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

Wolfgang Kemmler, Simon von Stengel, Wolfgang Kemmler, Simon von Stengel

Abstract

Background: The primary aim of this study was to determine the effect of 12 months of whole-body electromyostimulation (WB-EMS) exercise on appendicular muscle mass and abdominal fat mass in subjects specifically at risk for sarcopenia and abdominal obesity, but unable or unwilling to exercise conventionally.

Methods: Forty-six lean, nonsportive (<60 minutes of exercise per week), elderly women (aged 75 ± 4 years) with abdominal obesity according to International Diabetes Federation criteria were randomly assigned to either a WB-EMS group (n=23) which performed 18 minutes of intermittent, bipolar WB-EMS (85 Hz) three sessions in 14 days or an "active" control group (n=23). Whole-body and regional body composition was assessed by dual energy X-ray absorptiometry to determine appendicular muscle mass, upper leg muscle mass, abdominal fat mass, and upper leg fat mass. Maximum strength of the leg extensors was determined isometrically by force plates.

Results: After 12 months, significant intergroup differences were detected for the primary end-points of appendicular muscle mass (0.5% ± 2.0% for the WB-EMS group versus -0.8% ± 2.0% for the control group, P=0.025) and abdominal fat mass (-1.2% ± 5.9% for the WB-EMS group versus 2.4% ± 5.8% for the control group, P=0.038). Further, upper leg lean muscle mass changed favorably in the WB-EMS group (0.5% ± 2.5% versus -0.9% ± 1.9%, in the control group, P=0.033), while effects for upper leg fat mass were borderline nonsignificant (-0.8% ± 3.5% for the WB-EMS group versus 1.0% ± 2.6% for the control group, P=0.050). With respect to functional parameters, the effects for leg extensor strength were again significant, with more favorable changes in the WB-EMS group (9.1% ± 11.2% versus 1.0% ± 8.1% in the control group, P=0.010).

Conclusion: In summary, WB-EMS showed positive effects on the parameters of sarcopenia and regional fat accumulation. Further, considering the good acceptance of this technology by this nonsportive elderly cohort at risk for sarcopenia and abdominal obesity, WB-EMS may be a less off-putting alternative to impact appendicular muscle mass and abdominal fat mass, at least for subjects unwilling or unable to exercise conventionally.

Keywords: abdominal fat; aged; electrostimulation; exercise; muscle; sarcopenia.

Figures

Figure 1
Figure 1
Flow chart. Abbreviations: BMI, body mass index; BMD, bone mineral density; SD, standard deviation; WB-EMS, whole-body electromyostimulation; WC, waist circumference.
Figure 2
Figure 2
Whole-body electromyostimulation electrodes (vest and sleeves).
Figure 3
Figure 3
Whole-body electromyostimulation exercise protocol.

References

    1. Masel MC, Graham JE, Reistetter TA, et al. Frailty and health related quality of life in older Mexican Americans. Health Qual Life Outcomes. 2009;7:70.
    1. Stenholm S, Harris TB, Rantanen T, et al. Sarcopenic obesity: definition, cause and consequences. Curr Opin Clin Nutr Metab Care. 2008;11(6):693–700.
    1. Slentz CA, Aiken LB, Houmard JA, et al. Inactivity, exercise, and visceral fat. STRRIDE: a randomized, controlled study of exercise intensity and amount. J Appl Physiol. 2005;99(4):1613–1618.
    1. Latham N, Anderson C, Bennett D, et al. Progressive resistance strength training for physical disability in older people. Cochrane Database Syst Rev. 2003;2:CD002759.
    1. Peterson MD, Sen A, Gordon PM. Influence of resistance exercise on lean body mass in aging adults: a meta-analysis. Med Sci Sports Exerc. 2011;43(2):249–258.
    1. Strasser B, Arvandi M, Siebert U. Resistance training, visceral obesity and inflammatory response: a review of the evidence. Obes Rev. 2012;13(7):578–591.
    1. Weinheimer EM, Sands LP, Campbell WW. A systematic review of the separate and combined effects of energy restriction and exercise on fat-free mass in middle-aged and older adults: implications for sarcopenic obesity. Nutr Rev. 2010;68(7):375–388.
    1. Robert Koch Institut . Sportliche Aktivität. [Physical Exercise in Germany] Berlin, Germany: Robert Koch Institut; 2012. German.
    1. Physical activity guidelines for Americans. Okla Nurse. 2008;53(4):25. [No authors listed]
    1. Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, et al. American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009;41(7):1510–1530.
    1. Kemmler W, von Stengel S. Exercise frequency, health risk factors and diseases of the elderly. Arch Phys Med Rehabil. June2013 [Epub ahead of print.]
    1. Montoye HJ, Kemper HC, Saris WH, et al. Measuring Physical Activity and Energy Expenditure. Champaign, IL: Human Kinetics; 1996.
    1. Weineck J. Sportbiologie. [Exercise-Biology] Balingen, Germany: Spitta Verlag; 2009. German.
    1. Kemmler W, Schliffka R, Mayhew JL, et al. Effects of whole-body-electromyostimulation on resting metabolic rate, anthropometric and neuromuscular parameters in the elderly. The Training and Electro Stimulation Trial (TEST) J Strength Cond Res. 2010;24(7):1880–1886.
    1. Kemmler W, Birlauf A, von Stengel S. Einfluss von Ganzkörper-Elektromyostimulation auf das Metabolische Syndrom bei älteren Männern mit metabolischem Syndrom. [Effects of whole-body-electromyostimulation on body composition and cardiac risk factors in elderly men with the metabolic syndrome. The TEST-II study] Dtsch Z Sportmed. 2010;61(5):117–123. German.
    1. Wall TB, Dirks ML, Verdijk LB, et al. Neuromuscular electrical stimulation increases muscle protein synthesis in elderly type 2 diabetic men. Am J Physiol Endocrinol Metab. 2012;303:E614–E623.
    1. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome – a new worldwide definition. A consensus statement from the International Diabetes Federation. Diabet Med. 2006;23(5):469–480.
    1. Reid KF, Naumova EN, Carabello RJ, et al. Lower extremity muscle mass predicts functional performance in mobility-limited elders. J Nutr Health Aging. 2008;12(7):493–498.
    1. Janssen I, Heymsfield SB, Wang HJ, et al. Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr. J Appl Physiol. 2000;89(1):81–88.
    1. Kemmler W, Engelke K, Von Stengel S. Ganzkörper-Elektromyostimulation zur Prävention der Sarkopenie bei einem älteren Risikokollektiv. Die TEST-III Studie. [Effects of whole-body-electromyostimulation on Sarcopenia in lean, elderly sedentary women. The TEST-III Study] Dtsch Z Sportmed. 2012;63(12):16–23. German.
    1. Kemmler W, Von Stengel S, Bebenek M. Effekte eines Ganzkörper-Elektromyostimulations-Trainings auf die Knochendichte eines Hochrisikokollektivs für Osteopenie. Eine randomisierte Studie mit schlanken und sportlich inaktiven Frauen. [Effects of whole-body-electromyostimulation on bone mineral density in lean, sedentary elderly women with osteopeniaThe randomized controlled TEST-III Study] Osteologie. 2013;22(2):121–128. German.
    1. Liebermeister H. Prognosis in obesity, what has changed? Versicherungsmedizin. 1995;47(1):17–23. German.
    1. Balkau B, Charles MA. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR) Diabet Med. 1999;16(5):442–443.
    1. Kemmler W, Von Stengel S, Schwarz J, et al. Effect of whole-body electromyostimulation on energy expenditure during exercise. J Strength Cond Res. 2012;26(1):240–245.
    1. Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med. 1970;2(2):92–98.
    1. Hologic Corporation . QDR Discovery – Users Guide. Waltham, MA: Hologic Inc; 2008.
    1. Baumgartner RN, Koehler KM, Gallagher D, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998;147(8):755–763.
    1. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412–423.
    1. Lindemann U, Najaf B, Zijlstra W, et al. Distance to achieve steady state walking speed in frail elderly persons. Gait Posture. 2008;27(1):91–96.
    1. Mathiowetz V, Weber K, Volland G, et al. Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am. 1984;9(2):222–226.
    1. Tusker F. Bestimmung von Kraftparameter eingelenkiger Kraftmessungen. [Evaluation of strength parameters in single-joint strength assessments] Aachen, Germany: Shaker Verlag; 1994.
    1. Kemmler WV, Stengel S, Mayer S, Niedermayer M, Hentschke C, Kalender WA. Effect of whole body vibration on the neuromuscular performance of females 65 years and older: one-year results of the controlled randomized ELVIS study. Z Gerontol Geriatr. 2009 German.
    1. Kemmler W, Lauber D, Weineck J, et al. Benefits of 2 years of intense exercise on bone density, physical fitness, and blood lipids in early postmenopausal osteopenic women: results of the Erlangen Fitness Osteoporosis Prevention Study (EFOPS) Arch Intern Med. 2004;164(10):1084–1091.
    1. Kemmler W, Weineck J, Kalender WA, et al. The effect of habitual physical activity, non-athletic exercise, muscle strength, and VO2max on bone mineral density is rather low in early postmenopausal osteopenic women. J Musculoskelet Neuronal Interact. 2004;4(3):325–334.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Earlbaum Associates; 1988.
    1. Benecke A, Vogel H.Übergewicht und Adipositas. [Overweight and Obesity]. Report No 1 Berlin, Germany: Robert Koch Institut; 2003Available from Accessed September 23, 2013
    1. DESTATIS Verteilung der Bevölkerung auf Body-Mass-Index-Gruppen in Prozent Distribution of the German population with respect to Body Mass Index in percent 2012Available from Available from September 23, 2013
    1. World Health Organization Obesity: preventing and managing the global epidemic Geneva, Switzerland: World Health Organization; 2000Available from: Accessed September 5, 2013
    1. Zamboni M, Mazzali G, Fantin F, et al. Sarcopenic obesity: a new category of obesity in the elderly. Nutr Metab Cardiovasc Dis. 2008;18(5):388–395.
    1. Baumgartner RN. Body composition in healthy aging. Ann N Y Acad Sci. 2000;904:437–448.
    1. Davison KK, Ford ES, Cogswell ME, et al. Percentage of body fat and body mass index are associated with mobility limitations in people aged 70 and older from NHANES III. J Am Geriatr Soc. 2002;50(11):1802–1809.
    1. Zoico E, Di Francesco V, Guralnik JM, et al. Physical disability and muscular strength in relation to obesity and different body composition indexes in a sample of healthy elderly women. Int J Obes Relat Metab Disord. 2004;28(2):234–241.
    1. Morley JE. Sarcopenia: diagnosis and treatment. J Nutr Health Aging. 2008;12(7):452–456.
    1. Morley JE. Sarcopenia in the elderly. Fam Pract. 2012;29(Suppl 1):i44–i48.
    1. Morley JE, Baumgartner RN, Roubenoff R, et al. Sarcopenia. J Lab Clin Med. 2001;137(4):231–243.
    1. Patil R, Uusi-Rasi K, Pasanen M, et al. Sarcopenia and osteopenia among 70–80-year-old home-dwelling Finnish women: prevalence and association with functional performance. Osteoporos Int. 2013;24(3):787–796.
    1. Patil R, Syddall HS, Jameson K, et al. Prevalence of sarcopenia in community-dwelling older people in the UK using the European Working Group on Sarcopenia in Older People (EWGSOP) definition: findings from the Hertfordshire Cohort Study (HCS) Age Aging. 2013;42(3):378–384.
    1. Pataky Z, Bobbioni-Harsch E, Makoundou V, et al. Enlarged waist circumference and cardiovascular risk factors. Rev Med Suisse. 2009;5(196):671–672. French.
    1. LaForgia J, Withers RT, Gore CJ. Effects of exercise intensity and duration on the excess post-exercise oxygen consumption. J Sports Sci. 2006;24(12):1247–1264.
    1. Hamada T, Hayashi T, Kimura T, et al. Electrical stimulation of human lower extremities enhances energy consumption, carbohydrate oxidation, and whole body glucose uptake. J Appl Physiol. 2004;96(3):911–916.
    1. Ades PA, Savage PD, Brochu M, et al. Resistance training increases total daily energy expenditure in disabled older women with coronary heart disease. J Appl Physiol. 2005;98(4):1280–1285.
    1. Kemmler W, von Stengel S, Engelke K, et al. Exercise, body composition, and functional ability: a randomized controlled trial. Am J Prev Med. 2010;38(3):279–287.
    1. Binder EF, Yarasheski KE, Steger-May K, et al. Effects of progressive resistance training on body composition in frail older adults: results of a randomized, controlled trial. J Gerontol A Biol Sci Med Sci. 2005;60(11):1425–1431.
    1. Marques EA, Mota J, Machado L, et al. Multicomponent training program with weight-bearing exercises elicits favorable bone density, muscle strength, and balance adaptations in older women. Calcif Tissue Int. 2011;88(2):117–129.
    1. Nelson ME, Fiatarone MA, Layne JE, et al. Analysis of body-composition techniques and models for detecting change in soft tissue with strength training. Am J Clin Nutr. 1996;63(5):678–686.
    1. Kamel EG, McNeill G, Han TS, et al. Measurement of abdominal fat by magnetic resonance imaging, dual-energy X-ray absorptiometry and anthropometry in non-obese men and women. Int J Obes Relat Metab Disord. 1999;23(7):686–692.
    1. Kamel EG, McNeill G, Van Wijk MC. Change in intra-abdominal adipose tissue volume during weight loss in obese men and women: correlation between magnetic resonance imaging and anthropometric measurements. Int J Obes Relat Metab Disord. 2000;24(5):607–613.
    1. Jensen MD. Is visceral fat involved in the pathognesis of the metabolic syndrome? Human model. Obesity (Silver Spring) 2006;14(Suppl 1):S20–S24.
    1. Chaston TB, Dixon JB. Factors associated with percent change in visceral versus subcutaneous abdominal fat during weight loss: findings from a systematic review. Int J Obes (Lond) 2008;32(4):619–628.
    1. Kent-Braun JA, Ng AV, Young K. Skeletal muscle contractile and noncontractile components in young and older women and men. J Appl Physiol. 2000;88(2):662–668.
    1. Taaffe DR, Henwood TR, Nalls MA, et al. Alterations in muscle attenuation following detraining and retraining in resistance-trained older adults. Gerontology. 2009;55(2):217–223.
    1. Marques EA, Mota J, Carvalho J. Exercise effects on bone mineral density in older adults: a meta-analysis of randomized controlled trials. Age (Dordr) 2011;34(6):1493–1515.
    1. Kemmler W, Teschler M, Bebenek M, et al. Effekt von Ganzkörper-Elektromyostimulation auf die übergreifende sportmotorische Leistungsfähigkeit im Handball. [Effects of whole-body electromyostimulation on general performance and skills in handball players] Dtsch Z Sportmed. 2011;62(7/8):271. German.
    1. Quinn TJ, Klooster JR, Kenefick RW. Two short, daily activity bouts versus one long bout: are health and fitness improvements similar over twelve and twenty-four weeks? J Strength Cond Res. 2006;20(1):130–135.
    1. Howel D. Waist circumference and abdominal obesity among older adults: patterns, prevalence and trends. PLoS One. 2012;7(10):e48528.
    1. Heim N, Snijder MB, Heymans MW, et al. Optimal cutoff values for high-risk waist circumference in older adults based on related health outcomes. Am J Epidemiol. 2011;174(4):479–489.
    1. Kemmler W, von Stengel S. Alternative exercise technologies to fight against sarcopenia at old age: a series of studies and review. J Aging Res. 2012;2012:109013.
    1. Kemmler W, von Stengel S, Engelke K, et al. Exercise effects on bone mineral density, falls, coronary risk factors, and health care costs in older women: the randomized controlled senior fitness and prevention (SEFIP) study. Arch Intern Med. 2010;170(2):179–185.

Source: PubMed

3
Abonner