *	-3.06
	C	27.08 ± 6.82	27.75 ± 7.05*	2.39
Subcutaneous arm fat (mm)	EMS	16.04 ± 3.77	12.38 ± 2.98	-22.79	0.001
	TE	14.51 ± 4.72	13.35 ± 4.70 *	-8.59
	C	13.15 ± 4.03	13.47 ± 4.36 *#	2.55
Subcutaneous abdomen fat (mm)	EMS	30.75 ± 9.69	27.06 ± 9.06	-12.06	0.001
	TE	33.11 ± 6.32	31.77 ± 5.66*	-3.65
	C	31.88 ± 11.46	32.75 ± 11.57 *#	2.72
Running time (s)	EMS	584.23 ± 162.83	683.92 ± 203.80	17.15	0.001
	TE	689.07 ±194.05	714.23 ± 181.39*	4.92
	C	580.91 ± 216.68	588.42 ± 182.66*	4.53
Push-ups (n)	EMS	25.69 ± 8.17	30.00 ± 8.27	19.41	0.001
	TE	21.92 ± 8.42	27.61 ± 8.97	28.63
	C	27.91 ± 5.38	28.08 ± 5.71 *#	0.48
Sit-ups (n)	EMS	28.77 ± 5.73	32.46 ± 6.89	12.93	0.001
	TE	34.53 ± 9.98	37.00 ± 9.4	8.51
	C	29.75 ± 8.11	29.83± 6.91 *#	1.42

*Significant difference with EMS group; # significant difference with TE group.

Physical performance

There were no significant differences between groups at physical performance tests at pre-test (p>0.05). Following the intervention, we observed significant differences between groups in the aerobic (F_2,34=14.52, p=0.001, ηp²=0.46), sit-ups (F_2,34=10.33, p=0.001, ηp²=0.38) and push-up (F_2,34=21.24, p=0.001, ηp²=0.55) tests. The Bonferroni post-hoc tests showed that aerobic fitness improved significantly in the EMS group compared to other groups (p>0.05) (Table 1). In addition, both experimental groups demonstrated a substantial increase in the two muscle endurance tests (sit-up and push-up tests) compared to the C group (Table 1).

Biochemical indicators

The ANCOVA indicated that there was a significant difference between groups in adiponectin levels after the intervention (F_2,34=25.59, p=0.001, ηp²=0.60). Serum adiponectin increased significantly by 47.08% in the EMS group and 14.55 % in the TE group, but it decreased by -3.55 % in the C group (Fig 1). Hence, there was a significant difference between the two experimental groups and the control group (p<0.001), as well as between the EMS group and the training group (p=0.002). The serum concentration of resistin decreased by -21.96% in the EMS group, -18.23% in the TE group, and -4.56% in the C group. The circulatory level of resistin after the intervention was statistically different between groups (F_2,34=12.32, p=0.001, ηp²=0.42) (Fig. 2). The reduction of resistin levels in the two experimental groups was significantly different from the C group.

The cholesterol level after the intervention was statistically different between groups (F_2,34=7.51, p=0.002, ηp²=0.31) with a moderate effect size (Table 2). The reduction amount of cholesterol in the two experimental groups was significantly different from the C group. The triglyceride concentration after the intervention significantly differed between groups (F_2,34=16.03, p=0.001, ηp²=0.49) with a moderate effect size (Table 2). The changes in the TG level in the EMS and TE groups were significantly different from the C group. The LDL levels after the intervention were reduced in both experimental groups compared to the C group with a moderate effect size (F_2,34=7.36, p=0.002, ηp²=0.31). In contrast, the HDL levels after the intervention were increased in both experimental groups compared to the C group with a moderate effect size (F_2,34=16.38, p=0.001, ηp²=0.49).

Table 2: lipid profile of participants before and after the intervention

Variable	Group	Pre	Post	% change	P between
Triglyceride	EMS	175.92 ± 62.13	124.69 ± 34.20	-26.75	0.001
	TE	157.92 ± 46.30	130.00 ± 29.39	-14.96
	C	152.25 ± 34.37	157.08 ± 35.42^*#	3.16
Cholesterol	EMS	207.54 ± 39.85	177.85 ± 31.65	-13.75	0.002
	TE	183.23 ± 44.97	160.15 ± 32.06	-11.68
	C	178.33 ± 17.64	178.50 ± 17.12 ^*#	0.23
LDL	EMS	121.51 ± 37.81	95.29 ± 33.17	-22.14	0.002
	TE	108.56 ± 41.40	87.31 ± 29.46	-18.69
	C	103.13 ± 19.21	103.50 ± 21.70^*#	0.31
HDL	EMS	50.85 ± 12.86	57.61 ± 12.27	14.28	0.001
	TE	43.07 ± 5.12	46.85 ± 4.98	8.97
	C	44.75 ± 6.69	43.578± 7.05^*#	-2.07

*Significant difference with the EMS group; # significant difference with the TE group.

We aimed to test the effectiveness of 20 minutes of EMS training in improving fat profile, body composition, and adipokines release compared to the same amount of traditional training. The results indicated an improvement in the fat profile of both training groups compared to the C group, which was favorable to the EMS group. In addition, resistin levels decreased significantly in both training groups. However, a significant increase in adiponectin levels occurred in the EMS group compared to the TE group. Furthermore, the changes in body mass, fat percentage, and arm and abdominal fat thickness were significant in both training groups; and it was evident that the EMS group had a more favorable effect. Our hypothesis has been confirmed that EMS training is linked to further improvements in lipid profile, body composition, and the release of adipokines due to increased metabolic pressure. Therefore, EMS is a suitable choice for individuals who don't have much time to train.

The participants had lost their fitness due to inactivity and being overweight worsened this condition. In the present study, substantial improvements in body weight, body composition, fat percentage, and aerobic fitness were observed in the EMS group. Both training groups showed an improvement in muscle endurance. However, it is well known that participation in exercise training has health benefits and is associated with improved physical fitness and body composition (17). The WB-EMS suit also provides electrical stimulation to a wide range of muscle groups to simultaneously activate. In this regard, Banerjee. suggested that EMS is capable of eliciting a cardiovascular exercise response without loading the limbs or joints and inducing rapid, rhythmical contractions in the large leg muscles (18). They demonstrated significant improvements in peak oxygen consumption, walking distance, and quadriceps strength after 6 weeks. The EMS can activate both muscle fiber types (I & IIa) leading to preserving lean mass and enhancing muscle strength. In this regard, it was shown that the 20-minute EMS session at high impulse intensity could improve isokinetic strength in healthy men (19). Zink-Rückel, (2021) reported that 16 weeks of once-weekly EMS application was effective in enhancing stability and maximum strength, and low effect on lean body mass, and did not affect body-fat content in amateur golfers (20). Methodological differences can justify these contradictions. The subjects were healthy adults with normal fat percentage. In addition, research has shown that EMS has the greatest effect on body composition when the training frequency is more than 1.5 to 3 sessions per week (19, 21). In addition, it was reported that 1.5 sessions EMS per week (85 Hz; intermittent 6 s impulse, 4 s rest) was an efficient, and highly customizable training technology for maintaining muscle mass during energy restriction and can thus be considered as an alternative to more demanding resistance exercise protocols (22). Therefore, these findings indicate that exercise intensity must be high enough to receive the effects of body composition and physical performance (23).

We observed a significant increase in adiponectin and a decrease in resistin in the two training groups, in favor of the EMS group. In addition, the levels of adiponectin in the EMS group significantly increased compared to the TE group. These findings were supported by previous research findings that reported a decrease in resistin and an increase in adiponectin due to a training period (24, 25). Moreover, these findings have been confirmed in two studies that have used EMS (16, 19). In this regard, it was shown that the 20-minute EMS session at high impulse intensity (85 Hz) three times a week for six weeks could decline resistin levels and improve body composition (19). Additionally, Andre. (2021) also reported an increase in adiponectin levels and functional capacities after WB-EMS in obese subjects after bariatric surgery (16). It seems that the observed improvements in the levels of these two adipokines could be attributed to an alteration in body composition (fat reduction) because adipose tissue is the main source of the secretion of these two cytokines. Moreover, exercise training is associated with improvements in energy metabolism especially lipolysis and fat oxidation, and also mitochondrial function (26). Thus, it is obvious that the exercise protocols cause these changes in adipokines. It was interesting that the highest percentage of improvement was in the EMS group and a significant difference in adiponectin levels was observed between the two experimental groups. A study reported that a higher intensity of physical activity, with greater energy consumption, is associated with improved lipid profile and increased fat oxidation (27). The EMS stimulation in this study has sufficient intensity to stimulate fat metabolism. Hence, recruiting more muscle groups with EMS correlated to higher energy consumption. Therefore, more pronounced biochemical changes due to higher metabolic pressure were observed in the EMS group.

Research interventions led to the improvement of lipid profiles in two training groups compared to the C group. The percentage of improvement in the EMS group was higher than in the TE group. It is well-documented that physical activity is associated with an increase in HDL cholesterol and a decrease in LDL cholesterol and triglycerides (28–30). The increase in energy consumption and fat metabolism during physical activity is associated with the improvement of blood lipid levels. Exercise training has been shown to have an impact on blood lipid metabolism by increasing the concentration of lipoprotein lipase and its activity in skeletal muscles (29). In addition, aerobic and resistance training can increase the apo-A level and diminish plasma apo-B levels (28, 31). Therefore, exercise interventions can affect the plasma levels of HDL and LDL cholesterol. Furthermore, the lipid profile changes caused by exercise training are influenced by the type of exercise, intensity, frequency, and duration of each session. Studies have revealed that improving lipid profiles can be achieved through moderate and high-intensity training, but not through low-intensity exercise (32, 33). Therefore, the greater improvement in the EMS group can be attributed to the higher metabolic load compared to traditional training.

The authors affirm that there were constraints in carrying out this investigation. Fat percentage and fat thickness were measured using a body composition device and caliper, and it was not possible to measure with expensive and golden methods such as sonography and CT scan. This study did not evaluate any other adipokines or myokines. Therefore, researchers are advised to measure subcutaneous fat and muscle thickness with a CT scan, as well as other myokines, which would provide a better understanding of the efficiency of the EMS.

Greater improvements in lipid profile, body composition, and adipokines are achieved through EMS training as a result of increased metabolic pressure. Whole body EMS is a highly time-efficient training technique that significantly boosts the impact of isolated endurance and resistance-type exercise on fitness and fat parameters. Therefore, EMS is a suitable option for individuals with limited training time.

EMS: Electrical muscle stimulation; TE: traditional exercise; C: control; AMPK: AMP-activated protein kinase; ANCOVA: Analysis of covariance; BMI: Body mass index; ELISA: an enzyme-linked immunosorbent assay; ES: effect size; SD: standard deviation; HDL: high-density lipoprotein; LDL: low-density lipoprotein.

Acknowledgments

The researchers express their sincere gratitude and appreciation to all the participants in the research.

Author contributions

ZA: Conception and design of study, data interpretation. HH: Methodology, Data curation, Writing - original draft. SA-S: Supervision, Writing - review & editing. All authors read and approved the final manuscript.

Funding

This research received no specific grant from any funding agency.

Availability of data and materials

All data are available from the corresponding author upon reasonable request.

Ethics approval and consent to participate

All procedures performed in studies that involved human participants were in accordance with the Helsinki statement on human research. Participants were informed about the risks and benefits of the study, and they were given written informed consent before the initial assessments. The study was approved by the Ethic committees for Sport Sciences Research Institute of Iran (approval number: SSRI.REC-2311-2499).

Consent to publish

Not applicable.

Competing interests

No competing interests.

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No competing interests reported.

Effect of six weeks of Whole-body Electromyostimulation on resistin and adiponectin levels in overweight individuals

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Abstract

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