Trained athletes from various disciplines experienced increases in maximum isometric strength of between 15% and 40%, with an average of 32.6% (5, 6, 7, 9, 22, 24, 27).

The average improvement in maximum isometric strength following EMS training with untrained subjects was 23.5% (1, 2, 3, 4, 8, 10, 11, 14, 15, 16, 18, 19, 20, 21, 25, 28).

Athletes can achieve 30 – 40% improvements in maximum strength after only 5 weeks using EMS (12).

Using MVC, competitive swimmers achieved improvements in the eccentric and concentric contrac- tions of their latissimus dorsi and quadriceps femoris muscles and better freestyle swimming times (23).

Case study of a high-performance weightlifter: 4 months of EMS training: 1 RM (repetition maxi- mum) increased during squats by around 20kg, further improvements to ‘snatch’ and ‘clean and jerk’.

EMS can also be provided to untrained people and those looking to get fit: muscle size increased by around 10% after 8 weeks using isokinetic training (eccentric and concentric) combined with EMS (26, 29).

Mixed training (hypertrophy using machines) combined with EMS was shown to have the greatest effects on maximum strength (13).

Selected literature:

1. Alon, G., McCombre, S.A., Koutsantonis, S., Stumphauzer, L.J., Burgwin, K.C., Parent, M.M., & Bosworth, R.A. (1987). Com- parison of the Effects of Electrical Stimulation and Exercise on Abdominal Musculature. Journal of Orthopaedic and Sports Physical Therapy, 8 (12), 567-573.
2. Andersen, L.L., & Aagaard, P. (2006). Influence of maximal muscle strength and intrinsic muscle contractile properties on contractile rate of force development. Eur J Appl Physiol, 96, 46-52.
3. Balogun, J.A., Onilari, O.O., Akeju, A.O., & Marzouk, D.K. (1993). High Voltage Electrical Stimulation in the Augmentation of Muscle Strength: Effects of Pulse Frequency. Arch Phys Med Rehabil, 74, 910-6.
4. Boutelle, D., Smith, B., & Malone, T. A Strength Study Utilizing the Electro-Stim 180. Journal of Orthopaedic and Sports Physical Therapy, 7(2), 50-53.
5. Cabric, M., & Appell, H. J. (1987a). Zur Wirkung hochfrequenter EMS auf Muskelkraft und Muskelmasse.
6. Deutsche Zeitschrift für Sportmedizin, 38 (1), 15-18.
7. Cabric, M., & Appell, H. J. (1987b). Effect of electrical stimulation of high and low frequency on maximum isometric force
   and some morphological characteristics in men. Int J Sports Med, 8 (4), 256-260.
8. Colson, S., Martin, A., & Van Hoecke, J. (2000). Reexamination of training effects by electrostimulation in the human elbow
   musculoskeletal system. Int J Sports Med, 21 (4), 281-288.
9. Currier, D.P., & Mann, R. (1983). Muscular Strength Development by Electrical Stimulation in Healthy Individuals. Physical
   Therapy, 63 (6), 915-921.
10. Eriksson, E., Haggmark, T., Kiessling, K. H., & Karlsson, J. (1981). Effect of electrical stimulation on human skeletal muscle.
    J Sports Med., 2 (1), 18-22.
11. Gondin, J., Guette, M., Ballay, Y., & Martin, A. (2005). Electromyostimulation training effects on neural drive and muscle
    Med Sci Sports Exerc, 37 (8), 1291-1299.
12. Gondin, J., Guette, M., Ballay, Y., & Martin, A. (2006). Neural and muscular changes to detraining after electrostimulation training. Eur J Appl Physiol, 97 (2), 165-173.
13. Kots, J.M. & Chwilon, W. (1971). Das Muskelkrafttraining mit der Methode der Elektromyostimulation (russ.). In: Adrianowa, G. et al. (1974). Die Anwendung der Elektrostimulation für das Training der Muskelkraft.
14. Kreuzer, S., Kleinoeder, H., & Mester, J. (2006). Effects of whole body electro stimulation training and traditional strength training on various strength and blood parameter in juvenile elite water polo players. In: H. Hoppeler, T. Reilly, E. Tsolakidis, L. Gfeller & S. Klossner (Eds.) (Vol. 11, pp. 264). Cologne: Sportverlag Strauss.
15. Kubiak, R.J., Whitman, K.M., & Johnston, R.M. (1987). Changes in Quadriceps Femoris Muscle Strength Using Isometric Exercise Versus Electrical Stimulation. Journal of Orthopaedic and Sports Physical Therapy, 8 (11), 537-541.
16. Lai, H.S., de Domenico, G., & Straus, G.R., (1988). The Effect of Different Electro-Motor Stimulation Training Intensities on Strength Improvement. The Australian Journal of Physiotherapy, 34 (3), 151-164.
17. Laughman, R.K., Youdas, J.W., Garrett, T.R., & Chao, E.Y.S. (1983). Strength Changes in the Normal Quadriceps Femoris Mu- scle as a Result of Electrical Stimulation. Physical Therapy, 63 (4), 494-499.
18. Maffiuletti, N. A., Cometti, G., Amiridis, I. G., Martin, A., Pousson, M., & Chatard, J. C. (2000). The effects of electromyostimu- lation training and basketball practice on muscle strength and jumping ability. Int J Sports Med, 21 (6), 437-443.
19. Maffiuletti, N. A., Zory, R., Miotti, D., Pellegrino, M. A., Jubeau, M., & Bottinelli, R. (2006). Neuromuscular adaptations to electrostimulation resistance training. Am J Phys Med Rehabil, 85 (2), 167-175.
20. Martin, L., Cometti, G., Pousson, M., & Morlon, B. (1994). The influence of electrostimulation on mechanical and morpholo- gical characteristics of the triceps surae. J Sports Sci, 12 (4), 377-381.
21. Matsuse, H., Shiba, N., Umezu, Y., Nago, T., Tagawa, Y., Kakuma, T., Nagata, K., & Basford, J.R. (2006). Muscle Training by Means of Combined Electrical Stimulation and Volitional Contraction. Aviat Space Environ Med, 77, 581–585.
22. McMiken, D.F., Todd-Smith, M. & Thompson, C. (1983). Strengthening of human quadriceps muscles by cutaneous electri- cal stimulation. Scand J Rehab Med, 15 (1), 25-28.
23. Miller, C., & Thépaut-Mathieu, C. (1993). Strength Training by Electrostimulation Conditions for Efficacy. In. J Sports Med, 14 (1), 20-28.
24. 58. Pichon, F., Chatard, J. C., Martin, A., & Cometti, G. (1995). Electrical stimulation and swimming performance. Med Sci Sports Exerc, 27 (12), 1671-1676.
25. 59. Portmann, M., & Montpetit, R. (1991). Effects of training by static and dynamic electrical stimulation on the muscular contraction. Science & Sports, 6, 193-203.
26. Rich, N. C. (1992). Strength training via high frequency electrical stimulation. J Sports Med Phys Fitness, 32 (1), 19-25.
27. Ruther, C.L., Golden, C.L. Harris, R.T., Dudley, G.A. (1995). Hypertrophy, resistance training, and the nature of skeletal musc-

le activation. Journal of strength and Conditioning Research, 9, 155-159.

28. Selkowitz, D.M. (1985). Improvement in Isometric Strength of the Quadriceps Femoris Muscle after Training with Electrical

Stimulation. Physical Therapy, 65(2), 186-196.

29. Soo, C.-L., Currier, D.P., & Threlkeld, A.J. (1988). Augment in Voluntary Torque of Healthy Muscle by Optimization of Electri-

cal Stimulation. Phys Ther (United States), 68 (3), 333-337.

30. Stevenson, S.W., Dudley, G.A. (2001). Dietary creatine supplementation and muscular adaptation to resistive overload.

Medicine and Science in Sports & Exercise, 33, 1304-1310.

Various authors have confirmed a positive effect on contraction speed (1, 3, 5).

The EMS training group saw the greatest gain in movement speed (approx. 30% improvement in
muscles involved in bending bones), thus significantly increasing performance (4, 6).

A combination of classic strength training (hypertrophy) and EMS training increases both performance elements (movement speed and power), (4,6).

Selected literature:

1. Andersen, L.L., & Aagaard, P. (2006). Influence of maximal muscle strength and intrinsic muscle contractile properties on contractile rate of force development. Eur J Appl Physiol, 96, 46-52.
2. Babault, N., Cometti, G., Bernardin, M., Pousson, M. &Chatard, J.-C. (2007). Effects of Electromyostimulation Training on Muscle Strength and Power of Elite Rugby Players. Journal of Strength and Conditioning Research, 21(2), 431-437.
3. Colson, S., Martin, A., & Van Hoecke, J. (2000). Reexamination of training effects by electrostimulation in the human elbow musculoskeletal system. Int J Sports Med, 21(4), 281-288.
4. Kleinöder, H. (2007). Muskeltraining der Zukunft: Wissenschaftliche und praktische Anwendung von Ganz-körper-Elekt- romyostimulations-Training (GK-EMS) unter besonderer Berücksichtigung des Krafttrainings. Medicalsports network, 4/07.
5. Maffiuletti, N. A., Cometti, G., Amiridis, I. G., Martin, A., Pousson, M., & Chatard, J. C. (2000). The effects of electromyostimu-
   lation training and basketball practice on muscle strength and jumping ability. Int J Sports Med, 21(6), 437-443.

Speicher, U., Schmithüsen J., Nowak, S., Kleinöder, H., de Marées, M., & Mester, J. (2008). Effects of dynamic electromyosti-
mulation on current strength-diagnostics. (Noch unveröffentlichter BiSP Bericht 2009).

The sprint studies showed improvements in competitive athletes of 3.1±1.7% over a 3-week period. • Brocherie et al. (2) improvement of 4.8% in the sprint time of ice hockey players over 10m. Pichon et al. (9) improvement of 1.3% to cover 25m (sport type: swimming) and 1.45% for the 50m freestyle time.

With combined strength training (plyometrics/EMS), Herrero et al. recorded (3) a 2.3% reduction in time needed to sprint 20m among untrained individuals.

After EMS training, jumping abilities improved by between 2.3% and 19.2%; after isometric EMS training (an average of +10±6.5%); and 6.7% to 21.4% after dynamic EMS training (1, 4, 5, 7, 8, 13).

After combined EMS training, the literature states that there was an average increase in jumping ability of 11.2±5.5% (3, 6, 11).

Selected literature:

1. Babault, N., Cometti, G., Bernardin, M., Pousson, M. &Chatard, J.-C. (2007). Effects of Electromyostimulation Training on Muscle Strength and Power of Elite Rugby Players. Journal of Strength and Conditioning Research, 21(2), 431-437.
2. Brocherie, F., Babault, N., Cometti, G., Maffiuletti, N., & Chatard, J. C. (2005). Electrostimulation training effects on the phy- sical performance of ice hockey players. Med Sci Sports Exerc, 37(3), 455-460.
3. Herrero, J. A., Izquierdo, M., Maffiuletti, N. A., & Garcia-Lopez, J. (2006). Electromyostimulation and plyometric training effects on jumping and sprint time. Int J Sports Med,27(7), 533-539.
4. Kots, J.M. & Chwilon, W. (1971). Das Muskelkrafttrainingmit der Methode der Elektromyostimulation (russ.). In: Adrianowa, G. et al. (1974). Die Anwendung derElektrostimulation für das Training der Muskelkraft.
5. Maffiuletti, N. A., Cometti, G., Amiridis, I. G., Martin, A., Pousson, M., & Chatard, J. C. (2000). The effects of electromyostimu- lation training and basketball practice on muscle strength and jumping ability. Int J Sports Med, 21(6), 437-443.
6. Maffiuletti, N. A., Dugnani, S., Folz, M., Di Pierno, E., & Mauro, F. (2002a). Effect of combined electrostimulation and plyome- tric training on vertical jump height. Med Sci Sports Exerc, 34(10), 1638-1644.
7. Malatesta, D., Cattaneo, F., Dugnani, S., & Maffiuletti, N. A. (2003). Effects of electromyostimulation training and volleyball practice on jumping ability. J Strength Cond Res, 17 (3), 573-579.
8. Paillard, T. (2008). Combined Application of Neuromuskular Electrical Stimulation and Voluntary Muscular Contractions. Sports Med, 38 (2), 161-177.
9. Pichon, F., Chatard, J. C., Martin, A., & Cometti, G. (1995). Electrical stimulation and swimming performance. Med Sci Sports Exerc, 27(12), 1671-1676.
10. Ronnestad, B.R., Kvamme, N.H., Sunde, A., & Raastad, T. (2008). Short-Term Effects of Strength and Plyometric Training on Sprint and Jump Performance in Professional Soccer Players. Journal of Strength and Conditioning Research, 22(3), 733-780.
11. Venable, M.P., Collins, M.A., O ́Brynt, H.S., Denegar, C.R., Sedivec, M.J., & Alon, G. (1991). Effects of Supplemental Electrical Stimulation on the Development of Strength, Vertical Jump Performance and Power. Journal of Applied Sport Science Research, 5 (3), 139-143.
12. Willoughby, D.S., & Simpson, S. (1996). The Effects of Combined Electromyostimulation and Dynamic Muscular Contrac- tions on the Strength of College Basketball Players. Strength and Cond. Res., 10(1), 40-44.
13. Willoughby, D.S., & Simpson, S. (1998). Supplemental EMS and Dynamic Weight Training: Effects on Knee Extensor Strength and Vertical Jump of Female College Track & Field Athletes. Strength and Cond. Res., 12 (3), 131-137.

Wissloff, U., Castagna, C. Helgerud, J. Jones, R., & Hoff, J. (2004). Strong correlation of maximal squat strength with sprint performance and vertical jump height in elite soccer players. Br. J. Sports Med, 38, 285-288

Static endurance: the average increase is 30.3% at an average stimulation frequency of 75 +/- 44 Hz. (1, 2, 3)

Dynamic endurance: the average increase is 41% at an average stimulation frequency of 76 Hz +/- 10 Hz (2, 4, 5, 7).

Long-term stimulation with low frequency stimulation of skeletal muscle in experiments on animals (rabbits) resulted in the development of mainly slow twitch muscle fibres with a high proportion of mitochondria (6).

Selected literature:

1. Alon, G., McCombre, S.A., Koutsantonis, S., Stumphauzer, L.J., Burgwin, K.C., Parent, M.M., & Bosworth, R.A. (1987). Com- parison of the Effects of Electrical Stimulation and Exercise on Abdominal Musculature. Journal of Orthopaedic and Sports Physical Therapy, 8(12), 567-573.
2. Ballantyne, E., Donne, B. (1999): Effect of neuromuscular electrical stimulation on static and dynamic abdominal strength and endurance in healthy males. Sport Science, 431.
3. Kahanovitz, N., Nordin, M., Verderame, R., Parnianpour, M., Yabut, S., Viola, K., Greenidge, N., Mulvihill, M. (1987). Normal trunk muscle strength and endurance in women and the effect of exercises and electrical stimulation. Part 1: Normal en- durance and trunk muscle strength in 101 women. Spine, 12 (2): 105-111.
4. Kim, C. K., Takala, T. E. S., Seger, J. & Karpakka, J. (1995). Training Effects of Electrically Induced Dynamic Contractions in Human Quadriceps Muscle. Aviat Space Environ Med, 66, 251-255.
5. Marqueste, T., Hug, F., Decherchi, P. Jammes, Y. (2003). Changes in neuromuscular function after training by functional electrical stimulation. Muscle Nerve 28, 181-188.
6. Pette, D., Vrbova, G. (1985) Neural control of phenotypic expression in mammalian muscle fibres. Muscle Nerve 8, 676.
7. Porcari, J., Miller, J., Cornwell, K., Foster, C., Gibson, M., McLean, K., Kernozek, T. (2005). The Effects of Neuromuscular Elec- trical Stimulation Training on Abdominal Strength, Endurance and Selected Anthropometric Measures. J of Sport Science
   and Medicine, 4, 66-75.

Increasing bone density

Prevention of age-related fractures, particularly vertebrogenic compression fractures • Alleviation of osteoporosis

Optimisation of fat distribution and body fat/muscle ratio

Selected literature:

1. Effekt von Ganzkörper-Elektromyo -stimulation – „A series of studies“ Eine alternative Trainingstechnologie zur muskulos- kelettalen Prävention bei älteren Menschen Osteologie 1/2015, S. 3-17 W. Kemmler; M. Teschler; S. von Stengel Institut für Medizinische Physik, Friedrich-Alexander Universität Erlangen-Nürnberg
2. Whole-Body Electromyostimulation to Fight Osteopenia in Elderly Females: The Randomized Controlled Training and Elec- trostimulation Trial (TEST-III) Simon von Stengel, Michael Bebenek, Klaus Engelke, andWolfgang Kemmler Institute of Me- dical Physics, University of Erlangen-N ̈urnberg, 91052 Erlangen, Germany Journal of Osteoporosis Volume 2015, Article ID 643520, 7 pages
3. Whole-body electromyostimulation as a means to impact muscle mass and abdominal body fat in lean sedentary, older female adults: subanalysis of the TEST-III trial J. Clinical Interventions in Aging, 10/2013 Wolfgang Kemmler, Simon von Stengel
4. Impact of whole-body electromyostimulation on body composition in elderly women at risk for sarcopenia: the Training and ElectroStimulation Trial (TEST-III) Wolfgang Kemmler, Michael Bebenek, Klaus Engelke, Simon von Stengel Received: 11 December 2012 / Accepted: 29 July 2013 AGE; American Aging Association 2013
5. Effekte der Ganzkörper-Elektro -myostimulation auf die Knochendichte eines Hochrisikokollektivs für Osteoporose. Eine randomisierte Studie mit älteren, schlanken und sportlich inaktiven Frauen mit Osteopenie. Osteologie 2013; pg 22 ff W. Kemmler; M. Bebenek; S. von Stengel Institut für Medizinische Physik, Friedrich-Alexander Universität Erlangen-Nürnberg
6. Ganzkörper-Elektromyostimulation zur Prävention der Sarkopenie bei einem älteren Risikokollektiv. Die TEST-III Studie Kemmler W, Engelke K, von Stengel S Deutsche Zeitschrift für Sportmedizin Jahrgang 63, Nr. 12 (2012)

EMS training leads to an increase in maximal oxygen consumption or oxygen uptake at the anaero- bic threshold (at) of 22-37%.

Vo2max; VO2 at 22-37%

EMS training leads to an increase in maximum strength and/or performance at the anaerobic th-
reshold (at) by up to 32%.

Watt max; Watt at 32%

EMS leads to an increase in the cardiac ejection fraction (EF) of 8%

Selected literature:

1. Elektromyostimulation (EMS) bei kardiologischen Patienten. Wird das EMS-Training bedeutsam für die Sekundärpräventi- on? Dirk Fritzsche, Andreas Fruend1, Sören Schenk1, Klaus-Peter Mellwig2, Heinz Kleinöder3, Jan Gummert1, Dieter Horst- kotte2 Herz 35 · 2010 · Nr. 1 © Urban & Vogel
2. 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 Frank van Buuren • Klaus Peter Mellwig • Christian Prinz • Britta Korber • Andreas Frund • Dirk Fritzsche • Lothar Faber • Tanja Kottmann •Nicola Bogunovic • Johan- nes Dahm • Dieter Horstkotte Received: 17 November 2012 / Accepted: 3 April 2013 Clin Res Cardiol DOI 10.1007/s00392- 013-0562-5
3. Elektromyostimulation (EMS) verbessert die Leistungsfähigkeit und die linksventrikuläre Funktion bei Patienten mit chro- nischer Herzinsuffizienz Frank van Buuren1, Klaus Peter Mellwig1, Christian Prinz1, Tanja Kottmann1, Britta Körber1, Andreas Fründ1, Lothar Faber1, Nicola Bogunovic1, Johannes Dahm3, Dieter Horstkotte1, Dirk Fritzsche PERFUSION 2013; 26: 76–84
4. Elektromyostimulation: Verbesserung von Lebensqualität, Sauerstoffaufnahme und linksventrikulärer Funktion bei chro- nischer Herzinsuffizienz. F. van Buuren, D. Horstkotte, Dirk Fritzsche Rehabilitation 2014; 53: 321-326