Perspectives

Whole-body EMS training offers seniors a safe, joint-friendly and effective training option. Studies show positive effects on muscle mass, function and health. Find out more about the benefits and guidelines for seniors.

EMS training specifically for seniors? There are hardly any specific offers or targeted approaches for the senior target group so far. Prof. Dr. Wolfgang Kemmler from the Institute of Medical Physics at Friedrich-Alexander-University (FAU) Erlangen-Nuremberg raises the question of why this is the case. The whole-body EMS training method and the senior target group are a perfect match, even under scientific scrutiny.

"Dear Mr. Kemmler," said the elderly lady at the information event for our movement study, "I haven't done any sports for 50 years, so I won't start at 70 either." The lack of willingness and insight of many "sport-abstinent" seniors to begin regular and intensive physical training could not be put into words more clearly. The indication that physical training is effective at any age is usually "brushed off" with objections such as lack of time, shame, sweating/exertion, low performance, joint pain, and lack of individual care - interestingly, the financial aspect rarely plays a role.

Great Option for Seniors: Whole-Body EMS

Therefore, whole-body electromyostimulation (WB-EMS) appears to be a time-efficient, discreet, joint-friendly, and safe option for older, less sports-inclined people to positively influence health and performance on their own responsibility, at least in the currently recommended setting of close supervision [1]. In addition, even scientific critics of WB-EMS consider poorly trained, low-performance individuals as a suitable group for WB-EMS, an assessment confirmed by numerous studies with older people and predominantly positive results [2].

Study Situation with Consistently Positive Results

If one wants to evaluate the effectiveness of a WB-EMS application on risk factors and diseases of older age, a number of evidence-based studies are already available in this field. As a "resistance-type exercise", WB-EMS naturally has a particularly prominent effect on muscular parameters (overview in [3]). Focusing first on muscle mass, in addition to the influence on muscle function, there is also a central importance in the area of basal metabolic rate [4], increased capillarization and maximum oxygen uptake [5], and thermoregulation [6, 7]. Since muscle mass provides the highest contribution to basal metabolic rate, muscle mass plays an important role in the area of obesity [8] or sarcopenic obesity [9]. Several studies with older people (overview in [3]) show a significant increase in muscle mass in the range of HIT strength training [10]. An accompanying protein intake in the range of 1.5-1.7 g/d/kg body weight may further significantly enhance this WB-EMS induced effect [12, 13]. Also in the area of muscle function, which is particularly relevant for older people, WB-EMS concepts with adjuvant light forms of movement show a highly relevant influence on muscle function (overview in [3]). Regarding dynamic maximum strength, changes in strength in the range of 15-25% could be demonstrated after 12-16 weeks of WB-EMS application (1.5 x 20 min/week), which, in relation to the strength of hip and knee extensor muscles, is only slightly below the corresponding effects of a HIT-RT intervention [10]. Given the very positive effects on musculature, the effect of WB-EMS training on bone density as a surrogate for fracture resistance is less prominent [14]. Nevertheless, in our opinion, positive data [14] in the field of whole-body vibration can be expected [15].

In addition to musculoskeletal parameters, factors correlated with cardiometabolic risk factors and diseases also show favorable changes after WB-EMS application [3]. The effects on total and abdominal fat mass are particularly prominent. Almost all available studies show a reduction in total body fat that is somewhat higher than the increase in muscle mass [3]. In addition to classic cardiometabolic risk factors (blood pressure, blood lipids, glucose), some WB-EMS studies [17-19] also show effects in people with heart failure, including a higher ejection fraction [17, 18].

High Acceptance

Moreover, the existing studies with older people showed no significant "undesirable" side effects [3]. It is also noteworthy that the acceptance of WB-EMS training by seniors, at least in a closely supervised setting, is very high.

An Ideal and Effective Tool for Older People

Therefore, WB-EMS appears to be an ideal "tool" for health-oriented training of older people. However, for successful EMS training with seniors, some points need to be considered to a special degree. Particularly important for the application of WB-EMS within the often fragile group of older people with little body awareness and lack of reference for stress stimuli is the question of safety and tolerability.

A consistent review and application of exclusion criteria and medical contraindications is mandatory. For seniors who want a medical clearance for EMS training, even the mostly non-WB-EMS-savvy family doctor can be enabled to make a reliable decision for or against WB-EMS through an information flyer with a link to additional neutral information sources. Collaborations between doctors and EMS providers facilitate the medical decision through knowledge of the qualification of the facility and its staff.

Guidelines for Safe EMS Application

In addition, we consider the application of the WB-EMS guidelines [1] to be absolutely binding, not only, but especially for seniors. A central aspect of the guidelines is very close supervision, where a maximum of two trainees are supervised by one therapist. Older people who are neither sports nor technology-savvy benefit particularly from this very close supervision and interaction. Therefore, the closest possible supervision ratio is an absolute quality criterion not only in terms of safety but also effectiveness.

Great Potential with High Benefits

In conclusion, considering the very high potential and special features of WB-EMS training with seniors, it is surprising that senior-specific offers or at least senior-specific addressing of the existing, in some cases definitely high-quality offer in health-oriented WB-EMS currently hardly play a role.

EMS training in oncology offers cancer patients an innovative addition to exercise therapy. It enables effective muscle building and strength training that is easy on the joints, even during therapy. Initial experiences show potential for preparing for surgery and for combating weight and muscle mass loss (cachexia).

In November 2012, the Center for Integrated Oncology (CIO) Cologne Bonn, the University Hospital Cologne, and the German Sport University Cologne established a movement therapy training center exclusively for oncological patients.

In the past, cancer patients were advised to rest as much as possible and avoid exertion. This approach is now outdated. Today, medical professionals and scientists are convinced of a positive correlation between physical activity and the condition and mental state of cancer patients. In an area of approximately 110 square meters, cancer patients are trained by experienced and specially qualified therapists as part of their care and also within scientific studies.

What's special about Oncological Training Therapy in Cologne: Physicians, psychologists, and sports scientists work together under one roof, right where patients receive their medical care.

For over a year now, in addition to classic strength and endurance equipment, a medical EMS device from miha bodytec has also been in use.

Does EMS Training Work with Cancer Patients?

Our initial experiences with whole-body EMS training for oncological patients suggest that the training is not only feasible but also effective in building strength and muscle, potentially serving as a useful complement to conventional training methods. The training was very well implemented for patients before or after completed oncological therapy, but was also possible for patients undergoing acute medical treatment, such as chemotherapy or radiation. Of course, especially during acute therapy, specially trained oncology-specific trainers are needed to address possible contraindications and limitations due to the disease or therapy (e.g., low blood counts). Moreover, constant dialogue with patients before, during, and after training is mandatory.

The training itself should be conducted in a 1:1 setting, as oncological patients have very different prerequisites and limitations. For optimally effective training, intensities, exercises, and scope should be personalized. We found that patients approach this new training method with a healthy measure of caution in the first session, but become accustomed to the electrical stimulation during the initial training unit. Thus, the electrical impulses can and should be accompanied by everyday functional movements early on. By the second training session, many patients' initial inhibitions about higher intensities of electrical pulses were resolved, and the desired training ranges for muscle building could be achieved. This is an advantage over many conventional forms of training, where sufficient movement quality often needs to be established first to work safely at higher intensities. In EMS training, intensity regulation occurs through electrical application and is therefore passively administered to the patient, meaning that theoretically, one could train at very high intensities very quickly without special prior knowledge, at least in terms of muscle and strength training. This is where I see the primary application of EMS training in oncology. An effective and time-saving strength training that doesn't require special prior knowledge from cancer patients. Additionally, depending on the form of execution, the training can be conducted in a joint- and bone-sparing manner, which can be highly relevant in oncology in the context of osteoporosis, bones at risk of fracture, and chronic joint pain. I currently see no application for endurance training via EMS applications, as there are no discernible advantages over conventional methods for me.

Perspectives on EMS Training in Oncology

I consider EMS training to be a useful addition and extension to the movement therapy repertoire in oncology. Truly, EMS training is not suitable for everyone, but there are some situations where EMS training shows particular potential. On one hand, it needs to be clarified in the future whether EMS training is more effective compared to conventional strength training in maintaining or building muscle strength and mass. Tumor-associated weight and muscle mass loss (cachexia) often progresses rapidly and is difficult to treat. A multimodal approach with intensive strength training at initial weight loss could potentially slow down or halt the progression of cachexia, especially through the quickly achievable high intensities of EMS training for strength and muscle maintenance or building. Another potential of EMS training could be short-term interventions over a period of 2-3 weeks. This is often the timeframe between diagnosis and the start of therapy and offers the opportunity to conduct build-up training to best prepare patients for surgery or chemotherapy. Quickly learnable and effective training methods like EMS training are also suitable for this. Of course, these initial impressions still need to be demonstrated through high-quality studies. However, our first experiences already show initial positive trends. In my view, EMS training cannot replace proven training methods, but it offers an innovative addition to the existing movement therapy contingent in oncology.