JOURNAL CLUB

presented by
DEEPSHA KALIGITHI
Effect of pulsed electromagentic
field versus aerobic excercises on
women with polycystic ovary
syndrome : A single –blind
randomized controlled trail
ARTICLE INFORMATION

 Corresponding Author : Marwa Esmael Hasanin Esmael

 Published year : 16.01.2019
 Place : Department of physiotherapy for women

health.
Cario university,Egypt.
 Study design : A single –blind randomized

controlled trail.
 Population: obese women with polycystic ovary

syndrome
AIMS and OBJECTIVES
 This study was an attempt to compare the effect of
pulsed electromagnetic field versus aerobic exercise
on women with polycystic ovary syndrome
ABSTRACT
 Polycystic ovarian syndrome (PCOS) produces
symptoms in approximately 5% to 10% of women of
reproductive age (12–45 years old).
 It is thought to be one of the leading causes of female

infertility and the most frequent endocrine problem in

women of reproductive age.
 This study was an attempt to compare the effect of

pulsed electromagnetic field versus aerobic exercise

on women with polycystic ovary syndrome.
Material and Method: Thirty obese women
Ages : ranged between 20 and 35 years.
They were randomly and equally allocated to two
groups
 GROUP - A GROUP - B
• Composed of 15 women • composed of 15
• Receives PEMF with women.
perscribed diet •Receives aerobic
exercises in the form of
Walking on the
threadmill
40min/session including
the same diet as group A

•All the participants in both groups had 3 sessions/week

for 12 weeks
 Both the groups were performed before and after the study
by measuring their
 weight
 body mass index (BMI)
 C-reactive protein (CRP)
 luteinizing hormone (LH)/follicle stimulating hormone
(FSH) ratio.
INTRODUCTION
 Polycystic ovarian syndrome is a complex,
heterogeneous disorder of undefined etiology.
 It is one of the most common female endocrine
disorders.
 The definite pathophysiology and causes of PCOS are a
complex, the hormonal imbalance may be due to
hyperinsulinemia and hyperandrogenemia plus the
patient lifestyle and genetic factors
 PCOS is a pro-inflammatory state.
•Chronic low-grade inflammation leads to the development
of the metabolic disorder and ovarian dysfunction .
• The link between inflammation and obesity is a
positive correlation between adipose mass and
expression of the pro-inflammatory gene tumor
necrosis factor-α (TNFα).
• The link between obesity and inflammation has been
also illustrated by the increased plasma levels of
several pro-inflammatory markers including cytokines
and acute phase proteins like CRP in obese individual
 Many of the inflammatory markers found in plasma
of obese individuals appear to originate from adipose
tissue.
 These observations have led to the view that obesity

is a state of chronic low-grade inflammation that is

initiated by morphological changes in the adipose
tissue .
•Every cell membrane carries an electromagnetic
charge, and pulsed electromagnetic field (PEMFs) alters
this charge by causing movement of ions across the cell
membrane.
•Low- level PEMFs have been shown to exert an anti-
inflammatory effect through the restoration of plasma
membrane calcium ATPase activity .
• Aerobic exercise training was found to have a direct
effect on inflammatory process as it reduces
blood levels of leukocyte adhesion molecules
inhibits interactions between monocytes and endothelial
cells,
decreases the production of pro-inflammatory cytokines,
decreases CRP levels
increases the production of anti-inflammatory cytokines
by mononuclear cells.
reduction of body weight, body fat percentage, and waist
circumference.
improvement in maximum oxygen consumption.
METHODOLOGY
 Study design: single -blinded randomised controlled
trial
 Sample size: 30
 Study duration: 12 weeks
 Sample selection: obese women with pcos
 Study setting: Department of physiotherapy for

women health.
Cario university,Egypt
 Population: obese women with pcos
INCLUSION CRITERIA
 Obese women
 Age -20-35 years
 Amenorrhea
 Oligomenorrhea
 BMI : 30 to 34.9 kg/m2
 LH/FSH : greater than 2
EXCLUSON CRITERIA
 Disorders like
 Androgen –secreting neoplasia
 Thyriod dysfunction
 Cushings syndrome
 Ovarian tumor
EXCLUSION CRITERIA
 Diseases like:
 Cardiac and chest diseases
 Diabetes
 Obese class 2 and 3
 Contraindications for PEMF :
 Implanted devices
 Pacemaker
 Maligancies
 Seizure
 Atherosclerosis
 Viral infections
Pulsed electromagnetic field
treatment sessions for Group A
 PEMF machine was applied by Health waves generator
with two independent channels.
 Position of patient : supine lying position.
 Then the two plates of magnetotherapy was placed

over the lower lateral abdominal quadrant of the patient

(RT and LT) below the level of umbilicus by 5cm on
right and left side.
 The total treatment session lasted for 30 minutes. The

EMF sessions was applied 3 times/ weeks for 12

weeks, in addition to their prescribed diet.
Parameters of electromagnetic therapy

phases Intensity % frequency time

Phase 1 90% 2Hz 5min

Phase 2 100% 4Hz 15min

Phase 3 80% random 10min

Exercise program for Group B
 Aerobic exercise Treadmill was used for performing
aerobic exercises for women in Group B for 40
minutes/session,
 3 sessions per week for 12 weeks.
 The Treadmill has the following specifications:
 Speed range (0.8 mph to 16 mph)
 elevation range (0% to 15%) and
 power (220v, 60Hz, 15 amp).
 The exercise on the treadmill was divided into 3 stages
The first stage (Warming up):
 Starts with 5 minutes at slow speed with zero

inclination to enhance patient performance.

 To decrease the risk of hypotension, musculoskeletal

and cardiovascular complications.

 The second stage (Active phase): The speed of the
treadmill was increased gradually to achieve at least
70 % of maximum heart rate for each woman.
Duration gradually increased to 20 minutes.
 The third stage (Cooling down or Recovery

Period): At the end, the speed of the treadmill was

gradually decreasing until it reached zero for 5
minutes to allow the heart rate to return nearly to the
resting level.
OUTCOME MEASURES
 Weight –height scale
 BMI – KG/m2

Biomechanical assays :
 LH/FSH ratio
 CRP
HEIGHT – WEIGHT SCALE
RESULTS
 Baseline and demographic data :
 As indicated by the independent t-test, there were no

statistically significant differences between subjects in

both groups concerning age and height.
 In the same context, the multiple pairwise comparison

tests revealed that there was a significant reduction in

weight, BMI, CRP and LH/FSH ratio in the post-
treatment condition compared with the pre treatment
one in both groups.
Demographic characteristics of both group

Group A Group B Comparison

Mean ± Mean ± t-value P-value

SD SD

Age 26.4±3.9 26.46±2. 0.053 0.958

(years) 7- 74

Height 1.62±0.0 1.62±0.0 0.292 0.773

(m) 6 5
 Descriptive statistic and multiple pairwise comparison tests for the weight, BMI, CRP, and

LH/FSH ratio for both groups at different measuring period.

Group A Group B

Variables pre post Pre post

weight 91.33(8.1 79.06(8.5 91.13(8.5 80.86(7.1

0) 2) 2) 6)
BMI 34.36(1.2 29.72(1.5 34.64(3.2 30.73(2.6
4) ) 1) 7)
CRP 7.04(1.65 2.76(1.27 7.04(1.84 5.57(1.51
) ) ) )
LH/FSH 2.19(0.26 1.51 2.25(.34) 1.83(0.42
GROUP A GROUP B

Within the groups ( pre vs post)

P-value weight BMI CRP LH/FSH

Group A 0.0001 0.0001 0.0001 0.0001

Group B 0.0001 0.0001 0.0001 0.0001

Between groups (group A VS group B)

P-value weight BMI CRP LH/FSH

Pre 0.948 0.76 0.992 0.591

treatment
Post 0.536 0.21 0.0001 0.013
treatment
DISCUSSION
 The results of this study showed that there was significant
reduction in weight, BMI, CRP and LH/FSH ratio in the post-
treatment condition compared with the pretreatment one in
both groups A and B.
 Regarding between-subject effects there was significant
reduction in CRP and LH/FSH ratio in Group A patients who
were receiving treatment with PEMF compared with Group B
patients who were receiving treatment with aerobic exercise
(both groups received the same diet program) with no
significant differences in weight and BMI between both
groups
 Regarding the effect of PEMF, the results of the present
study showed, a significant decrease in BMI and
weight and this decreases were in agreement with
another study which reported that there was a
significant decrease in triglyceride and BMI, also there
was a significant increase in low-density lipoprotein,
and decline in high-density lipoprotein after application
of Pulsed Magnetic Field with frequency 15 Hz,
intensity 60 gauss and duration 20 min for 2 successive
months.
 PEMF has a positive effect on BMI and Triglycerides
but it had a negative effect on Total Cholesterol LDL
and HDL.
• Regarding physical activity, the results of the
present study showed the effect of aerobic
exercise and combined diet in decreasing the BMI
and weight.
• The alterations in body composition most often
attributed to aerobic exercise are a decrease
in fat weight and maintenance or slight increase in
fat-free mass indicating the importance of aerobic
exercise in burning calories and losing body fat.
•Reduction in CRP in the current study come in
agreement with the study reported that diet plus
exercise (walking on treadmill 3 days/week) were
effective in reducing inflammatory markers,
(CRP, interleukin-6 and TNFα).

•It was also reported that four months of aerobic

exercise of intensity 60–80% of maximal oxygen
consumption (VO2 max) in addition to diet was
effective for decreasing CRP.
LIMITATIONS

 small number of cases recruited

 lack of follow-up
CONCLUSION
• Both PEMF and aerobic exercise were effective in
decreasing the inflammatory level (decreasing CRP) and
improving the ovulation through decreasing LH/FSH ratio
but pulsed electromagnetic field was more effective than
aerobic exercise in reducing CRP and LH/FSH ratio in
PCOS women with no difference in its effect on the body
weight or the BMI.