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Phototherapy associated with mechanical stress for body-contouring and cellulite treatment

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Correspondence: Fernanda Rossi Paolillo, University of S ã o Paulo (USP): Av. Trabalhador S ã ocarlense, 400 Centro, CEP 13560-970, S ã o Carlos, SP, Brazil.
Fax: 55 16 33739810. E-mail: fer.nanda.rp@hotmail.com
(Rece ived 3 May 2011 ; accepted 14 May 2011 )
Introduction
Obesity and localized fat are not synonymous with
cellulite, but can be associated with it. In obesity
there are hyperplasia and hypertrophy of adipocytes,
whereas in localized fat there is hypertrophy of adi-
pocytes with different shapes and sizes, either disag-
gregated or united. With regards to cellulite, it can
occur in obese and lean women, because it is char-
acterized by alterations of the microcirculation and
the lymphatic system plus a dysfunction of cutaneous
and adipose tissue with a fi brotic reaction leading to
an orange peel skin appearance (1). Other terms
which have been used for cellulite are nodular lipo-
sclerosis, edemato-fi brosclerotic panniculopathy,
panniculosis, and gynoid lipodystrophy (2,3).
Cellulite is a common condition in women, fre-
quently found on the thigh and buttock regions, and
it shows four evolutionary grades or stages (4). Its
Journal of Cosmetic and Laser Therapy, 2011; 13: 166–171
ISSN 1476- 4172 print/ISS N 1476-4180 onl ine © 2011 Info rma U K, Ltd.
DOI : 10. 3109 /1476 4172. 2011.5 940 65
ORIGINAL ARTICLE
New treatment of cellulite with infrared-LED illumination applied
during high-intensity treadmill training
FERNANDA ROSSI PAOLILLO
1,2 , AUDREY BORGHI-SILVA
3 ,
NIVALDO ANTONIO PARIZOTTO
2,4 , CRISTINA KURACHI
1,2
& VANDERLEI SALVADOR BAGNATO
1,2
1 Optics Group from Instituto de F í sica de S ã o Carlos (IFSC), University of S ã o Paulo (USP), Brazil,
2 Biotechnology
Program, Federal University of S ã o Carlos (UFSCar), Brazil,
3 Cardiopulmonar y Physiotherapy Laboratory, Department
of Physical Therapy, Federal University of S ã o Carlos (UFSCar), Brazil, and
4 Electrother mophototherapy Laboratory,
Department of Physical Therapy, Federal University of S ã o Carlos (UFSCar), Brazil
Abstract
Phototherapy improves cellular activation which is an important factor for the treatment of cellulite. The objective of this
research was to develop and evaluate the effects of a new (noninvasive and nonpharmacological) clinical procedure to
improve body aesthetics: infrared-LED (850 nm) plus treadmill training. Twenty women (25 55 years old) participated in
this study. They were separated in two groups: the control group, which carried out only the treadmill training ( n 10),
and the LED group, with phototherapy during the treadmill training ( n 10). The training was performed for 45 minutes
twice a week over 3 months at intensities between 85% and 90% maximal heart rate (HR
max ). The irradiation parameters
were 39 mW/cm
2 and a fl uence of 106 J/cm
2 . The treatment was evaluated by interpreting body composition parameters,
photographs and thermography. This was primarily a treatment for cellulite with a reduction of saddlebag and thigh cir-
cumference. At the same time, the treadmill training prevented an increase of body fat, as well as the loss of lean mass.
Moreover, thermal images of the temperature modifi cation of the thighs are presented. These positive effects can result in
a further improvement of body aesthetics using infrared-LED together with treadmill training.
Key Words: body composition , cellulite , infrared-LED , thermography , treadmill training
aetiology is multi-factorial, including structural, genetic
and endocrinal causes, as well as age, diet, a sedentary
lifestyle and gender. Cellulite is predominantly found
in women because the skin tissue architecture is differ-
ent from that of men (5). The fi brous septae network
is perpendicular to the women s skin surface, whereas
for men it is criss-crossed (4,6). In addition, the
connective tissue matrix is altered and adipogenicity
is increased in women. This explains hypodermic
(subcutaneous fat) invaginations inside the dermis
(connective tissue) causing deformity (1,3,7).
The cosmetic problems caused are undesirable
for women. The objective of this research was to
develop and evaluate the effects of a new (noninva-
sive and nonpharmacological) clinical procedure to
improve body aesthetics using infrared radiation
originated from LEDs (850 nm) associated with
treadmill training.
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Treatment of cellulite and infrared-LED 167
Materials and methods
The current research has been approved by the
National Ethics Committee of the Ministry of
Health in Brasilia, Brazil and by the Ethics Com-
mittee of the Federal University of S ã o Carlos
(UFSCar) in S ã o Carlos, Brazil. All subjects signed
written informed consents before their participa-
tion in the study.
The treatment was performed on 20 women
(caucasian; aged between 25 and 55 years). They
were separated into two groups: the control group,
which carried out only the treadmill training ( n 10),
and the LED group, which included phototherapy
during the treadmill training ( n 10). The volunteers
were instructed not to change their eating habits (not
to diet) for the duration of this study.
The maximal effort test using a treadmill (Bruce
Protocol for young women and Modifi ed Bruce Pro-
tocol II for middle-aged women) (8 10) was per-
formed for diagnosis and elaboration of training
intensities based on HR
max via the electrocardiogram
(Ergo; HW Systems HeartWare Ltda, Belo Hori-
zonte, MG, Brazil) and the cardiofrequencimeter
monitor (Polar S830i; Polar Electro Inc., Woodbury,
NY, USA). Treadmill training at intensities between
85% and 90% HR
max with or without phototherapy
was performed twice a week for 3 months, each ses-
sion lasting 45 minutes. The HR
max and HR of the
training were, respectively, 170 13 bpm and
150 15 bpm for the LED group and 160 8 bpm
and 140 9 bpm for the control group.
For the phototherapy to be performed during tread-
mill training, the Optics Group from Instituto de
F í sica de S ã o Carlos (IFSC), University of S ã o Paulo
(USP) developed a system based on infrared-LEDs
(850 nm) to be used during physical exercise (10).
A power meter fi eldmaster (Coherent Inc., Santa
Clara, CA, USA) in the milliwatt range was used.
The average power density near the emitter is about
35 mW/cm
2 . The distance between the LED devices
and the volunteers skin was 15 cm and the average
power density on the skin was 39 mW/cm
2 . This
small increase of the power density of the emitters to
the skin is caused by the curvature of the surface
containing the LEDs. Such a curvature causes a
small focusing effect of the light (as in a curved mir-
ror) producing the observed increase in power den-
sity. The treatment time was 45 minutes, performed
bilaterally on thighs and buttocks. These parameters
led to an approximate fl uence of 106 J/cm
2 .
The volunteers wore safety glasses and swimwear
to ensure infrared absorption through the bare skin
during the treadmill training with infrared-LED
(Figure 1).
Always at the same time of the day, photographic
documentation of the skin was carried out in the
laboratory before and after treatment. Body mass
index [BMI: body weight (kg) divided by height (m)
squared] and waist hip ratio [waist (cm) divided by
hip (cm)] measurements were performed. These con-
sisted of performing measurements of body mass in
kilograms (kg) and height in centimeters (cm) using
a biometric scale. The measurements of the circum-
ferences were performed with a tape measure, applied
in a light way (not tight) on the skin surface only, in
order to avoid measurement errors due to compres-
sion. The anatomical landmarks to measure the cir-
cumference (cm) in the upright position of the body
were: (i) waist: measured at the midpoint between the
lowest rib and the iliac crest; (ii) hip: measured at the
level of maximum extension of the buttocks; and (iii)
right and left thighs: saddlebags or culotte de cheval
as well as 10 cm, 20 cm and 30 cm from the hip joint.
To measure the body fat and lean mass, the bipolar
impedance of the upper limbs (OMRON
®
, Kyoto,
Japan) was performed (11). Thermal images of the
right and left thighs using a thermographic IR-CAM
(FLUKE Corp., Everett, WA, USA) were performed
before (rest) and during exercise (an interval of 45
minutes) with and without infrared-LED.
Measurements were expressed by mean and stan-
dard deviations. The Shapiro-Wilk test was used to
analyze the normality. The paired Student s t -test was
used to compare changes in body composition before
and after treatment. The unpaired Student s t -test
was used to compare inter-group differences. All data
were analyzed using Statistica for Windows Release
Figure 1. New clinical procedure for the treatment of cellulite.
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168 F. R. Paolillo et al.
7 software (Statsoft, Inc.) and the signifi cance level
was set at 5% ( p 0.05).
Results
The results obtained for body composition comparing
pre- and post-treatment are shown in Table I. The
treatment of cellulite is exemplifi ed in Figures 2 and 3.
The temperature of the thighs during rest did not show
any signifi cant inter-group difference (control group:
T 33.5 0.5 ° C; LED group: T 33.5 0.5 ° C;
p 0.05). An increase of 1.08 0.11 ° C for the LED
group and a decrease of 0.86 0.15 ° C during tread-
mill training for the control group were observed.
The delta of the cutaneous temperature during the
exercises showed a signifi cant inter-group difference
( 1.72 0.36 ° C, p 0.000053). The thermogra-
phy images can be seen in Figure 4.
Discussion
To the best of our knowledge, this is the fi rst study
to report the use of phototherapy during physical
exercise to treat cellulite. Other studies have already
shown the benefi ts of various technologies during
rest (5).
Phototherapy improves cellular activation via
absorption of light by chromophores present in the
protein components of the respiratory chain. Chro-
mophores are located in the mitochondria, mainly
NADH dehydrogenases and cytochrome-c oxidase,
which lead to increased electron transport increasing
the synthesis of adenosine triphosphate (ATP) and
results in therapeutic effects (10,12).
The use of lasers (light amplifi cation by stimulated
emission of radiation) and LEDs (light-emitting
diodes) are important tools in treating cellulite because
phototherapy can result in several therapeutic effects
to rejuvenate (13,14) the skin and improve body aes-
thetics (15), such as promoting tissue regeneration
(12) with an antioxidant and anti-infl ammatory action
(16,17), or also increasing collagen synthesis (16),
microcirculation and lymphatic drainage (18).
Moreover, the advantages of LEDs versus lasers
are that LEDs have a comparably low operational cost,
allowing irradiation of larger areas and producing light
with a broad emission band and an absorption of pho-
tons by several chromophores (10,12,19).
Phototherapy applied before (20) or after (21)
physical exercise, as well as during exercise training (10)
has resulted in enhancing physical performance. Our
results show that without any diet, the women could
prevent an increase of both body mass and fat percent-
age, as well as a loss of lean mass. It is well known that
treadmill training is very important to enhance both
aerobic capacity and fat metabolism (8,22).
Research on body aesthetics has also showed the
treatment of cellulite and the reduction of thigh
measures in women who used both VellaSmooth
(23) [a combination of infrared (700 1500 nm) and
radio frequency with mechanical manipulation of
the skin] and the TriActive System [combines
infrared (diode laser 810 nm), contact cooling,
suction and massage] (5,24). Studies using these
optical devices also show that the treatment of
cellulite can smooth out the bumpy and dimpling
appearance of the skin. However, erythema, swelling
and a feeling of warmth have been noted as side
effects of these systems (5,24).
For the current clinical procedure, which com-
bines physical exercise and infrared-LED, no side
effects were related by the patients. Still, we believe
Table I. Statistical results of body composition.
Control group LED group
Pre-treatment Post-treatment Pre-treatment Post-treatment
Body mass (kg) 65.7 11.9 65.1 11.6 71.1 11.5 70.3 10.8
Body height (cm) 156.8 5.8 156.7 5.6 157.05 7.0 157.1 7.5
BMI (kg/m2)26.1 3.9 26.5 3.9 28.7 4.7 28.5 4.5
Waist (cm) 86.2 11.1 86.5 11.5 92.7 10.9 91.4 10.6
Hip (cm) 102.6 6.3 101.7 6.8 108.6 11.2 107.3 10.5
Waist-to-hip ratio (cm/cm) 0.83 0.08 0.83 0.09 0.85 0.08 0.85 0.09
Right saddlebags (cm) 62.2 5.5 61.5 4.7 65.9 7.0 63.9 7.1**
Left saddlebags (cm) 61.1 6.3 60.9 6.1 66.1 7.6 63.8 7.4**
Right thigh (10 cm) 58.8 4.6 59.2 5.2 64 7.1 62.6 7.2**
Left thigh (10 cm) 59.5 5.1 58.9 5.5 62.8 6.3 61.4 6.5**
Right thigh (20 cm) 49.5 4.8 50.2 5.9 55.5 7.2 53.6 7.58**
Left thigh (20 cm) 48.9 5.1 48.1 5.8 54.9 6.8 53.6 6.7**
Right thigh (30 cm) 41.7 4.9 42.1 5.2 46.2 6.1 45 6.0**
Left thigh (30 cm) 42.9 4.6 42.1 5.2 45.6 7.5 44.3 7.4*
Body fat (%) 35.7 2.7 36.9 3.6 38.4 5.2 37.6 5.5
Fat mass (kg) 23.8 5.5 24.3 6.1 27.3 8.0 27.1 6.0
Lean mass (kg) 42.7 5.7 41.3 6.2 44.1 4.3 43 6.0
Values given as mean and standard deviation.
*Signifi cant difference for pre- versus post-treatment (p 0.05).
**Signifi cant difference for pre- versus post-treatment (p 0.01).
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Treatment of cellulite and infrared-LED 169
Figure 3. Pre- and post-treatment in a 55-year-old woman.
that the infrared-LED increased microcirculation,
lymphatic drainage, as well as collagen synthesis. All
of these resulted in a signifi cant reduction of the
perimeter of the saddlebags and thighs, as well as an
improvement of the skin texture (buttocks and thigh)
due to the rejuvenation and treatment of the cellulite.
According to the researchers observations and the
reports of the women who performed the infrared-
LED plus treadmill training, the skin became smooth,
soft and rejuvenated. Some patients remarks: my
husband asked if I was using a new cream , my skin is
smooth and soft , my cellulite regressed .
Figure 2. Pre- and post-treatment with and without contraction of the buttocks in a 27-year-old woman.
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170 F. R. Paolillo et al.
Figure 4. Thermography images during rest and exercise for the LED and control groups.
The mechanism of the treatment of cellulite can
be explained using thermal images (25,26) of cuta-
neous temperature modifi cations; in our study these
images indicated increased metabolic activity for the
LED group because the infrared-LED resulted in
signifi cant temperature increases during the exercise
and the images of the control group showed decreases.
These results are in line with others studies. Merla
et al. (27) showed that the cutaneous temperature
was reduced during physical exercise and this indi-
cated a cutaneous vasoconstrictor response. How-
ever, Makihara et al. (28) showed that phototherapy
increased facial temperature because it improved the
microcirculation via the vasodilator refl ex with a
warming of the same side of the face that received
the application of the laser, as well as a warming of
the opposite side of the face. This increase of circula-
tion improves oxygen supply and promotes tissue
regeneration, mainly of the skin (29,30), as well as
lymphatic drainage (18).
Conclusion
The current study combines the benefi ts of physical
training with the therapeutic effects of phototherapy.
These positive effects lead to an improvement of
body aesthetics with a reduction of saddlebag and
thigh circumference as well as the treatment of
cellulite, possibly due to the increased metabolic
activity as observed in the thermal images, as well as
also preventing the increase of body fat in both young
and middle-aged women.
Acknowledgements
The authors acknowledge the Funda ç ã o de Amparo
a Pesquisa do Estado de S ã o Paulo (FAPESP)
Grant no. 98/14270-8, Conselho Nacional de Desen-
volvimento Cient í co e Tecnol ó gico (CNPq) and
Coordena ç ã o de Aperfei ç oamento de Pessoal de
N í vel Superior (CAPES).
Declaration of interest: The authors report no
confl icts of interest. The authors alone are respon-
sible for the content and writing of the paper.
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