1
|
von Stengel S, Fröhlich M, Ludwig O, Eifler C, Berger J, Kleinöder H, Micke F, Wegener B, Zinner C, Mooren FC, Teschler M, Filipovic A, Müller S, England K, Vatter J, Authenrieth S, Kohl M, Kemmler W. Revised contraindications for the use of non-medical WB-electromyostimulation. Evidence-based German consensus recommendations. Front Sports Act Living 2024; 6:1371723. [PMID: 38689869 PMCID: PMC11058671 DOI: 10.3389/fspor.2024.1371723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
Whole-body electromyostimulation has proven to be a highly effective alternative to conventional resistance-type exercise training. However, due to adverse effects in the past, very extensive contraindications have been put in place for the commercial, non-medical WB-EMS market. Considering recent positive innovations e.g., federal regulation, mandatory trainer education, revised guidelines, and new scientific studies on WB-EMS application, we believe that a careful revision of the very restrictive contraindications on WB-EMS is needed. This applies all the more because many cohorts with limited options for conventional exercise have so far been excluded. During a first meeting of an evidence-based consensus process, stakeholders from various backgrounds (e.g., research, education, application) set the priorities for revising the contraindications. We decided to focus on four categories of absolute contraindications: "Arteriosclerosis, arterial circulation disorders", "Diabetes mellitus" (DM), "Tumor and cancer" (TC), "Neurologic diseases, neuronal disorders, epilepsy". Based on scientific studies, quality criteria, safety aspects and benefit/risk assessment of the category, DM and TC were moved to the relative contraindication catalogue, while arteriosclerosis/arterial circulation disorders and neurologic diseases/neuronal disorders/epilepsy were still considered as absolute contraindications. While missing evidence suggests maintaining the status of neurologic diseases/neuronal disorders as an absolute contraindication, the risk/benefit-ratio does not support the application of WB-EMS in people with arteriosclerosis/arterial circulation diseases. Despite these very cautious modifications, countries with less restrictive structures for non-medical WB-EMS should consider our approach critically before implementing the present revisions. Considering further the largely increased amount of WB-EMS trials we advice regular updates of the present contraindication list.
Collapse
Affiliation(s)
- S. von Stengel
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - M. Fröhlich
- Department of Sports Science, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau, Kaiserslautern, Germany
| | - O. Ludwig
- Department of Sports Science, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau, Kaiserslautern, Germany
| | - C. Eifler
- German University for Prevention and Health Management, Saarbrücken, Germany
| | - J. Berger
- German University for Prevention and Health Management, Saarbrücken, Germany
| | - H. Kleinöder
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - F. Micke
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - B. Wegener
- Musculoskeletal University Center, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - C. Zinner
- Hessian College of Police and Administration, Wiesbaden, Germany
| | - F. C. Mooren
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - M. Teschler
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | | | | | - K. England
- Glucker Kolleg, Frankfurt, Germany
- Bundeswehr Medical Academy Munich, Munich, Germany
| | - J. Vatter
- Soccer Club Paderborn 07, Paderborn, Germany
- PT Lounge Cologne, Cologne, Germany
| | - S. Authenrieth
- Glucker Kolleg, Frankfurt, Germany
- EMS-Performance, Kornwestheim, Germany
| | - M. Kohl
- Department of Medical and Life Sciences, University of Furtwangen, Schwenningen, Germany
| | - W. Kemmler
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| |
Collapse
|
2
|
Beier M, Schoene D, Kohl M, von Stengel S, Uder M, Kemmler W. Non-Athletic Cohorts Enrolled in Longitudinal Whole-Body Electromyostimulation Trials-An Evidence Map. SENSORS (BASEL, SWITZERLAND) 2024; 24:972. [PMID: 38339689 PMCID: PMC10857049 DOI: 10.3390/s24030972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
Whole-body electromyostimulation (WB-EMS) can be considered as a time-efficient, joint-friendly, and highly customizable training technology that attracts a wide range of users. The present evidence map aims to provide an overview of different non-athletic cohorts addressed in WB-EMS research. Based on a comprehensive systematic search according to PRISMA, eighty-six eligible longitudinal trials were identified that correspond with our eligibility criteria. In summary, WB-EMS research sufficiently covers all adult age categories in males and females. Most cohorts addressed (58%) were predominately or exclusively overweight/obese, and in about 60% of them, diseases or conditions were inclusion criteria for the trials. Cohorts specifically enrolled in WB-EMS trials suffer from cancer/neoplasm (n = 7), obesity (n = 6), diabetes mellitus (n = 5), metabolic syndrome (n = 2), nervous system diseases (n = 2), chronic heart failure (n = 4), stroke (n = 1), peripheral arterial diseases (n = 2), knee arthrosis (n = 1), sarcopenia (n = 3), chronic unspecific low back pain (n = 4), and osteopenia (n = 3). Chronic kidney disease was an eligibility criterion in five WB-EMS trials. Finally, three studies included only critically ill patients, and two further studies considered frailty as an inclusion criterion. Of importance, no adverse effects of the WB-EMS intervention were reported. In summary, the evidence gaps in WB-EMS research were particular evident for cohorts with diseases of the nervous and cerebrovascular system.
Collapse
Affiliation(s)
- Miriam Beier
- Institute of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (M.B.); (D.S.); (S.v.S.); (M.U.)
| | - Daniel Schoene
- Institute of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (M.B.); (D.S.); (S.v.S.); (M.U.)
| | - Matthias Kohl
- Department of Medical and Life Sciences, University of Furtwangen, 78056 Villingen-Schwenningen, Germany;
| | - Simon von Stengel
- Institute of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (M.B.); (D.S.); (S.v.S.); (M.U.)
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (M.B.); (D.S.); (S.v.S.); (M.U.)
| | - Wolfgang Kemmler
- Institute of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (M.B.); (D.S.); (S.v.S.); (M.U.)
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, 91052 Erlangen, Germany
| |
Collapse
|
3
|
Reiter L, Bauer S, Traxler M, Schoufour JD, Weijs PJM, Cruz-Jentoft A, Topinková E, Eglseer D. Effects of Nutrition and Exercise Interventions on Persons with Sarcopenic Obesity: An Umbrella Review of Meta-Analyses of Randomised Controlled Trials. Curr Obes Rep 2023; 12:250-263. [PMID: 37249818 PMCID: PMC10482763 DOI: 10.1007/s13679-023-00509-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Sarcopenic obesity (SO) is an increasing phenomenon and has been linked to several negative health consequences. The aim of this umbrella review is the assessment of effectiveness and certainty of evidence of nutrition and exercise interventions in persons with SO. METHOD We searched for meta-analyses of RCTs in PubMed, EMBASE and CENTRAL that had been conducted in the last five years, focusing on studies on the treatment and prevention of SO. The primary endpoints were parameters for SO, such as body fat in %, skeletal muscle mass index (SMMI), gait speed, leg strength and grip strength. The methodological quality was evaluated using AMSTAR and the certainty of evidence was assessed using GRADE. RESULTS Four systematic reviews with between 30 to 225 participants were included in the umbrella review. These examined four exercise interventions, two nutrition interventions and four interventions that combined nutrition and exercise. Resistance training was the most frequently studied intervention and was found to improve gait speed by 0.14 m/s to 0.17 m/s and lower leg strength by 9.97 kg. Resistance, aerobic, mixed exercise and hypocaloric diet combined with protein supplementation is not significantly effective on selected outcomes for persons with SO compared to no intervention. The low number of primary studies included in the reviews resulted in moderate to very low certainty of evidence. CONCLUSION Despite the lack in certainty of evidence, resistance training may be a suitable intervention for persons with SO, in particular for improving muscle function. Nevertheless, further research is necessary to strengthen the evidence.
Collapse
Affiliation(s)
- Lea Reiter
- Medical University of Graz, Institute of Nursing Science, Neue Stiftingtalstraße 6 West, P/06, 8010, Graz, Austria
| | - Silvia Bauer
- Medical University of Graz, Institute of Nursing Science, Neue Stiftingtalstraße 6 West, P/06, 8010, Graz, Austria
| | - Mariella Traxler
- Medical University of Graz, Institute of Nursing Science, Neue Stiftingtalstraße 6 West, P/06, 8010, Graz, Austria
| | - Josje D Schoufour
- Faculty of Sports and Nutrition, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Dr. Meurerhuis, Dokter Meurerlaan 8, 1067 SM, Amsterdam, Netherlands
| | - Peter J M Weijs
- Faculty of Sports and Nutrition, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Dr. Meurerhuis, Dokter Meurerlaan 8, 1067 SM, Amsterdam, Netherlands
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Amsterdam Public Health Institute, VU University, Amsterdam, Netherlands
| | - Alfonso Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón Y Cajal (IRYCIS), Ctra. Colmenar Viejo, 28034, Madrid, Spain
| | - Eva Topinková
- Charles University Department of Geriatric Medicine, First Faculty of Medicine, Londynska 15, Praha 2, 120 00, Prague, Czech Republic
| | - Doris Eglseer
- Medical University of Graz, Institute of Nursing Science, Neue Stiftingtalstraße 6 West, P/06, 8010, Graz, Austria.
| |
Collapse
|
4
|
Kemmler W, Fröhlich M, Ludwig O, Eifler C, von Stengel S, Willert S, Teschler M, Weissenfels A, Kleinöder H, Micke F, Wirtz N, Zinner C, Filipovic A, Wegener B, Berger J, Evangelista A, D’Ottavio S, Singh Sara JD, Lerman A, Perez de Arrilucea Le Floc’h UA, Carle-Calo A, Guitierrez A, Amaro-Gahete FJ. Position statement and updated international guideline for safe and effective whole-body electromyostimulation training-the need for common sense in WB-EMS application. Front Physiol 2023; 14:1174103. [PMID: 37035684 PMCID: PMC10075322 DOI: 10.3389/fphys.2023.1174103] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Whole-Body Electromyostimulation (WB-EMS) is a training technology that enables simultaneous stimulation of all the main muscle groups with a specific impulse intensity for each electrode. The corresponding time-efficiency and joint-friendliness of WB-EMS may be particularly attractive for people unable or unmotivated to conduct (intense) conventional training protocols. However, due to the enormous metabolic and musculoskeletal impact of WB-EMS, particular attention must be paid to the application of this technology. In the past, several scientific and newspaper articles reported severe adverse effects of WB-EMS. To increase the safety of commercial non-medical WB-EMS application, recommendations "for safe and effective whole-body electromyostimulation" were launched in 2016. However, new developments and trends require an update of these recommendations to incorporate more international expertise with demonstrated experience in the application of WB-EMS. The new version of these consensus-based recommendations has been structured into 1) "general aspects of WB-EMS", 2) "preparation for training", recommendations for the 3) "WB-EMS application" itself and 4) "safety aspects during and after training". Key topics particularly addressed are 1) consistent and close supervision of WB-EMS application, 2) mandatory qualification of WB-EMS trainers, 3) anamnesis and corresponding consideration of contraindications prior to WB-EMS, 4) the participant's proper preparation for the session, 5) careful preparation of the WB-EMS novice, 6) appropriate regeneration periods between WB-EMS sessions and 7) continuous interaction between trainer and participant at a close physical distance. In summary, we are convinced that the present guideline will contribute to greater safety and effectiveness in the area of non-medical commercial WB-EMS application.
Collapse
Affiliation(s)
- Wolfgang Kemmler
- Institute of Radiology, University Hospital Erlangen (UKER), Erlangen, Germany
- *Correspondence: Wolfgang Kemmler,
| | - Michael Fröhlich
- Department of Sports Science, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau, Kaiserslautern, Germany
| | - Oliver Ludwig
- Department of Sports Science, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau, Kaiserslautern, Germany
| | - Christoph Eifler
- German University for Prevention and Health Management, Saarbrücken, Germany
| | - Simon von Stengel
- Institute of Radiology, University Hospital Erlangen (UKER), Erlangen, Germany
| | - Sebastian Willert
- Institute of Radiology, University Hospital Erlangen (UKER), Erlangen, Germany
| | - Marc Teschler
- Department of Rehabilitation Sciences, University of Witten/Herdecke, Witten, Germany
| | - Anja Weissenfels
- Institute of Sports Science, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Heinz Kleinöder
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - Florian Micke
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - Nicolas Wirtz
- Central Library for Sport Sciences, German Sport University Cologne, Cologne, Germany
| | - Christoph Zinner
- University of Applied Sciences for Police and Administration of Hesse, Wiesbaden, Germany
| | | | - Bernd Wegener
- Musculoskeletal University Center, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Joshua Berger
- German University for Prevention and Health Management, Saarbrücken, Germany
| | - Alexandre Evangelista
- Experimental Physiology and Biochemistry, Center for Physical Education and Sport, University Federal do Espírito Santo, Vitória, Brazil
| | - Stefano D’Ottavio
- Clinical Sciences and Translational Medicine Department, University of Rome, Rome, Italy
| | | | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo College of Medicine, Rochester, MN, United States
| | | | - Abraham Carle-Calo
- Department of Physical Education and Sport, University of Granada, Granada, Spain
| | | | - Francisco J. Amaro-Gahete
- Department of Physical Education and Sport, University of Granada, Granada, Spain
- Department of Physiology, University of Granada, Granada, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| |
Collapse
|