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Abstract

Whole-body electromyostimulation WB-EMS. is a young and time-effective training technology. Comparing the effect of WB-EMS with conventional resistance training, both methods were reported to be similarly effective on muscle mass, strength and cardiometabolic risk. However, due to its exceptional time efficiency, joint friendliness and individualized setting, WB-EMS may be a good choice for people unable or simply unwilling to conduct intense resistance training protocols. However, recent literature has reported negative side-effects concerning WB-EMS-induced rhabdomyolysis. Indeed, due to the ability to innervate large muscle areas simultaneously with dedicated individual intensity per muscle group, WB-EMS features many factors known to be associated with muscle damage. A recent WB-EMS study applying an initial application to exhaustion to healthy novices confirmed the reported exceptionally high creatine-kinase CK. concentrations. Although the study did not detect any of the reported clinical consequences of this “severe” rhabdomyolysis i.e. ≥50fold increase of resting CK., in less fit subjects who were neither optimally prepared nor supervised, initial WB-EMS to exertion may have more far-reaching consequences. Of importance, a subsequent WB-EMS conditioning phase of 10 weeks completed by a second WB-EMS test application to exhaustion demonstrated CK-peaks in the range of conventional resistance exercise. Thus, in summary a. too intense initial WB-EMS may indeed result in a severe rhabdomyolysis b. thus, initial WB-EMS application to exhaustion must be strictly avoided, and c. frequent WB-EMS application demonstrated a very pronounced repeated bout effect after a short conditioning phase.
218 DEUTSCHE ZEITSCHRIFT FÜR SPORTMEDIZIN 67. Jahrgang 9/2016
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SHORT REPORT
Introduction
Whole-body electromyostimulation (WB-EMS) is a
young and time eective training technology that
focuses primarily on body composition (i.e. muscle,
bone, fat tissue) and strength-related parameters
(5, 7, 9, 13, 14). However, other health rela ted outcomes
(i.e. cardio-metabolic risk factors) (4) were also re-
ported to be positively aected by WB-EMS. A di-
rect comparison of WB-EMS and the slightly more
time-consuming High Intensity (Resistance) Trai-
ning (H IT) (WB-EMS: 1. 5x20 vs. HI T: 2x30 min/week)
Whole-Body Electromyostimulation –
The Need for Common Sense! Rationale and
Guideline for a Safe and Effective Training
Prof. Dr. Wolfgang Kemmler
Friedrich-Alexander University Erlangen
(FAU), Institute of Medical Physic s
Henkestras se 91
91054 Erlangen, Germany
: wolfgang .kemmler@imp.uni-e rlangen.de
SCHLÜSSELWÖRTER:
Elektrostimulation, Kreatinkinase, Rhabdomyolyse,
WB-EMS-Applikation
KEY WORDS:
Electrostimulation, Creatine-Kinase, Rhabdomyolysis,
Recommendation WB-EMS
Whole-body electromyostimulation (WB-EMS) is a young
and time-ee ctive trai ning technolog y. Comparing the ee ct of
WB-E MS with conventional resista nce training , both methods
were report ed to be simil arly eective on mu scle mass, stre ngth
and card iometabolic risk . However, due to its exceptiona l time
eciency, joint friend liness and i ndividua lized set ting, W B-EMS
may be a good choice for people unable or simply unwilling t o
conduct inten se resistance t raining prot ocols.
However, recent literat ure has reported negative side -eects
concerning WB-EMS-induced rhabdomyolysis. Indeed, due
to the ability to innervate large muscle areas simultaneously
with ded icated ind ividual i ntensity per mus cle group, WB-E MS
features many fact ors known to be as sociated with mu scle da-
mage. A recent W B-EMS st udy applyi ng an initia l application t o
exhau stion to healthy nov ices conrmed the reported excepti-
onally h igh creatine-kinas e (CK) concentration s. Although the
study did not detect any of the r eported clinic al consequences
of this “severe” rha bdomyolysis (i.e. ≥50fold increa se of resting
CK), in less t su bjects who were neither opt imally pre pared nor
superv ised, init ial WB-EMS t o exertion may have more far-r ea-
ching consequences.
Of importance, a subsequent WB-EMS conditioning phase
of 10 weeks complete d by a second WB-EM S test application t o
exhau stion demonstra ted CK-peaks i n the range of convention al
resistance exercise.
Thus, in summary (a) too inten se initial W B-EMS may indee d
result in a s evere rhabdomyolysis (b) thus, in itial WB-EM S ap-
plicat ion to exhaus tion must be str ictly avoided, a nd (c) frequent
WB-E MS applicati on demonstrated a ver y pronounced repe ated
bout eect af ter a short condit ioning phase.
Ganzkörper-Elektromyostimulation (WB-EMS) erfreut
sich durch Zeit ezienz, Indi vidualisierba rkeit und Eektiv ität
zunehmender Beliebtheit. In jüngster Vergangenheit wurden
nach Erst anwendung von WB-E MS in Einzelf ällen jedoch (ex-
trem) hohe Kreat inkinase (CK)-Werte berichtet, die i n einem
gesundheitlich bedenk lichen Bereich liegen. Bed ingt durch die
ächige si multane Appli kation mit dez idierter An steuerung der
Stimula tionsächen treen f ür WB-EMS du rchaus die meisten
Voraussetzu ngen für eine „e xertional R habdomyolysis“, also ei ne
ausgeprä gte körper traini ngs-induzier te Muskelschä digun g zu.
Tatsächlich zeigte eine kürzlich erschienene Untersuchung
mit gesunden Spor tlern ohne WB -EMS Vorerfahrung n ach aus-
belaste ter, also hochintensiver, WB-EMS -Erstapplika tion eine
117-fache Erhöhung der CK-Konzentrations-Werte im Bereich
einer schweren („severe“) Rh abdomyolyse (≥50-fache Erhöhung
des Ruhe-C K). Obwohl für keinen der 26 St udienteilneh mer die in
der Literatu r berichten negati ven renale und kard ialen Indizien
einer (schweren) Rhabdomyolyse vorlagen , mögen die Konse-
quenzen bei vorges chädigt en, leistun gsschwachen und sc hlecht
vorbereiteten Ind ividuen deutlich dr amatischer ausfa llen.
Eine nachfolgende Untersuchung, welche den Eekt regel-
mäßigen W B-EMS-Trainings ev aluierte, zeig te nach 10-wöchi-
gem Konditionier ungszeitraum und anschließender, wieder-
um ausbelasteter, WB-EMS-Applikation einen ausgeprägten
„repeate d bout eect“ mit CK-Spitzenw erten im unteren B ereich
konventionellen K raftt raini ngs (<1000 IE/l), also in ei nem unbe-
denkl ichen Bereich.
Als Fazit le iten wir ab, d ass (a) unsachgemäße W B-EMS-Er stap-
plikation durchaus negative gesundheitliche Konsequen-
zen haben kann, (b) eine ausbelastende bzw. sehr intensive
WB-E MS-Erstapp likation i n jedem Fall zu unter bleiben hat und
(c) ein rascher G ewöhnungseek t auch hinsichtl ich ausbelaste -
ter WB -EMS-Appli kation auf tritt. L etzteres ist z ur Realis ierung
relevanter E ekte, vergleichba r einem konventionellen K rafttr ai-
ning , nicht zwin gend nötig.
July 2 016
10.5960/dzsm.2 016.24 6
Kemmler W, Froehlich M, von
Stengel S, Kleinöder H. Whole-Body
Electromy ostimulation – The Need for
Common Sense! Rationale and Guideline
for a Safe and Effe ctive Training. Dtsch Z
Sportmed . 2016; 67: 218-221.
Sept ember 2016
1. FRIEDRICH-ALEXANDER UNIVERSITY
ERLANGEN-NÜRNBERG, In stitute of
Medical Physics, Erlangen-Nürnberg,
Germany
2. UNIVERSITY OF KA ISERSLAUTERN,
Depar tment of Sport s Science,
Kaiserslautern, Germany
3. GERMAN SPORT UNIVERSITY COLOGNE,
Depar tment of Exerc ise Science s,
Cologne, Germany
Kemmler W 1, Froehlich M 2, von Stengel S 1, Kleinöder H 3
Ganzkörper-Elektromyostimulation –
eine Richtlinie zur sicheren und eektiven Anwendung
SHORT REPORT
219DEUTSCHE ZEITSCHRIFT FÜR SPORTMEDIZIN 67. Jahrgang 9/2016
WB-EMS Guideline
has shown that both methods are similarly eective in increa-
sing body composition, strength (7, 8) and cardio-metabolic
risk (4, 8). However, due to its exceptional time eciency (7),
joint friendliness and individualized setting, WB-EMS may be
a good choice for people unable or simply unwil ling to conduct
intense resistance training protocols. However, in a recent let-
ter to the British Medical Journal, Malnick et al. addressed the
potential risks of WB-EMS and “the need to regulate the use
of whole body electrical stimulation” (11). Indeed recent scien-
tic literature has reported negative side-eects concerning
WB-EMS induced increases in creatine-kinase up to a level of
severe rhabdomyolysis (i.e. >50-fold increases compared with
resting levels) (1, 2, 12).
Summarizing the mechanisms of exertional rhabdomyoly-
sis, in genera l WB-EMS u ndeniably features most of the factors
known t o be associated w ith (resista nce) exercise induc ed mus-
cle damage and very pronounced muscle soreness (10). Espe
-
cially the outstanding feature to innervate large muscle areas
(12-14 electrodes w ith up to 2,800 cm
2
) simultaneously, but wit h
dedicated indiv idual intensity p er electrode/muscle group, may
contribute to the problem of WB-EMS induced rhabdomyoly-
sis, at least when applying too high (current) intensity. us,
an adequate WB-EMS application is essential for preventing
rhabdomyolysis and corresponding renal, hepatic and cardiac
consequences.
In a recent study, we applied a ty pical but borderline ex haus-
tive WB-EMS protocol (20min , bipolar, 85Hz, 350µs, rectang u-
lar, 6s of current, 4s of rest) to 37 healthy WB-EMS novices (6).
And indeed, the CK increase af ter this borderline (too) intense
initial WB-EMS application conrmed the reported excep-
tionally high CK-levels and very pronounced muscle soreness
from 48h-96h (6). In detail, CK-concentration rose 117-fold
(28545±33 611 IU/l) with a peak a fter 72h and was 10 times hig h
-
er compared with the CK-levels after a marathon run that was
monitored in parallel (2795±883 IU/l after 48h). Although, we
did not detect any of the repor ted clinical consequences of t his
“severe” rhabdomyolysis on renal and cardiac risk factors (15),
in less t and healthy subjects neither optimally prepared
nor supervised, initial WB-EMS to exertion may have more
far-reaching consequences.
Signicantly, a subsequent WB-EMS conditioning phase of
10 weeks (1x20min WB-EMS/week, see above) completed by a
second WB-EMS te st session to exhaustion demonstrat ed a very
pronounced “repeated bout eect ” with indiv idual CK-peaks a ll
below 200 0 IU/l (MV±SD: 906±500 I U/l), i.e. in the lower ra nge of
conventional resista nce exercise trai ning (6, 10). is result
Guideline for Safe and Effective WB-EMS
In General
1. Safe and effective Whole-Body-EMS Training must be advised and ac-
companied by a trained and licensed WB-EMS trainer or scientifically
trained personnel familiar with this field of application.
2. Before the first training session of every beginner, an anamnesis of
possible contraindications based on a list of questions must be taken
and then documented in writing, confirmed by the client‘s signature
and archived. Where relevant anomalies are found, a doctor is to be
consulted and training only be commenced if clearance has been given.
Preparing for Training
1. As with any kind of intensive training, Whole-Body EMS training must
only be carried out in a good physical condition and free of pain. This
includes abstaining from alcohol, drugs, stimulants/muscle relaxants
or stress ahead of the training session. Training must never be carried
out by anybody suffering from an illness with fever.
2. Whole-Body-EMS training leads to very high metabolic stress of the
organism because of very high volume of muscle mass addressed. This
factor has to be taken into account through sufficient food intake that
is as high in carbohydrates as possible. If this is not possible, then at
least a high carbohydrate, but light snack (≈250kcal) should be eaten,
ideally about 2 hours before training.
3. So as to avoid possible renal stress (especially with undiagnosed prob-
lems) through intensive WB-EMS, additional fluids should be consumed
before/during and after training (500ml each).
4. Generally, medical – ideally sport-medicinal – consultation and clarifi-
cation is advisable in the case of any discomfort, physical restrictions,
infections or other internal, cardiological or orthopedic illnesses.
Training
1. Regardless of physical status, sport experience and the user‘s wishes
to that effect, under no circumstances may WB-EMS training to
exhaustion take place during the first training session or trial training.
In the past, this has led to undesired side effects and negative health
consequences and must be avoided at all costs.
2. After moderate initial WB-EMS, the stimulation level or current must
be successively increased and adapted to the individual goals. The
highest level is to be reached only after 8-10 weeks of systematic trai-
ning at the earliest (user‘s subjective effort impression: hard-hard+).
Training to complete exhaustion, especially in the sense of painful, con-
tinuous tetanus during the current phase, must generally be avoided.
3. In addition, the initial training should be conducted with a reduced
effective training period. Advisable is 5min impulse familiarization and
a curtailed training session with moderate stimulus intensity (user‘s
subjective effort impression: a bit hard) and 12min intermittent load
with short impulse phase (~4s). Only then should the training duration
be cautiously increased and never exceed 20min.
4. To ensure sufficient conditioning and to minimize or rule out possible
health impairments, training frequency may not exceed one training
unit per week during the first 8-10 weeks.
5. Even after this conditioning phase, an interval of ≥4 days must be
maintained between training units in order to avoid accumulation of
muscle breakdown products, permit regeneration and adaptation and
thus ensure a successful training outcome.
Safety Aspects During and After Training
1. During the training session, the trainer or the trained and qualified
personnel should concentrate exclusively on the interests of the user(s).
Before, during and after training the trainer verbally and visually
checks the user‘s condition so as to rule out health risks and ensure
effective training. Training is to be stopped immediately if there are any
contraindications.
2. During training, the equipment‘s operating controls must be directly
in reach of the trainer and the user at all times. Operation/adjustment
must be simple, quick and precise.
3. Actually, we generally advise against private use of technology without
support of a qualified and licensed trainer/instructor or correspon-
dingly scientifically trained personnel.
SHORT REPORT
220 DEUTSCHE ZEITSCHRIFT FÜR SPORTMEDIZIN 67. Jahrgang 9/2016
Richtlinien Ganzkörper-EMS
indicates that a short period of careful W B-EMS conditioning
should be mandatorily implemented in order to realize a safe
application.
Conclusion
We conclude that the problem of WB-EMS induced rhab-
domyolysis can be easily prevented with a minimum of com-
mon sense. Firstly, although some groups of highly motivated
WB-EMS novices may request an exertional initial WB-EMS
application, this approach should be strictly avoided. In pa ral-
lel, no clear-thinking instructor would apply an intense eccen-
tric resistance traini ng protocol to muscular failure during the
initial session to a resistance t raining nov ice. Secondly, as wit h
conventional resistance exercise there is no need to focus on
WB-EMS to ex haustion in order to generate relevant eects on
body composition and functional capacity (3, 7). Additionally,
contraindications for WB-EMS should be strictly heeded and
WB-EMS novices adequately informed so as to ensure a safe
and successful WB-EMS application. In order to realize the
latter aim, in a German consensus conference in December
2015, WB-E MS manufact urers (miha-body tec, Gersthofen, Ger -
many), educational institutions (GluckerKolleg, Kornwestheim,
Germa ny), Licensees (P T Lounge Köln, Colog ne, Germany) and
publishing researchers (see below) discussed the topic. Finally
in April 2016, the scientic part of the consortium (Fröhlich,
M.; Kemmler, W.; Kleinöder, H. v. Stengel, S.) has formulated a
general guideline, that we would like to disseminate and pub-
lish here. We are aw are that WB-EMS is a young and innovative
technolog y with considerable f urther potential, thu s extensions
and changes of this guideline may be necessary in the nearest
futu re. However, we think t he general recommendation s listed
may be a rst step to a more safe and eective WB-EMS appli-
cation.
Conict of Interest
e authors are aware that some commercial partners may have
had a conict of interest with respect to some issues. However,
the nal responsibility for the generation of this guideline clearly
lies by the authors.
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... Before commencing training, all subjects attended a preliminary screening, which included a medical anamnesis and physical examination to monitor agreement with the inclusion criteria. Participants were informed about contraindications [12,18]. ...
... Both groups ran twice weekly for eight weeks either with (EG) or without wbEMS (CG). Each training was limited to 20 min [18] and there was at least 48 h of rest between two sessions [20]. Training intensity was increased based on the results of the initial incremental step test every two weeks and controlled by means of perceived exertion (rating of perceived exertion > 7 out of 10, Supplemental Table 1) as described elsewhere [19]. ...
... In Krause et al. (2023) the procedure for wbEMS (Xenoma, Japan) is described in detail. The stimulation parameters were defined according to current scientific guidelines in order to ensure the safety of the participants and to rule out muscle spasms, co-activation or disabilities during motion [8,18,21,22]. Specifications were as follows: 26 bipolar electrodes transferred the electrical current to the muscles of the back (4), chest (4), abdomen (4), hip (2), thigh (8) and arms (4). Bipolar impulse type, stimulation sequencing 85 Hz, single stimulus width 180µs, rise 700 ms, duty cycle 50% on and 50% off (3 s on-and 3 s off-time). ...
Article
Full-text available
Background Applying whole-body electromyostimulation (wbEMS) to voluntary activation of the muscle is known to impact motor unit recruitment. Thus, wbEMS as an additional training stimulus enhances force-related capacities. This study aimed to evaluate the mono- and multiarticular strength adaptations to a running intervention with wbEMS compared to running without wbEMS. Methods In a randomized controlled trial (RCT), 59 healthy participants (32 female/ 27 male, 41 ± 7 years) with minor running experience conducted an eight-week running intervention (2x/ week à 20 min) with a wbEMS suit (EG) or without wbEMS (control group, CG). Maximal isokinetic knee extensor and flexor strength and jump height during countermovement jumps were recorded prior and after the intervention to assess maximal strength and power. Results Following eight weeks of running, maximal isokinetic knee extension torque decreased significantly over time for both interventions (EG $$\Delta$$ Δ -4%, CG $$\Delta$$ Δ -4%; F(1, 44.14) = 5.96, p = 0.02, $${\upeta }$$ η = 0.12). No changes were observed for flexion torque (F(1, 43.20) = 3.93, p = 0.05, $${\upeta }$$ η = 0.08) or jump height (F(1, 43.04) = 0.32, p = 0.57, $${\upeta }$$ η = 0.01). Conclusions The outcomes indicate that there is no additional effect over neuromuscular function adaptations with the inclusion of wbEMS during running training. Knee extensor strength is even slightly reduced which supports the principle of training specificity in regards to strength adaptation. We conclude that strength improvements cannot be achieved by running with wbEMS. Trial registration German Clinical Trials Register, ID DRKS00026827, date 10/26/21.
... Estudos que verificam a utilização de EMS apontam para a otimização da força muscular e habilidades funcionais, dentre elas habilidades essenciais como marcha e equilíbrio estático e dinâmico, auxiliando na restauração dos padrões de normalidade do indivíduo, diminuindo assim risco de quedas (CAULFIELD et al., 2013;CVECKA et al., 2015;PAILLARD, 2017). Conforme descrito anteriormente, a EMS pode auxiliar no Brazilian Journal of Development, Curitiba, v.9, n.10, p. 28004-28026, oct., 2023 tratamento pós-cirúrgico limitando a atrofia, prevenindo a diminuição da força e da deterioração das habilidades funcionais, reduzindo o tempo total de recuperação (GOULD, 1983;KEMMLER et al., 2016). ...
... Ao contrário desse modelo a EMS ativa artificialmente a contração muscular, sem a necessidade de carga extra, sendo considerada como um método moderno de treinamento, representando uma alternativa promissora para melhorar sistematicamente os parâmetros de força e habilidades motoras(FILIPOVIC et al., 2012).Sabe-se que a aplicação crônica e regular da EMS (ou treinamento com EMS) induz efeitos benéficos sobre a massa muscular e o desempenho em idosos(BARBERI et al., 2015;JONES et al., 2016;LANGEARD et al., 2017). O treinamento com EMS pode promover melhoras no ganho de força máxima, força de velocidade, aumento da potência de saltos e sprints(KEMMLER et al., 2016;NATSUME et al., 2018).Maffiuletti et al. (2006) e Salmons (2009) descrevem que fibras de contração lenta (tipo I) sofrem adaptações hipertróficas, e as de contração rápida (tipo II) aumentam a força, demonstrando que ambas foram eletroestimuladas e que não existe seleção de fibras na indução por EMS, ou seja, todas as unidades motoras podem ser recrutadas. Outro ponto interessante é o recrutamento síncrono de todas as unidades motoras pela EMS, mesmo as que não são recrutadas na contração voluntária máxima (PETTE; VRBOVÁ, 1999; GONDIN; COZZONE; BENDAHAN, 2011; MAFFIULETTI et al., 2011). ...
... Brazilian Journal of Development, Curitiba, v.9, n.10, p. 28004-28026, oct., 2023 momentos distintos de uma periodização que prioriza o fortalecimento muscular, podem otimizar as adaptações fisiológicas de forma quantitativa e qualitativa, pois aumentam a massa muscular, força, potência, ativação e resistência (MAFFIULETTI; PENSINI;MARTIN, 2002;PAILLARD, 2008;KEMMLER, 2016).Em vários estudos a EMS combinada ao exercício voluntário é apontada como a mais eficiente para otimização do salto vertical, quando associado ao treinamento pliométrico (BENITO-MARTÍNEZ et al., 2011). Outros autores apontam que devido ao padrão peculiar de recrutamento das unidades motoras a EMS permite ajustes de controle motor e gera adaptações neuromusculares e ganho de força eminente, e quando combinada ao exercício, pode otimizar a performance em vários esportes (PAILLARD, 2008; GONDIN; COZZONE; BENDAHAN, 2011). ...
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A eletroestimulação excita nervos periféricos e recruta unidades motoras. Associada ao exercício físico promove não só a hipertrofia, mas outras adaptações como aumento na velocidade de ativação muscular. Porém as pesquisas ainda são controversas, muito por conta de não existir uma parametrização para o uso da técnica. O objetivo do presente estudo foi verificar os efeitos da eletroestimulação no processo de contração muscular. Trata-se de uma revisão narrativa da literatura que analisou pesquisas que associam efeitos do uso da eletromioestimulação combinados ao exercício físico. A presente revisão verificou que além da hipertrofia muscular, as adaptações neuromusculares proporcionam aumento no dispêndio energético do músculo, no ângulo de penação, na velocidade de ativação muscular e da atividade eletromiográfica, mas combinar exercício físico com eletromioestimulação pode ocasionar lesão muscular.
... Before commencing training, all subjects attended a preliminary screening, which included a clinical anamnesis and physical examination to monitor agreement with the inclusion criteria. Participants were informed about contraindications [7,21]. ...
... Both groups exercised for eight weeks on two days of the week, with at least 48 h of rest between two sessions. Training duration was limited to 20 min [21]. During the first two weeks the first session was performed at the aerobic threshold (LT1). ...
... For wbEMS (Xenoma, Japan), the procedure is described in Krause et al. [20]. Stimulation parameters were based on current scientific recommendations to ensure participant's safety at all times in absence of muscle spasms or obstruction during running [14,21,23,24]: Impulse type bipolar, frequency 85 Hz, width 180µs, rise 700 ms, duty cycle 50% (3 s on-and 3 s off-time). For each participant, the current was determined individually at a subjective tolerance rating of 7/10 with the CR10scale [7] for every training session. ...
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Background This study aimed to evaluate the physiological and metabolic adaptations to an eight-week running intervention with whole-body electromyostimulation (wbEMS) compared to running without wbEMS. Methods In a randomized controlled trial (RCT), 59 healthy participants (32 female/ 27 male, 41 ± 7 years, rel.V̇O2max 40.2 ± 7.4 ml/min/kg) ran twice weekly à 20 min for eight weeks either with a wbEMS suit (EG) or without wbEMS (control group, CG). Before and after the intervention, (i) rel.V̇O2max, heart rate and time to exhaustion were recorded with an incremental step test with an incremental rate of 1.20 km/h every 3 min. They were interpreted at aerobic and (indirect) anaerobic lactate thresholds as well as at maximum performance. (ii) Resting metabolic rate (RQ) as well as (iii) body composition (%fat) were assessed. Results Following the intervention, V̇O2max was significantly enhanced for both groups (EG ∆13 ± 3%, CG ∆9 ± 3%). Velocity was elevated at lactate thresholds and maximum running speed (EG ∆3 ± 1%, CG ∆2 ± 1%); HRmax was slightly reduced by -1 beat/min. No significant changes were observed for time until exhaustion and lactate. RQ was significantly enhanced following both trainings by + 7%. %fat was reduced for both groups (EG ∆-11 ± 3%, CG ∆-16 ± 5%), without any changes in body mass. Results did not differ significantly between groups. Conclusions Both interventions had a positive impact on aerobic power. The rightward shift of the time-velocity graph points towards improved endurance performance. The effects of wbEMS are comparable to those after high-intensity training and might offer a time-efficient alternative to affect physiological and metabolic effects. Trial registration German Clinical Trials Register, ID DRKS00026827, date 10/26/21.
... The study adhered to the ethical principles of the Declaration of Helsinki and was approved by the ethics committee of University Witten/Herdecke (#91/2018). Participants had no history of cardiovascular or musculoskeletal diseases, orthopedic problems, or contraindications for WB-EMS (15). ...
... responses to exercise: low responders defined as <500 U/L, medium responders between 500 and 2,000 U/L, and high responders as >2,000 U/L (18). However, WB-EMS is known to substantially increase CK and Mb levels-by as much as 100-fold and 40-fold, respectively (3,4)-when specific quality criteria are not met (15). This suggests that conventional response categories may not be entirely appropriate for WB-EMS application. ...
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Purpose: This brief report aimed to characterize inter-individual training responses following a single session of high-intense whole-body electromyostimulation (WB-EMS) using markers of muscle damage over a period of 72h.Methods: Twelve healthy individuals (5 men, 7 women; 32.0±7 years) participated in a single 20-minute high-intensity WB-EMS training session. Markers of muscle damage, creatine kinase (CK) and myoglobin (Mb), were assessed before and immediately after training, as well as at 1.5, 3, 24, 48 and 72 h postexercise. Lactate levels were determined pre-and post-exercise.Results: Overall, WB-EMS induced significant CK elevations, peaking at 72 h (18.358±21.380 U/l; p<0.01), and correlating Mb levels peaking at 48 h (1.509±1.394 ng/dl, p<0.01). Despite significant inter-individual variability in CK levels, both slow (SR) and fast responders (FR) were identified. FR showed significant increases in CK at all time points post WB-EMS (p<0.05), whereas CK in SR significantly elevated after 48 h. Post-WB-EMS lactate concentration was identified to predict peak CK and Mb levels (r ≥ 0.65, both p<0.05).High-intensity WB-EMS has the potential to induce severe muscle damage, as indicated by elevated levels of CK and Mb. We identified two distinct groups of individuals, SR and FR, indicating variability in response to WB-EMS. Furthermore, we suggest that individual responses to WB-EMS can be predicted based on post-WB-EMS lactate concentration.The finding that post-WB-EMS lactate concentrations show a strong correlation with the muscle damage marker CK, particularly with peak CK levels, can be used for control of training load and/or developing individualized recovery and training strategies.
... 12,13 Only in the last decade has EMS technology made it possible to use the system for full body training and also guidelines regarding the safety of EMS training have begun to appear. 14,15 A training method that is gaining popularity is wholebody EMS (WB-EMS), which can stimulate several muscle groups at once with intensity that is targeted to specific regional areas. Although many different protocols could be used, WB-EMS typically uses brief impulse phases (4-6 s) interspersed with short rest phases (4 s), with moderate to high impulse intensity, lasting roughly 20 minutes. ...
Article
Purpose: This research aims to present the effects of a long-term interval whole-body electrical muscle stimulation (WB-EMS) training program on body composition and subjective pain experience for the patient after right shoulder adhesive capsulitis, known as a frozen shoulder. A 71-day program was designed for the patient two years after the frozen shoulder diagnosis and 6 months after finishing the postoperative rehabilitation phase. Methods: A WB-EMS trainer supervised a subject as he worked out, following a detailed interval program displayed on a projector screen. The subject exercised by imitating the movements shown in a previously recorded video, while the trainer carefully observed the subject. All measurements and exercises performed based on programmed training were made in the laboratory with access to appropriate equipment. Results: Body weight fluctuated during the training program. Comparing day 0 (before training) and day 71, an upward trend was observed for muscle mass and segmental body composition data for lean mass. A downward trend was observed for fat and segmental body composition data for fat mass. Body circumference data decreased for the hip, waist, and thigh. Body circumference data increased for the arm, calf, and chest. Our results indicated that combining WB-EMS with interval training can reduce fat (especially hip and waist area) and obtain gain mass, especially muscle mass. Conclusions: The WB-EMS interval training program was a joint-shoulder-friendly form of physical exercise during which the patient reported no pain. The subject achieved the training goal: reducing fat mass and gaining muscle mass. Because of the study's controlled environment, this training could likely be adapted for successful home use with careful attention to detail, especially having the trainer’s guidance readily accessible.
... In this context, whole-body electromyostimulation (WB-EMS) has emerged as an innovative therapeutic modality, offering a jointfriendly and time-efficient alternative that could potentially address the abovementioned main barriers to physical exercise [15]. Research has shown promising results for WB-EMS in improving muscle performance [16][17][18][19][20][21][22][23][24][25][26]. ...
Article
Abstract Introduction: Recent clinical studies confirmed that whole-body electromyostimulation (WB-EMS) training is a safe and time-efficient therapeutic method for patients with nonspecific chronic back pain (NSCBP). However, significant variations in initial pain intensity among subjects in these studies have been observed. This study aims to determine if patients with differing initial pain intensities experience varying degrees of benefit from WB-EMS and to assess the overall correlation between initial pain levels and pain reduction. Methods: Pain intensity datasets from two studies were combined. The pooled data included 121 NSCBP patients (38 males and 83 females) with an average age of 55.1 years (±11.8 years). Data was categorized by baseline pain intensity on the numeric rating scale (NRS) into seven groups: 0 to 2, >2 to 3, >3 to 4, >4 to 5, >5 to 6, >6 to 7, and >7. Both absolute and relative changes were analyzed. Additionally, a Spearman rho correlation test was performed on the entire dataset to evaluate the relationship between initial pain level and pain reduction. Results: Significant improvements were noted across all NRS11 categories, with strong effect sizes (p) in all classes above 2, ranging from 0.56 to 0.90. The >7 category exhibited the highest rate of clinically significant changes (80%) and an average improvement of 3.72 points. The overall group from >1 to 10 showed an average improvement of 1.33 points, with 37% of the participants experiencing clinically significant improvements. The Spearman rho correlation test revealed a moderate positive relationship between initial pain level and pain reduction (r_s = 0.531, p < 0.001), indicating that, generally, higher initial pain levels are associated with greater pain reduction. Conclusion: The findings support the hypothesis that NSCBP patients with higher baseline NRS values benefit more substantially from WB-EMS. Those with NRS values above 7 show the greatest improvement and highest rate of clinical significance. The overall positive correlation between initial pain intensity and pain reduction further underscores the efficacy of WB-EMS in managing NSCBP across different pain intensities.
... A study in which athletes were allocated to receive WB-EMS and local NMES, respectively, for a period of 10 days to 14 weeks did not show gains in strength, muscle contraction velocity, or muscle power to be significantly different between the groups (Filipovic et al. 2012). Both WB-EMS and local NMES are well tolerated even by untrained people, but WB-EMS is considered a risk factor for exertional rhabdomyolysis (Stöllberger and Finsterer 2019), especially when misapplied (Kemmler et al. 2016). ...
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Purpose Muscular changes induced by neuromuscular electrical stimulation (NMES) are well recognized, but knowledge of how NMES influences the physio-biochemical traits of the oldest old is still limited. This study investigated the effect of NMES applied for 12 weeks to the quadriceps muscles of female nursing-home residents aged 75 + on their functional capability and inflammatory, bone metabolism, and cardiovascular traits. Methods Nineteen women regularly taking part in two body conditioning sessions per week were randomized into an electrical stimulation group (ES; n = 10; 30 min sessions, 3 times per week) or a control group (CON; n = 9). At baseline and study week 12, all women performed the 30 s chair stand test (30sCST), the 6-minute walk test (6MWT), and the instrumented timed up and go test (iTUG). Resting heart rates, blood pressure, and the blood concentrations of inflammatory and bone metabolism markers were also measured twice. Results NMES increased the strength of participants’ quadriceps muscles and their performance on the 30sCST and 6MWT while lowering resting arterial blood pressure and inflammatory marker levels; osteoclast activity showed a tendency to decrease. Changes in the iTUG results were not observed. A multiple regression analysis found that the results of functional tests in the ES group were best correlated with pulse pressure (the 30sCST and iTUG tests) and diastolic blood pressure (the 6MWT test). Conclusion Twelve weeks of NMES treatment improved participants’ functional capacity and inflammatory, bone metabolism, and cardiovascular traits. The ES group participants’ performance on functional tests was best predicted by hemodynamic parameters.
Chapter
Due to the absence of high intensity, voluntary exercise, WB-EMS in general displays a lower orthopedic risk compared to similarly effective high intensity resistance (HIT-RT) exercise (Kemmler, Kohl et al. 2016; Kemmler, Teschler et al. 2016). However, the unique ability of WB-EMS technique to stimulate large areas of the body (up to 2800 cm2) involving all or at least most major muscle groups with — in excess — supramaximal stimulation intensity may immediately indicate potential cardiometabolic risks of this innovative training technology.
Book
This essential is intended as a compact reference for issues and aspects related to the innovative training technology of whole-body electromyostimulation (WB-EMS). In addition to background and information on WB-EMS application, in which the authors pay particular attention to safe and effective use, there is a current overview of research results summarizing the effects of WB-EMS on various target outcomes. Finally, a characterization of the market situation, current trends and a forecast of developments in the field of WB-EMS is presented.
Chapter
Health-related parameters are key outcomes of many WB-EMS trials (Le et al. 2024). In parallel, many studies focus on participants with diseases, conditions or other health related limitations (Beier et al. 2024). Considering the joint-friendly, time efficient, highly customizable and rigorously supervised setting of WB-EMS, WB-EMS might be one of the few options for effective and safe disease prevention and/or therapy even for (very) vulnerable cohorts otherwise unable or unmotivated to perform frequent and intense exercise protocols.
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Background: Time-efficient exercise protocols may encourage subjects to exercise more frequently and could thus be excellent tools for health promotion. The aim of this study was to compare the effectiveness of the time-efficient methods HIT and/versus WB-EMS on cardio-metabolic risk factors in untrained middle-aged males. Methods: Untrained, healthy males (30-50 years) were randomly allocated either to 16-weeks of WB-EMS with 3 applications of 20 min/2 weeks, or 16 weeks of high intensity (resistance) training (HIT) performing 2 sessions/week. Both methods addressed all the main muscle groups. Metabolic-Syndrome Z-Score (MetS-Z-Score), abdominal body fat and total cholesterol/HDL-cholesterol (TC/HDL-C) were defined as the study endpoints. Results: HIT and WB-EMS were similar (p≤.096) effective to improve the MetS-Z-Score (HIT: p=.031 vs. WB-EMS: p=.001) and abdominal body fat (HIT:-4.5±8.1%, p=.014 vs. WB-EMS-4.0±5.2%, p=.002) in this cohort. No significant changes (HIT:-2.7±7.4, p=. 216 vs. WB-EMS:-2.2±10.2 p=.441) or group-differences (p=.931) within and between the groups were determined for TC/HDL-C. Conclusion: WB-EMS and HIT-RT is equally effective, attractive, feasible and time-efficient methods for combatting cardio-metabolic risk factors in untrained middle-aged males. WB-EMS can be considered as an effective option, particularly for subjects with low time resources unwilling or unable to conduct exhausting HIT protocols. The paper's primary contribution is finding that both exercise methods, high intensity resistance training (HIT) as defined as " single-set-to-failure protocol with intensifying strategies " and whole-body electromyostimulation (WB-EMS) are equally effective, attractive and feasible approaches for tackling cardio-metabolic risk factors in untrained middle-aged males with limited time resources.
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High-intensity (resistance) exercise (HIT) and whole-body electromyostimulation (WB-EMS) are both approaches to realize time-efficient favorable changes of body composition and strength. The purpose of this study was to determine the effectiveness of WB-EMS compared with the gold standard reference HIT, for improving body composition and muscle strength in middle-aged men. Forty-eight healthy untrained men, 30–50 years old, were randomly allocated to either HIT (2 sessions/week) or a WB-EMS group (3 sessions/2 weeks) that exercised for 16 weeks. HIT was applied as “single-set-to-failure protocol,” while WB-EMS was conducted with intermittent stimulation (6 s WB-EMS, 4 s rest; 85 Hz, 350 ms) over 20 minutes. The main outcome parameters were lean body mass (LBM) as determined via dual-energy X-ray absorptiometry and maximum dynamic leg-extensor strength (isokinetic leg-press). LBM changes of both groups (HIT 1.25 ± 1.44% versus WB-EMS 0.93 ± 1.15 %) were significant ( p = . 001 ); however, no significant group differences were detected ( p = . 395 ). Leg-extensor strength also increased in both groups (HIT 12.7 ± 14.7 %, p = . 002 , versus WB-EMS 7.3 ± 10.3 %, p = . 012 ) with no significant ( p = . 215 ) between-group difference. Corresponding changes were also determined for body fat and back-extensor strength. Conclusion . In summary, WB-EMS can be considered as a time-efficient but pricy option to HIT-resistance exercise for people aiming at the improvement of general strength and body composition.
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Purpose: High Intensity (resistance exercise) Training (HIT) and Whole-Body Electromyostimulation (WB-EMS) may be the most promising approaches to generate favorable changes of body composition and strength with optimum time-efficiency. In this study, we compared the effect of WB-EMS on Body composition and muscle strength with the “golden standard” HIT over 16 weeks. ››Methods: 30-50 year-old men (n=48) were randomly allocated to a HIT (n=24) with 2 sessions/week of a “single-set-to-failure-protocol” or a WB-EMS-group that exercised 3 sessions in two weeks, using intermittent stimulation (6 sec - 4 sec rest; 85 Hz, 350 ms) over 20 min. An Intention to treat analysis was calculated with Lean Body Mass (LBM) defined as primary endpoint, and appendicular skeletal muscle mass (ASMM), Maximum dynamic leg-extensor and isometric back-extensor strength as secondary endpoints. ››Results: Net exercise time/session was 30.3±2.3 for HIT vs. 20±0 min for WB-EMS (p<.001). LBM (HIT: 1.24±1.40% vs. WB-EMS: 0.91±1.12%) and ASMM (1.92±1.51% vs. WB-EMS: 1.52±1.48%) significantly increased (p≤.003), with no significant group differences (LBM: p=.406 and ASMM: p=.341). In parallel, changes of maximum dynamic leg strength (HIT: 13.5±13.9%, p=.001 vs. WBEMS: 8.0±10.2%, p=.008) and maximum isometric back strength (10.4±9.0%, p<.001 vs. 11.7±9.9%; p<.001) were comparable (p=.332 and p=.609) between groups. Discussion: In conclusion, compared to HIT, WB-EMS can be considered as an even more time-efficient but pricey option for subjects who aim to improve their body composition and general strength.
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Whole-body electromyostimulation (WB-EMS) has been shown to be effective in increasing muscle strength and mass in elderly women. Because of the interaction of muscles and bones, these adaptions might be related to changes in bone parameters. 76 community-living osteopenic women 70 years and older were randomly assigned to either a WB-EMS group () or a control group (CG: ). The WB-EMS group performed 3 sessions every 14 days for one year while the CG performed gymnastics containing identical exercises without EMS. Primary study endpoints were bone mineral density (BMD) at lumbar spine (LS) and total hip (thip) as assessed by DXA. After 54 weeks of intervention, borderline nonsignificant intergroup differences were determined for LS-BMD (WB-EMS: % versus CG %, ) but not for thip-BMD (WB-EMS: % versus CG: %, ). With respect to secondary endpoints, there was a gain in lean body mass (LBM) of 1.5% () and an increase in grip strength of 8.4% () in the WB-EMS group compared to CG. WB-EMS effects on bone are less pronounced than previously reported effects on muscle mass. However, for subjects unable or unwilling to perform intense exercise programs, WB-EMS may be an option for maintaining BMD at the LS.
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Resistance exercise can result in localized damage to muscle tissue. This damage may be observed in sarcolemma, basal lamina, as well as, in the contractile elements and the cytoskeleton. Usually the damage is accompanied by release of enzymes such as creatine kinase (CK) and lactate dehydrogenase, myoglobin and other proteins into the blood. Serum CK has been proposed as one of the best indirect indicators of muscle damage due to its ease of identification and the relatively low cost of assays to quantify it. Thus, CK has been used as an indicator of the training intensity and a diagnostic marker of overtraining. However, some issues complicate CK's use in this manner. There is great interindividual variability in serum CK, which complicates the assignment of reliable reference values for athletes. Furthermore, factors such as training level, muscle groups involved, and gender can influence CK levels to a greater extent than differences in exercise volume completed. This review will detail the process by which resistance exercise induces a rise in circulating CK, illuminate the various factors that affect the CK response to resistance exercise, and discuss the relative usefulness of CK as a marker of training status, in light of these factors.
Article
Transcutaneous electrical stimulation (ES) of human nerves and muscles has long been used as a non-pharmacological treatment for pain relief,1 and for rehabilitation after disuse. Whole body ES has recently emerged as an alternative form of physical exercise for improving fitness and health in healthy people. Despite limited scientific evidence on the safety and effectiveness of this form of exercise, several ES company sponsored fitness centres have …
Article
The aim of the present study was to investigate the effects of a multiple set squat exercise training intervention with superimposed electromyostimulation (EMS) on strength and power, sprint and jump performance. Twenty athletes from different disciplines participated and were divided into two groups: strength training (S) or strength training with superimposed EMS (S+E). Both groups completed the same training program twice a week over a six week period consisting of four sets of the 10 repetition maximum of back squats. Additionally, the S+E group had EMS superimposed to the squat exercise with simultaneous stimulation of leg and trunk muscles. EMS intensity was adjusted to 70% of individual pain threshold to ensure dynamic movement. Strength and power of different muscle groups, sprint, and vertical jump performance were assessed one week before (pre), one week after (post) and three weeks (re) following the training period. Both groups showed improvements in leg press strength and power, countermovement and squat jump performance and pendulum sprint (p < 0.05), with no changes for linear sprint. Differences between groups were only evident at the leg curl machine with greater improvements for the S+E group (p < 0.05). Common squat exercise training and squat exercise with superimposed EMS improves maximum strength and power, as well as jumping abilities in athletes from different disciplines. The greater improvements in strength performance of leg curl muscles caused by superimposed EMS with improvements in strength of antagonistic hamstrings in the S+E group are suggesting the potential of EMS to unloaded (antagonistic) muscle groups.
Article
: We report 2 cases of enormously elevated creatine kinase (CK) activity after training with electromyostimulation (EMS) by 2 young male professional soccer players. In one of them, a single training session with EMS caused exercise-induced rhabdomyolysis with a maximal CK activity of 240 000 U/L. These cases illustrate that unaccustomed EMS exercise may be harmful and can cause rhabdomyolysis even in highly trained athletes and even after 1 single session. Thus, EMS has to be conducted carefully especially by individuals who are known to frequently show notable increases in CK activity even after modest training stimuli. We suggest that EMS should not be applied as sole training stimulus and should not be conducted by strength training beginners. Furthermore, we recommend controlling plasma CK activity and urine color for beginners with EMS when they report strong muscle ache. Athletes with signs of rhabdomyolysis after EMS should be brought to hospital for monitoring of renal function and possible further treatment.