Acupoint TENS vs Resistance Training for Iron Deficiency Anemia

Effect of Transcutaneous Electrical Acupoint Stimulation Versus Resistance Exercise on Hemoglobin Level in Women With Iron Deficiency Anemia

The current study is designed to compare between the effect of transcutaneous electrical acupoint stimulation and resistance exercises on hemoglobin level in women with iron deficiency anemia.The design of this study will be a randomized controlled trial (RCT) pretest post-test assessment.Sixty women diagnosed with iron deficiency anemia will be recruited in this study from Kafrelshiekh University Hospital, Kafrelshiekh Governorate, Egypt. Their ages will be ranged from 20 to 30 years old, and they will be randomly divided into three equal (n= 20) groups. Change in hemoglobin concentration (g/dL) after the intervention period and changes in RBC count, MCV, MCH, RDW, serum ferritin, fatigue level, and functional exercise capacity after treatment will be measured.

Study Overview

• Status: Recruiting
• Conditions: Iron Deficiency Anemia
• Intervention / Treatment: Device: Acupuncture transcutaneous electrical nerve stimulation (Acu-TENS); Drug: Ferrous Sulfate; Behavioral: Iron-rich diet with vitamin C; Behavioral: Avoidance of iron absorption inhibitors; Behavioral: Resistance exercise training

Detailed Description

Iron deficiency anemia (IDA) is one of the most common nutritional disorders among women and is associated with fatigue, weakness, reduced physical performance, and impaired quality of life. Non-pharmacological interventions such as Transcutaneous Electrical Nerve Stimulation (TENS) applied on acupuncture points such as gall bladder 39 and spleen 6 and resistance exercise may help improve circulation, stimulate physiological responses, and support hemoglobin production.This study is randomized controlled trial (RCT) pretest post test assessment aimed to compare the effects of acupoint TENS and resistance exercise on hemoglobin levels in women with iron deficiency anemia.Sixty women diagnosed with iron deficiency anemia will be recruited in this study . Their ages will be ranged from 20 to 30 years old, and they will be randomly divided into three equal (n= 20) groups as following:

1. Study group (A) includes 20 women who will receive acupuncture transcutaneous electrical nerve stimulation (Acu-TENS) in addition to routine medical treatment program.
2. Study group (B) includes 20 women who will undergo resistance exercise training in addition to routine medical treatment program.
3. Control group (C) includes 20 women who will receive routine medical treatment program only.

The treatment program will be applied once per day, three times per week for 12 consecutive weeks.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Phase 4

Contacts and Locations

• Study Contact: Name: Dina Ebrahim Mohamed Aboshady, BSc PT; Phone Number: 0201010481505; Email: dinaaboshady2020@gmail.com
• Study Contact Backup: Name: El-Sayed Essam El-Sayed Felaya, PhD; Phone Number: 0201007099643; Email: Elsayedessam22@yahoo.com

Study Locations

• Egypt
  • Cairo, Egypt
    • Recruiting
    • Kafrelsheikh University
    • Contact: Rasha Abdullah Elbahi Ragab, MD, PhD; Phone Number: 0201008046808; Email: Rasha_Ragab@med.kfs.edu.eg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Sixty women diagnosed with iron deficiency anemia within ≤6 months.
• Their hemoglobin concentrations ranging from 8.0 to 10.9 g/dL that classified as moderate anemia in accordance with the World Health Organization (WHO) criteria.
• The iron deficiency anemia resulted from the heavy monthly bleeding of menstrual cycle as reported by the women.
• Their age will be ranged from 20 and 30 years old.
• Their BMI will be ranged from 18.5 to 24.9 kg/m².
• They will have the same level of functional capacity assessed by 6-minute walking test.
• They will be receiving the same medical treatment programme.

Exclusion Criteria:

• Other causes of anemia (e.g., hemolytic anemia, anemia of chronic disease, megaloblastic anemia, thalassemia, or sickle cell disease).
• Severe anemia (hemoglobin < 8.0 g/dL)
• History of chronic kidney disease, liver disease, or malignancy.
• Current pregnancy or lactation, due to altered iron metabolism and hemoglobin thresholds.
• Recent blood transfusion or iron therapy (oral or intravenous) within the past 3 months.
• Use of hematopoietic agents (e.g., erythropoietin).
• Acute infection or inflammatory conditions at the time of enrollment.
• Inability or unwillingness to provide informed consent or comply with study procedures.
• Previous participation in complementary treatments/research within the last six months.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Study group (A); Study group (A) includes 20 women with iron deficiency anemia who will receive acupuncture transcutaneous electrical nerve stimulation (Acu-TENS) in addition to a routine medical treatment program.	Device: Acupuncture transcutaneous electrical nerve stimulation (Acu-TENS); This technique will be applied to the study group (A) only as follow: In the Acu-TENS group, electrodes of the TENS device will be applied over bilateral gall bladder 39 (on the lateral aspect of the lower leg, 3 cun above the tip of the external malleolus, on the anterior border of the fibula) and spleen 6 (a width of four fingers above the medial malleolus on the posterior border of the tibia); Drug: Ferrous Sulfate; Oral iron supplementation using ferrous sulfate 325 mg (approximately 65 mg elemental iron) administered as a single morning dose, preferably on alternate days, to optimize iron absorption and minimize gastrointestinal side effects based on current clinical recommendations.; Behavioral: Iron-rich diet with vitamin C; Dietary intervention including increased intake of iron-rich foods (such as red meat and legumes) along with vitamin C-rich foods (such as citrus fruits) to enhance iron absorption.; Behavioral: Avoidance of iron absorption inhibitors; Participants are advised to avoid tea, coffee, calcium, and antacids within 2 hours of iron intake to optimize absorption.
Experimental: Study group (B); ) Study group (B) includes 20 women with iron deficiency anemia who will undergo resistance exercise training in addition to routine medical treatment program.	Drug: Ferrous Sulfate; Oral iron supplementation using ferrous sulfate 325 mg (approximately 65 mg elemental iron) administered as a single morning dose, preferably on alternate days, to optimize iron absorption and minimize gastrointestinal side effects based on current clinical recommendations.; Behavioral: Iron-rich diet with vitamin C; Dietary intervention including increased intake of iron-rich foods (such as red meat and legumes) along with vitamin C-rich foods (such as citrus fruits) to enhance iron absorption.; Behavioral: Avoidance of iron absorption inhibitors; Participants are advised to avoid tea, coffee, calcium, and antacids within 2 hours of iron intake to optimize absorption.; Behavioral: Resistance exercise training; Resistance exercise training: This type of exercise training will be applied to the study group (B) only as follow: Resistance exercise is commonly prescribed using the FITT principle (Frequency, Intensity, Time, and Type).Multi-joint resistance exercises covering major muscle groups (legs, back, arms, core), by using free weights for legs and arms, body weight through (squats, lunges and pushups).
Active Comparator: Control group (C); Control group (C) includes 20 women with iron deficiency anemia who will receive routine medical treatment program only.	Drug: Ferrous Sulfate; Oral iron supplementation using ferrous sulfate 325 mg (approximately 65 mg elemental iron) administered as a single morning dose, preferably on alternate days, to optimize iron absorption and minimize gastrointestinal side effects based on current clinical recommendations.; Behavioral: Iron-rich diet with vitamin C; Dietary intervention including increased intake of iron-rich foods (such as red meat and legumes) along with vitamin C-rich foods (such as citrus fruits) to enhance iron absorption.; Behavioral: Avoidance of iron absorption inhibitors; Participants are advised to avoid tea, coffee, calcium, and antacids within 2 hours of iron intake to optimize absorption.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in hemoglobin concentration	Change in hemoglobin concentration (g/dL) measured before and after the intervention period.	3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in red blood cell (RBC) count	Change in red blood cell (RBC) count measured before and after the 3-month intervention period.	Baseline to 3 months
Change in mean corpuscular volume (MCV)	Change in mean corpuscular volume (MCV) measured before and after the 3-month intervention period.	Baseline to 3 months
Change in serum ferritin level	Change in serum ferritin (ng/mL) measured before and after the 3-month intervention period.	Baseline to 3 months
Change in fatigue level	Change in fatigue level assessed using the Fatigue Severity Scale (FSS). The FSS consists of 9 items, each scored from 1 to 7, with total scores calculated as the average of all items. Higher scores indicate greater fatigue severity.	Baseline to 3 months
Change in health-related quality of life	Change in health-related quality of life assessed using the Short Form-36 (SF-36) Health Survey. The SF-36 includes 36 items covering 8 domains, with each domain scored from 0 to 100. Higher scores indicate better health status and quality of life.	Baseline to 3 months
Change in cardiorespiratory fitness	Change in cardiorespiratory fitness assessed using the 6-Minute Walk Test (6MWT). The test measures the total distance walked in meters over 6 minutes, with higher distances indicating better functional exercise capacity and cardiorespiratory fitness.	Baseline to 3 months

Collaborators and Investigators

• Sponsor: Cairo University
• Collaborators: Kafrelsheikh University
• Investigators: Study Director: Dina Ebrahim Mohamed Aboshady, BSc PT, Faculty of Physical Therapy, Kafrelsheikh University; Principal Investigator: Nagwa Mohamed Hamed Badr, PhD, Cairo university; Principal Investigator: Dina Ebrahim Mohamed Aboshady, BSc PT, Faculty of Physical Therapy, Kafrelsheikh University

Publications and helpful links

General Publications

• Divya Mary, S. M., & Priyadharshini, P. (2022). Impact of resistance exercise versus diet supplements on iron deficiency anemia in girls. International Journal of Medical and Exercise Science, 8(2), 1302-1310. DOI:10.36678/IJMAES.2022.V08I02.006
• Hegazy, M., Obaya, H., Mohamed, F., & Draz, R. (2024). Effect of transcutaneous electrical acupoint stimulation versus aerobic exercise on iron deficiency anemic females. Bulletin of International Journal of Physiotherapy, 2(2), 28-34. https://doi.org/10.21608/BIJPT.2024.304165.1036

Study record dates

Study Major Dates

• Study Start (Actual): January 15, 2026
• Primary Completion (Estimated): August 15, 2026
• Study Completion (Estimated): October 15, 2026

Study Registration Dates

• First Submitted: May 8, 2026
• First Submitted That Met QC Criteria: May 18, 2026
• First Posted (Actual): May 26, 2026

Study Record Updates

• Last Update Posted (Actual): May 26, 2026
• Last Update Submitted That Met QC Criteria: May 18, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Iron Deficiency Anemia; Resistance Exercise; Hemoglobin levels; Acupoint TENS
• Additional Relevant MeSH Terms: Metabolic Diseases; Hematologic Diseases; Anemia; Iron Metabolism Disorders; Anemia, Hypochromic; Nutritional and Metabolic Diseases; Hemic and Lymphatic Diseases; Iron Deficiencies; Anemia, Iron-Deficiency; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Organic Chemicals; Therapeutics; Physical Therapy Modalities; Carbohydrates; Sugar Acids; Acids, Acyclic; Carboxylic Acids; Hydroxy Acids; Patient Care; Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Physical Conditioning, Human; Exercise; Ascorbic Acid; Resistance Training; ferrous sulfate
• Other Study ID Numbers: P.T.REC/012/006329

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No