Pulsed Electromagnetic Field (PEMF) therapy is a non-invasive treatment that utilizes electromagnetic fields to stimulate and promote natural healing processes within the body. PEMF therapy works by emitting low-frequency electromagnetic pulses, which penetrate deep into tissues and cells, enhancing cellular function and health. PEMF applications are vast, ranging from enhancing recovery in athletes to supporting overall well-being in everyday individuals. PEMF therapy is increasingly recognized in the realm of sports and physical activity for its profound benefits in enhancing performance, accelerating recovery, and preventing injuries. By improving circulation, enhancing tissue oxygenation, and promoting the body’s natural healing processes, PEMF therapy has become an invaluable tool in sports medicine, contributing to optimized physical health and prolonged athletic careers. In this review, we explore the effects of PEMF on exercise and the underlying physiological mechanisms.
1 Introduction
Pulsed electromagnetic fields (PEMF) are a non-invasive medical therapy utilized in clinical treatments. The FDA granted approval for the application of PEMF in the repair of non-union fractures in humans in 1979 (1). PEMF therapy is currently employed for treating bone conditions like osteoporosis (2) and fractures (3). PEMF stimulation can be also used to improve tissue oxygenation, microcirculation and angiogenesis (4, 5). Kwan et al. (6) applied PEMF therapy on diabetic subjects, reporting an increase in microcirculation through the enhancement of capillary blood flow. Some authors have proposed PEMF stimulation as an adjunct to exercise (7, 8) but, to the best of our knowledge, there are no comprehensive articles examining the impact of PEMF on physical activity and sport. The aim of this review is to provide up-to-date summary of the current literature on PEMF and physical exercise, elucidating discrepancies, and identifying areas necessitating further research.
2 Biological rationale for PEMF stimulation as an adjunct to exercise
The application of external electromagnetic energy to an injured area triggers modifications in the cellular environment, promoting the restoration of tissue integrity and function (9–11). PEMFs have the potential to enhance tissue oxygenation, microcirculation, and angiogenesis in rats, human erythrocytes, and cell-free assays (4, 12, 13, 14). PEMF application has also showed modulatory effect on microvasculature and can result in its remodeling (15). Moreover, PEMF has the potential to resolve chronic inflammation via inducing changes in gene expression related to heme catabolism, removal of reactive oxygen species, and lipid mediator biosynthesis (16).
From the above-mentioned premises, we can state that the biological effects of PEMF stimulation may be useful to speed up recovery of specific muscles after exercises or to enhance the effects of exercise on specific body parts. Here we speculate about such practical applications.
2.1 Effects of PEMF on bones
The positive effects of PEMF stimulation on bone repair may be beneficial in the prevention and treatment of stress fractures in athletes and soldiers. Stress fractures occur primarily in the lower limbs and result from the repetitive mechanical overload associated with high-volume of endurance training. Standard treatment includes rest, ice and painkillers. Some painkillers may actually impair bone healing (17). PEMF stimulation may be used as an adjunct to exercise training in people at high risk of stress fractures to prevent their development. In athletes and soldiers recovering from stress fractures, PEMF stimulation may accelerate the return to sport or duty by enhancing the healing of the damaged bone tissue (18). Furthermore, PEMF stimulation may relieve pain in people with stress fractures due to its analgesic effects.
2.2 Analgesic effects of PEMF
Because pain is a significant barrier to exercise, the analgesic effects of PEMF stimulation may help people with osteoarthritis perform regular training to improve their physical function (19). A similar strategy may be applied in other situations in which musculoskeletal pain may limit the ability or willingness of people to perform exercise.
2.3 Effects of PEMF that may enhance recovery but may also reduce the hypertrophic response to resistance exercise
Exercise can induce significant muscle damage, especially when it includes eccentric muscle contractions (20). PEMF stimulation has many biological effects that may acutely enhance the recovery from such damage. These effects include reduced pain and inflammation, enhanced cellular repair and regeneration, stem cell activation and improved microcirculation, leading to better oxygenation and nutrient delivery to tissues (21). However, muscle damage and related inflammation have been proposed to be important stimuli for chronic muscle adaptations to resistance exercise (22). Therefore, it is important to directly investigate the net effect of PEMF stimulation on the muscle hypertrophy induced by resistance exercise.
2.4 Effects of PEMF stimulation on peripheral blood flow
PEMF stimulation is known to enhance peripheral blood flow. This effect may be particularly helpful as an adjunct to exercise in patients with impaired peripheral blood flow such as diabetic patients and people suffering from peripheral arterial disease. Exercise training is an important component in the management of these conditions (23, 24). PEMF stimulation may further enhance its beneficial effects in body parts particularly affected by vascular and microvascular alterations (25). Steward et al., (25) found that 12 weeks of PEMF stimulation let to improved endothelial vascular function and reduced blood pressure in hypertensive subjects showing that PEMF treatment could be a potential non-pharmacological and non-invasive strategy to manage vascular function and blood pressure in cohorts with peripheral vascular disease as well as hypertension.
3 Effect of PEMF on physical exercise
PEMF therapy impacts physical exercise with both acute and chronic effects. Acutely, PEMF can enhance muscle recovery by increasing blood flow and reducing inflammation, leading to immediate relief from muscle soreness and faster recovery times after workouts. Chronically, regular use of PEMF can improve overall muscular health, endurance, and performance by promoting cellular repair and optimizing metabolic function over time.
3.1 Effects of PEMF stimulation on the acute responses to exercise
Trofè et al. investigated the acute effects PEMF on muscle oxygenation during exercise. The authors found that PEMF enhanced muscle oxygenation and accelerated deoxyhemoglobin on-transition kinetics, indicating improved local oxygen extraction (7). In another study, the authors also found that PEMF stimulation increases the activity and metabolism of muscle fibers during physical exercise, therefore, PEMF has the potential to enhance muscular responses, particularly in low-intensity exercise scenarios (8).
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