Heinz Kleinöder

Electromyostimulation--a systematic review of the influence of training regimens and stimulation parameters on effectiveness in electromyostimulation training of selected strength parameters.

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).

Cortical processes associated with continuous balance control as revealed by EEG spectral power.

Balance is a crucial component in numerous every day activities such as locomotion. Previous research has reported distinct changes in cortical theta activity during transient balance instability. However, there remains little understanding of the neural mechanisms underlying continuous balance control. This study aimed to investigate cortical theta activity during varying difficulties of continuous balance tasks, as well as examining the relationship between theta activity and balance performance. 37 subjects completed nine balance tasks with different levels of surface stability and base of support. Throughout the balancing task, electroencephalogram (EEG) was recorded from 32 scalp locations. ICA-based artifact rejection was applied and spectral power was analyzed in the theta frequency band. Theta power increased in the frontal, central, and parietal regions of the cortex when balance tasks became more challenging. In addition, fronto-central and centro-parietal theta power correlated with balance performance. This study demonstrates the involvement of the cerebral cortex in maintaining upright posture during continuous balance tasks. Specifically, the results emphasize the important role of frontal and parietal theta oscillations in balance control.

Electromyostimulation—a Systematic Review of the Effects of Different Electromyostimulation Methods on Selected Strength Parameters in Trained and Elite Athletes

Abstract 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.

Mechanical Load and Physiological Responses of Four Different Resistance Training Methods in Bench Press Exercise

Abstract Buitrago, S, Wirtz, N, Yue, Z, Kleinöder, H, and Mester, J. Mechanical load and physiological responses of four different resistance training methods in bench press exercise. J Strength Cond Res 27(4): 1091–1100, 2013—The purpose of the study was to compare the mechanical impact and the corresponding physiological responses of 4 different and often practically applied resistance training methods (RTMs). Ten healthy male subjects (27.3 ± 3.2 years) experienced in resistance training performed 1 exhausting set of bench press exercise until exhaustion for each of the following RTMs: strength endurance (SE), fast force endurance (FFE), hypertrophy (HYP), and maximum strength (MAX). The RTMs were defined by different lifting masses and different temporal distributions of the contraction modes per repetition. Mean concentric power (P), total concentric work (W), and exercise time (EXTIME) were determined. Oxygen uptake (V[Combining Dot Above]O2) was measured during exercise and for 30 minutes postexercise. Mean V[Combining Dot Above]O2, volume of consumed O2, and excess postexercise oxygen consumption (EPOC) were calculated over 30 minutes of recovery. Maximum blood lactate concentration (LAmax) was also determined postexercise. The P was significantly higher (p < 0.01) for FFE and MAX compared with that for SE and HYP. The W was significantly higher for FFE than for all other RTMs (p < 0.01), and it was also lower for SE than for MAX (p < 0.05). EXTIME for SE was significantly higher (p < 0.01) than for all other RTMs, whereas EXTIME for MAX was significantly lower (p < 0.01) than for all other RTMs. Mean V[Combining Dot Above]O2 was significantly higher during FFE than during all other RTMs (p < 0.01). Consumed O2 was significantly higher (p < 0.05) during SE than for HYP and MAX, and it was also significantly higher for FFE and HYP compared with MAX (p < 0.05). The LAmax was significantly higher after FFE than after MAX (p < 0.05). There were no significant differences in EPOC between all RTMs. The results indicate that FFE and MAX are adequate to train muscular power despite the discrepancy in the external load. Because FFE performance achieves the highest amount in mechanical work, it may also elicit the highest total energy expenditure. The FFE challenges aerobic metabolism most and SE enables the longest EXTIME, indicating both are appropriate to enhance aerobic muscular capacities. The EPOC and LA values may indicate that energy needs covered by anaerobic metabolism are not higher during HYP and MAX compared with the RTM of lower external load.

Moment-angle relations after specific exercise.

This study examined the amount and time-course of shifts in the moment-knee angle relation of the quadriceps (QF) and hamstring (HAM) muscles in response to different length-restricted strength training regimens. Thirty-two athletes were divided into three different training groups (G1-3): G1 performed isometric training at knee joint angles corresponding to long muscle-tendon unit (MTU) length for QF and HAM; G2 conducted concentric-eccentric contraction cycles that were restricted to a knee joint range of motion corresponding to predominantly long MTU length for QF and HAM; G3 combined the protocols of G1 and G2. Moment-knee angle and EMG-knee angle relations of QF and HAM were measured on five different occasions: two times before, after five and eight weeks of training and four weeks post training. Moments and EMG-data of each subject were normalized to the largest value produced at any knee joint position [% Max.]. Obtained by curve fitting, the optimal knee joint angle for QF moment production was significantly (P<0.05) shifted to longer MTU length in G1 and G3 after 5 weeks of training and in G2 after 8 weeks of training. Contrary, no significant shifts were detected for HAM. Our data suggest that the predominant MTU length during loading is a major trigger for human force-length adaptations.

Serum Concentrations of S100B are not Affected by Cycling to Exhaustion With or Without Vibration

Serum Concentrations of S100B are not Affected by Cycling to Exhaustion With or Without Vibration The calcium-binding protein S100B is produced primarily by astrocytes and exerts concentration-dependent paracrine and autocrine effects on neurons and glia. The numerous findings of a correlation between S100B and traumatic brain injury (TBI) have resulted in the employment of this protein as a clinical biomarker for such injury. Our present aim was to determine whether cycling with (V) or without (NV) vibration alters serum concentrations of S100B. Twelve healthy, male non-smokers (age: 25.3±1.6 yrs, body mass: 74.2±5.9 kg, body height: 181.0±3.7 cm, VO2peak: 56.9±5.1 ml·min-1·kg-1 (means ± SD)) completed in random order two separate trials to exhaustion on a vibrating bicycle (amplitude 4 mm and frequency 20 Hz) connected to an ergometer. The initial workload of 100 W was elevated by 50 W every 5 min and the mean maximal period of exercise was 25:27±1:30 min. The S100B in venous blood taken at rest, immediately after the test, and 30, 60 and 240 min post-exercise exhibited no significant differences (p>0.05), suggesting that cycling with and without vibration does not influence this parameter.

A model analysis of the effects of wobbling mass on whole-body vibration

The effects of wobbling mass on the whole-body vibration are studied in terms of the comparison between two models A and B regarding their detailed behavior during the ‘whole-body vibration,’ where Model A is a system of four degrees of freedom with rigid and wobbling masses in both lower body and upper body, while Model B is a system of three degrees of freedom with a rigid upper body and is otherwise identical to Model A. Various quantities are calculated for both models. It is found that for the frequency range where the foot-to-upper-body transmission is important, the wobbling mass is able to reduce the transmissibility, to reduce the amplitude of the oscillation of the center of mass of the body, and therefore to reduce the amplitude of the fluctuation of the external force from the source of vibration. The model analysis reveals the mechanism for these reductions as follows: The oscillation of the wobbling mass in the upper body is carried by the oscillation of the rigid mass of the upper body and therefore the phase of the wobbling mass lags behind the phase of the rigid mass. For this reason, the average power which the wobbling mass in the upper body gives to the rigid mass of the upper body is negative.

Physiological responses and perceived exertion during cycling with superimposed electromyostimulation.

Abstract Wahl, P, Schaerk, J, Achtzehn, S, Kleinöder, H, Bloch, W, and Mester, J. Physiological responses and perceived exertion during cycling with superimposed electromyostimulation. J Strength Cond Res 26(9): 2383–2388, 2012—The goal of the study was to evaluate and to quantify the effects of local electromyostimulation (EMS) during cycling on the cardiorespiratory system, muscle metabolism, and perceived exertion compared with cycling with no EMS. Ten healthy men (age: 24.6 ± 3.2 years, V[Combining Dot Above]O2max: 54.1 ± 6.0 ml·min−1·kg−1) performed 3 incremental cycle ergometer step tests, 1 without and 2 with EMS (30 and 85 Hz) until volitional exhaustion. Lactate values and respiratory exchange ratio were significantly higher at intensities ≥75% peak power output (PPO) when EMS was applied. Bicarbonate concentration, base excess (BE), and Pco2 were significantly lower when EMS was applied compared with the control at intensities ≥75% PPO. Saliva cortisol levels increased because of the exercise but were unaffected by EMS. Furthermore, EMS showed greater effects on CK levels 24 hours postexercise than normal cycling did. Rating of perceived exertion was significantly higher at 100% PPO with EMS. No statistical differences were found for heart rate, pH, and Po2 between the tested cycling modes. The main findings of this study are greater metabolic changes (lactate, respiratory exchange ratio, BE, , Pco2) during cycling with EMS compared with normal cycling independent of frequency, mainly visible at higher work rates. Because metabolic alterations are important for the induction of cellular signaling cascades and adaptations, these results lead to the hypothesis that applied EMS stimulations during cycling exercise might be an enhancing stimulus for skeletal muscle metabolism and related adaptations. Thus, superimposed EMS application during cycling could be beneficial to aerobic performance enhancements in athletes and in patients who cannot perform high workloads. However, the higher demand on skeletal muscles involved must be considered.

Elektromyostimulation (EMS) bei kardiologischen Patienten

ZusammenfassungHintergrund:Die Vorstellung, dass moderates Ausdauertraining im Rahmen der Sekundärprävention die Prognose der chronischen Herzinsuffizienz (CHI) verbessert, wurde inzwischen hinreichend validiert. In der klinischen Routine bleiben jedoch erfahrungsgemäß nur wenige, gut geführte, hoch motivierte und zumeist jüngere Patienten einer dauerhaften sportlichen Begleittherapie zugänglich. Die eigenen Erfahrungen mit Ganzkörper-Elektromyostimulation (EMS-Training) an herzinsuffizienten Patienten zeigen ein bislang nicht erahntes Potential bei der Regeneration neurohumoraler, inflammatorischer und skelettmuskulärer Krankheitssymptome im Rahmen der Systemerkrankung CHI.Die mittels Spiroergometrie dosierte, möglichst tägliche dynamische Belastung ist adjuvanter Bestandteil der leitliniengerechten Therapie von Patienten mit chronischer Herzinsuffizienz. Die positive Beeinflussung klinischer Symptome und der Prognose ist durch Ergebnisse prospektiver, randomisierter Studien evidenzbasiert belegt. In der klinischen Praxis zeigt sich jedoch, dass die Erfolge nur bei intensiver Betreuung und Führung dieser Patienten erreicht werden. Einmal in das häusliche Umfeld gänzlich entlassen, hält die Mehrzahl der Patienten die tägliche Herausforderung einer selbstständigen, aktiven Form der körperlichen Belastung aus mentalen, physischen oder sozialen Gründen nicht aufrecht, und der Circulus vitiosus Systemerkrankung CHI manifestiert sich erneut.Patienten und Methodik:Vor diesem Hintergrund haben die Autoren in einer prospektiven Pilotstudie die Wirkung und die Akzeptanz der Ganzkörper-EMS, einer Art passiven, von der mentalen Einstellung und dem physischen Leistungsvermögen weitgehend unabhängigen Trainingsform, bei herzinsuffizienten Patienten untersucht.Ergebnisse:Eine bis zu 96%ige Steigerung der Sauerstoffaufnahme an der anaeroben Schwelle konnte nachgewiesen werden (VO2at 19,39 [± 5,3] ml/kg Körpergewicht [KG] vor Trainingsbeginn; VO2at 24,25 [±6,34] ml/kg KG am Ende der Trainingsphase; p < 0,05). Der diastolische Blutdruck sank signifikant (psyst < 0,05; pdiast < 0,001), der Muskelzuwachs betrug bis 14% bei Gewichtskonstanz. Die Trainingsmethode wurde zu 100% akzeptiert (keine Abbrecher), die Patienten gaben eine deutlich gesteigerte subjektive Leistungsfähigkeit an.Schlussfolgerung:Die Ergebnisse lassen ein erhebliches Potential in der kardiologischen Primär- und Sekundärrehabilitation erahnen, wobei gerade schwer eingeschränkte Patienten mit CHI überproportional profitierten.AbstractBackground:Current guidelines concerning the treatment of patients with chronic congestive heart failure (CHF) include ergospirometry-directed dynamic exercises on a daily basis. Several prospective, randomized trials have confirmed its positive influence on clinical symptoms and prognosis of the disease.Patients with stable coronary artery disease (CAD) can benefit from a 27% reduction of mortality, as shown in meta-analyses of several studies. By contrast, patients with CHF have traditionally been discouraged from physical activities, which may have had detrimental consequences. They became even less able to participate in daily activities that in turn hastened the disease-driven atrophies of skeletal muscles. On the other hand, well-adjusted endurance training at 50–70% of maximum oxygen uptake was shown to improve overall fitness. In a recent metaanalysis, the mortality of patients with CHF was reduced by 35% by sports, and the rate of hospitalizations dropped by 28%.It is a well-perceived clinical problem that successful treatment is not possible without intensive guidance and a close therapeutic relationship. Being left in their routine situation and circumstances, the majority of patients cannot cope with the day-to-day challenge of an independent, active lifestyle. Among the primary reasons not to sustain physical activity are mental, psychological or social barriers.Patients and Methods:The authors have begun, in a cohort of patients with CHF, a prospective pilot study to investigate the impact of, and attitude to, electromyostimulation (EMS). Unique features of this treatment include its passive nature that remains independent of mental attitude.Results:An up to 96% increase of peak oxygen uptake at the anaerobic threshold could be shown (pre- vs. posttraining phase, VO2at 19.39 [± 5.3] ml/kg vs. 24.25 [± 6.34] ml/kg). The diastolic blood pressure decreased significantly. A 14% gain in muscle volume was observed, while overall body weight remained unchanged. All patients kept up the training until the conclusion of the study and found their overall fitness to be considerably improved.Conclusion:The results may indicate the enormous potential of EMS for the treatment of patients within the cardiologic arena, especially those with CHF.BACKGROUND Current guidelines concerning the treatment of patients with chronic congestive heart failure (CHF) include ergospirometry-directed dynamic exercises on a daily basis. Several prospective, randomized trials have confirmed its positive influence on clinical symptoms and prognosis of the disease. Patients with stable coronary artery disease (CAD) can benefit from a 27% reduction of mortality, as shown in meta-analyses of several studies. By contrast, patients with CHF have traditionally been discouraged from physical activities, which may have had detrimental consequences. They became even less able to participate in daily activities that in turn hastened the disease-driven atrophies of skeletal muscles. On the other hand, well-adjusted endurance training at 50-70% of maximum oxygen uptake was shown to improve overall fitness. In a recent metaanalysis, the mortality of patients with CHF was reduced by 35% by sports, and the rate of hospitalizations dropped by 28%. It is a well-perceived clinical problem that successful treatment is not possible without intensive guidance and a close therapeutic relationship. Being left in their routine situation and circumstances, the majority of patients cannot cope with the day-to-day challenge of an independent, active lifestyle. Among the primary reasons not to sustain physical activity are mental, psychological or social barriers. PATIENTS AND METHODS The authors have begun, in a cohort of patients with CHF, a prospective pilot study to investigate the impact of, and attitude to, electromyostimulation (EMS). Unique features of this treatment include its passive nature that remains independent of mental attitude. RESULTS An up to 96% increase of peak oxygen uptake at the anaerobic threshold could be shown (pre- vs. posttraining phase, VO(2at) 19.39 [+/- 5.3] ml/kg vs. 24.25 [+/- 6.34] ml/kg). The diastolic blood pressure decreased significantly. A 14% gain in muscle volume was observed, while overall body weight remained unchanged. All patients kept up the training until the conclusion of the study and found their overall fitness to be considerably improved. CONCLUSION The results may indicate the enormous potential of EMS for the treatment of patients within the cardiologic arena, especially those with CHF.

Influence of Whole-body Electrostimulation on Human Red Blood Cell Deformability

Abstract Filipovic, A, Kleinöder, H, Plück, D, Hollmann, W, Bloch, W, and Grau, M. Influence of whole-body electrostimulation on human red blood cell deformability. J Strength Cond Res 29(9): 2570–2578, 2015—Red blood cell–nitric oxide synthase (RBC-NOS)–dependent NO production is essential for the maintenance of RBC deformability, which is known to improve oxygen supply to the working tissue. Electrostimulation of the whole body (WB-EMS) has been shown to improve maximal strength, springiness, and jumping power of trained and untrained athletes. To examine whether these 2 parameters are associated, this study, for the first time, aimed to investigate the effects of an 18-week dynamic WB-EMS program on RBC deformability in addition to maximal strength performance (1 repetition maximum [1RM]) in elite soccer players. Fifteen test persons were assigned in either WB-EMS group (EG, n = 10) or training group (TG, n = 5). Next to their weekly training sessions, EG performed 3 × 10 squat jumps under the influence of WB-EMS twice per week between weeks 1 and 14 and once per week between weeks 14 and 18. Training group only performed 3 × 10 squat jumps. Performance was assessed by a maximal strength test on the leg press machine (1RM). Subjects were tested at baseline and after weeks 7, 14, and 18 with blood sampling before (Pre), 15–30 minutes after (Post), and 24 hours after (24-hour Post) the training. The results showed that maximal strength was significantly improved in EG (p < 0.01). Maximum RBC deformability (EImax) increased on EMS stimulus in EG while it remained unaffected in the TG. Acute increase in EImax at baseline was explained by an increase in RBC-NOS activation while chronic increase of deformability must be caused by different, yet unknown, mechanisms. EImax decreased between weeks 14 and 18 suggesting that 1 WB-EMS session per week is not sufficient to alter deformability (EImax). In contrast, the deformability at low shear stress (EI 3 Pa), comparable with conditions found in the microcirculation, significantly increased in EG until week 14, whereas in TG deformability only, increased until week 7 due to increasing training volume after the winter break. The results indicate that WB-EMS represents a useful and time-saving addition to conventional training sessions to improve RBC deformability and possibly oxygen supply to the working tissue and thus promoting general force components in high performance sport.