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Obesity is a multifactorial chronic disease, which affects more than 500 million people worldwide and contributes to
functional losses, poor quality of life, dementia, type 2 diabetes, and increases mortality rate, mainly due to cardiovascular
disorders and cancer. Considering the fail of conservative treatments, bariatric and metabolic surgery are considered the most
effective intervention and are among the most commonly performed gastrointestinal procedure in operating rooms today.
Although it can reach a record of >50% excess weight loss (EWL), in most cases there are up to 30% fat free mass loss, that
could compromise the long term results. The identification of the skeletal muscle as a secretory organ, mostly dependent
upon contraction and that can communicate with many organs, brought a new perspective about the importance of muscle
mass on the systemic health. The most effective intervention aiming to maintain and gain muscle mass is Strength Training,
integrated with consistent modifications in lifestyle. However, the first recommendation for hypertrophy is using loads close
to 80% of one repetition maximum (1RM), which can compromise articular integrity, due to a high mechanical load, low
grade inflammation, osteoarthritis and sedentary behavior. Subjects must follow an adaptation period that varies according
to the individual responses and nutritional intake. But what if we could increase the muscular activation level without raising
the load? It is plausible through the combination of Strength Training with Neuromuscular Electrical Stimulation (NMES),
that involves the application of an electric current through eletrodes placed over targeted muscle, while the subject does the
specific exercise. These combination is safe, and it can potentiates the muscle fiber activation, leading to quicker results in
strength, power, maximum voluntary force and possibly increasing the muscle cross sectional area (CSA), as many studies have
shown, in different cases, like reconstruction of the anterior cruciate ligament, osteoarthritis, spinal cord injury, patellofemoral
dysfunction, low back pain, preoperative total knee arthroplasty, COPD and even in athletes.