Electromyostimulation (EMS) on cardiac patients. Is EMS training becoming significant for the secondary prevention? (Fritzsche, D. / Freund, A. / Schenk, S. / Mellwig, K.-P. / Kleinöder, H. / Gummert, J. / Horstkotte, D., Bad Oeynhausen Heart Clinic, Herz 2010; 35 (1): 34–40)

The view that moderate endurance training as a part of secondary prevention improves the prognosis for chronic heart insufficiency has been sufficiently validated. Based on experience, however, only a few well supervised, highly motivated and mostly younger patients can be reached with a complimentary, sustained, sports therapy in clinical practice. Our own experience with whole body electromyostimulation of patients with cardiac insufficiency shows a thus far unanticipated potential for the regeneration of neurohumoral, inflammatory and skeletal muscular disease symptoms within the context of systemic CHI disease. Against this background, the effect and acceptance of whole body EMS in patients with cardiac insufficiency were investigated.

15 patients with a confirmed diagnosis of CHI completed a 6-month training program (whole body EMS) with a miha bodytec device. The stimulation parameters were defined as 80 Hz and 300 μs at 4 s pulse and 4 s pause for a period of 20 minutes, followed by a cooldown in the 100 Hz range. The patients themselves chose the amplitude (mA), and the subjective feeling of “muscle contraction/current sensation” was set at step 8 of a ten-step scale. The specifications were 40–70 repetitions in the main section, with exercises in isometric holding positions and dynamic motion drills. Cardiac efficiency was assessed in an initial test and after three and six months of training by means of spiroergometry, electrocardiography (EKG) and echo; the metabolic status including creatine kinase (CK) and lactate dehydrogenase (LDH); in addition, weight and body fat distribution were determined (impedance scale).

Up to a 96% increase in the oxygen uptake at the anaerobic threshold could be demonstrated (VO2AT 19.39 [± 5.3] ml/kg body weight [BW] before the start of training; VO2AT 24.25 [±6.34] ml/kg BW at the end of the training phase; p < 0.05). The diastolic blood pressure fell significantly (psyst < 0.05; pdiast < 0.001), muscle growth was up as high as 14% at constant weight. The training method was 100% accepted (no dropouts). The patients indicated that their subjective capacity was significantly higher.

For the first time, the study showed the effect of EMS training on patients with cardiac insufficiency. The improvement in the objective assessment of their capacity, as well as the optimization of muscle-physiological and metabolic parameters, by far surpassed the results of traditional types of aerobic training for primary and secondary cardiac rehabilitation in patients with CHI. The form of training selected holds great potential in the treatment of patients with cardiac insufficiency.

Influence of adjuvant EMS training on body composition and cardiac risk factors in older men with metabolic syndrome (KEMMLER, W. / BIRLAUF, A. / VON STENGEL, S., Erlangen-Nürnberg University 2009).

Sarcopenia and (abdominal) adiposity are closely associated with mortality, multimorbidity, and frailty in older people. The aim of this study was to determine to what extent whole body electromyostimulation (WB-EMS) training can influence body composition and cardiac risk factors in older men with metabolic syndrome.

After randomization, a total of 28 men with metabolic syndrome according to IDF (69.4±2.8 years) from the Erlangen area were assigned to a control group (CG: n = 14) or to a WB-EMS group (n = 14). The 14-week training WB-EMS regime provided a 30-minute endurance and strength program with the application of EMS every 5 days. In parallel, the control group underwent whole body vibration training focusing on “increasing flexibility and well-being.” The abdominal and whole body fat mass as well as the appendicular skeletal muscle mass (ASMM) were selected as the primary end points. Secondary endpoints were the parameters of the metabolic syndrome according to IDF (waist circumference, glucose, triglycerides, HDL cholesterol, systolic and diastolic blood pressure).

At a high effect size (ES: d`=1,33), the change in the abdominal fat mass shows significant differences (p = 0.004) between WB-EMS and CG (-252±196 g, p = 0.001 vs. -34±103 g, p = 0. 330). Parallel to this, whole body fat diminished by -1350±876 g (p = 0.001) in the WB-EMS group and -291±850 g (p = 0.307) in the CG (difference: p = 0.008, ES: d`= 1.23). The ASMM also showed significant differences (p = 0.024, ES: d`= 0.97) between the EMS group and vibration control group (249±444 g, p = 0.066 vs. -298±638 g, p=.173). With the exception of a significant inter-group difference (p = 0.023, ES: d` = 1.10) for the waist circumference (EMS: -5.2±1.8 cm, p = 0.001 vs. CG: -3.3±2.9 cm, p = 0.006), no further effects on the parameters of the metabolic syndrome (see above) were shown.

At a low training volume (about 45 minutes/week) and a short period of intervention (14 weeks), whole body EMS training exhibits significant effects on the body composition of older persons. Thus WB-EMS could be an appropriate alternative to conventional training programs for people with low cardiac and orthopedic capacity.

The effect of whole body electrical stimulation on the resting metabolic rate, anthropometric and muscular parameters of older people. The Training and Electromyostimulation Trial (TEST) (KEMMLER, W. / BIRLAUF, A. / VON STENGEL, S., University of Erlangen- Nuremberg 2009).

A substantial change in body composition, with an increase in abdominal body fat and a corresponding reduction in muscle mass, especially occurs in women after menopause. To counter this trend, whole body electromyostimulation training today stands out as an alternative to conventional muscle training featuring smaller orthopedic and cardiac loads at a comparably low training volume. The goal of this pilot study was to establish the applicability and feasibility of EMS training for older people as well as determine the effectiveness of this form of training on anthropometric, physiological and muscular parameters.

30 post-menopausal women with long training experience were assigned randomly to a control group (CG: n=15) where they continued their training as usual, and an EMS group (n=15), which completed a 20-minute whole body EMS training session every four days, in addition to twice weekly strength and endurance training. The most important anthropometric data (weight, size, the percentage of body fat, waist circumference, etc.) were determined, along with resting metabolic rate and VO2.

The resting metabolic rate showed significant reductions in the CG (-5.3%, p = 0. 038) and no changes (-0.2 %, p = 0.991) in the EMS group. Despite a medium effect size (ES: 0.62), mere tendencies without significant differences appeared between the EMS group and the CG (p= 0.065). The cumulative value for the skinfold thickness declined significantly in the EMS group (p= 0.001) by 8.6%, compared to a slight, insignificant increase in the control group (1.4%); a difference that turned out to be statistically significant (p = .0001, ES: 1.37). Waist circumference as a criterion for abdominal adiposity fell in the EMS group significantly (p > 0.001) by -2.3 % (vs. CG: +1.0 %, p= 0.106). The corresponding intermediate group difference turned out to be significant (p = 0.001, ES: 1.64).

In summary, improvements in functional parameters such as maximum strength and speed have been demonstrated along with health-relevant effects on body composition. In addition, a high acceptance of EMS training in this population of well-trained, post-menopausal women was established. So, aside from its effectiveness, the practicability of this type of training seems assured.

Short and long-term training effects on strength-related diagnostic parameters from mechanical and electrical stimulation (Speicher, U. / Nowak, S. / Schmithüsen J. / Kleinöder, H. / Mester, J., German Sport University Cologne 2008; published in “medical sports network” 04/2007, among others.)

The goal of the present study was to compare classic strength training methods with dynamic whole body EMS with regard to their effects on strength and speed.

80 sports students were randomized into equal parts into classic training groups for hypertrophy, maximum strength, quickness and muscular endurance, the modern procedure for the whole body EMS and vibration, as well as the two mixed groups, whole body EMS/hypertrophy and vibration/hypertrophy. The classic training groups worked on the leg curl and leg extension musculature on (Gym80) machines in the respective groups in 3 series with various additional weights (30-90%, 3-15 repetitions). The EMS groups executed side steps and knee bends without additional weights (load/interval 6 s/4 s, pulse frequency 85 Hz, pulse width 350 μs, bipolar rectangular pulse (60% intensity). Standardization was via visual biofeedback. The training took place twice a week over a period of 4 weeks. Entry and exit tests were carried out on strength diagnostic machines before and after the training as well as after a two-week regeneration phase. The dynamics were measured by means of performance (strength x speed) with 40% and 60% additional load at various angles.

All types of strength training were able to improve maximum performance significantly. Maximum strength improved the most, 16%, within the hypertrophy group, followed by 9-10% for EMS. Only the EMS groups showed significant improvement in speed. The measured speed performance improved by about 30% – significantly more than by classic methods (16-18%). This is apparently due to EMS‘s direct control of fast-twitch muscle fibers.

Mixed training designs such as EMS and classic hypertrophy training show the typical changes that result from the two training stimuli (a maximum 7 % growth in strength and 12% improvement in performance). Combinations of classic and modern training procedures could thus open up new, promising configurations of stimuli. Long-term effects of whole body EMS must, in particular, be emphasized. The greatest boosts in performance appear after a two-week period of regeneration.

Compared with various types of training to boost strength and speed, dynamic whole body EMS training with miha bodytec has been shown to be a highly effective training method. Whole body EMS was the sole form of training able to improve maximum sports performance in speed of movement. In addition, pronounced long-term effects are opening up new possibilities in training periodization. A carefully dosed amount of whole body EMS together with the dynamic execution of movement represents a promising combination for strength and speed training.

Electrical Muscle Stimulation as whole body training – Multicenter study on the use of full body EMS in fitness centers (VATTER, J., University of Bayreuth, 2003; publication AVM Verlag, Munich 2010).

The objective of this paper was to discover whether positive changes with regard to strength, anthropometry, body awareness, mood, general health factors, back pain and incontinence can be realized through the use of electrically stimulated whole body training in a field test.

In four fitness centers, 134 volunteer subjects (102 women and 32 men) averaging 42.5 years of age were surveyed, tested and compared to a control group (n=10) and examined based on age and gender before and after six weeks of training. This involved a determination of maximum strength, physical endurance, body weight, body fat percentage, girth, frequency and intensity of back and incontinence complaints, as well as general complaint status, mood, vitality, body stability and body contouring.

The 12 training units were carried out on a twice weekly basis with the following training parameters: pulse duration/interval 4 s/4 s, 85 Hz, rectangular pulses, pulse width 350 s. An approximately 25-minute training session with static exercise positions followed an habituation period totaling 10-15 minutes. The training session concluded with a five-minute relaxation program (pulse duration 1 s, pulse interval 1 s, 100 Hz, rectangular pulses, pulse width 150 s).

82.3% reduced their back pain, 29.9% were symptom-free afterward. 40.3% complained about chronic pain beforehand and 9.3% after completion. 75.8% saw improvements in incontinence, and 33.3% were free of symptoms afterward. The number of medical conditions was sharply reduced (about 50%). Maximum strength rose 12.2%, and muscular endurance 69.3%. Women benefited to a greater degree than men did (13.6% vs. 7.3%). 18 subjects ended the training prematurely. No changes were identified in the control group.

Body weight and BMI remained virtually the same. The body fat percentage fell 1.4% in the training group; it rose 6.7% in the control group. The younger persons undergoing the training lost more weight than the older; no gender- or weight-related variations resulted. Among the women in the training, the body circumferences were reduced significantly at the chest (-0.7 cm), thigh (-0.4 cm), waist (-1.4 cm) and hips (-1.1 cm). Among men, they decreased at the waist (-1.1 cm) with simultaneous growth in the upper arm (+1.5 cm), chest (+1.2 cm) and thigh (+0.3 cm). The control group showed no improvement and expanded at the waist and hips in the same time frame. Body feeling improved, with 83.0 % exhibiting less tension, 89.1% greater stability, and 83.8 % higher performance. 86.8 % noticed positive body contour effects. 90.0% of the participants perceived the training positively. High intensities brought more significant improvements for the patients with complaints but increased the incidence of muscle aches.

Whole body EMS training represents a persuasive method to reduce extremely common back and incontinence complaints. The increases in strength match the experience with conventional strength training and in some ways are even superior. The body contouring and mood aspects appeal to men and women at all age levels. Thus, whole body EMS is an effective form of training appealing to a wide spectrum of target groups.

Electro Muscle Stimulation (EMS) of the whole body musculature – An innovative method to relieve urinary incontinence (BOECKH-BEHRENS W.-U./SCHÄFFER, G., unpublished dissertation, University of Bayreuth, 2002).

The objective of this study was to investigate the effects of EMS training on urinary incontinence.

The presence, type and the intensity of urinary incontinence complaints were investigated in 49 individuals with back ailments with the help of initial and subsequent questionnaires (GAUDENZ 1979). A largely slight to moderate form of urinary incontinence was present in 17 individuals (15 women, 2 men) averaging 47 years of age.

10 units of EMS training, twice per week, each lasting 45 minutes, were carried out with the following training parameters: pulse duration 4 s, pulse interval 2 s, frequency 80 Hz, rise time 0 s, pulse width 350 s. In the process, a period of about 25 minutes of supervised training, during which various static exercise positions were assumed, followed a habituation period lasting 10-15 minutes in each case for the adjustment of individual pulse strengths. The training period concluded with a five-minute relaxation program (pulse duration 1 s, frequency 100 Hz, rise time 0 s, pulse width 150 s.

An alleviation of urinary incontinence complaints was achieved in 64.7% of the cases. 23.5% became complaint-free. A decrease in complaints occurred in 24.4%, and 35.9% saw no change. These results corresponded somewhat to the improvements that have been reported for treatments of incontinence with special, local electromuscular therapies (cf. Eriksen 1987, Sebastio 2000, Salinas Casado 1990, Meyer 2001).

Whole body EMS training represents an effective training system. It achieves therapeutic goals such as relief from incontinence and back complaints and preventive goals such as muscle formation, body contouring and improvements in mood, vitality, body stability and general performance.

Whole body Electro Muscle Stimulation (EMS Training) for back ailments (BOECKH-BEHRENS, W.-U. / GRÜTZMACHER, N. / SEBELEFSKY, J., unpublished dissertation, University of Bayreuth, 2002).

The objective of this study was to investigate the effects of extensive EMS training on back ailments.

49 employees of the University of Bayreuth with back ailments, 31 women and 18 men averaging 47 years of age, took part in the study voluntarily. The frequency and intensity of the back ailments as well as general complaint status, mood, vitality, body stability, and body contour were determined with the help of initial and subsequent questionnaires. 10 units of EMS training, twice a week, each lasting 45 minutes, were carried out within the following training parameters: pulse duration 4 s, pulse interval 2 s, frequency 80 Hz, rise time 0 s, pulse width 350 s. In the process, a period of about 25 minutes of training, during which various static exercise positions were assumed, followed a habituation period lasting 10-15 minutes in each case for the adjustment of individual pulse strengths. The training period concluded with a five-minute relaxation program featuring a pulse duration of 1 s, a pulse interval of 1 s, a frequency of 100 Hz, a rise time of 0 s, and a pulse width of 150 s.

88.7% of the subjects saw a reduction in back ailments, with significant relief from the complaints in 38.8% of the cases. A slight improvement in the general complaint condition resulted in 41.9% of the cases. The frequency and the intensity of the complaints also declined sharply during the training time frame.

In addition, the EMS training led to the following general effects: 61.4% of the individuals reported an improvement in their general complaint condition, 75.5% saw an improvement in their mood, 69.4% registered increased vitality, 57.1% of the men and 85.7% of the women perceived improved body stability, 50% of the subjects asserted positive effects on their body contour, and 75.5% felt more relaxed after the training.

Whole body EMS training combats back ailments, a common condition, very effectively. The current evidently engages even deep muscles that can only be reached with conventional treatment measures with difficulty. The special whole body EMS training represents a time-saving, very effective all-round training that achieves far-reaching, positive health effects. At the same time, therapeutic as well as preventive objectives are achieved.