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The need to get 'fit' has resulted in a planetary fitness centre expansion, which has by the principle of cause and effect brought out a massive number of different fitness exercising programmes, methods, equipment and props, with an aim to achieve better and faster training results, i.e. the wanted transformational anthropological status. The new fitness programs are emerging almost every day, which in spite of a vast marketing support and a current publicity are forgotten very fast. Within those conditions, in order to achieve satisfaction and trust of your clients, the offered programmes need to produce wanted effects in regards to the transformation of targeted abilities or characteristics of those who perform exercises. This presents constant challenges to the fitness industry, along with the obligation to seek for optimum, scientifically accepted and proven exercising methods. It is because of those reasons that the professional fitness centres are interested in introducing and applying only proven training methods, using highly sophisticated and technologically advanced equipment. This paper deals with analysis of Electro muscular stimulation (EMS) as one of the three methods which have been developed through a research designed for the astronauts. It was released into public after the fall of the " Berlin Wall 1989 " and opening the secret USSR and USA documents. The current research defines the related units starting from epistemology of the electro muscle stimulation (EMS), its application as an alternative to developing conditional capacities, clinical use in physiotherapy and EMS and EMS as one of the means to athlete recovery (body's regeneration processes) so as to prevent negative training effects (the development of overtraining and chronic fatigue). Each of the units will contain information which is relevant to the theory and practice in sport, recreation and convalescence of athletes and patients.
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Pavlović, R. et al.: Electro-muscle stimulation - the application in practice Acta Kinesiologica 10 (2016) Suppl 1: 49-55
Ratko Pavlović1, Drena Trkulja-Petkov2 and Stanislav Dragutinović1
1Faculty of Physical Education and Sport, University East Sarajevo, Bosnia and Herzegovina
2Faculty of Kinesiology, University of Zagreb, Croatia
Review paper
The need to get 'fit' has resulted in a planetary fitness centre expansion, which has by the principle of cause
and effect brought out a massive number of different fitness exercising programmes, methods, equipment
and props, with an aim to achieve better and faster training results, i.e. the wanted transformational
anthropological status. The new fitness programs are emerging almost every day, which in spite of a vast
marketing support and a current publicity are forgotten very fast. Within those conditions, in order to achieve
satisfaction and trust of your clients, the offered programmes need to produce wanted effects in regards to
the transformation of targeted abilities or characteristics of those who perform exercises. This presents
constant challenges to the fitness industry, along with the obligation to seek for optimum, scientifically
accepted and proven exercising methods. It is because of those reasons that the professional fitness centres
are interested in introducing and applying only proven training methods, using highly sophisticated and
technologically advanced equipment. This paper deals with analysis of Electro muscular stimulation (EMS) as
one of the three methods which have been developed through a research designed for the astronauts. It was
released into public after the fall of the “Berlin Wall 1989” and opening the secret USSR and USA documents.
The current research defines the related units starting from epistemology of the electro muscle stimulation
(EMS), its application as an alternative to developing conditional capacities, clinical use in physiotherapy and
EMS and EMS as one of the means to athlete recovery (body's regeneration processes) so as to prevent
negative training effects (the development of overtraining and chronic fatigue). Each of the units will contain
information which is relevant to the theory and practice in sport, recreation and convalescence of athletes
and patients.
Key words: electro-muscle stimulation (EMS), fitness and sport, the application in practice,
contraindications, convalescence.
In the last few decades with the right one can
speak of fitness as a serious, first of all, very
profitable industry. The need to be "fit" resulted in
the planetary expansion of the fitness, which
causally caused the emergence of a large number
of different fitness programs, exercise method,
devices, and equipment, with the aim of better and
faster training results, i.e. the desired
transformation of anthropological status. In such
circumstances, in order to achieve satisfaction and
customer trust, programs that are offered must
lead to the desired effects on the transformation of
targeted skills or characteristics of trainees. Thus,
almost every day, new fitness programs appear,
which despite massive marketing support, as well
as the current publicity, quickly fall into oblivion.
The most common reasons for this lie in the lack of
desired results, and termination of client interest
for this type of exercise. This continuously sets new
challenges to the fitness industry and imposes a
duty to seek optimal, therefore scientifically
accepted and proven method of exercise. It should
not be overlooked that such programs and methods
must follow the trends of modern understanding of
fitness. For these reasons, serious fitness centers
have the interest to introduce and practice only the
proven training methods, using at the same time
highly sophisticated, technologically advanced
equipment. In this study will be presented in detail
one of three methods that have arisen in research
intended for astronauts, i.e. the space program of
major world powers (Vrcić, Kovačević, &Abazović,
2015). These findings later found their place in the
military industry, and finally at the top sports, i.e.
the Olympic programs of the USSR and the USA.
Only by the cessation of the "cold war" and the
opening of secret documents, vibration training,
isokinetic training and electrical muscle stimulation
saw the daylight. This research will try to elucidate
knowledge in the field of electrical muscle
stimulation (EMS) and on objective and professional
way present scientific research findings of
mentioned training methods. The research aims to
answer key questions, give serious and proven
recommendations for safe application of EMS
methods in fitness and make explicitly the expected
benefits and possible contraindications.
Epistemology of electro-muscle stimulation (EMS)
The EMS stands for electric muscle stimulation, a
method widely used for years in rehab medicine
and sport. This method successfully restores and
improves muscle tonus, but it is also used in the
treatment of medical conditions which involve the
loss of muscle mass. In sports and fitness, the EMS
is used as an additional part of the conventional
training in order to stimulate specific muscle groups
Pavlović, R. et al.: Electro-muscle stimulation - the application in practice Acta Kinesiologica 10 (2016) Suppl 1: 49-55
to increase their strength and efficiency or
aesthetic appearance. Different level of muscle
contraction is achieved by sending electric pulses of
different types depending on the selected program.
These contractions reactivate muscles, increase
their efficiency and stamina and are very important
for muscles which, for whatever reason, were not
regularly used (muscle atrophy). In sport, it
represents benefit because it increases the effect of
training and improves performance. By typing the
term "electro-muscle stimulation" - EMS, the
browser opens a vast number of websites that offer
this type of training or services. By a more detailed
analysis of the offered content we can easily come
up with a few striking and for kinesiology practice a
bit worrying facts. Firstly, most of the conclusions
presented are at the level of scientific and
professional speculations, which means that they
are scientifically untested or, at worst, completely
It's a bit like this: "Muscle electro-stimulation is
electrotherapy treatment with a highly
sophisticated machine, which through a low-
frequency current breaks down fat and cellulite,
accelerates weight loss, stimulates peripheral
microcirculation, improves muscle tonus, shapes
the body and restores its thinness." (Vrcić, et al.,
2015). This is just one of a myriad of definitions
that can be found on mentioned sites, and even at
first glance, it shows that marketing is a very
cleverly written, and that it provides consumer a
quick and easy path to perfect figure without
excess fat. Another extremely important fact refers
to the type and use of facilities that provide these
treatments. Deliberately is used the term
treatment, not training, because it is evident that in
addition to fitness centers and physical medicine,
beauty salons or some wellness centers dominate
(Vrcić, et al. 2015). It is clear that electrical muscle
stimulation, as a service, is offered in a very large
number of facilities that have a completely different
purpose and essence of its work. This in itself
carries a third possibly decisive factor of "failures",
with the exception of the first marketing impression
on consumers, and that is actually a person "coach"
who realizes this type of treatment. It is clear that
we are talking about a very small number of
medical (physical medicine doctors and
physiotherapists) personnel, and occupations such
as beauticians, makeup artists and people of similar
professional profile dominate. It is almost
unbelievable that kinesiologists or people with
education in the field of physical training participate
the least in the provision and control of the
implementation of this type of training.
The situation is even worse if we take into account
that there are people with an adequate kinesiology
education, who because of marketing and quick
profits, through their facebook profiles and web
portals, promote unverified information, and
consciously or unconsciously confuse the public.
This leads to the appearance that this method is
discussed at the level of "hearsay" and there are
contradictory customer experiences, from complete
disappointment to rebirth in training, but also life in
general. The truth, as usual, is somewhere in
between, that is halfway between a disappointed
customer experience who is really overweight and
in chronically bad health condition, which, after
several EMS treatment has not improved at all, and
aggressive marketing campaigns to promote this
method as a breakthrough in the fight with all the
problems of the modern fitness centre users. In a
serious expert literature this training method is
generally defined as follows: "Electrical stimulation
is a type of training that is carried out through
passive movements of body segments, caused by
the application of electric current. The apparatus
used is called an electric muscle stimulator. It is
mainly used for the purpose of treatment of injuries
and muscle atrophy, during and after the
immobilization. It is believed that electrical
stimulation accelerates the renewal of muscle
tissue and shortens the duration of rehabilitation.
Improper use can result in burns to the skin and
deeper tissues." (Ostojic, 2006). EMS is primarily a
method of physical therapy and has been used for
many years as a method of rehabilitation of
muscles after injury or surgery. In the early 1960s,
it was often used in an attempt to prevent the
atrophy of skeletal muscle that occurred as a result
of weakened or interrupted innervations (Davis,
Hamzaid, & Fornusek, 2008). With the development
of stimulation devices the EMS has become a
popular method for the treatment of patients who
have suffered damage to the central nervous
system, most often due to stroke or spinal cord
injury (Scremin, Kurta, Gentili, et al., 1999;
Wheeler, Andrews, Lederer, et al. 2002). Over the
past 20 years, manufacturers have developed high-
quality devices, capable of modulating various
forms of pulses of electrical current, which can be
used to stimulate muscle contraction. For these
reasons, the EMS is being increasingly applied in
order to improve the strength of the lower
extremities (Laughman, Youdas, Garrett, et al.
1983) in the process of rehabilitation of patients
who have had orthopedic surgery, especially the
reconstruction of the anterior cruciate ligament
(Porcari, Mclean, Foster, et al., 2002; Avramidis,
Strike, Taylor, &Swain, 2003). To understand
better the idea of the use of electrical muscle
stimulation in rehabilitation, but also sport, it is
necessary to know the basic physiological
mechanisms of muscle contraction and its nervous
regulation, because it is the one that inspired the
researchers, using external excitation of muscles,
to try to cause its contraction and generate greater
force than during maximal voluntary contraction.
Physiological mechanisms of electro-muscle
stimulation (EMS) and functioning
EMS is achieved by an electric impulse which, via
electrodes on the skin stimulates nerves that
innervate specific muscle group (Figure 1). The
muscles work differently depending on the severity,
frequency and pulse width of electric impulse.
Muscle is made up of two types of muscle fibers:
red - which slowly contract and work under aerobic
Pavlović, R. et al.: Electro-muscle stimulation - the application in practice Acta Kinesiologica 10 (2016) Suppl 1: 49-55
conditions, and white - which react faster and are
capable of anaerobic work. The ratio of white and
red muscle fibers depends on the way the muscles
are used. Muscle fibers can be converted from one
form to another, depending on the signals they
receive. This is known as a trophic effect (Pavlović,
2014). Contraction (lat. contraho-contract) or
muscle spasm is a process of muscle shortening
whereby there is a manifestation of the forces at its
ends (tendons). All skeletal muscles are composed
of a large number of muscle fibers; each muscle
fiber contains several hundred to several thousand
muscle fibers or myofibrils. Each myofibril consists
of about 1500myosin and 3000 actin filaments or
microfilaments. The main commander and
controller of motor activity is the central nervous
system (CNS), which generates and transmits
nerve impulses necessary for muscle contraction.
Every nerve ending is tied with muscle fibers in the
neuromuscular junction, located approximately in
the middle of the muscle fiber. The nerve fiber
branches at its end, making web branched nerve
endings, which make the structure called the motor
plate. The electric impulse in the form of an action
potential travels along the motor nerve to its end
on the muscle fibers. Each impulse that arrives at
the neuromuscular junction typically creates the
potential motor plate, which is about three times
higher than the potential required to incite the
muscle fiber. When a nerve impulse reaches the
neuromuscular junction, from the nerve endings in
the synaptic cleft is emptied one part of the
neurotransmitter acetylcholine bubbles (10,000
Acetylcholine acts locally on the membrane of
muscle fibers and allows the entry of sodium ions
into the interior of the muscle fibers membrane.
This reaction promotes the formation of the action
potential in the muscle fiber, which along the
muscle fiber membrane travels in the same way as
along the nervous fiber membrane, leading to
depolarization of muscle membrane (2-4ms).The
membrane suddenly becomes very permeable to
sodium ions, which immediately neutralize the
impact of the normal polarized state of -90 mV and
the potential increases rapidly in the positive
direction (5mV). In this way, a large part of the
electric current of the action potential goes deep
within the muscle fiber, releasing from the
sarcoplasmic reticulum large amount of calcium
ions. Calcium ions induce forces of attraction
between the actin and myosin filaments, causing
their mutual sliding necessary to create muscle
contraction. Immediately thereafter (milliseconds)
calcium pump membrane returns the calcium ions
to sarcoplasmic reticulum where they remain stored
until a new action potential (Guyton, & Hall, 2003).
Spots of contact of muscular and nervous fibers
make the motor unit (muons). The motor unit
consists of a single α (alpha) -motor neurons (with
associated nerve fibers) and all the muscle cells
that irritate these individual neurons. During the
voluntary activity, CNS first activates the smallest
alpha motoneuron, while, with the increase of the
force, higher motoneurons are progressively
triggered. This principle is called the "recruitment in
size", and refers to the engagement of motor units
and depends on the size of the alpha motor
neurons. Among motor units, there are differences
in the frequency of nerve impulses, and these
differences depend on the type of muscle cells in
motor units (Mišigoj-Duraković, et al., 1999). The
male motor unit usually contains slow (red)
oxidative fibers of low threshold stimulation. Nerve
fibers, which sensitize them, have relatively low
impulse frequencies (10-20 Hz).Opposite of them
are the motor units with a fast (white) glycolytic
fibers, with the nerve fibers of high-frequency
impulses (40-60 Hz). Between these two types,
there are transitional fast oxidative-glycolytic fibers
(Type IIa), with the nerve fibers of medium impulse
frequency (20-40 Hz). Lower relative forces of
contraction (relative force is the strength
percentage) trigger the slow fibers. Between 40-
60% of relative forces are activated type IIa fibers,
and most of the high-speed fibers are activated
only above 90% of relative force (Pavlović, 2014;
Vrcić,et al., 2015). Increasing the force of
contraction leads to the increase of impulse
frequency of all types of motor units, up to a
maximum contraction, when the nerve fibers of all
activated motor units achieve the highest frequency
impulses, in terms characteristic for individual
fibers (so fibers of slow units will again have the
lowest and high-speed fiber units the highest
frequency). The order of muscle fibers activation is
reversed when the muscle is electro-stimulated
therefore activated by external stimuli through
electro-stimulator. In this case, first are recruited
fast contractile muscle fibers and with the highest
engagement, and after that, slow contractile
muscle fibers with low engagement (Porcari,
Mclean, Foster, et al., 2002). This phenomenon
significantly affects the size of the forces generated
during electro-stimulated contraction, i.e. the
difference between the force in this type of
contraction and the force generated during maximal
voluntary contraction.
The principle of electrical stimulation consists of
stimulating the nerve fibers by electrical impulses
that are transmitted through the electrodes. In
active training muscular work comes from the
brain, which sends the command in the form of
electrical signals to nerve fibers that contract. The
principle of electrical stimulation corresponds
exactly to the process that takes place at the
desired contraction. The stimulator sends an
electrical current impulse to the nerve fibers, which
causes their irritation. This irritation is submitted
further to the muscle fibers that perform
elementary mechanical response (muscle twitch) as
an essential element of muscle contraction. The
reaction of the muscle is fully synchronized with the
work of the muscles from the brain. In other words,
the muscle cannot distinguish the command from
the stimulator from those from the brain. Various
parameters (number of impulses per second, the
duration of contractions, the duration of resting
stages) allow different types of muscles to start
working, depending on the muscle fibers.
Pavlović, R. et al.: Electro-muscle stimulation - the application in practice Acta Kinesiologica 10 (2016) Suppl 1: 49-55
Fast fibers will be more prevalent among sprinters
while marathon runners will have more slow fibers.
Knowledge of human physiology and a perfect
mastering of stimulation parameters of the
program allow very precisely the work of muscles
to be directed to the desired objective (to
strengthen muscles, increase blood flow,
mounting). To achieve the pain relief effects the
electrical impulses can also arouse sensitive nerve
fibers. The stimulation of nerve fibers blocks the
transfer of the pain through the nervous system, in
contrast to the stimulation of some other types of
sensible fibers which causes an increase in the
production of endorphins alleviating pain. (Baker,
McNeal, Benton, et al. 1993).
Figure 1. Stimulation of motor neuron (EMS)-
afferent and efferent impulse
The use of EMS in sports and fitness
Electrical stimulation in recent years has begun to be
applied in sports, especially with athletes who need
strength. It is implemented by using special
appliances, and the length of stimulation lasts for 10-
15 seconds with breaks of 45-50 seconds, usually with
10 repetitions. It can be particularly useful when
properlydosed; otherwise, its use can cause harmful
effects, especially if used for longer than the scheduled
time. By applying electrical stimulation blood
circulation and metabolism of nutrients in muscle cells
are improved, thereby contributing to the increase of
muscle mass, and thus strength.Most often it is used
for the purpose of recovery, but after three weeks of
its effect lowers. The application of EMS in the sport
and fitness helps strengthen specific muscles or
muscle groups in order to achieve the desired
proportions of the body, the development of muscular
endurance, warming, strengthening and increasing
strength, improves muscle recovery and rehabilitation
of sports injuries (Vrcić, et al., 2015). It is important
to note that the effect of the EMS functioning can be
expected only in regular use, it does not replace
regular exercise but it is good as a complementary
part. There are only a few studies in the scientific
literature in the field of electrical stimulation of
muscles. There are even fewer allegations that
document the effects of applying this method to
healthy people, and the physically active
population, or recreational athletes (Banerjee,
Caulfield, Crowe, & Clark, 2005; Davis, Hamzaid, &
Fornusek, 2008). Previous research in the field of
the EMS identified the significant effects on
strength and power, but in isolated muscle groups
(m. quadriceps femoris or m.bicepsfemoris).There
are top sportsmen (canoe or kayak) with a very
positive attitude towards electrical stimulation, but
even they apply it locally (on several muscles),
before major competitions, including the Olympics.
Some allegations indicate that if the EMS is applied
regularly (twice a day) on the small muscles of the
foot arch, improvements are probable, or on higher
muscle groups the EMS treatment can vary from
15-60 minutes, twice a week to several times
(Malacko & Rađo, 2004). In addition, the EMS has
been successfully applied to the extensor muscles
of the spine with the rowers and kayakers, who
tend to the occurrence of pain in the lower back
(Wheeler, Andrews, & Lederer, R., 2002 Zaciorski,
& Kremer, 2009). Advantages of using the EMS to
the whole body in order to achieve better physical
form or shape have never been tested. However, it
is evident that the EMS has an important place in
the field of recreational exercise, and a growing
number of fitness centers that follow the modern
trends offer this type of training.
The first allegations and the first documented
research in the Soviet Union state that the EMS is a
more effective method of developing strength and
power of skeletal muscles in athletes than exercise
without the use of electrical stimulation (Kots,
1977).This method was used in the Soviet Union on
the athletes at the end of the sixties of the
twentieth century, but contrary to some beliefs it
was not regularly used as a substitute for
traditional strength training. Often the authors
state that the advantage of using the EMS lies in a
different mode of motor unit recruitment in relation
to the exercise with maximum voluntary
contraction. The EMS method found its application
in the field of sports and fitness mainly through a
technique called tetanic stimulation. It represents a
series of repeated stimulus-electrical impulses,
which are determined by two key factors: the
duration of each impulse and the time between
consecutive impulses.Tetanic stimulation makes it
possible to manipulate the impulse duration and
breaks between two consecutive impulses, which
determines the total load on the stimulated muscle.
If the time between two consecutive impulses is
short, the muscle will not be ready for the next
contraction. This period is called the absolute non-
irritability refraction period lasting from 1-3ms.
(Pavlović, 2014).
Pavlović, R. et al.: Electro-muscle stimulation - the application in practice Acta Kinesiologica 10 (2016) Suppl 1: 49-55
This method theoretically should cause the
maximum possible power development as a series
of consecutive impulses causes the maximum
contractions of the stimulated muscle. It is
recommended to use with athletes or recreational
athletes with a higher level of quality. Electrical
muscle stimulation in sport and fitness is applied
mainly through external electrodes, i.e. through the
skin. Bipolar electrodes are commonly used (which
means that the electrode has two different poles).
The electrodes are typically attached to the skin
above the stimulated muscle. For proper and
comfortable work it is very important to use the
appropriate size electrodes and properly position
them in the muscle (Knez, 2000). For the
successful implementation of the EMS method, it is
necessary to take into account the quality of the
stimulation device. In fact, studies have shown that
the actual frequency of electrical impulses
(modulation), provided by stimulator, can
significantly (for several times) be different from
those declared on the device.Specifically, the
muscle fatigue is increased with the increase in the
stimulation frequency (DeVahl, 1992). Most of the
previously used protocols, intended for the
development of strengths and the power, indicate
that the frequency must be sufficiently high to
achieve a tetanic contraction, but at the same time
sufficiently low to minimize the muscle fatigue
(Baker, et al., 1993). Usually, this is achieved by
using frequencies of between 50 and 75 Hz.
Excessive stimulation frequency in combination
with short breaks between contractions leads to
extreme fatigue at stimulated muscle fibers, which
can result in an insignificant increase in muscle
strength after the EMS. Another factor that can
affect muscle fatigue, and thus the size of the
effects, is the order of engaged muscle fibers
during the EMS (considerably changed in relation to
the voluntary contraction).So, first are engaged the
fast contractile muscle fibers (Van Swearingen,
1993). In addition, there is a synchronous
activation of all of the same sized axons, at equal
distance from the electrode (Baker, et al., 1993).
Thus, in relation to the voluntary contraction,
electrically caused contraction leads to a much
greater fatigue of the muscle fibers, due to
selective engagement of fast contractile muscle
fibers in combination with synchronous activation of
the same muscle fibers repeatedly. Accordingly,
protocols used to develop strength and muscle
strength using the EMS, usually are designed to
reduce fatigue. The first manner of reducing fatigue
is to allow plenty of time to recover muscle fibers
after each contraction. This is often accomplished
by the ratio of contraction and relaxation of 1: 5
(Baker et al., 1993). However, a large number of
stimulators used in research allows a relatively
short recovery time. This ratio is ranged from 1: 3
to 1: 5. Although in the offer can be found different
types of electro-stimulation treatments or training,
in professional sports literature is mainly mentioned
the so-called "Russian protocol".
Russian Protocol (Zaciorski and Kremer. 2009):
• Carrying signal - sinusoidal or triangular
• Frequency - greater than 2500 Hz
• Modulation - 50 Hz
Amplitude of stimulus - adapted to the individual
to induce a force greater than 100% of maximal
isometric force or up to the limit of athlete's
endurance; the amplitude of the stimuli depends on
the output of the impedance of the stimulator, and
is often greater than 90 V
• Duration of contraction -10 s
• Pause between contractions - 50 s
• The number of contractions – 10 daily
• The number of training days - 5 times a week
Extremely important factor for the development of
strength and power is the intensity of the training,
which is carried out regardless of whether
combined with external irritation or not. The EMS in
previous studies was mostly combined with a
generally isometric type of muscle contraction. The
results of the studies which combined the EMS and
strength training, thefirst state that to achieve an
increase in strength of contractions the muscle
should be stimulated above the critical threshold.
This threshold can be very low 30% of the maximal
voluntary contraction (MVC) in untrained
individuals, but must strictly be in the range of 60-
80% MVC in athletes (Mueller, 1959).After a series
of studies to determine the minimum threshold
required to achieve improvements in strength
(Currier, Lehman, & Lightfoot, 1979) it was
concluded that electrically induced contraction must
be at least 60% of MVC (Currier, et al., 1979;
Currier, & Mann 1983; Soo, Currier, &Threlkeld,
1988). Studies have established that if the power of
electrically induced contraction was less than 20%
of MVC, the stimulus is below the critical threshold
needed to increase muscle strength and changes in
the appearance of a healthy person.
In fact, in a study on healthy people was
administered a battery of tests that included: body
weight, percentage of subcutaneous adipose tissue
- skin folds, circumferences, isometric and
isokinetic strength (biceps, triceps, quadriceps and
hamstring) and appearance (photos - forward,
backward) in order to determine the actual effects
of the EMS on physical strength, reduction of body
fat and general appearance of trainees (Porcari,
Mclean, Foster, & et al. 2002). Treatment of 8
weeks long EMS stimulation did not result in
statistically significant effects on these variables.
The findings of this study do not support the
manufacturers' claims that the EMS is important for
the development of strength and power, and that it
lowers the proportion of subcutaneous fat as well
as the general appearance of healthy people.
Electrical stimulation could serve as a useful
addition to traditional training methods. It can
stimulate not only the creation of maximum force
but also the speed of movement and muscle
endurance. Time of accommodation is usually
twenty to twenty-five days of training, the training
for the development of maximum power, and ten to
twelve days for speed training.
Pavlović, R. et al.: Electro-muscle stimulation - the application in practice Acta Kinesiologica 10 (2016) Suppl 1: 49-55
If electro-stimulation is applied to increase
muscular endurance, stabilization cannot be
achieved even after thirty-five units of training.
However, although the EMS has the potential to
increase the strength, many experienced athletes
do not accept this method. In addition to the usual
resistance to everything that is new, there are two
very strong reasons for this. First, athletes can take
advantage of advances in an isometric mode in real
competitive activities. Second, some athletes
during the electro-stimulation had an unpleasant
feeling that they lose the muscle control or
coordination, and therefore refused to continue
further treatment. This confirms the theory that the
electro-stimulation trains only the muscles (but not
the neurological factor). The ability to increase
activation of a muscle cell is not increased by this
type of training (Zaciorski and Kremer, 2009). In
the end, it is necessary to indicate the possible
contraindications and precautions to be followed
during each non-medical application of electrical
stimulation, regardless of the objective and
Contraindications of the EMS
It is not applied to the thoracic area in
patients with arrhythmia, congestive heart failure,
recent myocardial infarction and other heart
Not applied anywhere on the body in a
patient with a built-heart stimulator, defibrillator or
other medical electrical stimulators;
Not applied to the area of the carotid
arteries as it can cause a rise in blood pressure,
cause reflex vasodilatation and slow down the heart
Not applied to the head area (electrical
impulse travels "through the head");
not applied at malignant (cancer) tissues;
not applied to the area of damaged or irritated skin
because it can cause pain and discomfort,
exception is medical electrical stimulation for
wound healing;
Not applied to the territory or close contact
with metals, such as external pins, orthopedic
fixations, etc. (metals are excellent conductors of
Not applied to any patient who has a
negative feeling of stimulation;
Not applied to a patient with undiagnosed
pain, without conclusions on the cause of the
Not applied to a patient who cannot provide
adequate feedback on the level of stimulation
(children, people with mental disorders).
Precautions during the EMS
Pay special attention when using the EMS
with high amplitudes directly over the area where
the bone is positioned on surface (it can lead to
periosteal pain);
Pay special attention when applying in
areas of excessive body fat, because they require
high stimulation to activate the desired muscles
which may cause pain;
Pay particular attention to the application
near the womb during pregnancy and childbirth
(possible effects on the fetus have not been
established); pay special attention when applying in
the region of the bladder, because it can interfere
its normal function;
Pay particular attention to the
implementation to patients with a history of
metastatic diseases.
Based on the above it can be concluded that EMS is
now commonly used as an additional method in the
development of the strength at experienced
athletes or top recreational sportsmen. Electrical
stimulation provides the highly effective ability of
muscular work with the development of different
quality muscles without the fatigue of
cardiovascular system and psyche, by the low
workload of joints and tendons, allowing muscles a
greater working task than working with the willful
To be effective this work must be carried out
preferably with the activation of a large number of
muscle fibers, and the number of fibers depends on
the stimulation energy. The user himself/herself is
responsible for this aspect of the simulation. The
higher the stimulation energy, there is a greater
number of working muscle fibers, so the progress
In order to the extract greater benefit from the
achieved results during the application of the EMS
we need to pay attention to all information obtained
during previous research and practical application,
in order to achieve the desired effects and improve
training practice of top athletes, and recreational
athletes in fitness centers.
However, the existing knowledge of the EMS is still
not fully explored scientifically and not practically
confirmed, it requires further experimental research
in the field of professional sport and fitness so that
this method could take its place in everyday use.
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Potreba za "uklapanjem" dovela je do planetarnog ekspanzije fitnes centara. Novi fitnes programi se pojavljuju
skoro svaki dan, no uprkos velikoj marketinškoj podršci i trenutne javnosti vrlo brzo budu zaboravljeni. U okviru tih
uslova, a u cilju postizanja zadovoljstva i povjerenja svojih klijenata, ponuđeni program treba proizvesti željene
efekte u vezi sa transformacijom ciljanih sposobnosti ili karakteristika onih koji obavljaju vježbe. Ovo predstavlja
stalne izazove za fitnes industriju, uz obavezu da se traže optimalne, znanstveno prihváene i dokazane metode
koje se obavljaju. Ovaj rad se bavi analizom elektromišíne stimulacije (EMS), kao jednim od tri načina koji su
razvijeni kroz istraživanja dizajnirana za astronaute. Pušten je u javnost nakon pada Berlinskog zida 1989.godine i
otvaranja tajnih SSSR i SAD dokumenata. Sadašnja istraživanja definiraju odgovarajúe jedinice, počevši od
epistemologije na elektromišíastimulacije (EMS), njegove primjene kao alternative razvoja uslovnog kapaciteta,
kliničke primjene u fizikalnoj terapiji i EMS kao jedan od načina za oporavak sportaša (regeneracije tijela) kako bi
se spriječili negativni efekti treninga (razvoj pretreniranosti i kroničnog umora). Svaka jedinica ́e sadržiti
informacije koje su relevantne za teoriju i praksu u sportu, rekreaciju i oporavku sportista i pacijenata.
Ključne riječi: elektromišína stimulacija (EMS), fitnes i sport, primjena u praksi, kontraindikacija, izliječenja
Received: July 23, 2016
Accepted: September 5, 2016
Correspondence to:
Assoc. Prof. Ratko Pavloví
Faculty of Physical Education and Sports,
University of East Sarajevo,
St. Vuka Karadžía 30,
71126 Lukavica, East Sarajevo
Phone: +387 (65) 934-131
... It usually works by stimulating the natural process of exercising muscles. It uses low current electrical for muscle stimulation and cause them to contract mostly used for therapeutic rehabilitation purposes in sports [14]. ...
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... Medtronic device was used in the treatment of epilepsy and Parkinson's disease. Electrical Muscle Stimulation (EMS) also uses electric currents and a similar apparatus and procedure for treatment [32]. People typically get confused between TENS and EMS systems. ...
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To assess changes in peak functional aerobic power after a 36-session, progressive functional electric stimulation (FES) rowing hybrid training program for persons with spinal cord injury (SCI) and to examine the safety and acceptability of the ROWSTIM II device as well as the integrity of technical modifications to it. Repeated-measures training study, quasi-experimental design, within-person data comparison. A university-based recreational physical activity facility for persons with physical disabilities. Six persons with level C7-T12 SCI (American Spinal Injury Association classes A-C). Progressive rowing training program, 30 minutes per session, 3 times a week for 12 weeks at 70% to 75% of pretest peak functional aerobic power during FES rowing on an open loop control, FES-assisted rowing machine. Total rowing distance, peak functional oxygen consumption, and peak oxygen pulse. Subjects completed between 22 to 36 sessions. After 3 months of training, rowing distance increased by 25% (P<.02), peak oxygen consumption by 11.2% (P<.001), and peak oxygen pulse by 11.4% (P<.01). Heart rate response to hybrid training did not change at the end of training, although peak heart rate with FES lower-extremity exercise increased significantly from pre- to posttraining (P<.01). Pre- and posttraining peak aerobic power values for ROWSTIM II training were comparable to previously reported values for hybrid cycle and upper-extremity exercise. We conclude that FES-assisted rowing is an effective, safe, and well-tolerated training system for persons with SCI.
The strength of muscles is adapted to needs by muscular growth. The stimulus for increase in muscle strength is not fatigue but the force exerted during the job. When this force exceeds one-third of maximum strength, the maximum speed of increase in strength is reached with one single, short duration static contraction per day. With one single, short duration contraction per week the rate is one-third of this maximum. Loss of strength after training by daily contraction is at the rate at. which it was gained. The slower increase by weekly training leads to a more permanent acquisition of strength. To avoid fatigue in static work the muscles should be trained against a force about double the highest static force which occurs during the jobInactivity lowers strength about 30 per cent in a week, with an equally quick return to normal strength by now activity. Atrophy can be prevented by one contraction per day with a force one-fifth of maximal strength. Normal strength is maintained by contractions lying between one-fifth and one-third of maximum strength. The ability of muscles to increase maximum strength varies from muscle to muscle and from person to person. For men it is maximal at 25 years of ago and half maximal at ages 10 and 60 years. The rate of increase in men is double that of women at ago 25 yours and 25 per cent higher at ages 10 and 60 years. This trainability has u minimum in winter and a maximum in summer. It reacts positively on exposure to ultra-violet radiation. It is not improved by a high protein diet but is reduced by a low protein diet
Functional electrical stimulation (FES)-induced leg exercise offers the potential for individuals with lower-limb paralysis to otherwise gain some benefits conferred by leg exercise. Although its original intent is to reactivate the leg muscles to produce functional upright mobility, as a rehabilitation therapy, FES-evoked exercise increases the whole-body metabolism of individuals with spinal cord injury (SCI) so that they may gain general and localized health and fitness benefits. The physiological and psychosocial responses during FES-evoked cycling, standing, rowing, leg extension, or stepping have been extensively explored for over 20 years. Some of the advantages of such exercise include augmented cardiorespiratory fitness, promotion of leg blood circulation, increased activity of specific metabolic enzymes or hormones, greater muscle volume and fiber size, enhanced functional exercise capacity such as strength and endurance, and altered bone mineral density. Positive psychosocial adaptations have also been reported among SCI individuals who undergo FES exercise. This article presents a position review of the available literature on the effects of FES-evoked exercise since the earliest date until 2007, to warrant a conclusion about the current status and potential of FES-evoked exercise for paralyzed people.
Thirty-seven healthy subjects took part in an investigation to determine if the application of electrical stimulation to normal muscle, in combination with exercise, augments strength. Subjects were divided into three groups. Grwoup A (n = 14) was a control group (no exercise, no electrical stimulation). Group B members (n = 11) engaged in 10 sessions of maximum isometric exercise, and Group C subjects (n = 12) performed 10 sessions of maximum isometric exercise while simultaneously receiving electrical stimulation. The knee extensor muscles of subjects in Groups B and C increased in strength. However, the strength gains for Groups B and C were equivalent, suggesting that electrical stimulation combined with maximum isometric contractions has no greater effect on enhancing strength than does conventional static exercise.
The purpose of this study was to evaluate the ability of electrical stimulation (2,500-Hz sine waves, interrupted for 50 pulsed bursts per second) to improve muscle torque using low-dosage training characteristics. Fifteen healthy subjects (9 men, 6 women), 20 to 32 years of age, participated in the experiment. All subjects received electrical stimulation of the right anterior thigh musculature while their left leg served as the control. Electrical stimulation was repeated eight times per session, each stimulation producing isometric torque equal to 50% of the subject's maximum voluntary isometric contraction. The sessions were repeated twice a week over a period of five weeks. Results showed that electrical stimulation, when used with the specified low-dosage training characteristics of this study, will augment quadriceps femoris muscle torque of men.
The purpose of this study was to examine the effectiveness of an electronic muscle stimulator in strengthening normal quadriceps femoris muscle without the assistance of simultaneous isometric muscle contraction. The sample consisted of 58 subjects who were randomly divided into three independent groups. One group (n = 19) served as controls; one group (n = 20) underwent daily stimulation of the right quadriceps femoris muscle using a specified protocol; and one group (n = 19) underwent isometric strengthening of the quadriceps femoris muscle using a specified protocol. The mechanical force of isometric quadriceps femoris muscle contraction was recorded weekly for the three groups, and the initial and final values were subjected to an analysis of covariance. The electrical-stimulation and isometric-exercise groups had statistically significant increases in quadriceps femoris muscle torque when compared with the nonexercised controls (p less than .001). The data supported the use of this electronic stimulator as an appropriate device for strengthening skeletal muscle without voluntary effort.
The effects of electrical stimulation and its comparison with various resistance training modes were investigated in 34 subjects who trained their dominant leg isometrically three times a week for five weeks. Group E (n = 8) used maximum voluntary isometric contractions only, Group S (n = 8) received only electrical stimulation, and Group ES (n = 9) trained using a concurrent combination of isometric exercise and electrical stimulation. In addition, Group C (n = 9), a control group, did no experimental training. The expected gain in torque was shown in the isometric strength scores of the three experimental groups; however, there was little change in the isometric strength of the control group and in the isokinetic (100, 200, and 300 degrees/sec) results of any of the four groups. After adjustments were made for pretest strength results, a one-way analysis of covariance indicated that the posttest isometric strength scores of the three experimental groups differed significantly from those of the control group. No other posttest differences were found among any of the other training modes.
To determine the magnitude of changes in muscle mass and lower extremity body composition that could be induced with a regular regimen of functional electrical stimulation (FES)-induced lower-extremity cycling, as well as the distribution of changes in muscle mass among the thigh muscles in persons with spinal cord injury (SCI). Thirteen men with neurologically complete motor sensory SCI underwent a 3-phase, FES-induced, ergometry exercise program: phase 1, quadriceps strengthening: phase 2, progressive sequential stimulation to achieve a rhythmic pedaling motion (surface electrodes placed over the quadriceps, hamstrings, and gluteal muscles); phase 3, FES-induced cycling for 30 minutes. Participants moved from one phase to the next when they met the objectives for the current phase. Computed tomography of legs to assess muscle cross-sectional area and proportion of muscle and adipose tissue. Scans were done at baseline (before subjects started the program), at first follow-up, typically after 65.4+/-5.6 (SD) weekly sessions, and at second follow-up, typically after 98.1+/-9.1 sessions. Increases in cross-sectional areas were found in the following muscles: rectus femoris (31%, p<.001). sartorius (22%, p<.025), adductor magnus-hamstrings (26%, p<.001), vastus lateralis (39%, p = .001), vastus medialis-intermedius (31%, p = .025). Cross-sectional area of adductor longus and gracilis muscles did not change. The ratio of muscle to adipose tissue increased significantly in thighs and calves. There was no correlation among the total number of exercise sessions and the magnitude of muscle hypertrophy. Muscle cross-sectional area and the muscle to adipose tissue ratio of the lower extremities increased during a regular regimen of 2.3 FES-induced lower extremity cycling sessions weekly. The distribution of changes was related to the proximity of muscles to the stimulating electrodes.
Electrical muscle stimulation devices (EMS) have been advertised to increase muscle strength, to decrease body weight and body fat, and to improve muscle firmness and tone in healthy individuals. This study sought to test those claims. Twenty-seven college-aged volunteers were assigned to either an EMS (n = 16) or control group (n = 11). The EMS group underwent stimulation 3 times per week following the manufacturer's recommendations, whereas the control group underwent concurrent sham stimulation sessions. Bilaterally, the muscles stimulated included the biceps femoris, quadriceps, biceps, triceps, and abdominals (rectus abdominus and obliques). An identical pre- and posttesting battery included measurements of body weight, body fat (via skinfolds), girths, isometric and isokinetic strength (biceps, triceps, quadriceps, hamstrings), and appearance (via photographs from the front, side, and back). EMS had no significant effect on the any of the measured parameters. Thus, claims relative to the effectiveness of EMS for the apparently healthy individual are not supported by the findings of this study.