The combination of strength training with complementary whole-body electromyostimulation (WB-EMS) and plyometric exercises has been shown to increase strength and jumping performance in athletes. In elite sport, however, the mesocycles of training are often organized according to block periodization. Furthermore, WB-EMS is often applied onto static strength exercises, which may hamper the transfer into more sport-specific tasks. Thus, this study aimed at investigating whether four weeks of strength training with complementary dynamic vs. static WB-EMS followed by a four-week block of plyometric training increases maximal strength and jumping performance. A total of n = 26 (13 female/13 male) trained adults (20.8 ± 2.2 years, 69.5 ± 9.5kg, 9.7 ± 6.1h of training/w) were randomly assigned to a static (STA) or volume-, load- and work-to-rest-ratio-matched dynamic training group (DYN). Before (PRE), after four weeks (three times weekly) of WB-EMS training (MID) and a subsequent four-week block (twice weekly) of plyometric training (POST), maximal voluntary contraction (MVC) at leg extension (LE), leg curl (LC) and leg press machines (LP) and jumping performance (SJ, Squat Jump; CMJ, counter-movement-jump; DJ, drop-jump) were assessed. Furthermore, perceived effort (RPE) was rated for each set and subsequently averaged for each session. MVC at LP notably increased between PRE and POST in both STA (2335 ± 539 vs. 2653 ± 659N, standardized mean difference [SMD] = 0.528) and DYN (2483 ± 714N vs. 2885 ± 843N, SMD = 0.515). Reactive strength index of DJ showed significant differences between STA and DYN at MID (162.2 ± 26.4 vs. 123.1 ± 26.5 cm·s-1, p = 0.002, SMD = 1.478) and POST (166.1 ± 28.0 vs. 136.2 ± 31.7 cm·s-1, p = 0.02, SMD = 0.997). Furthermore, there was a significant effect for RPE, with STA rating perceived effort higher than DYN (6.76 ± 0.32 vs. 6.33 ± 0.47 a.u., p = 0.013, SMD = 1.058). When employing a training block of high-density WB-EMS both static and dynamic exercises lead to similar adaptations.

The aim of this multicenter trial was to compare the effects of whole-body electromyostimulation (WB-EMS) and whole-body vibration (WBV) with conventional back-strengthening training (CT) on changes in mean back pain intensity (MPI) and trunk strength in patients suffering from chronic non-specific low back pain (CNLBP). Two-hundred and forty CNLBP patients (40–70 years; 62% female) were randomly assigned to three intervention arms (WB-EMS: n = 80 vs. WBV: n = 80 vs. CT: n = 80). All training intervention programs were performed for 12 weeks in their usual commercial training setting. Before and during the last 4 weeks of the intervention, MPI was recorded using a 4-week pain diary. Additionally, maximal isometric trunk extension and -flexion strength was assessed on the BackCheck® machine. A moderate but significant decrease of MPI was observed in all groups (WB-EMS: 29.7 ± 39.1% (SMD 0.50) vs. WBV: 30.3 ± 39.3% (SMD 0.57) vs. CT: 30.5 ± 39.6% (SMD 0.59); p < 0.001). Similar findings were observed for maximal isometric strength parameters with a significant increase in all groups (extension: WB-EMS: 17.1 ± 25.5% vs. WBV: 16.2 ± 23.6% vs. CT: 21.6 ± 27.5%; p < 0.001; flexion: WB-EMS: 13.3 ± 25.6% vs. WBV: 13.9 ± 24.0% vs. CT: 13.9 ± 25.4%; p < 0.001). No significant interaction effects for MPI ( p = 0.920) and strength parameters (extension: p = 0.436; flexion: p = 0.937) were observed. WB-EMS, WBV, and CT are comparably effective in improving MPI and trunk strength. However, training volume of WB-EMS was 43 or 62% lower, compared with CT and WBV.

The aim of this study was to compare the effects of short-term strength training with and without superimposed whole-body electromyostimulation (WB-EMS) on straight sprinting speed (SSS), change of direction speed (CODS), vertical and horizontal jumping, as well as on strength and power in physically active females. Twenty-two active female participants (n = 22; mean ± SD: age: 20.5 ± 2.3 years; height: 171.9 ± 5.5 cm; body mass: 64.0 ± 8.2 kg; strength training experience 5.1 ± 3.6 years) were randomly assigned to two groups: strength training (S) or strength training with superimposed WB-EMS (S+E). Both groups trained twice a week over a period of 4 weeks and differed in the application of free weights or WB-EMS during four strength (e.g., split squats, glute-ham raises) and five sprinting and jumping exercises (e.g., side and box jumps, skippings). The WB-EMS impulse intensity was adjusted to 70% of individual maximal sustainable pain. SSS was tested via 30-m sprinting, CODS by a T-run, vertical and horizontal jumping using four different jump tests at pre-, post-, and retests. Maximal strength (Fmax) and power (Pmax) testing procedures were conducted on the Leg Press (LP), Leg Extension (LE), and Leg Curl (LC) machine. Significant time × group interaction effects revealed significant decreases of contact time of the Drop Jump and split time of CODS (p ≤ 0.043; η p 2 = 0.15-0.25) for S (≤ 11.6%) compared to S+E (≤ 5.7%). Significant time effects (p < 0.024; η p 2 = 0.17-0.57) were observed in both groups for SSS (S+E: ≤6.3%; S: ≤8.0%) and CODS (S+E: ≤1.8%; S: ≤2.0%) at retest, for jump test performances (S+E: ≤13.2%; S: ≤9.2%) as well as Fmax and Pmax for LE (S+E: ≤13.5%; S: ≤13.3%) and LC (S+E: ≤18.2%; S: ≤26.7%) at post- and retests. The findings of this study indicate comparable effects of short-term strength training with and without superimposed WB-EMS on physical fitness in physically active females. Therefore, WB-EMS training could serve as a reasonable but not superior alternative to classic training regimes in female exercisers.

Background. Low back pain (LBP) affects almost everyone at least once in their lifetime. Various meta-analyses show promising effects on pain reduction for conventional exercise. However, the lack of time and, especially for pain patients, a fear of movement (“kinesiophobia”) as well as functional limitations often oppose participation in such activities. In contrast, the advantage of novel training technologies like whole-body electromyostimulation (WB-EMS) lies particularly in a joint-friendly, time-effective, and highly customized training protocol and might be an alternative option for LBP patients. A meta-analysis of individual patient data and a comparison of WB-EMS against a passive control group confirmed the proof principle. Thus, the aim of this randomized controlled trial is to compare WB-EMS with a recognized back-strengthening exercise protocol to determine the corresponding effects on chronic, nonspecific LBP in people suffering from this. Methods and Findings. This randomized, controlled multicenter study is focused on novel and time-effective training technologies and LBP. In this contribution, the focus is primarily on the comparison of WB-EMS against a comparable conventional exercise training (CT). One hundred ten nonspecific chronic LBP patients, 40–70 years old, were randomly allocated to the intervention arms (WB-EMS: 55 vs. CT: 55). Both groups completed a 12-week program (WB-EMS: 1 × 20 min/week vs. CT: 1 × 45 min/week) specifically dedicated to LBP. The selection of the content of the active control group was based on the principles of WB-EMS training, which uses electrical stimulation to train mainly strength and stabilization in a very short time. Exercises were similar in all groups, with the focus on strengthening and stabilizing the trunk. Outcome measures were assessed by a four-week pain diary (before and during the last four weeks of intervention) as well as an isometric maximum strength measurement of the trunk muscles at baseline and after 12 weeks of intervention. Primary study endpoint was average pain intensity at the lumbar spine. Secondary study endpoints were maximum isometric strength of the back and the abdominals. The mean pain intensity of LBP decreased significantly in both groups (WB-EMS: −22.3 ± 20.9% vs. CT: −30.2 ± 43.9%; p<0.001), however, without significant intergroup difference (p=0.160). A similar result was observed for “maximum isometric strength of trunk muscles.” The increase in back strength (WB-EMS: 15.6 ± 24.9% vs. CT: 23.0 ± 30.9%) was highly significant in both groups (p=0.001), and similar changes were observed for the trunk flexors (WB-EMS: 17.6 ± 24.8% vs. CT: 18.1 ± 24.8%). Also, at the secondary endpoint, no significant difference in pairwise comparison was observed in both cases (extension: p=0.297; flexion: p=0.707). Conclusion. In summary, both, WB-EMS and conventional back-strengthening protocol are comparably effective in reducing nonspecific chronic LBP in this dedicated cohort. The result is particularly positive in terms of time effectiveness and offers an adequate alternative for people with limited time resources or other barriers to conventional training methods.

Background: Whole-body electromyostimulation (WB-EMS) gained increasing interest in sports within recent years. However, few intervention studies have examined the effects of WB-EMS on trained subjects in comparison to conventional strength training. Objective: The aim of the present mini-meta-analysis of 5 recently conducted and published randomized controlled WB-EMS trails of our work group was to evaluate potentially favorable effects of WB-EMS in comparison to conventional strength training. Methods: We included parameter of selected leg muscle's strength and power as well as sprint and jump performance. All subjects were moderately trained athletes [>2 training sessions/week, >2 years of experience in strength training; experimental group (n = 58): 21.5 ± 3.3 y; 178 ± 8 cm; 74.0 ± 11 kg; control group (n = 54): 21.0 ± 2.3 y; 179.0 ± 9 cm; 72.6 ± 10 kg]. The following WB-EMS protocols were applied to the experimental group (EG): 2 WB-EMS sessions/week, bipolar current superimposed to dynamic exercises, 85 Hz, 350 μs, 70% of the individual pain threshold amperage. The control groups (CG) underwent the same training protocols without WB-EMS, but with external resistance. Results: Five extremely homogenous studies (all studies revealed an I 2 = 0%) with 112 subjects in total were analyzed with respect to lower limb strength and power in leg curl, leg extension and leg press machines, sprint-and jump performance. Negligible effects in favor of WB-EMS were found for Fmax of leg muscle groups [SMD: 0.11 (90% CI: -0.08, 0.33), p = 0.73, I 2 = 0%] and for CMJ [SMD: 0.01 (90% CI: -0.34, 0.33), p = 0.81, I 2 = 0%]. Small effects, were found for linear sprint [SMD: 0.22 (90% CI: -0.15, 0.60), p = 0.77, I 2 = 0%] in favor of the EMS-group compared to CON. Conclusion: We conclude that WB-EMS is a feasible complementary training stimulus for performance enhancement. However, additional effects on strength and power indices seem to be limited and sprint and jump-performance appear to be benefiting only slightly. Longer training periods and more frequent application times and a slightly larger stimulus could be investigated in larger samples to further elucidate beneficial effects of WB-EMS on performance parameters in athletes.

The purpose of this study was to assess the effects of dynamic superimposed submaximal whole-body electromyostimulation (WB-EMS) training on maximal strength and power parameters of the leg muscles compared with a similar dynamic training without WB-EMS. Eighteen male sport students were randomly assigned either to a WB-EMS intervention (INT; n = 9; age: 28.8 (SD: 3.0) years; body mass: 80.2 (6.6) kg; strength training experience: 4.6 (2.8) years) or a traditional strength training group (CON; n = 9; age: 22.8 (2.5) years; body mass: 77.6 (9.0) kg; strength training experience: 4.5 (2.9) years). Both training intervention programs were performed twice a week over a period of 8 weeks with the only difference that INT performed all dynamic exercises (e.g., split squats, glute-ham raises, jumps, and tappings) with superimposed WB-EMS. WB-EMS intensity was adjusted to 70% of the individual maximal tolerable pain to ensure dynamic movement. Before (PRE), after (POST) and 2 weeks after the intervention (FU), performance indices were assessed by maximal strength (Fmax) and maximal power (Pmax) testing on the leg extension (LE), leg curl (LC), and leg press (LP) machine as primary endpoints. Additionally, vertical and horizontal jumps and 30 m sprint tests were conducted as secondary endpoints at PRE, POST and FU testing. Significant time effects were observed for strength and power parameters on LE and LC (LE Fmax +5.0%; LC Pmax +13.5%). A significant time × group interaction effect was merely observed for Fmax on the LE where follow-up post hoc testing showed significantly higher improvements in the INT group from PRE to POST and PRE to FU (INT: +7.7%, p < 0.01; CON: +2.1%). These findings indicate that the combination of dynamic exercises and superimposed submaximal WB-EMS seems to be effective in order to improve leg strength and power. However, in young healthy adults the effects of superimposed WB-EMS were similar to the effects of dynamic resistance training without EMS, with the only exception of a significantly greater increase in leg extension Fmax in the WB-EMS group.

The aim of the present study was to investigate the effects of a multiple set squat exercise training intervention with superimposed electromyostimulation (EMS) on strength and power, sprint and jump performance. Twenty athletes from different disciplines participated and were divided into two groups: strength training (S) or strength training with superimposed EMS (S+E). Both groups completed the same training program twice a week over a six week period consisting of four sets of the 10 repetition maximum of back squats. Additionally, the S+E group had EMS superimposed to the squat exercise with simultaneous stimulation of leg and trunk muscles. EMS intensity was adjusted to 70% of individual pain threshold to ensure dynamic movement. Strength and power of different muscle groups, sprint, and vertical jump performance were assessed one week before (pre), one week after (post) and three weeks (re) following the training period. Both groups showed improvements in leg press strength and power, countermovement and squat jump performance and pendulum sprint (p < 0.05), with no changes for linear sprint. Differences between groups were only evident at the leg curl machine with greater improvements for the S+E group (p < 0.05). Common squat exercise training and squat exercise with superimposed EMS improves maximum strength and power, as well as jumping abilities in athletes from different disciplines. The greater improvements in strength performance of leg curl muscles caused by superimposed EMS with improvements in strength of antagonistic hamstrings in the S+E group are suggesting the potential of EMS to unloaded (antagonistic) muscle groups. Key pointsSimilar strength adaptations occurred after a 6 week 10 RM back squat exercise program with superimposed EMS (S+E) and 10 RM back squat exercise (S) alone.Specific adaptations for S+E at the leg curl muscles were evident.S and S+E improved SJ, CMJ and pendulum sprint performance.No improvement occurred in linear sprint performance.

Filipovic, A, Kleinoder, H, Dormann, U, and Mester, J. Electromyostimulation-a systematic review of the effects of different electromyostimulation methods on selected strength parameters in trained and elite athletes. J Strength Cond Res 26(9): 2600-2614, 2012-This is the first part of 2 studies that systematically review the current state of research and structure the results of selected electromyostimulation (EMS) studies in a way that makes accurate comparisons possible. This part will focus on the effects of EMS on strength enhancement. On the basis of these results, part 2 will deal with the influence of the training regimen and stimulation parameters on EMS training effectiveness to make recommendations for training control. Out of about 200 studies, 89 trials were selected according to predefined criteria: subject age (<35 years), subject health (unimpaired), EMS type (percutaneous stimulation), and study duration (>7 days). To evaluate these trials, we first defined appropriate categories according to the type of EMS (local or whole body) and type of muscle contraction (isometric, dynamic, isokinetic). Then, we established the most relevant strength parameters for high-performance sports: maximal strength, speed strength, power, jumping and sprinting ability. Unlike former reviews, this study differentiates between 3 categories of subjects based on their level of fitness (untrained subjects, trained subjects, and elite athletes) and on the types of EMS methods used (local, whole-body, combination). Special focus was on trained and elite athletes. Untrained athletes were investigated for comparison purposes. This scientific analysis revealed that EMS is effective for developing physical performance. After a stimulation period of 3-6 weeks, significant gains (p < 0.05) were shown in maximal strength (isometric Fmax +58.8%; dynamic Fmax +79.5%), speed strength (eccentric isokinetic Mmax +37.1%; concentric isokinetic Mmax + 41.3%; rate of force development + 74%; force impulse + 29%; vmax + 19%), and power (+67%). Developing these parameters increases vertical jump height by up to +25% (squat jump +21.4%, countermovement jump +19.2%, drop jump +12%) and improves sprint times by as much as -4.8% in trained and elite athletes. With regard to the level of fitness, the analysis shows that trained and elite athletes, despite their already high level of fitness, are able to significantly enhance their level of strength to same extent as is possible with untrained subjects. The EMS offers a promising alternative to traditional strength training for enhancing the strength parameters and motor abilities described above. Because of the clear-cut advantages in time management, especially when whole-body EMS is used, we can expect this method to see the increasing use in high-performance sports.

Filipovic, A, Kleinöder, H, Dörmann, U, and Mester, J. Electromyostimulation—a systematic review of the effects of different electromyostimulation methods on selected strength parameters in trained and elite athletes. J Strength Cond Res 26(9): 2600–2614, 2012—This is the first part of 2 studies that systematically review the current state of research and structure the results of selected electromyostimulation (EMS) studies in a way that makes accurate comparisons possible. This part will focus on the effects of EMS on strength enhancement. On the basis of these results, part 2 will deal with the influence of the training regimen and stimulation parameters on EMS training effectiveness to make recommendations for training control. Out of about 200 studies, 89 trials were selected according to predefined criteria: subject age (,35 years), subject health (unimpaired), EMS type (percutaneous stimulation), and study duration (.7 days). To evaluate these trials, we first defined appropriate categories according to the type of EMS (local or whole body) and type of muscle contraction (isometric, dynamic, isokinetic). Then, we established the most relevant strength parameters for high-performance sports: maximal strength, speed strength, power, jumping and sprinting ability. Unlike former reviews, this study differentiates between 3 categories of subjects based on their level of fitness (untrained subjects, trained subjects, and elite athletes) and on the types of EMS methods used (local, whole-body, combination). Special focus was on trained and elite athletes. Untrained athletes were investigated for comparison purposes. This scientific analysis revealed that EMS is effective for developing physical performance. After a stimulation period of 3–6 weeks, significant gains (p , 0.05) were shown in maximal strength (isometric Fmax +58.8%; dynamic Fmax +79.5%), speed strength (eccentric isokinetic Mmax +37.1%; concentric isokinetic Mmax + 41.3%; rate of force development + 74%; force impulse + 29%; vmax + 19%), and power (+67%). Developing these parameters increases vertical jump height by up to +25% (squat jump +21.4%, countermovement jump +19.2%, drop jump +12%) and improves sprint times by as much as –4.8% in trained and elite athletes. With regard to the level of fitness, the analysis shows that trained and elite athletes, despite their already high level of fitness, are able to significantly enhance their level of strength to same extent as is possible with untrained subjects. The EMS offers a promising alternative to traditional strength training for enhancing the strength parameters and motor abilities described above. Because of the clear-cut advantages in time management, especially when whole-body EMS is used, we can expect this method to see the increasing use in high-performance sports.

Filipovic, A, Kleinöder, H, Dörmann, U, and Mester, J. Electromyostimulation—A systematic review of the influence of training regimens and stimulation parameters on effectiveness in electromyostimulation training of selected strength parameters. J Strength Cond Res 25(11): 3218–3238, 2011—Our first review from our 2-part series investigated the effects of percutaneous electromyostimulation (EMS) on maximal strength, speed strength, jumping and sprinting ability, and power, revealing the effectiveness of different EMS methods for the enhancement of strength parameters. On the basis of these results, this second study systematically reviews training regimens and stimulation parameters to determine their influence on the effectiveness of strength training with EMS. Out of about 200 studies, 89 trials were selected according to predefined criteria: subject age (<35 years), subject health (unimpaired), EMS type (percutaneus stimulation), and study duration (>7 days). To evaluate these trials, we first defined appropriate categories according to the type of EMS (local or whole-body) and type of muscle contraction (isometric, dynamic, isokinetic). Unlike former reviews, this study differentiates between 3 categories of subjects based on their level of fitness (untrained subjects, trained subjects, and elite athletes) and on the types of EMS methods used (local, whole-body, combination). Special focus was on trained and elite athletes. Untrained subjects were investigated for comparison purposes. The primary purpose of this study was to point out the preconditions for producing a stimulus above the training threshold with EMS that activates strength adaptations to give guidelines for implementing EMS effectively in strength training especially in high-performance sports. As a result, the analysis reveals a significant relationship (p < 0.05) between a stimulation intensity of ≥50% maximum voluntary contraction (MVC; 63.2 ± 19.8%) and significant strength gains. To generate this level of MVC, it was possible to identify guidelines for effectively combining training regimens (4.4 ± 1.5 weeks, 3.2 ± 0.9 sessions per week, 17.7 ± 10.9 minutes per session, 6.0 ± 2.4 seconds per contraction with 20.3 ± 9.0% duty cycle) with relevant stimulation parameters (impulse width 306.9 ± 105.1 microseconds, impulse frequency 76.4 ± 20.9 Hz, impulse intensity 63.7 ± 15.9 mA) to optimize training for systematically developing strength abilities (maximal strength, speed strength, jumping and sprinting ability, power).