Efficacy and Safety of Low Frequency Whole-Body Electromyostimulation (WB-EMS) to Improve Health-Related Outcomes in Non-athletic Adults. A Systematic Review

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.

Comparison of the effects of core stability and whole-body electromyostimulation exercises on kyphosis angle and core muscle endurance of inactive people with hyper kyphosis: A quasi-experimental pre-post study

OBJECTIVE

Restoring the degree of kyphosis to be consistent with good sagittal alignment of the spine is a key concern. This study aimed to compare the effect of core stability exercises (CSE) versus whole-body electromyostimulation (WB-EMS) and a combined program (PLUS) on kyphosis angle and core muscle endurance in sedentary individuals with hyperkyphosis.

DESIGN

A quasi-experimental single group pre-post study.

SETTINGS

Laboratory of corrective exercise.

PARTICIPANTS

seventy-five untrained men (28.9 ± 5.3 years) with thoracic hyperkyphosis.

MAIN OUTCOME MEASURES

A flexible ruler was used to measure the angle of kyphosis and McGill's test was used to evaluate core stability.

RESULTS

The results of the post hoc test demonstrated that the kyphosis angle was improved in the WB-EMS and PLUS groups compared to that in the CG (P < 0.05), but no significant difference was observed among the three groups(P > 0.05). In the post-test, core stability was significantly improved in CSE, WB-EMS and PLUS groups compared to that in the CG.

CONCLUSIONS

The WB-EMS and PLUS protocols as new training methods seem to be effective in changing posture parameters and correcting postural deformities, including kyphosis. Therefore, these protocols along with other rehabilitation programs can be used to correct kyphosis and improve core muscle endurance.

Physical exercise improves memory in sedentary middle-aged adults: Are these exercise-induced benefits associated with S-Klotho and 1,25-dihydroxivitamin D? The FIT-AGEING randomized controlled trial

We aimed to investigate the effect of three types of exercise interventions on memory (i.e., immediate memory (IM), long-term memory (LTM), and recognition). We also investigated whether exercise-induced changes in circulating S-Klotho and 1,25-dihydroxivitamin D (1,25(OH)2 D) levels were related to those observed in memory in healthy middle-aged sedentary adults. A 12-week randomized controlled trial was performed with a parallel-group design. Seventy-four participants (45-65 years old: 53% women) were randomly assigned to (1) no exercise (control) group, (2) concurrent training based on the international physical activity recommendations (PAR) group, (3) high-intensity interval training (HIIT) group, or (4) HIIT plus whole-body electromyostimulation (HIIT-EMS) group. Memory outcomes were assessed using the Wechsler Memory Scale-third edition. S-Klotho plasma levels were determined according to a solid-phase sandwich enzyme-linked immunosorbent assay kit while 1,25(OH)2 D plasma levels were measured using a DiaSorin-Liaison immunochemiluminometric analyzer. IM-Verbal Paired Associates (IM-VPA) and IM-Logical Memory (IM-LM) were improved in both the HIIT and HIIT-EMS groups compared with the control group (all p ≤ 0.045). Exercise-induced changes in S-Klotho plasma levels were positively associated with those observed in IM, LTM, and recognition (all p ≤ 0.007), whereas exercise-induced changes in 1,25(OH)2 D plasma levels were directly related to changes in IM and LTM (all p ≤ 0.048). In conclusion, a 12-week HIIT intervention with or without WB-EMS seems to be the most effective exercise program to improve IM. The significant and positive associations between exercise-induced changes in S-Klotho and 1,25(OH)2 D levels with those observed in memory outcomes suggest that these factors may be potentially related to exercise-induced improvements of memory in middle-aged adults.

Acute Effects of Combining Whole-Body Electromyostimulation with Resistance Training in Active Women

Strength training elicits benefits both in performance and on a psychological level in women, such as increased muscle strength and improved self-esteem. Whole-body electromyostimulation (WB-EMS) could be a training strategy for enhancing muscular strength. The aim of this study was to assess the acute effects of a single session of WB-EMS superimposed over classic resistance training on isometric strength, endurance strength and flexibility. Furthermore, the safety of the protocol was assessed by monitoring the levels of creatine kinase (CK) 48 h after the training protocol was completed. Sixteen active women (aged 22.06 ± 1.88) were randomly assigned to an experimental group (EG) (n = 8) and a control group (CG) (n = 8). The EG performed four sets of 12 repetitions of three strength exercises with superimposed WB-EMS, while the CG performed the same protocol without WB-EMS. RM-ANOVA showed a significant time*group interaction on posterior kinetic chain extensors' mean and peak strength in the EG (F(1,14) = 10.036; p = 0.007; and F(1,14) = 20.719; p < 0.001; respectively). A significant time*group interaction was found in the sit and reach test for the EG (F(1,14) = 10.362; p = 0.006). Finally, ANOVA performed on the CK levels showed no significant difference between the groups (F(1,14) = 0.715; p = 0.412). WB-EMS training led to an immediate improvement in strength performance and flexibility, and this protocol was shown to be safe in terms of CK levels, 48 h after completing the training protocol.

Whole-Body Electromyostimulation Impacts Physiological Responses During Aerobic Running: A Randomized Trial

Objective: The aim of the current study was to evaluate the physiological and metabolic responses to running with whole-body electromyostimulation (wbEMS) compared to running without electromyostimulation (control, CG). Methods: Twenty healthy participants (9 male/11 female, age 42 ±7 years) conducted an incremental step test with respiratory gas analysis until exhaustion. Trials were conducted as wbEMS and CG in a random order. As outcome measures, (A) objective total exhaustion, (B) athletic responses (max. time and velocity) and (C) physiological and metabolic responses (V'O2/ kg, V'E, EE, RER, lactate) were compared. (D) The impact on the skeletal muscle was assessed prior, 48 h & 72 h after trial. Results: During both trials, participants (A) ran until total exhaustion. Nonetheless, (B) time and velocity till exhaustion as well as (C) RER prior to the first lactate threshold and V'E were reduced with wbEMS. All other correlates did not differ significantly between wbEMS and CG. Following 48 h and 72 h after the trial with wbEMS, (D) the impact on the skeletal muscle was 7- to 9-fold higher compared to baseline values. Values differed significantly to those after running without wbEMS. Conclusion: With the additional stimulation during voluntary activation, wbEMS induces earlier fatigue and a shift in energy metabolism toward fat utilization. Even during aerobic endurance tasks, a great impact on the skeletal muscle indicated by the rise in CK could be observed which promotes wbEMS as an alternative training stimulus that is easy-to-apply and effective during endurance training.

Effect of 8-week frequency-specific electrical muscle stimulation combined with resistance exercise training on muscle mass, strength, and body composition in men and women: a feasibility and safety study

In recent years, electrical muscle stimulation (EMS) devices have been developed as a complementary training technique that is novel, attractive, and time-saving for physical fitness and rehabilitation. While it is known that EMS training can improve muscle mass and strength, most studies have focused on the elderly or specific patient populations. The aim of this study was to investigate the effects of frequency-specific EMS combined with resistance exercise training for 8 weeks on muscle mass, strength, power, body composition, and parameters related to exercise fatigue. Additionally, we aimed to evaluate the feasibility and safety of EMS as an exercise aid to improve body composition. We recruited 14 male and 14 female subjects who were randomly assigned to two groups with gender parity (seven male and seven female/group): (1) no EMS group (age: 21.6 ± 1.7; height: 168.8 ± 11.8 cm; weight: 64.2 ± 14.4 kg) and (2) daily EMS group (age: 21.8 ± 2.0; height: 167.8 ± 9.9 cm; weight: 68.5 ± 15.5 kg). The two groups of subjects were very similar with no significant difference. Blood biochemical routine analysis was performed every 4 weeks from pre-intervention to post-intervention, and body composition, muscle strength, and explosive power were evaluated 8 weeks before and after the intervention. We also performed an exercise challenge analysis of fatigue biochemical indicators after 8 weeks of intervention. Our results showed that resistance exercise training combined with daily EMS significantly improved muscle mass (p = 0.002) and strength (left, p = 0.007; right, p = 0.002) and significantly reduced body fat (p < 0.001) than the no EMS group. However, there was no significant advantage for biochemical parameters of fatigue and lower body power. In summary, our study demonstrates that 8 weeks of continuous resistance training combined with daily upper body, lower body, and abdominal EMS training can significantly improve muscle mass and upper body muscle strength performance, as well as significantly reduce body fat percentage in healthy subjects.

Differential Effects of Very-Low-Volume Exercise Modalities on Telomere Length, Inflammation, and Cardiometabolic Health in Obese Metabolic Syndrome Patients: A Subanalysis from Two Randomized Controlled Trials

Oxidative stress (OS) and inflammation are features of metabolic syndrome (MetS) that can contribute to the shortening of telomere length (TL), a marker of cellular ageing. Research indicates that exercise can positively influence MetS-associated conditions and TL. However, the effects of low-volume exercise types on TL are still unknown. We investigated the impact of very-low-volume high-intensity interval training (LV-HIIT), one-set resistance training (1-RT), and whole-body electromyostimulation (WB-EMS) on TL, inflammation, and cardiometabolic indices in 167 MetS patients. Data were derived from two randomized controlled trials where patients were allocated to an exercise group (2 sessions/week, for 12 weeks) or a control group. All groups received standard-care nutritional weight loss counselling. TL was determined as the T/S ratio (telomere to single-copy gene amount). All groups significantly reduced body weight (p < 0.05), but the T/S-ratio (p < 0.001) only increased with LV-HIIT. OS-related inflammatory markers (C-reactive protein, interleukin-6, and lipopolysaccharide-binding protein) only decreased (p < 0.05) following LV-HIIT. The MetS severity z-score improved with LV-HIIT (p < 0.001) and 1-RT (p = 0.014) but not with WB-EMS. In conclusion, very-low-volume exercise modalities have differential effects on telomeres, inflammation, and cardiometabolic health. Only LV-HIIT but not strength-based low-volume exercise increased TL in MetS patients, presumably due to superior effects on OS-related inflammatory markers.

Running with whole-body electromyostimulation improves physiological determinants of endurance performance - a randomized control trial

BACKGROUND

This study aimed to evaluate the physiological and metabolic adaptations to an eight-week running intervention with whole-body electromyostimulation (wbEMS) compared to running without wbEMS.

METHODS

In a randomized controlled trial (RCT), 59 healthy participants (32 female/ 27 male, 41 ± 7 years, rel.V̇O2max 40.2 ± 7.4 ml/min/kg) ran twice weekly à 20 min for eight weeks either with a wbEMS suit (EG) or without wbEMS (control group, CG). Before and after the intervention, (i) rel.V̇O2max, heart rate and time to exhaustion were recorded with an incremental step test with an incremental rate of 1.20 km/h every 3 min. They were interpreted at aerobic and (indirect) anaerobic lactate thresholds as well as at maximum performance. (ii) Resting metabolic rate (RQ) as well as (iii) body composition (%fat) were assessed.

RESULTS

Following the intervention, V̇O2max was significantly enhanced for both groups (EG ∆13 ± 3%, CG ∆9 ± 3%). Velocity was elevated at lactate thresholds and maximum running speed (EG ∆3 ± 1%, CG ∆2 ± 1%); HRmax was slightly reduced by -1 beat/min. No significant changes were observed for time until exhaustion and lactate. RQ was significantly enhanced following both trainings by + 7%. %fat was reduced for both groups (EG ∆-11 ± 3%, CG ∆-16 ± 5%), without any changes in body mass. Results did not differ significantly between groups.

CONCLUSIONS

Both interventions had a positive impact on aerobic power. The rightward shift of the time-velocity graph points towards improved endurance performance. The effects of wbEMS are comparable to those after high-intensity training and might offer a time-efficient alternative to affect physiological and metabolic effects.

TRIAL REGISTRATION

German Clinical Trials Register, ID DRKS00026827, date 10/26/21.

Acute Effects of Whole-Body Electrostimulation Combined with Stretching on Lower Back Pain

Data from recent studies suggest that whole-body electromyostimulation (WB-EMS) is a time-effective and tailored intervention for chronic lower back pain (CLBP). The aim of this non-randomized controlled study was to compare the efficacy of a WB-EMS training and the association between WB-EMS specific training with passive stretching (Well Back System, [WBS]) on CLBP. Forty patients with CLBP, 43-81 years old, were assigned to one of the two groups: WB-EMS (n=20) and WB-EMS+WBS (n=20). Both groups completed 12 sessions (8 weeks) of the WB-EMS protocol (2×20 minutes/week). The second group performed core-specific exercises with WB-EMS plus 6 extra stretching sessions (30 minutes each). Primary study endpoints were based on changes on the visual analogue scale (VAS) and changes on the Oswestry Low Back Disability Questionnaire (ODI). Secondary study endpoints were percentage changes of maximum trunk flexion (Sit & Reach, [SR]) and changes in consumption of painkillers. Both interventions significantly improved VAS, ODI, and SR values (p range: 0.04;<0.001). However, the change of VAS (-46% vs. -17%, p<0.001), ODI (-53% vs. -17%, p<0.001), and SR (+ 7 vs.+3 cm, p=0.001) were significantly higher in the WB-EMS+WBS group compared to the WB-EMS group. The working method with WB-EMS+WBS can be a joint-friendly, individualized form to decrease CLBP.

Sarcopenic obesity: emerging mechanisms and therapeutic potential

Sarcopenic obesity, or the loss of muscle mass and function associated with excess adiposity, is a largely untreatable medical condition associated with diminished quality of life and increased risk of mortality. To date, it remains somewhat paradoxical and mechanistically undefined as to why a subset of adults with obesity develop muscular decline, an anabolic stimulus generally associated with retention of lean mass. Here, we review evidence surrounding the definition, etiology, and treatment of sarcopenic obesity with an emphasis on emerging regulatory nodes with therapeutic potential. We review the available clinical evidence largely focused on diet, lifestyle, and behavioral interventions to improve quality of life in patients with sarcopenic obesity. Based upon available evidence, relieving consequences of energy burden such as oxidative stress, myosteatosis, and/or mitochondrial dysfunction is a promising area for therapeutic development in the treatment and management of sarcopenic obesity.

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.

Whole body-electromyostimulation effects on serum biomarkers, physical performances and fatigue in Parkinson's patients: A randomized controlled trial

Background

Whole-body electromyostimulation (WB-EMS) was never previously applied to Parkinson's disease (PD) patients. This randomized controlled study aimed to find the most effective and safe WB-EMS training protocol for this population.

Methods

Twenty-four subjects (age: 72.13 ± 6.20 years), were randomly assigned to three groups: a high-frequency WB-EMS strength training group (HFG) (rectangular stimulation at 85 Hz, 350 μs, 4 s stimulation/4 s rest), a low-frequency WB-EMS aerobic training group (LFG) (rectangular stimulation 7 Hz, 350 μs, with a continuous pulse duration), and an inactive control group (CG). Participants of the two experimental groups underwent 24 controlled WB-EMS training sessions, with a duration of 20 min each, during 12-week intervention. Serum growth factors (BDNF, FGF-21, NGF and proNGF), α-synuclein, physical performance and Parkinson's Disease Fatigue Scale (PFS-16) responses were analyzed to evaluate the pre-post variation and differences among groups.

Results

Significant interactions of Time*Groups were detected for BDNF (Time*Groups p = 0.024; Time*CG, b = -628, IC95% = -1,082/-174, p = 0.008), FGF-21 (Time*Groups p = 0.009; Time*LFG b = 1,346, IC95% = 423/2268, p = 0.005), and α-synuclein (Time*Groups p = 0.019; Time*LFG b = -1,572, IC95% = -2,952/-192, p = 0.026). Post hoc analyses and comparisons of ΔS (post-pre), performed independently for each group, showed that LFG increased serum BDNF levels (+ 203 pg/ml) and decreased α-synuclein levels (-1,703 pg/ml), while HFG showed the opposite effects (BDNF: -500 pg/ml; α-synuclein: + 1,413 pg/ml). CG showed a significant BDNF reduction over time. Both LFG and HFG showed significant improvements in several physical performance outcomes and the LFG showed better results than HFG. Concerning PFS-16, significant differences over time (b = -0.4, IC95% = -0.8/-0.0, p = 0.046) and among groups (among all groups p < 0.001) were found, and the LFG exhibited better results than the HFG (b = -1.0, IC95% = -1.3/-0.7, p < 0.001), and CG (b = -1.7, IC95% = -2.0/-1.4, p < 0.001) with this last one that worsened over time.

Conclusion

LFG training was the best choice for improving or maintaining physical performance, fatigue perception and variation in serum biomarkers.

Clinical trial registration

https://www.clinicaltrials.gov/ct2/show/NCT04878679, identifier NCT04878679.

Spatial Distribution of Muscular Effects of Acute Whole-Body Electromyostimulation at the Mid-Thigh and Lower Leg-A Pilot Study Applying Magnetic Resonance Imaging

Whole-body electromyostimulation (WB-EMS) is an innovative training method that stimulates large areas simultaneously. In order to determine the spatial distribution of WB-EMS with respect to volume involvement and stimulation depth, we determined the extent of intramuscular edema using magnetic resonance imaging (MRI) as a marker of structural effects. Intense WB-EMS first application (20 min, bipolar, 85 Hz, 350 µs) was conducted with eight physically less trained students without previous WB-EMS experience. Transversal T2-weighted MRI was performed at baseline and 72 h post WB-EMS to identify edema at the mid-thigh and lower leg. The depth of the edema ranged from superficial to maximum depth with superficial and deeper muscle groups of the mid-thigh or lower leg area approximately affected in a similar fashion. However, the grade of edema differed between the muscle groups, which suggests that the intensity of EMS-induced muscular contraction was not identical for all muscles. WB-EMS of the muscles via surface cuff electrodes has an effect on deeper parts of the stimulated anatomy. Reviewing the spatial and volume distribution, we observed a heterogeneous pattern of edema. We attribute this finding predominately to different stimulus thresholds of the muscles and differences in the stress resistance of the muscles.

Acute Effects of Whole-Body Electromyostimulation during a Single Maximal Strength Training Session

Whole-body electromyostimulation (WB-EMS) training is effective in improving training adaptation. However, WB-EMS may have side effects and contraindications that can lead to excessive muscle damage and physiological impairment. This randomized crossover study aimed to analyze the acute effects of WB-EMS on muscle damage, autonomic modulation and performance during a single maximal strength session in physically active participants. Twenty healthy and physically active participants randomly performed three maximal strength training sessions (90% 1RM) consisting of bench presses and squat exercises, with a continuous stimulus, a coordinated stimulus with concentric and eccentric phases, and without WB-EMS. Data showed no significant differences between the trials for muscle damage (blood creatine kinase levels), lactate blood levels and performance after exercise. Likewise, the heart rate, blood oxygen saturation and the rate of perceived exertion were similar during exercise between trials. The heart rate variability analysis also showed a similar autonomic response among the trials. Training with WB-EMS seemed to be safe at the observed time intervals while offering a stimulus similar to regular training in physically active participants, regardless of the delivery of the electrical stimuli. More studies are needed to assess the effectiveness of WB-EMS in improving exercise adaptations during training programs.

Effects of whole-body electromyostimulation training on upper limb muscles strength and body composition in moderately trained males: A randomized controlled study

Resistance training has been known to have a positive effect on muscle performance in exercisers. Whole-body electromyostimulation (WB-EMS) is advertised as a smooth, time-efficient, and highly individualized resistance training technology. The purpose of this study is to evaluate the effects of WB-EMS training on maximum isometric elbow muscle strength and body composition in moderately trained males in comparison to traditional resistance training. The study was a randomized controlled single-blind trial. Twenty, moderately trained, male participants (25.15 ± 3.84, years) were randomly assigned to the following groups: a WB-EMS training group (n = 11) and a traditional resistance training group (the control group [CG]: n = 9). Both training intervention programs consisted of 18 training sessions for six consecutive weeks. All subjects performed dynamic movements with the WB-EMS or external weights (CG). The primary outcome variables included maximum isometric elbow flexor strength (MIEFS), maximum isometric elbow extensor strength (MIEES) and surface electromyography amplitude (sEMG_RMS). Secondary outcomes involved lean body mass, body fat content, arm fat mass, and arm lean mass. ANOVAs, Friedman test and post hoc t-tests were used (P = 0.05) to analyze the variables development after the 6-week intervention between the groups. Significant time × group interactions for MIEFS (η² = 0.296, P _Bonferroni = 0.013) were observed, the increase in the WB-EMS group were significantly superior to the CG [23.49 ± 6.48% vs. 17.01 ± 4.36%; MD (95% CI) = 6.48 (1.16, 11.80); d = 1.173, P = 0.020]. There were no significant differences were observed between interventions regarding MIEES, sEMG_RMS and body composition. These findings indicate that in moderately trained males the effects of WB-EMS were similar to a traditional resistance training, with the only exception of a significantly greater increase in elbow flexor strength. WB-EMS can be considered as an effective exercise addition for moderately trained males.

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.

Effect of Modulated Electromyostimulation on the Motor System of Elderly Neurological Patients. Pilot Study of Russian Currents Also Known as Kotz Currents

In this brief report, we present preliminary findings from a study of the use of electromyostimulation (EMS) in neurological patients. Assuming the approach to be sufficiently effective, we decided to investigate the motor system of elderly neurological patients before and after a course of Russian currents EMS, which were developed for Soviet athletes and cosmonauts. To this point, 19 patients—EMS (n = 11) and control (n = 8)—have successfully completed the study. The study included patients aged 60–90 years with confirmed walking and balance disorders with a history of chronic cerebral ischemia. Patients in the experimental group underwent a course of modulated EMS of the hip and shin muscles from 3 to 9 procedures. Preliminary results of the study showed good patient acceptance of EMS. After the course, the EMS group showed a significant improvement from baseline in the Tinetti Test (+1.4 points, p = 0.0045), Rivermead Mobility Index (+0.5 points, p = 0.0022), and Timed Up and Go Test (−1.2 s, p = 0.0053). There was also a significant improvement in balance quality of 8.6% (p = 0.04). Shin muscle strength, although trending positively, did not change significantly. There was also no change in hip and shin muscles’ tone. No significant changes were observed in the control group in the same tests. It can be concluded that stimulation of the hip and shin muscles with Russian (Kotz) currents has a positive effect on the motor system of elderly neurological patients. Significant effects with a course of short duration indicate that this EMS regimen is promising.

"HIIT the Inflammation": Comparative Effects of Low-Volume Interval Training and Resistance Exercises on Inflammatory Indices in Obese Metabolic Syndrome Patients Undergoing Caloric Restriction

Exercise is a cornerstone in metabolic syndrome (MetS) treatment. However, the effects of low-volume exercise modalities on MetS-associated low-grade inflammation are unclear. A total of 106 MetS patients (53.7 ± 11.4 years) were randomized to low-volume high-intensity interval training (LOW-HIIT, 14 min/session), single-set resistance training (1-RT, ~15 min/session), whole-body electromyostimulation (WB-EMS, 20 min/session), three-set resistance training (3-RT, ~50 min/session), each performed 2 ×/week for 12 weeks, or a control group (CON). All groups received nutritional counseling for weight loss. Inflammatory and cardiometabolic indices were analyzed pre- and post-intervention. All groups significantly reduced body weight by an average of 3.6%. Only LOW-HIIT reduced C-reactive protein (CRP) (−1.6 mg/L, p = 0.001) and interleukin-6 (−1.1 pg/mL, p = 0.020). High-sensitivity CRP and lipopolysaccharide-binding protein decreased following LOW-HIIT (−1.4 mg/L, p = 0.001 and −2.1 ng/mL, p = 0.004) and 3-RT (−0.6 mg/L, p = 0.044 and −2.0 ng/mL, p < 0.001). MetS severity score improved with LOW-HIIT (−1.8 units, p < 0.001), 1-RT (−1.6 units, p = 0.005), and 3-RT (−2.3 units, p < 0.001). Despite similar effects on body weight, low-volume exercise modalities have different impact on inflammatory and cardiometabolic outcomes in MetS patients. LOW-HIIT has superior efficacy for improving inflammation compared to 1-RT and WB-EMS. Resistance-based exercise appears to require a higher volume to promote beneficial impact on inflammation.

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.

ENERGY EXPENDITURE IN HIIT WHOLE BODY ASSOCIATED WITH ELECTROMYOSTIMULATION

ABSTRACT Introduction: The use of whole body electromyostimulation (WB-EMS) has been shown to be an efficient method for inducing significant improvements in muscle strength and performance outcomes. Hypothetically, WB-EMS had been considered an enhancer of energy expenditure in the session, but this remains unclear. Objective: In view of the lack of information, this study aims to evaluate the energy expenditure of WB-EMS associated with whole body High-Intensity Interval Training (HIIT). Methods: Fourteen male participants were submitted into two randomized exercise sessions: HIIT (whole body weight exercises without WB-EMS) and HIIT+WB-EMS (whole body weight exercises associated with WB-EMS). For both exercise conditions, the subjects performed whole body HIIT according to the following protocol: 3 minutes of warm-up followed by 4 exercises (30 seconds of stimulus) organized in 2 blocks, with 3 sets in each exercise, a rest period of 15 seconds between sets, and 180 seconds between blocks. The following exercises were performed: jumping jacks, squat and thrusts, burpees, and spider plank. Results: Significant differences were found in the absolute VO2 (HIIT:2.18±0.34, HIIT+WB-EMS:2.32±0.36 L.min−1) and relative VO2 (HIIT:26.30±3.77, HIIT+WB-EMS:28.02± 3.74 ml.kg.min−1), MET (HIIT:7.51±1.07, HIIT+WB-EMS:8.00±1.07), lactate concentration (HIIT:11.59±2.16, HIIT+WB-EMS: 12.64±1.99 mmol.L−1) and total energy expenditure (HIIT: 249.6± 45.04 Kcal, HIIT+ WB-EMS: 268.9±40.67 Kcal; 7.46 ± 5.31%). Conclusion: Our data indicate that the use of WB-EMS associated with HIIT generated a slightly higher metabolic demand than that of the control. However, the absolute differences do not allow us to indicate the superiority of WB-EMS, and future trials should be designed to determine the long-term effects.

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.

Assessment of the Strength Parameters of the Quadriceps Femoris Muscles in Polish University Students after a 3-Week Program of Neuromuscular Electrical Stimulation Using the RSQ1 Method

A rehabilitative program for patients who lose strength and muscle mass along with the ability to perform intensive exercises is lacking. We developed a 3-week training program based on neuromuscular electrical stimulation (NMES) using a RSQ1 device (modulated current resulting from the overlapping of two-component currents) for RSQ1 electrostimulation to improve strength parameters of the quadricep femoris muscles and compare its effectiveness to isometric training. Nineteen university students were randomly divided into the NMES group (10 sessions) and the control group who trained. We measured the circumference of the thigh, as well as peak torques of the flexor and extensor muscles before and after the start and after the end of the training program. Both tested training programs gave similar results. Differences between measured parameters were not significant except for differences in the peak torques of the knee flexors (9.9% for left limb; p = 0.2135 vs. 7.8% for rift limb; p = 0.2135) and the circumference of the left thigh—2% for both (left p = 0.5839 and right p = 0.1088). Comparable results of the tested training programs suggest that NMES is a good alternative for people who cannot perform exercises, but want to maintain or improve their physical fitness.

Output of Electronic Muscle Stimulators: Physical Therapy and Police Models Compared

INTRODUCTION

Both physical therapists and police officers use electrical muscle stimulation. The typical physical therapist unit is attached with adhesive patches while the police models use needle-based electrodes to penetrate clothing. There have been very few papers describing the outputs of these physical therapy EMS (electrical muscle stimulator) units.

METHODS

We purchased 6 TENS/EMS units at retail and tested them with loads of 500 Ω, 2 kΩ, and 10 kΩ.

RESULTS

For the typical impedance of 500 Ω, the EMS units delivered the most current followed by the electrical weapons; TENS units delivered the least current. At higher im-pedances (> 2 kΩ) the electrical weapons delivered more current than the EMS units, which is explained by the higher voltage-compliance of their circuits. Some multi channel EMS units deliver more calculated muscle stimula tion than the multi-channel weapons.

CONCLUSION

Present therapeutic electrical muscle stimula-tors can deliver more current than present law-enforcement muscle stimulators.

Whole-Body EMS Superimposed Walking and Nordic Walking on a Treadmill-Determination of Exercise Intensity to Conventional Exercise

Electrical muscle stimulation (EMS) is an increasingly popular training method and has become the focus of research in recent years. New EMS devices offer a wide range of mobile applications for whole-body EMS (WB-EMS) training, e.g., the intensification of dynamic low-intensity endurance exercises through WB-EMS. The present study aimed to determine the differences in exercise intensity between WB-EMS-superimposed and conventional walking (EMS-CW), and CON and WB-EMS-superimposed Nordic walking (WB-EMS-NW) during a treadmill test. Eleven participants (52.0 ± years; 85.9 ± 7.4 kg, 182 ± 6 cm, BMI 25.9 ± 2.2 kg/m²) performed a 10 min treadmill test at a given velocity (6.5 km/h) in four different test situations, walking (W) and Nordic walking (NW) in both conventional and WB-EMS superimposed. Oxygen uptake in absolute (VO₂) and relative to body weight (rel. VO₂), lactate, and the rate of perceived exertion (RPE) were measured before and after the test. WB-EMS intensity was adjusted individually according to the feedback of the participant. The descriptive statistics were given in mean ± SD. For the statistical analyses, one-factorial ANOVA for repeated measures and two-factorial ANOVA [factors include EMS, W/NW, and factor combination (EMS^*W/NW)] were performed (α = 0.05). Significant effects were found for EMS and W/NW factors for the outcome variables VO₂ (EMS: p = 0.006, r = 0.736; W/NW: p < 0.001, r = 0.870), relative VO₂ (EMS: p < 0.001, r = 0.850; W/NW: p < 0.001, r = 0.937), and lactate (EMS: p = 0.003, r = 0.771; w/NW: p = 0.003, r = 0.764) and both the factors produced higher results. However, the difference in VO₂ and relative VO₂ is within the range of biological variability of ± 12%. The factor combination EMS^*W/NW is statistically non-significant for all three variables. WB-EMS resulted in the higher RPE values (p = 0.035, r = 0.613), RPE differences for W/NW and EMS^*W/NW were not significant. The current study results indicate that WB-EMS influences the parameters of exercise intensity. The impact on exercise intensity and the clinical relevance of WB-EMS-superimposed walking (WB-EMS-W) exercise is questionable because of the marginal differences in the outcome variables.

Four weeks of electromyostimulation improves muscle function and strength in sarcopenic patients: a three-arm parallel randomized trial

BACKGROUND

Sarcopenia, defined as loss of muscle mass, quality, and function, is associated with reduced quality of life and adverse health outcomes including disability and mortality. Electromyostimulation (EMS) has been suggested to attenuate the loss of muscle mass and function in elderly, sedentary individuals. This study aimed to investigate the effects of EMS on muscle strength and function during 4 weeks of inpatient medical rehabilitation.

METHODS

Patients receiving 4 weeks of inpatient medical rehabilitation diagnosed with sarcopenia using bioimpedance analysis were eligible to participate. One hundred and thirty-four patients (55.7 ± 7.9 years, 25.4% female) were randomly assigned to three groups: whole-body (WB) EMS (n = 48): stimulation of major muscle groups (pectoral muscles, latissimus, trapezius, abdominals, upper arm and leg, lower back muscles, gluteal muscles, and thighs); part-body (PB) EMS (n = 42): stimulation of leg muscles including gluteal muscles and thighs; and control group (CG, n = 44). All participants performed six 20 min training sessions including dynamic movements (squats, lunges, biceps curl, chest press, butterfly reverse, reverse lunges, standing diagonal crunches, etc.) with superimposed (WB-, PB-) EMS or without EMS (CG) in addition to the standard rehabilitation programme. Primary outcome variables included muscle function assessed by chair rise test and 6 min walking test as well as muscle strength (isometric grip strength, leg, arm, and back extension).

RESULTS

Primary outcome variables chair rise test and leg extension improved significantly (P = 0.001, η²  = 0.06 and P = 0.008, η²  = 0.06; EMS vs. CG) in that chair rise test results increased in WB-EMS from 5 (4; 7) to 7 (5; 9), in PB-EMS from 5 (5; 7) to 7 (6; 8), and in CG from 6 (4; 7) to 7 (5; 8) repetitions. Knee extension increased in WB-EMS from 692.3 ± 248.6 to 831.7 ± 298.7 N, in PB-EMS from 682.8 ± 257.8 to 790.2 ± 270.2 N, and in CG from 638.5 ± 236.9 to 703.2 ± 218.6 N. No adverse events or side effects occurred.

CONCLUSIONS

We conclude that EMS might be an additional training option to improve muscle function and strength in sarcopenic patients during a 4 week rehabilitation programme. EMS provides greater functional and strength improvements compared with standard treatment with additional potential health benefits for sarcopenic cardiac and orthopaedic patients.

Whole-body electrical stimulation as a strategy to improve functional capacity and preserver lean mass after bariatric surgery: a randomized triple-blind controlled trial

BACKGROUND/OBJECTIVES

Bariatric surgery (BS) is a successful, long-lasting treatment option for obese. The early postoperative (PO) period is followed by dietary restriction and physical inactivity, leading to declines in muscle mass and functional capacity. Whole-body electromyostimulation (WB-EMS) may be a feasible and potential early rehabilitation strategy post BS. The aim was to evaluate the effects of WB-EMS with exercise training (Fe) on functional capacity, body composition, blood biomarkers, muscle strength, and endurance post BS.

SUBJECTS/METHODS

This is a randomized, triple-blind, sham-controlled trial. Thirty-five volunteers underwent a Roux-en-Y gastric bypass and were randomized into a WB-EMS (WB-EMSG) or control group (ShamG). Preoperative evaluations consisted of maximal and submaximal exercise testing, body composition, blood biomarkers, quadriceps strength, and endurance. After discharge, functional capacity and body composition were obtained. Exercise training protocols in both groups consisted of 14 dynamic exercises, 5 days per week, completing 30 sessions. The WB-EMSG also underwent an electrical stimulation protocol (Endurance: 85 Hz, 350 ms, 6 s of strain, 4 f of rest; Strength: 30 Hz, 350 ms, 4 s of strain, 10 seconds of rest, with bipolar electrical pulse). After intervention, subjects were reevaluated.

RESULTS

The protocol started on average 6.7 ± 3.7 days after discharge. Both groups presented with a decline in functional capacity after BS (p < 0.05) and a reduction in all body composition measurements (p < 0.05). The exercise training program led to significant improvements in functional capacity (ShamG - PO: 453.8 ± 66.1 m, Post: 519.2 ± 62.8 m; WB-EMSG- PO: 435.9 ± 74.5, Post: 562.5 ± 66.4 m, p < 0.05), however, only the WB-EMSG demonstrated significant changes of distance walked (interaction time vs group effect, p < 0.05). In addition, adiponectin significantly increased only in the WB-EMSG (p < 0.05). The WB-EMSG was also able to preserve muscle strength, endurance, and fatigue index, while the ShamG demonstrated significant decline (p < 0.05).

CONCLUSION

WB-EMS + Fe can be an attractive and feasible method following BS to enhance functional capacity and prevent deterioration of muscle function in the early PO.

CLINICAL TRIAL REGISTRATION

ReBEC, RBR-99qw5h, on 20 February 2015.

Psychological Effects of Whole-body Electromyostimulation Training: a Controlled Pilot Study in Healthy Volunteers

BACKGROUND

Whole-body electromyostimulation (WB-EMS) training is used in popular and health sports to improve muscular performance. Little is known about the possible psychological effects of WB-EMS training. The aim of the study is therefore to investigate the possible psychological effects of WB-EMS training on subjective well-being, relaxation, mood, and perceived stress.

MATERIALS AND METHODS

Twenty-five healthy subjects underwent conventional WB-EMS training and Sham training (without the application of electrical stimulation) as part of a randomized, controlled pilot study in a crossover design. Subjective well-being and subjective relaxation were assessed using visual analog scales, the current state of mood was assessed with Multidimensional Mood State Questionnaires (MDBF), and the current level of stress was assessed with Recovery-Stress Questionnaires/Erholungs-Belastungs-Fragebögen (RESTQEBF) before and after training.

RESULTS

WB-EMS training has a statistically significant positive effect on subjective well-being and subjective relaxation, as well as on the awake subscale of the MDBF. No significant main effect of sequence and no interaction effects were found. Also, compared to a Sham training session, a single WB-EMS training session had no significant effect on mood, nervousness, or the current level of stress.

CONCLUSION

Besides physiological effects, WB-EMS might also have a strong psychological impact. WB-EMS could be beneficial for people who, due to their limitations, have problems training on a regular basis and with adequate training intensity.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00012583 , 22 June 2017.

A Single Session of Whole-Body Electromyostimulation Increases Muscle Strength, Endurance and proNGF in Early Parkinson Patients

Parkinson's disease (PD) patients lead a sedentary lifestyle, being unable or unwilling to exercise conventionally, due to physical and mental limitations. The aim of this study was to assess the acute effects of a single session of whole-body electromyostimulation (WB-EMS) on the physical performances and serum levels of the neurotrophic factors in PD patients. Ten subjects (aged 72.60 ± 6.82) underwent 20 min of physical activity with superimposed WB-EMS and, after four weeks, the same protocol with no WB-EMS. WB-EMS was conducted with intermittent stimulation, with 4 s WB-EMS/4 s rest, at 85 Hz, 350 μs. A physical fitness assessment and blood samples collection, to evaluate neurotrophic factors' levels (BDNF, FGF21, proNGF, mNGF), were collected before and after the intervention. The RM-ANOVA showed significant improvements in sit-to-stand (p < 0.01), arm curl (p < 0.01), handgrip (p < 0.01) and soda pop test (p < 0.01) after the WB-EMS intervention. Higher proNFG serum levels were observed in the WB-EMS condition compared to the no WB-EMS after 60 min post-intervention (p = 0.0163). The effect of WB-EMS confirmed the electrostimulation ability to modulate the proNGF quantity. The positive impact of the WB-EMS protocol on physical functioning, and eye-hand coordination, makes this intervention a promising strategy to improve motor and non-motor symptoms in PD patients.

Iron Beats Electricity: Resistance Training but Not Whole-Body Electromyostimulation Improves Cardiometabolic Health in Obese Metabolic Syndrome Patients during Caloric Restriction-A Randomized-Controlled Study

Caloric restriction (CR) and exercise are cornerstones in the treatment of obesity and cardiometabolic disorders. Recently, whole body electromyostimulation (WB-EMS) has emerged as a more time-efficient alternative to traditional resistance training (RT). However, the effects of WB-EMS compared to RT on cardiometabolic health in obese metabolic syndrome (MetS) patients performed during CR are still unclear. In total, 118 obese MetS patients (52.7 ± 11.8 years, BMI: 38.1 ± 6.9 kg/m²) undergoing CR over 12 weeks (aim: −500 kcal deficit/day) were randomly allocated to either WB-EMS, single-set RT (1-RT), 3-set RT (3-RT) or an inactive control group (CON). Primary outcome was MetS severity (MetS z-score). Secondary outcomes were body composition, muscle strength and quality of life (QoL). All groups significantly reduced body weight (~3%) and fat mass (~2.6 kg) but only 1-RT and 3-RT preserved skeletal muscle mass (SMM). All exercise groups increased muscle strength in major muscle groups (20–103%). However, only the two RT-groups improved MetS z-score (1-RT: −1.34, p = 0.003; 3-RT: −2.06, p < 0.001) and QoL (1-RT: +6%, p = 0.027; 3-RT: +12%, p < 0.001), while WB-EMS and CON had no impact on these outcomes. We conclude that traditional RT has superior effects on cardiometabolic health, SMM and QoL in obese MetS patients undergoing CR than WB-EMS.

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.

Effect of exercise intensity on metabolic responses on combined application of electrical stimulation and voluntary exercise

The combined application of voluntary exercises and neuromuscular electrical stimulation (NMES) has been developed as a new type of exercise that can recruit motor units contributing to both aerobic and anaerobic energy metabolisms. We aimed to investigate the effect of voluntary exercise intensity on metabolic responses on the combination of voluntary exercise and NMES. In 13 volunteers, oxygen consumption and the blood lactate concentration were measured during (1) voluntary pedaling exercise at four different intensities: 50%, 75%, 100%, and 125% of the ventilatory threshold (VT) (VOL), (2) these voluntary exercises with superimposed NMES applied to the gluteus and thigh muscles (VOL+NMES), and (3) NMES only (NMES). Oxygen consumption and the blood lactate concentration in VOL+NMES were significantly greater than VOL at each exercise intensity (p < 0.05). Differences in oxygen consumption between VOL+NMES and VOL decreased with exercise intensity, and that at 125% VT was significantly lower than the net gain in oxygen consumption following NMES (p < 0.05). Differences in the blood lactate concentration between VOL+NMES and VOL increased with exercise intensity, and that at 50% VT was significantly lower than the net gain in the blood lactate concentration following NMES (p < 0.05). Our results suggest that voluntary exercise intensity has a critical impact on metabolic responses during the combined application of voluntary exercises and NMES. Superimposing NMES onto voluntary exercises at high exercise intensities may induce overlapping recruitment of motor units, leading to a markedly reduced benefit of additional metabolic responses on its superimposition.

Cardiorespiratory, Metabolic and Perceived Responses to Electrical Stimulation of Upper-Body Muscles While Performing Arm Cycling

This study was designed to assess systemic cardio-respiratory, metabolic and perceived responses to incremental arm cycling with concurrent electrical myostimulation (EMS). Eleven participants (24 ± 3 yrs; 182 ± 10 cm; 86 ± 16.8 kg) performed two incremental tests involving arm cycling until volitional exhaustion was reached with and without EMS of upper-body muscles. The peak power output was 10.1% lower during arm cycling with (128 ± 30 W) than without EMS (141 ± 25 W, p = 0.01; d = 0.47). In addition, the heart rate (2-9%), oxygen uptake (7-15%), blood lactate concentration (8-46%) and ratings of perceived exertion (4-14%) while performing submaximal arm cycling with EMS were all higher with than without EMS (all p < 0.05). Upon exhaustion, the heart rate, oxygen uptake, lactate concentration, and ratings of perceived exertion did not differ between the two conditions (all p > 0.05). In conclusion, arm cycling with EMS induced more pronounced cardio-respiratory, metabolic and perceived responses, especially during submaximal arm cycling. This form of exercise with stimulation might be beneficial for a variety of athletes competing in sports involving considerable generation of work by the upper body (e.g., kayaking, cross-country skiing, swimming, rowing and various parasports).

Can A Superimposed Whole-Body Electromyostimulation Intervention Enhance the Effects of a 10-Week Athletic Strength Training in Youth Elite Soccer Players?

Strength training in youth soccer has both a preventive and a sports-specific component. Whole-body electromyostimulation (WB-EMS) could represent an interesting time-saving add-on to classical strength exercises in performance-oriented soccer. The objective of this study was to find out whether a 10-week superimposed WB-EMS training might have a more positive impact on strength parameters in male youth elite soccer players than regular athletic strength exercises alone. A total of 30 male youth soccer players from a youth academy aged 15 to 17 years participated in the study. Before and after the intervention, the isometric extension and flexion forces of trunk and knee, and the hip abduction and adduction forces were tested. Twelve players (control group) absolved a conventional 20-minute strength training once a week for a period of ten weeks. Eighteen players absolved the same exercises but with superimposed WB-EMS. Blood creatine kinase concentration was measured for training control. ANOVAs, Friedman tests and post hoc t-tests were calculated (p = 0.05) to examine the strength development during the training period between the groups. While we could not find significant strength increases in the leg, hip and trunk muscles in the control group (<4%), the strength of the WB-EMS group improved significantly in 4 of the 6 muscle groups tested. In this group, the strength of knee flexors increased significantly by 20.68 ± 21.55%, knee extensors by 31.43 ± 37.02%, hip adductors by 21.70 ± 12.86% and trunk flexors by 33.72 ± 27.43%. The rates of strength increase are partly in line with other studies, partly clearly higher, which might be explained by the athletically active target group. A 10-week superimposed WB-EMS training improves the strength of certain leg, hip and trunk muscles in male adolescent elite soccer players to a greater extent than a pure athletic strength training of the same duration.

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 an Impulse Frequency Dependent 10-Week Whole-body Electromyostimulation Training Program on Specific Sport Performance Parameters

The difference in the efficacy of altered stimulation parameters in whole-body-electromyostimulation (WB-EMS) training remains largely unexplored. However, higher impulse frequencies (>50 Hz) might be most adequate for strength gain. The aim of this study was to analyze potential differences in sports-related performance parameters after a 10-week WB-EMS training with different frequencies. A total of 51 untrained participants (24.9 ± 3.9 years, 174 ± 9 cm, 72.4 ± 16.4 kg, BMI 23.8 ± 4.1, body fat 24.7 ± 8.1 %) was randomly divided into three groups: one inactive control group (CON) and two training groups. They completed a 10-week WB-EMS program of 1.5 sessions/week, equal content but different stimulation frequencies (training with 20 Hz (T20) vs. training with 85 Hz (T85)). Before and after intervention, all participants completed jumping (Counter Movement Jump (CMJ), Squat Jump (SJ), Drop Jump (DJ)), sprinting (5m, 10m, 30m), and strength tests (isometric trunk flexion/extension). One-way ANOVA was applied to calculate parameter changes. Post-hoc least significant difference tests were performed to identify group differences. Significant differences were identified for CMJ (p = 0.007), SJ (p = 0.022), trunk flexion (p = 0.020) and extension (p=.013) with significant group differences between both training groups and CON (not between the two training groups T20 and T85). A 10-week WB-EMS training leads to significant improvements of jump and strength parameters in untrained participants. No differences could be detected between the frequencies. Therefore, both stimulation frequencies can be regarded as adequate for increasing specific sport performance parameters. Further aspects as regeneration or long term effects by the use of different frequencies still need to be clarified.

Impact of Active Recovery and Whole-Body Electromyostimulation on Blood-Flow and Blood Lactate Removal in Healthy People

This study aimed to determine whether an active recovery with added whole-body electromyostimulation (WB-EMS) can increase blood flow and lead to blood lactate removal after intense exercise. Thirty-five healthy individuals (23.1 ± 4.6 years) were randomly assigned to: (a) an experimental group using active recovery together with the WB-EMS (n = 18) or (b) a control group using the same active recovery protocol with the suit with no-stimulation (CON, n = 17). Participants performed a maximal graded exercise test followed by an active recovery protocol (walking at 40% of their maximum aerobic velocity). During the recovery, participants in WB-EMS and CON received continuous stimulation at 7 Hz or no stimulation, respectively. Heart rate, blood lactate concentrations, pain/discomfort, and hemodynamic measurements were recorded before and after the test, and repeated immediately after and at min 30 and 60. The between-group analysis showed a substantially greater Peak blood velocity (-0.27 [-0.68; 0.14]) in WB-EMS compared to CON. The pain/discomfort levels were also lower in WB-EMS compared with CON (0.66 [-0.12; 1.45]). Non-significant differences in participants' blood lactate were observed in WB-EMS compared with CON both immediately; at 30and 60 min. Our findings suggest that increased local blood flow induced by WB-EMS may have contributed to greater lactate removal from active muscles and blood lactate clearance. WB-EMS may be an effective means of increasing muscle blood flow after a maximal graded exercise test and could result in improved recovery.

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.

Exercise training improves sleep quality: A randomized controlled trial

BACKGROUND

Exercise holds promise as a non-pharmacological intervention for the improvement of sleep quality. Therefore, this study investigates the effects of different training modalities on sleep quality parameters.

MATERIAL & METHODS

A total of 69 (52.7% women) middle-aged sedentary adults were randomized to (a) control group, (b) physical activity recommendation from the World Health Organization, (c) high-intensity interval training (HIIT) and (d) high-intensity interval training group adding whole-body electromyostimulation training (HIITEMS). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) scale and accelerometers.

RESULTS

All intervention groups showed a lower PSQI global score (all P < .022). HIIT-EMS group improved all accelerometer parameters, with higher total sleep time and sleep efficiency, and lower wake after sleep onset (all P < .016). No differences were found between groups in any sleep quality parameter.

CONCLUSION

In conclusion, exercise training induced an improvement in subjective sleep quality in sedentary middleaged adults. Moreover, HIIT-EMS training showed an improvement in objective sleep quality parameters (total sleep time, sleep efficiency and wake after sleep onset) after 12 weeks of exercise intervention. The changes observed in the HIIT-EMS group were not statistically different to the other exercise modalities.

Metabolic rate in sedentary adults, following different exercise training interventions: The FIT-AGEING randomized controlled trial

BACKGROUND & AIMS

This study compares the influence of different exercise training programs on basal metabolic rate (BMR) and fat oxidation, in basal conditions (BFox) and during exercise (MFO), in sedentary, middle-aged adults.

METHODS

The study subjects of this 12 week-long, randomised controlled trial, were 71 middle-aged adults (age 53.5 ± 4.9 years; 52% women). Subjects were randomly assigned to one of the following groups: (1) no exercise, (2) concurrent training based on international physical activity recommendations (PAR group), (3) high intensity interval training (HIIT group), and (4) high intensity interval training plus whole-body electromyostimulation (HIIT + EMS group). Subject BMR, BFox and MFO were determined by indirect calorimetry before and after the intervention.

RESULTS

The HIIT + EMS subjects showed significant increases in BFox following the intervention compared with the control group (all P = 0.043); no such differences were seen in the PAR and HIIT compared with the control group (all P ≥ 0.1). A significant increase in post-intervention MFO was noted for the HIIT and HIIT + EMS group compared to the non-exercise control group (P < 0.05); no such difference was seen in the PAR group compared to the control group (all P ≥ 0.05).

CONCLUSIONS

Twelve weeks of high intensity interval training plus whole-body electromyostimulation may increase the BFox and MFO of middle-aged sedentary adults. These findings have important clinical implications; a well-designed high-intensity interval training program plus whole-body electromyostimulation might be followed to help combat the appearance of chronic metabolic diseases characterized by metabolic inflexibility in middle-aged sedentary adults, though it will be necessary to determine how long the effects last.