EMS studies Health

Eine junge Frau trainiert mit dem kabellosen EMS-Anzug von Antelope in einem EMS-Studio, zusammen mit einem Personal Trainer. Ihr Trainer trägt das Antelope EMS Tank-Top und steht seitlich neben seiner Kundin. Er korrigiert ihre Körperhaltung. Die Kundin sitzt auf einer Bank und hält eine Kurzhantel mit beiden Händen hinter ihrem Kopf. Ihr Oberkörper ist aufrecht. Im Hintergrund ist ein heller Fitnessraum zu sehen.

According to studies, EMS training can help you to live a healthy lifestyle. The following overview shows you which research findings already exist about electrical muscle stimulation training. Because many studies show: EMS training offers you advantages – both in terms of sports and fitness as wall as health.

This is what training with electrical muscle stimulation can do

Several studies show the possibility of reducing body fat percentage with the help of electrical muscle stimulation. In addition to improving physical fitness and sports performance, EMS training can also be helpful in relieving certain diagnosed ailments, such as pain and tension in the back. Also, EMS can be used to relieve incontinence. EMS training can also be a support on the way to a pain-free everyday life – and also in the prevention of such pain. According to researchers, people who have certain diseases, such as chronic heart failure, osteoporosis or sarcopenia, can also benefit from EMS training.

The following overview provides you with the most important findings from the EMS studies. With a click on the respective topic, you learn more about the study results. Some studies can be assigned to several topics and are therefore listed multiple times. We have summarized the studies about sports and fitness separately for you. It should be noted that some studies have limitations. These include small samples or limited gender and age distributions within the samples.

Health

Reduction of body fat percentage

Aim of analysis
The object of the study was to compare the effects of WB-EMS (whole body EMS) and HIT (high intensity training) on muscular parameters in healthy, untrained and working middle-aged men. For this purpose, 46 men aged between 30 and 50 years were randomly assigned to a WB-EMS and a HIT group. The study is to be understood as a training studio in parallel group design, which was conducted for 16 weeks. 

Results
Total lean mass (LBM) changed significantly (p≤.003) in both groups (HIT: 1.24±1.40% vs. WB-EMS: 0.91±1.12%). No significant difference was found between the groups. Abdominal body fat mass (AF) and total body fat percentage (TF) also reduced significantly in both groups (-4.1±7.4% to 5.9±6.2%; p=.031 – p<.001). Again, there were no significant differences between the groups (TF: p=.975; AF: p=499). Favorable changes were noted in dynamic maximum strength of the leg extensors (HIT: 13.5±13.9%, p<.001 vs. WB-EMS: 8.0±10.2%, p=.008), but no significant differences (p=.332) were found between groups. This effect remained consistent even after adjusting for borderline (non) significant differences in basal values (p=.348). Static maximum strength of trunk extensors also showed no significant differences (HIT: 10.4±9.0%, p<.001 versus 11.7±9.9%, p<001) between the two groups.

2015, W. Kemmler, M. Teschler, A. Weissenfels M. Froehlich, M. Kohl, S. von Stengel.

Learn more about this study

Aim of analysis
The study examined whether electrically stimulated whole-body training resulted in positive changes in strength, back pain, body image, anthropometry, mood, incontinence, and general health factors. 

Methods
A total of 134 subjects, 102 women and 32 men with an average age of 42.5 years, were interviewed and tested before and after six weeks of training. They were compared with a control group consisting of 10 subjects (n=10) and by age and gender. Total whole-body EMS training sessions were performed twice a week for a total of 12 times. The training parameters were composed as follows:  Pulse duration/pause 4 s/4 s, 85 Hz, square pulses, pulse width 350µs. A training session consisted of a 10-15 minute familiarization session followed by 25 minutes of training with static exercise positions. Subsequently, a five-minute training program was performed with the following training parameters: (pulse duration 1 s, pulse pause 1 s, 100Hz, rectangular pulses, pulse width 150 µs). 18 subjects terminated the training prematurely.

Results
BMI and body weight remained approximately the same in the subjects. For the female subjects, body circumference significantly reduced at the chest (- 0.7 cm), thighs (- 0.4 cm), waist (- 1.4 cm) and hips (- 1.1 cm). For the male subjects, waist circumference decreased (- 1.1 cm) with simultaneous increases in upper arms (+ 1.5 cm), chest (+ 1.2 cm), and thigh (+0.3 cm). No improvements were noted in the control group, while subjects in the control group had gained in hips and waist over the period.  

In addition, 86.8% reported noticing positive body sculpting effects. 90% perceived the training as positive. 83% reported being less tense, 89.1% felt more stability.  Stronger improvements, especially in patients with complaints, were noted with height and intensity. However, this also resulted in greater muscle soreness. 

University of Bayreuth, 2003, J. Vatter.

Aim of analysis
The aim was to investigate the influence of neuromuscular electrical stimulation, self-administered, on changes in endurance, strength, selected anthropometric measures, as well as in satisfaction and shape of the abdominal region, perceived by the subjects, 

Methods
On 5 days per week, 24 subjects stimulated their abdominal muscles for 20 to 40 minutes per session. The stimulation took place over a period of 8 weeks. The subjects refrained from further exercise during this time. 16 additional subjects were assigned to a control group and refrained from abdominal training or other exercise during the period. 

Results 
Abdominal endurance increased by 100% in the stimulation group and by 28% in the control group. Within the stimulation group, abdominal muscle strength also increased by 58%, while the control group showed no change in this regard. Waist circumference decreased by 3.5 cm within the stimulation group. No significant change in waist circumference was observed in the control group. The feeling that their midsection appeared “firmer” and more toned was experienced by all 24 subjects in the stimulation group. In addition, they reported noticing improved posture as a result of the stimulation. Within the control group, none of the subjects reported this. Regarding body weight, BMI, and skinfold thickness, no significant differences were found in the stimulation and control groups. In the study, NMES led to significant improvements in endurance and muscle strength, as well as perceived satisfaction and  
Shape of the abdominal region by subjects in the stimulation group.

2005, J. P. Porcari , J. Miller, K. Cornwell, C. Foster, M. Gibson, K. McLean, T. Kernoze.

Aim of analysis
Metabolic syndrome (MetS) includes the clinical parameters HDL-C, triglycerides, fasting glucose, mean arterial blood pressure (MAP), and waist circumference (according to the NCEP-ATP III criteria (2009)). The aim of the study was to find out what positive effects whole-body electromyostimulation (WB-EMS) has on the MetS

Methods
For the study, 75 independently living women 70+ with sarcopenic obesity were recruited and randomly assigned to one of three supervised study groups. The groups performed whole-body electromyostimulation training (Wb-EMS training) once a week for 20 minutes for six months (bipolar, 85Hz, 350ms, intermittent 4s current-4s current pause) with adjunctive protein addition (Wb-EMS+P) and without adjunctive protein addition (0.33g/kg/body weight). The control group was supposed to keep their lifestyle stable during the study period. 

Results
The two training groups showed similar effects in terms of MetS-Z score (WB-EMS+protein:-0.89 ± 1.1 vs. WB-EMS: -0.46 ± 1.1; p=.49) at a comparable attendance rate. The between-group effect (p=.009) was due to negative trends in the control group. The WB-EMS+P group and the control group were significantly different from each other (p=.009), but the EMS and control groups were not (p=.150). The improvement in Z-score in the two training groups can be explained by significant changes in abdominal circumference and mean arterial blood pressure. 

Conclusion
WB-EMS has shown to be effective in reducing risk factors of MetS in vulnerable women aged 70 years and older, in addition to being time efficient and joint-friendly execution. 

Preliminary data from the Formosa study, Imp Erlangen, 2016, M. Teschler, A. Weissenfels, S. von Stengel, M. Bebenek, W. Kemmler.

The used program is similar to the strength program by Antelope.

Methods
For the study, 28 men (69.4±2.8 years) with metabolic syndrome (according to IDF) were randomly assigned to a WB-EMS group (whole-body EMS training) (n=14) or a control group (KG; N=14). The WB-EMS group trained for 30 minutes every fifth day for 14 weeks with an endurance and strength program using EM

Results
The abdominal fat mass changed significantly (p=.004) at high effect size ((ES): d`=1.33) between the WB-EMS and control groups (-252±196 g, p=.001 vs. -34±103 g, p=.330). Appendicular skeletal muscle mass also changed significantly (p=.024, ES: d`=.97) between the EMS and control groups (249±444 g, p=.066 vs. -298±638 g, p=.173). Total body fat decreased by -1350±876 g (p=.001) in the WB-EMS group and -291±850 g (p=.307) in the KG (difference: p=.008, ES: d`=1.23). There were also significant differences in waist circumference between groups (p=.023, ES: d`=1.10) (EMS: -5.2±1.8, p=.000 vs. KG: -3.3±2.9 cm, p=.006). There were no further effects for the other parameters of the metabolic syndrome. 

The Test ll Trial, University of Erlangen-Nürnberg, 2009, W. Kemmler, A. Birlauf, S. von Stengel.

Relief from discomfort

Back pain

Aim of analysis
The study examined whether electrically stimulated whole-body training resulted in positive changes in strength, back pain, body image, anthropometry, mood, incontinence, and general health factors. 

Methods
A total of 134 subjects, 102 women and 32 men with an average age of 42.5 years, were interviewed and tested before and after six weeks of training. They were compared with a control group consisting of 10 subjects (n=10) and by age and gender. Total whole-body EMS training sessions were performed twice a week for a total of 12 times. The training parameters were composed as follows:  Pulse duration/pause 4 s/4 s, 85 Hz, square pulses, pulse width 350µs. A training session consisted of a 10-15 minute familiarization session followed by 25 minutes of training with static exercise positions. Subsequently, a five-minute training program was performed with the following training parameters: (pulse duration 1 s, pulse pause 1 s, 100Hz, rectangular pulses, pulse width 150 µs). 18 subjects terminated the training prematurely.

Results
82.3% reported that their back pain had improved and 29.9% that they were symptom-free after the training. Before the study began, 40.3% of subjects complained about chronic pain, compared to 9.3% after completion. 18 subjects terminated the training prematurely. No changes were noted within the control group. 

According to the subjects, 83.0% suffered from less tension after completion of the study. 89.1% reported feeling more stability and 83.8% reported increased performance. Positive body sculpting effects were noted by 86.8% of subjects. Overall, 90% of subjects received the training as positive. Stronger improvements, especially in patients with complaints, were noted with height and intensities. However, also a stronger muscle soreness occurred. No changes were noted within the control group. 

University of Bayreuth, 2003, J. Vatter.

Methods
49 employees of the University of Bayreuth voluntarily participated in the study, 31 women as well as 18 men with an average age of 47 years, who reported having back complaints. The intensity and frequency of back complaints and the general state of discomfort were determined, as well as mood, vitality, body shaping and stability. A total of 10 EMS training sessions of 45 minutes each were performed 2 times per week. 

Results
88.7% of the subjects reported that their back pain had reduced after completion of the study. 38.8% reported a strong reduction in back pain. According to the subjects’ data, 41.9% experienced a slight improvement in their discomfort status and a significant reduction in the intensity and frequency of their discomfort. In addition, 61.4% of the subjects reported that their general discomfort status had improved. An improved mood was noted by 75.5%, increased vitality by 69.4%, positive body shaping effects by 50%, and perceived relaxation after training by 75.5%. An improvement in body stability was reported by 85.7% of the female and by 57.1% of the male subjects.  

University of Bayreuth, 2002, W.-U. Boeckh-Behrens, N. Grützmacher, J. Sebelefsky.

Incontinence

Aim of analysis
The study examined whether electrically stimulated whole-body training resulted in positive changes in strength, back pain, body image, anthropometry, mood, incontinence, and general health factors. 

Methods
A total of 134 subjects, 102 women and 32 men with an average age of 42.5 years, were interviewed and tested before and after six weeks of training. They were compared with a control group consisting of 10 subjects (n=10) and by age and gender. Total whole-body EMS training sessions were performed twice a week for a total of 12 times. The training parameters were composed as follows:  Pulse duration/pause 4 s/4 s, 85 Hz, square pulses, pulse width 350µs. A training session consisted of a 10-15 minute familiarization session followed by 25 minutes of training with static exercise positions. Subsequently, a five-minute training program was performed with the following training parameters: (pulse duration 1 s, pulse pause 1 s, 100Hz, rectangular pulses, pulse width 150 µs). 18 subjects terminated the training prematurely.

Results
75.8% reported an improvement in incontinence. 33.3% were reported to be symptom-free thereafter. No changes were observed in the control group. 

University of Bayreuth, 2003, J. Vatter.

The used program is similar to the strength program by Antelope.

Methods
The study involved 49 people with back problems, in whom the presence, type and intensity of incontinence problems were determined. It was found that 17 subjects, 15 men and 2 women with an average age of 47 years, had a mostly mild to moderate form of urinary incontinence. A total of 10 EMS training sessions were performed 2 times a week for 45 minutes each. The training sessions were composed of the following training parameters: Pulse duration 4 s, pulse pause 2 s, frequency 80 Hz, rise time 0 s, pulse width 350 µs. A training session lasted approximately 25 minutes, preceded by a 10-15 minute familiarization period during which the individual pulse strength was adjusted. During the training period, various static exercise positions were performed. This was followed by a five-minute relaxation program (pulse duration 1 s, pulse pause 1 s, frequency 100 Hz, rise time 0 s, pulse width 150 µs).

Results
64.7% of the patients reported relief from urinary incontinence symptoms, 23.5% reported freedom from symptoms. A reduction in symptoms was reported by 24.4%. 35.9% did not notice any change.

Unpublished diploma thesis, University of Bayreuth, 2002, W.-U. Boeckh-Behrens, G. Schäffer.

The used program is similar to the strength program by Antelope.

Support for diseases

Overweight

Aim of analysis
The study aimed to investigate whether percutaneous electrical muscle stimulation (EMS) attenuates postprandial hyperglycemia in individuals with type 2 diabetes. 

Methods
A total of eleven patients with type 2 diabetes participated in 2 experimental sessions. One session consisted of 30 minutes of electrical muscle stimulation after breakfast (EMS group) and the other session consisted of complete rest after breakfast (control group). In both groups, blood was sampled before the meal and 30, 60, 80, and 120 minutes after breakfast. 

Results
In the EMS group, postprandial glucose levels were significantly decreased 60, 90, and 120 min after the meal (p < 0.05), as was C-peptide concentration (p < 0.01). Creatine phosphokinase (CPK) concentration was not significantly increased in either group. 

Conclusion
The results suggest for the first time that electrical muscle stimulation may be a new exercise method for the treatment of postprandial hyperglycemia in individuals with type 2 diabetes. This may be particularly relevant for individuals who are unable to exercise sufficiently voluntarily due to obesity, orthopedic conditions, or severe diabetic complications. . 

2012, T. Miyamoto, K. Fukudab, T. Kimurac, Y. Matsubarab, K. Tsudaa, T. Moritania.

Learn more about this study

Metabolic syndrome

Methods
For the study, 28 men (69.4±2.8 years) with metabolic syndrome (according to IDF) were randomly assigned to a WB-EMS group (whole-body EMS training) (n=14) or a control group (KG; N=14). The WB-EMS group trained for 30 minutes every fifth day for 14 weeks with an endurance and strength program using EM

Results
The abdominal fat mass changed significantly (p=.004) at high effect size ((ES): d`=1.33) between the WB-EMS and control groups (-252±196 g, p=.001 vs. -34±103 g, p=.330). Appendicular skeletal muscle mass also changed significantly (p=.024, ES: d`=.97) between the EMS and control groups (249±444 g, p=.066 vs. -298±638 g, p=.173). Total body fat decreased by -1350±876 g (p=.001) in the WB-EMS group and -291±850 g (p=.307) in the KG (difference: p=.008, ES: d`=1.23). There were also significant differences in waist circumference between groups (p=.023, ES: d`=1.10) (EMS: -5.2±1.8, p=.000 vs. KG: -3.3±2.9 cm, p=.006). There were no further effects for the other parameters of the metabolic syndrome. 

The Test ll Trial, University of Erlangen-Nürnberg, 2009, W. Kemmler, A. Birlauf, S. von Stengel.

Learn more about this study

Aim of analysis
The aim of the study was to compare the influence of HIT (High Intensity Training) and WB-EMS (Whole Body EMS Training) on cardiometabolic risk factors in untrained middle-aged men (30-50 years). 

Methods
Untrained men were randomized into two groups. One group trained for 16 weeks (bipolar, 20min, 85Hz, 350ms, intermittent), the other group also trained for 16 weeks with HIT training. 

Results
Time effectiveness between the two groups showed comparable results in terms of net training time (~30min/TE; HIT: 60min/wk vs. WB-EMS: 30min/wk). The WB-EMS and also the HIT training showed significant improvements (p=.096) in terms of MetS-Z score (HIT: p=.031 vs. W B-EMS: p=.001) and abdominal fat content (HIT:-4.5±8.1%, p=.014 vs. W B-EMS:-4.0±5.2%, p=.002). Cholesterol/HDL-C rates did not show significant changes between groups, although this was initially hypothesized (HIT: -2.7±7.4, p=.216 vs. W B-EMS: -2.2±10.2, p=.441).  

Conclusion 
The results indicate that both HIT and WB-EMS are comparably effective, economical, and attractive methods to reduce cardiometabolic risk factors in untrained middle-aged men. WB-EMS can be considered a training option that may be effective but high-cost and suitable for a target group that has low time resources and cannot perform classic HIT training. 

Imp Erlangen, 2016, A. Weissenfels, M. Teschler, S. von Stengel, W. Kemmler, M. Bebenek.

The used EMS programm is similar to the strength program by Antelope.

Aim of analysis
Metabolic syndrome (MetS) includes the clinical parameters HDL-C, triglycerides, fasting glucose, mean arterial blood pressure (MAP), and waist circumference (according to the NCEP-ATP III criteria (2009)). The aim of the study was to find out what positive effects whole-body electromyostimulation (WB-EMS) has on the MetS

Methods
For the study, 75 independently living women 70+ with sarcopenic obesity were recruited and randomly assigned to one of three supervised study groups. The groups performed whole-body electromyostimulation training (Wb-EMS training) once a week for 20 minutes for six months (bipolar, 85Hz, 350ms, intermittent 4s current-4s current pause) with adjunctive protein addition (Wb-EMS+P) and without adjunctive protein addition (0.33g/kg/body weight). The control group was supposed to keep their lifestyle stable during the study period. 

Results
The two training groups showed similar effects in terms of MetS-Z score (WB-EMS+protein:-0.89 ± 1.1 vs. WB-EMS: -0.46 ± 1.1; p=.49) at a comparable attendance rate. The between-group effect (p=.009) was due to negative trends in the control group. The WB-EMS+P group and the control group were significantly different from each other (p=.009), but the EMS and control groups were not (p=.150). The improvement in Z-score in the two training groups can be explained by significant changes in abdominal circumference and mean arterial blood pressure. 

Conclusion
WB-EMS has shown to be effective in reducing risk factors of MetS in vulnerable women aged 70 years and older, in addition to being time efficient and joint-friendly execution. 

Preliminary data from the Formosa study, Imp Erlangen, 2016, M. Teschler, A. Weissenfels, S. von Stengel, M. Bebenek, W. Kemmler.

The used program is similar to the strength program by Antelope.

Chronic heart failure

Aim of analysis
The purpose of the study was to investigate the influence of different stimulation options on important parameters of exercise tolerance in individuals with chronic heart failure.  

Methods
Twenty-four stable patients (NYHA II-III) with chronic heart failure were recruited for an EMS training program. An EMS training program was performed twice weekly for 10 weeks. Per session, the training lasted 20 minutes. An EMS training device available on the market was used for the study. Electrical stimulation took place simultaneously on 8 major muscle areas (extensive EMS training; 12 patients; 9 male; mean age 62.17±12.6 years). These results were to be compared with a group in which patients received limited electrical stimulation to gluteal and thigh muscles (limEMS; 12 patients; 10 male; mean age 62.17±12.6 years). The effects on oxygen uptake, left ventricular function, exercise tolerance, and recognized biomarkers of chronic heart failure were studied. 

Results
Oxygen consumption at the anaerobic threshold increased significantly in both groups: In the exEMS group from 14.7±3.42 to 19.6±4.5 ml/kg/min (+32.65%, p<0.001) and in the limEMS group from 13.6±3.0 to 16.0±3.8 ml/kg/min (+17.6%, p=0.003). In the exEMS group, left ventricular ejection fraction increased from 38.42±7.6 to 45.21±8.6% (+18.42%, p=0.001) and in the limEMS group from 37.1±3.0 to 39.5±5.3% (+6.5%, p=0.27). The changes in terms of oxygen consumption and ejection fraction were greater in the exEMS group than in the limEMS group. The difference between the groups was not significant.

PERFUSION, 2013, F. van Buuren, K. P. Mellwig, C. Prinz, T. Kottmann, B. Körber, A. Fründ, L. Faber, N. Bogunovic, J. Dahm, D.  Horstkotte, D. Fritzsche. 

Learn more about this study

Aim of analysis
The study was designed to find out what effects electrical muscle stimulation training has on patients with stable chronic heart failure.  

Methods
10 Patients were randomly assigned to an 8-week exercise program or habitual activity for a crossover study (9 men, age 66 +/- 6.5 years).  

Results
The mean values of maximal oxygen consumption, 6-minute walking distance, quadriceps strength, and body mass index at baseline were 19.5 +/- 3.5 mL x kg x min, 415.1 +/- 56.6m, 377.9 +/- 110.4N, and 27.9 +/- 3.1 kg/m, respectively(2). After finishing the training program, peak maximal oxygen consumption had increased to 21.2 +/- 5.1 mL x kg x min (P < .05), 6-min walking distance had increased to 454.9 +/- 54.5M (P < .005), and quadriceps strength had increased to 404.9 +/- 108.6N (P < .005). No significant effect was found for BMI (P > .05). 

Conclusion
For sedentary adults who have stable chronic heart failure, EMS could improve physical fitness and functional performance. EMS may be an exercise alternative for patients who are unable to perform more conventional forms of physical activity.  

2009, P. Banerjee, B. Caulfield, L. Crowe, A. L. Clark.

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Type 2 diabetes

Aim of analysis
The study aimed to investigate whether percutaneous electrical muscle stimulation (EMS) attenuates postprandial hyperglycemia in individuals with type 2 diabetes. 

Methods
A total of eleven patients with type 2 diabetes participated in 2 experimental sessions. One session consisted of 30 minutes of electrical muscle stimulation after breakfast (EMS group) and the other session consisted of complete rest after breakfast (control group). In both groups, blood was sampled before the meal and 30, 60, 80, and 120 minutes after breakfast. 

Results
In the EMS group, postprandial glucose levels were significantly decreased 60, 90, and 120 min after the meal (p < 0.05), as was C-peptide concentration (p < 0.01). Creatine phosphokinase (CPK) concentration was not significantly increased in either group. 

Conclusion
The results suggest for the first time that electrical muscle stimulation may be a new exercise method for the treatment of postprandial hyperglycemia in individuals with type 2 diabetes. This may be particularly relevant for individuals who are unable to exercise sufficiently voluntarily due to obesity, orthopedic conditions, or severe diabetic complications. . 

2012, T. Miyamoto, K. Fukudab, T. Kimurac, Y. Matsubarab, K. Tsudaa, T. Moritania.

Learn more about this study

Fit at old age

Osteoporosis

Methods
In a randomized and prospective study, 30 subjects with osteoporosis performed a training consistently for 4 months. One group (group A; n=10) trained with the “Back School” program, a second group (group B; n=10) trained with conventional equipment training, and a third group (group C; n=10) trained exclusively with EMS whole-body training. During the training period, concomitant medication was not modified. 

Results 
At the end of the study, improvements were seen in bone densitometry and physical capacity. However, these improvements were only significant in group C (EMS training). 

Diploma thesis at the German University of Physical Culture and Sports, in cooperation with MedandSports, 2009, Th. Walluseck. 

Sarcopenia

Aim of analysis
The study examined the effect of whole-body electromyostimulation training (WB-EMS) on appendicular muscle mass and abdominal fat mass in individuals at specific risk for sarcopenia and abdominal obesity and who are unwilling or unable to exercise conventionally. 

Methods
A total of 46 subjects were recruited for the study. Those subjects were lean, non-athletic women who exercised less than 60 minutes per week and had abdominal obesity according to International Diabetes Federation criteria. Randomly, 23 subjects were assigned to a WB-EMS group that performed 18 minutes of bipolar, intermittent WB-EMS (85 Hz) in three sessions over 14 days, and the remaining 23 were assigned to a control group. Appendicular muscle mass, thigh muscle mass, abdominal fat, and thigh fat mass were measured. Strength measurement plates were used to isometrically determine the maximum force of the leg extensors.   

Results
Significant differences were noted between the two groups after 12 months for the primary end points of appendicular muscle mass (0.5% ± 2.0% for the WB-EMS group versus -0.8% ± 2.0% for the control group, P=0.025) and abdominal fat mass (-1.2% ± 5.9% for the WB-EMS group versus 2.4% ± 5.8% for the control group, P=0.038). The muscle mass of the thighs of the subjects in the WB-EMS group changed positively (0.5% ± 2.5% versus -0.9% ± 1.9% in the control group, P=0.033). Fat mass of the thighs changed in a borderline non-significant manner (-0.8%±3.5% in the WB-EMS group versus 1.0%±2.6% in the control group, P=0.050). The functional parameters of leg extensor strength changed significantly, with the most favorable change in the WB-EMS group (9.1% ± 11.2% versus 1.0% ± 8.1% in the control group, P=0.010). . 

Conclusion
The study found overall positive effects of WB-EMS on the parameters of sarcopenia and regional fat accumulation. Because WB-EMS was well accepted in the non-athletic, older subjects at risk for sarcopenia and abdominal obesity, WB-EMS may be a less daunting alternative for affecting appendicular muscle mass and abdominal fat mass in individuals unable or unwilling to exercise conventionally.  

Subanalysis of the TEST-III trial, Clinical Interventions in Aging, 2013, W. Kemmler, S. von Stengel.

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Aim of analysis
The aim of the study was to investigate the influence of whole-body electromyostimulation (WB-EMS) on body composition parameters and sarcopenia in women aged 70 years and older.  

Methods
A total of 76 women with osteopenia, athletically inactive and lean and over 70 years of age, were randomly assigned to a WB-EMS group (n=38) or an active control group (akg; n=38). Over 54 weeks, the WB-EMS group performed a 20-minute light “exercise program” with EMS application 1.5 times per week. The control group performed (2 times 10 weeks, 1 time 60 min/week) light functional training with similar exercises. Regional and total lean body mass formed the primary endpoints of the study. 

Results
Significant differences between the groups were observed in appendicular skeletal muscle mass (ASSM: WB-EMS: 62 ± 346 g vs. aKG: -233 ± 475 g), lean body mass (LBM: WB-EMS: 273 ± 589 g vs. aKG: -296 ± 977 g) and thigh ROI muscle mass (WB-EMS: 39 ± 223 g vs. aKG: -136 ± 237 g) (p = 0.005 – 0.008; ES: d` = 0.71 – 0.76). Leg strength also showed significant positive effects (p = 0.003, ES: d` = 0.97) in the WB-EMS group. No significant differences were recorded for body fat mass, appendicular fat mass, and thigh ROI fat mass (secondary study endpoints) (p = 0.459 – 0.865; ES: d` = 0.05 – 0.15). There was a high acceptance of WB-EMS training during the course of the study based on drop-out and attendance rates.

The TEST-III trial, German Journal of Sports Medicine, 2012, W. Kemmler, K. Engelke, S. von Stengel.

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Aim of analysis
The review should provide a detailed overview of the extent to which physiological changes can occur through EMS. The starting point for this review is that EMS has been shown to improve and increase muscle strength and mass, respectively, so it can be assumed that EMS can also be used to treat sarcopenia. For the review, only clinical and experimental human studies were chosen as reference articles. 
 
Conclusion
The high-frequency electrical stimulation appears o have primary effects on muscle mass gain. Low-frequency electrical stimulation, on the other hand, appears to favor increases in muscle mass. Improvements in oxidative enzymatic activity and glucose uptake, as well as changes in muscle fiber composition, appear to be promoted by EMS. 

2016, M. M. Nishidaa, T. Tsuboyamaa, T. Moritanib, H. Araiac.

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Incontinence

Aim of analysis
The study examined whether electrically stimulated whole-body training resulted in positive changes in strength, back pain, body image, anthropometry, mood, incontinence, and general health factors. 

Methods
A total of 134 subjects, 102 women and 32 men with an average age of 42.5 years, were interviewed and tested before and after six weeks of training. They were compared with a control group consisting of 10 subjects (n=10) and by age and gender. Total whole-body EMS training sessions were performed twice a week for a total of 12 times. The training parameters were composed as follows:  Pulse duration/pause 4 s/4 s, 85 Hz, square pulses, pulse width 350µs. A training session consisted of a 10-15 minute familiarization session followed by 25 minutes of training with static exercise positions. Subsequently, a five-minute training program was performed with the following training parameters: (pulse duration 1 s, pulse pause 1 s, 100Hz, rectangular pulses, pulse width 150 µs). 18 subjects terminated the training prematurely.

Results
75.8% reported an improvement in incontinence. 33.3% were reported to be symptom-free thereafter. No changes were observed in the control group. 

University of Bayreuth, 2003, J. Vatter.

The used program is similar to the strength program by Antelope.

Methods
The study involved 49 people with back problems, in whom the presence, type and intensity of incontinence problems were determined. It was found that 17 subjects, 15 men and 2 women with an average age of 47 years, had a mostly mild to moderate form of urinary incontinence. A total of 10 EMS training sessions were performed 2 times a week for 45 minutes each. The training sessions were composed of the following training parameters: Pulse duration 4 s, pulse pause 2 s, frequency 80 Hz, rise time 0 s, pulse width 350 µs. A training session lasted approximately 25 minutes, preceded by a 10-15 minute familiarization period during which the individual pulse strength was adjusted. During the training period, various static exercise positions were performed. This was followed by a five-minute relaxation program (pulse duration 1 s, pulse pause 1 s, frequency 100 Hz, rise time 0 s, pulse width 150 µs).

Results
64.7% of the patients reported relief from urinary incontinence symptoms, 23.5% reported freedom from symptoms. A reduction in symptoms was reported by 24.4%. 35.9% did not notice any change.

Unpublished diploma thesis, University of Bayreuth, 2002. W.-U. Boeckh-Behrens, G. Schäffer.

The used program is similar to the strength program by Antelope.

Metabolic syndrome

Methods
For the study, 28 men (69.4±2.8 years) with metabolic syndrome (according to IDF) were randomly assigned to a WB-EMS group (whole-body EMS training) (n=14) or a control group (KG; N=14). The WB-EMS group trained for 30 minutes every fifth day for 14 weeks with an endurance and strength program using EM

Results
The abdominal fat mass changed significantly (p=.004) at high effect size ((ES): d`=1.33) between the WB-EMS and control groups (-252±196 g, p=.001 vs. -34±103 g, p=.330). Appendicular skeletal muscle mass also changed significantly (p=.024, ES: d`=.97) between the EMS and control groups (249±444 g, p=.066 vs. -298±638 g, p=.173). Total body fat decreased by -1350±876 g (p=.001) in the WB-EMS group and -291±850 g (p=.307) in the KG (difference: p=.008, ES: d`=1.23). There were also significant differences in waist circumference between groups (p=.023, ES: d`=1.10) (EMS: -5.2±1.8, p=.000 vs. KG: -3.3±2.9 cm, p=.006). There were no further effects for the other parameters of the metabolic syndrome. 

The TEST ll-trial, University of Erlangen-Nürnberg, 2009, W. Kemmler, A. Birlauf, S. von Stengel.

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Aim of analysis
The aim of the study was to compare the influence of HIT (High Intensity Training) and WB-EMS (Whole Body EMS Training) on cardiometabolic risk factors in untrained middle-aged men (30-50 years). 

Methods
Untrained men were randomized into two groups. One group trained for 16 weeks (bipolar, 20min, 85Hz, 350ms, intermittent), the other group also trained for 16 weeks with HIT training. 

Results
Time effectiveness between the two groups showed comparable results in terms of net training time (~30min/TE; HIT: 60min/wk vs. WB-EMS: 30min/wk). The WB-EMS and also the HIT training showed significant improvements (p=.096) in terms of MetS-Z score (HIT: p=.031 vs. W B-EMS: p=.001) and abdominal fat content (HIT:-4.5±8.1%, p=.014 vs. W B-EMS:-4.0±5.2%, p=.002). Cholesterol/HDL-C rates did not show significant changes between groups, although this was initially hypothesized (HIT: -2.7±7.4, p=.216 vs. W B-EMS: -2.2±10.2, p=.441).  

Conclusion 
The results indicate that both HIT and WB-EMS are comparably effective, economical, and attractive methods to reduce cardiometabolic risk factors in untrained middle-aged men. WB-EMS can be considered a training option that may be effective but high-cost and suitable for a target group that has low time resources and cannot perform classic HIT training. 

Imp Erlangen, 2016, A. Weissenfels, M. Teschler, S. von Stengel, W. Kemmler, M. Bebenek.

The used EMS programm is similar to the strength program by Antelope.

Aim of analysis
Metabolic syndrome (MetS) includes the clinical parameters HDL-C, triglycerides, fasting glucose, mean arterial blood pressure (MAP), and waist circumference (according to the NCEP-ATP III criteria (2009)). The aim of the study was to find out what positive effects whole-body electromyostimulation (WB-EMS) has on the MetS

Methods
For the study, 75 independently living women 70+ with sarcopenic obesity were recruited and randomly assigned to one of three supervised study groups. The groups performed whole-body electromyostimulation training (Wb-EMS training) once a week for 20 minutes for six months (bipolar, 85Hz, 350ms, intermittent 4s current-4s current pause) with adjunctive protein addition (Wb-EMS+P) and without adjunctive protein addition (0.33g/kg/body weight). The control group was supposed to keep their lifestyle stable during the study period. 

Results
The two training groups showed similar effects in terms of MetS-Z score (WB-EMS+protein:-0.89 ± 1.1 vs. WB-EMS: -0.46 ± 1.1; p=.49) at a comparable attendance rate. The between-group effect (p=.009) was due to negative trends in the control group. The WB-EMS+P group and the control group were significantly different from each other (p=.009), but the EMS and control groups were not (p=.150). The improvement in Z-score in the two training groups can be explained by significant changes in abdominal circumference and mean arterial blood pressure. 

Conclusion
WB-EMS has shown to be effective in reducing risk factors of MetS in vulnerable women aged 70 years and older, in addition to being time efficient and joint-friendly execution. 

Preliminary data from the Formosa study, Imp Erlangen, 2016, M. Teschler, A. Weissenfels, S. von Stengel, M. Bebenek, W. Kemmler.

The used program is similar to the strength program by Antelope.

Chronic heart failure

Aim of analysis
The purpose of the study was to investigate the influence of different stimulation options on important parameters of exercise tolerance in individuals with chronic heart failure.  

Methods
Twenty-four stable patients (NYHA II-III) with chronic heart failure were recruited for an EMS training program. An EMS training program was performed twice weekly for 10 weeks. Per session, the training lasted 20 minutes. An EMS training device available on the market was used for the study. Electrical stimulation took place simultaneously on 8 major muscle areas (extensive EMS training; 12 patients; 9 male; mean age 62.17±12.6 years). These results were to be compared with a group in which patients received limited electrical stimulation to gluteal and thigh muscles (limEMS; 12 patients; 10 male; mean age 62.17±12.6 years). The effects on oxygen uptake, left ventricular function, exercise tolerance, and recognized biomarkers of chronic heart failure were studied. 

Results
Oxygen consumption at the anaerobic threshold increased significantly in both groups: In the exEMS group from 14.7±3.42 to 19.6±4.5 ml/kg/min (+32.65%, p<0.001) and in the limEMS group from 13.6±3.0 to 16.0±3.8 ml/kg/min (+17.6%, p=0.003). In the exEMS group, left ventricular ejection fraction increased from 38.42±7.6 to 45.21±8.6% (+18.42%, p=0.001) and in the limEMS group from 37.1±3.0 to 39.5±5.3% (+6.5%, p=0.27). The changes in terms of oxygen consumption and ejection fraction were greater in the exEMS group than in the limEMS group. The difference between the groups was not significant.

PERFUSION, 2013, F. van Buuren, K. P. Mellwig, C. Prinz, T. Kottmann, B. Körber, A. Fründ, L. Faber, N. Bogunovic, J. Dahm, D.  Horstkotte, D. Fritzsche. 

Aim of analysis
The study was designed to find out what effects electrical muscle stimulation training has on patients with stable chronic heart failure.  

Methods
10 Patients were randomly assigned to an 8-week exercise program or habitual activity for a crossover study (9 men, age 66 +/- 6.5 years).  

Results
The mean values of maximal oxygen consumption, 6-minute walking distance, quadriceps strength, and body mass index at baseline were 19.5 +/- 3.5 mL x kg x min, 415.1 +/- 56.6m, 377.9 +/- 110.4N, and 27.9 +/- 3.1 kg/m, respectively(2). After finishing the training program, peak maximal oxygen consumption had increased to 21.2 +/- 5.1 mL x kg x min (P < .05), 6-min walking distance had increased to 454.9 +/- 54.5M (P < .005), and quadriceps strength had increased to 404.9 +/- 108.6N (P < .005). No significant effect was found for BMI (P > .05). 

Conclusion
For sedentary adults who have stable chronic heart failure, EMS could improve physical fitness and functional performance. EMS may be an exercise alternative for patients who are unable to perform more conventional forms of physical activity.  

2009, P. Banerjee, B. Caulfield, L.Crowe, A. L. Clark.

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Glossary

Anaerobic threshold
the highest intensity of exertion that a person can sustain for an extended period of time while achieving a state of equilibrium between the formation and degradation of lactate (salt of lactic acid in the muscles).

Anthropometry
science of human body and skeletal features and their exact
determination.

Carry over effect
influence of a therapy by a previous treatment.

Chronic heart failure
progressive heart disease in which the heart‘s ability to
pump blood decreases to the point that not enough blood
and therefore oxygen and nutrients can be pumped to
organs.

Creatine kinase (CK)
enyzm used for the diagnosis of muscle diseases.

Crossing effect
bilateral muscle is only trained on one side and leads to an
increase in strength of the muscle on the opposite side.

Electromyostimulation
„Myo“ means muscle. The term means „electrical muscle
stimulation“.

EMG activity
EMG stands for „electromyography“. Electromyographic
examination measures the electrical activity of specific muscles, which can be used to assess muscle and nerve function.

Functional electrostimulation (FES)
allows to address nerves that the central nervous system
does not manage to control.

High Intensity Training (HIT)
workout with a short period of time but at the same time
intense exercises.

Hypertrophy
excessive increase in size of tissues and organs due to enlargement of cells (especially because of increased exertion).

Isometric training
strength training during which the muscle is under maximum sustained tension (isometric contraction) by holding a push or pull for as long as possible.

Left ventricular
relating to the left ventricle of the heart.

Maximum force
maximum force that a person‘s neuromuscular system can
voluntarily exert against a resistance.

MCV value (mean corpuscular volume)
indicates the average volume of a red blood cell.

Metabolic syndrome
combination of the following risk factors: too much abdominal fat, high blood fat and blood sugar levels as well as high blood pressure.

Neuromuscular electrical stimulation
triggering of contractions of muscle groups or individual
muscles using an electrical stimulus (can be compared to
electrical muscle stimulation).

Obesity
excessive body weight caused by excess fat.

Postprandial hyperglycemia
refers to elevated blood glucose levels after a meal.

Sarcopenia
describes the increasing loss of muscle strength and mass
with advancing age.

Speed strength
ability of the human neuromuscular system to produce the
largest possible impulse of force within a short period of
time.

Strength endurance
ability of the body to sustain a dynamic or static load for an
extended period.

Torque
measure of the effort of a body to rotate.

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