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Prof. Wolfgang Kemmler
Institute of Medical Physics, Friedrich Alexander University of Erlangen-Nuernberg

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Original article
Published: 09 June 2021 in Journal of Cachexia, Sarcopenia and Muscle
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Background Sarcopenia, defined as loss of muscle mass, quality, and function, is associated with reduced quality of life and adverse health outcomes including disability and mortality. Electromyostimulation (EMS) has been suggested to attenuate the loss of muscle mass and function in elderly, sedentary individuals. This study aimed to investigate the effects of EMS on muscle strength and function during 4 weeks of inpatient medical rehabilitation. Methods Patients receiving 4 weeks of inpatient medical rehabilitation diagnosed with sarcopenia using bioimpedance analysis were eligible to participate. One hundred and thirty-four patients (55.7 ± 7.9 years, 25.4% female) were randomly assigned to three groups: whole-body (WB) EMS (n = 48): stimulation of major muscle groups (pectoral muscles, latissimus, trapezius, abdominals, upper arm and leg, lower back muscles, gluteal muscles, and thighs); part-body (PB) EMS (n = 42): stimulation of leg muscles including gluteal muscles and thighs; and control group (CG, n = 44). All participants performed six 20 min training sessions including dynamic movements (squats, lunges, biceps curl, chest press, butterfly reverse, reverse lunges, standing diagonal crunches, etc.) with superimposed (WB-, PB-) EMS or without EMS (CG) in addition to the standard rehabilitation programme. Primary outcome variables included muscle function assessed by chair rise test and 6 min walking test as well as muscle strength (isometric grip strength, leg, arm, and back extension). Results Primary outcome variables chair rise test and leg extension improved significantly (P = 0.001, η2 = 0.06 and P = 0.008, η2 = 0.06; EMS vs. CG) in that chair rise test results increased in WB-EMS from 5 (4; 7) to 7 (5; 9), in PB-EMS from 5 (5; 7) to 7 (6; 8), and in CG from 6 (4; 7) to 7 (5; 8) repetitions. Knee extension increased in WB-EMS from 692.3 ± 248.6 to 831.7 ± 298.7 N, in PB-EMS from 682.8 ± 257.8 to 790.2 ± 270.2 N, and in CG from 638.5 ± 236.9 to 703.2 ± 218.6 N. No adverse events or side effects occurred. Conclusions We conclude that EMS might be an additional training option to improve muscle function and strength in sarcopenic patients during a 4 week rehabilitation programme. EMS provides greater functional and strength improvements compared with standard treatment with additional potential health benefits for sarcopenic cardiac and orthopaedic patients.

ACS Style

Marc Teschler; Melina Heimer; Boris Schmitz; Wolfgang Kemmler; Frank C. Mooren. Four weeks of electromyostimulation improves muscle function and strength in sarcopenic patients: a three‐arm parallel randomized trial. Journal of Cachexia, Sarcopenia and Muscle 2021, 12, 843 -854.

AMA Style

Marc Teschler, Melina Heimer, Boris Schmitz, Wolfgang Kemmler, Frank C. Mooren. Four weeks of electromyostimulation improves muscle function and strength in sarcopenic patients: a three‐arm parallel randomized trial. Journal of Cachexia, Sarcopenia and Muscle. 2021; 12 (4):843-854.

Chicago/Turabian Style

Marc Teschler; Melina Heimer; Boris Schmitz; Wolfgang Kemmler; Frank C. Mooren. 2021. "Four weeks of electromyostimulation improves muscle function and strength in sarcopenic patients: a three‐arm parallel randomized trial." Journal of Cachexia, Sarcopenia and Muscle 12, no. 4: 843-854.

Akuelles
Published: 08 June 2021 in Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin
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Ganzkörper-EMS (WB-EMS) eine relativ neue Trainingstechnologie deutschen Ursprungs, wurde etwa 2006 kommerziell verbreitet und erfreut sich aktuell in ca. 2700 kommerziellen nicht-medizinischen Einrichtungen (zur Hälfte spezialisierte Mikrostudios) 1 ansteigender Beliebtheit. Nicht zuletzt durch diese frühe Markteinführung und die schiere Präsenz seiner kommerziellen Anwendung zeigen sich Probleme und Entwicklung dieser Trainingstechnologie oft zunächst in Deutschland. Nach Publikation erster Einzelfallstudien 2 3 4 und Medienberichten zu negativen gesundheitlichen Effekten (u. a. Spiegel online 2015, 4 5) in Deutschland und Israel wurden 2016 erste Forderungen nach einer offiziellen Regulierung durch die zuständigen Behörden veröffentlicht („its time to regulate whole-body electromyostimulation“ 4). Obgleich die DIN 33961-5 6 sowie die Empfehlungen 7 und Kontraindikationen 8 des Fachkreises WB-EMS, Aspekte wie Sicherheit, Effektivität, Überwachung und Dokumentation eingehend adressieren, gingen diese Normen dem Gesetzgeber nachvollziehbarerweise nicht weit genug. Im Jahr 2019 veröffentlichte das deutsche „Bundesministerium für Umwelt, Naturschutz und Reaktorsicherheit (BMU)“ die zu erwartende novellierte Strahlenschutzverordnung, die unter Artikel 4 neben Ultraschall- und Lasergeräte, auch die nichtmedizinischen Anwendungen im Bereich EMF und damit auch WB-EMS einschließt („Anwendungen nichtionisierender Strahlung am Menschen“; NiSV)9. Die im Januar 2021 in Kraft getretene NiSV regelte damit mehrere Aspekte der kommerziellen WB-EMS-Anwendung. Der erste Aspekt der NiSV konzentrierte sich überwiegend auf die obligatorische Meldung und Registrierung bei/durch der/die örtliche(n) Aufsichtsbehörde und enthält Hinweise auf die ordnungsgemäße Einrichtung des Geräts und Einweisungen durch den Hersteller, die erforderlichen Kenntnisse für Inspektion und Wartung sowie die Funktionsprüfung vor jedem Einsatz. Der zweite Aspekt der NISV legte den Fokus auf die Aufklärung der Kunden und umfasste Informationen zu Anwendung und Wirkung von WB-EMS, Risiken und mögliche unerwünschte Effekte. Im Gegensatz zur DIN 33961–5 6 bleibt die NiSV insbesondere bei der WB-EMS Anwendung vage, so bleiben zentrale Kriterien von Sicherheit und Effektivität wie Betreuungsschlüssel, Überwachung und Interaktion 12 in der NiSV unerwähnt. Der dritte Aspekt der NiSV bezieht sich auf die „Dokumentation“, nicht nur in Bezug auf Installation, Wartung, Störungen und Schäden des Gerätes, Einweisung und Qualifikation des Personals, sondern (Anlage 2, NiSV) ebenfalls auf die individuelle WB-EMS-Anwendung. Letzteres beinhaltet sowohl die Dokumentation der WB-EMS-Spezifikationen wie Impulsfrequenz, -intensität und Expositionsdauer, als auch die Dokumentation der Langzeitanwendung (Trainingsplan, Trainingshäufigkeit, Progression) inklusive unerwünschte Wirkungen, deren Ursache, Folgen und Maßnahmen zu deren Beseitigung. In Anbetracht der Tatsache, dass die derzeitige Generation von WB-EMS-Geräten die entsprechende Spezifikation speichern und übertragen, bleibt der Aufwand für die Anlagen und Anwender jedoch akzeptabel. Die wichtigste Neuerung der NiSV ist schließlich die verpflichtende Zertifizierung („Fachkunde“) der WB-EMS Trainer, durch anerkannte Schulungsträger . Im Bereich des WB-EMS ist die Voraussetzung für die Fachkunde-Ausbildung eine Übungsleiter- bzw. Trainerlizenz oder eine vergleichbare Ausbildung mit einem Schulungsumfang von mindestens 120 Lerneinheiten (à 45 Minuten). Die Inhalte und Vorgaben der zusätzlichen WB-EMS-Fachkunde-Ausbildung mit einem Schulungsumfang von 24 Lerneinheiten werden vom NiSV detailliert vorgeschrieben, unterscheiden sich aber bis auf wenige Ausnahmen nicht vom bisherigen Curriculum der anerkannten Bildungsträger. Dem Umstand der enormen Anzahl an nicht oder nicht ausreichend zertifizierten WB-EMS-Trainern geschuldet, wird der NiSV-Aspekt der Fachkunde nicht vor Januar 2022 in Kraft treten. Inwieweit dieser Zeitraum ausreichend ist, einen regulären Betrieb der kommerziellen Einrichtungen zu gewährleisten, bleibt fraglich. Neben der schieren Anzahl an benötigten Zertifizierungen kollidiert ein weiterer formaler Aspekt mit der Verfügbarkeit von vorsichtig geschätzten 5000 WB-EMS-Trainern, die „der Markt“ im Jahr 2022 benötigt. Obgleich die formale Akkreditierung einer Personenzertifizierungsstelle nach DIN EN-ISO/IEC 17024 6 durch die amtlich bestellte Stelle (Deutsche Akkreditierungsstelle, DAkkS) derzeit (noch) nicht verpflichtend ist, sichert sie die Konformitätsannahme mit der DIN EN-ISO/IEC 17024 durch die Aufsichtsbehörden, die ansonsten die entsprechende Konformität des Zertifikats bezweifeln und letztlich nicht anerkennen können. Die Akkreditierung nach DIN EN-ISO/IEC 17024 6 ist allerdings ein aufwändiger, sehr strenger und kostenpflichtiger Prozess – mit Blick auf den deutschen Markt ist zu vermuten, dass nur eine Handvoll Bildungseinrichtungen die Kriterien der Akkreditierung erfüllen können. Neben dieser strukturellen Problematik der Bereitstellung einer ausreichenden Anzahl von zertifizierten Trainern steht die weitere Entwicklung des WB-EMS-Marktes (nicht nur) in Deutschland vor großen Herausforderungen. Im Zusammenhang mit der verschärften Regulierung der NISV und deren Kosten, der COVID-19 induzierten Schließung von WB-EMS-Einrichtungen in Deutschland und dem „Peleton“-Phänomen fokussieren sich neue Geschäftsmodelle auf die nicht-supervisierte WB-EMS-Anwendung zu Hause.

ACS Style

Wolfgang Kemmler; Michael Fröhlich; Christoph Eifler. Quo vadis kommerzielles nicht-medizinisches Ganzkörper-EMS. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2021, 31, 157 -158.

AMA Style

Wolfgang Kemmler, Michael Fröhlich, Christoph Eifler. Quo vadis kommerzielles nicht-medizinisches Ganzkörper-EMS. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin. 2021; 31 (03):157-158.

Chicago/Turabian Style

Wolfgang Kemmler; Michael Fröhlich; Christoph Eifler. 2021. "Quo vadis kommerzielles nicht-medizinisches Ganzkörper-EMS." Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 31, no. 03: 157-158.

Brief report
Published: 25 May 2021 in International Journal of Environmental Research and Public Health
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Whole-body electromyostimulation (WB-EMS), an innovative training technology, is considered as a joint-friendly, highly customizable and particularly time-effective option for improving muscle strength and stability, body composition and pain relief. The aim of the present study was to determine the effect of 16 weeks of once-weekly WB-EMS on maximum isometric trunk (MITS), leg extensor strength (MILES), lean body mass (LBM) and body-fat content. A cohort of 54 male amateur golfers, 18 to 70 years old and largely representative for healthy adults, were randomly assigned to a WB-EMS (n = 27) or a control group (CG: n = 27). Bipolar low-frequency WB-EMS combined with low-intensity movements was conducted once per week for 20 min at the participants’ locations, while the CG maintained their habitual activity. The intention to treat analysis with multiple imputation was applied. After 16 weeks of once-weekly WB-EMS application with an attendance rate close to 100%, we observed significant WB-EMS effects on MITS (p< 0.001), MILES (p = 0.001), LBM (p = 0.034), but not body-fat content (p = 0.080) and low-back pain (LBP: p ≥ 0.078). In summary, the commercial setting of once-weekly WB-EMS application is effective to enhance stability, maximum strength, body composition and, to a lower extent, LBP in amateur golfers widely representative for a healthy male cohort.

ACS Style

Carina Zink-Rückel; Matthias Kohl; Sebastian Willert; Simon von Stengel; Wolfgang Kemmler. Once-Weekly Whole-Body Electromyostimulation Increases Strength, Stability and Body Composition in Amateur Golfers. A Randomized Controlled Study. International Journal of Environmental Research and Public Health 2021, 18, 5628 .

AMA Style

Carina Zink-Rückel, Matthias Kohl, Sebastian Willert, Simon von Stengel, Wolfgang Kemmler. Once-Weekly Whole-Body Electromyostimulation Increases Strength, Stability and Body Composition in Amateur Golfers. A Randomized Controlled Study. International Journal of Environmental Research and Public Health. 2021; 18 (11):5628.

Chicago/Turabian Style

Carina Zink-Rückel; Matthias Kohl; Sebastian Willert; Simon von Stengel; Wolfgang Kemmler. 2021. "Once-Weekly Whole-Body Electromyostimulation Increases Strength, Stability and Body Composition in Amateur Golfers. A Randomized Controlled Study." International Journal of Environmental Research and Public Health 18, no. 11: 5628.

Brief report
Published: 01 May 2021 in Nutrients
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The present study aimed to determine the effect of detraining on muscle quality (MQ) in older men with osteosarcopenia. Forty-three community-dwelling older men (78 ± 4 years) were randomly allocated to a consistently supervised high-intensity resistance exercise training (HIRT) group (n = 21) or a control group (CG, n = 22). The HIRT scheduled a periodized single set protocol twice weekly. After the intervention, the men were subjected to six months of detraining. Muscle quality (MQ), defined as maximum isokinetic hip/leg extensor strength per unit of mid-thigh intra-fascia volume, was determined by magnetic resonance imaging (MRI) or per unit of thigh muscle mass assessed by dual-energy X-ray absorptiometry (DXA). Intention-to-treat analysis with multiple imputations was applied. We observed significant exercise effects for MQ (p = 0.001). During detraining, the HIRT group lost about one-third of the intervention-induced gain and displayed significantly (p = 0.001) higher MQ reductions compared to the CG. Nevertheless, after training and detraining, the overall intervention effect on MQ remained significant (p ≤ 0.004). In summary, six months of absence from HIRT induce a significant deleterious effect on MQ in older osteosarcopenic men. We conclude that intermitted training programs with training breaks of six months and longer should be replaced by largely continuous exercise programs, at least when addressing MQ parameters.

ACS Style

Mansour Ghasemikaram; Klaus Engelke; Matthias Kohl; Simon von Stengel; Wolfgang Kemmler. Detraining Effects on Muscle Quality in Older Men with Osteosarcopenia. Follow-Up of the Randomized Controlled Franconian Osteopenia and Sarcopenia Trial (FrOST). Nutrients 2021, 13, 1528 .

AMA Style

Mansour Ghasemikaram, Klaus Engelke, Matthias Kohl, Simon von Stengel, Wolfgang Kemmler. Detraining Effects on Muscle Quality in Older Men with Osteosarcopenia. Follow-Up of the Randomized Controlled Franconian Osteopenia and Sarcopenia Trial (FrOST). Nutrients. 2021; 13 (5):1528.

Chicago/Turabian Style

Mansour Ghasemikaram; Klaus Engelke; Matthias Kohl; Simon von Stengel; Wolfgang Kemmler. 2021. "Detraining Effects on Muscle Quality in Older Men with Osteosarcopenia. Follow-Up of the Randomized Controlled Franconian Osteopenia and Sarcopenia Trial (FrOST)." Nutrients 13, no. 5: 1528.

Physiology
Published: 13 April 2021 in Frontiers in Physiology
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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.

ACS Style

Florian Micke; Anja Weissenfels; Nicolas Wirtz; Simon von Stengel; Ulrike Dörmann; Matthias Kohl; Heinz Kleinöder; Lars Donath; Wolfgang Kemmler. Similar Pain Intensity Reductions and Trunk Strength Improvements Following Whole-Body Electromyostimulation vs. Whole-Body Vibration vs. Conventional Back-Strengthening Training in Chronic Non-specific Low Back Pain Patients: A Three-Armed Randomized Controlled Trial. Frontiers in Physiology 2021, 12, 1 .

AMA Style

Florian Micke, Anja Weissenfels, Nicolas Wirtz, Simon von Stengel, Ulrike Dörmann, Matthias Kohl, Heinz Kleinöder, Lars Donath, Wolfgang Kemmler. Similar Pain Intensity Reductions and Trunk Strength Improvements Following Whole-Body Electromyostimulation vs. Whole-Body Vibration vs. Conventional Back-Strengthening Training in Chronic Non-specific Low Back Pain Patients: A Three-Armed Randomized Controlled Trial. Frontiers in Physiology. 2021; 12 ():1.

Chicago/Turabian Style

Florian Micke; Anja Weissenfels; Nicolas Wirtz; Simon von Stengel; Ulrike Dörmann; Matthias Kohl; Heinz Kleinöder; Lars Donath; Wolfgang Kemmler. 2021. "Similar Pain Intensity Reductions and Trunk Strength Improvements Following Whole-Body Electromyostimulation vs. Whole-Body Vibration vs. Conventional Back-Strengthening Training in Chronic Non-specific Low Back Pain Patients: A Three-Armed Randomized Controlled Trial." Frontiers in Physiology 12, no. : 1.

Journal article
Published: 06 April 2021 in International Journal of Environmental Research and Public Health
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To investigate below-knee compression garments during exercise and a post-exercise period of 6 h on clinical, functional, and morphological outcomes in delayed-onset muscle soreness (DOMS). Eighteen volunteers (age: 24.1 ± 3.6, BMI 22.7 ± 2.7 kg/m2) were enrolled. Measures were acquired at baseline, 6 h, and 48 h after eccentric and plyometric exercise, with wearing a compression garment (21–22 mmHg) on a calf during and for the first 6 h after exercise. 3T MRI was performed for quantification of intramuscular edema (T2 signal intensity (SI), T2 time, and manual volume segmentation); jump height, calf circumference, ankle dorsiflexion (DF), creatine kinase (CK), and muscle soreness were assessed. DOMS was confirmed in all participants after 48 h, with an increase in soreness (p < 0.001) and CK (p = 0.001), decrease in jump height (p < 0.01), and the presence of intramuscular edema (p < 0.01) in both the compressed and non-compressed limbs. No differences between the compressed and non-compressed limbs were observed for muscle soreness and jump height. MRI T2 SI, T2 time, soreness, and manual segmentation revealed no effect of the compression treatment. The assessment of calf circumference and DF showed no changes in either the compression or non-compression limb (p = 1.0). Wearing compression garments during combined eccentric and plyometric exercise and for 6 h post-exercise has no effect on clinical signs of DOMS, jump performance, or the development of intramuscular edema.

ACS Style

Thilo Hotfiel; Svenja Höger; Armin Nagel; Michael Uder; Wolfgang Kemmler; Raimund Forst; Martin Engelhardt; Casper Grim; Rafael Heiss. Multi-Parametric Analysis of Below-Knee Compression Garments on Delayed-Onset Muscle Soreness. International Journal of Environmental Research and Public Health 2021, 18, 3798 .

AMA Style

Thilo Hotfiel, Svenja Höger, Armin Nagel, Michael Uder, Wolfgang Kemmler, Raimund Forst, Martin Engelhardt, Casper Grim, Rafael Heiss. Multi-Parametric Analysis of Below-Knee Compression Garments on Delayed-Onset Muscle Soreness. International Journal of Environmental Research and Public Health. 2021; 18 (7):3798.

Chicago/Turabian Style

Thilo Hotfiel; Svenja Höger; Armin Nagel; Michael Uder; Wolfgang Kemmler; Raimund Forst; Martin Engelhardt; Casper Grim; Rafael Heiss. 2021. "Multi-Parametric Analysis of Below-Knee Compression Garments on Delayed-Onset Muscle Soreness." International Journal of Environmental Research and Public Health 18, no. 7: 3798.

Original research
Published: 01 April 2021 in Clinical Interventions in Aging
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Purpose: Temporary cessation of exercise but maintenance of habitual physical activity might be a frequent situation in older people’s lives. Particularly the COVID-19 induced lockdown of exercise training facilities with individual outdoor activities still being allowed might be a blueprint for this potentially harmful scenario. Thus, the aim of the present study was to determine the effects of 6 months of detraining after 18 months of high-intensity resistance exercise (HIT-RT) on body composition and cardiometabolic outcomes in predominately obese older men with osteosarcopenia. Materials and Methods: Community-dwelling predominately obese men 72– 91 years old with low muscle and bone mass (n=43) were randomly assigned to an 18-month HIT-RT (EG: n=21) or a non-training control group (CG, n=22). After the intervention, participants of the EG discontinued HIT-RT for 6 months, but increased their habitual physical activity. Study outcomes were group differences in detraining changes (“effects”) for lean body mass (LBM), total and abdominal body fat rate (determined by dual-energy x-ray absorptiometry) and the Metabolic Syndrome Z-Score (MetSZ). We applied an intention-to-treat analysis with multiple imputation to analyze the data. Results: After the 18-month HIT-RT, we observed significant positive training effects for LBM, total and abdominal body fat rate and the MetSZ (all p< 0.001). Abrupt cessation of HIT-RT for 6 months resulted in significantly higher unfavorable changes in the HIT-RT compared with the CG for LBM (p=0.001), total body fat (p=0.003) and the MetSZ (p=0.003), apart from abdominal body fat (p=0.059). However, significant overall effects were still present after 24 months for LBM and body fat indices but not for the MetSZ. Conclusion: The present study clearly indicates the unfavorable effects of 6 months of detraining after HIT-RT. Correspondingly, exercise protocols particularly for older people should focus on continuous exercise with short regeneration periods rather than on intermitted protocols with pronounced training breaks.

ACS Style

Wolfgang Kemmler; Daniel Schoene; Matthias Kohl; Simon von Stengel. Changes in Body Composition and Cardiometabolic Health After Detraining in Older Men with Osteosarcopenia: 6-Month Follow-Up of the Randomized Controlled Franconian Osteopenia and Sarcopenia Trial (FrOST) Study. Clinical Interventions in Aging 2021, ume 16, 571 -582.

AMA Style

Wolfgang Kemmler, Daniel Schoene, Matthias Kohl, Simon von Stengel. Changes in Body Composition and Cardiometabolic Health After Detraining in Older Men with Osteosarcopenia: 6-Month Follow-Up of the Randomized Controlled Franconian Osteopenia and Sarcopenia Trial (FrOST) Study. Clinical Interventions in Aging. 2021; ume 16 ():571-582.

Chicago/Turabian Style

Wolfgang Kemmler; Daniel Schoene; Matthias Kohl; Simon von Stengel. 2021. "Changes in Body Composition and Cardiometabolic Health After Detraining in Older Men with Osteosarcopenia: 6-Month Follow-Up of the Randomized Controlled Franconian Osteopenia and Sarcopenia Trial (FrOST) Study." Clinical Interventions in Aging ume 16, no. : 571-582.

Original research
Published: 12 March 2021 in Calcified Tissue International
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Periods of absence from supervised group exercise while maintaining physical activity might be a frequent pattern in adults' exercise habits. The aim of the present study was to determine detraining effects on musculoskeletal outcomes after a 3-month detraining period in early post-menopausal, osteopenic women. Due to the COVID-19 pandemic, we terminated the 18-month randomized controlled ACTLIFE exercise intervention immediately after the 13-month follow-up assessment. This put an abrupt stop to the high-intensity aerobic and resistance group exercise sessions undertaken three times per week by the exercise group (EG: n = 27) and the gentle exercise program performed once per week for the attention control group (CG: n = 27); but both groups were permitted to conduct individual outdoor activity for the 3-month lock-down period. Study endpoints were lean body mass (LBM), bone mineral density (BMD) at the lumbar spine (LS), maximum hip-/leg extension strength and power. Detraining-induced reductions of LBM, hip/leg strength and power (but not BMD-LS) were significantly greater (p < 0.001 to p = 0.044) compared with the CG. Significant exercise effects, i.e. differences between EG and CG, present after 13 months of exercise, were lost after 3 months of detraining for LBM (p = 0.157) and BMD-LS (p = 0.065), but not for strength (p < 0.001) and power (p < 0.001). Of note, self-reported individual outdoor activities and exercise increased by about 40% in both groups during the lock-down period. Three months' absence from a supervised group exercise protocol resulted in considerable detraining effects for musculoskeletal parameters. Thus, exercise programs for adults should be continuous rather than intermittent. Trial registration number: ClinicalTrials.gov: NCT04420806, 06.05.2020.

ACS Style

Wolfgang Kemmler; Michael Hettchen; Matthias Kohl; Marie Murphy; Laura Bragonzoni; Mikko Julin; Tapani Risto; Simon von Stengel. Detraining Effects on Musculoskeletal Parameters in Early Postmenopausal Osteopenic Women: 3-Month Follow-Up of the Randomized Controlled ACTLIFE Study. Calcified Tissue International 2021, 109, 1 -11.

AMA Style

Wolfgang Kemmler, Michael Hettchen, Matthias Kohl, Marie Murphy, Laura Bragonzoni, Mikko Julin, Tapani Risto, Simon von Stengel. Detraining Effects on Musculoskeletal Parameters in Early Postmenopausal Osteopenic Women: 3-Month Follow-Up of the Randomized Controlled ACTLIFE Study. Calcified Tissue International. 2021; 109 (1):1-11.

Chicago/Turabian Style

Wolfgang Kemmler; Michael Hettchen; Matthias Kohl; Marie Murphy; Laura Bragonzoni; Mikko Julin; Tapani Risto; Simon von Stengel. 2021. "Detraining Effects on Musculoskeletal Parameters in Early Postmenopausal Osteopenic Women: 3-Month Follow-Up of the Randomized Controlled ACTLIFE Study." Calcified Tissue International 109, no. 1: 1-11.

Journal article
Published: 02 March 2021 in International Journal of Environmental Research and Public Health
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Adherence is important for an exercise program’s efficacy. This study aims at investigating whether the COVID-19 lockdown had different consequences on the adherence to an exercise program specifically designed for women with postmenopausal osteoporosis when administered as individual home training (IHT) or gym group training (GGT). At the start of the lockdown, which imposed the temporary closure of any gym activities, GGT participants were invited to continue to exercise at home. IHT participants continued to exercise at home as usual. Adherence was recorded via logs and measured as the percentage of exercise sessions actually performed out of the total number of scheduled sessions in three 1-month periods: one before (PRE) and two after (M1 and M2) the beginning of lockdown. Before lockdown, IHT (66.8% ± 26.6) and GGT (76.3% ± 26.6) adherence were similar. During lockdown, IHT participation increased (M1: 81.5% ± 31.0; M2: 88.0% ± 28.3), while that of GGT showed no statistical differences (M1: 79.4% ± 34.2; M2: 80.6% ± 36.4). Exercise protocols based on supervised gym practice must consider the possibility of disruptive events, which could cause a sudden interruption of gym activity and include educational initiatives to instruct participants to exercise effectively and safely without a trainer’s direct supervision.

ACS Style

Erika Pinelli; Giuseppe Barone; Sofia Marini; Francesco Benvenuti; Marie Murphy; Mikko Julin; Wolfgang Kemmler; Simon Von Stengel; Stefano Di Paolo; Laura Dallolio; Pasqualino Maietta Latessa; Raffaele Zinno; Laura Bragonzoni. Effects of COVID-19 Lockdown on Adherence to Individual Home- or Gym-Based Exercise Training among Women with Postmenopausal Osteoporosis. International Journal of Environmental Research and Public Health 2021, 18, 2441 .

AMA Style

Erika Pinelli, Giuseppe Barone, Sofia Marini, Francesco Benvenuti, Marie Murphy, Mikko Julin, Wolfgang Kemmler, Simon Von Stengel, Stefano Di Paolo, Laura Dallolio, Pasqualino Maietta Latessa, Raffaele Zinno, Laura Bragonzoni. Effects of COVID-19 Lockdown on Adherence to Individual Home- or Gym-Based Exercise Training among Women with Postmenopausal Osteoporosis. International Journal of Environmental Research and Public Health. 2021; 18 (5):2441.

Chicago/Turabian Style

Erika Pinelli; Giuseppe Barone; Sofia Marini; Francesco Benvenuti; Marie Murphy; Mikko Julin; Wolfgang Kemmler; Simon Von Stengel; Stefano Di Paolo; Laura Dallolio; Pasqualino Maietta Latessa; Raffaele Zinno; Laura Bragonzoni. 2021. "Effects of COVID-19 Lockdown on Adherence to Individual Home- or Gym-Based Exercise Training among Women with Postmenopausal Osteoporosis." International Journal of Environmental Research and Public Health 18, no. 5: 2441.

Physiology
Published: 26 February 2021 in Frontiers in Physiology
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This systematic review and meta-analysis set out to determine the efficacy on whole-body electromyostimulation (WB-EMS) on body composition and strength parameters in non-athletic cohorts. A systematic review of the literature according to the PRISMA statement included (a) controlled trials, (b) WB-EMS trials with at least one exercise and one control group, (c) WB-EMS as primary physical intervention, (d) WB-EMS with at least six electrodes covering most muscle groups, (e) non-athletic cohorts. We searched eight electronic databases up to June 30, 2020, without language restrictions. Standardized mean differences (SMD) for muscle mass parameters, total body fat mass, maximum leg extension, and trunk extension strength were defined as outcome measures. In summary, 16 studies with 19 individual WB-EMS groups representing 897 participants were included. Studies vary considerably with respect to age, BMI, and physical conditions. Impulse protocols of the studies were roughly comparable, but training frequency (1–5 sessions/week) and intervention length (6–54 weeks) differed between the studies. SMD average was 1.23 (95%-CI: 0.71–1.76) for muscle mass, 0.98 (0.74–1.22) for maximum leg, and 1.08 (0.78–1.39) for maximum trunk extension strength changes (all p < 0.001). SMD for body fat changes (−0.40, [−0.98 to 0.17]), however, did not reach significance. I 2 and Q-statistics revealed substantial heterogeneity of muscle and fat mass changes between the trials. However, rank and regression tests did not indicate positive evidence for small-study bias and funnel plot asymmetries. This work provided further evidence for significant, large-sized effects of WB-EMS on muscle mass and strength parameters, but not on body fat mass. Clinical Trial Registration: ClinicalTrials.gov, PROSPERO; ID: CRD42020183059.

ACS Style

Wolfgang Kemmler; Mahdieh Shojaa; James Steele; Joshua Berger; Michael Fröhlich; Daniel Schoene; Simon von Stengel; Heinz Kleinöder; Matthias Kohl. Efficacy of Whole-Body Electromyostimulation (WB-EMS) on Body Composition and Muscle Strength in Non-athletic Adults. A Systematic Review and Meta-Analysis. Frontiers in Physiology 2021, 12, 1 .

AMA Style

Wolfgang Kemmler, Mahdieh Shojaa, James Steele, Joshua Berger, Michael Fröhlich, Daniel Schoene, Simon von Stengel, Heinz Kleinöder, Matthias Kohl. Efficacy of Whole-Body Electromyostimulation (WB-EMS) on Body Composition and Muscle Strength in Non-athletic Adults. A Systematic Review and Meta-Analysis. Frontiers in Physiology. 2021; 12 ():1.

Chicago/Turabian Style

Wolfgang Kemmler; Mahdieh Shojaa; James Steele; Joshua Berger; Michael Fröhlich; Daniel Schoene; Simon von Stengel; Heinz Kleinöder; Matthias Kohl. 2021. "Efficacy of Whole-Body Electromyostimulation (WB-EMS) on Body Composition and Muscle Strength in Non-athletic Adults. A Systematic Review and Meta-Analysis." Frontiers in Physiology 12, no. : 1.

Conference paper
Published: 01 February 2021 in Jahreskongress DVO OSTEOLOGIE 2021
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Einleitung Die vollständige oder temporäre Einstellung eines gezielten Trainingsprograms ist leider eine häufige Situation im Bewegungsverhalten älterer Menschen. Mehrere Untersuchungen berichten bereits nach 3-6-monatigem „Detraining“, (also der Aufgabe des Trainingsprograms ohne weitere körperliche Inaktivität), von Reduktionen muskuloskeletaler Größen in den Bereich der Ausgangswerte - allerdings nach überwiegend kurzzeitigen Interventionsdauern. Ziel der vorliegenden Studie war es, die entsprechenden Auswirkungen eines 6-monatigen „Detrainings“ nach vorherigem 18-monatigen, hochintensivem Krafttraining (HIT-RT) zu evaluieren. Methode Selbstständig lebende Männer 72 Jahre und älter mit Osteosarkopenie (n = 43) wurden randomisiert einer 18-monatigen HIT-RT (TG: n = 21) oder einer nicht trainierenden Kontrollgruppe (KG, n = 22) zugeteilt. Nach der Intervention beendeten die Teilnehmer der EG die Intervention für 6 Monate, führten aber ihre habituelle körperliche Aktivität unverändert durch. Studienendpunkte waren die fettfreie Masse (LBM), die Knochendichte (BMD) an der Lendenwirbelsäule (LS) und der Hüfte (TH), die maximale Hüft-/Beinstreckkraft, die Handkraft und die habituelle Gehgeschwindigkeit. Wir führten eine Intention-to-treat-Analyse mit multipler Imputation durch. Ergebnisse Nach 18-monatigem HIT-RT konnten mit Ausnahme der habituellen Gehgeschwindigkeit jeweils signifikante Trainingseffekte (TG vs. KG) für LBM, BMD-LS, BMD-TH, maximale Hüft-/Beinstreckkraft und Handkraft erfasst werden. Nach 6-monatigem Detraining waren die Reduktionen der TG im Vergleich zur KG deutlich ausgeprägter, wobei dieser Effekt nur für LBM sowie die Kraft der Hüft-/Beinstrecker (p = .002 und p = .013), nicht aber für LS-BMD (p = .068), TH-BMD (p = .069), Handkraft (p = .066) oder Gehgeschwindigkeit (p = .067) signifikant war. Nach 24 Monaten Beobachtungsdauer wurden lediglich noch Gesamteffekte (TG vs. KG) für LBM (p<.001) und maximale Hüft-/Beinstreckkraft (p<.001) beobachtet. Diskussion Ein 6-monatiges Detraining zeigt hochrelevante, negative Effekte auf muskuloskeletale und funktionelle Größen in einem Kollektiv älterer Männer mit Osteosarkopenie. Im Gegensatz zu Trainingsprogrammen von geringer Dauer zeigt die vorliegende Untersuchung aber nach Ende des Detrainingszeitraum noch grundsätzlich positive Effekte („Anpassungs-festigkeit“). Die Daten implizieren, dass im Spannungsgeld präventiver und rehabilitativer Trainingsprogramme für den älteren Menschen, weitgehend kontinuierliche und nicht intermittierende Übungsprogramme implementiert werden sollten. Keywords Training, Detraining, Osteosarkopenie Korrespondenzadresse Wolfgang Kemmler, Friedrich-Alexander Universität Erlangen-Nürnberg, Institut für Medizinische Physik und Gewebetechnik, Osteoporose-Forschungszentrum, Henkestrasse 91, 91052 Erlangen, Deutschland E-Mail [email protected] Publication Date:05 March 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany

ACS Style

W Kemmler; S von Stengel. Reduktion muskuloskeletaler Größen nach abrupter Beendigung eines intensiven Krafttrainings bei älteren Männern mit einer Osteosarkopenie. Follow-up der randomisierten kontrollierten FrOST-Studie. Jahreskongress DVO OSTEOLOGIE 2021 2021, 30, A 01 .

AMA Style

W Kemmler, S von Stengel. Reduktion muskuloskeletaler Größen nach abrupter Beendigung eines intensiven Krafttrainings bei älteren Männern mit einer Osteosarkopenie. Follow-up der randomisierten kontrollierten FrOST-Studie. Jahreskongress DVO OSTEOLOGIE 2021. 2021; 30 (01):A 01.

Chicago/Turabian Style

W Kemmler; S von Stengel. 2021. "Reduktion muskuloskeletaler Größen nach abrupter Beendigung eines intensiven Krafttrainings bei älteren Männern mit einer Osteosarkopenie. Follow-up der randomisierten kontrollierten FrOST-Studie." Jahreskongress DVO OSTEOLOGIE 2021 30, no. 01: A 01.

Conference paper
Published: 01 February 2021 in Jahreskongress DVO OSTEOLOGIE 2021
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Einleitung Der Übergang in die Wechseljahre ist eine kritische Phase im Leben der Frau. Körperliches Training gehört ohne Zweifel zu den vielversprechendsten Optionen, um der Vielzahl von Risikofaktoren zu begegnen, die mit dem ausgeprägten Östradiolabfall der Peri- und frühen Postmenopause in Verbindung stehen. Das Ziel dieser Studie war es, den Effekt eines 18-monatigen Mehrzweck-Trainingsprogramms auf menopausa-le Risikofaktoren und Symptome unter besonderer Berücksichtigung der Knochendichte zu evaluieren. Methode Vierundfünfzig Frauen 1-5 Jahre postmenopausal mit einer Osteopenie oder Osteoporose wurden nach dem Zufallsprinzip (1) einer Trainingsgruppe mit hoher Reizintensität/hoher Ausbelastung/Bewegungsgeschwindigkeit (EG: n = 27), die dreimal wöchentlich trainierte, oder (2) einer aktiven Kontrollgruppe (CG: n = 27), die einmal wöchentlich Übungen mit niedriger Intensität durchführte, zugeordnet. Beide Gruppen wurden mit Cholecalciferol und Calcium versorgt. Primäre Studienendpunkte waren die Knochendichte (BMD) an der Lendenwirbelsäule (LS) und an der Hüfte (tHip), sekundäre Endpunkte waren die fettfreie Körpermasse (LBM), gesamtes- und abdominales Körperfett, der Z-Score des metabolischen Syndroms (MetS-Z), Wechseljahresbeschwerden sowie Muskelkraft und -leistung. Infolge von COVID-19 mußte die Studie nach 13 von 18 Monaten abgebrochen werden. Ergebnisse Wir beobachteten signifikante Effekte für die BMD-LS (EG: .002±.018 versus CG: -.009 ± 0.018 mg/cm2, p = .027), nicht aber für BMD-tHip (EG: -0.01±.016 versus CG: -.009 ± 0.020 mg/cm2, p = .129). Die LBM verbesserte sich bei der EG signifikant und verringerte sich bei der CG grenzwertig nicht signifikant (0,39 ± 1,08 vs. -0,37 ± 1,34 kg, p = .026). Signifikante Effekte zeigten sich ebenfalls für die gesamt und abdominale Körperfettrate (-1,44 ± 1,49 % vs. -0,02 ± 1,55 %, p = .002 respektive 1,50 ± 2,33 % vs. 0,08 ± 2,07 %, p = .011), sowie für Wechseljahresbeschwerden (p = .029), Hüft-/Beinextensions-Kraft und -Leistung (je p < .001). Die Veränderungen des MetS-Z unterschieden sich jedoch nicht signifikant (p = .149) zwischen EG und CG. Diskussion Zusammenfassend konnten wir mit wenigen Ausnahmen die Wirksamkeit eines Mehrzweck-Trainingsprotokolls auf Risikofaktoren und Beschwerden die im Zusammenhang mit den Wechseljahren stehen in diesem Kollektiv früh-postmenopause Frauen bereits nach 13 Monaten klar belegen. Ob bzw. inwieweit eine längere Studiendauer mit längerer Expositionszeit überschwelliger Reize insbesondere die BMD an der Hüfte positiv beeinflusst hätte lässt sich nur spekulieren. Korrespondenzadresse Wolfgang Kemmler, Friedrich-Alexander Universität Erlangen-Nürnberg, Institut für Medizinische Physik und Gewebetechnik, o, Henkestrasse 91, 91052 Erlangen, Deutschland E-Mail [email protected] Publication Date:05 March 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany

ACS Style

W Kemmler; S von Stengel. Effekte eines 13 monatigen intensiven körperlichen Trainings auf menopausale Risikofaktoren bei früh-postmenopausalen Frauen mit einer Osteopenie - die randomisierte kontrollierte ACTLIFE Studie. Jahreskongress DVO OSTEOLOGIE 2021 2021, 30, A 08 .

AMA Style

W Kemmler, S von Stengel. Effekte eines 13 monatigen intensiven körperlichen Trainings auf menopausale Risikofaktoren bei früh-postmenopausalen Frauen mit einer Osteopenie - die randomisierte kontrollierte ACTLIFE Studie. Jahreskongress DVO OSTEOLOGIE 2021. 2021; 30 (01):A 08.

Chicago/Turabian Style

W Kemmler; S von Stengel. 2021. "Effekte eines 13 monatigen intensiven körperlichen Trainings auf menopausale Risikofaktoren bei früh-postmenopausalen Frauen mit einer Osteopenie - die randomisierte kontrollierte ACTLIFE Studie." Jahreskongress DVO OSTEOLOGIE 2021 30, no. 01: A 08.

Clinical trial report
Published: 01 January 2021 in Clinical Interventions in Aging
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The menopausal transition is a critical period in women’s lives. Exercise might be the most promising non-pharmaceutic intervention to address the large variety of risk factors related to the pronounced estradiol decline during peri- and early-postmenopause. The aim of this study was to determine the effect of an 18-month multipurpose exercise program on risk factors and symptoms related to the menopausal transition. Fifty-four women 1– 5 years postmenopause with osteopenia or osteoporosis were randomly assigned 1) to a high impact weight-bearing/high-intensity/velocity resistance training group (EG: n=27) exercising three times a week or 2) to an attendance control group (CG: n=27) that performed low-intensity exercise once a week. Both groups were supplemented with cholecalciferol and calcium. The primary study endpoint was bone mineral density (BMD) at lumbar spine (LS) and total hip, secondary outcomes were lean body mass (LBM), total and abdominal body percentage, metabolic syndrome Z-Score (MetS-Z), menopausal symptoms and muscle strength and power. Due to COVID-19, the study was stopped after 13 months. We observed significant effects for BMD-LS (EG: 0.002± .018 versus CG: − .009± 0.018 mg/cm2, p=0.027) but not for BMD total hip (EG: − 0.01± .016 versus CG: − .009± 0.020 mg/cm2, p=0.129). LBM improved significantly in the EG and decreased in the CG (0.39± 1.08 vs − 0.37± 1.34 kg, p=0.026). Total and abdominal body fat improved significantly in the EG and was maintained in the CG (− 1.44± 1.49 vs − 0.02± 1.55 kg, p=0.002 and -1.50± 2.33 vs 0.08± 2.07 kg, p=0.011). Significant effects in favor of the EG were also determined for menopausal symptoms (p=0.029), hip/leg extension strength (p< 0.001) and power (p< 0.001). However, changes of the MetS-Z did not differ significantly (p=0.149) between EG and CG. In summary, with minor exceptions, we demonstrated the effectiveness of a multipurpose exercise protocol dedicated to early-postmenopausal women on various risk factors and complaints related to the menopausal transition.

ACS Style

Michael Hettchen; Simon von Stengel; Matthias Kohl; Marie H Murphy; Mahdieh Shojaa; Mansour Ghasemikaram; Laura Bragonzoni; Francesco Benvenuti; Claudio Ripamonti; Maria Grazia Benedetti; Mikko Julin; Tapani Risto; Wolfgang Kemmler. Changes in Menopausal Risk Factors in Early Postmenopausal Osteopenic Women After 13 Months of High-Intensity Exercise: The Randomized Controlled ACTLIFE-RCT. Clinical Interventions in Aging 2021, ume 16, 83 -96.

AMA Style

Michael Hettchen, Simon von Stengel, Matthias Kohl, Marie H Murphy, Mahdieh Shojaa, Mansour Ghasemikaram, Laura Bragonzoni, Francesco Benvenuti, Claudio Ripamonti, Maria Grazia Benedetti, Mikko Julin, Tapani Risto, Wolfgang Kemmler. Changes in Menopausal Risk Factors in Early Postmenopausal Osteopenic Women After 13 Months of High-Intensity Exercise: The Randomized Controlled ACTLIFE-RCT. Clinical Interventions in Aging. 2021; ume 16 ():83-96.

Chicago/Turabian Style

Michael Hettchen; Simon von Stengel; Matthias Kohl; Marie H Murphy; Mahdieh Shojaa; Mansour Ghasemikaram; Laura Bragonzoni; Francesco Benvenuti; Claudio Ripamonti; Maria Grazia Benedetti; Mikko Julin; Tapani Risto; Wolfgang Kemmler. 2021. "Changes in Menopausal Risk Factors in Early Postmenopausal Osteopenic Women After 13 Months of High-Intensity Exercise: The Randomized Controlled ACTLIFE-RCT." Clinical Interventions in Aging ume 16, no. : 83-96.

Original research
Published: 24 December 2020 in BMJ Open Sport & Exercise Medicine
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ObjectivesSarcopenia is related to the metabolic syndrome (MetS), a cluster of cardiometabolic risk-factors (CRF). Most exercise trials apply aerobic rather than resistance exercise to address CRF, while the strategy for maintaining muscle and bone is the opposite. However, there is considerable evidence that resistance exercise positively affects CRF. In the present study, we determined the effect of high-intensity resistance exercise training (HIT-RT) on CRF represented by the MetS in older men.MethodsForty-three osteosarcopenic and predominately obese older men (>72 years) living independently in Erlangen-Nürnberg, Germany were randomly assigned to two study arms. The HIT-RT group (n=21) conducted a periodised high intensity/effort protocol dedicated to muscle and bone mass and function two times per week, while the control group (CG: n=22) maintained their habitual physical activities. Both groups were supplemented with protein, cholecalciferol and calcium. Study outcomes presented here were the MetS-Z (MetSZ) score and its underlying risk-factors.ResultsAfter 18 months of intervention, we observed significant effects for the MetSZ score (pConclusionContinuously supervised HIT-RT is an effective, attractive, feasible and safe method to address cardiometabolic risk factors in community-dwelling men aged 72 years and older. Further, considering the proven effects on musculoskeletal risk factors, the present results indicate a more prominent role for HIT-RT within non-pharmacological prevention strategies of older adults.Trial registration numberNCT03453463.

ACS Style

Wolfgang Kemmler; Matthias Kohl; Simon Von Stengel; Daniel Schoene. Effect of high-intensity resistance exercise on cardiometabolic health in older men with osteosarcopenia: the randomised controlled Franconian Osteopenia and Sarcopenia Trial (FrOST). BMJ Open Sport & Exercise Medicine 2020, 6, e000846 .

AMA Style

Wolfgang Kemmler, Matthias Kohl, Simon Von Stengel, Daniel Schoene. Effect of high-intensity resistance exercise on cardiometabolic health in older men with osteosarcopenia: the randomised controlled Franconian Osteopenia and Sarcopenia Trial (FrOST). BMJ Open Sport & Exercise Medicine. 2020; 6 (1):e000846.

Chicago/Turabian Style

Wolfgang Kemmler; Matthias Kohl; Simon Von Stengel; Daniel Schoene. 2020. "Effect of high-intensity resistance exercise on cardiometabolic health in older men with osteosarcopenia: the randomised controlled Franconian Osteopenia and Sarcopenia Trial (FrOST)." BMJ Open Sport & Exercise Medicine 6, no. 1: e000846.

Journal article
Published: 26 November 2020 in Bone
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Detraining after dedicated exercise programs might be a frequent situation in older people's exercise patterns. The aim of the present study was thus to determine the effects of 6 months of detraining after 18 months of high intensity resistance exercise (HIT-RT) on musculoskeletal outcomes in older men with sarcopenia. Community-dwelling men aged 72 years and older with osteosarcopenia (n=43) were randomly assigned to an 18-month HIT-RT (EG: n=21) or a non-training control group (CG, n=22). After the intervention, participants of the EG stopped HIT-RT for 6 months, but continued their habitual physical activity. Study outcomes were skeletal muscle mass index, bone mineral density (BMD) at the lumbar-spine and total-hip, maximum hip/leg-extensor strength, handgrip strength and gait velocity. We applied an intention-to-treat analysis with multiple imputation. Changes in the HIT-RT were much more pronounced during the detraining period compared with the CG, although this effect was only significant for skeletal muscle mass index and hip-/leg-extensor strength (p=.002 and p=.013), but not for lumbar-spine BMD (p=.068), total-hip BMD (p=.069), handgrip strength (p=.066) or gait velocity (p=.067). Apart from total-hip BMD (p=.055), handgrip strength (p=.069) and gait velocity (p=.881) values of the HIT-RT group decreased significantly during detraining. However, after 24 months, overall effects (p<.001) were still observed for skeletal muscle mass index and hip-/leg-extensor strength. Although unable to state from which point in time relevant detraining effects emerge, we conclude that health care providers should focus on continuous rather than intermitted exercise programs for older people. Clinical trial number: clinicalTrials.gov: NCT03453463; NCT04444661.

ACS Style

Wolfgang Kemmler; Matthias Kohl; Michael Fröhlich; Daniel Schoene; Simon von Stengel. Detraining effects after 18 months of high intensity resistance training on osteosarcopenia in older men—Six-month follow-up of the randomized controlled Franconian Osteopenia and Sarcopenia Trial (FrOST). Bone 2020, 142, 115772 .

AMA Style

Wolfgang Kemmler, Matthias Kohl, Michael Fröhlich, Daniel Schoene, Simon von Stengel. Detraining effects after 18 months of high intensity resistance training on osteosarcopenia in older men—Six-month follow-up of the randomized controlled Franconian Osteopenia and Sarcopenia Trial (FrOST). Bone. 2020; 142 ():115772.

Chicago/Turabian Style

Wolfgang Kemmler; Matthias Kohl; Michael Fröhlich; Daniel Schoene; Simon von Stengel. 2020. "Detraining effects after 18 months of high intensity resistance training on osteosarcopenia in older men—Six-month follow-up of the randomized controlled Franconian Osteopenia and Sarcopenia Trial (FrOST)." Bone 142, no. : 115772.

Geriatric medicine
Published: 07 October 2020 in BMJ Open
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IntroductionObesity is highly prevalent in older adults aged 65 years or older. Different lifestyle interventions (diet, exercise, self-management) are available but benefits and harms have not been fully quantified comparing all available health promotion interventions. Special consideration must be given to functional outcomes and possible adverse effects (loss of muscle and bone mass, hypoglycaemia) of weight loss interventions in this age group. The objective of this study is to synthesise the evidence regarding the effects of different types and modalities of lifestyle interventions, or their combinations, on physical function and obesity-related outcomes such as body composition in older adults with obesity.Methods and analysesSix databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Psychinfo and Web of Science) and two trial registries (Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform) will be searched for randomised controlled trials of lifestyle interventions in older adults with obesity. Screening (title/abstract and full-text) and data extraction of references as well as assessment of risk of bias and rating of the certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluation for network meta-analyses) will be performed by two reviewers independently. Frequentist random-effects network meta-analyses will be conducted to determine the pooled effects from each intervention.Ethics and disseminationWe will submit our findings to peer-reviewed journals and present at national and international conferences as well as in scientific medical societies. Patient-targeted dissemination will involve local and national advocate groups.PROSPERO registration numberCRD42019147286.

ACS Style

Gabriel Torbahn; Daniel Schoene; Lukas Schwingshackl; Gerta Rücker; Helge Knüttel; Wolfgang Kemmler; Cornel C Sieber; John A Batsis; Dennis T Villareal; Nanette Stroebele-Benschop; Dorothee Volkert; Eva Kiesswetter. Effective SLOPE: EffectS of Lifestyle interventions in Older PEople with obesity: a systematic review and network meta-analysis protocol. BMJ Open 2020, 10, e038330 .

AMA Style

Gabriel Torbahn, Daniel Schoene, Lukas Schwingshackl, Gerta Rücker, Helge Knüttel, Wolfgang Kemmler, Cornel C Sieber, John A Batsis, Dennis T Villareal, Nanette Stroebele-Benschop, Dorothee Volkert, Eva Kiesswetter. Effective SLOPE: EffectS of Lifestyle interventions in Older PEople with obesity: a systematic review and network meta-analysis protocol. BMJ Open. 2020; 10 (10):e038330.

Chicago/Turabian Style

Gabriel Torbahn; Daniel Schoene; Lukas Schwingshackl; Gerta Rücker; Helge Knüttel; Wolfgang Kemmler; Cornel C Sieber; John A Batsis; Dennis T Villareal; Nanette Stroebele-Benschop; Dorothee Volkert; Eva Kiesswetter. 2020. "Effective SLOPE: EffectS of Lifestyle interventions in Older PEople with obesity: a systematic review and network meta-analysis protocol." BMJ Open 10, no. 10: e038330.

Physiology
Published: 27 August 2020 in Frontiers in Physiology
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To date, there has been no study on the long-term effects of resistance exercise on sarcopenia and obesity indices for people with sarcopenia. The present study thus aimed to determine the effect of 18 months of periodized, high-velocity/intensity/effort progressive resistance training (HIT-RT) on body composition and strength in older men with osteosarcopenia. Using a single-blind, two-group parallel design, 43 community-dwelling men, 72 years and older, with osteopenia and sarcopenia in Erlangen-Nürnberg, Germany, were randomly assigned to two study arms by drawing lots: (1) an exercise group that conducted a consistently supervised periodized high-velocity/intensity/effort protocol (HIT-RT; n = 21) on machines twice a week for 18 months or (2) a control group (CG; n = 22) that maintained their physical activity/exercise habits. Both groups were supplied with protein, cholecalciferol, and calcium according to current recommendations. The study outcomes were lean body mass (LBM), total and abdominal body fat as determined by dual-energy X-ray absorptiometry and maximum hip/leg extensor strength as assessed on an isokinetic leg press at baseline and after 8, 12, and 18 months of follow-up. The intention-to-treat principle and multiple imputation were applied to calculated study outcomes. After 18 months of HIT-RT, altogether five participants were lost to follow up (HIT-RT: n = 2, CG: n = 3). The attendance rates (95%) for HIT-RT were high; relevant adverse effects were not observed. Significant effects (i.e., differences between HIT-RT vs. CG) in favor of HIT-RT were determined for LBM (+1.73 kg, 95% CI: +1.13 to +2.32 kg), total body fat mass (−2.44 kg, 95% CI: −1.28 to 3.60 kg), abdominal body fat percentage (−2.68, 95% CI: −1.70 to −3.66), and maximum hip/leg extensor strength (+533 N, 95% CI: +397 to +670 N; all p < 0.001). Even after adjusting for multiple testing, all effects remained significant. Of note, after 8 months of HIT-RT, only slight (LBM and fat indices) to moderate (maximum strength) ongoing effects were observed. Carefully introduced, continuously supervised HIT-RT is an effective, attractive, feasible, and safe method to improve body composition and muscle strength in older community-dwelling men with sarcopenia. However, even when consequently applying principles of exercise intensity progression within the RT protocol, only slight further positive changes were observed after 8 months of exercise.

ACS Style

Wolfgang Kemmler; Matthias Kohl; Michael Fröhlich; Klaus Engelke; Simon Von Stengel; Daniel Schoene. Effects of High-Intensity Resistance Training on Fitness and Fatness in Older Men With Osteosarcopenia. Frontiers in Physiology 2020, 11, 1 .

AMA Style

Wolfgang Kemmler, Matthias Kohl, Michael Fröhlich, Klaus Engelke, Simon Von Stengel, Daniel Schoene. Effects of High-Intensity Resistance Training on Fitness and Fatness in Older Men With Osteosarcopenia. Frontiers in Physiology. 2020; 11 ():1.

Chicago/Turabian Style

Wolfgang Kemmler; Matthias Kohl; Michael Fröhlich; Klaus Engelke; Simon Von Stengel; Daniel Schoene. 2020. "Effects of High-Intensity Resistance Training on Fitness and Fatness in Older Men With Osteosarcopenia." Frontiers in Physiology 11, no. : 1.

Review article
Published: 12 August 2020 in Calcified Tissue International
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In this sub-analysis of a comprehensive meta-analysis, we aimed to determine the effect of different types of exercise on (areal) bone mineral density (BMD) in postmenopausal women. A systematic review of the literature according to the PRISMA statement included (a) controlled trials, (b) with at least one exercise and one control group, (c) intervention ≥ 6 months, (d) BMD assessments at lumbar spine (LS), femoral neck (FN) or total hip (TH), (e) in postmenopausal women. Eight electronic databases were scanned without language restrictions up to March 2019. The present subgroup analysis was conducted as a mixed-effect meta-analysis with “type of exercise” as the moderator. The 84 eligible exercise groups were classified into (a) weight bearing (WB, n = 30) exercise, (b) (dynamic) resistance exercise (DRT, n = 18), (c) mixed WB&DRT interventions (n = 36). Outcome measures were standardized mean differences (SMD) for BMD-changes at LS, FN and TH. All types of exercise significantly affect BMD at LS, FN and TH. SMD for LS average 0.40 (95% CI 0.15–0.65) for DRT, SMD 0.26 (0.03–0.49) for WB and SMD 0.42 (0.23–0.61) for WB&DRT. SMD for FN were 0.27 (0.09–0.45) for DRT, 0.37 (0.12–0.62) for WB and 0.35 (0.19–0.51) for WB&DRT. Lastly, SMD for TH changes were 0.51 (0.28–0.74) for DRT, 0.40 (0.21–0.58) for WB and 0.34 (0.14–0.53) for WB&DRT. In summary, we provided further evidence for the favorable effect of exercise on BMD largely independent of the type of exercise. However, in order to generate dedicated exercise recommendations or exercise guideline, meta-analyses might be a too rough tool.

ACS Style

Wolfgang Kemmler; Mahdieh Shojaa; Matthias Kohl; Simon Von Stengel. Effects of Different Types of Exercise on Bone Mineral Density in Postmenopausal Women: A Systematic Review and Meta-analysis. Calcified Tissue International 2020, 107, 409 -439.

AMA Style

Wolfgang Kemmler, Mahdieh Shojaa, Matthias Kohl, Simon Von Stengel. Effects of Different Types of Exercise on Bone Mineral Density in Postmenopausal Women: A Systematic Review and Meta-analysis. Calcified Tissue International. 2020; 107 (5):409-439.

Chicago/Turabian Style

Wolfgang Kemmler; Mahdieh Shojaa; Matthias Kohl; Simon Von Stengel. 2020. "Effects of Different Types of Exercise on Bone Mineral Density in Postmenopausal Women: A Systematic Review and Meta-analysis." Calcified Tissue International 107, no. 5: 409-439.

Journal article
Published: 05 August 2020 in Nutrients
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The present study aimed to evaluate the effect of high intensity dynamic resistance exercise (HIT-DRT) and whey protein supplementation (WPS) on bone mineral density (BMD) and sarcopenia parameters in osteosarcopenic men. Men ≥ 72 years with osteosarcopenia (n = 43) were randomly assigned to a HIT-RT (HIT-RT: n = 21) or a non-training control group (n = 22). Supervised HIT-RT twice/week was applied for 18 months, while the control group maintained their habitual lifestyle. Supplying WPS, total protein intake amounted to 1.5–1.6 (HIT-RT) and 1.2 g/kg/body mass/d (control). Both groups were supplied with calcium and vitamin D. Primary study outcomes were BMD and the sarcopenia Z-score. After adjusting for multiplicity, we observed significant positive effects for sarcopenia Z-score (standardized mean difference (SMD): 1.40), BMD at lumbar spine (SMD: 0.72) and total hip (SMD: 0.72). In detail, effect sizes for skeletal muscle mass changes were very pronounced (1.97, p < 0.001), while effects for functional sarcopenia parameters were moderate (0.87, p = 0.008; handgrip strength) or low (0.39, p = 0.209; gait velocity). Apart from one man who reported short periods of temporary worsening of existing joint pain, no HIT-RT/WPS-related adverse effects or injuries were reported. We consider HIT-RT supported by whey protein supplementation as a feasible, attractive, safe and highly effective option to fight osteosarcopenia in older men.

ACS Style

Wolfgang Kemmler; Matthias Kohl; Franz Jakob; Klaus Engelke; Simon Von Stengel. Effects of High Intensity Dynamic Resistance Exercise and Whey Protein Supplements on Osteosarcopenia in Older Men with Low Bone and Muscle Mass. Final Results of the Randomized Controlled FrOST Study. Nutrients 2020, 12, 2341 .

AMA Style

Wolfgang Kemmler, Matthias Kohl, Franz Jakob, Klaus Engelke, Simon Von Stengel. Effects of High Intensity Dynamic Resistance Exercise and Whey Protein Supplements on Osteosarcopenia in Older Men with Low Bone and Muscle Mass. Final Results of the Randomized Controlled FrOST Study. Nutrients. 2020; 12 (8):2341.

Chicago/Turabian Style

Wolfgang Kemmler; Matthias Kohl; Franz Jakob; Klaus Engelke; Simon Von Stengel. 2020. "Effects of High Intensity Dynamic Resistance Exercise and Whey Protein Supplements on Osteosarcopenia in Older Men with Low Bone and Muscle Mass. Final Results of the Randomized Controlled FrOST Study." Nutrients 12, no. 8: 2341.

Originalarbeit
Published: 16 July 2020 in Osteologie
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ZusammenfassungZiel dieser Metaanalyse war es (1) den Effekt eines dynamischen Krafttrainings (DRT) auf die Knochendichte (BMD) der Lendenwirbelsäule (LWS) einzuschätzen, (2) günstige Belastungs-komponenten zu identifizieren und (3) Trainingsempfehlungen abzuleiten.Eine systematische Literaturrecherche schloss (a) kontrollierte Studien, (b) DRT ≥ 6 Monate mit mindestens einer Trainings- (TG) und einer Kontrollgruppe (KG), (c) LWS-BMD-Messung vor und nach der Intervention und (e) postmenopausale Frauen ein. Subgruppenanalysen wurden für Interventionsdauer, Art des DRT, Trainingshäufigkeit (TH), und -volumen sowie Reizintensität durchgeführt.17 Artikel mit 20 TG und 18 KG konnten eingeschlossen werden. Die standardisierte Mittelwertdifferenz für die LWS-BMD zeigte einen signifikanten Effekt (0,59; 95%-CI: 0,26–0,92). Eine niedrige TH zeigte signifikant höhere Effekte auf die BMD als eine TH von ≥ 2 Einheiten/Woche.Die Meta-Analyse zeigte einen moderaten DRT-Effekt auf die LWS-BMD. Ergebnisse der Subanalysen standen zum Teil im Gegensatz zur vorliegenden Literatur. Subanalysen meta-analytischer Auswertung scheinen zur Generierung erfolgversprechender Trainingsprotokolle nicht geeignet zu sein.

ACS Style

Wolfgang Kemmler; Mahdieh Shojaa; Matthias Kohl; Daniel Schoene; Simon Von Stengel. Dynamisches Krafttraining und Knochendichte an der Lendenwirbelsäule postmenopausaler Frauen. Osteologie 2020, 1 .

AMA Style

Wolfgang Kemmler, Mahdieh Shojaa, Matthias Kohl, Daniel Schoene, Simon Von Stengel. Dynamisches Krafttraining und Knochendichte an der Lendenwirbelsäule postmenopausaler Frauen. Osteologie. 2020; ():1.

Chicago/Turabian Style

Wolfgang Kemmler; Mahdieh Shojaa; Matthias Kohl; Daniel Schoene; Simon Von Stengel. 2020. "Dynamisches Krafttraining und Knochendichte an der Lendenwirbelsäule postmenopausaler Frauen." Osteologie , no. : 1.