Effects of Whole-Body Electromyostimulation Associated with Dynamic Exercise on Functional Capacity and Heart Rate Variability After Bariatric Surgery: a Randomized, Double-Blind, and Sham-Controlled Trial



Bariatric surgery is the most effective treatment for morbid obesity. In association with dietary restrictions, the ability to exercise in the immediate post-surgical phase is limited. In this context, whole-body electromyostimulation (WB-EMS), strategy that stimulates various muscle groups, in conjunction with physical exercise, holds promise for improving functional capacity, and cardiac autonomic control, following surgery. The purpose of this study was to analyze whether a rehabilitation program consisting of WB-EMS with 30 exercise training sessions following bariatric surgery significantly improves functional capacity, body mass and heart rate variability (HRV).


Randomized, double-blind, and sham-controlled trial. Twenty obesity patients were randomized into the WB-EMS (n = 10) and sham (n = 10) groups. On average, 7 days after surgery, individuals underwent a six-minute walk test (6MWT), HRV, and body composition analysis at rest. The next day, patients initiated an exercise training protocol, five times per week, over 6 weeks. Walking distance changes (post-pre = ΔWD) obtained by 6MWT and HRV indices were determined following the intervention.


Only WB-EMSG significantly increased WD and body mass index (BMI) after the intervention (p = 0.002) and ΔWD was significantly higher in this group when compared with sham (p = 0.04). Moreover, both groups demonstrated an improvement in key measures of HRV after the intervention.


An exercise training intervention initiated shortly after bariatric surgery improved functional capacity and cardiac autonomic tone. Improvements in functional capacity and BMI following exercise training were greater with the addition of WB-EMS but did not promote additional improvements in HRV beyond that realized with exercise training alone.

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The authors would like to thank all colleagues from the Cardiopulmonary Physical Therapy Laboratory of Physical Therapy Department, Federal University of São Carlos (UFSCar), Brazil, for their collaboration and all patients included in the present study for their effort and enthusiastic cooperation throughout the study. Ottoboni Comércio e Importação Ltda (Rio de Janeiro – Brazil) by donating part of the multi-frequency bioimpedance analysis, and the Gastro Vita clinic.


This study is supported by a research grant from Fundação de Amparo à Pesquisa do Estado de São Paulo, São Paulo, Brazil (FAPESP) Process N° 2015/04101-1. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES - 001) and CNPq: 141803/2019 -3. Paula Angélica Ricci is a doctorade student supported by FAPESP, Process N° 2018/13332-5. AB-S is an Established Investigator (level IB) of the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.

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Correspondence to Audrey Borghi-Silva.

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Ricci, P.A., Di Thommazo-Luporini, L., Jürgensen, S.P. et al. Effects of Whole-Body Electromyostimulation Associated with Dynamic Exercise on Functional Capacity and Heart Rate Variability After Bariatric Surgery: a Randomized, Double-Blind, and Sham-Controlled Trial. OBES SURG 30, 3862–3871 (2020). https://doi.org/10.1007/s11695-020-04724-9

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  • Whole-body electromyostimulation
  • Functional capacity
  • Autonomic control
  • Bariatric surgery