EMS studies Sports and Fitness

Sophia Bergner spielt Tennis mit dem kabellosen EMS-Anzug von Antelope, mit dem sie gute Trainingserfahrungen gesammelt hat. Sie ist von vorne bis oberhalb der Knie und mit einem lächelndem Blick zur Seite zu sehen. In ihrer rechten Hand hält sie einen Tennisschläger.

Being fit, building muscle, achieving good sports performance – according to some study results, this is possible with electrical muscle stimulation training. The following overview shows you what research findings already exist about training with EMS. And the studies show: EMS training offers you advantages – both in terms of sports and fitness as well as of health. 

This is what electrical muscle stimulation training can do

EMS training can help to improve maximum strength and target specific muscle groups – leg, abdominal, arm and back muscles. Strength endurance and speed can also be trained with the help of EMS, resulting in improved sports performance. In particular, sprint time and jumping power can be enhanced by EMS training. In addition, some studies show the possibility of improving maximum oxygen consumption with the help of EMS training, which plays an important role in sports performance. Electrical muscle stimulation training has also turned out to be a suitable training supplement for certain sports such as soccer, swimming or tennis.

The following overview provides you with the most important findings from 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 health 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.

Sports and fitness

Maximum strength

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
Maximum strength increased by 12.2% and strength endurance by 69.3%. Female subjects benefited more from the training than male subjects (13.6% vs. 7.3%).  BMI and body weight remained about the same. Among female subjects, body circumference significantly reduced at the chest (- 0.7 cm), thigh (- 0.4 cm), waist (- 1.4 cm), and hips (- 1.1 cm). Among 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 positive body sculpting effects. 90% perceived the EMS training as positive. 83% stated that they felt less tense and 89.1% felt more stability. Stronger improvements, especially in patients with complaints, were noted with height and intensities. However, greater muscle soreness also occurred here. 

University of Bayreuth, 2003. J. Vatter.

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

Aim of analysis
The influence of whole-body electromyostimulation on body composition as well as strength within the adult relationship was analyzed.  

Methods
The analysis includes clinical randomized trials. Within the intervention groups, all subjects must have completed the same exercises with a whole-body electrical stimulation suit. Those data from adult subjects who had no prior experience with whole-body EMS should be considered. Primary endpoints of this study are muscle mass or fat-free mass and percent fat or fat mass. Secondary endpoints are muscle and maximal strength. 

Results 
Body composition in women (pre- and post-menopausal) and in trained subjects has been effectively altered by whole-body electromyostimulation. Previous studies have also found an increase in performance and strength in the elderly, as well as in professional athletes. However, no systematic study has examined the effect of both variables in either group of persons.

2021. L. Rodriguez-Santana, J. C. Adsudar, G. Louro, J. Perez-Gomez.

Learn more about this study

Aim of analysis
The objective of the case study was to investigate the efficiency of EMS training during tennis training. 

Methods
Antelope accompanied tennis player Sophia Bergner for three months. In addition to Sophia’s normal training, she performed EMS training two to three times a week. After the three months, Sophia’s strength and mobility were measured using FPZ equipment from the company DAVID. 

Results
After the three months, the following strength gains were measured for Sophia: Trunk extension increased by 12 percent, trunk flexion decreased by 5.4 percent. The punching movement or rotation with her right arm increased by 25.2 percent, with her left arm it was even 51.9 percent. Strength gains in rotation of both outer shoulder joints improved by 19.5 percent. Strength gains were also observed in her legs: The strength in her right leg improved by 6.4 percent, and that of her left leg improved by 17.1 percent. An improved strength gain of 29.2 percent was observed on the leg press, and the strength gain of knee flexion on both sides was 11.5 percent.  

Publication year: 2022

Learn more about this study

Methods
A total of 80 sports students from the German Sport University Cologne were randomized into the following 8 different training groups: EMS, maximal strength, rapid strength, strength endurance, vibration, hypertrophy, EMS/hypertrophy, vibration/hypertrophy. Subjects had strength training experience of at least two years and a sports fitness certificate. Training sessions were performed by the subjects twice a week for 4 weeks. Classical training and strength diagnostics were performed on the Leg Extension and a Leg Curl machine. After a warm-up on a bicycle ergometer, the strength diagnostic procedure was performed.

Results
An increase in maximum power could only be increased with the help of EMS training via the velocity component, with 40% additional load (29%). The velocity component, together with the strength component, determines dynamic performance. Even the training groups with typical maximal strength or rapid strength designs were able to significantly increase maximal performance only in conjunction with or exclusively via the strength component. Thus, at submaximal intensity, dynamic EMS training appears to offer new opportunities to increase practice-relevant maximal power. 

German Sport University Cologne, 2009. J. Mester, S. Nowak, J. Schmithüsen, H. Kleinöder, U. Speicher.

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Aim of analysis
The object of the study was to investigate the influence of WB EMS (whole body ems) and HIT on muscle strength and body composition in middle-aged men. For this purpose, 48 untrained, healthy men aged between 30 and 50 years were randomly assigned to a WB-EMS group (3 sessions in two weeks) or a HIT group (2 sessions in one week). Both groups trained for a total of 16 weeks. The WB EMS group trained with intermittent stimulation (6 s WB-EMS, 4 s rest; 85 Hz, 350 µs) for 20 min and the HIT group as a “single-set-to-failure protocol.”  

Results
In both groups, the changes in LBM (lean body mass) were significant (HIT 1.25% ± 1.44% vs. WB EMS). The differences between the groups were not significant. Back extensor strength and leg extensor strength increased in the WB EMS group and in the HIT group, but again no significant differences were recorded between groups. Corresponding to these changes, changes were also noted for body fat.  

Conclusion
Based on the study results, WB EMS can be considered as a costly but at also time time-saving alternative to HIT resistance training for those individuals who want to achieve improvement in overall body and strength composition.    

2016. W. Kemmler. M. Teschler, A. Weißenfels, M. Bebenek, M. Fröhlich, M. Kohl, S. von Stengel.

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

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Aim of analysis 
The object of the study was to investigate the effects of two methods of electrical stimulation on calf circumference, skinfold thickness, and maximum isometric force of the stimulated and unstimulated (contralateral) legs.  

Methods
The subjects consisted of 36 men who voluntarily participated in the study and were each assigned to one of three groups. Over a period of 21 days, subjects in groups 1 and 2 were stimulated daily with the electrical stimulation method of the triceps surae muscle. Group 1 was stimulated with a low frequency alternating current (50 Hz) and group 2 with a higher frequency alternating current (20000 Hz). The third group was the control group.  

Results 
The maximum isometric muscle strength of the stimulated (50.3% and 58.8%) and non-stimulated (contralateral) muscles in group 1 and group 2 increased significantly (39.7% and 32.2%). Such a significant increase in maximal isometric force was not observed in group 3 (control group). In both experimental groups, calf circumference also increased. In group 2, skinfold thickness decreased by 21.6%. 

International Journal of Sports Medicine, 1987. M. Cabric, H. J. Appell.

Methods
80 sports students trained the leg flexor and leg extensor muscles twice a week on training machines (company GYM80) in different groups (muscle building, strength endurance, maximum strength; in 3 series each). For this purpose, the subjects trained with different additional loads (30 to 90% of the individual maximum strength; 1 repetition maximum) with 3 to 15 repetitions. The sports students had at least 2 years of experience with strength training before the start of the study. Another group trained with whole-body EMS. For this, subjects in this group performed lunges and squats without additional load under electrical stimulation (3 series, 10 repetitions, load/pause 6 s/4s, pulse frequency 85Hz, pulse width350µs, rectangular pulse). Training would be twice weekly for 4 weeks. The subjects’ dynamics were measured by power, which is composed of force and velocity and can be increased via these components. 

Results
The leg extension and leg flexor muscle performance improved significantly in all groups that performed strength training. These improvements occurred across the strength factor, except in the whole-body EMS group and the mixed WB-EMS/muscle-building group. Only these two groups showed significant improvements in speed. The improvement in measured performance was via increased speed by approximately 30. Thus, speed, which is not easy to target, was improved within a short period of time. This could be due to the fact that the fast muscle fibers are directly targeted via electrical stimulation during whole-body EMS training. Furthermore, the results could show that whole-body EMS in combination with a dynamic execution of a movement can be a promising way of speed and strength training, as long as the whole-body EMS training is used in a well-dosed way.  

Medicalsports network, 2007. H. Kleinöder.

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

Learn more about this study

Aim of analysis
The effects of electrostimulation training of 14 competitive swimmers on their swimming performance and strength of the latissimus dorsi muscle were to be investigated in the study.  

Methods
For this purpose, the subjects were assigned to an electrostimulated training group (7 subjects) and a control group (7 subjects). With the help of an isokinetic dynamometer, the peak torques at different speeds (from -60 deg.s(-1) to 360 deg.s(-1)) during extension as well as flexion of the arm were to be registered. The subjects’ performances were measured over a 50-meter freestyle swim as well as over a 25-meter pull buoy. 

Results
A significant increase (P < .05) was recorded for peak torques under concentric, isometric, and eccentric conditions for the electrostimulated training group. There was also a significant decrease in swim times within the electrostimulation training group of 0.38 +/- 0.24 s for the 50-m freestyle and 0.19 +/- 0.14 s for the 25-m pull-buoy. No significant differences were found within the control group. Variations in peak torque (measured in the eccentric condition; -60 deg.s(-1)) were associated with variations in performance within the control group (r = 0.77; P < 0.01). Thus, it can be said that swimming performance as well as latissimus dorsi muscle strength of competitive swimmers can be improved with the help of an electrostimulated training program. 

Medicine & Science in Sports & Exercise, 1995. F Pichon, J. C. Chatard, A. Martin, & G. Cometti.

Learn more about this study

Aim of analysis
The aim of this stury was to investigate whether electromyostimulation training lasting less than 15 minutes would improve muscle strength and other parameters. It was also intended to measure the degree of muscle tissue stress caused by EMS training, the intensity, and indirectly the effectiveness of the training. 

Methods
Fifty-five male sport students with a mean age of 22.9 years were randomly divided into two training groups: Group 1 trained for 5 minutes with EMS, and Group 2 trained for 10 minutes with EMS (n = 22 for each). In addition, there was a control group (n = 11). For a total of 6 weeks, the subjects trained twice a week with the following stimulation parameters: Pulse duration 4 s, pulse pause 4 s, frequency 80 Hz, pulse width 350 μs, bipolar square pulses. Dynamic maximum strength, strength endurance, body weight, body fat percentage, and CK (creatine kinase) levels were determined 24 hours after training. Body perception, mood, and state of mind were also determined.

Results
The dynamic strength endurance and maximum strength were increased highly significantly (p ≤ 0.001) in both training groups: From up to 41% and 34%, respectively, in strength endurance and from up to 10% and 8%, respectively, in maximum strength. No significant difference in strength effects could be measured (p > 0.05). A significant weight gain of 0.83 % was determined for group 1 and 0.90 % for group 2. In contrast, no improvements were observed in body fat content. Creatine kinase levels were 595 U/l in group 1 and slightly higher at 761 U/l in group 2. Creatine kinase activity was primarily influenced by training intensity.

Conclusion
The strength increases did not improve with a shortened working time to 5 and 10 minutes, respectively, unlike with previous studies. The results indicate that a training duration of approximately 15 minutes is considered optimal to achieve strength gains. The high increase in creatine kinase levels after EMS training indicates that the muscles were subjected to a very intense load. However, a shortened training duration does not decisively change the activity of the creatine kinase enzyme, but rather it seems that the current intensity plays an important role in increasing creatine kinase.

Unpublished diploma thesis, University of Bayreuth, 2006. W.-U. Boeck-Behrens, D. Mainka.

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

Aim of analysis
The influence of electrostimulated strength exercises on anaerobic performance of tennis players during the preparation season was to be investigated in the study. 

Methods
12 tennis players (7 female and 5 male) completed 9 training sessions for the quadriceps over 3 weeks, each lasting 16 minutes (frequency: 85 Hz; on-off ratio: 5.25-25 seconds). For this purpose, electrostimulated training sessions were integrated into the tennis training sessions. Shuttle sprint time, maximum quadriceps force, and vertical jump height were measured.

Results
Compared to the start of the study, jump height from countermovement was significantly higher at week five (+5.3%) and week six (+6.4%) (p < 0.05). In the sixth week, subjects showed a significantly shortened 2 x 10-meter sprint time (-3.3%) compared to pre-training (p = 0.004). The training parameters were linearly progressive within the 3-week training period. Thus, electrostimulated strength training was successfully integrated into the training. Anaerobic power and stretch-shortening cycle power exhibited delayed improvement throughout the study period. The study results indicate that progressive electrostimulated strength training can be integrated into the early tennis season and improve anaerobic performance for both women and men. 

2009. N. Maffiuletti, J. Bramanti, M. Jubeau, M. Bizzini, G. Deley, G. Cometti.

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Speed strength

Methods
80 sports students trained the leg flexor and leg extensor muscles twice a week on training machines (company GYM80) in different groups (muscle building, strength endurance, maximum strength; in 3 series each). For this purpose, the subjects trained with different additional loads (30 to 90% of the individual maximum strength; 1 repetition maximum) with 3 to 15 repetitions. The sports students had at least 2 years of experience with strength training before the start of the study. Another group trained with whole-body EMS. For this, subjects in this group performed lunges and squats without additional load under electrical stimulation (3 series, 10 repetitions, load/pause 6 s/4s, pulse frequency 85Hz, pulse width350µs, rectangular pulse). Training would be twice weekly for 4 weeks. The subjects’ dynamics were measured by power, which is composed of force and velocity and can be increased via these components. 

Results
The leg extension and leg flexor muscle performance improved significantly in all groups that performed strength training. These improvements occurred across the strength factor, except in the whole-body EMS group and the mixed WB-EMS/muscle-building group. Only these two groups showed significant improvements in speed. The improvement in measured performance was via increased speed by approximately 30. Thus, speed, which is not easy to target, was improved within a short period of time. This could be due to the fact that the fast muscle fibers are directly targeted via electrical stimulation during whole-body EMS training. Furthermore, the results could show that whole-body EMS in combination with a dynamic execution of a movement can be a promising way of speed and strength training, as long as the whole-body EMS training is used in a well-dosed way.  

Medicalsports network, 2007. H. Kleinöder.

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

Learn more about this study

Aim of analysis
The objective of the case study was to investigate the efficiency of EMS training during tennis training. 

Methods
Antelope accompanied tennis player Sophia Bergner for three months. In addition to Sophia’s normal training, she performed EMS training two to three times a week. After the three months, Sophia’s strength and mobility were measured using FPZ equipment from the company DAVID. 

Results
After the three months, the following strength gains were measured for Sophia: Trunk extension increased by 12 percent, trunk flexion decreased by 5.4 percent. The punching movement or rotation with her right arm increased by 25.2 percent, with her left arm it was even 51.9 percent. Strength gains in rotation of both outer shoulder joints improved by 19.5 percent. Strength gains were also observed in her legs: The strength in her right leg improved by 6.4 percent, and that of her left leg improved by 17.1 percent. An improved strength gain of 29.2 percent was observed on the leg press, and the strength gain of knee flexion on both sides was 11.5 percent.  

Publication year: 2022

Learn more about this study

Aim of analysis
To investigate the effects of a 5-week electrostimulation training program on shooting speed, muscle strength, sprinting as well as vertical jump performance of soccer players. 

Methods 
Twenty amateur soccer players participated in the study and were assigned to an electrostimulation group (n = 10) and a control group (n = 10). Electrostimulation was performed on the quadriceps muscles for 5 weeks. Measurements were taken before, during (week 3), and after (week 5) the EMS training program. 

Results
An increase in eccentric maximal as well as isometric knee extension moments was observed in week 3. Additionally, improved ball speed without run-up was measured in week 3. The results suggest that EMS training should be performed for at least 3 weeks to achieve positive effects on specific soccer skills, such as ball speed.  

2010. M. Billot, A. Martin, C. Paizis, C. Cometti, N. Babault.

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Aim of analysis
The object of the study was to investigate the influence of a 6-week training program combined of low-intensity plyometric training (PT) and whole-body electrical stimulation on 20-meter jump time, handgrip strength, and vertical jump performance. The results needed to be compared with those of traditional plyometric training. 

Methods
20 sports students (10 female and 10 male) were randomly assigned to an experimental group or a control group. Over a 6-week period, both groups trained three times a week at low intensity. On the third day, the training in the experimental group was simultaneously combined with whole-body EMS. Peak counter movement jump (CMJ) performance, 20-meter sprint time, handgrip strength, and CMJ height were measured before and after the training period.  

Results
CMJ height and peak CMJ power increased significantly in both groups, although the effect size was larger in the experimental group (p < 0.001, g = 0.68; p < 0.001, g = 0.70, respectively). No significant differences were measured between groups at follow-up. Handgrip strength increased in both groups. However, the effect sizes were minimal. In addition, a significant improvement in 20-meter sprint time was observed, but the effect size was larger in the control group (p < 0.001, g = -1.68). The combined program of plyometric training and whole-body EMS produced the best results for improving CMJ performance, and traditional plyometric training showed the most effective results for 20-meter sprint time.  

2022. M. Á. Martín-Simón, D. Rojano-Ortega.

Learn more about this study

Aim of analysis
The effects of electrostimulation training of 14 competitive swimmers on their swimming performance and strength of the latissimus dorsi muscle were to be investigated in the study.  

Methods
For this purpose, the subjects were assigned to an electrostimulated training group (7 subjects) and a control group (7 subjects). With the help of an isokinetic dynamometer, the peak torques at different speeds (from -60 deg.s(-1) to 360 deg.s(-1)) during extension as well as flexion of the arm were to be registered. The subjects’ performances were measured over a 50-meter freestyle swim as well as over a 25-meter pull buoy. 

Results
A significant increase (P < .05) was recorded for peak torques under concentric, isometric, and eccentric conditions for the electrostimulated training group. There was also a significant decrease in swim times within the electrostimulation training group of 0.38 +/- 0.24 s for the 50-m freestyle and 0.19 +/- 0.14 s for the 25-m pull-buoy. No significant differences were found within the control group. Variations in peak torque (measured in the eccentric condition; -60 deg.s(-1)) were associated with variations in performance within the control group (r = 0.77; P < 0.01). Thus, it can be said that swimming performance as well as latissimus dorsi muscle strength of competitive swimmers can be improved with the help of an electrostimulated training program. 

Medicine & Science in Sports & Exercise, 1995. F Pichon, J. C. Chatard, A. Martin, & G. Cometti.

Learn more about this study

Methods
A total of 80 sports students from the German Sport University Cologne were randomized into the following 8 different training groups: EMS, maximal strength, rapid strength, strength endurance, vibration, hypertrophy, EMS/hypertrophy, vibration/hypertrophy. Subjects had strength training experience of at least two years and a sports fitness certificate. Training sessions were performed by the subjects twice a week for 4 weeks. Classical training and strength diagnostics were performed on the Leg Extension and a Leg Curl machine. After a warm-up on a bicycle ergometer, the strength diagnostic procedure was performed.

Results
An increase in maximum power could only be increased with the help of EMS training via the velocity component, with 40% additional load (29%). The velocity component, together with the strength component, determines dynamic performance. Even the training groups with typical maximal strength or rapid strength designs were able to significantly increase maximal performance only in conjunction with or exclusively via the strength component. Thus, at submaximal intensity, dynamic EMS training appears to offer new opportunities to increase practice-relevant maximal power. 

German Sport University Cologne, 2009. J. Mester, S. Nowak, J. Schmithüsen, H. Kleinöder, U. Speicher.

Learn more about this study

Aim of analysis
The object of the study was to examine the effects of a 12-week electromyostimulation training program on the performance of elite rugby players.  

Methods
The subjects consisted of 25 rugby players. 15 of them were assigned to an electrostimulated group and 10 others to a control group. The training sessions were performed three times a week for the first six weeks and only once a week for the next six weeks. Electrical stimulation was performed on the glutes, foot flexors, and knee extensors. Sprint run times, vertical jump height, and knee flexor strength were also measured.  

Results
Squat jump (+10.0 +/- 9.5%; p < 0.01), fall jump from a height of 40 centimeters (+6.6 +/- 6.1%; p < 0.05), knee flexion strength (+15.0 +/- 8.0%; < p 0.001), and maximum concentric torque (p < 0.05) improved in the electrostimulation group. There were no significant changes within the control group. Performance and muscle strength in elite rugby players improved after a 12-week electrostimulated training at least in certain tests, but rugby skills such as sprinting or scrummaging showed no such improvements.

Journal of Strength and Conditioning Research, 2007. N. Babault, G. Cometti, M. Bernardin, M. Pousson, J.-C. Chatard.

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Power endurance

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
Maximum strength increased by 12.2% and strength endurance by 69.3%. Female subjects benefited more from the training than male subjects (13.6% vs. 7.3%).  BMI and body weight remained about the same. Among female subjects, body circumference significantly reduced at the chest (- 0.7 cm), thigh (- 0.4 cm), waist (- 1.4 cm), and hips (- 1.1 cm). Among 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 positive body sculpting effects. 90% perceived the EMS training as positive. 83% stated that they felt less tense and 89.1% felt more stability. Stronger improvements, especially in patients with complaints, were noted with height and intensities. However, greater muscle soreness also occurred here. 

University of Bayreuth, 2003. J. Vatter.

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

Aim of analysis
The aim of this study was to investigate whether there would be a change in the neuromuscular function of the flexor digitorium brevis (FDB) and rectus femoris (RF) after 6 weeks of training with functional electrical stimulation (FES). Also, whether the effects would persist after a recovery period of 6 weeks needed to be investigated.. 

Methods
Muscles were stimulated over a 6-week period (30 min/day, 5 days/week, total of 30 sessions). The stimulation pattern consisted of a biphasic symmetrical pulse current (10 V, i.e., submaximal) with ramp modulation of frequency (4-75-4 HZ) and pulse duration (400-100-400 μs). FES was administered via a clinical neurostimulator (Multiprocess 16+, Physitech; Electronique Médicale, Marseille, France). 

Results
Immediately after functional electrical stimulation, a significant increase in maximum voluntary contraction (MVC) was observed in the recuts femoris and flexor digitorum brevis. This significant increase was still observed after 6 weeks of functional electrical stimulation. Functional electrical stimulation also resulted in a significant increase in endurance time to exhaustion (+18 ± 7%). In contrast, the unstimulated muscles showed no changes in endurance time to exhaustion and MCV. The results suggest that muscle function can be improved using functional electrical stimulation and that central muscle activation can be altered. For flexor digitorium brevis, the benefits of functional electrical stimulation were greater. Furthermore, in the present results, the benefits lasted longer in the FDB.  

2003. T. Marqueste, F. Hug, P. Decherchi, Y. Jammes.

Learn more about this study

Aim of analysis
The aim of this stury was to investigate whether electromyostimulation training lasting less than 15 minutes would improve muscle strength and other parameters. It was also intended to measure the degree of muscle tissue stress caused by EMS training, the intensity, and indirectly the effectiveness of the training. 

Methods
Fifty-five male sport students with a mean age of 22.9 years were randomly divided into two training groups: Group 1 trained for 5 minutes with EMS, and Group 2 trained for 10 minutes with EMS (n = 22 for each). In addition, there was a control group (n = 11). For a total of 6 weeks, the subjects trained twice a week with the following stimulation parameters: Pulse duration 4 s, pulse pause 4 s, frequency 80 Hz, pulse width 350 μs, bipolar square pulses. Dynamic maximum strength, strength endurance, body weight, body fat percentage, and CK (creatine kinase) levels were determined 24 hours after training. Body perception, mood, and state of mind were also determined.

Results
The dynamic strength endurance and maximum strength were increased highly significantly (p ≤ 0.001) in both training groups: From up to 41% and 34%, respectively, in strength endurance and from up to 10% and 8%, respectively, in maximum strength. No significant difference in strength effects could be measured (p > 0.05). A significant weight gain of 0.83 % was determined for group 1 and 0.90 % for group 2. In contrast, no improvements were observed in body fat content. Creatine kinase levels were 595 U/l in group 1 and slightly higher at 761 U/l in group 2. Creatine kinase activity was primarily influenced by training intensity.

Conclusion
The strength increases did not improve with a shortened working time to 5 and 10 minutes, respectively, unlike with previous studies. The results indicate that a training duration of approximately 15 minutes is considered optimal to achieve strength gains. The high increase in creatine kinase levels after EMS training indicates that the muscles were subjected to a very intense load. However, a shortened training duration does not decisively change the activity of the creatine kinase enzyme, but rather it seems that the current intensity plays an important role in increasing creatine kinase.

Unpublished diploma thesis, University of Bayreuth, 2006. W.-U. Boeck-Behrens, D. Mainka.

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

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.

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Building and strengthening the musculature

Leg muscles

Aim of analysis
To what extent the normal quadriceps femoris muscle can be strengthened with the help of electrical muscle stimulation, without the support of a simultaneous isometric muscle contraction, should be investigated in the study. 

Methods 
A total of 58 subjects were randomly assigned to one of three independent groups. One group was trained with isometric strengthening of the quadriceps femoris muscle (n = 20), and another group was stimulated daily with the right quadriceps femoris muscle (n = 19). A third group served as a control group (n = 19).  

Results
The torque of the quadriceps femoris muscle increased in each case in the group with isometric training and in the group with electrical stimulation (p < .001).  Such significant change was not observed in the control group. The data support the use of this electronic stimulator as a suitable device for strengthening skeletal muscles without voluntary effort. 

1983. R. K. Laughman, J. W. Youdas, T. R. Garrett, E. Y. S. Chao.

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Aim of analysis
The aim of this study was to investigate whether there would be a change in the neuromuscular function of the flexor digitorium brevis (FDB) and rectus femoris (RF) after 6 weeks of training with functional electrical stimulation (FES). Also, whether the effects would persist after a recovery period of 6 weeks needed to be investigated.

Methods
Muscles were stimulated over a 6-week period (30 min/day, 5 days/week, total of 30 sessions). The stimulation pattern consisted of a biphasic symmetrical pulse current (10 V, i.e., submaximal) with ramp modulation of frequency (4-75-4 HZ) and pulse duration (400-100-400 μs). FES was administered via a clinical neurostimulator (Multiprocess 16+, Physitech; Electronique Médicale, Marseille, France). 

Results
Immediately after functional electrical stimulation, a significant increase in maximum voluntary contraction (MVC) was observed in the recuts femoris and flexor digitorum brevis. This significant increase was still observed after 6 weeks of functional electrical stimulation. Functional electrical stimulation also resulted in a significant increase in endurance time to exhaustion (+18 ± 7%). In contrast, the unstimulated muscles showed no changes in endurance time to exhaustion and MCV. The results suggest that muscle function can be improved using functional electrical stimulation and that central muscle activation can be altered. For flexor digitorium brevis, the benefits of functional electrical stimulation were greater. Furthermore, in the present results, the benefits lasted longer in the FDB.  

2003. T. Marqueste, F. Hug, P. Decherchi, Y. Jammes.

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Aim of analysis
The objective of the case study was to investigate the efficiency of EMS training during tennis training. 

Methods
Antelope accompanied tennis player Sophia Bergner for three months. In addition to Sophia’s normal training, she performed EMS training two to three times a week. After the three months, Sophia’s strength and mobility were measured using FPZ equipment from the company DAVID. 

Results
After the three months, the following strength gains were measured for Sophia: Trunk extension increased by 12 percent, trunk flexion decreased by 5.4 percent. The punching movement or rotation with her right arm increased by 25.2 percent, with her left arm it was even 51.9 percent. Strength gains in rotation of both outer shoulder joints improved by 19.5 percent. Strength gains were also observed in her legs: The strength in her right leg improved by 6.4 percent, and that of her left leg improved by 17.1 percent. An improved strength gain of 29.2 percent was observed on the leg press, and the strength gain of knee flexion on both sides was 11.5 percent.  

Publication year: 2022

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Aim of analysis
Over a two-week period, female subjects exercised the gastrocnemius muscle with electrical stimulation.  

Methods
Skinfold thickness, lower leg circumference, and maximum static plantar flexion force were measured before the start of the study and after the stimulation period. 

Results
After the end of the stimulation period, the skinfold thickness of the subjects was significantly reduced. In addition, lower leg circumference had slightly increased highly significantly. The strength was also highly significantly increased. Based on the results, it can be suggested that the increase in strength that may result from electrical stimulation may be accompanied by an increase in muscle mass. Additionally, an improved intramuscular coordination can be assumed here. 

German Journal of Sports Medicine, 1987. M. Cabric & H. J. Appell.

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Aim of analysis
The study aimed to investigate whether the isometric force of the quadriceps femoris muscle can be significantly increased with the help of isometric training under electrical stimulation (ES). It also aimed to measure whether the relative strength and duration of the training contractions were related to the changes in strength.

Methods
A total of 24 subjects were assigned to an experimental group (n=12) and a control group (n=12). Subjects in both groups underwent pre-test and post-test. Thus, maximal voluntary isometric contractions (MVISCs) were determined. For four weeks, the experimental group trained three times a week with maximal tolerable isometric contractions induced by electrical stimulation. 

Results
Both the experimental and control groups showed an increase in isometric strength of the quadriceps femoris muscle. However, the experimental group with electrical stimulation had a significantly greater increase (p < .01) in isometric training with electrical stimulation than the control group without electrical stimulation. In the experimental group, the relative strength improvement correlated with the intensity and duration of the training contraction. Moreover, the relative strength improvement was positive and significant in this group.

Physical Therapy, 1985. D.M. Selkowitz.

Aim of analysis
The influence of electrostimulated strength exercises on anaerobic performance of tennis players during the preparation season was to be investigated in the study. 

Methods
12 tennis players (7 female and 5 male) completed 9 training sessions for the quadriceps over 3 weeks, each lasting 16 minutes (frequency: 85 Hz; on-off ratio: 5.25-25 seconds). For this purpose, electrostimulated training sessions were integrated into the tennis training sessions. Shuttle sprint time, maximum quadriceps force, and vertical jump height were measured.

Results
Compared to the start of the study, jump height from countermovement was significantly higher at week five (+5.3%) and week six (+6.4%) (p < 0.05). In the sixth week, subjects showed a significantly shortened 2 x 10-meter sprint time (-3.3%) compared to pre-training (p = 0.004). The training parameters were linearly progressive within the 3-week training period. Thus, electrostimulated strength training was successfully integrated into the training. Anaerobic power and stretch-shortening cycle power exhibited delayed improvement throughout the study period. The study results indicate that progressive electrostimulated strength training can be integrated into the early tennis season and improve anaerobic performance for both women and men. 

2009. N. Maffiuletti, J. Bramanti, M. Jubeau, M. Bizzini, G. Deley, G. Cometti.

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Aim of analysis
The object of the study was to assess the effects of low-dose electrical stimulation on muscle torque improvement. 

Methods
Six healthy women and nine healthy men (20 to 32 years of age) received electrical stimulation on the right anterior thigh muscle. The left leg was not electrically stimulated and served as a control. Electrical stimulation sessions were performed twice a week for five weeks. Electrical stimulation was repeated eight times per session. Each stimulation elicited isometric torque, with each stimulation producing isometric torque equal to 50% of the subject’s maximum voluntary isometric contraction. 

Results
Electrical stimulation was able to increase quadriceps femors torque in the male subjects of the study after it was used with low-dose and specified training features. 

Physical Therapy, 1988. C.-L. Soo, D.P. Currier, A.J. Threlkeld.

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Aim of analysis
The object of the study was to examine the effects of a 12-week electromyostimulation training program on the performance of elite rugby players.  

Methods
The subjects consisted of 25 rugby players. 15 of them were assigned to an electrostimulated group and 10 others to a control group. The training sessions were performed three times a week for the first six weeks and only once a week for the next six weeks. Electrical stimulation was performed on the glutes, foot flexors, and knee extensors. Sprint run times, vertical jump height, and knee flexor strength were also measured.  

Results
Squat jump (+10.0 +/- 9.5%; p < 0.01), fall jump from a height of 40 centimeters (+6.6 +/- 6.1%; p < 0.05), knee flexion strength (+15.0 +/- 8.0%; < p 0.001), and maximum concentric torque (p < 0.05) improved in the electrostimulation group. There were no significant changes within the control group. Performance and muscle strength in elite rugby players improved after a 12-week electrostimulated training at least in certain tests, but rugby skills such as sprinting or scrummaging showed no such improvements.

Journal of Strength and Conditioning Research, 2007. N. Babault, G. Cometti, M. Bernardin, M. Pousson, J.-C. Chatard.

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Methods
80 sports students trained the leg flexor and leg extensor muscles twice a week on training machines (company GYM80) in different groups (muscle building, strength endurance, maximum strength; in 3 series each). For this purpose, the subjects trained with different additional loads (30 to 90% of the individual maximum strength; 1 repetition maximum) with 3 to 15 repetitions. The sports students had at least 2 years of experience with strength training before the start of the study. Another group trained with whole-body EMS. For this, subjects in this group performed lunges and squats without additional load under electrical stimulation (3 series, 10 repetitions, load/pause 6 s/4s, pulse frequency 85Hz, pulse width350µs, rectangular pulse). Training would be twice weekly for 4 weeks. The subjects’ dynamics were measured by power, which is composed of force and velocity and can be increased via these components. 

Results
The leg extension and leg flexor muscle performance improved significantly in all groups that performed strength training. These improvements occurred across the strength factor, except in the whole-body EMS group and the mixed WB-EMS/muscle-building group. Only these two groups showed significant improvements in speed. The improvement in measured performance was via increased speed by approximately 30. Thus, speed, which is not easy to target, was improved within a short period of time. This could be due to the fact that the fast muscle fibers are directly targeted via electrical stimulation during whole-body EMS training. Furthermore, the results could show that whole-body EMS in combination with a dynamic execution of a movement can be a promising way of speed and strength training, as long as the whole-body EMS training is used in a well-dosed way.  

Medicalsports network, 2007. H. Kleinöder.

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

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Aim of analysis
The adaptive and acute effects of electrical stimulation on the quadriceps muscle should be examined in healthy male subjects. 

Results
Four weeks of electrical stimulation improved muscle strength. This improvement resembled the results of a corresponding voluntary exercise program. The acute effects of electrical stimulation (the formation of lactate, the decrease in certain enzyme activities, and the depletion of glycogen and phosphagen stores) were similar to the effects previously recorded with intensive muscle training. No significant changes in muscle properties, mitochondrial properties, or enzyme activities were observed within four to five weeks after electrical stimulation. The effects of electrical stimulation on the quadriceps muscle appeared to be less “speed specific” and more “position specific” compared to the other training performed with slow isokinetic contractions. 

International Journal of Sports Medicine, 1981. E. Eriksson, T. Haggmark, K. H. Kiessling & J. Karlsson.

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Aim of analysis
The aim of the study was to investigate the influence of a four-week as well as an eight-week electromyostimulation training on the neural and muscular adaptations of the knee extensor muscle. 

Methods
12 men were assigned to the electrostimulation group and 8 men to the control group. Subjects were tested at three time points: Before the start of the study, after 4 weeks, and after 8 weeks. In a total of 32 sessions, the training program was performed with isometric EMS. Neural adaptations were assessed using EMG activity as well as muscle activation measured under maximal voluntary contraction. The EMG responses and torque during electrically evoked contractions, the wide angle of the lateral vastus (VL), and the anatomical cross-sectional area of the muscle (ACSA) were examined to study the muscular changes.

Results
At week 8, a significant increase in normalized EMG activity of the vastus medialis and vastus lateralis muscles was observed (+69 and +39%, respectively, P < 0.001). No significant increase was observed for the rectus femoris muscle at week 8. Maximum voluntary contraction of the knee extensors increased significantly by 27% (P < 0.001) and was associated with VL pennation angle (+14%, P < 0.001), ACSA (physiological cross-sectional area) of the quadriceps (+6%, P < 0.001), and an increase in muscle activation (+6%, P < 0.01).  At week 8, ACSA of the VM, VL, and vastus intermedius muscles had also significantly increased (5-8%, P < 0.001), but not at week 4. No changes were observed in the RF muscle. 

Conclusion
The results suggest that voluntary torque (of the knee extensor muscle) can be increased after EMS training because of both neural and muscular adaptations. The changes selectively affected the monoarticular vastii muscles. 

Medicine & Science in Sports & Exercise, 2005. J. Gondin, M. Guette, Y. Ballay, A. Martin.

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Aim of analysis
The influence of a four-week training program following an eight-week training program with electrical stimulation on muscular and neuronal properties of the muscles of the knee extensor as well as on changes in muscle strength should be investigated. 

Methods
9 subjects performed an eight-week training program consisting of 32 sessions of isometric electrical stimulation training. Subjects were tested before training, after the eight-week ES training, and after the four-week training. 

Results
After training, a significant 26% increase in knee extensor torque was observed. This increase was accompanied by an increase in EMG activity of the vastus medialis muscle (normalized to the respective M-wave (+43%), muscle activation, and physiological cross-sectional area (ACSA) of the quadriceps (+6%). Knee extensor MVC values remained significantly (14%) above baseline values at the end of the study period. This was associated with greater ACSA of the quadriceps (3%), but not with greater neural activation. After completion of detraining, muscle activation (5%), MVC of the knee extensors (9%), EMG activity of the vastus medialis muscle (20%), and ACSA of the quadriceps (3%) increased significantly. 

European Journal of Applied Physiology, 2006. J. Gondin, M. Guette, Y. Ballay & A. Martin.

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Aim of analysis
The purpose of the study was to measure and compare the isometric and isokinetic torque of the quadriceps muscle.  

Methods
Subjects were divided into three groups. Group 1 served as the control group (n=9) and was not allowed to change their daily activities for five weeks. Group 2 trained their quadriceps femoris muscle three times a week for five weeks with maximal voluntary isometric exercises (n=10). Group 3 trained contractions of the quadriceps femoris muscle three times a week for five weeks with electrical stimulation. 

Results
The analysis of the results revealed significant increases in strength (P < 0.05) for both the electrostimulation and isometric exercise groups. No changes in strength were observed in the control group. 

Journal of Orthopaedic and Sports Physical Therapy, 1987. R.J. Kubiak, K.M. Whitman, R.M. Johnston.

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Aim of Analysis
The influence of electromotive stimulation (EMS) on quadriceps femoris strength gain should be investigated.  

Methods
Randomly, 24 subjects were assigned to one of three groups: One group exercised at 50% of maximal voluntary isometric contractions (high intensity, HI), and another group exercised at 25% of maximal isometric contractions (low intensity, LI). A third group served as a control group. 

Results
After 3 weeks of EMS training program, significant improvement in strength was observed in both training groups. The increase in strength was significantly greater within the HI training group (48.5%) than in the LI training group (24.2%) (p<0.01). A three-week period of follow-up revealed a significant carry over effect, which was particularly prominent in the HI group. Positive isokinetic changes in concentric mode strength were also recorded in the training groups. Additionally, a significant cross-transfer effect was observed in the contralateral homologous muscle group of both training groups (p<0.01). 

The Australian Journal of Physiotherapy, 1988. H.S. Lai, G. de Domenico, G.R. Straus.

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Aim of analysis
The effects of an electromyostimulation training program over 4 weeks on knee extensor strength and vertical jump performance in basketball players should be investigated. 

Methods
10 basketball players trained three times a week with electrical stimulation. One session consisted of 48 contractions. Three tests were performed: One test before the start of the study, one test after four weeks of electromyostimulation training program, and one test after 4 weeks of normal basketball training.

Results
Isometric strength at the two angles adjacent to the training angle was increased by electromyostimulation training (p < 0.01). At week 4, jump from squat increased significantly by 14% (p < 0.01); jump from countermovement expressed no change. Isokinetic force increased significantly (p < 0.05) at eccentric and high concentric velocities (between 180 and 3608 × s-1), but not at low concentric velocities (60 and 1208 × s-). The increases in isometric and isokinetic strength during jump performance and squat jump were maintained at week eight. Power increased by 17% at week eight (p < 0.01). The basketball players, electromyostimulation, which served as part of a brief strength training program, improved squat jump performance and knee extensor strength. 

2000. N. A. Maffiuletti, G. Cometti, I.G. Amiridis, A. Martin, M. Pousson, J. C. Chatard.

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Aim of analysis
The object of the study was to determine the effects of short-term resistance training with electrical stimulation on the neural and muscular adaptations of the weaker or less dominant quadriceps femoris muscle on healthy subjects.  

Results
An increase in maximal voluntary force (+12%) was observed. This increase was accompanied by muscular (impairment of contractile properties of the whole muscle) and neural (increased muscle activation and cross-education effect) changes. In addition, significant changes in the cross-sectional area of single fibers (+27% for type 1 muscle fibers and +6% for type 2A muscle fibers), specific tension of type 1 fibers (+67%) but not of type 2A fibers, and relative myosin heavy chain (MHC) content (+22% for MHC-2A and -28% for MHC-2X) were detected. The changes that occurred at the level of individual muscle fibers as a result of resistance training with electrical stimulation were significant and primarily affected type 1 slow fibers.

2006. N. A. Maffiuletti, R. Zory, D. Miotti, M. A. Pellegrino, M. Jubeau, R. Bottinelli.

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Aim of analysis 
The effects of electrical stimulation training on quadriceps strength should be investigated.

Methods 
Sixteen healthy subjects were randomly assigned to two groups (an electrical stimulation group and an isometric group). All subjects trained four times a week for three weeks. The isometric training consisted of 10-second maximum contractions with 50-second rest periods per session.

Results 
Quadriceps strength was significantly improved in both groups (22 +/- 5.3% in the electrical group and by 25 +/- 6.9% in the isometric group (p < 0.02)). Apparently, the strength did not change depending on the level of stimulation voltage (5-10 V) nor was it dependent on the induced voltage. There were no significant differences between the increases in strength (p > 0.05)). No muscle lesions, pain, or other adverse effects were noted within the electrical stimulation group. The results indicate that cutaneous electrical stimulation may be a viable option for strengthening. Cutaneous electrical stimulation appears to be a practical application for the rehabilitation of patients who are unable to perform effective voluntary contraction.

Journal of Rehabilitation Medicine, 1983. D.F. Miken, M. Todd-Smith & C. Thompson. Scandinavian.

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Aim of analysis
The influence of a four-week electromyostimulation training (EMS) program on the vertical jump performance of volleyball players should be investigated.  

Methods
A total of 12 volleyball players participated in the study. EMS training sessions were integrated into the volleyball training three times per week. The knee extensor and plantar flexor muscles were stimulated simultaneously 20-22 times during the EMS training sessions for approximately 12 minutes.  

Results
After completion of EMS training, countermovement jump and squat jump performance had not significantly changed, but mean power and mean height significantly increased by approximately 4%. (p < 0,05). At 10 days after completion of EMS training, a significant increase in jump height (p < 0.05) was observed for single jumps (SJ +6.5%, CMJ +5.4%). To the extent that EMS resistance training is intended to improve vertical jumping ability, sport-specific training following EMS training could allow the central nervous system to generate optimized control over neuromuscular properties. 

The Journal of Strength and Conditioning Research, 2003. D. Malatesta, F. Cattaneo, S. Dugnani & N. A. Maffiuletti. 

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Back muscles

Aim of analysis
The object of the study was to investigate the influence of WB EMS (whole body ems) and HIT on muscle strength and body composition in middle-aged men. For this purpose, 48 untrained, healthy men aged between 30 and 50 years were randomly assigned to a WB-EMS group (3 sessions in two weeks) or a HIT group (2 sessions in one week). Both groups trained for a total of 16 weeks. The WB EMS group trained with intermittent stimulation (6 s WB-EMS, 4 s rest; 85 Hz, 350 µs) for 20 min and the HIT group as a “single-set-to-failure protocol.”  

Results
In both groups, the changes in LBM (lean body mass) were significant (HIT 1.25% ± 1.44% vs. WB EMS). The differences between the groups were not significant. Back extensor strength and leg extensor strength increased in the WB EMS group and in the HIT group, but again no significant differences were recorded between groups. Corresponding to these changes, changes were also noted for body fat.  

Conclusion
Based on the study results, WB EMS can be considered as a costly but at also time time-saving alternative to HIT resistance training for those individuals who want to achieve improvement in overall body and strength composition.    

2016. W. Kemmler. M. Teschler, A. Weißenfels, M. Bebenek, M. Fröhlich, M. Kohl, S. von Stengel.

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

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Arm muscles

Aim of analysis
The objective of the case study was to investigate the efficiency of EMS training during tennis training. 

Methods
Antelope accompanied tennis player Sophia Bergner for three months. In addition to Sophia’s normal training, she performed EMS training two to three times a week. After the three months, Sophia’s strength and mobility were measured using FPZ equipment from the company DAVID. 

Results
After the three months, the following strength gains were measured for Sophia: Trunk extension increased by 12 percent, trunk flexion decreased by 5.4 percent. The punching movement or rotation with her right arm increased by 25.2 percent, with her left arm it was even 51.9 percent. Strength gains in rotation of both outer shoulder joints improved by 19.5 percent. Strength gains were also observed in her legs: The strength in her right leg improved by 6.4 percent, and that of her left leg improved by 17.1 percent. An improved strength gain of 29.2 percent was observed on the leg press, and the strength gain of knee flexion on both sides was 11.5 percent.  

Publication year: 2022

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Abdominal muscles

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.

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Methods
32 subjects (21 women, 11 men) aged 20 to 40 years were randomly assigned to one of four groups: One group received electrical stimulation, one group performed exercises, another group performed exercises with concurrent electrical stimulation, and one group served as a control group. The study period was 4 weeks. The duration of sustained contraction and the number of repetitions were increased during this period by a value determined before the start of the study

Results
Abdominal strength increased significantly the most within the electrical stimulation group. There was no significant change between groups in terms of endurance. Tissue resistance decreased, while current intensity and voltage increased significantly. It appeared that the combination of a training as well as stimulation could be the most effective method to improve the abdominal strength.  

Journal of Orthopaedic and Sports Physical Therapy, 1987. G. Alon, S.A. McCombre, S. Koutsantonis, L.J. Stumphauzer, K.C. Burgwin, M.M. Parent, R.A. Bosworth.

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Oxygen consumption

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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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 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 consumption, left ventricular function, exercise tolerance, and recognized biomarkers of chronic heart failure were investigated. 

Results
The oxygen uptake 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 aimed to investigate the extent to which training with WB-EMS (whole-body electromystimulation) affects muscle fatigue and metabolic demand. 

Methods
A total of 10 subjects participated in the study. An experimental group trained with whole-body EMS (5 exercises) and a control group performed five bodyweight exercises. The training sessions were 15 minutes each, they were based on isometric intermittent contractions (6 contractions with 4 seconds rest). Tests were performed to measure muscle fatigue using determination of force decrease: jump with countermovement, isometric mid-thigh pull, plyometric push-up. With the help of a measurement of respiratory gas exchange, the energy expenditure and oxygen consumption during the exercises were measured.

Results
A greater amount of energy consumption (WB-EMS 470 ± 71 kcal/h; control group 438 ±61 kcal/h, p = 0.013) and oxygen consumption (WB-EMS 1584 ± 251 ml/min; control group 1465 ± 216 ml/min, p = 0.006) was detected in the whole-body EMS group than in the control group. Whole-body EMS training resulted in muscle fatigue (all PRE vs. POST tests p ≤ 0.02), but not in the control group (all p > 0.14).

Sport Sciences for Health, 2016. G. Boccia, A. Fornasiero, A.Savoldelli, L. Bortolan, A. Rainoldi, F. Schena & B. Pellegrini. 

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HIT and EMS

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.

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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

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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