Physical training augmented with whole body electronic muscle stimulation favorably impacts cardiovascular biomarkers in healthy adults - A pilot randomized controlled trial

BACKGROUND

Physical activity is protective against cardiovascular disease (CVD) and favorably improves CVD risk profile. However, more than 25 % of American adults report no participation in physical activity. Whole body electronic muscle stimulation (WB-EMS) training is a novel FDA-cleared technology which offers a time-efficient and adaptable method for physical training by simultaneously stimulating the main muscle groups using percutaneous electrical impulse transmission. Studies have demonstrated increased muscle mass, reduced fat mass, and improved functional capacity in sedentary individuals after training with WB-EMS, but studies evaluating the role of WB-EMS training on CVD risk profile are lacking.

METHODS

We performed a pilot randomized controlled trial in healthy adults randomized to physical training with versus without WB-EMS for one session of 20 min duration per week across 16-weeks. Study participants were asked to perform their usual activities but to abstain from any strength training during the study. During each training session, all study participants wore a specifically designed vest and arm and leg straps that were connected with electrical wires to the WB-EMS device (Miha Bodytec Gersthofen, Germany). Biphasic electrical stimulation was delivered through the vest and straps (4 s on, 4 s off) at a frequency that elicited a score of 5 or 6 on the Borg rating of perceived exertion scale from study participants when each of the following muscle groups was stimulated: thighs, buttocks, lower back, upper back, latissimus dorsi, abdomen, chest and arms. These frequencies were 'titrated' during the first 4 weeks and were then fixed at each muscle group for each participant. Individuals randomized to no WB-EMS wore the same equipment but received no electrical stimulation. Physical training sessions were provided by personal trainers certified for WB-EMS training and consisted of a fixed number of exercises and repetitions. We measured and compared several clinically important cardiovascular parameters at baseline and post-intervention.

RESULTS

Seventy-eight participants were recruited between January 2021 and March 2022 with a mean age of 35.9 ± 11.2, 61.3 % females, median BMI 24.3 (21.8, 28.1); N = 46 were randomized to intervention group and N = 32 were randomized to the control group. Eighteen (23 %) participants dropped out of the trial, including 9 participants from the EMS arm (19.6 %), and 9 participants in control arm (28.1 %). There was no significant differences in the rate of dropping out of the WB-EMS and control groups (p = 0.27). Those in the intervention group compared to controls exhibited the following changes after 16-weeks of training: waist:hip ratio (∆ -0.03 ± 0.05, p = 0.01 vs. -0.01 ± 0.0, p = 0.1), peripheral endothelial function, measured using reactive hyperemia peripheral arterial tonometry (∆: 0.02 ± 0.1, p = 0.5 vs. -0.20 ± 0.3 p = 0.05), high-sensitivity C-reactive protein (∆: 0.06 ± 0.7, p = 0.3 vs. 0.20 ± 2.3 p = 0.02), total cholesterol (∆: -1.7 ± 25.1, p = 0.3 vs. 19.2 ± 26.5, p < 0.001), high density lipoprotein (∆: 2.02 ± 6.6, p = 0.2 vs. 3.6 ± 7.5 p = 0.01) and low density lipoprotein cholesterol (∆: 0.5 ± 26.7, p = 0.4 vs. 17.1 ± 23.2, p < 0.001).

CONCLUSION

Once weekly physical training with WB-EMS in healthy adults resulted in either improved or stable biomarkers of cardiovascular risk, which either remained stable or worsened in those undergoing conventional training alone. Thus WB-EMS may provide an effective and time-efficient form of physical training that may be considered in those unable or unwilling to perform exercise conventionally.

Effect of electrical muscle stimulation on the improvement of deltoid muscle atrophy in a rat shoulder immobilization model

Immobilization following trauma or surgery induces skeletal muscle atrophy, and improvement in the muscle atrophy is critical for successful clinical outcomes. The purpose of this study is to evaluate the effect of electrical muscle stimulation (EMS) on muscle atrophy. The study design is a controlled laboratory study. Eighty rats (56 to establish the deltoid muscle atrophy [DMA] model and 24 to evaluate the effect of EMS on the model) were used. DMA was induced by completely immobilizing the right shoulder of each rat by placing sutures between the scapula and humeral shaft, with the left shoulder as a control. After establishing the DMA model, rats were randomly assigned into three groups: low-frequency EMS (L-EMS, 10 Hz frequency), medium-frequency EMS (M-EMS, 50 Hz frequency), and control (eight rats per group). After 3 weeks, the deltoid muscles of each rat were harvested, alterations in gene expression and muscle cell size were evaluated, and immunohistochemical analysis was performed. DMA was most prominent 3 weeks after shoulder immobilization. Murf1 and Atrogin were significantly induced at the initial phase and gradually decreased at approximately 3 weeks; however, MyoD expressed an inverse relationship with Murf1 and Atrogin. IL6 expression was prominent at 1 week. The time point for the EMS effect evaluation was selected at 3 weeks, when the DMA was the most prominent with a change in relevant gene expression. The M-EMS group cell size was significantly larger than that of L-EMS and control group in both the immobilized and intact shoulders (all p < 0.05), without significant differences between the L-EMS and control groups. The M-EMS group showed significantly lower mRNA expressions of Murf1 and Atrogin and higher expressions of MyoD and Col1A1 than that of the control group (all p < 0.05). In immunohistochemical analysis, similar results were observed with lower Atrogin staining and higher MyoD and Col1A1 staining in the M-EMS group. DMA model was established by complete shoulder immobilization, with the most prominent muscle atrophy observed at 3 weeks. M-EMS improved DMA with changes in the expression of relevant genes. M-EMS might be a solution for strengthening atrophied skeletal muscles and facilitating rehabilitation after trauma or surgery.

Fatigue Alleviation by Low-Level Laser Preexposure in Ischemic Neuromuscular Electrical Stimulation

PURPOSE

Despite its susceptibility to muscle fatigue, combined neuromuscular electrical stimulation (NMES) and blood flow restriction (BFR) are effective regimens for managing muscle atrophy when traditional resistance exercises are not feasible. This study investigated the potential of low-level laser therapy (LLLT) in reducing muscle fatigue after the application of combined NMES and BFR.

METHODS

Thirty-six healthy adults were divided into control and LLLT groups. The LLLT group received 60 J of 850-nm wavelength LLLT before a training program of combined NMES and BFR of the nondominant extensor carpi radialis longus (ECRL). The control group followed the same protocol but received sham laser therapy. Assessments included maximal voluntary contraction, ECRL mechanical properties, and isometric force tracking for wrist extension.

RESULTS

The LLLT group exhibited a smaller normalized difference in maximal voluntary contraction decrement (-4.01 ± 4.88%) than the control group (-23.85 ± 7.12%) ( P < 0.001). The LLLT group demonstrated a smaller decrease in muscle stiffness of the ECRL compared with the control group, characterized by the smaller normalized changes in frequency ( P = 0.002), stiffness ( P = 0.002), and relaxation measures ( P = 0.011) of mechanical oscillation waves. Unlike the control group, the LLLT group exhibited a smaller posttest increase in force fluctuations during force tracking ( P = 0.014), linked to the predominant recruitment of low-threshold MU ( P < 0.001) without fatigue-related increases in the discharge variability of high-threshold MU ( P > 0.05).

CONCLUSIONS

LLLT preexposure reduces fatigue after combined NMES and BFR, preserving force generation, muscle stiffness, and force scaling. The functional benefits are achieved through fatigue-resistant activation strategies of motor unit recruitment and rate coding.

Assessing the Impact of Neuromuscular Electrical Stimulation-Based Fingerboard Training versus Conventional Fingerboard Training on Finger Flexor Endurance in Intermediate to Advanced Sports Climbers: A Randomized Controlled Study

Competitive climbers engage in highly structured training regimens to achieve peak performance levels, with efficient time management as a critical aspect. Neuromuscular electrical stimulation (NMES) training can close the gap between time-efficient conditioning training and achieving optimal prerequisites for peak climbing-specific performances. Therefore, we examined potential neuromuscular adaptations resulting from the NMFES intervention by analyzing the efficacy of twice-weekly NMES-supported fingerboard (hang board) training compared with thrice-weekly conventional fingerboard training over 7 training weeks in enhancing climbing-specific endurance among intermediate to advanced climbers. Participants were randomly divided into the NMES and control groups. Eighteen participants completed the study (14 male, 4 female; mean age: 25.7 ± 5.3 years; mean climbing experience: 6.4 ± 3.4 years). Endurance was assessed by measuring the maximal time athletes could support their body weight (hanging to exhaustion) on a 20 mm-deep ledge at three intervals: pre-, in-between- (after 4 weeks of training), and post-training (after 7 weeks of training). The findings revealed that despite the lower training volume in the NMES group, no significant differences were observed between the NMES and control groups in climbing-specific endurance. Both groups exhibited notable improvements in endurance, particularly after the in-between test. Consequently, a twice-weekly NMES-supported fingerboard training regimen demonstrated non-inferiority to a thrice-weekly conventional training routine. Incorporating NMES into fingerboard workouts could offer time-saving benefits.

Effects of 12 weeks of neuromuscular electrical stimulation of the quadriceps muscles on the function and physio-biochemical traits in functionally fit female nursing-home residents aged 75 + years: a pilot study

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.

The Effect of Whole-Body Electromyostimulation Program on Physical Performance and Selected Cardiometabolic Markers in Obese Young Females

Background and Objectives: Whole-body electromyostimulation is under investigation as a potential aid for obesity-related health problems, supplementing a comprehensive, evidence-based obesity management strategy that includes lifestyle, diet, and exercise. The study investigated the impact of a whole-body electromyostimulation training program on physical performance and cardiometabolic markers in young obese females. Materials and Methods: Twenty-eight obese females, aged over 18 years with BMI over 30 and body fat over 28% and no underlying health conditions or medication, were divided into a whole-body electromyostimulation group (15 participants) and a control group (13 participants). The whole-body electromyostimulation program lasted 12 weeks, with two 20 min sessions weekly, using bipolar, rectangular current. Assessments pre and post intervention included body composition, blood pressure, lipid profile, C-reactive protein levels, maximal oxygen consumption, and jumping and sprint performance. Two-way ANOVA and t-tests were used for analysis. Results: Statistical analysis revealed significant (group × time) interactions for body composition, systolic blood pressure, maximal oxygen consumption, jumping and sprint performance, and plasma levels of lipids and C-reactive protein. Post hoc analyses for the whole-body electromyostimulation group indicated improvements in body composition indices (p < 0.01), systolic blood pressure (p = 0.003), maximal oxygen consumption (p = 0.010), and both jumping and 30 m sprint performance (p < 0.001 and p = 0.001, respectively) after the intervention. Furthermore, plasma levels of lipids (p < 0.01) and C-reactive protein (p = 0.002) showed significant improvements following the training program. In contrast, no significant changes were observed for these variables in the control group. Conclusions: A 12-week whole-body electromyostimulation program significantly improved body composition (skeletal muscle mass, body mass index, body fat, and waist circumference), physical performance (maximal oxygen consumption, jumping and sprint performance), and certain cardiometabolic (plasma level of lipids) and inflammatory markers (C-reactive protein) in obese young women. Further research is needed to explore the broader effects of whole-body electromyostimulation on physical and cardiometabolic health.

Effects of Four Weeks of Static vs. Dynamic Bodyweight Exercises with Whole-Body Electromyostimulation on Jump and Strength Performance: A Two-Armed, Randomized, Controlled Trial

The combination of strength training with complementary whole-body electromyostimulation (WB-EMS) and plyometric exercises has been shown to increase strength and jumping performance in athletes. In elite sport, however, the mesocycles of training are often organized according to block periodization. Furthermore, WB-EMS is often applied onto static strength exercises, which may hamper the transfer into more sport-specific tasks. Thus, this study aimed at investigating whether four weeks of strength training with complementary dynamic vs. static WB-EMS followed by a four-week block of plyometric training increases maximal strength and jumping performance. A total of n = 26 (13 female/13 male) trained adults (20.8 ± 2.2 years, 69.5 ± 9.5kg, 9.7 ± 6.1h of training/w) were randomly assigned to a static (STA) or volume-, load- and work-to-rest-ratio-matched dynamic training group (DYN). Before (PRE), after four weeks (three times weekly) of WB-EMS training (MID) and a subsequent four-week block (twice weekly) of plyometric training (POST), maximal voluntary contraction (MVC) at leg extension (LE), leg curl (LC) and leg press machines (LP) and jumping performance (SJ, Squat Jump; CMJ, counter-movement-jump; DJ, drop-jump) were assessed. Furthermore, perceived effort (RPE) was rated for each set and subsequently averaged for each session. MVC at LP notably increased between PRE and POST in both STA (2335 ± 539 vs. 2653 ± 659N, standardized mean difference [SMD] = 0.528) and DYN (2483 ± 714N vs. 2885 ± 843N, SMD = 0.515). Reactive strength index of DJ showed significant differences between STA and DYN at MID (162.2 ± 26.4 vs. 123.1 ± 26.5 cm·s-1, p = 0.002, SMD = 1.478) and POST (166.1 ± 28.0 vs. 136.2 ± 31.7 cm·s-1, p = 0.02, SMD = 0.997). Furthermore, there was a significant effect for RPE, with STA rating perceived effort higher than DYN (6.76 ± 0.32 vs. 6.33 ± 0.47 a.u., p = 0.013, SMD = 1.058). When employing a training block of high-density WB-EMS both static and dynamic exercises lead to similar adaptations.

The effect of blood flow restriction training combined with electrical muscle stimulation on neuromuscular adaptation: a randomized controlled trial

Objective: Low-intensity resistance training (≤25% 1RM) combined with blood flow restriction training (BFRT) is beneficial to increasing muscle mass and muscle strength, but it cannot produce increased muscle activation and neuromuscular adaptation, as traditional high-intensity strength training does. The purpose of this study is to investigate the effects of independently applying BFRT and electrical muscle stimulation (EMS), as well as combining the two methods, on muscle function. Methods: Forty healthy participants with irregular exercise experiences were randomly assigned to four groups: BFRT-alone group (BFRT, n = 10), EMS-alone group (EMS, n = 10), BFRT combined with EMS group (CMB, n = 10), and the control group (CTR, n = 10). All participants received low-intensity squat training at a load of 25% 1RM 5 times/week for 6 weeks. Cross-sectional area (CSA) and electromyographic root mean square (RMS) in the rectus femoris, as well as peak torque (PT) of the knee extensor, were measured before and following a 6-week intervention. Results: Following the 6-week intervention, the increases in muscle activation in the CMB group were statistically higher than those in the BFRT group (p < 0.001), but not different from those in the EMS group (p = 0.986). Conclusion: These data suggest that the combination of BFRT and EMS for low-intensity squat training improved the muscle strength of the lower limbs by promoting muscle hypertrophy and improving muscle activation, likely because such a combination compensates for the limitations and deficiencies of the two intervention methods when applied alone.

Electrical Stimulation and Muscle Strength Gains in Healthy Adults: A Systematic Review

ABSTRACT

Mukherjee, S, Fok, JR, and van Mechelen, W. Electrical stimulation and muscle strength gains in healthy adults: A systematic review. J Strength Cond Res 37(4): 938-950, 2023-Electrical muscle stimulation (EMS) is a popular method for strength gains among athletes and fitness enthusiasts. This review investigated the literature from 2008 to 2020 on EMS application protocols, strength adaptations, neural adaptations, and its use as an independent and combined training tool for strength gain in healthy adults. The investigation was modeled after the 2020 PRISMA guidelines. The eligibility criteria included studies that assessed the effect of EMS, either alone or in combination with voluntary resistance training (VRT) in healthy adult populations, involving a control group performing either usual or sham training, with at least 1 performance outcome measure assessed during experimental randomized controlled trials (RCTs), cluster RCT, randomized crossover trials, or nonrandomized studies. Ten studies met the eligibility criteria with a total of 174 subjects. Eight studies investigated the effect of EMS on lower limb muscles and 2 on elbow flexors. Five studies used concurrent VRT. Studies were heterogenous in methods, subject characteristics, intervention, and EMS protocols. All 10 studies reported significant strength gains as an outcome of EMS treatment, but there were no improvements in strength-related functional outcome measures. The optimal threshold for treatment duration, EMS intensity, pulse, and frequency could not be determined due to methodological differences and EMS application protocol inconsistency between studies. Protocol variations also existed between the studies that combined EMS with VRT. Standardized protocols are needed for electrode placement location, motor point identification, positioning of the body part being investigated, impulse type, intensity, and duration of stimulus.

A single session of EMS training induces long-lasting changes in circulating muscle but not cardiovascular miRNA levels: a randomized crossover study

Electromyostimulation (EMS) is used to maintain or build skeletal muscle and to increase cardiopulmonary fitness. Only limited data on the molecular mechanisms induced by EMS are available and effects on circulating microRNAs (c-miRNAs) have not been reported. This study aimed to evaluate whether EMS induces long-term changes in muscle- and cardiovascular-specific c-miRNA levels. Twelve healthy participants (33.0 ± 12.0 yr, 7 women) performed a 20-min whole body EMS training and a time- and intensity-matched whole body circuit training (CT) in random order. Blood samples were drawn pre-/posttraining and at 1.5, 3, 24, 48, and 72 h to determine creatine kinase (CK) and miRNA-21-5p, -126-3p, -133a-3p, -146a-5p, -206-3p, -222-3p, and -499a-5p levels. Muscular exertion was determined using an isometric strength test, and muscle soreness/pain was assessed by questionnaire. EMS participants reported higher muscle soreness 48 and 72 h postexercise and mean CK levels after EMS increased compared with CT at 48 and 72 h (time × group P ≤ 0.01). The EMS session induced a significant elevation of myomiR-206 and -133a levels starting at 1.5 and 3 h after exercise. Both miRNAs remained elevated for 72 h with significant differences between 24 and 72 h (time × group P ≤ 0.0254). EMS did not induce changes in cardiovascular miRNAs and no elevation in any miRNA was detected following CT. Time-course analysis of muscle damage marker CK and c-miR-133a and -206 levels did not suggest a common scheme (P ≥ 0.277). We conclude that a single EMS session induces specific long-lasting changes of miR-206 and miR-133 involved in muscle proliferation and differentiation. A single EMS session does not affect primary cardiovascular miRNA-21-5p, -126-3p, -146a-5p, and -222-3p levels.NEW & NOTEWORTHY Our study describes the long-term effects of electromyostimulation (EMS) on circulating miRNA levels. The observed increase of functional myomiR-206 and -133a levels over 72 h suggests long-lasting effects on muscle proliferation and differentiation, whereas cardiovascular miRNAs appear unaffected. Our findings suggest that circulating miRNAs provide useful insight into muscle regeneration processes after EMS and may thus be used to optimize EMS training effects.

Immediate Effects of Whole-Body versus Local Dynamic Electrostimulation of the Abdominal Muscles in Healthy People Assessed by Ultrasound: A Randomized Controlled Trial

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.

Additional Active Movements Are Not Required for Strength Gains in the Untrained during Short-Term Whole-Body Electromyostimulation Training

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.

Effects of electrical muscle stimulation on core muscle activation and physical performance in non-athletic adults: A randomized controlled trial

BACKGROUND

Electrical muscle stimulation (EMS) activates muscles through electrical currents, resulting in involuntary muscle contractions. This study aimed to evaluate the immediate clinical effects of superimposing EMS on strength training compared with conventional exercise in healthy non-athletic adults.

METHODS

This study was a randomised, controlled, parallel-group trial conducted at a single centre. Forty-one healthy young volunteers were recruited and randomised into two groups: strengthening with superimposed EMS (S+E) and strengthening (S) groups. All participants underwent the 30 minutes of strength training program, three times a week for 8 weeks, consisting of core muscle exercises. Additionally, the S+E group received EMS during training, which stimulated the bilateral abdominal, gluteus, and hip adductor muscles. As the primary outcome measure, we evaluated the changes in muscle thickness, including the abdominal, gluteal, and hip adductor muscles, using ultrasound. Muscle thickness was measured in both resting and contracted states. For secondary outcomes, physical performance (Functional Movement System score, McGill's core stability test, and hip muscle power) and body composition analysis were evaluated. All assessments were performed at the beginning and end of the intervention.

RESULTS

39 participants (S+E group = 20, S group = 19) completed the study. The clinical characteristics and baseline functional status of each group did not differ significantly between the groups. After completion of the training, the S+E group showed more efficient contraction in most of the evaluated muscles. The resting muscle thickness did not differ significantly between the groups; however, the contracted muscle thickness in the S+E group was higher than that in the S group (p < 0.05). Physical performance and body composition were not significantly different between the two groups. No intervention-related complications were reported during the study.

CONCLUSION

EMS seems to be a safe and reasonable modality for improving physical fitness in healthy individuals.

Combined Static Stretching and Electrical Muscle Stimulation Induce Greater Changes in Range of Motion, Passive Torque, and Tendon Displacement Compared with Static Stretching

The purpose of this study was to determine the combined effects of static stretching and electrical muscle stimulation on maximal dorsiflexion angle and passive properties. Sixteen healthy subjects participated in three randomly ordered experimental trials: combined static stretching and electrical muscle stimulation, static stretching alone, and control. In combined trial, subjects performed 5 min of calf stretching while receiving electrical muscle stimulation of the gastrocnemius medialis. In static stretching trial, subjects performed calf stretching only. Maximal dorsiflexion angle, passive torque, and muscle displacement were measured before and after intervention. Tendon displacement was also calculated. The difference from pre- to post-intervention in maximal dorsiflexion angle in combined trial was greater compared with that in the control (p = 0.026), but the static stretching trial exhibited no significant difference (both p > 0.05). Passive torque at submaximal dorsiflexion angles was significantly decreased only after combined trial (all p < 0.05). Muscle displacement at maximal dorsiflexion angle was significantly increased in all conditions (all p < 0.05). Tendon displacement at maximal dorsiflexion angle was higher after combined trial compared with static stretching trial (p = 0.030). These results revealed additional effects of adding electrical muscle stimulation to static stretching on maximal dorsiflexion angle, passive torque, and tendon displacement.

Neuromuscular Electrical Stimulation Training vs. Conventional Strength Training: A Systematic Review and Meta-Analysis of the Effect on Strength Development

ABSTRACT

Happ, KA, and Behringer, M. Neuromuscular electrical stimulation Training vs. conventional strength training: a systematic review and meta-analysis of the effect on strength development. J Strength Cond Res 36(12): 3527-3540, 2022-A systematic review of the current state of literature and a meta-analysis were conducted to compare the strength development between neuromuscular electrical stimulation (NMES) and conventional strength training when training volume is matched. Searches of PubMed and several other databases were conducted for studies that met the following primary inclusion criteria: randomized studies of >20 days duration with a sample size of >4 subjects in each group ("voluntary contraction" [VC] and "electrically stimulated" [ES]) conducted with percutaneous stimulation only in healthy individuals at equal training volume. Finally, a total of 19 studies were included in the analysis. When comparing strength gains between groups (ES-VC), no favorable effect toward a training method could be observed (0.023 hg [95% CI: -0.198 to 0.246, p = 0.836]). Subgroup analyses were performed based on the application type (NMES evoked and NMES onto voluntary contractions) and stimulation frequency. Both analyses revealed no favorable effect and significant difference of groups (significance level set at 0.05). A meta-regression evaluated the relationship between stimulation frequency and effect size difference. The regression showed a tendency of higher stimulation frequencies being associated with higher study effect size differences (predicted effect size = -0.599 + 0.008 (Hz) ( p = 0.176)). The findings indicate that training with NMES results in virtually identical strength gains compared with conventional strength training when training volume is matched. If training with NMES is preferred, the stimulation frequency type (regular or Burst Mode Alternating Current) can be chosen according to preference without loss of effectiveness.

Acute Effects of Whole-Body Electromyostimulation on Energy Expenditure at Resting and during Uphill Walking in Healthy Young Men

The effects of the different electrical frequencies of whole-body electrical stimulation (WB-EMS) on energy expenditure (EE) and the respiratory exchange ratio (RER) remain poorly understood. This study aimed to determine the effects of different WB-EMS electrical frequencies on EE and the RER during supine resting and uphill walking. A total of 10 healthy and recreationally active men (21.6 ± 3.3 years old) participated in the present study. Participants completed two testing sessions in a randomized order. In each session, a variety of impulse frequencies (1 hertz (Hz), 2 Hz, 4 Hz, 6 Hz, 8 Hz, and 10 Hz) were applied in a randomized order, allowing a 10 min passive recovery between them. Oxygen consumption and carbon dioxide production were measured to calculate EE and the RER. All frequencies increased EE at rest (all p ≤ 0.001), with 4 Hz being the frequency producing the highest increase (Δ = 8.89 ± 1.49 kcal/min), as did 6 Hz (Δ = 8.05 ± 1.52 kcal/min) and 8 Hz (Δ = 7.04 ± 2.16 kcal/min). An increment in the RER at rest was observed with 4 Hz, 6 Hz, 8 Hz and 10 Hz (all p ≤ 0.016), but not with 1 Hz and 2 Hz (p ≥ 0.923). During uphill walking, the frequency that elicited the highest increase in EE was 6 Hz (Δ = 4.87 ± 0.84 kcal/min) compared to the unstimulated condition. None of the impulse frequencies altered the RER during uphill walking. WB-EMS increases EE in healthy young men both during resting and uphill walking.

Bibliometric Analysis of Studies on Whole Body Electromyostimulation

Simple Summary

This work consists of a review with bibliometric analysis on WB-EMS. One hundred and two articles were analyzed in the period from 2010 to 2022 to find out which country, author and institutions produce the most knowledge on this topic. The results of this work are important to know to determine publication growth trend as well as the most relevant clusters and authors.

Abstract

Whole Body Electromyostimulation [WB-EMS] is a training methodology that applies electrostimulation in the main muscle groups of the human body superimposed with active training exercises. This study aims to carry out a bibliometric analysis on WB-EMS to provide an overview of the state of research and provide new insights for research in the field. Method: One hundred and two citations extracted were examined using a bibliometric approach based on data stored in the Web of Science Core Collection, applying traditional bibliometric laws, and using VOSviewer and excel for data and metadata processing. Results: Among the results, this study points out that Germany is the country that produces more scientific knowledge on WB-EMS. Wolfgang Kemmler is the most relevant author in this field. Moreover, Frontier of Physiology is the journal where the authors publish the most. Conclusion: Research on WB-EMS has been growing in recent years. German and Spanish researchers lead two clusters where most studies and collaborations in this field are carried out. These findings will provide a better understanding of the state of WB-EMS research and may guide the emergence of new lines of investigation and research ideas.

Effects of electromyostimulation on performance parameters in sportive and trained athletes: A systematic review and network meta-analysis

This systematic review and network meta-analysis aimed to evaluate the effectiveness of different electromyostimulation (EMS) training interventions on performance parameters in trained athletes. The research was conducted until may 2021 using the online databases PubMed, Web of Science, Cochrane and SPORTDiscus for studies with the following inclusion criteria: (a) controlled trials, (b) EMS trials with at least one exercise and/or control group, (c) strength and/or jump and/or sprint and/or aerobic capacity parameter as outcome (d) sportive/trained subjects. Standardized mean differences (SMD) with 95% confidence interval (CI) and random effects models were calculated. Thirty-six studies with 1.092 participants were selected and 4 different networks (strength, jump, sprint, aerobic capacity) were built. A ranking of different exercise methods was achieved. The highest effects for pairwise comparisons against the reference control "active control" were found for a combination of resistance training with superimposed EMS and additional jump training (outcome strength: 4.43 SMD [2.15; 6.70 CI]; outcome jump: 3.14 SMD [1.80;4.49]), jump training with superimposed whole-body electromyostimulation (WB-EMS) (outcome sprint: 1.65 SMD [0.67; 2.63 CI] and high intensity bodyweight resistance training with superimposed WB-EMS (outcome aerobic capacity: 0.83 SMD [-0.49; 2.16 CI]. These findings indicate that the choice of EMS-specific factors such as the EMS application mode, the combination with voluntary activation, and the selection of stimulation protocols has an impact on the magnitude of the effects and should therefore be carefully considered, especially in athletes. Superimposed EMS with relatively low volume, high intensity and outcome-specific movement pattern appeared to positively influence adaptations in athletes.

Therapeutic Potential of Electromyostimulation (EMS) in Critically Ill Patients—A Systematic Review

Ample evidence exists that intensive care unit (ICU) treatment and invasive ventilation induce a transient or permanent decline in muscle mass and function. The functional deficit is often called ICU-acquired weakness with critical illness polyneuropathy (CIP) and/or myopathy (CIM) being the major underlying causes. Histopathological studies in ICU patients indicate loss of myosin filaments, muscle fiber necrosis, atrophy of both muscle fiber types as well as axonal degeneration. Besides medical prevention of risk factors such as sepsis, hyperglycemia and pneumonia, treatment is limited to early passive and active mobilization and one third of CIP/CIM patients discharged from ICU never regain their pre-hospitalization constitution. Electromyostimulation [EMS, also termed neuromuscular electrical stimulation (NMES)] is known to improve strength and function of healthy and already atrophied muscle, and may increase muscle blood flow and induce angiogenesis as well as beneficial systemic vascular adaptations. This systematic review aimed to investigate evidence from randomized controlled trails (RCTs) on the efficacy of EMS to improve the condition of critically ill patients treated on ICU. A systematic search of the literature was conducted using PubMed (Medline), CENTRAL (including Embase and CINAHL), and Google Scholar. Out of 1,917 identified records, 26 articles (1,312 patients) fulfilled the eligibility criteria of investigating at least one functional measure including muscle function, functional independence, or weaning outcomes using a RCT design in critically ill ICU patients. A qualitative approach was used, and results were structured by 1) stimulated muscles/muscle area (quadriceps muscle only; two to four leg muscle groups; legs and arms; chest and abdomen) and 2) treatment duration (≤10 days, >10 days). Stimulation parameters (impulse frequency, pulse width, intensity, duty cycle) were also collected and the net EMS treatment time was calculated. A high grade of heterogeneity between studies was detected with major cofactors being the analyzed patient group and selected outcome variable. The overall efficacy of EMS was inconclusive and neither treatment duration, stimulation site or net EMS treatment time had clear effects on study outcomes. Based on our findings, we provide practical recommendations and suggestions for future studies investigating the therapeutic efficacy of EMS in critically ill patients.

Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021262287].

Profile of Whole Body Electromyostimulation Training Users-A Pilot Study

(1) Introduction: Whole Body Electromyostimulation is a technological and time efficient personal training practiced all over the world. With the increase of practitioners in the last 10 years, the need to study more about practitioners has arisen, so this pilot study aims to trace a user profile of this method through the analysis of socio-demographic data for a better understand of the profile of people looking for this type of training to improve the effectiveness of the intervention and develop programs that are in accordance with the motivation of practitioners. (2) Methods: 270 users from 5 countries answered an online questionnaire with socio-demographic questions. Data were treated using descriptive statistics. Possible differences between sexes and between groups were analyzed by means of non-parametric statistical tests: Mann−Whitney U-test (continuous variables); in addition to studying possible dependence relationships and differences between proportions, using the Chi-square statistic with pairwise z-test using the Bonferroni correction (categorical variables). (3) Results: Middle-aged women are the main user of this type of training. The majority of WB-EMS users do another type of physical activity with significant difference between men and woman (p < 0.05) men are more active than women. Weight loss, health and wellness and muscle mass increase are the main goals of the WB-EMS users. There are significant differences in weight loss and rehabilitation between genders (p < 0.05). Women look much more than men to lose weight and men look more than women to rehabilitation. (4) Conclusions: The user profile is a physically active woman, aged 35−49 years, with normal weight and high educational level, who carries out twice weekly full body electrostimulation training with the goals of weight loss, health and/or wellness and muscle mass gain.

Changes in Muscle Thickness after 8 Weeks of Strength Training, Electromyostimulation, and Both Combined in Healthy Young Adults

The aim of this study was to verify and compare the effects of electromyostimulation training (EMS), strength training (ST), and both combined (STEMS), through the analysis of the elbow flexors muscle thickness. Forty subjects (24.45 ± 3.53 years), were randomly divided equally in 4 groups: 3 experimental groups and 1 control group. Each experimental group was submitted to one of three interventions, either an ST protocol, an EMS protocol, or a STEMS protocol. The control group (CG) did not perform any type of physical activity. Ultrasonography (US) was used to measure muscle thickness (MT) at 50 and 60% of the distance between the acromion and the olecranon. The results showed a significant difference in the elbow flexors muscle thickness after 8 weeks, both in the STG, EMSG, and STEMSG, but not in the CG. However, no significant differences were observed between the intervention protocols. It seems that an increase in MT can be obtained using either with ST, EMS, or both combined, however, the results doesn’t support the overlap of one method in relation to the others. EMS can be another interesting tool to induce muscle hypertrophy, but not necessarily better.

A scoping review of the contralateral effects of unilateral peripheral stimulation on neuromuscular function

It is known that resistance exercise using one limb can affect motor function of both the exercised limb and the unexercised contralateral limb, a phenomenon termed cross-education. It has been suggested that cross-education has clinical implications, e.g. in rehabilitation for orthopaedic conditions or post-stroke paresis. Much of the research on the contralateral effect of unilateral intervention on motor output is based on voluntary exercise. This scoping review aimed to map the characteristics of current literature on the cross-education caused by three most frequently utilised peripheral neuromuscular stimulation modalities in this context: electrical stimulation, mechanical vibration and percutaneous needling, that may direct future research and translate to clinical practice. A systematic search of relevant databases (Ebsco, ProQuest, PubMed, Scopus, Web of Science) through to the end of 2020 was conducted following the PRISMA Extension for Scoping Review. Empirical studies on human participants that applied a unilateral peripheral neuromuscular stimulation and assessed neuromuscular function of the stimulated and/or the unstimulated side were selected. By reading the full text, the demographic characteristics, context, design, methods and major findings of the studies were synthesised. The results found that 83 studies were eligible for the review, with the majority (53) utilised electrical stimulation whilst those applied vibration (18) or needling (12) were emerging. Although the contralateral effects appeared to be robust, only 31 studies claimed to be in the context of cross-education, and 25 investigated on clinical patients. The underlying mechanism for the contralateral effects induced by unilateral peripheral stimulation remains unclear. The findings suggest a need to enhance the awareness of cross-education caused by peripheral stimulation, to help improve the translation of theoretical concepts to clinical practice, and aid in developing well-designed clinical trials to determine the efficacy of cross-education therapies.

Effects of Acute Resistance Exercise with and without Whole-Body Electromyostimulation and Endurance Exercise on the Postprandial Glucose Regulation in Patients with Type 2 Diabetes Mellitus: A Randomized Crossover Study

Background: Long hyperglycemic episodes trigger complications in type 2 diabetes mellitus (T2DM) patients. Postprandial glucose excursions can be reduced by acute physical activity. However, it is not yet clear which type of exercise has the best effect on postprandial glucose levels. Methods: Six T2DM patients participated in three 20-min moderate-intensity exercise sessions after breakfast in a randomized order: resistance exercise with whole-body electromyostimulation (WB-EMS), resistance exercise without electromyostimulation (RES) and cycling endurance exercise (END). A continuous glucose monitoring system recorded glucose dynamics. Results: Postprandially-increased glucose levels decreased in all cases. Time to baseline (initial value prior to meal intake) was quite similar for WB-EMS, RES and END. Neither glucose area under the curve (AUC), nor time in range from the start of the experiment to its end (8 h later) differed significantly. A Friedman analysis of variance, however, revealed an overall significant difference for AUC in the post-exercise recovery phase (END seems to have superior effects, but post-hoc tests failed statistical significance). Conclusions: There are no notable differences between the effects of the different types of exercise on glucose levels, especially when comparing values over a longer period of time.

Effects of neuromuscular electrical stimulation on torque and performance in recreational distance runners: A randomized controlled trial

INTRODUCTION

Neuromuscular electrical stimulation (NMES) is used by athletes to improve muscle performance. However, evidence on the use of NMES in long distance runners is scarce. As such, this study aimed to evaluate the effects of NMES on the muscle torque and sports performance of long-distance recreational runners.

METHODS

This was a blinded randomized controlled trial. Data from 30 volunteers were analyzed. Participants were randomly allocated to an experimental (n = 15) or control group (n = 15). The experimental group was submitted to running training (RT) and a strengthening protocol with NMES (1 kHz, modulated in 2 ms bursts, 50 Hz modulated burst frequency and 10% duty cycle, 15 min totaling 18 contractions per sessions) for 6 weeks, with 3 sessions per week, while controls were submitted to RT alone. The following variables were analyzed: peak isometric (ISO), concentric (CON), and eccentric (ECC) torque of the quadriceps muscle in voluntary contractions, ventilatory anaerobic thresholds (VATs), maximal oxygen uptake (VO2max), and oxygen cost of transport (OCT).

RESULTS

The NMES group obtained higher values of ISO, 21.04% (p = 0.001), CON, 21.97% (p = 0.001) and ECC, 18.74% (p = 0.001) peak torque and VAT1, 9.56% (p = 0.001), as well as a statistically significant improvement in oxygen cost of transport at VAT1 when compared to controls (p = 0.001).

CONCLUSION

NMES was effective in improving peak isometric, concentric and eccentric quadriceps muscle torque, in addition to being an interesting resource for enhancing sports performance in long-distance recreational runners and future clinical trials should be performed to compare the use of NMES to different forms of training over longer training periods.

Effects of whole-body neuromuscular electrical stimulation device on hemodynamics, arrhythmia, and sublingual microcirculation

Neuromuscular electrical stimulation has been used to treat cardiovascular diseases and other types of muscular dysfunction. A novel whole-body neuromuscular electrical stimulation (WB-NMES) wearable device may be beneficial when combined with voluntary exercises. This study aimed to investigate the safety and effects of the WB-NMES on hemodynamics, arrhythmia, and sublingual microcirculation. The study included 19 healthy Japanese volunteers, aged 22-33 years, who were not using any medication. Electrocardiogram (ECG), echocardiography, and blood sampling were conducted before a 20-min WB-NMES session and at 0 and 10 min after termination of WB-NMES. Their tolerable maximum intensity was recorded using numeric rating scale. Arrhythmia was not detected during neuromuscular electrical stimulation or during 10 min of recovery. Blood pressure, heart rate, left ventricular ejection fraction, and diastolic function remained unchanged; however, mild mitral regurgitation was transiently observed during WB-NMES in a single male participant. A decrease in blood glucose and an increase in blood lactate levels were observed, but no changes in blood fluidity, sublingual microcirculation, blood levels of noradrenaline, or oxidative stress were shown. WB-NMES is safe and effective for decreasing blood glucose and increasing blood lactate levels without changing the blood fluidity or microcirculation in healthy people.

The effects of whole-body muscle stimulation on body composition and strength parameters: A protocol for systematic review and meta-analysis

BACKGROUND

This study will analyze the effect of Whole Body Electromyostimulation (WB-EMS) in strength and body composition outcomes in adult population.

METHODS

This study will search the following electronic databases up to July 21, 2020: PubMed, WOS, Scopus, SPORTDiscus y EMBASE. There will be no language limitation. Two authors will independently identify titles/abstracts and full text all potential studies, and will collect data from eligible studies. Additionally, study quality will be assessed by PEDro Scale risk of bias. We will conduct meta-analysis if enough trials are included.

RESULTS

This study will explore the effects of WB-EMS in strength and body composition outcomes.

CONCLUSION

The findings of this study may summarize the effectiveness of WB-EMS in increasing strength and improving body composition in adult population.

INPLASY REGISTRATION NUMBER

INPLASY202120050.

Effects of Whole-Body Electromyostimulation Associated with Dynamic Exercise on Functional Capacity and Heart Rate Variability After Bariatric Surgery: a Randomized, Double-Blind, and Sham-Controlled Trial

PURPOSE

Bariatric surgery is the most effective treatment for morbid obesity. In association with dietary restrictions, the ability to exercise in the immediate post-surgical phase is limited. In this context, whole-body electromyostimulation (WB-EMS), strategy that stimulates various muscle groups, in conjunction with physical exercise, holds promise for improving functional capacity, and cardiac autonomic control, following surgery. The purpose of this study was to analyze whether a rehabilitation program consisting of WB-EMS with 30 exercise training sessions following bariatric surgery significantly improves functional capacity, body mass and heart rate variability (HRV).

METHODS

Randomized, double-blind, and sham-controlled trial. Twenty obesity patients were randomized into the WB-EMS (n = 10) and sham (n = 10) groups. On average, 7 days after surgery, individuals underwent a six-minute walk test (6MWT), HRV, and body composition analysis at rest. The next day, patients initiated an exercise training protocol, five times per week, over 6 weeks. Walking distance changes (post-pre = ΔWD) obtained by 6MWT and HRV indices were determined following the intervention.

RESULTS

Only WB-EMSG significantly increased WD and body mass index (BMI) after the intervention (p = 0.002) and ΔWD was significantly higher in this group when compared with sham (p = 0.04). Moreover, both groups demonstrated an improvement in key measures of HRV after the intervention.

CONCLUSION

An exercise training intervention initiated shortly after bariatric surgery improved functional capacity and cardiac autonomic tone. Improvements in functional capacity and BMI following exercise training were greater with the addition of WB-EMS but did not promote additional improvements in HRV beyond that realized with exercise training alone.

Similar Pain Intensity Reductions and Trunk Strength Improvements Following Whole-Body Electromyostimulation vs. Whole-Body Vibration vs. Conventional Back-Strengthening Training in Chronic Non-specific Low Back Pain Patients: A Three-Armed Randomized Controlled Trial

The aim of this multicenter trial was to compare the effects of whole-body electromyostimulation (WB-EMS) and whole-body vibration (WBV) with conventional back-strengthening training (CT) on changes in mean back pain intensity (MPI) and trunk strength in patients suffering from chronic non-specific low back pain (CNLBP). Two-hundred and forty CNLBP patients (40–70 years; 62% female) were randomly assigned to three intervention arms (WB-EMS: n = 80 vs. WBV: n = 80 vs. CT: n = 80). All training intervention programs were performed for 12 weeks in their usual commercial training setting. Before and during the last 4 weeks of the intervention, MPI was recorded using a 4-week pain diary. Additionally, maximal isometric trunk extension and -flexion strength was assessed on the BackCheck® machine. A moderate but significant decrease of MPI was observed in all groups (WB-EMS: 29.7 ± 39.1% (SMD 0.50) vs. WBV: 30.3 ± 39.3% (SMD 0.57) vs. CT: 30.5 ± 39.6% (SMD 0.59); p < 0.001). Similar findings were observed for maximal isometric strength parameters with a significant increase in all groups (extension: WB-EMS: 17.1 ± 25.5% vs. WBV: 16.2 ± 23.6% vs. CT: 21.6 ± 27.5%; p < 0.001; flexion: WB-EMS: 13.3 ± 25.6% vs. WBV: 13.9 ± 24.0% vs. CT: 13.9 ± 25.4%; p < 0.001). No significant interaction effects for MPI (p = 0.920) and strength parameters (extension: p = 0.436; flexion: p = 0.937) were observed. WB-EMS, WBV, and CT are comparably effective in improving MPI and trunk strength. However, training volume of WB-EMS was 43 or 62% lower, compared with CT and WBV.

Higher Impulse Electromyostimulation Contributes to Psychological Satisfaction and Physical Development in Healthy Men

Background and Objectives: This study investigated the various impulse effects of whole-body electromyostimulation (WB-EMS) on psychophysiological responses and adaptations. Materials and Methods: The participants included fifty-four men between 20 and 27 years of age who practiced isometric exercises for 20 min, three days a week, for 12 weeks while wearing WB-EMS suits, which enabled the simultaneous activation of eight muscle groups with three types of impulse intensities. Participants were allocated to one of four groups: control group (CON), low-impulse-intensity group (LIG), mid-impulse-intensity group (MIG), and high-impulse-intensity group (HIG). Psychophysiological conditions were measured at week 0, week 4, week 8, and week 12. Results: Compared with the CON, (1) three psychological conditions in LIG, MIG, and HIG showed positive tendencies every four weeks, and the analysis of covariance (ANCOVA) test revealed that body image (p = 0.004), body shape (p = 0.007), and self-esteem (p = 0.001) were significantly different among the groups. (2) Body weight, fat mass, body mass index, and percent fat in the CON showed decreasing tendencies, whereas those in LIG, MIG, and HIG showed a noticeable decrease, which revealed that there were significant differences among the groups. Specifically, a higher impulse intensity resulted in a greater increase in muscle mass. (3) Although there was no interaction effect in the abdominal visceral fat area, there were significant interactions in the abdominal subcutaneous fat (ASF) and total fat (ATF) areas. Both the ASF and ATF in the CON showed decreasing tendencies, whereas those in other groups showed a noticeable decrease. The ANCOVA revealed that the ASF (p = 0.002) and ATF (p = 0.001) were significantly different among the groups. In particular, the higher the impulse intensity, the greater the decrease in abdominal fat. Conclusions: This study confirmed that high-impulse-intensity EMS can improve psychophysiological conditions. In other words, healthy young adults felt that the extent to which their body image, body shape, and self-esteem improved depended on how intense their EMS impulse intensities were. The results also showed that higher levels of impulse intensity led to improved physical conditions.

The effects of whole-body electromyostimulation (WB-EMS) in comparison to a multimodal treatment concept in patients with non-specific chronic back pain-A prospective clinical intervention study

Background

According to present guidelines, active exercise is one key component in the comprehensive treatment of nonspecific chronic back pain (NSCBP). Whole body electromyostimulation (WB-EMS) is a safe, and time-effective training method, that may be effective in NSCBP-patients.

Methods

In this prospective and controlled nonrandomized clinical study, two therapeutic approaches were compared. One group received 20 minutes WB-EMS per week. An active control group (ACG) received a multimodal therapy program. A third group included subjects without back pain. To all groups, the following measurement instruments were applied: Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), North American Spine Society Instrument (NASS); SF 36 survey and measurements for muscular function and postural stability. In the EMS-group: T0: baseline; T1: at 6 weeks; T2: at 12 weeks and T3: at 24 weeks. In the ACG: T0 baseline and T1 after 4 weeks.

Results

In the intervention group, 128 patients with low back pain were enrolled, 85 in the WB-EMS group and 43 in the ACG. 34 subjects were allocated to the passive control group. The average age was 58.6 years (18–86 years). In the EMS group, the NRS (1–10) improved statistically and clinically significantly by 2 points. The ODI was reduced by 19.7 points. The NASS and most of the SF 36 items improved significantly. In the multimodal treatment group, only the muscular function improved slightly.

Conclusion

Our data support the hypothesis that WB-EMS is at least as effective as a multimodal treatment, which is often referred to as being the golden standard. Therefore WB-EMS may be an effective and, with 20 min./week training time, very time-efficient alternative to established multimodal treatment models.

Effects of Whole Body Electromyostimulation on Physical Fitness and Health in Postmenopausal Women: A Study Protocol for a Randomized Controlled Trial

Background: Age-related problems such as chronic diseases, functional limitation and dependence, reduce the quality of life in the elderly, and increase public spending in health. It has been established that physical activity plays a fundamental role in the health of the elderly. The whole body electromyostimulation (WB-EMS) could be a successful methodology as high-intensity training to improve the physical fitness of older people. Methods: A minimum of 13 women between 55 and 70 years old will be randomized in two groups. The exercise with WB-EMS group (EX + WB-EMS) will conduct a resistance strength training program with superimposed WB-EMS while the exercise group (EX) will perform only resistance strength and aerobic training. Balance, strength, flexibility, agility, speed, and aerobic performance (EXERNET battery and progressive resistance test), as well as body composition, blood parameters and physical activity reporting (IPAQ-E) will be assessed to analyze the effects of whole body electromyostimulation in the physical fitness and the health in postmenopausal women. Discussion: Innovative and scientifically well-designed protocols are needed to enhance the knowledge of the body's responses within this training methodology which is being used by a big quantity of population. This trial will provide evidence on the effectiveness of whole-body electromyostimulation in physical fitness and health in elderly women. Trial Registration: ISRCTN15558857 registration data: 27/11/2019 (retrospectively registered).

Impact of Whole Body Electromyostimulation on Velocity, Power and Body Composition in Postmenopausal Women: A Randomized Controlled Trial

Menopause is associated with losses in strength and power along with weight and fat mass gains, which may result from menopause-related hormonal changes, aging-associated diseases, and decreased physical activity time. The objective of this study is to analyze if whole-body electromyostimulation (WB-EMS) is suitable for the prevention and treatment of postmenopausal physical deterioration. Thirty-four healthy sedentary women between 55 and 69 years followed an experimental design pre-post test. Both groups conducted 10 weeks of aerobic and strength training program. The experimental group conducted the training with superimposed WB-EMS during exercise. At the end of the intervention, the experimental group obtained better power (Squat: mean difference (MD) = 38.69 W [1.75,75.62], d = 0.81; Bench press: MD = 25.64 W [17.48, 33.82], d = 2.39) and velocity (Squat: MD = 0.04 m·s-1 [0.01, 0.08], d = 0.98; Bench press: MD = 0.10 m·s-1 [0.06, 0.14], d = 1.90) score improvements than the other group (pBonferroni < 0.05). Furthermore, trivial to small effects were found in the body composition of the participants of both groups (p > 0.050). WB-EMS showed a favorable isolated effect on the development of power and velocity, but it induced negligible effects on the body composition of postmenopausal women.

Whole-body electromyostimulation in physical therapy: do gender, skinfold thickness or body composition influence maximum intensity tolerance?

[Purpose] Whole-body electromyostimulation (WB-EMS) is an extension of the EMS application known in physical therapy. In WB-EMS, body composition and skinfold thickness seem to play a decisive role in influencing the Ohmic resistance and therefore the maximum intensity tolerance. That is why the therapeutic success of (WB-)EMS may depend on individual anatomical parameters. The aim of the study was to find out whether gender, skinfold thickness and parameters of body composition have an influence on the maximum intensity tolerance in WB-EMS. [Participants and Methods] Fifty-two participants were included in the study. Body composition (body impedance, body fat, fat mass, fat-free mass) and skinfold thicknesses were measured and set into relation to the maximum intensity tolerance. [Results] No relationship between the different anthropometric parameters and the maximum intensity tolerance was detected for both genders. Considering the individual muscle groups, no similarities were found in the results. [Conclusion] Body composition or skinfold thickness do not seem to have any influence on the maximum intensity tolerance in WB-EMS training. For the application in physiotherapy this means that a dosage of the electrical voltage within the scope of a (WB-) EMS application is only possible via the subjective feedback (BORG Scale).

EMS-effect of Exercises with Music on Fatness and Biomarkers of Obese Elderly Women

Background and objectives: Electromyostimulation (EMS) has been shown to improve body composition, but what biomarkers it affects has not been investigated. The purpose of this study was to compare the EMS-effect of exercises with music on fatness and biomarker levels in obese elderly. Materials and Methods: Twenty-five women were randomly classified into a control group (CON) and EMS group (EMSG). EMS suits used in this study enabled the simultaneous activation of eight pairs with selectable intensities. Program sessions of EMS were combined with exercises of listening to music three times a week for eight weeks. Although both groups received the same program, CON did not receive electrical stimuli. Results: Compared with CON, a significant effect of the EMS intervention concerning decreased fatness, as well as an increased skeletal muscle mass and basal metabolic rate, were evident. Tumor necrosis factor-a, C-reactive protein, resistin, and carcinoembryonic antigen of biomarkers were significantly different in the groups by time interaction. Similarly, the positive changes caused by EMS were represented in lipoprotein-cholesterols. Conclusions: The results indicate that a significant effect due to the EMS intervention was found concerning body composition and biomarkers in obese elderly women.

Frequency-Dependent Reaction of the Triceps Surae Muscle of the Mouse During Electromyostimulation

The difference in the efficacy of altered stimulation parameters in whole-body-electromyostimulation training (WB-EMS) has hardly been examined. Higher impulse frequencies (>50 Hz) might be most adequate for strength gains because of the force frequency relationship (FFR), which describes a greater force production by increasing the applied frequency. Frequencies below this value, however, also seem to have positive influences on muscle strength increases. Therefore, the aim of this study was to analyze possible muscle length changes to different stimulation frequencies of the dissected mouse triceps surae muscle. A bending rod transducer was used to measure and compare changes in muscle lengths at different frequencies in relation to the initial length in the prepared muscle. We found significant differences between the muscle shortening at different frequencies (p < 0.001). At 20 Hz the largest muscle shortening was observed (20 Hz = 3.32 ± 2.06, 60 Hz = 0.77 ± 0.58, 85 Hz = 0.32 ± 0.29, 100 Hz = 0.31 ± 0.29). From a frequency of 60 Hz, the muscle shortening decreased progressively, at stimulation frequencies above 60 Hz the lowest shortenings were recorded. The results demonstrate a different behavior of the isolated triceps surae muscle of the mouse in an ex vivo environment. Even if there is no FFR in this investigation, the results indicate a higher metabolic demand using higher frequencies in electromyostimulation, despite the experimental execution in ex vivo design. Therefore, future studies should take this faster fatigue into account when drawing up training protocols in order to counteract possible frequency modulations.

Effects of Whole-Body Electromyostimulation on Physical Fitness in Postmenopausal Women: A Randomized Controlled Trial

Whole-body electromyostiulation (WB-EMS) has experienced a boom in recent years, even though its effectiveness is controversial. A sedentary lifestyle is deeply rooted in the European population, mainly in the elderly. This experimental study analyzed the impact of WB-EMS on the physical fitness of postmenopausal women. Thirty-four healthy sedentary women between 55 and 69 years followed an experimental design pre–post-test. Both groups conducted a ten-week aerobic and strength training program. The experimental group overlaid the WB-EMS during exercise. At the end of the intervention, both groups improved upper and lower body strength, lower extremity flexibility, agility, and speed levels (p_Bonferroni < 0.05). Significant interactions were observed at upper and lower body strength, agility, speed, and cardiovascular endurance (p < 0.05). The WB-EMS group scored better agility than the control group at the end of the intervention (p_Bonferroni < 0.05) and was the only group that improved cardiovascular endurance. WB-EMS shows a favorable isolate effect on the development of dynamic leg strength, agility, and cardiovascular endurance but did not in dynamic arm strength, gait speed, balance, or flexibility of postmenopausal women.

Design considerations for the development of neuromuscular electrical stimulation (NMES) exercise in cancer rehabilitation

Aim: The aim of this narrative review is to explore design considerations for effective neuromuscular electrical stimulation exercise prescription in cancer rehabilitation, with simultaneous consideration for fundamental principles of exercise training and the current state of the art in neuromuscular electrical stimulation technologies and application methodologies.Method: Narrative review.Results: First, we consider the key neuromuscular electrical stimulation exercise design considerations, with a focus on training objectives and individual training requirements and constraints for individuals with cancer. Here, we contend that concurrent, low and high frequency neuromuscular electrical stimulation exercise, individually prescribed and progressed may be optimal for enhancing physical function. Second, we review the appropriate literature to identify the most appropriate stimulation parameters (pulse frequency, intensity, duration and duty cycle) to deliver effective neuromuscular electrical stimulation in cancer rehabilitation.Conclusions: We propose an informed and innovative neuromuscular electrical stimulation exercise intervention design and provide practical information for clinicians and practitioners who may work with and implement neuromuscular electrical stimulation exercise in cancer.Implications for rehabilitationNeuromuscular electrical stimulation is an emerging technology in cancer rehabilitation to help provide an aerobic and muscle strengthening exercise stimulus.Neuromuscular electrical stimulation may help improve aerobic exercise capacity, muscle strength and augment quality of life.Current prescription in cancer lacks adherence to the fundamental principles of exercise training, which may negatively affect adherence.

Combined Effects of Static Stretching and Electrical Stimulation on Joint Range of Motion and Muscle Strength

Mizuno, T. Combined effects of static stretching and electrical stimulation on joint range of motion and muscle strength. J Strength Cond Res 33(10): 2694-2703, 2019-The purpose of this study was to examine the effects of the combination of static stretching (SS) and electrical stimulation (ES) for 8 weeks on joint range of motion (ROM), muscle strength, and muscle architecture. Thirty-one subjects were divided into 3 groups: the SS combined with ES (SS + ES) group, SS group, and control group. The SS + ES group performed calf stretching simultaneously with ES to the gastrocnemius medialis, whereas the SS group performed calf stretching only. The training regimen consisted of four 30-second sets of stretching, with 30-second rest intervals, 3 days per week for 8 weeks. The control group did not perform any intervention exercise. Before and after training, measurements were taken to determine the ankle ROM, plantar flexion 1 repetition maximum strength, muscle thickness, pennation angle, and circumference of the lower leg. The results showed that 8 weeks of training led to significant improvements in the ankle ROM and muscle thickness in both the SS + ES and SS groups. There were significant increases in plantar flexion 1 repetition maximum strength and pennation angle in all 3 groups. For all parameters, there was no difference between the SS + ES and SS groups. These results clarify that 8 weeks of SS improves joint ROM and muscle thickness and shows that there is no additional benefit gained by combining ES with SS in this particular training regime.

(Whole-Body) Electromyostimulation, Muscle Damage, and Immune System: A Mini Review

Exercise-induced muscular damage (EIMD) is a well-known phenomenon in exercise medicine that is closely related to the type and intensity of training, with especially eccentric training content providing various physiological irritations, including mechanical as well as metabolic. Besides the increase in markers of muscular damage, such as creatine kinase (CK) and myoglobin (Mb), several physiological shifts trigger a kind of stepwise repair chain reactions lasting over a time course from several hours to days. Subsequent inflammatory processes are closely related to muscular damage with decisive influence on physiological repair mechanisms, as indicated by an increased invasion of immune cells and typical patterns of pro- and anti-inflammatory cytokines. Previously, whole-body electromyostimulation (WB-EMS) showed significant, partly extreme distractions in markers of muscular damage lasting over several days. Because of the large area of stimulated muscle mass and a relatively high proportion of eccentric movements, initially too intense WB-EMS is predisposed to produce serious changes on several physiological levels due to its unfamiliar muscular strain. Therefore, it is the aim of this short review to focus on the possible immunological side effects of this aspiring training technology. As the number of original investigations in this field is rather small, we will include data from other studies about the relation of exercise-induced muscle damage and immune regulation.

Effects of neuromuscular electrical stimulation training on muscle size in collegiate track and field athletes

The purpose of this study was to examine the effects of neuromuscular electrical stimulation training for 12 weeks on the abdominal muscle size in trained athletes. Male collegiate track and field athletes participated in the present study and were randomly allocated to either training or control groups. Eleven participants of the training group completed a 60-session training program over a 12-week period (23 min/session, 5 days/week) involving neuromuscular electrical stimulation (mostly 20 Hz) for the abdominal muscles in addition to their usual training for the own events. The participants of the control group (n = 13) continued their usual training. Before and after the intervention period, cross-sectional areas of the rectus abdominis and abdominal oblique muscles (the internal and external obliques and transversus abdominis) and subcutaneous fat thickness were measured with magnetic resonance and ultrasound imaging. There were no significant changes in cross-sectional area of the rectus abdominis or abdominal oblique muscles or in subcutaneous fat thickness in the training or control groups after the intervention period. The change in cross-sectional area of the rectus abdominis in each participant was not significantly correlated with pre-training cross-sectional area and neither was the mean value of fat thickness at pre- and post-training. These results suggest that low-frequency (20 Hz) neuromuscular electrical stimulation training for 12 weeks is ineffective in inducing hypertrophy of the abdominal muscles in trained athletes, even when they have a thin layer of subcutaneous fat.

Adjustment Effects of Maximum Intensity Tolerance During Whole-Body Electromyostimulation Training

Intensity regulation during whole-body electromyostimulation (WB-EMS) training is mostly controlled by subjective scales such as CR-10 Borg scale. To determine objective training intensities derived from a maximum as it is used in conventional strength training using the one-repetition-maximum (1-RM), a comparable maximum in WB-EMS is necessary. Therefore, the aim of this study was to examine, if there is an individual maximum intensity tolerance plateau after multiple consecutive EMS application sessions. A total of 52 subjects (24.1 ± 3.2 years; 76.8 ± 11.1 kg; 1.77 ± 0.09 m) participated in the longitudinal, observational study (38 males, 14 females). Each participant carried out four consecutive maximal EMS applications (T1-T4) separated by 1 week. All muscle groups were stimulated successively until their individual maximum and combined to a whole-body stimulation index to carry out a possible statement for the development of the maximum intensity tolerance of the whole body. There was a significant main effect between the measurement times for all participants (p < 0.001; 𝜂² = 0.39) as well as gender specific for males (p = 0.001; 𝜂² = 0.18) and females (p < 0.001; 𝜂² = 0.57). There were no interaction effects of gender × measurement time (p = 0.394). The maximum intensity tolerance increased significantly from T1 to T2 (p = 0.001) and T2 to T3 (p < 0.001). There was no significant difference between T3 and T4 (p = 1.0). These results indicate that there is an adjustment of the individual maximum intensity tolerance to a WB-EMS training after three consecutive tests. Therefore, there is a need of several habituation units comparable to the identification of the individual 1-RM in conventional strength training. Further research should focus on an objective intensity-specific regulation of the WB-EMS based on the individual maximum intensity tolerance to characterize different training areas and therefore generate specific adaptations to a WB-EMS training compared to conventional strength training methods.

The Effects of Superimposed Whole-Body Electromyostimulation During Short-Term Strength Training on Physical Fitness in Physically Active Females: A Randomized Controlled Trial

The aim of this study was to compare the effects of short-term strength training with and without superimposed whole-body electromyostimulation (WB-EMS) on straight sprinting speed (SSS), change of direction speed (CODS), vertical and horizontal jumping, as well as on strength and power in physically active females. Twenty-two active female participants (n = 22; mean ± SD: age: 20.5 ± 2.3 years; height: 171.9 ± 5.5 cm; body mass: 64.0 ± 8.2 kg; strength training experience 5.1 ± 3.6 years) were randomly assigned to two groups: strength training (S) or strength training with superimposed WB-EMS (S+E). Both groups trained twice a week over a period of 4 weeks and differed in the application of free weights or WB-EMS during four strength (e.g., split squats, glute-ham raises) and five sprinting and jumping exercises (e.g., side and box jumps, skippings). The WB-EMS impulse intensity was adjusted to 70% of individual maximal sustainable pain. SSS was tested via 30-m sprinting, CODS by a T-run, vertical and horizontal jumping using four different jump tests at pre-, post-, and retests. Maximal strength (F_max) and power (P_max) testing procedures were conducted on the Leg Press (LP), Leg Extension (LE), and Leg Curl (LC) machine. Significant time × group interaction effects revealed significant decreases of contact time of the Drop Jump and split time of CODS (p ≤ 0.043; ηp2 = 0.15–0.25) for S (≤ 11.6%) compared to S+E (≤ 5.7%). Significant time effects (p < 0.024; ηp2 = 0.17–0.57) were observed in both groups for SSS (S+E: ≤6.3%; S: ≤8.0%) and CODS (S+E: ≤1.8%; S: ≤2.0%) at retest, for jump test performances (S+E: ≤13.2%; S: ≤9.2%) as well as F_max and P_max for LE (S+E: ≤13.5%; S: ≤13.3%) and LC (S+E: ≤18.2%; S: ≤26.7%) at post- and retests. The findings of this study indicate comparable effects of short-term strength training with and without superimposed WB-EMS on physical fitness in physically active females. Therefore, WB-EMS training could serve as a reasonable but not superior alternative to classic training regimes in female exercisers.

Effects of whole-body ELECTROMYOSTIMULATION on health and performance: a systematic review

BACKGROUND

Whole-body electrical myostimulation (WB-EMS) is a relatively recent training methodology that has been extraordinarily used in recent years. However, there is a lack of consensus on the effectiveness of WB-EMS in the situations in which its use has been largely popularized. The objective of this systematic review was to determine the effects produced by WB-EMS.

METHODS

A search of PubMed, Web of Science, Scopus and Cochrane was performed to identify all the studies that have applied electrical stimulation in lower and upper limbs simultaneously and that have clearly presented their protocols for the training and application of the stimulation. The last search was performed on September 9, 2018. Studies written in English or German were included.

RESULTS

A total of 21 articles met the inclusion criteria and were analyzed following the guidelines of the Cochrane Guide for Systematic Reviews. Nineteen studies analyzed the chronic effects of WB-EMS, and 2 analyzed acute effects with a total of 505 subjects (310 men and 195 women). In total, 35% were moderately trained, and 65% were sedentary subjects. Different dependent variables were studied, such as anthropometric parameters, strength parameters, energy expenditure, psychophysiological parameters and blood parameters. There is a lack of randomized controlled studies, and the studies included exhibit a moderate to high level of risk of bias.

CONCLUSIONS

Given the limited number of available studies on WB-EMS, the scarce amount of scientific evidence found does not allow definitive conclusions about its effects; therefore, future studies about WB-EMS are necessary.

Changes in Physical Fitness After 12 Weeks of Structured Concurrent Exercise Training, High Intensity Interval Training, or Whole-Body Electromyostimulation Training in Sedentary Middle-Aged Adults: A Randomized Controlled Trial

This study aimed to investigate the influence of different exercise training modalities [(i) a concurrent training based on physical activity recommendation from the World Health Organization group (PAR group), (ii) a high intensity interval training group (HIIT group), and (iii) a high intensity interval training adding whole-body electromyostimulation group (WB-EMS group)] on physical fitness in sedentary middle-aged adults. A total of 89 (52.7% women) middle-aged sedentary adults (53.7 ± 5.1 years old) were enrolled in the FIT-AGING study. Cardiorespiratory fitness was determined by a maximum treadmill test using indirect calorimetry. Lower, upper, and core body muscular strength were assessed by an isokinetic strength test, by the handgrip strength test, and by several core strength endurance tests, respectively. All the exercise types induced similar increases on cardiorespiratory fitness (Δ VO₂max ≥ 11%, Δ maximal heart rate ≥ 8%, and Δ total test duration ≥ 14%; all P ≤ 0.034), as well as on muscular strength (Δ extension and flexion peak torque ≥ 10%, Δ total hand grip ≥ 3%, Δ core strength endurance tests ≥ 20%; all P ≤ 0.050) compared with a control group. In conclusion, our results suggest that a 12-week structured exercise intervention improves physical fitness regardless of the training program in sedentary middle-aged adults. Despite slightly greater improvements in some physical fitness variables, the changes observed in the WB-EMS group were not superior to the other exercise programs.

Does whole-body electrical muscle stimulation combined with strength training promote morphofunctional alterations?

OBJECTIVES

The aim of this study was to evaluate the effects of 8 weeks of strength training (ST) combined with whole-body electrical stimulation (EMS) on morphofunctional adaptations in active individuals.

METHODS

Fifty-eight volunteers were randomly distributed into the following groups: an untrained control (UN) group (n=16), an ST group (n=21) or an ST combined with EMS (ST+EMS) group (n=21). Both intervention groups (the ST and ST+EMS groups) performed 3 exercises (biceps curl, back squats and high-pulley tricep extensions) twice a week for 8 weeks. The subjects performed 3 sets of 8 to 12 maximum repetitions (MRs) with a 90-second rest duration between sets. The ST+EMS group performed the resistance training exercises wearing a whole-body suit that provided electrical stimulation at frequencies between 80-85 Hz, with a continuously bipolar impulse duration and pulse breadth of 350 µs. The intensity for each muscle group was controlled by Borg's category ratio (CR)-10 scale; the intensity started at 5-6 and eventually reached 7-8. One-repetition maximum strength (1RM) and muscle thickness (MT) were measured before and after the training intervention. MT was evaluated in the biceps brachii (BB), triceps brachii (TB), and vastus lateralis (VL).

RESULTS

No differences (p>0.05) were found between the ST and ST+EMS groups. Improvements (p<0.05) in the absolute values of the morphofunctional parameters after the training protocol were observed. Significant differences were found between both the intervention groups and the UN group (p<0.05). The ST+EMS group presented high percentage changes (p<0.05) in muscular strength for the 1RMsquat (43.2%, ES=1.64) and the MT of the BB (21.6%, ES=1.21) compared to the ST (20.5%, ES=1.43, 11.9%, ES=0.77) group.

CONCLUSIONS

Our data suggest that the combination of ST+EMS may promote alterations in muscle strength and MT in healthy active subjects.

Effects of an Eight-Week Superimposed Submaximal Dynamic Whole-Body Electromyostimulation Training on Strength and Power Parameters of the Leg Muscles: A Randomized Controlled Intervention Study

The purpose of this study was to assess the effects of dynamic superimposed submaximal whole-body electromyostimulation (WB-EMS) training on maximal strength and power parameters of the leg muscles compared with a similar dynamic training without WB-EMS. Eighteen male sport students were randomly assigned either to a WB-EMS intervention (INT; n = 9; age: 28.8 (SD: 3.0) years; body mass: 80.2 (6.6) kg; strength training experience: 4.6 (2.8) years) or a traditional strength training group (CON; n = 9; age: 22.8 (2.5) years; body mass: 77.6 (9.0) kg; strength training experience: 4.5 (2.9) years). Both training intervention programs were performed twice a week over a period of 8 weeks with the only difference that INT performed all dynamic exercises (e.g., split squats, glute-ham raises, jumps, and tappings) with superimposed WB-EMS. WB-EMS intensity was adjusted to 70% of the individual maximal tolerable pain to ensure dynamic movement. Before (PRE), after (POST) and 2 weeks after the intervention (FU), performance indices were assessed by maximal strength (Fmax) and maximal power (Pmax) testing on the leg extension (LE), leg curl (LC), and leg press (LP) machine as primary endpoints. Additionally, vertical and horizontal jumps and 30 m sprint tests were conducted as secondary endpoints at PRE, POST and FU testing. Significant time effects were observed for strength and power parameters on LE and LC (LE Fmax +5.0%; LC Pmax +13.5%). A significant time × group interaction effect was merely observed for Fmax on the LE where follow-up post hoc testing showed significantly higher improvements in the INT group from PRE to POST and PRE to FU (INT: +7.7%, p < 0.01; CON: +2.1%). These findings indicate that the combination of dynamic exercises and superimposed submaximal WB-EMS seems to be effective in order to improve leg strength and power. However, in young healthy adults the effects of superimposed WB-EMS were similar to the effects of dynamic resistance training without EMS, with the only exception of a significantly greater increase in leg extension Fmax in the WB-EMS group.