Effects of Longitudinal Whole-Body Electromyostimulation on Maximum Strength and Power in Sportspeople and Athletes—A Systematic Review and Meta-Analysis

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript addresses an important and current topic in sports science. Whole-body electromyostimulation (WB-EMS) is increasingly used in both recreational and professional training settings, and therefore a comprehensive synthesis of the available evidence is highly valuable.

In my opinion, this manuscript presents a solid and well-conducted analysis of the existing literature. The authors demonstrate a strong understanding of the topic, and it is evident that they are actively engaged in this research field. The study follows a systematic approach, applies appropriate methodology, and provides a structured and transparent presentation of the results. Overall, the paper makes a meaningful contribution to the current knowledge on WB-EMS.

The meta-analysis indicates positive effects of WB-EMS on strength and power outcomes; however, the authors appropriately acknowledge the limitations of the available evidence. In particular, the heterogeneity between studies is considerable and should be taken into account when interpreting the findings. Differences in study design, participant characteristics, and WB-EMS protocols make direct comparisons difficult. Additionally, some of the included studies are based on relatively small sample sizes, which further limits the strength of the conclusions. These limitations are inherent to the available literature and are not related to the quality of the present work.

A relevant aspect is the variability of WB-EMS protocols across studies, including differences in duration, intensity, and whether the stimulation was superimposed on voluntary exercise. The lack of a standardized protocol makes it challenging to draw precise and general conclusions. The manuscript would benefit from a brief emphasis on the need for more standardized approaches in future research, which would improve comparability and strengthen future evidence synthesis.

I also note that the manuscript includes a relatively high number of self-citations. However, in this case, they appear to be justified and relevant, as the cited works contribute directly to the development of the research field and provide important context for the current analysis.

The discussion is balanced, and the authors are careful in their interpretation of the results. They do not overstate their conclusions and appropriately highlight the need for further high-quality research with larger sample sizes and more standardized protocols. It may also be helpful to briefly emphasize the practical implications of the findings for coaches and athletes.

In conclusion, this is a well-prepared and scientifically sound manuscript that provides a valuable overview of WB-EMS effects in sportspeople and athletes. Despite the inherent limitations of the available studies, the authors present their findings in a careful and responsible manner.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This paper is a review paper studying the effect of whole body NMS alone or in association with other stimuli, on the strength.

The review is comprehensevely well structured.

Albeit the topic is not new (and I think the authors should include the early studies in the introduction)  the authors provided consistent evidences of the usefulness of the NSM in improving muscular strenght, albeit the authors find little evidences of usefulness in sport.

Introduction an methods used are well described and appropriate.

The results section provide a clear picture and the tables are extensive and understandable reporting full information.

Discussion is also sound and well structured. As only a few paper have been found the evidences are necessarly few.

However, at least in the introduction and in the discussion, I reccomend to incorporate the early works on the topic in order to make the conclusions more complete.

 

 

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The aim of this systematic review was to determine the effect of whole-body electrostimulation on maximum hip/lower extremity strength and power

Introduction

• The rationale is too generic; the authors should better justify why WB-EMS specifically for hip/lower-extremity strength is clinically or sport-relevant.
• Consider to better explain the potentiality of Longitudinal Whole-Body Electromyostimulation in athletes. Indeed, this technique could help in improving performance and avoiding injuries. For this reason, a screening on healthy athletes could be considered essential to define training protocol, including electromyostimulation and avoid future damages (DOI: 10.1016/j.heliyon.2024.e25401)
• Clarify whether the focus is on athletes or also recreationally active individuals (define better)

Methods

• The use of the “inverse heterogeneity model” needs justifications.

Results

• High heterogeneity (I² = 86%) for strength outcomes is not discussed and requires exploration (e.g., subgroup/sensitivity analyses).
• The distinction between “superimposed” and “non-superimposed” WB-EMS should be clearly defined earlier.
• The wording “positive effects” is too strong given the heterogeneity and wide confidence intervals.
• Clarify whether results are clinically meaningful, not only statistically significant.
• Consider integrating a brief statement on practical implications and limitations.

Conclusion

• The conclusion is too cautious yet still vague; it should better reflect the heterogeneity and limitations of the included studies.
• The phrase “might positively affect” is acceptable but should be explicitly linked to the quality of evidence.

Comments on the Quality of English Language

Consider to use a more formal language (i.e. avoiding "we" or "our")

Author Response

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Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

Dear Authors,

This manuscript presents significant and compelling results, offering robust conclusions regarding WB-EMS effects on strength and power. However, I would like to make some suggestions to improve the quality and the readability of the manuscript:

• At figure 3, it is difficult to distinguish between Mean and SD. The numbers are very close each other.
• I recommend adding the P value related to the significance of the analysis to the figures, as this will help to illustrate the magnitude of the change more clearly.
• I suggest changing “figure 5 and 6” by "figure 5" separated in two parts: A) and B).
• The use of different methodological approaches in strength and power measurements is different between studies and somehow difficult to compare. Although it is mentioned across the manuscript, I highly recommend remarking this as a limitation. For that reason, it would be interesting to make a brief list with the limitations of the study.

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The paper has been sufficently improved

Author Response

Thank you!

Reviewer 3 Report

Comments and Suggestions for Authors

Consider to better explain the potentiality  of screening before the choice of the use of Longitudinal Whole-Body Electromyostimulation in athletes. Indeed, this technique could help in improving performance and avoiding injuries. For this reason, a screening on healthy athletes could be considered essential to define training protocol, including electromyostimulation and avoid future damages. (DOI: 10.1016/j.heliyon.2024.e25401)

Author Response

Please see attached file

Author Response File: Author Response.pdf