[(Very) high Creatinkinase concentration after exertional whole-body electromyostimulation application: health risks and longitudinal adaptations]

Due to its individualization, time-efficiency and effectiveness Whole-body-Electromyo-stimulation (WB-EMS) becomes increasingly popular. However, recently (very) high Creatin-kinase concentration were reported, at least after initial WB-EMS-application. Thus, the aim of the study was to determine (1) WB-EMS induced increases of CK-concentration, (2) their impact on corresponding health parameters and (3) training-induced changes of CK-levels.Twenty-six healthy, sportive volunteers without previous experience with WB-EMS were included. Initial high intense WB-EMS application (bipolar, 85 Hz; 350 ms; intermittent, 20 min) led to an increase of the CK-level by the 117fold (28.545 ± 33.611 IU/l) of baseline. CK-peaks were detected after 72-96 h. Despite this pronounced "exertional rhabdomyolysis", we did not determine rhabdomyolysis-induced complications (e.g. acute renal failure, hyperkalemia, hypocalcaemia). After 10 weeks of WB-EMS (1 session/week) CK-reaction to intensive WB-EMS-Application was significantly blunted (906 ± 500 IE/l) and averaged in the area of conventional resistance exercise.In summary, intensity of WB-EMS should be carefully increased during the initial sessions.

Effect of whole-body electromyostimulation and / or protein supplementation on obesity and cardiometabolic risk in older men with sarcopenic obesity: the randomized controlled FranSO trial

BACKGROUND

Sarcopenic Obesity (SO) is characterized by low lean and high fat mass; i.e. from a functional aspect a disproportion between engine (muscle) and mass to be moved (fat). At present, most research focuses on the engine, but the close "cross talk" between age-associated adipose and skeletal muscle tissue inflammation calls for comprehensive interventions that affect both components alike. Protein and exercise are likely candidates, however with respect to the latter, the enthusiasm for intense and frequent exercise is rather low, especially in functionally limited older people. The aim of this study was therefore to evaluate the effect of whole-body electromyostimulation (WB-EMS), a time-efficient, joint-friendly and highly customizable exercise technology, on obesity parameters and cardiometabolic risk in men with SO.

METHODS

One-hundred community-dwelling (cdw) Bavarian men ≥70 years with SO were randomly assigned to either (a) whey protein supplementation (WPS), (b) WB-EMS and protein supplementation (WB-EMS&P) or (c) non-intervention control (CG). Protein supplementation contributed to an intake of 1.7-1.8 g/kg/body mass/d, WB-EMS consisted of 1.5 × 20 min/week (85 Hz, 350 μs, 4 s of strain-4 s of rest) with moderate-high intensity. Using an intention to treat approach with multiple imputation, the primary study endpoint was total body fat mass (TBF), secondary endpoints were trunk fat mass (TF), waist circumference (WC) and total-cholesterol/HDL-cholesterol ratio (TC/HDL-C).

RESULTS

After 16 weeks of intervention, TBF was reduced significantly in the WPS (- 3.6 ± 7.2%; p = 0.005) and WB-EMS&P (- 6.7 ± 6.2%; p < 0.001), but not in the CG (+ 1.6 ± 7.1%; p = 0.191). Changes in the WB-EMS&P (p < 0.001) and the WPS group (p = 0.011) differ significantly from the CG. TF decreased in the WB-EMS&P (p < 0.001) and WPS (p = .117) and increased in the CG (p = .159); WC decreased significantly in the treatment groups and was maintained in the CG. Lastly, the TC/HDL-C ratio improved significantly in the WB-EMS&P and WPS group and was maintained in the CG. Significant differences between WB-EMS&P and WPS were determined for waist circumference only (p = 0.015; TBF: p = 0.073; TF: p = 0.087; TC/HDL-C: p = .773).

CONCLUSION

Moderate-high dosed whey protein supplementation, especially when combined with WB-EMS, may be a feasible choice to address obesity and cardiometabolic risk in older cdw men with SO unable or unmotivated to exercise conventionally.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT02857660 ; registration date: 05/01/2017.

Side effects of whole-body electro-myo-stimulation

Whole-body-electro-myo-stimulation (WB-EMS) has been introduced as an alternative to physical training. The aim of the review is to summarize the data about indications and side effects of WB-EMS.A literature search in PubMed disclosed 11 randomized trials, 3 cohort studies, and 7 case reports. From healthy volunteers, enormous creatine kinase (CK) elevations were reported. There is a lack of data about biological consequences of WB-EMS on other organs. In randomized trials, CK levels were not investigated, but several patients discontinued WB-EMS because of "muscular discomfort." Contraindications for WB-EMS are not clearly defined. Nine cases of rhabdomyolysis after WB-EMS were found, preferentially after the first application.Regulatory authorities should increase the safety of WB-EMS. Patients with a history of rhabdomyolysis should not undergo WB-EMS and those experiencing rhabdomyolysis should be neurologically investigated. Since the value of WB-EMS as an alternative to physical exercise is uncertain, we need to proof or disproof its benefit.

Effects of involuntary eccentric contraction training by neuromuscular electrical stimulation on the enhancement of muscle strength

BACKGROUND

Neuromuscular electrical stimulation is well-known as a modality to improve the performance of neuromuscular system, but its clinical value on muscle strengthening remains equivocal. In this study, we designed a system for an involuntary eccentric contraction of biceps brachii muscles using continuous passive movement and commercial neuromuscular electrical stimulation devices.

METHODS

To investigate the effects of involuntary eccentric contraction training by neuromuscular electrical stimulation on the enhancement of muscle strength, seven healthy men between the ages of 24 and 29 years participated in this study. Participants were trained two times per week for 12 weeks. Each exercise session was performed for 30 min with no rest intervals. Isometric elbow flexion torque and biceps brachii muscle thickness were chosen as evaluation indices, and were measured at pre-/post-training.

FINDINGS

After the 12-week training, the isometric elbow flexion torque of the trained side significantly increased by approximately 23% compared to the initial performance (P<0.01). Meanwhile, the torque of the untrained side showed no significant change (P=0.862). During the 12-week training period, the biceps brachii muscle thickness of the trained side significantly increased by around 8% at rest and 16% at maximum voluntary contraction (P<0.01).

INTERPRETATION

The developed system and the technique show promising results, suggesting that it has the potential to be used to increase the muscle strength in patients with neuromuscular disease and to be implemented in design rehabilitative protocols.

Effect of electromyostimulation and plyometrics training on sports-specific parameters in badminton players

Badminton is one of the world's most popular racquet sports, demanding motor skills such as agility and vertical jump mainly for striking a shuttlecock. This study compared the effects of four weeks of plyometric training and electromyostimulation of knee extensor and ankle plantar flexor muscles on agility, 30-m sprint, lower limb explosive power and jumping ability amongst badminton players. State-level badminton players (n ​= ​90) were randomly allocated into three groups: plyometric (PG), electromyostimulation (EG) and control group (CG), each with 30 players. Randomized-to-Groups Pretest-Posttest Design with two experimental (plyometric and electromyostimulation) groups and a control group was used. The plyometric training was carried out two times/week while the EMS training was four times/week for four weeks. The control group did not receive any intervention. All three groups continued their general badminton training throughout the study. Players were assessed for agility, a 30-m sprint, a standing broad jump and a vertical jump height before and after four weeks. A significant improvement (p ​= ​0.01) in 30-m sprint time was observed (3.83%) in PG as compared to controls. Jumping ability was significantly improved in both the PG and EG in comparison to the controls (4.45%, p ​= ​0.003 for PG and 3.95%, p ​= ​0.048 for EG). No significant improvement was found in agility and lower limb explosive power in either of the PG or EG groups in comparison to the controls. Plyometric training showed significant improvement in sprint time and jumping ability, whereas electromyostimulation training showed significant improvement only in jumping ability.

Feasibility of eccentric overloading and neuromuscular electrical stimulation to improve muscle strength and muscle mass after treatment for head and neck cancer

PURPOSE

Treatment of head and neck cancer (HNC) results in severe weight loss, mainly due to the loss of lean body mass. Consequently, decreases in muscular strength and health-related quality of life (HRQL) occur. This study investigated the feasibility of a 12-week novel strength training (NST) and conventional strength training (CST) intervention delivered after HNC treatment.

METHODS

Participants were randomized to a NST group (n = 11) involving eccentric overloaded strength training and neuromuscular electrical stimulation (NMES), or a CST group (n = 11) involving dynamic resistance exercises matched for training volume. Feasibility outcomes included recruitment, completion, adherence, and evidence of progression. A neuromuscular assessment involving maximal isometric voluntary contractions (MIVCs) in the knee extensors was evaluated prior to and during incremental cycling to volitional exhaustion at baseline and after the interventions. Anthropometrics and patient-reported outcomes (PROs) were also assessed.

RESULTS

Although recruitment was challenging, completion was 100% in NST and 82% in CST. Adherence was 92% in NST and 81% in CST. Overall, MIVC increased by 19 ± 23%, muscle cross-sectional area improved 18 ± 22%, cycling exercise time improved by 18 ± 13%, and improvements in HRQL and fatigue were clinically relevant.

CONCLUSIONS

Both interventions were found to be feasible for HNC patients after treatment. Strength training significantly improved maximal muscle strength, muscle cross-sectional area, and PROs after HNC treatment. Future research should include fully powered trials and consider the use of eccentric overloading and NMES during HNC treatment.

IMPLICATIONS FOR CANCER SURVIVORS

Eccentric- and NMES-emphasized strength training may be useful alternatives to conventional strength training after HNC treatment.

Multidirectional effect of low-intensity neuromuscular electrical stimulation on gene expression and phenotype in thigh and calf muscles after one week of disuse

PURPOSE

This study investigated the effects of a one-week disuse, both with and without low-intensity neuromuscular electrical stimulation-a safe (non-traumatic) approach to prevent the loss of muscle mass, on the functional capacities and gene expression in thigh and calf muscles.

METHODS

This study assessed the efficiency of low-intensity (~ 10% of maximal voluntary contraction) electrical stimulation in preventing the negative effects of 7-day disuse (dry immersion without and with daily stimulation) on the strength and aerobic performance of the ankle plantar flexors and knee extensors, mitochondrial function in permeabilized muscle fibers, and the proteomic (quantitative mass spectrometry-based analysis) and transcriptomic (RNA-sequencing) profiles of the soleus muscle and vastus lateralis muscle.

RESULTS

Application of electrical stimulation during dry immersion prevented a decrease in the maximal strength and a slight reduction in aerobic performance of the knee extensors, as well as a decrease in maximal (intrinsic) ADP-stimulated mitochondrial respiration and changes in the expression of genes encoding mitochondrial, extracellular matrix, and membrane proteins in the vastus lateralis muscle. In contrast, for the ankle plantar flexors/soleus muscle, electrical stimulation had a positive effect only on maximal mitochondrial respiration, but slightly accelerated the decline in the maximal strength and muscle fiber cross-sectional area, which appears to be related to the activation of inflammatory genes.

CONCLUSION

The data obtained open up broad prospects for the use of low-intensity electrical stimulation to prevent the negative effects of disuse for "mixed" muscles, meanwhile, the optimization of the stimulation protocol is required for "slow" muscles.

Superimposed electromyostimulation of the thigh muscles during passive isokinetic cycling increases muscle strength without effort

Objectives

This study was designed to investigate the effects of a completely passive isokinetic cycle (PIC) exercise with electromyostimulation (EMS) on improving muscle strength and the changes in kinesthesia during daily activities.

Methods

Twenty-nine sedentary females were divided into three groups. The EMS anterior and whole groups performed the PIC exercise without EMS 3 times a week for 3 weeks, followed by a 1-week break, and then performed it with EMS applied to the anterior and entire thigh muscles, respectively, 3 times a week for 3 weeks. The control group did not perform any training.

Results

The PIC exercise with EMS significantly increased the 30s chair stand test scores by 12-16% and the maximum isometric knee extension and flexion torques by 38-68% in both EMS-applied groups. The participants found its exercise easy and felt more comfortable with daily physical activities. The exercise without EMS did not show similar improvements. Muscle soreness was significantly greater in the EMS anterior group than in the EMS whole group; however, it was not severe.

Conclusions

The PIC exercise with EMS resulted in significant increases in muscle strength, facilitating a perceived ease of daily physical activities, while minimizing difficulties, effort, and notable muscle soreness.