Science

Whole-body EMS training offers an effective and time-saving solution for the prevention and therapy of muscle atrophy and sarcopenia, especially for older people or those who are not very sporty. With individual supervision in a 1:1 or 1:2 setting, a high stimulus intensity is achieved that promotes muscle mass, strength and function, while being easier on the joints and less stressful than traditional strength training. Studies show the effectiveness of EMS in old age, particularly in terms of muscle building and maintenance.

The ageing process of the human body is not only reflected in wrinkled skin and grey hair. In youth and young adulthood, muscle mass and strength usually increase and reach maximum values, stagnate in mid-life and decrease again with advancing age.

Whole-body EMS training offers a simple and effective way to start building and maintaining muscle mass and function early on, because this is the prerequisite for counteracting muscle loss in old age or sarcopenia. Maintaining and building muscle helps to maintain quality of life in the long term [4, 5].

Extent and causes of age-related muscle loss

The ageing process is associated with a generalised and progressive loss of muscle mass and strength. From the age of 50, muscle mass decreases by around 1–2 % and muscle strength by 1.5–5 % per year [1]. The loss of fast-twitch type 2 muscle fibres is particularly rapid [2]. This is associated with a decrease in functional performance, which manifests itself, for example, in difficulties with walking, standing up or carrying. Mobility and independence are increasingly affected [2].

A variety of complex age-related processes are responsible for muscle loss, including:

• changes in hormonal balance
• changes in muscle protein synthesis and breakdown
• neurodegeneration
• increase in inflammatory factors
• insulin resistance
• reduction in the number and activation of satellite cells
• oxidative stress

Factors that promote muscle anabolism, such as insulin-like growth factor-1 (IGF-1) or testosterone, decrease. Factors that contribute to skeletal muscle breakdown, such as inflammatory cytokines, increase. In old age, connective tissue and fat are also increasingly deposited in and around the muscles [2-4].

 

Sarcopenia: definition and measurement methods

Sarcopenia is generally defined as an excessive, progressive, generalised loss of muscle mass, strength and function. Sarcopenia is now considered a skeletal muscle disease caused by adverse muscle changes that occur over the course of a lifetime.

Sarcopenia is common among older adults, with prevalence/incidence increasing with age. However, younger people can also suffer from it [5, 6]. Sarcopenia is considered ‘primary’ (or age-related) if no other specific cause for muscle loss can be identified beyond aging. If other causal factors are present (or in addition to aging), it is considered ‘secondary’. These include systemic diseases such as cancer, endocrine, neurological and, in particular, inflammatory diseases [5]. In addition, physical inactivity, for example due to a sedentary lifestyle or illness-related immobility, as well as poor nutrition with insufficient energy and/or protein intake, can lead to the development of sarcopenia [4, 5].

Consequences of sarcopenia

Sarcopenia is associated with a number of negative, often serious, consequences. For those affected, coping with everyday life becomes increasingly difficult. Sarcopenia leads to an increased risk of falling [7, 8], impaired mobility [9] and a progressive loss of independence [10] and quality of life [11, 12]. Sarcopenia is a major cause of the geriatric syndrome frailty [13] and is associated with osteoporosis [12], type 2 diabetes [14], heart disease [15], respiratory disease [16] and cognitive impairment [17]. Ultimately, sarcopenia is associated with disability [5], hospitalisation [18], the need for care [19] and a 3.6-fold increase in mortality [7].

Prevention and treatment of muscle loss in old age/sarcopenia

Physical activity, especially strength training, is considered the most effective intervention for the prevention and treatment of normal and excessive (sarcopenia) age-related muscle loss – and is also recommended in the guidelines. It improves muscle strength, muscle mass and physical performance. [4, 6]

To prevent or delay sarcopenia as much as possible, the musculature should be maximised in youth and young adulthood, maintained in middle age, and muscle loss minimised in old age [5, 20]. Regular strength training in middle to old age can slow muscle loss, prevent sarcopenia, and maintain physical function, mobility, independence, and quality of life for longer.

Whole-body EMS training is an ideal prevention and therapy option into old age.

Not all older people are able to achieve the comparatively high stimulus intensity required for good muscle building and maintenance in strength training, or to perform conventional high-intensity strength training. Furthermore, many people refuse to do strength training several times a week. In addition to a lack of motivation and convenience, a lack of time often plays a major role. [21, 22]

For this group of people who are not very sporty or are already weakened, whole-body EMS training is an attractive and effective option [21, 22]. It overcomes the challenges and hurdles of conventional strength training for muscle building – for people of all ages.

The application takes place under individual supervision in a 1:2 or 1:1 setting and, at once a week for about 20 minutes, is a time-saving procedure in which the effect of light, subliminal physical exercises is intensified to an effective level and a high stimulus intensity is achieved. EMS training also ensures immediate, continuous recruitment of type 2 muscle fibres [21-24]. Since no weights are used, whole-body EMS training is particularly gentle on the joints and subjectively less demanding.

The effectiveness and safety of whole-body EMS for the prevention and therapy of age-related muscle loss and sarcopenia has been demonstrated in various studies. Among other things, it has been shown to have a positive influence on muscle mass, strength, function, functional performance and abdominal fat [25-29]. At the molecular level, EMS modulates factors, particularly IGF-1, that promote muscle protein synthesis, inhibit muscle breakdown and activate satellite cells [30, 31].

Whole-body electromyostimulation (WB-EMS) is a time-efficient, high-intensity training method targeting all major muscle groups simultaneously. While effective and safe when applied correctly, improper use can cause severe risks like rhabdomyolysis. This guide outlines absolute and relative contraindications, ensuring safe WB-EMS application in therapy, prevention, and sports contexts. Learn essential precautions, updates, and best practices for optimal results and risk management

Whole-body electromyostimulation (WB-EMS) refers to the simultaneous stimulation of all major muscle groups (using at least six applied current channels) with a training-effective stimulus that triggers adaptations. It is used as a highly intensive and time-efficient form of training in therapy and prevention, as well as in recreational, amateur and professional sports (Berger, 2021; Kemmler, Kleinöder & Fröhlich, 2020).

When applied correctly, GK-EMS is an effective and safe form of training. However, due to the extensive application and simultaneous contraction of large muscle groups, it also carries a certain risk if not performed correctly. Supramaximal stimulation of the individual body regions and the resulting high metabolic stress for the organism can lead to undesirable side effects, including overuse, which in the worst case can result in rhabdomyolysis (muscle tissue breakdown) caused by a massive increase in creatine kinase (CK), which is an enzyme that occurs when muscle tissue is damaged (Teschler et al., 2016). In general, there is an adequate increase in CK after every sporting activity. However, an excessive increase due to overloading the muscles is a factor that must be avoided at all costs in GK-EMS. In past studies, an initial GK-EMS application that was too intensive led to a massive increase in CK values, from which it was concluded that the initial GK-EMS training units in particular to slowly get the organism used to the new form of training and to prevent rhabdomyolysis (Kemmler, Fröhlich, Stengel & Kleinöder, 2016).

As with any new form of training, the start of GK-EMS training should therefore be done cautiously and with consideration of the current state of health of the user, as well as with professional support from trained specialists. Apart from aspects of individualised and adequate implementation, there are other essential criteria for GK-EMS that must be met before the first application can take place (Berger, 2022; Kemmler et al., 2019). Due to the involuntary contraction of the musculature and – in the event of improper use – the resulting potential for danger, GK-EMS can only be compared to a limited extent with classic strength or endurance training. For this reason, it seems essential to formulate guidelines for the safe and effective implementation of GK-EMS. The first instructions regarding anamnesis, initial instruction, the care relationship and the safe implementation of training were therefore already published in 2016 (Kemmler et al., 2016). Based on this, the test criteria of DIN 33961 – Part 5 include further formalised regulations regarding contraindications to the use of GK-EMS. These are intended to serve as a guide in daily practice by defining exclusion criteria for GK-EMS training.

A distinction is made between relative and absolute contraindications (Kemmler et al., 2019). In the presence of absolute contraindications, GK-EMS application must be categorically rejected due to the acute risk to the trainee, as it can lead to physical impairments that are significantly detrimental to health. Thus, GK-EMS application would be associated with too high risks and should not be carried out under any circumstances due to the duty of care towards customers/patients.

Absolute contraindications

The absolute contraindications, as well as the relative contraindications discussed later, must be checked in advance of the first GK-EMS training session and archived in a separate medical history sheet. The following factors are considered absolute contraindications:

• Acute illnesses, bacterial infections and inflammatory processes:
  During athletic exertion, the body experiences an increased immunological stress situation. In the presence of acute illnesses, bacterial infections and inflammatory processes, the body is already significantly weakened before training and more susceptible to further infections, which is why athletic exertion and accordingly GK-EMS training is generally not recommended (Baum & Liesen, 1998).
  
  
• Recently performed surgery:
  If there is an open or sutured wound in the application area of the GK-EMS electrodes due to surgery, this fundamentally precludes training. Outpatient procedures such as the removal of a mole are not directly affected by this, provided the wound is not directly under an electrode. Physical exertion of any kind should be avoided as long as the wound has not yet closed on its own and has been sutured. In general, it is important to note that complete recovery from the condition that necessitated the operation must have occurred before GK-EMS training. To be on the safe side, consult with the doctor treating you.
  
  
• Arteriosclerosis and arterial circulatory disorders:
  Atherosclerosis is also known as hardening of the arteries and describes the deposits of blood lipids, blood clots, connective tissue and calcium (so-called plaques) on the inner wall of arterial vessels. As a result, the affected muscles and organs are no longer supplied with sufficient blood due to the narrowing and hardening of the arteries. In the worst case, a blood clot (thrombus) forms on the deposits, causing the artery to close and resulting in a heart attack or stroke (Marées, 2003). The effects of GK-EMS in particular on arteriosclerotic diseases have not been sufficiently researched at this time. However, since the progression of the disease can be life-threatening, GK-EMS training should be avoided at all costs in the context of the clinical picture described here (Kemmler et al., 2019).
  
  
• Stents and bypasses that have been active for less than six months:
  Stents are used to stabilise and widen narrowed vessels and, as vascular supports, ensure that the artery does not become narrowed or blocked again. Bypasses bypass narrowed blood vessels and thus redirect the blood flow. Both procedures represent a major intervention in the human organism, which is why it is important, especially during the rehabilitation phase, to slowly get the patient used to sporting activities. Intensive training should therefore be avoided at all costs in order not to put too much strain on the new structures. Recommendations of the German Heart Foundation include light endurance training in the form of fast walking or participating in a cardiac sports group. In comparison, GK-EMS is a much more intensive form of training, which puts many times more strain on the organism and all the structures involved in the movement. Therefore, it should only be performed in postoperative rehabilitation (lasting six months) after sufficient recovery and medical clearance (Albrecht & Mooren, 2018).
  
  
• Untreated high blood pressure:
  High blood pressure (arterial hypertension) is one of the main risk factors for cardiovascular diseases and is one of the most common chronic conditions worldwide. As blood pressure rises, so does the risk of stroke and heart attack, and there is an increased risk of kidney failure (Reimers & Völker, 2018). Once high blood pressure has been treated, an adapted, medically supervised sporting activity is possible without any problems – however, untreated high blood pressure must be medically clarified in order to avoid possible consequences and fundamentally excludes a sporting training programme, including GK-EMS (Predel, 2007).
  
  
• Diabetes mellitus:
  Diabetes mellitus, a disorder of carbohydrate metabolism, occurs in different forms and can be categorised into type 1 diabetes mellitus (absolute insulin deficiency), type 2 diabetes mellitus (insulin resistance and different insulin availability) and other specific forms of diabetes (endocrinopathies, drug-induced forms, etc.). Depending on the severity of the disease, physical activity can have a positive effect on the organism. However, the simultaneous strain on many large muscle groups and the resulting high metabolic load can lead to complications such as hypoglycaemia in the present clinical picture. Although the exact influence of GK-EMS on the organism of a diabetic person has not yet been conclusively clarified, diabetes mellitus is to be regarded as an absolute contraindication due to the high risk potential (Kemmler et al., 2019).
  => Update June 2024: Diabetes is no longer an absolute contraindication for EMS, but a relative contraindication that requires careful evaluation and individual adjustment. When used correctly and under medical supervision, EMS training can be a valuable addition to the management of diabetes.
  
  
• Pregnancy:
  There are currently no scientific findings regarding the risks of using GK-EMS during pregnancy. However, this lack of information contributes to its classification as an absolute contraindication, since a lack of evidence of harmful effects is not synonymous with the safe use of GK-EMS during pregnancy. The protection of both mother and child is paramount, which is why any potential risk posed by GK-EMS must be ruled out.
  
  
• Electrical implants and pacemakers:
  Electrical implants and pacemakers measure cardiac activity using a sensor in the ventricle or in direct contact with the heart muscle. In the event of cardiac dysfunction, the necessary countermeasure can be taken immediately in the form of an electrical impulse, e.g. in the case of ventricular fibrillation, which is a life-sustaining measure. Since electrical impulses are also used in GK-EMS and so far there is no manufacturer information about potential interference of these impulses with those of the implants, a negative influence of the GK-EMS cannot be fundamentally excluded. Therefore, there is a possibility that, in the worst case, the stimulation could endanger the life of the trainee, which is why electrical implants and pacemakers are listed as absolute contraindications.
  
  
• Cardiac arrhythmias:
  After extensive diagnosis of an existing cardiac arrhythmia, training at an adequate intensity can in many cases have a health-promoting effect, although this depends to a large extent on the exact nature of the condition. To date, there is no evidence-based information on whether high-intensity GK-EMS training can be performed despite cardiac arrhythmias, which is why its use should be ruled out due to potentially life-threatening consequences (Hordern et al., 2012).
  
  
• Tumours and cancer:
  In the case of tumours and cancer, physical activity is usually recommended, even at a high intensity (Dimeo & Thiel, 2008). At present, there are no evidence-based statements regarding the design of GK-EMS training for the treatment of this disease. Furthermore, there are no findings on potential tumour growth due to GK-EMS in the acute therapy phase, which is why GK-EMS training should be excluded. After the acute therapy phase has ended, GK-EMS application can be considered after prior medical clarification.
  => Update June 2024: Cancer is now viewed in a differentiated way and is no longer seen as an absolute contraindication, but as a relative contraindication that requires careful individual evaluation. Close coordination between patient, doctor and trainer is always a prerequisite for the use of EMS to ensure that the training is safe and beneficial.
  
  
• Bleeding disorder and bleeding tendency (haemophilia):
  In the case of a bleeding disorder, also known as haemophilia, wounds close more slowly and spontaneous bleeding may occur, e.g. in the form of joint bleeding. Wounds close much more slowly in those affected, occur more frequently and can lead to high blood loss. Since the effects of GK-EMS on bleeding disorders or bleeding tendencies have not yet been fully researched, GK-EMS training is categorically excluded due to the high risk for the affected patients (Kemmler et al., 2019).
  
  
• Neuronal diseases, epilepsy and severe sensitivity disorders:
  In GK-EMS, the involuntary contraction of the musculature is caused by stimulation of the nerve fibres located under the electrode, which transmits the signal to the muscle. In the case of epileptic disorders or hyper-excitability of nerve cells, this external stimulation could already lead to an increased tendency to have seizures, which is why GK-EMS is contraindicated due to the increased risk potential.
  
  
• Abdominal wall and inguinal hernias:
  As an acute and serious injury to the abdomen, an abdominal or inguinal hernia could be aggravated by physical exertion or pressure and tensile stress on the corresponding wound. This can result in the potential leakage or damage of internal organs. In this case, direct medical attention is required and therefore excludes any kind of sporting activity, including GK-EMS.
  
  
• Acute influence of alcohol, drugs or intoxicants:
  Due to the risk of massive damage to the organism under the influence of alcohol, drugs or intoxicants, physical training must be ruled out.

Relative contraindications

Relative contraindications describe indications that must be clarified by a specialist before GK-EMS training can be carried out or that exclude application to certain areas of the body. They are not general exclusion criteria for GK-EMS training and leave a certain amount of room for interpretation and action, which can, however, lead to uncertainties in practical implementation. The relative contraindications include the following factors:

• Acute back pain without diagnosis
• Acute neuralgia, herniated discs
• Implants that are older than six months
• Diseases of the internal organs, especially kidney disease
• Cardiovascular diseases
• Motion sickness
• Larger fluid accumulations in the body, oedema
• Open skin injuries, wounds, eczema, burns
• Taking certain medications

The relative contraindications, some of which are broadly and imprecisely formulated, are not intended to deter customers/patients, as indications must be clarified in advance with a medical professional. Rather, they serve a protective purpose: serious health impairments are to be recorded in order to determine whether these could have a direct influence on the resilience of the exercisers. This ensures safe and effective GK-EMS training. Medical conditions or episodes of pain that occurred some time ago do not constitute acute impairments. The decision as to whether or not to request a medical clearance ultimately depends on the overall medical history of the individual and the overall assessment of their state of health and their level of resilience.

If the impairments are only minor or occurred some time ago, this does not necessarily have to lead to a classification as a relative contraindication. Neuralgia (pain in the area supplied by a nerve) or herniated discs, for example, are only relative contraindications in the acute phase, as they lead to an impairment of the functional state, whereby the performance of the intervention is not possible without restrictions.

Relative contraindications such as oedema formation (accumulation of fluid in the body) or motion sickness (dizziness when moving) are symptoms whose cause usually remains unknown without medical clarification. These causes may be harmless; however, they could also be a leading symptom of a serious illness. Therefore, a specialist medical examination is essential in order to be able to carry out safe and effective GC-EMS training. However, if this is carried out within the scope of responsibility and competence of the trainer or therapist, care should be taken to ensure that the health benefits of GC-EMS application are weighed against the risks of the illnesses when checking for potentially existing relative contraindications. The aim of the query should not be to dramatise minor health impairments by classifying them as relative contraindications and only allowing GK-EMS training to take place after medical clearance.

In summary, it should be noted that the query of absolute and relative contraindications in accordance with scientific guidelines and in compliance with national regulations (e.g. DIN 33961 – Part 5) supports the effective and safe implementation of training and is of great advantage for both the customer/patient and the trainer/therapist.

Discover how whole-body EMS is becoming a global standard for safe and effective muscle stimulation. Learn about DIN 33961-5 and new international guidelines shaping prevention and rehabilitation practices.

The application of whole-body electromyostimulation (EMS) requires a high level of safety due to the intense stimulation of the muscles. In recent years, scientific studies have further clarified the measures necessary for its safe and effective use. Alongside national standardization in Germany, the internationalization of safety standards is becoming increasingly significant.

As early as 2017, safety guidelines were developed in collaboration with leading exercise scientists from the universities of Cologne, Kaiserslautern, and Erlangen to establish clear standards for users, operators, and trainers. These guidelines were incorporated into the German DIN 33961-5 standard in 2019. By specifying the interaction between trainers and users, the standard ensures necessary control and minimizes risks such as rhabdomyolysis, a severe muscle injury.

With the growing global popularity of whole-body EMS, the importance of international standards is becoming increasingly clear. The international position paper by Kemmler et al. (2023), published in Frontiers in Physiology, marks a milestone in the harmonization of safe EMS applications. A research group comprising 20 experts from Germany, Spain, the United States, and other countries developed comprehensive guidelines for the safe and effective use of whole-body EMS. These guidelines are scientifically grounded and provide practical recommendations for implementation.

The paper highlights the potential of EMS in prevention and rehabilitation, provided strict safety standards are observed. It also underscores the importance of robust training for EMS trainers to ensure both effectiveness and safety. Combining national standards, such as DIN 33961-5, with international guidelines creates a reliable foundation for the safe use of EMS and enhances confidence in its health benefits.

These developments represent a crucial step toward establishing whole-body EMS as a safe and effective method in prevention and therapy—both in Germany and worldwide.

Whole-Body electromyostimulation – a guideline for safe and effective use

Definition

Whole-body EMS is a simultaneous application of current via at least six current channels involving all major muscle groups, with a current pulse that is effective in training and triggers adaptations.

In general,

1. Safe and effective whole-body EMS training must always be carried out with the support of a trained and licensed EMS trainer.
2. A trainer may supervise a maximum of two trainees at a time. For each newcomer, an anamnesis must be carried out before the first training session, with a written query of the contraindications. This is documented in writing, confirmed by the signature of the customer and the person querying, and archived. If there are any relevant abnormalities, training may only be carried out after medical clearance.

Preparation for training:

1. As with any intensive physical training, it is important to note that whole-body EMS training should only be carried out by people who are in good physical condition and do not experience pain. This includes not consuming alcohol, drugs, stimulants/muscle relaxants or exhaustive exercise beforehand. In particular, training should be avoided completely if you have a feverish illness.
2. Whole-body EMS training leads to a very high metabolic load on the organism due to the very high amount of muscle mass used. This condition should be taken into account by consuming a sufficient amount of carbohydrate-rich food in advance. If this is not possible, a carbohydrate-rich snack (≈250 kcal) that is not burdensome should be consumed ideally about 2 hours before training.
3. To counteract possible kidney stress (especially in the case of unknown pre-existing damage) caused by intensive WB-EMS application, an increased fluid intake (500 ml each) before/during and after training is to be ensured.

Conducting the training:

1. Regardless of the user's physical condition, previous sports experience and the corresponding desire, under no circumstances should a WB-EMS training session take place during the first training session or a trial training session. In the past, this approach in particular has led to undesirable side effects and negative health consequences and must therefore be avoided at all costs.
2. After a moderate initial WB-EMS application, the stimulus level or current intensity must be gradually increased and adapted to the individual goals. The highest level of exertion may only be applied after 8–10 weeks of systematic training at the earliest (user's subjective assessment of exertion: hard–hard+). A full exertion workout, especially in the sense of a painful, continuous tetanus during the current phase, must be avoided in general.
3. In addition, the initial training should take place with a reduced effective training time. A 5-minute impulse familiarisation and a shortened training session with a moderate stimulus intensity (user's subjective assessment of the level of difficulty: somewhat difficult) and intermittent loading with a short impulse phase (≈) over 12 minutes is recommended. The training duration should only be carefully increased after this and should ultimately not exceed a maximum of 20 minutes.
4. To ensure sufficient conditioning and to minimise or exclude possible health impairments, the training frequency must not exceed one training session per week during the first 8–10 weeks.
5. Even after this conditioning phase, a period of ≥4 days must be observed between training sessions to prevent the accumulation of muscle breakdown products, to ensure recovery and adaptation, and thus to ensure training success.

Safety aspects during and after training:

1. The trainer or trained and licensed personnel must attend exclusively to the needs of the user(s) during the training session. Before, during and after training, the trainer must check the condition of the user verbally and by visual inspection to rule out health risks and ensure effective training. If there are any contraindications, training must be stopped immediately.
2. The distance between trainer and trainee should only be such that the trainer can visually monitor the trainee, exchange information with the trainee without a greater spatial distance and reach the trainee within one second.
3. To control the intensity of the current, a verbal query about the individual strain and, if necessary, an adjustment of the current intensity must be made at least three times during a training session (usually 20 minutes of training) for each current channel or muscle group. This is the only way to ensure an effective training stimulus intensity on the one hand and to minimise the risk of overloading on the other.
4. During training, the device's controls must be directly accessible to the trainer and the trainee at all times. It must be possible to operate/adjust the device easily, quickly and precisely.

Conclusion:

In the context of these guidelines, the experts have only addressed supervised WB-EMS. In fact, there was general consensus that safe and effective WB-EMS application can only be guaranteed in this context. They therefore explicitly advise against private use of the technology without the supervision of a trained and licensed trainer or appropriately scientifically trained personnel. In this context, they are also critical of the approach taken by some providers of increasing the supervision ratio to such an extent that, even taking into account technical developments and the training of trainers, it no longer allows for personalised and thus safe and effective training.

 

Kemmler W, Fröhlich M, Ludwig O, Eifler C, Von Stengel S, Willert S, Teschler M, Weissenfels A, Kleinöder H, Micke F, Wirtz N, Zinner C, Filipovic A, Wegener B, Berger J, Evangelista A, D’ottavio S, Sara JDS, Lerman A, Perez De Arrilucea Le Floc’h UA, Carle-Calo A, Guitierrez A and Amaro-Gahete FJ (2023) Corrigendum: Position statement and updated international guideline for safe and effective whole-body electromyostimulation training-the need for common sense in WB-EMS application. Front. Physiol. 14:1207584. doi: 10.3389/fphys.2023.1207584

Applications of electric, magnetic and electromagnetic fields (EMF) in humans for non-medical purposes  - Recommendation by the German Commission on Radiological Protection with scientific background - Adopted by circulation on 12 August 2019 - BAnz AT 04.03.2020 B6

Non-specific back pain is widespread and often chronic. EMS-Training offers a time-efficient, joint-sparing solution for treatment and prevention by specifically strengthening the core muscles – effective in just 20 minutes a week.

Non-specific back pain is particularly prevalent in high-income countries where sedentary lifestyles and a lack of physical activity are common [1, 2]. This causes muscles in the trunk area in particular to atrophy and lose strength and stabilisation power [3].

EMS-Training is a highly effective and sustainable treatment. This innovative concept, based on a modern form of electrotherapy, offers a time-efficient solution for strengthening the core muscles – both in prevention and in therapy. Numerous studies show a comparatively high level of effectiveness compared to conventional strategies for back strengthening, including the multimodal treatment programme considered the gold standard [4, 5].

 

Back pain: The most common cause of incapacity to work and early retirement

Back pain is one of the most common complaints among the population: around three quarters of all Germans suffer from back pain at least once in their lives [6]. 70–80% of back pain is pain in the lower lumbar area (low back pain, LBP) [7]. The complaints affect more women than men and mainly people in middle age between the ages of 40 and 69 [7].

Since back pain is the most common reason for being unable to work and the second most common cause of early retirement after mental illness and behavioural disorders, the economic impact is also considerable [6]. Depending on their cause, back pain is categorised as either specific or non-specific. In 80% of cases, the pain is non-specific and must be distinguished from back pain caused by a specific condition, such as a herniated disc, infection, fracture or tumour, based on a targeted medical history and physical examination. If there are no neurological symptoms, extravertebral causes or so-called ‘red flags’ (warning signs), the diagnosis of non-specific back pain can be made [6].

 

Therapy:  EMS-Training as a way out of the vicious circle

Non-specific back pain often leads to a vicious circle that hinders active pain control. In most cases, this results in chronicity. On average, two-thirds of those affected (42–75 %) report persistent symptoms after 12 months. Accordingly, avoiding chronification is the declared therapeutic goal in the treatment of non-specific back pain. Risk factors for chronification include sedentary work, low physical fitness, stress, smoking and obesity, but also psychosocial, workplace-related or iatrogenic factors [6]. Non-specific back pain is treated symptomatically and based on the quality and intensity of the pain, the degree of functional impairment and the temporal course of the symptoms (acute (< 6 weeks), subacute [6–12 weeks] and chronic (> 12 weeks) non-specific back pain).

In addition to maintaining physical activity, initial adjunctive analgesic, pharmacological and non-pharmacological treatment options such as acupuncture, relaxation techniques, functional training, manual therapy, heat therapy, etc. can be used. Evaluating and addressing any risk factors and teaching health-conscious behaviour also play an important role in the treatment of non-specific back pain. If the symptoms persist or there is a risk of chronicity or if it already exists, national and European guidelines offer a multimodal treatment programme that is individually tailored to the patient and consists of physiotherapy, physical therapy, psychotherapy, occupational therapy and education [6]. This programme, which can be carried out in both an outpatient and inpatient setting, is currently considered the gold standard for the treatment of non-specific back pain – however, it is very costly and time-consuming.

A more time-efficient method of treating non-specific back pain, which according to study data is comparably effective, is medical electrical muscle stimulation (EMS-Training). A prospective, controlled non-randomised clinical study showed that medical EMS-Training is just as effective as the gold standard of a multimodal therapeutic approach in treating non-specific back pain – and it only takes 20 minutes a week [4].

 

Prevention: Effectiveness and motivation for lasting and holistic behavioural change

Exercise, especially strengthening and stabilising exercises for the core muscles, helps to prevent non-specific back pain. Regular training is essential to strengthen the muscles permanently [6].

With conventional training methods, it is necessary to train several times a week. This is not only time-consuming, but it also leads to increased strain on the joints and the affected musculoskeletal system. A lack of motivation is another factor that makes it particularly difficult to prevent back pain. EMS training offers an effective, particularly joint-friendly and time-efficient solution for long-term prevention – with proven effectiveness in various studies – in just 20 minutes per week [4, 5]. Personal support ensures the necessary motivation and regularity.

The Mayo Clinic's study on Whole-Body Electromyostimulation (WB-EMS) highlights its time-efficient and effective benefits for cardiovascular health. Published in the International Journal of Cardiology, the research led by Dr. Jaskanwal D. Sara and Dr. Amir Lerman shows WB-EMS improves cardiovascular biomarkers, enhances joint protection, and activates more muscle fibers compared to conventional training. With just 20 minutes per week, WB-EMS offers a gentler yet powerful alternative, ideal for those seeking efficient, low-impact exercise.

The Mayo Clinic is considered one of the world's most renowned medical centres and is particularly known for its clinical excellence, research and innovative spirit in medicine.

The study "Physical Training Augmented with Whole Body Electronic Muscle Stimulation (WB-EMS) Favourably Impacts Cardiovascular Biomarkers in Healthy Adults" was conducted by a Mayo Clinic research team led by Dr Jaskanwal D. Sara and Dr. Amir Lerman and was published in November in the International Journal of Cardiology. This journal is one of the most renowned publications in the field of cardiology and regularly publishes new research findings on cardiovascular diseases and preventive cardiology. The results were also presented at the annual meeting of the American Heart Association.

According to the Mayo Clinic study, supervised whole-body electrical muscle stimulation (WB-EMS) training has some notable advantages over conventional training methods, particularly in terms of efficiency and effectiveness for cardiovascular health indicators.

The main advantages of WB-EMS compared to conventional training are:

1. Time efficiency:
   WB-EMS training sessions last only 20 minutes per week, which is a time saving compared to traditional training methods that can take several hours to achieve similar muscle activation and intensity. This makes WB-EMS particularly attractive for people with a limited time budget.
2. Better cardiovascular results:
   The study shows that WB-EMS produces a significant improvement in cardiovascular biomarkers, such as a greater reduction in waist-to-hip ratio and total cholesterol levels compared to conventional exercise. Anaerobic capacity and respiratory efficiency also improved significantly with WB-EMS, which means better oxygen utilisation and energy supply for muscles.
   
   
3. Joint protection:
   As WB-EMS triggers muscle contractions via electrical impulses without high mechanical stress, it is suitable for people who are unable to perform conventional training due to joint problems or other physical limitations. It can be an alternative for people who want to build muscle and promote cardiovascular health but need to avoid intense physical exertion.
   
   
4. Activation of a higher number of muscle fibres:
   WB-EMS simultaneously activates over 90% of large muscle groups and a greater number of muscle fibres compared to conventional training, resulting in higher muscle recruitment. This leads to more intense muscle contractions and potentially better strength gains in less time.

In summary, supervised WB-EMS offers a time-efficient, gentler and more intensive training alternative that is particularly suitable for people who need efficiency and less joint stress or who want to optimise their training.