The use of class IV laser received increased body of support in clinical settings through its s successful therapeutic results. 182, 183, 184 HLLT safety can be demonstrated when considering the demonstrated of safety usage of laser in cosmetic applications that require use thousands of times more power than class IV therapy lasers. Since approved in 2005; class IV lasers therapy has been successfully introduced in verities of rehabilitation programs. 185 High-Level pulsed Nd: YAG laser works with high peak powers and able to stimulate deep tissues and organs that are difficult to be reached by LLLT. 186
The application of HLLT can result in therapeutic effects without tissue damage through control of photothermal and photomechanical processes. HLLLT, using a pulsed Nd:YAG laser, is characterized by a wavelength of 1064 nm that allows it to penetrate and spread more easily through the tissue. Moreover, with Nd:YAG pulses it is possible to deliver power peaks of up to 1000 Watt for times of 200µ seconds; extremely elevated peak intensity in very brief times. Pulsed nature of HLLLT prevents heat accumulation and tissue damage during treatment. At the same time, the photothermal effect can be controlled in terms of patient safety and comfort by modulating pulse intensity and frequency, 124 stimulation of several metabolic processes in addition to immunomodulation. 187 Because therapeutic efficacy of the treatment is “stimulus strength”-dependent, 188 it’s a realistic hypothesis that HLLT can yield more favorable results than LLLT due to its higher intensity and deeper penetration depth 176, 186, 187
Despite the dearth of published studies on the use of laser therapy, many problems and limitations exist, including the lack of standard protocols, there is no standard therapy programme regarding dose, period, type of laser and detailed therapy steps application. 189 literatures on laser therapy provide confusing clues, lack standardization makes it difficult to decide which protocol to follow during laser treatment. Each approach has its own parameters; power, energy, energy density, duration and wavelength that vary according to the underlying pathology. Furthermore; variability in laser parameters and application procedures (including wavelength, time of application, the distance between body and laser probe and frequencies) yielded different outcomes even in the same cases. 190
Studies conducted during the past two decades in Saudi Arabia have shown that obesity affects all age groups of both genders from both urban and rural areas. At least one out of three adults, one out of five adolescents and one out of ten children are suffering from obesity in KSA. 77, 78, 79, 80, 81, 82 Globalization and economic prosperity has been a double-edged sword for Saudi Arabia, and the country now must fight obesity along with the rest of the world. Something must be done to slow this “age of obesity” in Saudi Arabia. 191 It is urgent that national as well as international policies address rising obesity to prevent avoidable population deaths. Obesity in Saudi Arabia is a major and serious health problem, which needs further and new types of research mainly clinical trials, genetics, in addition to qualitative research, which deals with the attitude of obese patients toward their problem and quality?of?life. 192
Because obesity management in the Arab world is still in its early stages and much research in this area is urgently needed, societies should work hard to attain the WHO target trying to put an “obesity stop point” by 2025. Considering the progressive rising in the obesity epidemic; it is reasonable to take concerted actions and conduct more serious researches that should finally be translated into obesity control programs. Effective obesity management options should consider more complex strategies that incorporate both traditional and newly elaborated approaches to gain more success in the “obesity-fighting battle” and to alleviate the related consequences.
This study will be a preliminary work in which effects of modern HLLT technology as a newly established therapeutic modality in obesity management will be objectively evaluated. To our knowledge, and up to date and available literatures; no study has been conducted to clearly investigate the distinct effects of HLLT on obesity indices, ventilatory function, functional capacity and health related quality of life in obese patients. So, the aim of this study is to objectively evaluate effects of the HLLT as novel therapeutic modality in treatment of obesity to provide new treatment guidelines for obese patients.