For those of you who follow me on Instagram and keep up with my stories, you may remember me alluding to a new workout phenomenon that caught my eye.
TBH, I normally consider fitness "fads" highly suspicious. I mean, sheesh, how many times can the health wheel be reinvented—and who's profiting off the latest and greatest "craze" anyway? Does that thing you heard about in the news actually help people get fitter and healthier—or at the very least, do its potential benefits outweigh its potential risks?
Too many times to count, the newest "fads" have failed these questions, in my professional opinion. But when I was introduced to a relatively new training methodology called whole body electrical muscle stimulation (EMS), something about it really made me pause.
So, you know me. I had to do a little digging to see what all the "buzz" was about.
The Basics: A Primer on Electrical Muscle Stimulation
EMS dates back to the late 18th century, and it's been used in physical therapy, professional sports, and rehabilitation science for decades. Research backs EMS as a treatment for various neurological and musculoskeletal disorders including strokes, traumatic brain injuries, and acute and chronic pain. It's also been shown to restore or prevent muscle wasting caused by periods of prolonged immobilization, such as casting to heal a broken bone or sedation in patients on intensive care units.
That's all super relevant to me. If injured or even critically ill people can benefit from EMS, it reasonable to say healthy individuals may benefit, too.
These days, there are several types of electrical muscle stimulation used for a wide variety of goals and within many fields, including fitness and rehabilitation. It's basic premise is that by intermittently stimulating muscle fibers with electrical impulses (generally transmitted via wires and electrodes), you can induce muscle contractions that mimic contraction during voluntary movement or exercise.
Generally, we can classify the use of EMS into four main categories:
- Improve muscle strength
- Assist with post-workout recovery
- Assist with physical rehabilitation
- Enhance motor planning and correct faulty movement and muscle fiber recruitment patterns
There's a decent amount of research supporting each of these uses. For instance, EMS has been approved as a muscle-conditioning approach by the U.S. Food and Drug Administration.
And a 2011 literature review published in the European Journal of Applied Physiology concluded that a specific type of EMS called neuromuscular electrical stimulation (NMES) is an effective adjunct therapy to resistance training. It even appears to help fast twitch muscle fibers contract at lower force levels, which may be relevant from an injury-prevention standpoint.
Another study published in a 2011 edition of The Journal of Strength and Conditioning Research concluded that "in prepubertal gymnasts, a 6-week EMS program, combined with the daily gymnastic training, induced significant increases both in knee extensor muscle strength and nonspecific and some specific jump performances."
So, EMS may help build stronger muscles AND translate to better function? I can get on board with that.
A third study published the June 2017 volume of the Annals of Rehabilitation Medicine found that the combination of EMS and abdominal exercises significantly improved ab separation in postnatal women (who also saw improvements in BMI, waist/hip ratio, and ab strength). This is where things really caught my eye. You see, I know this to be true in a physical therapy standpoint. I believe and understand why this would work for people who are having issues firing some core muscles after pregnancy, have motor control issues that are limiting them from having proper core function and even healing their abs post pregnancy.
But you'll notice the above studies look specifically at EMS that use electrodes placed on specific muscle groups, like the quads or biceps. This begs the question: what about whole body EMS—the new fitness phenomenon that I was recently introduced to?
The Backstory: Does Whole Body EMS Training Actually Work?
The whole body EMS technology on the market today looks like a wetsuit embedded with electrodes. When the wetsuit is on, these electrodes sit atop major muscle groups, including the quads, biceps, and pecs. The basic premise of whole-body EMS training—which is similar to EMS training involving single muscle groups—is that the person is subjected to the electrical muscle stimulation as they're working out—resulting in both voluntary (from the person) and involuntary (from the EMS device) muscle contraction.
In other words, a person puts on the whole body EMS suit and runs through their workout. Meanwhile, electrical impulses are sent to contracting muscles through the suit, which is wirelessly controlled by a trained professional.
I've tried it twice and EMS feels like intense vibrations—not exactly comfortable, but not outright painful either. Whole body EMS allegedly causes muscles to contract 20 times more frequently than voluntary contraction alone. The theory follows that this makes your workout more efficient and effective.
At least some research supports this theory (I think we need more). For instance, a 2018 study published in the Journal of Exercise Rehabilitation found that, compared to a control group, participants using whole body EMS saw improvements in systolic blood pressure and oxygen uptake (known as VO2max) during a graded exercise test. These subjects also reported decreased soreness, fatigue, anxiety, and sleeplessness, although this could be more related to perception rather than a true physiological effect (but it's still pretty cool).
Another 2016 randomized controlled study published in Evidenced-Based Complementary and Alternative Medicine compared whole body EMS training to MY FAVE, high intensity interval training (HIIT). Researchers randomly assigned 48 healthy men into either a whole body EMS group or a HIIT group. After 16 weeks of workouts, the researchers found comparable increases in lean body mass and leg extension strength in both groups. They suggest (a bit boldly, in my opinion), that whole body EMS training "can be considered as an attractive, time-efficient, and effective option to HIT-resistance [sic] exercise for people seeking to improve general strength and body composition." The authors acknowledge that, at least right now, whole body EMS is pricey...meanwhile, I'll acknowledge that I will never recommend skipping HIIT if you're capable of doing it!
However promising, EMS isn't picture perfect. The same authors cited previous studies which showed that EMS rendered no improvements in things like fat mass, or found "that the force increases induced by EMS...are similar to, but not greater than, those induced by voluntary training."
Another issue with this type of technology is that because muscles are stimulated peripherally by direct contact with electrodes, EMS may not induce the type of deep central nervous system activation you can get from, let's say, a good back squat or heavy deadlift. And you WANT central nervous system activation for better strength gains and overall movement proficiency. This is actually one of the major problems I have with it.
The other BIG issue I have- is maintaining proper core function during use. Sure it may help with all these things that research is saying, but I'm telling you from experience when you have that suit on and are getting shocked (which is what it feels like) it's DIFFICULT to maintain proper pattern with your core unit. I mean, it's hard to NOT get out of rhythm with your inhale and exhale and your core unit coming along for the ride. You know, when you inhale pelvic floor should relax and go down, when you exhale, it should engage and come up. TVA should be doing the same, relaxing on inhale, engaging slightly on exhale. With this suit on it's hard not to bare down and PUSH (yup like in labor) bc it's so freaking intense. I had to really SLOW down and focus to make sure that I was correctly engaging while in the suit.
I was chatting with friends who have been doing it and they were all joking that they feel like the are in labor and pushing a baby out with the suit on in certain movements. They don't really understand what that means of course or how catastrophic that can be for some women. This is a PROBLEM. We either need to teach how to engage core and coach that during these sessions and/or we need to take the intensity WAY down so women don't lose touch with their core or maybe it's just not what it's cracked up to be bc maybe you will get the benefits above but you'll be damaging your core function and pelvic floor along the way. And in that case, it will be a hard pass from me for any of my clients. if you decide to do this and your trainer isn't hands on, coaching your breathing pattern and core engagement, you need to bounce outta there or at least do my ab rehab program before trying this, so you are educated on this and can coach yourself as you're doing EMS training.
Overall, I do see potential here. Potentially a lot of potential too, in the area of correcting faulty motor patterns, enhancing posture, and improving body awareness. And hey, if whole body EMS technology continues to improve, and more research comes out showing that it can safely/legally/effectively enhance muscle growth and strength, then I'll welcome it with strong open arms. I think as always, it's really hard to find a good trainer, and in this case even harder to find an EMS trainer that is really good. They just can't take you through primal movements, they need to really coach form, positioning and core function.
In a perfect world, if I ever started a EMS studio, I would have a 10 minute warm up that included core activation and breathing pattern work THEN go into a 20 minute EMS session while coaching and checking in on everyones core engagement THE ENTIRE TIME. Currently neither of those things exist. At least not that I have seen. Not because EMS trainers don't have your best interest at heart, but because they just don't know any better. And Unfortunately for my client, a Mom, that's just not gonna cut it.
My Takeaway: EMS Might be Worth a Second Look
All and all I'm SUPER interested in whole body EMS training. I also acknowledge that it isn't some panacea for your health, and it can never replace a solid, smart, and intense exercise program supported by an equally solid nutrition plan.
Do I think EMS can be used as a stand-in for legitimate strength and conditioning exercises? Of courssse nottttt. Do I recommend strapping yourself up to electrodes and going HAM without supervision from someone who has been trained in the proper use of EMS? Nope and nope again, and you wouldn't be able to anyway because these machines are HARD TO FIND and never operated without a trained EMS professional. And to be clear, EMS is contraindicated in many cases, so it's not appropriate for everyone.
BUT from what I've seen so far, there's enough research to support its use as a complementary technology that may enhance the effects your workout (it's worth a try, anyway). So, stay tuned. I'll keep you (and myself) updated on the research. Keep in mind, this is also expensive! Like really expensive, like $70-95 for a 20 minute session expensive. I've been thinking about doing a little study on myself for 8-12 weeks but having a hard time swallowing that $$ pill to do so. Because I still have to pay for my gym (as EMS can't be your only form of training to have a well rounded fitness regimen for fitness an health) and that starts adding up quick.
In closing, in case any of you are post-docs or grad students in the exercise, Kinesiology, or rehabilitation sciences, lemme just say I think it'd be realllllll swell if some research came out specifically looking at how whole body EMS training affects core function and activation in the postpartum woman. Cuz you know that's kinda my jam and honestly that is the biggest red flag I see here for long term function in these clients. Do you want to try EMS? What do you think about this whole new craze? Let me know what you think below!
Sources:
https://e-fit.com/en/about_ems
https://www.strokeassociation.org/en/about-stroke/effects-of-stroke/physical-effects-of-stroke/physical-impact/functional-electrical-stimulation
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789460/
https://www.ncbi.nlm.nih.gov/pubmed/28758085
https://www.refinery29.com/en-us/electrical-muscle-stimulation-training-workout
https://www.t-nation.com/training/truth-about-ems
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784391/
https://ieeexplore.ieee.org/document/5778539
https://www.ncbi.nlm.nih.gov/pubmed/28758085
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833968/
https://journals.lww.com/nsca-jscr/Fulltext/2011/02000/Effects_of_Combined_Electromyostimulation_and.32.aspx
https://www.ncbi.nlm.nih.gov/pubmed/21909714
https://biomedicalengineering.tcnj.edu/muscle-atrophy-reduction-system/
https://health.usnews.com/wellness/fitness/articles/2018-10-18/is-ems-training-the-missing-link-to-your-dream-body
https://www.compexstore.com/sites/default/files/documents/COMPEX-CLINICAL%20STUDIES-EN.pdf
https://www.acefitness.org/about-ace/press-room/press-releases/256/electrical-muscle-stimulation-ems-claims-exposed