Whole-Body Vibration Training in Women With Obesity With and Without Type 2 Diabetes

Women with obesity and type 2 diabetes will receive supervised whole-body vibration training twice weekly for eight weeks, totaling 16 sessions. Training will be delivered using a side-alternating vibration platform and will progress through three stages: weeks 1-2, 3-5, and 6-8. Each session will include a walking warm-up, platform-based exercises, and mat-based cool-down exercises. Exercises will be adapted to participants' functional capacity and tolerance within the protocol limits. Perceived exertion will be recorded using the Borg 6-20 scale after each session. Assessments will be performed before and after the intervention.

Supervised whole-body vibration training will be delivered using a Hypervibe G14 Home V3 side-alternating platform twice weekly for eight weeks (16 sessions). The program comprises three stages: weeks 1-2, 3-5, and 6-8. Exercise-specific frequencies range from 6 to 30 Hz. Planned active vibration exposure per session is 12 minutes, 10.5 minutes, and 15.5 minutes across the three stages, respectively. Sessions include a 5-minute walking warm-up, platform-based exercises and vibration massage, followed by mat-based cool-down exercises. Exercise position, range of motion, support, duration, and rest will be adapted to participant tolerance within protocol limits. Borg 6-20 ratings will be recorded after each session, with a target perceived exertion of 12-14 guiding subsequent adjustments. Both groups will receive the same protocol.

Women with obesity without type 2 diabetes will receive the same supervised whole-body vibration training program as participants with type 2 diabetes, twice weekly for eight weeks, totaling 16 sessions. Training will be delivered using a side-alternating vibration platform and will progress through three stages: weeks 1-2, 3-5, and 6-8. Each session will include a walking warm-up, platform-based exercises, and mat-based cool-down exercises. Exercises will be adapted to participants' functional capacity and tolerance within the protocol limits. Perceived exertion will be recorded using the Borg 6-20 scale after each session. Assessments will be performed before and after the intervention.

Supervised whole-body vibration training will be delivered using a Hypervibe G14 Home V3 side-alternating platform twice weekly for eight weeks (16 sessions). The program comprises three stages: weeks 1-2, 3-5, and 6-8. Exercise-specific frequencies range from 6 to 30 Hz. Planned active vibration exposure per session is 12 minutes, 10.5 minutes, and 15.5 minutes across the three stages, respectively. Sessions include a 5-minute walking warm-up, platform-based exercises and vibration massage, followed by mat-based cool-down exercises. Exercise position, range of motion, support, duration, and rest will be adapted to participant tolerance within protocol limits. Borg 6-20 ratings will be recorded after each session, with a target perceived exertion of 12-14 guiding subsequent adjustments. Both groups will receive the same protocol.

Bilateral tibialis anterior muscle activation will be measured using surface electromyography during level walking, tandem walking, and tandem standing. Root mean square (RMS) amplitudes will be normalized to the corresponding muscle- and side-specific maximal voluntary isometric contraction (MVIC) reference and expressed as %MVIC. For each side and task, both mean and maximum normalized RMS amplitudes will be calculated for each valid trial and averaged separately across three valid trials. Mean and maximum amplitudes will be analyzed separately; no composite score will be calculated. Changes will be calculated as the post-intervention value minus the corresponding baseline value and expressed in percentage points of MVIC. Right and left sides and the three tasks will be evaluated separately.

Bilateral soleus muscle activation will be measured using surface electromyography during level walking, tandem walking, and tandem standing. Root mean square (RMS) amplitudes will be normalized to the corresponding muscle- and side-specific maximal voluntary isometric contraction (MVIC) reference and expressed as %MVIC. For each side and task, both mean and maximum normalized RMS amplitudes will be calculated for each valid trial and averaged separately across three valid trials. Mean and maximum amplitudes will be analyzed separately; no composite score will be calculated. Changes will be calculated as the post-intervention value minus the corresponding baseline value and expressed in percentage points of MVIC. Right and left sides and the three tasks will be evaluated separately.

Bilateral medial gastrocnemius muscle activation will be measured using surface electromyography during level walking, tandem walking, and tandem standing. Root mean square (RMS) amplitudes will be normalized to the corresponding muscle- and side-specific maximal voluntary isometric contraction (MVIC) reference and expressed as %MVIC. For each side and task, both mean and maximum normalized RMS amplitudes will be calculated for each valid trial and averaged separately across three valid trials. Mean and maximum amplitudes will be analyzed separately; no composite score will be calculated. Changes will be calculated as the post-intervention value minus the corresponding baseline value and expressed in percentage points of MVIC. Right and left sides and the three tasks will be evaluated separately.

Neuropathic symptoms will be assessed using the questionnaire section of the Michigan Neuropathy Screening Instrument in women with obesity, with and without type 2 diabetes. The questionnaire contains 15 yes/no items, of which 13 contribute to the total score. Scores range from 0 to 13, with higher scores indicating more neuropathic symptoms. Change will be calculated as the post-intervention score minus the baseline score. Negative changes indicate fewer reported symptoms.

Peripheral neuropathy signs will be assessed using the physical examination section of the Michigan Neuropathy Screening Instrument in women with obesity, with and without type 2 diabetes. Both feet will be examined for abnormal appearance, ulceration, ankle reflexes, vibration perception at the great toe, and monofilament sensation. The total score ranges from 0 to 10, with higher scores indicating more abnormal findings. Change will be calculated as the post-intervention score minus the baseline score. Negative changes indicate fewer clinical signs of neuropathy.

Functional mobility will be assessed using the Timed Up and Go test. The time required to rise from a chair, walk 3 meters, turn, return to the chair, and sit down will be recorded in seconds. Two trials will be performed at each assessment, and their mean completion time will be used for analysis. Lower values indicate better functional mobility. Change will be calculated as the post-intervention mean time minus the baseline mean time. Negative changes indicate improved performance.

Body mass index (BMI) will be calculated as body weight in kilograms divided by height in meters squared and expressed in kg/m². Body weight will be measured using the Tanita BC-418 analyzer. Change will be calculated as post-intervention BMI minus baseline BMI.

Total body fat percentage will be estimated using the Tanita BC-418 segmental bioelectrical impedance analyzer under standardized measurement conditions. Values will be expressed as a percentage of total body weight. Change will be calculated as the post-intervention value minus the baseline value and expressed in percentage points. Negative changes indicate a reduction in body fat percentage.

Total fat-free mass will be estimated using the Tanita BC-418 segmental bioelectrical impedance analyzer under standardized measurement conditions and expressed in kilograms. Fat-free mass includes all non-fat body components and is not equivalent to skeletal muscle mass. Change will be calculated as post-intervention fat-free mass minus baseline fat-free mass.

Segmental predicted muscle mass will be estimated using the Tanita BC-418 segmental bioelectrical impedance analyzer under standardized measurement conditions. Device-derived estimates will be recorded in kilograms for the right arm, left arm, right leg, left leg, and trunk. Each segment will be evaluated separately. Change will be calculated as the post-intervention value minus the baseline value for each segment.

Body weight will be measured in kilograms using the Tanita BC-418 analyzer under standardized measurement conditions. Change will be calculated as post-intervention weight minus baseline weight. Negative values indicate a reduction in body weight.