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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.
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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
Elektrostimulation, Kreatinkinase, Rhabdomyolyse,
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
Medical Physics, Erlangen-Nürnberg,
Depar tment of Sport s Science,
Kaiserslautern, Germany
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
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
) 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
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.
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
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.
Richtlinien Ganzkörper-EMS
indicates that a short period of careful W B-EMS conditioning
should be mandatorily implemented in order to realize a safe
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-
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.
(1) FINSTERER J, STOLLBERGER C. Severe rhabdomyolysis a fter miha-
bodytec(R) electrostimu lation with previous mild hyper-CK-
emia and noncompaction. Int J Cardiol. 2015; 180 : 100-102.
(2) KAS TNER A, BR AUN M, MEYER T. Two Cases of rhabdomyolysis
after training w ith electromyostimulation by 2 young male
professiona l soccer players. Clin J Spor t Med. 2014; 25: 71-73.
whole-body electromyostimulation on body composition
in elderly women at risk for sa rcopenia: the Tra ining and
ElectroStimu lation Trial (TEST-III). Age (Dordr). 2014; 36: 395-
406 . doi:10.1007/s11357-013-9575-2
(4) KEMMLER W, KOHL M, VON STENGEL S. Eects of h igh intensity
resistance tra ining versus whole-body electromyostimu lation
on cardiometabol ic risk factors in untrained midd le aged males.
A randomi zed controlled trial. J Sports Med . 2016; [accepted for
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FRÖHLICH M, KOHL M, VON STENGEL S. Eects of whole-body
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... After the publication of some case studies (Kastner et al., 2014;Finsterer and Stollberger, 2015;Malnick et al., 2016) and public media releases that reported negative side effects (in particular severe rhabdomyolysis) predominately after an initial WB-EMS application (Habich, 2015) the first calls for official regulation of WB-EMS were published in 2016 (Malnick et al., 2016). More reliable data on negative side effects of inadequate WB-EMS application , the early launch (i.e., in about 2007) and the impressive number of some 2,500 commercial WB-EMS facilities in Germany might explain the concerted efforts of national WB-EMS research groups to ensure safe and effective WB-EMS application through dedicated recommendations in 2016 (Kemmler et al., 2016a). Although this "Guideline for safe and effective whole-body electromyostimulation" was not a mandatory norm or even a dedicated clinical practice guideline, we were convinced that the voluntary implementation of the recommendations by most providers has contributed to more safety and effectiveness in the area of non-medical commercial WB-EMS application. ...
... We conducted a simplified multi-step Delphi method (Verhagen et al., 1998) to achieve expert consensus: 1) Forming an expert panel, 2) individual revision of the 2016 recommendations (Kemmler et al., 2016a) by all working groups considering critical aspects raised and submitted by the study coordinator (UKER, Germany), 3) Structured anonymized rounds that focus on revisions and specifications of the drafts to establish consensus, and 4) obtaining selected stakeholder input and finalizing the recommendations. ...
... In detail, scientific expert groups from Brazil (AE), Germany (MF, OL, CE, MT,AW, HK, FM, NW, CZ, AF, BW, and JB), Italy (SD), Spain (UP, ACC, AG, and FAG) and the US (JD and AL) responded to the invitation of the UKER, Germany (WK, SvS, and SB) that initiated and coordinated the consensus process. 2) All expert groups were provided with the Microsoft Word version of the 2016 recommendation (Kemmler et al., 2016a) that was revised by the coordinating institution (UKER) using the word track changes and comment function to highlight critical aspects. Expert groups were asked to comment on these positions but were also free to address additional critical aspects which in their opinion ought to be discussed. ...
Full-text available
Whole-Body Electromyostimulation (WB-EMS) is a training technology that enables simultaneous stimulation of all the main muscle groups with a specific impulse intensity for each electrode. The corresponding time-efficiency and joint-friendliness of WB-EMS may be particularly attractive for people unable or unmotivated to conduct (intense) conventional training protocols. However, due to the enormous metabolic and musculoskeletal impact of WB-EMS, particular attention must be paid to the application of this technology. In the past, several scientific and newspaper articles reported severe adverse effects of WB-EMS. To increase the safety of commercial non-medical WB-EMS application, recommendations "for safe and effective whole-body electromyostimulation" were launched in 2016. However, new developments and trends require an update of these recommendations to incorporate more international expertise
... Both applications are well accepted even by untrained people, but they are not free of contraindications, especially when their application is global; in addition to the contraindications of EMS, there are systemic conditions (Diabetes mellitus, etc.) and health risks due to inappropriate use (rhabdomyolysis exertional) [7,8]. For this reason, the WB-EMS guide's recommendations for its proper and safe use have been considered in this study [9]. ...
... The inclusion criteria for the study were: (a) healthy subjects of both sexes; (b) age range between 18 and 35 years old; (c) a good medical history with normal medical examinations and no previous history of cardiac disturbance; and (d) no surgeries in the previous year. The exclusion criteria were [8,9]: (a) body mass index (BMI) greater than 30 kg/m 2 ; (b) elite or professional physical activity performance; (c) hyperventilation/hypercapnia and a score equal to or greater than 23 points on the Nijmegen questionnaire [36]; (d) women during their menstrual period; (e) habitual intake of medications; (f) abdominal surgeries (scars or keloids); (g) old or recent muscle injury at the abdominal level; (h) congenital diseases with musculoskeletal alterations at the level of the back and lower extremities, such as scoliosis, protrusion, or disc herniation; (i) presence of chronic low back, hip, or thigh pain; and (j) present any contraindication to WB-EMS/EMS [7]: pregnancy; viral or bacterial infections; arterial circulatory disorders, advanced arteriosclerosis; type I diabetes; hemophilia, bruising, hemorrhage; cognitive deficits; neuronal diseases, neuronal disorders, or epilepsy; recently performed operations in stimulation areas; abdominal wall and inguinal hernia; acute diseases, or inflammatory diseases, etc. ...
... The guide of recommendations for the appropriate and safe use of WB-EMS [9] was Next, the interventions were performed by the same researcher who received previous training on WB-EMS/EMS [9,40], and they started in January 2022, in the afternoon hours, at the same location and under the same environmental conditions (22 • -24 • ambient temperature and 40-60% relative air humidity). Please see Section 2.6 below for detailed interventions. ...
Full-text available
Dynamic electrostimulation consists of the application of local or global electrostimulation together with physical exercise. This study aimed to investigate the immediate effects of a dynamic electrostimulation session on the thickness of the abdominal musculature, inter-rectus distance, heart rate, blood pressure, and body temperature, and to identify possible differences in its form of application. A total of 120 healthy participants were divided into three groups: the whole-body electrostimulation group, the local electrostimulation group, and the control group without electrical stimulation. All groups performed a single session with the same dynamic exercise protocol. Muscle thickness and inter-rectus distance were evaluated ultrasonographically using the Rehabilitative Ultrasound Imaging technique both at rest and in muscle contraction (the active straight leg raise test) to find the post-intervention differences. The results showed significant differences in immediate post-intervention heart rate, with a smaller increase in the local electrostimulation group compared to the control and whole-body electrostimulation groups. No significant differences were identified between the groups after the interventions in the rest of the variables analyzed. Therefore, a local application, with the same effects as a global application on the abdominal musculature, has fewer contraindications, which makes its use more advisable, especially in populations with cardiorespiratory disorders, for which more research is needed.
... After endurance exercises, CK level was shown to be two to three times higher after two days (Totsuka et al., 2002). Thus, increased CK might reflect a greater impact on the skeletal muscle, such as after muscle training (Callegari et al., 2017); at the same time, overload by means of rhabdomyolysis must be avoided by ensuring professional and detailed supervision during application (Kemmler et al., 2016). ...
... Inclusion criteria comprised an age between 30 and 50 years and no or minor wbEMS (≤ once) and jogging-experience (<4 km/ week). Participants were informed about contraindications (Berger et al., 2020;Kemmler et al., 2016). Exclusion criteria were cardiovascular or respiratory diseases, dermatological illnesses, neurological diseases, physical disability limiting the participants' mobility and medication that affects physical performance. ...
... Devices were connected via Bluetooth with the advantage of no additional wires to ensure mobility and a total range of motion during dynamic movements. Stimulation parameters were based on current scientific recommendations to ensure participant's safety at all times (Amaro-Gahete et al., 2019;Filipovic et al., 2012;Hainaut & Duchateau, 1992;Kemmler et al., 2016). Stimulation settings were as follows: impulse-type bipolar, frequency 85 Hz, pulse width 180 µs, rise cycle 700 ms and duty cycle 50% (3s on-and 3 s off-time). ...
Full-text available
Objective: The aim of the current study was to evaluate the physiological and metabolic responses to running with whole-body electromyostimulation (wbEMS) compared to running without electromyostimulation (control, CG). Methods: Twenty healthy participants (9 male/11 female, age 42 ±7 years) conducted an incremental step test with respiratory gas analysis until exhaustion. Trials were conducted as wbEMS and CG in a random order. As outcome measures, (A) objective total exhaustion, (B) athletic responses (max. time and velocity) and (C) physiological and metabolic responses (V'O2/ kg, V'E, EE, RER, lactate) were compared. (D) The impact on the skeletal muscle was assessed prior, 48 h & 72 h after trial. Results: During both trials, participants (A) ran until total exhaustion. Nonetheless, (B) time and velocity till exhaustion as well as (C) RER prior to the first lactate threshold and V'E were reduced with wbEMS. All other correlates did not differ significantly between wbEMS and CG. Following 48 h and 72 h after the trial with wbEMS, (D) the impact on the skeletal muscle was 7- to 9-fold higher compared to baseline values. Values differed significantly to those after running without wbEMS. Conclusion: With the additional stimulation during voluntary activation, wbEMS induces earlier fatigue and a shift in energy metabolism toward fat utilization. Even during aerobic endurance tasks, a great impact on the skeletal muscle indicated by the rise in CK could be observed which promotes wbEMS as an alternative training stimulus that is easy-to-apply and effective during endurance training.
... Whole-body electromyostimulation (WB-EMS) as a time-efficient, joint-friendly and highly effective training option enables individualized training for a wide range of users particularly due to its personal training character [1]. For novice applicants in particular, WB-EMS offers an easy way to start an effective and safe workout routine supported by individualized WB-EMS impulse intensity control and supervision of the voluntary exercises by experienced instructors [2]. Nevertheless, WB-EMS is also attractive for highperformance athletes and leads to significant improvements for them as well, since the involuntary EMS-induced contraction causes high metabolic and structural stress which is reported to result in significant improvements of parameters such as jumping power, maximum strength or shooting speed in soccer players [3,4]. ...
... In light of these adverse effects, in Germany, Austria and Israel great emphasis has been placed on safety, standardization, and monitoring aspects by the scientific WB-EMS community in DACH. Evidence-based recommendations, position papers and standards have been published [2] aiming to specify in-depth the application of WB-EMS in commercial, nonmedical settings [13]. In particular, DIN 33961-5, a German norm on commercial nonmedical WB-EMS facilities, provided requirements for equipment, operation, monitoring and application in adequate detail. ...
... This includes (1) frequent feedback from the participant about perceived exertion for each area of stimulation, (2) permanent visual monitoring of the participant and eye contact to check participant stress, avoid overload and to react immediately to the first signs of cardiorespiratory or metabolic side effects, and (3) verbal and haptic movement corrections and rapid assistance in cases of emergency, particularly cutting off the device power supply and preventing fall-related injuries [1]. This leads us to strongly advise a 1:1 instructor-participant ratio, although a 1:2 ratio is also considered tolerable for non-medical WB-EMS application with less critical participants [2]. ...
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As a time-efficient and highly effective form of training, whole-body electromyostimulation (WB-EMS) enables personalised training for a wide range of users due to its personal training character and the individual control of the training intensity. However, due to misuse, negative side effects of WB-EMS have been reported in the past, resulting in expert guidelines for safe and effective WB-EMS application being issued. Furthermore, the use of WB-EMS is now legally permitted only for qualified personnel with certified equipment. This professionalization of the WB-EMS market as per the definition of quality standards for the devices and the personnel ensured a safe and effective WB-EMS application. However, recent market developments are undermining these standards through the growing of WB-EMS offers for the private sector. Hereby, most concepts focus on completely or predominately non-supervised WB application without control of potential overload by a qualified trainer. WB application is by no means trivial and the shift of responsibility for safety and effectiveness from the certified personnel to the trainees themselves is a clear step backwards in the development of WB-EMS use. We conclude that private, inadequately supervised WB-EMS application bears more dangers than potential benefits, not only for the trainees but also for the WB-EMS market as a whole.
... To provide a safe and effective application of WB-EMS, guidelines recommend restricting the duration of one session to a maximum of 20 min. Moreover, the frequency should be limited to one session a week for at least the first eight weeks or a minimum interval of four days should be maintained thereafter [13]. Perceived exertion should be rated approximately as "hard" to "hard+" (lower during initial training) [13], corresponding to 5 to 6 on the Borg CR 10 scale [14]. ...
... Moreover, the frequency should be limited to one session a week for at least the first eight weeks or a minimum interval of four days should be maintained thereafter [13]. Perceived exertion should be rated approximately as "hard" to "hard+" (lower during initial training) [13], corresponding to 5 to 6 on the Borg CR 10 scale [14]. Nevertheless, in some trials, the training frequencies were higher [2,15], and sometimes lower with one session a week [16,17] compared to the aforementioned recommendation after familiarization. ...
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Recommendations for conventional strength training are well described, and the volume of research on whole-body electromyostimulation training (WB-EMS) is growing. The aim of the present study was to investigate whether active exercise movements during stimulation have a positive effect on strength gains. A total of 30 inactive subjects (28 completed the study) were randomly allocated into two training groups, the upper body group (UBG) and the lower body group (LBG). In the UBG (n = 15; age: 32 (25-36); body mass: 78.3 kg (53.1-114.3 kg)), WB-EMS was accompanied by exercise movements of the upper body and in the LBG (n = 13; age: 26 (20-35); body mass: 67.2 kg (47.4-100.3 kg)) by exercise movements of the lower body. Therefore, UBG served as a control when lower body strength was considered, and LBG served as a control when upper body strength was considered. Trunk exercises were performed under the same conditions in both groups. During the 20-min sessions, 12 repetitions were performed per exercise. In both groups, stimulation was performed with 350 µs wide square pulses at 85 Hz in biphasic mode, and stimulation intensity was 6-8 (scale 1-10). Isometric maximum strength was measured before and after the training (6 weeks set; one session/week) on 6 exercises for the upper body and 4 for the lower body. Isometric maximum strength was significantly higher after the EMS training in both groups in most test positions (UBG p < 0.001-0.031, r = 0.88-0.56; LBG p = 0.001-0.039, r = 0.88-0.57). Only for the left leg extension in the UBG (p = 0.100, r = 0.43) and for the biceps curl in the LBG (p = 0.221, r = 0.34) no changes were observed. Both groups showed similar absolute strength changes after EMS training. Body mass adjusted strength for the left arm pull increased more in the LBG group (p = 0.040, r = 0.39). Based on our results we conclude that concurring exercise movements during a short-term WB-EMS training period have no substantial influence on strength gains. People with health restrictions, beginners with no experience in strength training and people returning to training might be particularly suitable target groups, due to the low training effort. Supposedly, exercise movements become more relevant when initial adaptations to training are exhausted.
... 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.
... Even though it is very effective this training method can also have negative consequences if used incorrectly. In this regard, a guide for timely and appropriate use has been developed (Allen & Goodman 2014;Kemmler et al., 2016). ...
... Whole-body EMS, a relatively recent training methodology, has been reported to be as effective for muscle strength as conventional resistance training [20]. However, while whole-body EMS has the advantage of innervating large muscle areas simultaneously, negative-side effects related to its large areas and stimulation intensity have also been reported, and guidelines for its safe and effective training have been provided [21,22]. If there is a difference in training effect depending on the muscles on which EMS is superimposed, it helps to select the muscles to which EMS is applied according to the characteristics of the sport or physical exercise and to improve their performance e ciently without overloading them. ...
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Background Consecutive rebound jump (RJ) training performed while applying electromyostimulation (EMS) to the calf muscle increases muscle strength and Achilles tendon stiffness, and enhances jump performances. The present study investigated whether the effects on jumping performance of consecutive RJ training with EMS differed depending on lower limb muscles on which EMS was superimposed. Methods Forty-nine men who trained every other day for 4 weeks were divided into five groups: a non-EMS group and EMSCALF, EMSAF, EMSPF, and EMSTHIGH groups in which EMS was applied to the calf, anterior femoris, posterior femoris, and all thigh muscles, respectively. Participants were only instructed to perform RJs at the same spot but were not instructed on jumping action and its kinesthetic sensation. Results After training, the jump heights increased in all EMS-applied groups. Kinesthetic sensation and the joint angles in which maximum voluntary isometric contraction torque increased differed depending on the muscles on which EMS was superimposed during RJs. The EMSCALF group experienced a clear “bounce” sensation during jumping and increased ankle plantar flexion torque and Achilles tendon stiffness in the ankle dorsiflexion position. The body was moved backward in the EMSAF group during RJs but forward in the EMSPF group. The EMSTHIGH group felt the easiest to jump during jumping. Conclusions The application of EMS to lower limb muscles during RJs enhanced jumping performance, but its mechanism and effects depended on the muscles to which it was applied.
... Even though it is very effective this training method can also have negative consequences if used incorrectly. In this regard, a guide for timely and appropriate use has been developed (Allen & Goodman 2014;Kemmler et al., 2016). ...
Conference Paper
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The aim of the research was to determine the effects of exercise programs on lower limbs’ explosive strength in junior tennis players. For collecting of appropriate scientific researches from 2010 till 2021 the following keywords were used: tennis, eplosive strength, training and exercise program, motor ability- in three electronic databases (Google Scholar, KobSon, SCI index). Based on the keywords, the existing scientific researches have gone through three levels of selection in order to enter the final analysis. These analyzed researches are presented through five groups of parameters: authors of the research, sample description (sex, age and number), experimental treatment (description, frequency), measuring instruments and results. Only 10 researches have met the criteria, and the analysis shown that the exercise programs lasted from 6 to 8 weeks, with weekly training frequency between two and three times of 30 minutes, that is, as an addition to the training. Exercise programs that have been used for the development of lower limbs’ explosive strength in tennis players were of plyometric type, with and without equipment. The tests, by which the assessment of the lower limb’ explosive strength was determined, were: CMJ, CMJ (bilateral/unilateral), SJ, DJ and OLH. The results of the applied exercise programs have shown, in all of the analyzed researches, statistically significant progress (p<0.05). A lower-limb explosive strength represents a very significant segment within the basic motor skills of tennis players in the junior category due to the latent period of development period, but also to the pretensions of the increasing dynamism of the tennis game. In accordance with this, the research can help trainers to use the information for planning the development of the explosive strength of their tennis players, and for athletes to advance and manifest the maximum potential of this part of this basic motor space.
EMS liegt im Trend. Das Trainieren in feuchter Weste soll schnell, gezielt und gelenkschonend die Kraft und Funktionalität der Muskulatur verbessern. Profitieren können nicht nur Untrainierte, Breitensportler*innen oder Spitzenathlet*innen. Bei Patient*innen mit unspezifischen chronischen Rückenbeschwerden wirkt richtig dosiertes EMS-Training so gut wie intensives Krafttraining. Bei Senioren und Seniorinnen kann das Trainieren unter Strom den im Alter einsetzenden Muskelschwund ausbremsen.
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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.
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 …
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.
: 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.