Safety of a Combined WB-EMS and High-Protein Diet Intervention in Sarcopenic Obese Elderly Men

Abstract

Purpose: Whole-body electromyostimulation (WB-EMS) especially in combination with a high-protein supplementation has been established as an efficient treatment against sarcopenia. However, there are several case reports of rhabdomyolysis after WB-EMS application. Thus, we asked if this training could potentially lead to deteriorations of the cardiac as well as the renal function.

Materials and methods: One hundred sarcopenic obese men aged 70 years and older were randomly balanced (1-1-1) and allocated to one of the three study arms. During 16 weeks of intervention, these groups either performed WB-EMS and took a protein supplement (WB-EMS&P), solely received the protein supplement (Protein) or served as control group (CG). WB-EMS consisted of 1.5×20 min (85 Hz, 350 μs, 4 s of strain to 4 s of rest) applied with moderate-to-high intensity while moving. We further generated a daily protein intake of 1.7-1.8 g/kg/body mass per day. At baseline and 8-10 days after completion of the intervention, blood was drawn and biomarkers of muscle, cardiac and renal health were assessed.

Results: Hereby, we found slight but significant elevations of creatine kinase (CK) levels in the WB-EMS group pointing to minor damages of the skeletal muscle (140 U/l [81-210], p < 0.001). This was accompanied by a significant, low-grade increase of creatine kinase-muscle brain (CK-MB, 0.43 ng/mL [-0.29-0.96], p < 0.01) and high-sensitivity troponin T (hsTnT, 0.001 ng/mL. [0.000-0.003], p < 0.001) but without a higher risk of developing heart failure according to N-terminal prohormone of brain natriuretic peptide (NT-proBNP, -5.7 pg/mL [-38.8-24.6], p = 0.17). Estimated glomerular filtration rate (eGFR) was impaired neither by the high-protein supplementation alone nor in combination with WB-EMS (CG 76.0 mL/min/1.73 m2 [71.9-82.2] vs Protein 73.2 mL/min/1.73 m2 [63.0-78.9] vs WB-EMS&P 74.6 mL/min/1.73 m2 [62.8-84.1], p = 0.478).

Conclusion: In conclusion, even in the vulnerable group of sarcopenic obese seniors, the combination of WB-EMS with a high-protein intake revealed no short-term, negative impact on the eGFR, but potential consequences for the cardiovascular system need to be addressed in future studies.

Keywords: CK-MB; cystatin C; electromyostimulation; high protein; hsTnT; rhabdomyolysis; sarcopenic obesity.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2020 Kemmler et al.

Figures

Figure 1

Diagram of participants flow through the study.

Figure 2

Biomarkers of muscular and cardiovascular health of the intervention groups at baseline and follow-up with clinical reference range (dotted lines). (A) creatine kinase, (B) CKMB, (C) hsTnT, (D) NT-proBNP, (E) hsCRP and (F) hsIL 6. The boxes represent interquartile ranges with the bold horizontal lines denoting the median. The whiskers show the highest and lowest values within the 1.5-fold interquartile range. The circles represent outliers and asterisks represent extreme outliers. Significant changes within a group and between groups at the same time point are marked with black lines. *p < 0.05; **p < 0.01; ***p < 0.001.

Figure 3

Biomarkers of protein metabolism and renal health of the intervention groups at baseline and follow-up. (A) daily protein intake of the participants, (B) albumin, (C) total protein, (D) urea, (E) creatinine, (F) cystatin C, (G) creatinine-based eGFR and (H) cystatin C-based eGFR. The boxes represent interquartile ranges with the bold horizontal lines denoting the median. The whiskers show the highest and lowest values within the 1.5-fold interquartile range. The circles represent outliers and asterisks represent extreme outliers. Significant changes within a group and between groups at the same time point are marked with black lines. **p < 0.01; ***p < 0.001.