Electrical Muscle Stimulation (EMS) is increasingly used in aesthetic medicine, physiotherapy, and rehabilitation. Its effectiveness and patient compliance depend largely on the tolerance of electrical impulses, which can induce discomfort or pain. Understanding factors that influence pain thresholds is essential for optimizing treatment protocols and ensuring patient safety.

This pilot study investigated the relationship between body composition, skin parameters, and pain tolerance to EMS stimuli in women. Sixteen healthy female participants (mean age 35.9 ± 12.3 years) underwent comprehensive anthropometric assessments, bioelectrical impedance analysis (BIA), and high-frequency ultrasound of abdominal skin. EMS was applied to the abdominal region using the Evolvex system (InMode, Israel), with gradually increasing intensity until the pain threshold was reached. The maximum tolerated EMS intensity ranged from 12V to 55V (median 33V). Significant positive correlations were found between pain tolerance and body weight (R=0.76, p<0.001), hip circumference (R=0.66, p<0.001), body fat mass (R=0.61, p=0.012), visceral fat area (R=0.55, p=0.029), and skinfold thickness (R=0.61, p=0.013). No significant associations were observed with muscle mass, water compartments, or skin ultrasound parameters.

These findings suggest that tolerance to EMS is strongly influenced by adipose tissue characteristics and selected anthropometric indices, whereas muscle tissue and skin structural parameters play a negligible role. Women with higher body fat levels exhibited greater tolerance to electrical stimulation, likely due to current attenuation in adipose tissue.

This study highlights the importance of individualized EMS protocols tailored to patient body composition. Personalized adjustment of stimulation intensity may improve treatment comfort, adherence, and clinical outcomes in both aesthetic and rehabilitative settings. Future studies with larger and more diverse cohorts are warranted to confirm these preliminary observations.

Agata Lebiedowska obtained her PhD in Medical and Health Sciences from the Medical University of Silesia in Katowice in 2019. She also holds a Master’s degree in Biotechnology and a Bachelor’s degree in Cosmetology from the same university. Her doctoral research focused on the physiological effects of stochastic mechanical vibration on female body composition assessed by bioimpedance analysis.

She is currently a researcher at the Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia. Her scientific work integrates cosmetology, dermatology, medical biotechnology, and aesthetic medicine. She has authored and co-authored numerous peer-reviewed publications in international journals with a cumulative Impact Factor exceeding 77. Her recent research includes studies on electrical muscle stimulation tolerance, non-invasive diagnostic methods, advanced light-based and injectable treatments, and quantitative imaging of skin physiology.

She has been actively involved in several national and international research projects, serves as a reviewer for international scientific journals, and acts as an external expert for agencies such as the Medical Research Agency and the Foundation for Polish Science. She is also a certified court expert in the field of medical biotechnology, cosmetology, and pharmaceutical sciences. Her academic and professional activities reflect a strong focus on evidence-based innovation in cosmetology and aesthetic medicine.