STUDY PROTOCOL article
Effects of Whole Body Electromyostimulation on Physical Fitness and Health in Postmenopausal Women: A Study Protocol for a Randomized Controlled Trial
- 1Research Group Human Movement, University of Lleida, Lleida, Spain
- 2EUSES Health and Sport Sciences School, Rovira i Virgili University, Tarragona, Spain
Background: Age-related problems such as chronic diseases, functional limitation and dependence, reduce the quality of life in the elderly, and increase public spending in health. It has been established that physical activity plays a fundamental role in the health of the elderly. The whole body electromyostimulation (WB-EMS) could be a successful methodology as high-intensity training to improve the physical fitness of older people.
Methods: A minimum of 13 women between 55 and 70 years old will be randomized in two groups. The exercise with WB-EMS group (EX + WB-EMS) will conduct a resistance strength training program with superimposed WB-EMS while the exercise group (EX) will perform only resistance strength and aerobic training. Balance, strength, flexibility, agility, speed, and aerobic performance (EXERNET battery and progressive resistance test), as well as body composition, blood parameters and physical activity reporting (IPAQ-E) will be assessed to analyze the effects of whole body electromyostimulation in the physical fitness and the health in postmenopausal women.
Discussion: Innovative and scientifically well-designed protocols are needed to enhance the knowledge of the body's responses within this training methodology which is being used by a big quantity of population. This trial will provide evidence on the effectiveness of whole-body electromyostimulation in physical fitness and health in elderly women.
Trial Registration: ISRCTN15558857 registration data: 27/11/2019 (retrospectively registered).
In recent years, the aging of the world population is increasing at an accelerated rate. In 2017, world population over 60 years old was of 962 million people, which doubled the 1980 figures when there were 382 million. In 2050 the number of elderly people is expected to reach 2.1 billion (1). Two key factors influence the aging of the population. The first one is the increase of life expectancy: on average, people around the world are now living longer. The second one is the decrease of fertility rates (2). Aging is associated with a decline of physical fitness, which has a negative impact on their quality of life and increases their level of dependence (3). As a result, global concern is being generated, both for what aging means for the health of the elderly, and the increase in public spending associated with it (4).
Faced with this situation, many governments are beginning to adopt policies for the prevention, reduction and treatment of diseases derived from advanced age to promote healthy aging (5). It has been established that physical activity plays a fundamental role in the prevention and treatment of age-related problems such as chronic diseases, functional limitation and dependence, which also makes it a facilitating element of a good quality of life (6, 7). In fact, physical activity has been presented as an excellent medicine to prevent and treat various chronic diseases derived from aging (8).
Succinctly, there are several aspects related to physical fitness affected by aging whose impact can be reduced with adherence to physical activity programs. These benefits have been observed particularly in the postmenopausal woman (9), whose hormonal status enhances the risk of diverse health diseases (10). One of the most widespread consequences is sarcopenia. Sarcopenia is the major cause of falls and inability to perform typical daily life activities. It increases dependence, morbidity and death probabilities (11, 12). The decrease in strength, coupled with the balance deficit and instability in gait are the greatest risk factors for falls in older people (13). Sarcopenia has a high prevalence in postmenopausal women, leading to mobility restriction, functional impairment, physical disability and fractures (14). As a solution to this physical decline, it has been established that there is clear evidence of exercise's effectiveness as prevention and remedy against physical frailty, sarcopenia (15, 16), loss of balance and gait difficulties (17, 18). For this reason, the key components of preventing falls training include muscular strength, in addition to balance, walking displacement skills and flexibility (19).
Aging is also the biggest risk factor associated with cardiovascular diseases (20) and due to this, it has been established that age is a facilitating element of metabolic syndrome. As a result of the aging population, cardiovascular problems generate more deaths in Europe than any other cause. In many countries, it even doubles the number of deaths caused by cancer (21). The evaluation of aerobic performance can predict cardiovascular problems (22, 23). Hence, reliable and quality of evidence has established the benefit of cardiorespiratory exercise as a prevention and treatment of cardiovascular diseases (24, 25), contributing decisively to healthy aging (26). In fact, metabolic syndrome is described as an association of cardiovascular risk factors and high levels of HDL cholesterol and triglycerides (27). Exercise as an intervention for patients with metabolic syndrome leads to improved coronary artery disease risk factors, including atherogenic dyslipidemia, blood pressure, and fat metabolism (28).
Parallel to these decreases in strength and cardiorespiratory capacity, older people also experience decreasing body composition and agility with advancing age, which significantly limits their ability to perform daily activities (29). This is where exercise can play a role of great social relevance, since adherence to physical activity programs has been associated with improvements in body composition (30–32), agility (33, 34) and functional capacity (35–37).
Apart from the previously commented diseases, blood tests allow the detection of some other ones which increase with age. On one hand, aging is a risk factor for increased insulin resistance, which makes the glucose levels appear high. This plays an important role in the development of type 2 diabetes (38–40). Physical activity has shown great effectiveness in the prevention and treatment of this disease through programs aimed at the development of strength (41) and aerobic resistance (42, 43). On another hand, the prevalence of thyroid disorders increases with age and the most common thyroid disease in older individuals is hypothyroidism what can be observed in high levels of thyroid-stimulating hormone (TSH) (44). Concretely in women, it has been demonstrated that hypothyroidism is related to low physical activity levels (45).
Despite all the benefits it offers as compensation for the deterioration of physical fitness and health, physical activity has been a resource in critical disuse as a preventive and efective strategy for healthy aging (46). Mainly, sedentary behavior is primarily observed in older people. In fact, they spend 65–80% of their waking time in a sitting position (47). Therefore, to overcome sedentary lifestyles and promote adherence to physical exercise in the elderly, it will be necessary for health authorities to generate physical activity programs with an attractive profile. This programs should provide easily perceived benefits and should enjoy good social support (48).
In recent years, high-intensity training programs have been developed with older people, successfully developing increments in strength (49–53) and resistance (54, 55). Thus, it is possible that whole-body electromyostimulaiton (WB-EMS), as a training method that facilitates a high intensity of charges, could be an appropriate methodology for the exercise of this population group. Traditional local EMS is based in the application of a rectangular, biphasic and symmetrical electrical current to defined muscles by placing on them single surface electrodes. The direct electrical impulse produces muscle contraction by transcutaneous peripheral nerve stimulation (56). Recently, through some technical developments, EMS progressed to WB-EMS by using a suit in which electrodes are strategically placed on the targeted muscles. The WB-EMS devices generally allow the simultaneous activation of the muscles in thighs, arms, buttocks, abdomen, chest, lower back, upper back, wide dorsal, and two auxiliary channels of free choice. The total electrode area is 2,800 cm2 (57). Kemmler et al. (58) compared the effects of a WB-EMS training with those of a traditional high-intensity interval training, concluding that both programs showed the same effectiveness in improving the physical condition of sedentary men with cardio-metabolic risk. Following this line of research, the present study has raised the possibility of using this methodology as high-intensity training to improve the physical condition of older women. Our study will take into account that the WB-EMS guarantees sufficient effort in those unable or reluctant to do it on their own initiative (59).
Previous studies have analyzed the effects of WB-EMS on the health of older people, finding improvements in cardio-metabolic risk and sarcopenia (59–65). In addition, the WB-EMS has established itself as an effective method of physical conditioning, achieving improvements in VO2max, Aerobic Threshold, Anaerobic Threshold and Economy in the race (66), maximum isometric strength of the leg extenders, vertical jump, and handgrip strength (58, 59, 65–67).
Unfortunately, the high risk of bias of some of the previous studies leads to little evidence regarding the effectiveness of training with WB-EMS (68). So, there is a need for new studies which ensure the use of protocols compatible with a rigorous scientific methodology. The objective of this study is to analyze, from a broad and multivariable perspective, the influence of a 10-weeks WB-EMS training program on the physical condition and health of postmenopausal women using a 2-arm parallel group design with follow-up.
The study is designed as a blinded two-arm randomized trial with parallel-groups and a follow-up. This study protocol is reported following the SPIRIT guideline for standard protocol items in interventional trials (69). The study protocol is registered in the ISRCTN registry (trial-ID: ISRCTN15558857 (70) where all the important modifications will be recorded.
Participants will be blinded and distributed into two groups by a computer random number generator (71), the voluntary exercise with WB-EMS group (EX + WB-EMS) or the voluntary exercise group (EX). The EX + WB-EMS group will conduct a resistance strength training program with superimposed WB-EMS while the EX group will perform only resistance strength training. Participants will be evaluated at the beginning (baseline), at the end of the 10 weeks of intervention (post-test) and 6 months after the end of the intervention (follow-up) (see Figure 1).
The sample size was determined by an a-priori power analysis using the G*Power3 software for Mac (72) following the indications of Beck (73). The effect size value used was: d = 0.70 with a total sample size of 30, based on a study of WB-EMS training on hip circumference in postmenopausal women (60), with two levels for the between-subject factor (EX+WB-EMS, EX), three levels for the within-subject factor (Baseline, 10 weeks, 6 months), alpha error probability set at 0.05 and a power of 0.80. This analysis indicated a minimum total sample size of 22 participants. Considering a dropout rate of 25%, 14 participants per arm will be required. In order to check the minimum effect size to which the model will be sensitive, a sensitivity analyses with the overestimated sample size assuming a 25% of dropout rate (n = 28) was done. The power and alpha values used were 0.80 and 0.05, respectively. The model will be sensitive enough to detect effects as small as d = 0.60.
The target of this recruitment is post-menopausal women between 55 and 70 years old (400 subjects) with a sedentary lifestyle at least 4 months prior to the study. They will be enrolled in the Ekke sports center in Lleida (Spain). They will be contacted by phone call to be informed about the nature of this study. All of them will be invited to attend an informational meeting where more details will be given on the benefits and possible risks that their participation in the project might entail. The subjects who show interest in their participation will be recruited, according to the exclusion criteria. They will be allocated and informed about their assigned arm by phone call by an external collaborator.
According to the shelf reporting in the IPAQ questionnaire of weekly physical activity, participants should be in a sedentary situation according to the scales provided by the Eurobarometer (74). Those who suffer from heart disease, metabolic disorders, tumor processes, or neurological disturbances will be excluded from this study. All participants will be informed of the details of the study and will sign an informed consent form before starting the investigation. The protocol of this study has been approved by the ethical committee of the Arnau of Vilanova's University Hospital, Lérida, (Spain). Participants will be informed of their voluntary participation. Taking into account the possible discomfort which WB-EMS could generate in the participants, they will be informed of their right to withdraw from the study without any prejudice or harm. The deterioration of the participant's health or any accident that could influence the correct development of the treatment will be reasons that will lead to their exclusion at any stage of the intervention. They will be also assured of their anonymity and the reporting of their views in aggregate form to protect their identities.
Hormone assessments will be performed from fasting serum samples taken between 8:00 and 10:00 AM. Serum will be separated by centrifugation for 10 min at 2,200 × g. Systemic FSH levels will be immunoassayed using IMMULITE 2000 XPi (Siemens Healthcare Diagnostics, UK). Participants' menopause status will be determined based on the self-reported menstrual cycle.
Applying the categorization of (75) subjects will be categorized as postmenopausal if there has been no menstrual bleeding during the 6 previous months and following cut values will be applied FSH > 30 IU/L. Participants will write a self-report concerning their health problems, gynecologic status, and use of medications.
Both groups will train with a frequency of 2 weekly sessions. They will have 48 h of rest between sessions. To ensure the blinding of participants, the EX + WB-EMS group will train on Mondays and Thursdays while the EX group will train on Tuesdays and Fridays. Both groups will perform the same program consisting of endurance tasks and resistance strength exercises, but the EX + WB-EMS group will also implement a superimposed WB-EMS during the training. The training protocols will be supervised by two instructors graduated in Physical Activity And Sports Sciences with wide experience in WB-EMS training. Participants were asked not to make physical efforts outside the training program.
EX Group Intervention
The sessions will last 40 min. Participants will perform a 10-min warm-up by walking on a treadmill. Participants will be instructed to walk at the speed they normally would during a stroll in the park. Subsequently, participants will execute the resistance training protocol, which will consist of performing three multi-articular exercises involving push and pull actions (squat, deadlift, and bench press) as it is recommended (76–78).
The strength training will last 10 min divided into two blocks of 5 min. One block will consist of 10 sets of each exercise. Sets will be composed of two repetitions with 2 s of eccentric and 1 second of concentric phase (6 s in total per set). Between repetitions, the participants will have 4 s of rest.
The intensity of the resistance training will be 40% of the 1RM (77), assessed by an indirect measurement test (79). Following the line of (80) the absolute load will be increased by 5% every 2 weeks to apply the progressive overload principle. After the strength exercises, participants will perform 10 min of cardiovascular work on the treadmill, at a constant individualized speed, obtained from the talk test (81). The highest speed they can walk while talking will be estimated. The intensity of cardiovascular training will be increased by 5% every week. Finally, the participants will perform a 10 min stretching of the whole body's muscles as a cooldown.
At the end of each session, a scale will be presented (82) with a range from level 6 (No exertion at all) to 20 (Maximal exertion) in which the participants will record their extent of perceived exertion. The assessment will always end at 15 (Hard).
WB-EMS Group Intervention
The EX + WB-EMS group will perform the same training as EX group but with superimposed WB-EMS. A rectangular, bipolar compensated current of 6 s duration and 4 s of rest will be applied with a Wiemspro® electrostimulator (Malaga, Spain) (Figure 2). The weight of the complete kit does not reach 1.5 kg.
Since there is evidence that a minimum current frequency of 50 Hz is necessary to cause adaptations in strength training (83, 84), a frequency of 55 Hz will be applied during the strength exercises, with a 60% duty cycle (pulse width: leg, glute 350 μs, lumbar, abdominal, dorsal 300 μs, Trapeze 250 μs, chest 200 μs, arm 150 μs), 800 ms of ascent ramp, and descent ramp of 500 ms. During cardiovascular training on the treadmill, the frequency will be 7 Hz with a duty cycle of 100%.
During the WB-EMS sessions, following a similar procedure used by (60), four levels will be established on a scale from 1 to 10 to control the intensity perception of the electrical current (IPC) in the participants. The levels are from 1 to 4 (mild), from 4 to 6 (moderate), from 6 to 8 (intense), and from 8 to 10 (pain). Participants will give constant information on the IPC during the session. The first 2 weeks, training will be conducted at “moderate” IPC level to promote familiarization and adaptation to the WB-EMS. The remaining 8 weeks of the intervention, the intensity will increase to an “intense” PIC level.
Adverse events including physical injuries will be monitored by the instructors of the intervention and the responsible staff of the assessments and documented through the facility's incident reporting process.
Assessments will be carried on during the study development as it is shown in Table 1. Participants will be asked not to take any stimulants before assessments to avoid influencing the results. The data will be recorded in a spreadsheet that will be stored in an encrypted USB by an external collaborator, to guarantee the privacy of the participants. He will assess the safety and validity of the research data. A blinded statistician will have access to the final dataset of the study.
One of the evaluations of the physical performance will be carried out by the EXERNET test consisting of 8 tests modified and previously adapted from the “Senior Fitness Test Battery” and “Eurofit Testing Battery” (85).
1. Balance: “Flamingo test.” Participants will start standing, with both feet on the ground. After the signal, they will try to stand on the sole of one foot. The time the subject can stay in that posture up to a maximum of 60 s will be recorded. The test will be performed alternately, twice with each leg. The best attempt of the four will be registered.
2. Leg strength: “Chair Stand Test.” The participant will start from a sitting position with her arms crossed and the palms of her hands resting on her shoulders. The number of times she will be able to get up and sit in 30 s will be registered. The test will be performed only once.
3. Arm strength: “Arm Curl Test.” Participants will sit on a bench holding a 2.5-kg dumbbell. The maximum number of elbow's flexo-extension that the participant will be able to execute in 30 s will be registered. The test will be performed once with each arm.
4. Legs flexibility: “Chair Sit-and-Reach Test.” Participants will begin the test sitting, with one leg extended and the heel resting on the floor, while her hands will be directed toward the toes of that leg. The existing distance, positive or negative, in centimeters, between the fingers and toes will be registered. The test will be performed once with each leg.
5. Arms Flexibility: “Back Scratch Test.” The participant will place a hand over the shoulder of that same arm, and the opposite hand from the bottom up, trying to touch each other. The participant will try to touch or overlap the fingers of both hands. The distance in centimeters (positive or negative) between the fingertips of each hand will be registered. The test will be carried out twice, once with each arm.
6. Agility: “8-Foot Up-and-Go Test.” From a sitting position, the seconds that the participant will take to get up, walk to a cone located at 2.45 m, go around it, and sit down again will be registered. The test will be performed twice with at least 1-min rest between repetitions and the best result will be recorded.
7. Speed: “Brisk Walking Test.” The time taken for each participant to walk 30 m will be measured. Two repetitions will be performed with a minute of rest between them. The best of both results will be recorded.
8. Cardiovascular resistance: “6-Min Walk Test.” In a circuit of 46 meters delimited by cones, the distance in meters that each participant will be able to cover walking for 6 min will be registered.
In addition to the mentioned evaluations, a progressive resistance test (PRT) (86) will be carried out to make a more accurate assessment of the strength development. The PRT permits simultaneous direct calculations of strength (N), velocity (m·s-1). and power (w), produced with different loads, and at the same time. Taking into account that as a consequence of aging, losses in strength are observed mostly in the type II fibers (87), the mean velocity and the mean power of exertion will be assessed in this study.
Following the PRT test protocol, we will assess the mentioned variables with the execution of 6 to 8 series of 2 to 3 repetitions in squat and bench press, applying the maximum acceleration possible, alternated with rest intervals of 2–5 min. The rest period is proportional to the intensity and duration of the effort, to avoid the prediction errors caused by the accumulated fatigue. The load will be increased progressively with the series. For each magnitude of weight lifted, it is necessary to select the repetition with which the highest values of average velocity and power are reached, as this factor expresses the highest mechanical efficiency of the exercise (88). In this study, the best repetition of the best series will be recorded. Then, the load in which that best series is done in the pre-test will be used in the post-test to compare the evolution of the variables after the intervention in the post-test 1 and the follow-up.
To perform this test a lineal encoder Chronojump® (Bosco–System, Barcelona, Spain) will be used in order to detect the position of the resistance during linear movements. This data permits an estimate of the range of movement, acceleration, velocity, strength and the power produced during each action (89).
The following parameters will be measured: height, weight, body mass index (BMI), body fat percentage, fat mass, visceral fat, lean mass, abdominal fold, contracted arm perimeter, waist perimeter, hip perimeter, and sum of six folds.
Height will be determined with an accuracy of 0.10 cm with a SECA stadiometer (SECA, Hamburg, Germany). Participants will stand erect without shoes, with heels together and their head in the Frankfort horizontal plane. Body weight will be evaluated with an electronic balance with a sensitivity of 0.10 kg (Tanita BC 418 MA, Tanita Corp. Tokyo, Japan). Body mass index will be obtained using the formula: body weight / height2. The fat mass, visceral fat and lean mass will be estimated by bioelectrical impedance analysis (BIA) using an eight-contact electrode segmental body composition analyzer (Tanita BC-418, Tanita Corp. Tokyo, Japan).
To assess skinfolds and perimeters, a 0.50 mm sensitivity Slim Guide caliper and a measuring tape (CESCORF) will be used, respectively (90). The muscle mass will be estimated by using the formula of (91).
All measurements will be made in duplicate non-consecutively and using the average value as the final value. All women will be measured at the same time of the day for pre- and post-intervention to avoid errors due to differences in hydration. All analyses will be performed by a level I anthropometric technician certified by the International Society for the Advancement of Kineanthropometry (ISAK) as described in its Reference Manual (92).
A full analytical profile will be made to extract different parameters detailed below. The activity of Creatin Kinasa will allow analyzing the muscle damage caused by the exercise (93). High density lipoprotein (HDL) cholesterol and triglycerides will yield information on the presence of metabolic syndrome, understanding this as an association of cardiovascular risk factors (27). Glucose will be measured to analyze the presence of diabetes mellitus and know cardiovascular risk (94). The level of oxidative stress and cardiovascular risk will be known through uric acid (95). Sodium and potassium will be examined to determine if there is an adequate response to the osmotic balance in the body (96). The status of the thyroid gland will be determined by observing the levels of Thyroid Stimulating Hormone (TSH) (97). Finally, Glycohemoglobin A1c (HbA1c) will allow monitoring the evolution of sugar in the months prior to the study (98, 99). The blood tests will be made by the endocrinology department of the Arnau of Vilanova's University Hospital, Lérida, (Spain).
International Physical Activity Questionnaire (IPAQ-E)
The IPAQ-E consists of seven open questions in reference to the activities carried out by the elderly in the last 7 days. These questions evaluate the intensity by classifying it into Vigorous Physical Activity (VPA), Moderate Physical Activity (MPA), or Slight Intensity Activities (SPA). They also evaluated the frequency (days per week) as well as the time spent in each of these activities. The Total Physical Activity (TPA) is the sum of the VPA, the MPA, and SPA (100). They are considered VPA those that involve an intense physical effort and that entails breathing much more intensely than normal. MPA requires a physical effort that increases breathing at a somewhat more intense intensity than normal. Slight intensity activities include walking recreationally or for leisure (101). Only activities that last a minimum of 10 min will be considered for registration. The IPAQ-E will allow verifying the untrained condition of the participants since it gives information about the amount of physical activity which they practice in their daily life. At the same time, IPAQ-E will be the control tool regarding the amount of physical activity which the participants will practice in the time run between post-test and follow up.
After checking normality and homogeneity assumptions, the effectiveness of different training programs on quantitative dependent variables will be assessed by a 2 × 2 mixed ANOVA. Group training intervention (“EX+WB-EMS,” “EX”) will be included as between-subjects factor, improvement (“10 weeks from Baseline,” “6 months from Baseline”) will be included as the repeated within-subjects factor, and group * improvement will be included to account for the interaction effects. Whenever a significant main effect or interaction will be observed, Bonferroni's post hoc correction will be used to aid interpretation of these main effects or interactions, either between-subjects factor at whatever time point or within-subjects factor at whatever group (102, 103). Hedge's g effect size (g) will be calculated and interpreted as follows g < 0.20 = trivial, gfrom0.20to0.50 = mild, g from 0.50 to 0.80 = moderate and g > 0.80 = large (104). Whenever the data fails to meet assumptions, robust methods will be performed following procedures of (105) and the explanatory measure of effect size (ξ) will be calculated and interpreted as suggested by (106). Values of ξ = 0.10, 0.30, and 0.50 correspond to small, medium, and large effect sizes, respectively. The qualitative ordinal variables will be analyzed with a 2 × 2 rank-based ANOVA following directions from (107). Significance level will be set at α= 0.05. The statistician will be blinded to both groups during data analyses. Intention-to-treat analysis will be performed for the primary and secondary outcomes. If necessary, a multiple imputation technique will be used to handle missing data. All analyses will be performed with JASP (version 0.11.1; JASP Team (2019), University of Amsterdam, the Netherlands) and with statistical software R Core Team (2019) for Mac and WRS2 package (108).
The worldwide implementation of effective protocols to study the WB-EMS's effects is limited. However, it is a much-extended training methodology which is being used by thousands of people without a specific legislative control and an adequate official instructional guide for health professionals. Therefore, the present study aims to enhance the knowledge of the body's responses within this training methodology. The aim is to analyze the effect of a training program with WB-EMS on the physical condition and health of postmenopausal women. To do so, we will carry out an intervention based on the development of the physical condition through the implementation of the WB-EMS. This will allow us to carry out a subsequent multivariable analysis of the effects of this program, through evaluation techniques of different kinds. We will proceed with the analysis of blood parameters to observe the evolution of endocrine and metabolic aspects. We will carry out a physical performance test as a way to observe the differences in physical condition. With an anthropometric analysis, we will study changes in body composition and with the IPAQ we will analyze the adherence to physical exercise generated by the intervention in the participants by comparing the total activity in the week before the intervention and the total activity in the week before the follow-up. This variety of techniques for assessing physical fitness has the purpose of approaching the problem from various perspectives, which becomes the main contribution with respect to the previous literature.
To verify the effectiveness of WB-EMS, it is essential the isolation of its effects from the ones produced by voluntary contraction. In some of the previous studies, the control group received an intervention that was not equivalent to the one applied in the experimental group (58, 109–112). This procedure prevents the analysis of the WB-EMS's effect by itself. In other studies, the control group did not receive any type of intervention (64, 113), which prevents comparability between treatments. Another study compared two different types of training with WB-EMS, which only allowed the comparison of one treatment with another but prevents the analysis of the effect of the WB-EMS by itself (66). Other studies designed interventions whose control group carried out exercises of the same nature as the experimental group, but their training did not match the volume and frequency of training loads (58, 60, 114, 115). The protocol of the present study intends to carry out an experimental phase in which the interventions of both groups are completely comparable in terms of type of movements and training volume (116–118). It will allow identifying precisely the isolated effect of the WB-EMS.
The expected effects of our WB-EMS application protocol related to the development of physical fitness are based on those found by (112) when carrying out a 12-weeks training program with sedentary men. The authors observed that, except for slight improvements in some physical variables, the changes caused by the WB-EMS training were not superior to those of other exercise programs. Similar results were found by (116) in physically active women. The authors concluded that after 4 weeks of intervention, the WB-EMS training could serve as a reasonable but not superior alternative to classic training regimes. On the basis of this finding, it could be considered that the WB-EMS could be an adequate methodology to guarantee the training intensity necessary to cause positive adaptations in the organism. While it does appear to be as effective as other methodologies such as high-intensity interval training (HIIT), WB-EMS could be a good tool in order to reach the intended training intensity with the absence of abrupt movements and high resistance loads. Thus, it would be an adequate approach to postmenopausal women's physical training.
In Filipovic et al. (119), Kemmler et al. (58), and Wirtz et al. (118) the effects of WB-EMS on anthropometric parameters were analyzed without finding significant differences between the experimental group and the control group. Regarding the analysis of blood parameters, it could appear that there was some kind of significant improvement in cholesterol levels, as it happens in (109). Due to this, given the results obtained to date, the fact of finding significant changes in the blood parameters of the present study would be possible. In Kemmler et al. (113) no changes in triglycerides, glucose and cholesterol were observed after 26 weeks of training with WB-EMS. Similar results were noted in (80) given that no differences were noted in the analysis of the evolution of testosterone, cortisol, and growth hormone.
The way in which the health professional approaches the proposal of the physical activity program to which the patient is intended to adhere seems to be of great importance. It is necessary to assess correctly the needs of the person to propose appropriate exercise to their characteristics. It will also be crucial for the health professional to know how to clearly convey the need to adopt a healthy lifestyle and plan a good methodology and guidelines that will have to be followed to achieve it (120). To comply with this methodology, this study will hold theoretical lectures in which participants will be informed about the type of physical exercise they will perform during the study. They will be explained in detail the training program that we will carry out with them as well as the benefits it will entail for their health and their quality of life. It has been established that technology-based exercise programs have good adherence and may provide a sustainable means of promoting physical activity and preventing falls in older people (121). Taking these results into account, we hope to obtain satisfactory adherence to physical activity with the sample of this study.
Some advantages and limitations of this protocol deserve comments. On one hand, as the main advantage, we should mention that it ensures the assessment of the isolated WB-EMS's effects. Besides, by carrying out this multivariate assessment it is possible to evaluate postmenopausal physical fitness from various perspectives. It can be said that the study will allow other clinicians to use a more structured guide to get reproducible results. On the other hand, as limitations, it must be pointed out that the selection of the participants is carried out from a voluntary population from a big sports center. This procedure could derivate in a selection bias. This must be considered in the generalization of the results to other health systems.
In summary, this trial will provide insight into the effect of WB-EMS in postmenopausal women, after a 10-weeks intervention. Practitioners, exercise therapists, and instructors will be provided with a feasible, validated WB-EMS training program whose effect on physical fitness and health is scientifically assessed. Finally, the results of the current trial may help to develop further theories and models explaining WB-EMS training effects in general and particularly with older adults.
The protocol of this study has been approved by the ethical committee of the Arnau of Vilanova's University Hospital, Lérida, (Spain). Project reference: CEIC-1701. All participants will be informed of the details of the study and will sign an informed consent form before starting the investigation.
Research Group Human Movement, University of Lleida, Av. de l'Estudi General, n.4 E-25001Lleida, Spain. number: +34649546894. Email: firstname.lastname@example.org.
AP-R and JR-M conceived and designed the protocol and conducted the article searches. AP-R and VH-G drafted the manuscript. JB-G projected the analytic plan and interpretation. All authors read and approved the final manuscript.
This study was funded by the non-profit organization: Institut de Desenvolupament Social i Territorial. Universitat de Lleida. The name of this project is ‘Active aging, quality of live and intergenerational relationships.' Grant INDEST2016 Trial sponsor contact: email@example.com, +34 973 70 22 47.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
BMI, Body mass index; EX group, Exercise group; EX + WB-EMS, Exercise with whole-body electromyostimulation; IPAQ-E, International physical activity questionnaire; IPC, Intensity perception electrical current; MPA, Moderate physical activity; PRT, Progressive resistance test; 1RM, One-repetition maximum; SPA, Slight intensity activities; TPA, Total physical activity; VO2max, maximum oxygen consumption; VPA, Vigorous physical activity; USB, universal serial bus; WB-EMS, Whole-body electromyostimulation.
2. WHO. WHO | Population aging. World Health Organization. World Health Organization; (2010). Available from: https://www.who.int/features/qa/72/en/ [accessed November 7, 2019].
3. Trombetti A, Reid KF, Hars M, Herrmann FR, Pasha E, Phillips EM, et al. Age-associated declines in muscle mass, strength, power, and physical performance: impact on fear of falling and quality of life. Osteoporos Int. (2016) 27:463–71. doi: 10.1007/s00198-015-3236-5
4. Bloom DE, Chatterji S, Kowal P, Lloyd-sherlock P, Mckee M, Rosenberg L, et al. Macroeconomic implications of population ageing and selected policy responses. Lancet. (2016) 385:649–57. doi: 10.1016/S0140-6736(14)61464-1
6. Kaushal N, Langlois F, Desjardins-Crepeau L, Hagger MS, Bherer L. Investigating dose-response effects of multimodal exercise programs on health-related quality of life in older adults. Clin Interv Aging. (2019) 14:209–17. doi: 10.2147/CIA.S187534
7. Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. (2007) 39:1435–45. doi: 10.1249/mss.0b013e3180616aa2
9. Agostini D, Zeppa Donati S, Lucertini F, Annibalini G, Gervasi M, Ferri Marini C, et al. Muscle and bone health in postmenopausal women: role of protein and vitamin D supplementation combined with exercise training. Nutrients. (2018) 10:1103. doi: 10.3390/nu10081103
10. Messier V, Rabasa-Lhoret R, Barbat-Artigas S, Elisha B, Karelis AD, Aubertin-leheudre m. menopause and sarcopenia: a potential role for sex hormones. Maturitas. (2011) 68:331–6. doi: 10.1016/j.maturitas.2011.01.014
12. Alikari V, Sachlas A, Giatrakou S, Stathoulis J, Fradelos E, Theofilou P, et al. Sarcopenia and its impact on quality of life. GeNeDis 2016 Genet Neurodegener. (2017) 987:243–56. doi: 10.1007/978-3-319-57379-3_22
13. Gschwind YJ, Kressig RW, Lacroix A, Muehlbauer T, Pfenninger B, Granacher U. A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: study protocol for a randomized controlled trial. BMC Geriatr. (2013) 13:1–13. doi: 10.1186/1471-2318-13-105
14. Anagnostis P, Dimopoulou C, Karras S, Lambrinoudaki I, Goulis DG. Sarcopenia in post-menopausal women: Is there any role for vitamin D? Maturitas. (2015) 82:56–64. doi: 10.1016/j.maturitas.2015.03.014
15. Marzetti E, Calvani R, Tosato M, Cesari M, Di Bari M, Cherubini A, et al. Physical activity and exercise as countermeasures to physical frailty and sarcopenia. Aging Clin Exp Res. (2017) 29:35–42. doi: 10.1007/s40520-016-0705-4
16. Beaudart C, Dawson A, Shaw SC, Harvey NC, Kanis JA, Binkley N, et al. Nutrition and physical activity in the prevention and treatment of sarcopenia: systematic review. Osteoporos Int. (2017) 28:1817–33. doi: 10.1007/s00198-017-3980-9
18. Cadore EL, Rodríguez-Mañas L, Sinclair A, Izquierdo M. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Res. (2013) 16:105–14. doi: 10.1089/rej.2012.1397
19. Van Diest M, Lamoth CJ, Stegenga J, Verkerke GJ, Postema K. Exergaming for balance training of elderly: state of the art and future developments. J Neuroeng Rehabil. (2013) 10:1. doi: 10.1186/1743-0003-10-101
20. Kovacic JC, Moreno P, Hachinski V, Nabel EG, Fuster V. Cellular senescence, vascular disease, and aging: part 1 of a 2-part review. Circulation. (2011) 123:1650–60. doi: 10.1161/CIRCULATIONAHA.110.007021
22. Ross R, Blair SN, Arena R, Church TS, Després JP, Franklin BA, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the american heart association. Circulation. (2016) 134:653–99. doi: 10.1161/CIR.0000000000000461
23. Landi F, Calvani R, Picca A, Tosato M, D'Angelo E, Martone AM, et al. Relationship between cardiovascular health metrics and physical performance in community-living people: results from the Longevity check-up (Lookup) 7+ project. Sci Rep. (2018) 8:4–11. doi: 10.1038/s41598-018-34746-4
24. Lavie CJ, Arena R, Swift DL, Johannsen NM, Sui X, Lee D, et al. Exercise and the cardiovascular system: clinical science and cardiovascular outcomes. Circ Res. (2016) 117:207–19. doi: 10.1161/CIRCRESAHA.117.305205
25. Jin Y, Tanaka T, Ma Y, Bandinelli S, Ferrucci L, Talegawkar SA. Cardiovascular health is associated with physical function among older community dwelling men and women. (2017) 72:1710–6. doi: 10.1093/gerona/glw329
26. Wallace ARG, Twomey LC, Turner J, Moyna N, Cummins PM, Murphy RP. The role of epigenetics in cardiovascular health and aging: a focus on physical activity and nutrition. Mech Ageing Dev. (2018) 174:76–85. doi: 10.1016/j.mad.2017.11.013
27. Nieto CIR, Pérez JDM, Freire LM, Morales KR de P, Vicente ERC. Prevalencia de síndrome metabólico y factores de riesgo asociados en jóvenes universitarios ecuatorianos. Nutr Hosp. (2015) 31:1574–81. doi: 10.3305/nh.2015.31.4.8371
29. Milanović Z, Pantelić S, Trajković N, Sporiš G, Kostić R, James N. Age-related decrease in physical activity and functional fitness among elderly men and women. Clin Interv Aging. (2013) 8:549–56. doi: 10.2147/CIA.S44112
30. Recio-rodríguez JI, Sanchez-aguadero N, Rodríguez-sánchez E, Martinez-Vizcaino V, Martin-cantera C, Patino-alonso MC, et al. Physical activity and adiposity among older adults of the Evident study. J Aging Phys Act. (2017) 25:254–60. doi: 10.1123/japa.2016-0065
31. Liberman K, Forti LN, Beyer I, Bautmans I. The effects of exercise on muscle strength, body composition, physical functioning and the inflammatory profile of older adults : a systematic review. Eur PMC. (2017) 20:30–53. doi: 10.1097/MCO.0000000000000335
32. Liao C-D, Tsauo J, Wu Y-T, Cheng C, Chen H-CHHH-C, Huang Y-C, et al. Effects of protein supplementation combined with resistance exercise on body composition and physical function in older adults: a systematic review and meta-analysis. Am J Clin Nutr. (2017) 106:1078–91. doi: 10.3945/ajcn.116.143594
33. Reed-Jones RJ, Dorgo S, Hitchings MK, Bader JO. Vision and agility training in community dwelling older adults: incorporating visual training into programs for fall prevention. Gait Posture. (2012) 35:585–9. doi: 10.1016/j.gaitpost.2011.11.029
35. Zhao Y, Chung PK, Tong TK. Effectiveness of a balance-focused exercise program for enhancing functional fitness of older adults at risk of falling: a randomised controlled trial. Geriatr Nurs. (2017) 38:491–7. doi: 10.1016/j.gerinurse.2017.02.011
36. Hong J, Kim J, Kim SW, Kong HJ. Effects of home-based tele-exercise on sarcopenia among community-dwelling elderly adults: body composition and functional fitness. Exp Gerontol. (2017) 87:33–9. doi: 10.1016/j.exger.2016.11.002
37. Nawrocka A, Mynarski W, Cholewa J. Adherence to physical activity guidelines and functional fitness of elderly women, using objective measurement. Ann Agric Environ Med. (2017) 24:632–5. doi: 10.5604/12321966.1231388
38. Alessa HB, Chomistek A, Hankinson SE, Barnett JB, Rood J, Matthews CE, et al. Objective Measures of Physical Activity and Cardiometabolic and Endocrine Biomarkers. Med Sci Sport Exerc. (2017) 49:1817–25. doi: 10.1249/MSS.0000000000001287
39. Keske MA, Premilovac D, Bradley EA, Dwyer RM, Richards SM, Rattigan S. Muscle microvascular blood flow responses in insulin resistance and ageing. J Physiol. (2016) 594:2223–31. doi: 10.1113/jphysiol.2014.283549
41. Yang C-W, Li C-I, Li T-C, Liu C-S, Lin C-H, Lin W-Y, et al. The joint association of insulin sensitivity and physical activity on the skeletal muscle mass and performance in community-dwelling older adults. Exp Gerontol. (2017) 95:34–8. doi: 10.1016/j.exger.2017.05.006
42. Short KR, Vittone JL, Bigelow ML, Proctor DN, Rizza RA, Coenen-Schimke JM, et al. Impact of Aerobic Exercise Training on Age-Related Changes in Insulin Sensitivity and Muscle Oxidative Capacity. Diabetes. (2003) 52:1888–96. doi: 10.2337/diabetes.52.8.1888
45. Tanriverdi A, Ozcan Kahraman B, Ozsoy I, Bayraktar F, Ozgen Saydam B, Acar S, et al. Physical activity in women with subclinical hypothyroidism. J Endocrinol Invest. (2019) 42:779–85. doi: 10.1007/s40618-018-0981-2
47. Wullems JA, Verschueren SMP, Degens H, Morse CI, Onambélé GL. A review of the assessment and prevalence of sedentarism in older adults, its physiology/health impact and non-exercise mobility counter-measures. Biogerontology. (2016) 17:547–65. doi: 10.1007/s10522-016-9640-1
50. Vechin FC, Libardi CA, Conceicao MS, Damas FR, Lixandrao ME, Berton RPB, et al. Comparisons between low-intensity resistance training with blood flow restriction and high-intensity resistance training on quadriceps muscle mass and strength in elderly. J strength Cond Res. (2015) 29:1071–6. doi: 10.1519/JSC.0000000000000703
53. Winett RA, Ogletree AM. Evidence-based, high-intensity exercise and physical activity for compressing morbidity in older adults: a narrative review. Innov Aging. (2019) 3:igz020. doi: 10.1093/geroni/igz020
55. Osuka Y, Matsubara M, Hamasaki A, Hiramatsu Y, Ohshima H, Tanaka K. Development of low-volume, high-intensity, aerobic-type interval training for elderly Japanese men: a feasibility study. Eur Rev Aging Phys Act. (2017) 14:1–8. doi: 10.1186/s11556-017-0184-4
57. Wiemspro - Electrostimulation for Fitness. (2019). Available online at: https://wiemspro.com/?lang=es (accessed July 22, 2019).
58. Kemmler W, Teschler M, Weißenfels A, Bebenek M, Fröhlich M, Kohl M, et al. Effects of whole-body electromyostimulation versus high-intensity resistance exercise on body composition and strength: a randomized controlled study. Evidence-based Complement. Altern Med. (2016) 2016:9236809. doi: 10.1155/2016/9236809
59. Kemmler W, Bebenek M, Engelke K, von Stengel S. Impact of whole-body electromyostimulation on body composition in elderly women at risk for sarcopenia: the Training and ElectroStimulation Trial (TEST-III). Age. (2014) 36:395–406. doi: 10.1007/s11357-013-9575-2
60. Kemmler W, Schliffka R, Mayhew JL, von Stengel S. Effects of whole-body electromyostimulation on resting metabolic rate, body composition, and maximum strength in postmenopausal women: the Training and ElectroStimulation Trial. J Strength Cond Res. (2010) 24:1880–7. doi: 10.1519/JSC.0b013e3181ddaeee
61. von Stengel S, Bebenek M, Engelke K, Kemmler W. Whole-body electromyostimulation to fight osteopenia in elderly females: the randomized controlled training and electrostimulation trial (TEST-III). J Osteoporos. (2015) 2015:643520. doi: 10.1155/2015/643520
62. Kemmler W, Teschler M, Weissenfels A, Bebenek M, von Stengel S, Kohl M, et al. Whole-body electromyostimulation to fight sarcopenic obesity in community-dwelling older women at risk. Resultsof the randomized controlled FORMOsA-sarcopenic obesity study. Osteoporos Int. (2016) 27:3261–70. doi: 10.1007/s00198-016-3662-z
63. Schink K, Herrmann HJ, Schwappacher R, Meyer J, Orlemann T, Waldmann E, et al. Effects of whole-body electromyostimulation combined with individualized nutritional support on body composition in patients with advanced cancer: a controlled pilot trial. BMC Cancer. (2018) 18:1–17. doi: 10.1186/s12885-018-4790-y
64. Kemmler W, Grimm A, Bebenek M, Kohl M, von Stengel S. Effects of combined whole-body electromyostimulation and protein supplementation on local and overall muscle/fat distribution in older men with sarcopenic obesity: the randomized controlled franconia sarcopenic obesity (FranSO) Study. Calcif Tissue Int. (2018) 103:266–77. doi: 10.1007/s00223-018-0424-2
65. Kemmler W, Weissenfels A, Teschler M, Willert S, Bebenek M, Shojaa M, et al. Whole-body electromyostimulation and protein supplementation favorably affect sarcopenic obesity in community-dwelling older men at risk: the randomized controlled FranSO study. Clin Interv Aging. (2017) 12:1503–13. doi: 10.2147/CIA.S137987
66. Amaro-Gahete FJ, De-la-O A, Sanchez-Delgado G, Robles-Gonzalez L, Jurado-Fasoli L, Ruiz JR, et al. Functional exercise training and undulating periodization enhances the effect of whole-body electromyostimulation training on running performance. Front Physiol. (2018) 9:720. doi: 10.3389/fphys.2018.00720
67. von Stengel S, Kemmler W. Trainability of leg strength by whole-body electromyostimulation during adult lifespan: a study with male cohorts. Clin Interv Aging. (2018) 13:2495–502. doi: 10.2147/CIA.S185018
68. Pano-Rodriguez A, Beltran-Garrido JV, Hernandez-Gonzalez V, Reverter-Masia J. Effects of whole-body electromyostimulation on health and performance: a systematic review. BMC Complement Altern Med. (2019) 19:87. doi: 10.1186/s12906-019-2485-9
69. Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, KrleŽa-Jerić K, et al. Spirit 2013 statement: defining standard protocol items for clinical trials. Chinese J Evidence-Based Med. (2013) 13:1501–7. doi: 10.7326/0003-4819-158-3-201302050-00583
70. ISRCTN Registry. Available online at: http://www.isrctn.com/ (accessed December 12, 2019).
71. Moniker Privacy Services. Random Team Generator — Split a List Into Random Groups. Available online at: https://www.randomlists.com/team-generator (accessed November 26, 2019).
72. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. (2007) 39:175–91. doi: 10.3758/BF03193146
74. Sjöström M, Oja P, Hagströmer M, Smith BJ, Bauman A. Health-enhancing physical activity across European Union countries: the eurobarometer study. J Public Health. (2006) 14:291–300. doi: 10.1007/s10389-006-0031-y
75. Kovanen V, Aukee P, Kokko K, Finni T, Tarkka IM, Tammelin T, et al. Design and protocol of Estrogenic Regulation of Muscle Apoptosis (ERMA) study with 47 to 55-year-old women's cohort: novel results show menopause-related differences in blood count. Menopause. (2018) 25:1020–32. doi: 10.1097/GME.0000000000001117
76. Galbreath M, Campbell B, Bounty PL, Id JB, Dove J, Harvey T, et al. Effects of adherence to a higher protein diet on weight loss, markers of health, and functional capacity in older women participating in a resistance-based exercise program. Nutrients. (2018) 10. doi: 10.3390/nu10081070
78. Aragão-Santos JC, de Resende-Neto AG, Costa Nogueira A, Feitosa-Neta ML, Albuquerque Brandão LH, da Silva Chaves LM, et al. The effects of functional and traditional strength training on different parameters of strength elderly women: a trial randomized and controlled. J Sport Med Phys Fit. (2018) 59:380–6. doi: 10.23736/S0022-4707.18.08227-0
80. Wirtz N, Wahl PH., Kleinöder H, Wechsler K, Achtzehn S, Mester J, et al. Acute metabolic, hormonal, and psychological responses to strength training with superimposed EMS at the beginning and the end of a 6 week training period. J Musculoskelet Neuronal Interact. (2015) 15:325–32.
84. Filipovic A, Klein Der H, Rmann UD, Mester J, Kleinoder H, Dormann U, et al. Electromyostimulation—a systematic review of the influence of training regimens and stimulation parameters on effectiveness in electromyostimulation training of selected strength parameters. J strength Cond Res. (2011) 25:3218–38. doi: 10.1519/JSC.0b013e318212e3ce
85. Muñoz-arribas A, Mata E, Pedrero-chamizo R, Espino L, Gusi N, Villa G, et al. Obesidad sarcopénica y condición física en octogenarios; proyecto multicéntrico EXERNET. Nutr Hosp. (2013) 28:1877–83. doi: 10.3305/nh.2013.28.6.6951
86. Fernando, Jiménez Gutiérrez A, Alvar BA, Peterson MD. Assessing strength and power in resistance training. J Hum Sport Exerc Off J Area Phys Educ Sport Fac Educ Univ Alicant Spain. (2009) 4:100–13. doi: 10.4100/jhse.2009.42.04
87. Lamboley CR, Wyckelsma VL, Dutka TL, McKenna MJ, Murphy RM, Lamb GD. Contractile properties and sarcoplasmic reticulum calcium content in type I and type II skeletal muscle fibres in active aged humans. J Physiol. (2015) 593:2499–514. doi: 10.1113/JP270179
89. Vivancos A, Zambudio A, Ramírez F, Del Águila A, Castrillón F, Pardo P. OC14 Reliability and validity of a linear position transducer for strength assessment. Br J Sports Med. (2014) 48 (Suppl. 3):A5.2–A5. doi: 10.1136/bjsports-2014-094245.14
90. Alvero Cruz JE Al. Protocolo de valoración de la composición corporal para el reconocimiento médico-deportivo. Documento de Consenso del Grupo Español de Cineantropometría de la Federacion Española de Medicina del Deporte. Arch Med del Deport. (2009) 26(Cc):166–79.
91. Lee RC, Wang Z, Heo M, Ross R, Janssen I, Heymsfield SB. Total-body skeletal muscle mass: development and cross-validation of anthropometric prediction models. Am J Clin Nutr. (2000) 72:796–803. doi: 10.1093/ajcn/72.3.796
92. International Society for Advancement of Kinanthropometry. International strandars for anthropometric assessment. In: Underdale SA, editor. International Society for the Advancement of Kinanthropometry ©2001. Australia: ISAK (2001).
93. Deli CK, Fatouros IG, Paschalis V, Georgakouli K, Zalavras A, Avloniti A, et al. A comparison of exercise-induced muscle damage following maximal eccentric contractions in men and boys. Pediatr Exerc Sci. (2017) 29:1–26. doi: 10.1123/pes.2016-0185
94. Davies MJ, Merton KW, Vijapurkar U, Balis DA, Desai M. Canagliflozin improves risk factors of metabolic syndrome in patients with type 2 diabetes mellitus and metabolic syndrome. Diabetes Metab Syndr Obes. (2017) 10:47–55. doi: 10.2147/DMSO.S126291
95. Neto GR, Novaes JS, Salerno VP, Goncalves MM, Batista GR, Cirilo-Sousa MS. Does a resistance exercise session with continuous or intermittent blood flow restriction promote muscle damage and increase oxidative stress? J Sports Sci. (2017) 36:104–10. doi: 10.1080/02640414.2017.1283430
97. Chaturvedi A, Nayak G, Nayak A, Rao A. Comparative assessment of the effects of hatha yoga and physical exercise on biochemical functions in perimenopausal women. J Clin Diagnostic Res. (2016) 10:KCO1–4. doi: 10.7860/JCDR/2016/18891.8389
99. Dijkstra A, Lenters-Westra E, de Kort W, Bokhorst AG, Bilo HJG, Slingerland RJ, et al. Whole blood donation affects the interpretation of hemoglobin A1c. PLoS ONE. (2017) 12:e0170802. doi: 10.1371/journal.pone.0170802
100. Rubio Castañeda FJ, Tomás Aznar C, Muro Baquero C. Validity, reliability and associated factors of the international physical activity questionnaire adapted to elderly (IPAQ-E). Rev Esp Salud Publica. (2017) 91:1–12.
101. Hurtig-Wennlf A, Hagstrmer M, Olsson LA. The international physical activity questionnaire modified for the elderly: aspects of validity and feasibility. Public Health Nutr. (2010) 13:1847–54. doi: 10.1017/S1368980010000157
109. Kemmler W, Kohl M, Freiberger E, Sieber C, von Stengel S. Effect of whole-body electromyostimulation and / or protein supplementation on obesity and cardiometabolic risk in older men with sarcopenic obesity: the randomized controlled FranSO trial. BMC Geriatr. (2018) 18:70. doi: 10.1186/s12877-018-0759-6
110. Kemmler W, Birlauf A, von Stengel. Einfluss eines Elektromyostimulations-trainings auf die körperzusammensetzung bei älteren männern mit metabolischem syndrom. die tEst-II-studie. Dtsch Z Sportmed. (2010) 61:117–23.
111. Kemmler W, Teschler M, Bebenek M, von Stengel S. Hohe kreatinkinase-werte nach exzessiver ganzkörper-elektromyostimulation: gesundheitliche relevanz und entwicklung im trainingsverlauf. Wiener Medizinische Wochenschrift. (2015) 165(21–22):427–35. doi: 10.1007/s10354-015-0394-1
112. Amaro-gahete FJ, De-la-o A, Jurado-fasoli L, Dote-montero M, Gutiérrez Á, Ruiz JR, et al. Changes in physical fitness after 12 weeks of structured concurrent exercise training, high intensity interval training, or whole-body electromyostimulation training in sedentary middle-aged adults : a randomized controlled trial. Front Physiol. (2019) 10:1–15. doi: 10.3389/fphys.2019.00451
113. Wittmann K, Sieber C, Von Stengel S, Kohl M, Freiberger E, Jakob F, et al. Impact of whole body electromyostimulation on cardiometabolic risk factors in older women with sarcopenic obesity: the randomized controlled FORMOsA-sarcopenic obesity study. Clin Interv Aging. (2016) 11:1697–706. doi: 10.2147/CIA.S116430
114. Kemmler W, von Stengel S. 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. Clin Interv Aging. (2013) 8:1353–64. doi: 10.2147/CIA.S52337
115. Amaro-Gahete FJ, De-la-O A, Sanchez-Delgado G, Robles-Gonzalez L, Jurado-Fasoli L, Ruiz JR. Whole-body electromyostimulation improves performance-related parameters in runners. Front Physiol. (2018) 9:1576. doi: 10.3389/fphys.2018.01576
116. Dörmann U, Wirtz N, Micke F, Morat M, Kleinöder H, Donath L. The effects of superimposed whole-body electromyostimulation during short-term strength training on physical fitness in physically active females : a randomized controlled trial. Front Physiol. (2019) 10:728. doi: 10.3389/fphys.2019.00728
117. Wirtz N, Kleinöder H, Micke F, Dörmann U, Donath L. Effects of an eight-week superimposed submaximal dynamic whole-body electromyostimulation training on strength and power parameters of the leg muscles: a randomized controlled intervention study. Front Physiol. (2018) 9:1719. doi: 10.3389/fphys.2018.01719
118. Wirtz N, Zinner C, Doermann U, Kleinoeder H, Mester J. Effects of loaded squat exercise with and without application of superimposed EMS on physical performance. J Sport Sci Med. (2016) 15:26–33.
119. Filipovic A, Grau M, Kleinoeder H, Zimmer P, Hollmann W, Bloch W, et al. Effects of a whole-body electrostimulation program on strength, sprinting, jumping, and kicking capacity in elite soccer players. J Sports Sci Med. (2016) 15:639–48.
120. Chanpimol S, Seamon B, Hernandez H, Harris-love M, Blackman MR. Role of counseling to promote adherence in healthy lifestyle medicine: strategies to improve exercise adherence and enhance physical activity. Prog Cardiovasc Dis. (2017) 59:455–62. doi: 10.1016/j.pcad.2016.09.003
Keywords: whole-body electrical muscle stimulation, whole-body electrostimulation, physical exercise, physical fitness, healthy aging, elderly, public health
Citation: Pano-Rodriguez A, Beltran-Garrido JV, Hernandez-Gonzalez V and Reverter-Masia J (2020) Effects of Whole Body Electromyostimulation on Physical Fitness and Health in Postmenopausal Women: A Study Protocol for a Randomized Controlled Trial. Front. Public Health 8:313. doi: 10.3389/fpubh.2020.00313
Received: 07 February 2020; Accepted: 09 June 2020;
Published: 23 July 2020.
Edited by:Lei Feng, National University of Singapore, Singapore
Reviewed by:Alexjandro C. Daviano, DynaMed Plus, EBSCO Health, United States
Liang Shen, National University of Singapore, Singapore
Qiushi Feng, National University of Singapore, Singapore
Copyright © 2020 Pano-Rodriguez, Beltran-Garrido, Hernandez-Gonzalez and Reverter-Masia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Alvaro Pano-Rodriguez, firstname.lastname@example.org