The effectiveness of EMS in preventing atrophy and building muscle mass: the research and the evidence

The study participant is being subjected to blood flow restriction and electrical muscle stimulation to prevent muscle atrophy (photo from the article of College of Biological Sciences, Ontario, Canada. Author: J. Berr)
The study was first published in The Journal of Cachexia, Sarcopenia and Muscle – international peer-reviewed magazine dedicated to scientific and clinical materials related to cachexia and sarcopenia and to the body composition, its physiological and pathophysiological changes.
The content of the article


Positive effect of physical exercises on life quality and expectancy is a multiple proven fact. There is a clear correspondence between lifestyle and the possibility of cardiovascular disease and muscle atrophy even for healthy people. According to the study, published in 2015, sedentary lifestyle is a direct risk factor for sarcopenia.
Thus, the decrease of the muscle atrophy possibility and physical activity adaptation are able to increase vitals, as well as life expectancy. However, one of the main obstacles for regular training is the lack of free time. Using the alternative training methods that take less time but stay effective could become a solution to this problem.
Electromyostimulation (EMS-trainings) is one of these methods, which have become more and more popular in different sports. The effectiveness of these methods is experimentally proved, not only by cells and muscles testing but also by human testing.

Cell cultures testing

The first cell tests of EMS effects were conducted back in 1994. Verle and his colleagues created myotube cultures from satellite cells of the rat with various fibers composition: slow twitch soleus muscle, diaphragm and fast twitch tibialis anterior.
These cell cultures were subjected to electrical stimulation for 13 days.
Impulses with a duration of 250 ms at a frequency of 40 Hz repeating every 4 sec, were leading to the isoform switch, as evidenced by an increase in the expression of slow myosin.
Later studies allowed to determine the specific biochemical processes occurring in myocytes under the electrical stimulation. In particular, it causes activation of AMP-activated protein kinase (AMPK), endothelial nitric oxide synthase (eNOS), insulin-dependent glucose transporter (GLUT4), and other substances regulating energy balance and cell metabolism. Moreover, EMS-stimulated translocation GLUT4 helps to prevent insulin-resistance – an important risk factor of diabetes mellitus and cardiovascular diseases.
The data obtained during the molecular studies reflect the impact of EMS on muscle tissue in general.

Animal testing

More detailed EMS-tests were done to examine the effect of different types of impulses on animals. In particular, 2012 study supposed to use electromyostimulation at a frequency of 20 Hz for 3 hour 2 times a day.
One limb was subjected to stimulation, while the other one was control.
EMS-subjected soleus muscle demonstrated the significant growth of muscle mass and peak strength. These changes probably resulted from the increase of miosattelites and the decrease of cell death.
The other scientists described this effect back in 2010. The low-frequency EMS (20 Hz for 3 hours) was being done for 28 days.
The other studies (Nakagawa and colleagues in 2017 and Xing and colleagues in 2015) clearly demonstrated that electromyostimulation helps to slow down atrophy processes of muscle tissue.
In aggregate, electromyostimulation seems to be effective in fighting muscle atrophy and muscular dysfunction in experimental models of atrophy. Apparently, proliferation activation of satellite cells and preventing cell apoptosis are important mechanisms initiating these positive effects.

Human testing

As many studies show, neuromuscular electrical stimulation (NMES) can be an effective alternative way to build muscle mass and to increase the strength of legs in case of various diseases related to muscular atrophy (summarized in Thierry Paillard research).
This method is the most useful for people with sarcopeia, who are unable to exercise regularly. The study conducted in 2014 among the people aged 75+ demonstrated the increase of cross sectional area of rectus femoris approximately by 30% after 4 months of EMS (total 48 sessions).
The increase in muscle mass influenced by EMS resulted not only from muscular metabolism stimulation, but also from slowing down katabolic processes. The latter is achieved due to the expression of MafBx and MuRF1 enzymes, suppression of myostatin mRNA, and inhibition of the formation of reactive oxygen species. In addition, it was found that, compared to random training programs, EMS is more effective for older people. Back in 1998 hypothesis about the efficiency of physical activity and EMS-trainings combination was created. Since then there have been many studies on using electromyostimulation together with standard trainings in different sports.
Depending on the situation, the most suitable universal EMS-parameters, necessary for building muscle mass, may vary. Based on several articles, in 2018 Paillard defined the following parameters: biphasic current, long-term impulsation (300-450 μs), high frequency (50-100 Hz for young people and about 30 Hz for older people), relaxation period not shorter than stimulation time, maximum tolerated intensity, regularity: 5-6 weeks, minimum 3 sessions a week.
Speaking about complications of using EMS, documented cases of dramatic increase of creatine kinase concentration in blood that could be a sign of severe rhabdomyolysis, should be noted. Meanwhile, no other signs of rhabdomyolysis was found as a response to EMS. Nevertheless, some authors point to the need of gradual increase of stimulation parameters that will help to avoid dramatic increase of creatine kinase concentration. This is demonstrated by the fact that in the future, under EMS, the growth of the indicator slowed down and eventually reached the value that is standard for weight training.


Based on many data given in scientific literature, we can make a conclusion about the safety and effectiveness of EMS in preventing sarcopenia and building muscle mass.
Electromyostimulation can be a valuable method to cure patients with sarcopenia and cardiovascular diseases, when it’s impossible to use the traditional supplementary methods. Moreover, EMS can be used as an intermediate stage before standard trainings, if the person is in bad physical condition and cannot start the training process immediately.
At the same time, you should not consider electromyostimulation as a substitute for training sessions in general, because their positive effect is not only in building muscle mass. Training programs not only help to build muscles, but also improve the functions of respiratory and cardiovascular systems.
Muscular tissue atrophy processes are quite widespread among elders. This is due to low activity and incapability of running standard training programs in full. The implementation of EMS in practice will allow to achieve positive results without wasting any additional time.

The article is based on the study published in The Journal of Cachexia, Sarcopenia and Muscle in 2018.
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