Intended for healthcare professionals

Letters Whole body electrical stimulation

It’s time to regulate the use of whole body electrical stimulation

BMJ 2016; 352 doi: (Published 30 March 2016) Cite this as: BMJ 2016;352:i1693
  1. Stephen D H Malnick, director1,
  2. Yael Band, resident1,
  3. Pavel Alin, senior physician1,
  4. Nicola A Maffiuletti, director2
  1. 1Department of Internal Medicine, Kaplan Medical Center, Rehovot, Israel
  2. 2Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
  1. nicola.maffiuletti{at}

Transcutaneous electrical stimulation (ES) of human nerves and muscles has long been used as a non-pharmacological treatment for pain relief,1 and for rehabilitation after disuse. Whole body ES has recently emerged as an alternative form of physical exercise for improving fitness and health in healthy people. Despite limited scientific evidence on the safety and effectiveness of this form of exercise, several ES company sponsored fitness centres have recently been opened in different countries worldwide,2 making this technology easily accessible to the general population.

On 4 August 2015, a 20 year old man presented to our hospital with severe muscle pain shortly after a session of gym based whole body ES exercise supervised by a fitness professional. Rhabdomyolysis was diagnosed, and he was treated with intravenous 0.9% saline for five days.

On 3 December 2015, an Israeli public television channel presented the potential dangers of whole body ES in a documentary, in which two of us (SDHM and NAM) discussed the increased risk of rhabdomyolysis, warned against inappropriate use of whole body ES, and recommended a more active involvement of the regulatory authorities.3

In the first few days after the documentary, several other people with aching muscles after supervised whole body ES exercise contacted our hospital for advice (two other diagnoses of rhabdomyolysis were made). We suspect that the true number of people injured by this form of exercise may be much higher but they are undiagnosed.

On 11 January 2016, the Health Ministry of Israel issued an official safety warning and recommended that ES devices must not be used in gyms and without medical supervision.4

Regulatory authorities, clinicians, and users need a greater understanding and awareness of the risk of ES induced rhabdomyolysis, heightened ability to recognise this condition, and more diligent strategies to prevent this potentially harmful effect. The Health Ministry of Israel has played a key part in this regard, and this should serve as an example to other regulatory authorities worldwide.



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