Visceral fat loss by whole‐body electromyostimulation is attenuated in male and absent in female older Non‐Insulin‐Dependent diabetes patients

Abstract

Introduction: Type 2 diabetes and its reversal correlate with increases and decreases in visceral fat (VF). Resistance exercise reduces VF in healthy persons, but little is known in type 2 diabetes. Muscle contractions induced by whole-body electromyostimulation (WB-EMS) provide a very effective form of resistance training. We hypothesized that WB-EMS reduces VF and improves plasma glucose measures in older non-insulin dependent diabetes mellitus (NIDDM) males and females. Methods: A four-arm age-matched case control study was done on WB-EMS twice a week in older NIDDM patients (27 males, 18 females) compared with controls (15 males, 15 females). VAT area (VAT, cm 2 ), total fat mass (TFM, kg) and lean body mass (LBM, kg) were assessed by DEXA-scanning. HbA1c, fasting glucose and plasma lipoproteins were measured at baseline and after 4 months.Results: Baseline control VAT was higher in males than females (140.5 ± 35.6 vs. 96.7 ± 42.3, p < .001). In NIDDM, VAT was higher with no significant sex difference (206.5 ± 65.0 vs. 186.5 ± 60.5). In controls, WBEMS reduced VAT in males and females to similar extent (−16.9% and −16.4%, p < .001 vs. baseline) and in preference to TFM (−9.2% and −3.6%) or body weight loss (−2.8 and −2.1%). In NIDDM, VF loss was attenuated in males (−7.3%, p < .01) but completely absent in females. WBEMS reduced HbA1c and cholesterol and increased HDL levels (all p < .05) only in male NIDDM Conclusions: WBEMS induced VF loss in healthy older males and females an effect strongly attenuated in male and completely absent in female NIDDM patients. This questions the effectiveness of muscle contraction-induced VF lipolysis in NIDDM.Sex differences may dictate the success of resistance training in NIDDM, a subject that needs to be addressed in future studies.

Revised contraindications for the use of non-medical WB-electromyostimulation. Evidence-based German consensus recommendations

“…Five randomized and non-randomized trials or intervention studies without CG applied WB-EMS for two to four months in cohorts with non-insulin dependent Diabetes Mellitus (NIDDM) ( 17 , 18 , 35 , 37 , 39 ) 5 . Two of the studies included hospitalized cohorts with end-stage diabetes kidney disease ( 37 ) or diabetic ulcers undergoing minor amputation ( 18 ).…”

Outcomes Addressed by Whole-Body Electromyostimulation and Belt Electrode-Skeletal Muscle Electrical Stimulation Trials in Middle Aged to Older Adults – an Evidence Map

“…More than two thirds of the studies/projects reported changes body composition parameters as primary, secondary or tertiary outcome. Although difficult to conclude 8 , about 14 studies considered changes in body composition and anthropometry at least as a core outcome [21,23,27,39,44,49,50,53,54,58,59,63,68,77] (Figure 3 31,39,44,57,75,92], one study [37] relied on the caliper method and a further study [53] determined changes in thigh and calf circumference.…”

“…Apart from total body fat, several studies determined trunk, abdominal, or visceral fat mass/rate by BIA [46,65], DXA [19,31,39,41] or CT [68] or, less sophisticated, by waist circumference [19, 21,39,65,71,75,94]. Eleven studies focus on local muscle parameters (muscle thickness, cross-sectional area, crosssectional volume) predominately at the mid-thigh/quadriceps site [23,27,29,46,54,58,59,63,68,83,86], calf [23] or upper arm [27] applying either ultrasound (US) [23,27,29,63,86], computed tomography (CT) [58,59,68] or magnetic resonance imaging (MRI) [46,83] techniques.…”

“…Apart from the studies that determined Insulin [18,21,69,70,82,83] or Resistin levels [50,67] several other studies addressed glucose metabolism, the MetS or NIDDM with more dedicated outcomes or scores [18,21,31,40,47,69,72,82,83,86,89,94]. HbA1c results were reported by six studies [21,31,69,72,82,83,89]. HOMA and/or Quicki-Indices were reported by Amaro-Gahete et al [18]; Bellia et al [21]; Park et al [69], Reljic et al [72], and Suzuki et al [83].…”

“…Three other studies calculated a metabolic risk [18]/Metabolic Syndrome Z-Score [72,94]. Parameters related to the MetS [21,72], or insulin resistance [31,83,86,89] were considered as primary or main outcome in six studies.…”