Focus on Seniors - An Ideal Target Demographic

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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.

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References:

1. Kemmler W, Froehlich M, von Stengel S, Kleinöder H. Whole-Body Electromyostimulation – The Need for Common Sense! Rationale and Guideline for a Safe and Effective Training. Dtsch Z Sportmed. 2016;67:218-221.
2. Kemmler W, Shojaa M, Kohl M, von Stengel S. Exercise effects on bone mineral density in older men: a systematic review with special emphasis on study interventions. Osteoporos Int. 2018.
3. Kemmler W, Weissenfels A, Willert S, et al. Efficacy and safety of low frequency Whole-Body Electromyostimulation (WB-EMS) to improve health-related outcomes in non-athletic adults. A systematic review. Frontiers of Physiology. 2018;9:573. :doi: 10.3389/fphys.2018.0057.
4. Muller MJ, Geisler C, Hubers M, Pourhassan M, Braun W, Bosy-Westphal A. Normalizing resting energy expenditure across the life course in humans: challenges and hopes. Eur J Clin Nutr. 2018;72:628-637.
5. Hepple RT, Mackinnon SL, Goodman JM, Thomas SG, Plyley MJ. Resistance and aerobic training in older men: effects on VO2peak and the capillary supply to skeletal muscle. J Appl Physiol (1985). 1997;82:1305-1310.
6. Payne S, Macintosh A, Stock J. Body size and body composition effects on heat loss from the hands during severe cold exposure. American journal of physical anthropology. 2018;166:313-322.
7. Rowland LA, Bal NC, Periasamy M. The role of skeletal-muscle-based thermogenic mechanisms in vertebrate endothermy. Biological reviews of the Cambridge Philosophical Society. 2015;90:1279-1297.
8. Strasser B, Schobersberger W. Evidence for resistance training as a treatment therapy in obesity. Journal of obesity. 2011;2011:http://dx.doi.org/10.1155/2011/482564.
9. Goisser S, Kemmler W, Porzel S, et al. Sarcopenic obesity and complex interventions with nutrition and exercise in community-dwelling older persons--a narrative review. Clin Interv Aging. 2015;10:1267-1282.
10. Kemmler W, Teschler M, Weissenfels A, Fröhlich M, Kohl M, von Stengel S. Ganzkörper-Elektromyostimulationst versus HIT-Krafttraining - Effekte auf Körperzusammensetzung und Muskelkraft. Dtsch Z Sportmed. 2015;66:321-327.
11. Bauer J, Biolo G, Cederholm T, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc. 2013;14:542-559.
12. Kemmler W, Grimm A, Bebenek M, Kohl M, von Stengel S. Effects of Combined Whole-Body Electromyostimulation and Protein Supplementation on Local and Overall Muscle/Fat Distribution in Older Men with Sarcopenic Obesity: The Randomized Controlled Franconia Sarcopenic Obesity (FranSO) Study. Calcif Tissue Int. 2018;103:266-277.
13. Kemmler W, Weissenfels A, Teschler M, et al. Whole-body Electromyostimulation and protein supplementation favorably affect Sarcopenic Obesity in community-dwelling older men at risk. The Randomized Controlled FranSO Study. Clin Interv Aging. 2017;12.
14. von Stengel S, Bebenek M, Engelke K, Kemmler W. Whole-Body Electromyostimulation to Fight Osteopenia in Elderly Females: The Randomized Controlled Training and Electrostimulation Trial (TEST-III). Journal of osteoporosis. 2015;2015:643520.
15. Peretti AL, Ciqueleiro RT, Flores LJ, Bertolini GR. Use of whole-body vibration as osteoporosis treatment in postmenopausal women: a systematic review. Eur J Clin Exp Med. 2019;17:146-152.
16. Teschler M, Wassermann A, Weissenfels A, et al. Short time effect of a single session of intense whole-body electromyostimulation on energy expenditure. A contribution to fat reduction? Appl Physiol Nutr Metab. 2018;43:528-530.
17. van Buuren F, Mellwig KP, Frund A, et al. Electromyostimulation: Verbessserung von Lebensqualität, Sauerstoffaufnahme und linksventrikuläerer Funktion bei chronischer Herzinsuffizienz. Rehabilitation. 2014;53:321-326.
18. van Buuren F, Mellwig KP, Prinz C, et al. Electrical myostimulation improves left ventricular function and peak oxygen consumption in patients with chronic heart failure: results from the exEMS study comparing different stimulation strategies. Clinical research in cardiology: official journal of the German Cardiac Society. 2013;102:523-534.
19. Fritzsche D, Fruend A, Schenk S, et al. Elektromyostimulation (EMS) bei kardiologischen Patienten. Wird das EMS-Training bedeutsam für die Sekundärprävention? Herz. 2010;35:34