Guidelines for Safe and Effective Whole-Body EMS Application

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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

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References:

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

DIN 33961-5:2023-09 Fitness club - Requirements for equipment and operation - Part 5: Electromyostimulation training (EMS-Training)