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BACKGROUND: Physical activity referral schemes (PARS) are composed of various components, such as a written prescription or a person-centered approach. The role of these components in their effectiveness is yet to be understood. Therefore, we aimed to explore the relationships between PARS components and physical activity, scheme uptake, and adherence rate; and to estimate the effect of PARS. METHODS: We searched Scopus, PubMed, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE. Eligible studies were published between 1990 and November 2023 in English or German, investigated PARS with participants aged ≥ 16 years, and reported physical activity, scheme uptake, or scheme adherence. Separate random-effects meta-analysis by comparison group were conducted for physical activity. Scheme uptake and adherence rates were pooled using proportional meta-analysis. The components were analyzed via univariate meta-regression. We rated the risk of bias using RoB2 and ROBINS-I, and the certainty of evidence using GRADE. RESULTS: Fifty-two studies were included. PARS were more effective in increasing physical activity than usual care (k = 11, n = 5046, Hedges' g = 0.18, 95%CI 0.12 to 0.25; high certainty of evidence). When PARS were compared with physical activity advice or enhanced scheme versions, the pooled Hedges' g values for physical activity were -0.06 (k = 5, n = 1082, 95%CI -0.21 to 0.10; low certainty of evidence), and 0.07 (k = 9, n = 2647, 95%CI -0.03 to 0.18; low certainty of evidence) respectively. Scheme uptake was 87% (95%CI 77% to 94%, k = 14, n = 5000) across experimental studies and 68% (95%CI 51% to 83%, k = 14, n = 25,048) across non-experimental studies. Pooled scheme adherence was 68% (95%CI 55% to 80%, k = 16, n = 3939) and 53% (95%CI 42% to 63%, k = 18, n = 14,605). The meta-regression did not detect any significant relationships between components and physical activity or scheme uptake. A person-centered approach, screening, and brief advice were positively associated with scheme adherence, while physical activity sessions were negatively associated. CONCLUSION: PARS are more effective in increasing physical activity than usual care only. We did not identify any components as significant predictors of physical activity and scheme uptake. Four components predicted scheme adherence, indicating that the component-effectiveness relationship warrants further research.
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Exercício Físico , Cooperação do Paciente , Encaminhamento e Consulta , Humanos , Promoção da Saúde/métodos , AdultoRESUMO
INTRODUCTION: Recent clinical studies confirmed that whole-body electromyostimulation (WB-EMS) training is a safe and time-efficient therapeutic method for patients with nonspecific chronic back pain (NSCBP). However, significant variations in initial pain intensity among subjects in these studies have been observed. This study aims to determine if patients with differing initial pain intensities experience varying degrees of benefit from WB-EMS and to assess the overall correlation between initial pain levels and pain reduction. METHODS: Pain intensity datasets from two studies were combined. The pooled data included 121 NSCBP patients (38 males and 83 females) with an average age of 55.1 years (±11.8 years). Data was categorized by baseline pain intensity on the numeric rating scale (NRS) into seven groups: 0 to 2, >2 to 3, >3 to 4, >4 to 5, >5 to 6, >6 to 7, and >7. Both absolute and relative changes were analyzed. Additionally, a Spearman rho correlation test was performed on the entire dataset to evaluate the relationship between initial pain level and pain reduction. RESULTS: Significant improvements were noted across all NRS11 categories, with strong effect sizes (p) in all classes above 2, ranging from 0.56 to 0.90. The >7 category exhibited the highest rate of clinically significant changes (80%) and an average improvement of 3.72 points. The overall group from >1 to 10 showed an average improvement of 1.33 points, with 37% of the participants experiencing clinically significant improvements. The Spearman rho correlation test revealed a moderate positive relationship between initial pain level and pain reduction (r_s = 0.531, p < 0.001), indicating that, generally, higher initial pain levels are associated with greater pain reduction. CONCLUSION: The findings support the hypothesis that NSCBP patients with higher baseline NRS values benefit more substantially from WB-EMS. Those with NRS values above 7 show the greatest improvement and highest rate of clinical significance. The overall positive correlation between initial pain intensity and pain reduction further underscores the efficacy of WB-EMS in managing NSCBP across different pain intensities.
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OBJECTIVES: This study evaluated stakeholders' experiences of participating in a coproduction process to develop a physical activity referral scheme (PARS) in the German healthcare system. The focus was on examining facilitators and challenges, along with gathering insights on potential modifications to the joint development process, all from the viewpoint of stakeholders. DESIGN: This qualitative study employed one-to-one semi-structured interviews, and the findings were analysed using summarising qualitative content analysis. SETTING: The study focused on the German healthcare system. PARTICIPANTS: Seven stakeholders from the coproduction process were purposefully selected for interviews using maximum variation sampling. The interviewees represented different sectors (physician associations, physical activity professionals' associations, health insurance companies and patient organisations), various positions within their organisations, and different levels of attendance during the coproduction process. RESULTS: In almost all interviews, the following factors were highlighted as facilitators of the development process: coproduction approach, process of coproduction, multi-sector stakeholder group, possibility of active participation, coordinating role of researchers, communication, atmosphere and interaction. In contrast, differences in roles and hierarchy, merging of different perspectives, clarification of intervention costs, and competition and conflicting interests were pointed out as challenges. Only a few suggestions regarding adaptations in terms of group composition and cooperation among stakeholders were mentioned. CONCLUSIONS: Stakeholder experiences with the joint development process were predominantly positive, indicating that coproduction is a beneficial approach for the development of PARS intended for integration into healthcare systems. The effective management of power differences among stakeholders is intricately tied to the coproduction method; therefore, it should be selected carefully. The research team plays a pivotal role in coordinating and negotiating the process, and the team should be equipped with a diverse set of skills and knowledge, particularly to understand the intricacies of the healthcare system where the PARS is intended for implementation. TRIAL REGISTRATION NUMBER: NCT04947787.
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Exercício Físico , Pesquisa Qualitativa , Encaminhamento e Consulta , Humanos , Alemanha , Participação dos Interessados , Entrevistas como Assunto , Atenção à SaúdeRESUMO
BACKGROUND: Physical activity referral schemes (PARS) are complex multicomponent interventions that represent a promising healthcare-based concept for physical activity (PA) promotion. This systematic review and narrative synthesis aimed to identify the constitutive components of PARS and provide an overview of their effectiveness. METHODS: Following a published protocol, we conducted a systematic search of PubMed, Scopus, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE from 1990 to January 2023. We included experimental, quasi-experimental, and observational studies that targeted adults participating in PARS and reported PA outcomes, scheme uptake, or adherence rates. We performed an intervention components analysis using the PARS taxonomy to identify scheme components and extracted data related to uptake, adherence, and PA behavior change. We combined these to provide a narrative summary of PARS effectiveness. RESULTS: We included 57 studies reporting on 36 PARS models from twelve countries. We identified 19 PARS components: a patient-centered approach, individualized content, behavior change theory and techniques, screening, brief advice, written materials, a written prescription, referral, baseline and exit consultation, counselling support session(s), PA sessions, education session(s), action for non-attendance, structured follow-up, a PA network, feedback for the referrer, and exit strategies/routes. The PARS models contained a mean of 7 ± 2.9 components (range = 2-13). Forty-five studies reported PA outcome data, 28 reported uptake, and 34 reported adherence rates. Of these, approximately two-thirds of studies reported a positive effect on participant PA levels, with a wide range of uptake (5.7-100.0%) and adherence rates (8.5-95.0%). CONCLUSIONS: Physical activity referral scheme components are an important source of complexity. Despite the heterogeneous nature of scheme designs, our synthesis was able to identify 19 components. Further research is required to determine the influence of these components on PARS uptake, adherence, and PA behavior change. To facilitate this, researchers and scheme providers must report PARS designs in more detail. Process evaluations are also needed to examine implementation and increase our understanding of what components lead to which outcomes. This will facilitate future comparisons between PARS and enable the development of models to maximize impact.
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Exercício Físico , Atividade Motora , Adulto , Humanos , Prescrições , Encaminhamento e ConsultaRESUMO
[This corrects the article DOI: 10.3389/fphys.2023.1174103.].
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Whole-Body Electromyostimulation (WB-EMS) is a training technology that enables simultaneous stimulation of all the main muscle groups with a specific impulse intensity for each electrode. The corresponding time-efficiency and joint-friendliness of WB-EMS may be particularly attractive for people unable or unmotivated to conduct (intense) conventional training protocols. However, due to the enormous metabolic and musculoskeletal impact of WB-EMS, particular attention must be paid to the application of this technology. In the past, several scientific and newspaper articles reported severe adverse effects of WB-EMS. To increase the safety of commercial non-medical WB-EMS application, recommendations "for safe and effective whole-body electromyostimulation" were launched in 2016. However, new developments and trends require an update of these recommendations to incorporate more international expertise with demonstrated experience in the application of WB-EMS. The new version of these consensus-based recommendations has been structured into 1) "general aspects of WB-EMS", 2) "preparation for training", recommendations for the 3) "WB-EMS application" itself and 4) "safety aspects during and after training". Key topics particularly addressed are 1) consistent and close supervision of WB-EMS application, 2) mandatory qualification of WB-EMS trainers, 3) anamnesis and corresponding consideration of contraindications prior to WB-EMS, 4) the participant's proper preparation for the session, 5) careful preparation of the WB-EMS novice, 6) appropriate regeneration periods between WB-EMS sessions and 7) continuous interaction between trainer and participant at a close physical distance. In summary, we are convinced that the present guideline will contribute to greater safety and effectiveness in the area of non-medical commercial WB-EMS application.
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BACKGROUND: While effective physical activity referral schemes (PARSs) and related structures for promoting physical activity (PA) already exist in several countries, in Germany, PARSs have not yet been implemented systematically and nationwide. Through a co-production approach with relevant actors in the German healthcare system, a PARS was developed, and an implementation plan was created (e.g. financing). This study protocol aims to evaluate the developed PARS for people with non-communicable diseases (NCDs) in Germany regarding its potential effectiveness and implementation success. METHODS: To evaluate the effectiveness and implementation success of the PARS, we will apply a pragmatic cluster-randomised controlled trial (cRCT) in Hybrid II design by comparing two intervention groups (PARS vs PA advice [PAA]). The trial will take place in the Nürnberg metropolitan region, with 24 physician practices recruiting 567 people with NCDs. Both groups will receive brief PA advice from a physician to initially increase the participants' motivation to change their activity level. Subsequently, the PARS group will be given individualised support from an exercise professional to increase their PA levels and be transferred to local exercise opportunities. In contrast, participants in the PAA group will receive only the brief PA advice as well as information and an overview of regional PA offerings to become more active at their own initiative. After 12 and 24 weeks, changes in moderate to vigorous PA and in physical activity-related health competence (movement competence, control competence, self-regulation competence) will be measured as primary outcomes. Secondary outcomes will include changes in quality of life. To measure implementation success, we refer to the RE-AIM framework and draw on patient documentation, interviews, focus groups and surveys of the participating actors (physicians, exercise professionals). DISCUSSION: Through a between-group comparison, we will investigate whether additional individual support by an exercise professional compared to brief PA advice alone leads to higher PA levels in people with NCDs. The acceptance and feasibility of both interventions in routine care in the German healthcare system will also be evaluated. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04947787 . Registered 01 June 2021.
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Exercício Físico , Qualidade de Vida , Atenção à Saúde , Exercício Físico/fisiologia , Alemanha , Humanos , Ensaios Clínicos Pragmáticos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Encaminhamento e ConsultaRESUMO
Due to the beneficial impact of regular physical activity (PA) on non-communicable diseases, the number of countries integrating exercise referral schemes (ERSs) into their healthcare systems is growing. Owing to the limitations of existing PA promotion concepts in Germany's healthcare system, efforts are currently being made towards developing a nationwide referral pathway. A research group at the Friedrich-Alexander-University Erlangen-Nürnberg is coordinating these efforts within a project funded by the Federal Ministry of Health. The aim is to develop, implement and evaluate a regional-level ERS that has the potential to be scaled up across Germany in the event of its demonstrated effectiveness. The project is based on an adapted Cooperative Planning approach requiring interaction between the academic sector and different actors of the healthcare sector. The present commentary reflects on challenges faced in the early stages of the co-production process. Besides the development of an adequate co-production methodology, it critically discusses stakeholder participation, knowledge gaps and actors' willingness to take responsibility. In addition, although patients are represented by dedicated organizations, their perspective cannot be adequately captured using a co-production approach. Despite the joint development of an ERS, there remain important questions regarding the appropriateness of the co-production approach in a healthcare setting.
Regular physical activity (PA) reduces one's risk of developing various diseases and also plays a favourable role in managing symptoms and preventing further complications. Nationally and internationally, there exist different concepts on how to increase PA in the population at large. The Friedrich-Alexander-University Erlangen-Nürnberg is currently working on a project that focuses on promoting PA in primary care. This project involves collaboration among various actors in the German healthcare system, such as healthcare insurances, representatives of physicians, patients and exercise specialists, who represent different interests and are experts in their fields of knowledge. During this process, various barriers have come to light, which yield important lessons for further studies. For example, there are differences in actors' levels of knowledge of the healthcare system and their willingness to take responsibility and initiative in the collaborative process. This article should give an impression of the joint development of exercise referral schemes, show the strengths and weaknesses and encourage exchanges of similar experiences of co-production processes.
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Exercício Físico , Encaminhamento e Consulta , Atenção à Saúde , Alemanha , Humanos , Serviços Preventivos de SaúdeRESUMO
INTRODUCTION: In its attempt to establish effective physical activity promotion methods, research on physical activity referral schemes (PARS) is attracting significant attention. Sometimes known as physical activity on prescription schemes, PARS involve a well-defined procedure whereby a primary healthcare professional introduces a participant to the topic of physical activity and employs prescription or referral forms to connect the participant to physical activity opportunities, such as local fitness offers. The planned systematic review will focus on these referral routes and scheme components and how they are integrated into various PARS models worldwide. We seek to identify the evidence-based core components that play the most important roles in the effectiveness of PARS. METHODS AND ANALYSIS: The development and reporting of the protocol follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. We plan to conduct a systematic main literature search on PubMed, Scopus, Web of Science, CINAHL, HTA, SpringerLink and other databases. We will include studies that report outcomes on physical activity, PARS uptake and adherence rates or descriptive information about PARS models. We intend for all review stages, citation screening, data extraction and risk of bias assessment to be conducted by at least two independent reviewers. As a broad spectrum of study designs, including randomised and non-randomised studies of interventions and mixed methods, will be eligible, we will use three separate tools to assess the risk of bias in individual studies. The data will be primarily synthesised narratively, following Intervention Component Analysis. If the data allow, we will perform a random-effects meta-analysis and meta-regression to investigate the impact of specific PARS components on effect sizes. ETHICS AND DISSEMINATION: This systematic review does not require formal ethics approval. The results will be submitted to a peer-reviewed journal and international conferences to reach the scientific community. PROSPERO REGISTRATION NUMBER: CRD42021233229.
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Exercício Físico , Projetos de Pesquisa , Humanos , Metanálise como Assunto , Atenção Primária à Saúde , Encaminhamento e Consulta , Revisões Sistemáticas como AssuntoRESUMO
The aim of this multicenter trial was to compare the effects of whole-body electromyostimulation (WB-EMS) and whole-body vibration (WBV) with conventional back-strengthening training (CT) on changes in mean back pain intensity (MPI) and trunk strength in patients suffering from chronic non-specific low back pain (CNLBP). Two-hundred and forty CNLBP patients (40-70 years; 62% female) were randomly assigned to three intervention arms (WB-EMS: n = 80 vs. WBV: n = 80 vs. CT: n = 80). All training intervention programs were performed for 12 weeks in their usual commercial training setting. Before and during the last 4 weeks of the intervention, MPI was recorded using a 4-week pain diary. Additionally, maximal isometric trunk extension and -flexion strength was assessed on the BackCheck® machine. A moderate but significant decrease of MPI was observed in all groups (WB-EMS: 29.7 ± 39.1% (SMD 0.50) vs. WBV: 30.3 ± 39.3% (SMD 0.57) vs. CT: 30.5 ± 39.6% (SMD 0.59); p < 0.001). Similar findings were observed for maximal isometric strength parameters with a significant increase in all groups (extension: WB-EMS: 17.1 ± 25.5% vs. WBV: 16.2 ± 23.6% vs. CT: 21.6 ± 27.5%; p < 0.001; flexion: WB-EMS: 13.3 ± 25.6% vs. WBV: 13.9 ± 24.0% vs. CT: 13.9 ± 25.4%; p < 0.001). No significant interaction effects for MPI (p = 0.920) and strength parameters (extension: p = 0.436; flexion: p = 0.937) were observed. WB-EMS, WBV, and CT are comparably effective in improving MPI and trunk strength. However, training volume of WB-EMS was 43 or 62% lower, compared with CT and WBV.
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INTRODUCTION: Physical activity referral schemes (PARSs) are recommended to promote physical activity (PA) among adults at risk of developing or with established non-communicable diseases (NCDs). In Germany, this kind of referral schemes has not yet been implemented systematically and nationwide. In this study protocol, we present the methodological design of a co-production research study aimed at establishing a PARS for adults with NCDs in German primary healthcare. METHODS AND ANALYSIS: We will employ a co-production approach consistently throughout the four project phases: (1) development of the PARS; (2) preparation period; (3) implementation and evaluation; (4) development of a strategic plan for scaling up the PARS to the national level as part of standard care. The first phase will additionally include a status quo analysis of the existing physical activity pathways nationwide as well as an overview of international PARS models. A pragmatic trial design will be used for evaluating the developed PARS. The co-production approach will involve relevant actors in the German healthcare system, namely, healthcare service providers (eg, physicians, exercise professionals), health insurance providers, exercise providers, patients' representatives, experts in the development and implementation of educational concepts, and scientists from the fields of sports science and public health. ETHICS AND DISSEMINATION: The project has been reviewed and approved by the ethics committee of the Friedrich-Alexander-University Erlangen-Nürnberg (ethics approval number: 331_20 B). Through cooperation agreements, the stakeholders involved gave their consent to participate and were informed about the study in detail. The results of this study will be disseminated by international conference presentations and peer-reviewed publications, and if possible, a manual for the use of the PARS will be provided.
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Exercício Físico , Encaminhamento e Consulta , Adulto , Alemanha , Humanos , Atenção Primária à Saúde , Projetos de PesquisaRESUMO
BACKGROUND: Low back pain (LBP) affects almost everyone at least once in their lifetime. Various meta-analyses show promising effects on pain reduction for conventional exercise. However, the lack of time and, especially for pain patients, a fear of movement ("kinesiophobia") as well as functional limitations often oppose participation in such activities. In contrast, the advantage of novel training technologies like whole-body electromyostimulation (WB-EMS) lies particularly in a joint-friendly, time-effective, and highly customized training protocol and might be an alternative option for LBP patients. A meta-analysis of individual patient data and a comparison of WB-EMS against a passive control group confirmed the proof principle. Thus, the aim of this randomized controlled trial is to compare WB-EMS with a recognized back-strengthening exercise protocol to determine the corresponding effects on chronic, nonspecific LBP in people suffering from this. METHODS AND FINDINGS: This randomized, controlled multicenter study is focused on novel and time-effective training technologies and LBP. In this contribution, the focus is primarily on the comparison of WB-EMS against a comparable conventional exercise training (CT). One hundred ten nonspecific chronic LBP patients, 40-70 years old, were randomly allocated to the intervention arms (WB-EMS: 55 vs. CT: 55). Both groups completed a 12-week program (WB-EMS: 1 × 20 min/week vs. CT: 1 × 45 min/week) specifically dedicated to LBP. The selection of the content of the active control group was based on the principles of WB-EMS training, which uses electrical stimulation to train mainly strength and stabilization in a very short time. Exercises were similar in all groups, with the focus on strengthening and stabilizing the trunk. Outcome measures were assessed by a four-week pain diary (before and during the last four weeks of intervention) as well as an isometric maximum strength measurement of the trunk muscles at baseline and after 12 weeks of intervention. Primary study endpoint was average pain intensity at the lumbar spine. Secondary study endpoints were maximum isometric strength of the back and the abdominals. The mean pain intensity of LBP decreased significantly in both groups (WB-EMS: -22.3 ± 20.9% vs. CT: -30.2 ± 43.9%; p < 0.001), however, without significant intergroup difference (p=0.160). A similar result was observed for "maximum isometric strength of trunk muscles." The increase in back strength (WB-EMS: 15.6 ± 24.9% vs. CT: 23.0 ± 30.9%) was highly significant in both groups (p=0.001), and similar changes were observed for the trunk flexors (WB-EMS: 17.6 ± 24.8% vs. CT: 18.1 ± 24.8%). Also, at the secondary endpoint, no significant difference in pairwise comparison was observed in both cases (extension: p=0.297; flexion: p=0.707). CONCLUSION: In summary, both, WB-EMS and conventional back-strengthening protocol are comparably effective in reducing nonspecific chronic LBP in this dedicated cohort. The result is particularly positive in terms of time effectiveness and offers an adequate alternative for people with limited time resources or other barriers to conventional training methods.
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Estimulação Elétrica/métodos , Terapia por Exercício/métodos , Exercício Físico/fisiologia , Dor Lombar/fisiopatologia , Dor Lombar/terapia , Adulto , Idoso , Composição Corporal/fisiologia , Terapia por Estimulação Elétrica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Músculo Esquelético/fisiopatologiaRESUMO
Purpose: Overweight and obesity are an increasing problem worldwide. However, most studies that focus on weight reduction by energy restriction and/or aerobic exercise reported considerable loss of muscle mass as well. Increased protein intake and/or resistance exercise might inhibit this detrimental effect during a negative energy balance. Whole-body electromyostimulation (WB-EMS), a time effective, joint-friendly, and highly customizable training technology, showed similar hypertrophic effects compared with high-intensity resistance training. The aim of this study is to evaluate the effect of WB-EMS on body composition during negative energy balance with maintained/increased protein intake in overweight premenopausal women. Patients and Methods: Ninety premenopausal, 25-50-year-old, overweight women were randomly assigned to three groups (n = 30 each). (1) Negative energy balance (-500 kcal/day) by energy restriction with compensatory protein intake (CG). (2) Negative energy balance (-500 kcal/day) by energy restriction (-250 kcal/day) and increased physical activity (-250 kcal/day) with increased protein intake (PA). (3) Negative energy balance (-500 kcal/day) due to energy restriction and increased physical activity with increased protein intake plus WB-EMS. The duration of the intervention was 16 weeks. Participants underwent restrictions in kcal per days and supplementation of protein (CG: 1.2 or PA/WB-EMS: 1.7 g/kg body mass/day) where needed. Bipolar WB-EMS was applied 1.5× week for 20 min (85 Hz; 350 µs; intermittent 6 s impulse, 4 s rest; rectangular). The primary study endpoint "lean body mass" (LBM) and secondary endpoint body fat mass (BFM) were assessed by bio-impedance analysis (BIA). Results: LBM decreased in the CG and PA group (CG: -113 ± 1,872 g; PA: -391 ± 1,832 g) but increased in the WB-EMS group (387 ± 1,769 g). However, changes were not significant (p > 0.05). Comparing the groups by ANOVA, no significant differences were observed (p = 0.070). However, pairwise adjusted comparisons determined significant differences between WB-EMS and PA (p = 0.049). BFM decreased significantly (p < 0.001) in all groups (CG: -2,174 ± 4,331 g; PA: -3,743 ± 4,237 g; WB-EMS: -3,278 ± 4,023 g) without any significant difference between the groups (ANOVA: p = 0.131). Conclusion: WB-EMS is an efficient, joint-friendly, and highly customizable training technology for maintaining muscle mass during energy restriction and can thus be considered as an alternative to more demanding resistance exercise protocols.
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PURPOSE: Low back pain (LBP) is one of the most frequent chronic conditions worldwide. Data from a recent meta-analysis indicated that whole-body electromyostimulation (WB-EMS), a time-effective, joint-friendly, and highly individualized training technology, demonstrated promising effects on LBP; however, methodologic limitations prevent definitive evidence for this result. Thus, the aim of this study was to conduct a randomized controlled WB-EMS trial to determine the corresponding effect on chronic, nonspecific LBP in people with chronic LBP. PATIENTS AND METHODS: Thirty LBP patients, 40-70 years old, were randomly assigned into two groups (WB-EMS: 15; control [CG]: 15). While the nonactive CG maintained their lifestyle, the WB-EMS group completed a 12-week WB-EMS protocol (1×20 min/week) with slight movements, specifically dedicated to LBP. Pain intensity and frequency were determined by a 4-week pain diary before and during the last 4 weeks of intervention. Primary study endpoint was average pain intensity at the lumbar spine. RESULTS: At baseline, no group differences apart from nonregular exercise were observed. Mean intensity of LBP decreased significantly in the WB-EMS group (P=0.002) and remained unchanged in the CG (P=0.730), with a significant difference between both groups (P=0.027). Maximum isometric trunk extensors improved significantly in the WB-EMS group (P=0.005), while no significant difference was seen in the CG (P=0.683). In contrast to the significant difference between WB-EMS group and CG for the latter parameter (P=0.038), no intergroup difference was determined for maximum isometric trunk flexors (P=0.091). The WB-EMS group showed a significant increase of this parameter (P=0.003), while no significant change was determined in the CG (P=0.563). CONCLUSION: WB-EMS is a time-effective training method for reducing chronic nonspecific LBP and increasing maximum trunk strength in people with such complaints. After this promising comparison with a nonactive CG, research needs to be extended to include comparisons with active groups (WB-Vibration, conventional back strengthening).
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Exercise positively affects most risk factors, diseases and disabling conditions of middle to advanced age, however the majority of middle-aged to older people fall short of the exercise doses recommended for positively affecting cardio-metabolic, musculoskeletal and neurophysiological fitness or disabling conditions. Whole-Body Electromyostimulation (WB-EMS) may be a promising exercise technology for people unable or unmotivated to exercise conventionally. However, until recently there has been a dearth of evidence with respect to WB-EMS-induced effects on health-related outcomes. The aim of this systematic review is to summarize the effects, limitations and risks of WB-EMS as a preventive or therapeutic tool for non-athletic adults. Electronic searches in PubMed, Scopus, Web of Science, PsycINFO, Cochrane and Eric were run to identify randomized controlled trials, non-randomized controlled trials, meta-analyses of individual patient data and peer reviewed scientific theses that examined (1) WB-EMS-induced changes of musculoskeletal risk factors and diseases (2) WB-EMS-induced changes of functional capacity and physical fitness (3) WB-EMS-induced changes of cardio-metabolic risk factors and diseases (4) Risk factors of WB-EMS application and adverse effects during WB-EMS interventions. Two researchers independently reviewed articles for eligibility and methodological quality. Twenty-three eligible research articles generated by fourteen research projects were finally included. In summary, thirteen projects were WB-EMS trials and one study was a meta-analysis of individual patient data. WB-EMS significantly improves muscle mass and function while reducing fat mass and low back pain. Although there is some evidence of a positive effect of WB-EMS on cardio-metabolic risk factors, this aspect requires further detailed study. Properly applied and supervised, WB-EMS appears to be a safe training technology. In summary, WB-EMS represents a safe and reasonable option for cohorts unable or unwilling to join conventional exercise programs. However, much like all other types of exercise, WB-EMS does not affect every aspect of physical performance and health.
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BACKGROUND/OBJECTIVE: In soccer the recovery time between matches is often not long enough for complete restoration. Insufficient recovery can result in reduced performance and a higher risk of injuries. The purpose of this study was to evaluate the potential of Deep Oscillation (DO) as a recovery method. METHODS: In a randomized crossover study including 8 male soccer players (22⯱â¯3.3 years) the following parameters were evaluated directly before and 48â¯h after a fatiguing soccer-specific exercise: Maximum isokinetic strength of the leg and hip extensors and flexors (Con-Trex® Leg Press, Physiomed, Germany), rating of perceived exertion (RPE) during isokinetic testing (Borg scale 6-20), creatine kinase (CK) serum levels and Delayed Onset Muscle Soreness (DOMS; visual analogue scale 1-10). By random allocation, half of the group performed a DO self-treatment twice daily (4 applications of 15min each), whilst the other half received no intervention. 4 weeks later a cross-over was conducted. Two-way repeated measures analysis of variance was used to compare treatment versus control. RESULTS: A significant treatment effect was observed for maximum leg flexion strength (p = 0.03; DO: 125 ± 206 N vs. CG: -115 ± 194; p = 0.03) and for RPE (DO: -0.13 ± 0.64; vs. CG: +1.13 ± 1.36; p = 0.03). There was a trend to better recovery for maximum leg extension strength (DO: -31 ± 165 N vs. CG: -138 ± 212; p = 0.028), CK values (DO: 72 ± 331 U/ml vs. CG: 535 ± 797 U/ml; p = 0.15) and DOMS (DO: 3.4 ± 1.5 vs. CG: 4.1 ± 2.6; p = 0.49). CONCLUSION: In the present study we found significant effects of DO on maximum leg flexion strength and perceived rate of exertion. Other variables showed a consistent trend in favour of DO compared with the control without significance. DO seems to be a promising method to accelerate the time-course of peripheral recovery of muscle which should be addressed in larger studies in future. TRIAL REGISTRATION: ClinicalTrials.gov; NCT03411278, 18.01.2018 (during the study).
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To determine the underlying mechanisms after 1 session of (intense) whole-body electromyostimulation (WB-EMS) on total energy expenditure (TEE) and resting metabolic rate (RMR), 16 subjects followed a standardized protocol of indirect calorimetry for up to 72 h in 12-h intervals. The single session significantly increased RMR by approximately 25% ± 10% (p < 0.001) and TEE by approximately 9.5% ± 1%, a net effect of â¼460 ± 50 kcal (WB-EMS vs. control group).
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Composição Corporal , Estimulação Elétrica , Metabolismo Energético , Metabolismo dos Lipídeos , Adulto , Metabolismo Basal , Índice de Massa Corporal , Peso Corporal , Calorimetria Indireta , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiologia , Adulto JovemRESUMO
OBJECTIVE: The comparison between different techniques to quantify the 3-dimensional size of inflammatory bone erosions in rheumatoid arthritis(RA) patients. METHODS: Anti-cyclic citrullinated peptide antibody(ACPA) positive RA patients received high-resolution peripheral quantitative computed tomography (HR-pQCT) scans of the metacarpophalangeal joints (MCP). Erosions were measured by three different segmentation techniques: (1) manual method with calculation by half-ellipsoid formula, (2) semi-automated modified Evaluation Script for Erosions (mESE), and (3) semi-automated Medical Image Analysis Framework (MIAF) software. Bland & Altman plots were used to describe agreement between methods. Furthermore, shape of erosions was classified as regular or irregular and then compared to the sphericity obtained by MIAF. RESULTS: A total of 76 erosions from 65 RA patients (46 females/19 males), median age 57 years, median disease duration 6.1 years and median disease activity score 28 of 2.8 units were analyzed. While mESE and MIAF showed good agreement in the measurement of erosion size, the manual method with calculation by half-ellipsoid formula underestimated erosions size, particularly with larger erosions. Accurate segmentation is particularly important in larger erosions, which are irregularly shaped. In all three segmentation techniques irregular erosions were larger in size than regular erosions (MIAF: 19.7 vs. 3.4mm3; mESE: 15.5 vs. 2.3mm3; manual = 7.2 vs. 1.52mm3; all p < 0.001). In accordance, sphericity of erosions measured by MIAF significantly decreased with their size (p < 0.001). CONCLUSION: MIAF and mESE allow segmentation of inflammatory bone erosions in RA patients with excellent inter reader reliability. They allow calculating erosion volume independent of erosion shape and therefore provide an attractive tool to quantify structural damage in individual joints of RA patients.
Assuntos
Anticorpos Antiproteína Citrulinada/sangue , Artrite Reumatoide/diagnóstico por imagem , Articulação Metacarpofalângica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Artrite Reumatoide/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Índice de Gravidade de DoençaRESUMO
In order to evaluate the favorable effect of whole-body electromyostimulation (WB-EMS) on low back pain (LBP), an aspect which is frequently claimed by commercial providers, we performed a meta-analysis of individual patient data. The analysis is based on five of our recently conducted randomized controlled WB-EMS trials with adults 60 years+, all of which applied similar WB-EMS protocols (1.5 sessions/week, bipolar current, 16-25 min/session, 85 Hz, 350 µs, and 4-6 s impulse/4 s impulse-break) and used the same pain questionnaire. From these underlying trials, we included only subjects with frequent-chronic LBP in the present meta-analysis. Study endpoints were pain intensity and frequency at the lumbar spine. In summary, 23 participants of the underlying WB-EMS and 22 subjects of the control groups (CG) were pooled in a joint WB-EMS and CG. At baseline, no group differences with respect to LBP intensity and frequency were observed. Pain intensity improved significantly in the WB-EMS (p < .001) and was maintained (p = .997) in the CG. LBP frequency decreased significantly in the WB-EMS (p < .001) and improved nonsignificantly in the CG (p = .057). Group differences for both LBP parameters were significant (p ≤ .035). We concluded that WB-EMS appears to be an effective training tool for reducing LBP; however, RCTs should further address this issue with more specified study protocols.
RESUMO
BACKGROUND: Sarcopenic obesity (SO) is a geriatric syndrome characterized by the disproportion between the amount of lean mass and fat mass. Exercise decreases fat and maintains muscle mass; however, older people fail to exercise at doses sufficient to affect musculoskeletal and cardiometabolic risk factors. The aim of this study was to evaluate the effect of whole-body electromyostimulation (WB-EMS), a time-efficient, joint-friendly and highly individualized exercise technology, on sarcopenia and SO in older men. MATERIALS AND METHODS: A total of 100 community-dwelling northern Bavarian men aged ≥70 years with sarcopenia and obesity were randomly (1-1-1) assigned to either 16 weeks of 1) WB-EMS and protein supplementation (WB-EMS&P), 2) isolated protein supplementation or 3) nonintervention control. 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. The primary study end point was Sarcopenia Z-Score, and the secondary study end points were body fat rate (%), skeletal muscle mass index (SMI) and handgrip strength. RESULTS: Intention-to-treat analysis determined a significantly favorable effect of WB-EMS&P (P<0.001) and protein (P=0.007) vs control. Both groups significantly (P<0.001) lost body fat (WB-EMS&P: 2.1%; protein: 1.1%) and differed significantly (P≤0.004) from control (0.3%). Differences between WB-EMS&P and protein were significant for the Sarcopenia Z-Score (P=0.39) and borderline nonsignificant (P=0.051) for body fat. SMI increased significantly in both groups (P<0.001 and P=0.043) and decreased significantly in the control group (CG; P=0.033); differences between the verum groups and control were significant (P≤0.009). Handgrip strength increased in the WB-EMS group (1.90 kg; P<0.001; P=0.050 vs control) only. No adverse effects of WB-EMS or protein supplementation were recorded. CONCLUSION: WB-EMS&P is a safe and efficient method for tackling sarcopenia and SO in older men. However, the suboptimum effect on functional parameters should be addressed by increased voluntary activation during WB-EMS application.