## 4 Discussion
necessary to propose more extended aerobic tasks in order to obtain a significant drop in blood pressure, as stated by different authors [88; 89]. Recently, WB-EMS is an effective tool for improving muscle strength outcome measurements in deconditioned subjects [11]. However, an excessive intensity in the first phase of a WB-EMS training program was related to some severe side effects. A few case reports have characterized substantial muscle damage and rhabdomys following just one single training session [90; 91; 92]. In fact, recent studies showed an extreme increase in muscle damage markers, such as CK after a WB-EMS application [93; 94]. In the present study, the results showed values considered normal in the literature [95]. An increase of CK values begins between 2 and 12 h after the muscular damage and then a progressive decrease is observed during the next five days if the exercise stops [96]. Muscular damage is usually accompanied by an increase of GGT and ALT, which could emulate hepatic damage [97]. In the present study, the GGT and ALT decreased, which could confirm, together with the CK values, that no subject of this study suffered rhabdomy. As indicated by the literature, the correct application of the training program by professionals is important for safe and effective training [91; 93]. In this study, the training protocols were supervised by two instructors graduated in Physical Activity and Sports Sciences and post-graduated in Sports Training. Their academic formation and wide experience in WB-EMS training guaranteed the correct training load administration, which led to safety training with a decreasing GGT and ALT. We observed changes in triglycerides in both groups, which is in agreement with the results of previous studies showing a positive influence of concurrent training in the blood triglyceride values [98; 99]. This could be explained by the idea that combined strength and aerobic training increases the rate of fat oxidation, also presenting triglycerides as an important source of fuel for this type of exercise. Exercise would lead to triglycerides consumed by muscle tissue, and increases lipoprotein lipase (LPL), which would result in more triglycerides hydrolysis [100]. Recent studies have shown that low skeletal muscle mass can contribute to NAFLD, mostly in postmenopausal women [101; 102]. The FLI was described by [PERSON] et al., 2006 [68] for the diagnosis of patients with NAFLD, and includes BMI, abdominal circumference, triglycerides and GGT, with values ranging from 0 to 100. NAFLD, which is associated with cardiovascular disease, is characterized by the deposition of free fatty acids and triglycerides in the cytoplasm of hepatocytes, in the form of large vacuoles, in patients without toxic alcohol consumption, and not associated with other liver diseases [103; 104]. It is also a predictor of type 2 diabetes [105]. Thus, the role of FLI as an independent marker of cardiovascular disease, without cardiovascular risk factors, is interesting. According to the results of three studies, when FLI value is higher than 60, it indicates an increased cardiovascular risk [106; 107]. In our work, we found that FLI improved significantly after 10 weeks of training in both groups. The whole sample ended up with FLI below 30, which is the value recommended by scientific societies as a predictor of good health [108]. It should be noted that, in the case of the EX + WB-EMS group, the effect size was much larger than in the EX group. The improvement of some subject's FLI in this study may reflect the reduction of ectopic fat deposits that are responsible for the improvement of insulin resistance, these results would confirm those found by other authors [106]. Some studies suggested positive effects of an exercise intervention on liver metabolic signaling pathways, such as improved oxidative enzyme activity, increased fatty acid oxidation and reduced intracellular lipid accumulation in the liver [109]. [PERSON] et al.