Exercise-Based Approaches to the Treatment of Cellulite

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Introduction
Cellulite (also known as edematofibrosclerotic panniculitis or
orange peel syndrome) can be defined as unfavorable changes
of the skin and subcutaneous adipose tissue, commonly on
the pelvic region (specifically the buttocks) and abdomen.
With this condition, the semblance of the skin changes,
appearing like an “orange peel” or “cottage cheese”.1,2 Cellulite
was first described in 1978 as a sex-related condition in the
structure of skin and subcutaneous tissue.3 It is a widespread
disorder in adult females compared with males; as some
degree of cellulite has been reported in approximately 85% of
women over the age of twenty.2 Indeed, it has been confirmed
that the perpendicular nature of the fibrous septa in women
is the main reason for the appearance of cellulite as a rippled
formation is created, while these fibers in men have an oblique
orientation and prevent such unaesthetic alterations.4,5
Subcutaneous fat, fibrotic dermal septa, dermal laxity,
and muscle atrophy all are parts of the multifactorial
pathophysiology of cellulite. Several factors also affect the
formation and aggravation of cellulite that include hormonal
changes, a genetic predisposition to abnormal fat deposition,
family history, weak muscle structure, inflammation, stress,
poor eating habits, and a sedentary lifestyle.6-9 Cellulite, an
undesirable cosmetic problem, can lead to considerable
distress for women, specifically younger women, and
potentially impair their self-esteem and quality of life.1,8,10,11
Thus, investigating effective and suitable methods for the
control and treatment of cellulite is highly important. Although
exercise and weight loss have been proposed as means of
improving cellulite,9 few studies to date have examined the role
of exercise training in treating cellulite. In the present study,
all available data concerning different exercise modalities
was reviewed and summarized. Recommendations for future
well-designed investigations are also outlined.
A Summary of Routine Clinical Options for Cellulite
There is a wide range of different therapeutic regimens to treat
cellulite. They can be summarized as mechanical stimulation
(device-based or manual massage), energy-based devices
(radiofrequency, laser and light, acoustic wave therapy),
topical agents (methylxanthines such as aminophylline,
theophylline, and caffeine), minimally invasive subcision
techniques, and injectable options (dermal fillers such
as calcium hydroxyapatite, active biologic agents such as
collagenase).4,12,13 Despite these multiple therapeutic options,
no clearly proven procedures exist.
Endurance Training and Cellulite
Today, nonpharmacological treatments receive more
attention in the world, and a variety of proposed noninvasive
methods for the treatment of cellulite includes weight loss
using calorie restriction, massages, the use of topical creams,
oral supplements (weight-management supplements),
phototherapy with infrared waves, and shockwave therapy
alone or in combination with some kinds of exercise
training.7,8,10,11 Regular running,8 cycling,10 or resistance
training11 can help improve the appearance of cellulite
through controlling body weight or increasing muscle
strength. In this context, Paolillo et al. examined the effects
of a new noninvasive method including infrared-LED (850
nm) plus endurance training on a group of 25–55 years old
women.8 Twenty Caucasian women were randomly allocated
to the control group (treadmill training) or the LED group
(treadmill training plus phototherapy) and performed 45
Exercise-Based Approaches to the Treatment of Cellulite
Behzad Taati1*, Maryam Khoshnoodnasab1
1Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht, Iran
Corresponding Author: Behzad Taati, PhD Student, Department of Exercise Physiology, Faculty of Sport Sciences, University of
Guilan, Rasht, Iran. Tel: +98-9354511284, Email: taati.behzad@yahoo.com
Copyright © 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://
creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Abstract
The presence of cellulite in women, as an unacceptable cosmetic condition related to skin and subcutaneous tissue, is a growing issue
worldwide. Having a sedentary lifestyle is one of the most important factors regarding the formation of cellulite. However, only a limited
number of scientific studies have been done to investigate the possible effects of exercise training on cellulite improvement. This focused
review aimed to summarize the available evidence on this subject and provide a road map for conducting future exercise-based research
on how to treat cellulite.
Keywords: Cellulite, Endurance Training, Resistance Training, Therapeutics
Citation: Taati B, Khoshnoodnasab M. Exercise-based approaches to the treatment of cellulite. Int J Med Rev. 2019;6(1):26-27. doi:10.29252/
IJMR-060105.
Received August 2, 2018; Accepted November 16, 2018; Online Published March 15, 2019
Int J Med Rev 2019;6(1):26-27
Mini Review
10.29252/IJMR-060105
doi
INTERNATIONAL JOURNAL OF
MEDICAL
REVIEWS

Exercise-Based Approaches to the Treatment of Cellulite
International Journal of Medical Reviews. 2019;6(1):26–27 27
minutes of running training per session at intensities between
85% and 90% maximal heart rate (HRmax), with or without
phototherapy, twice a week for 12 weeks. LED devices were
placed at a distance of 15 cm from each participant, and the
average power density on the volunteers’ skin was 39 mW/
cm2. The results showed significant reductions in saddlebag
and thigh circumferences as well as cellulite only in the LED
group. The authors concluded that these therapeutic effects
are due to the increased metabolic activity and preventing the
increase of body fat. However, the net effect of phototherapy
is not clear in this study because of the absence of a
phototherapy-only group.
Increasing blood flow in subcutaneous fat tissue is a
therapeutic target of exercise training to increase lipolysis and
accelerate local fat loss in some regions of the body; it is called
“spot reduction”. Because a lower body negative/positive
pressure leads to changes in the peripheral blood flow, the
question was raised whether exercise training with lower body
pressure (LBP) can increase regional fat loss and decrease
ratings of cellulite in the lower extremities of overweight
women.10 In a randomized controlled trial, 86 obese women
were randomly assigned to one of four 12-week interventions,
including a control group (no intervention), diet only group,
diet plus exercise group, and a diet, exercise, and LBP group.
The 3 treatment groups followed the same diet (350–500
kcal/d below the calculated energy requirements), and the 2
exercise groups additionally followed an endurance training
program of three sessions of cycling per week at 50% VO2max
for 30 minutes, with or without LBP (an initial constant high
pressure of 7.5 mm Hg for 4 minutes, followed by alternating
under- and overpressure of between −15 and +15 mm Hg
at intervals of 20 seconds). As expected, endurance training
along with a daily energy deficit was successful in reducing
body weight in all three intervention groups. However, the
application of LBP to the lower extremities was especially
appropriate to improve skin appearance and cellulite.10 These
results show that Hypoxi training may be a safe and applicable
treatment for cellulite.
Resistance Training and Cellulite
In addition to endurance training, regular resistance training
using body weight has a beneficial effect on improving the
photo-numeric cellulite severity scale in women aged 18–65
years. Two home-based gluteal exercises were performed with
15 repetitions per leg twice a day over 12 weeks. However,
this effect was superior if the training program was combined
with 6 sessions of extracorporeal shock wave therapy (0.35
mJ/mm2, 2000 impulses) at both gluteal and thigh regions.11
While it appears that resistance training may reinforce the
therapeutic effect of routine treatments for cellulite, to date,
only one study has employed resistance training. Therefore,
there is a considerable need to examine the potential role of
this type of exercise.
Conclusions
Cellulite prevalence among women is a widespread concern
and it should be taken into more accurate consideration.
There are multiple factors associated with cellulite, and its
pathophysiology is complex. Thus, a complete treatment for
cellulite has not been well-established. Finding a comprehensive
method that targets these factors can be important. Although
exercise training can improve lipolysis and body composition
and decrease the severity of cellulite through increased blood
flow to adipose tissue, it seems that the combination of regular
physical activity and other therapeutic methods (i.e., diet,
infrared waves, extracorporeal shock wave, and LBP) is more
effective. However, it is not known which type of exercise
training (endurance, resistance, or combined training) and
what duration, intensity, and frequency of exercise is optimal
to achieve the best outcomes. Furthermore, there is no strong
evidence to indicate which type of therapeutic method used
in conjunction with exercise is more suitable and applicable.
Therefore, future, well-designed, prolonged studies should be
performed to determine these desired aspects.
Authors’ Contributions
BT and MK contributed equally to the study.
Conflict of Interest Disclosures
The authors declare that they have no conflicts of interest.
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