Quick Overview

If you are obsessed with optimizing your training, this matters. A 2023 randomized controlled study tested low-load squats at just 25% 1RM. Some groups added EMS. Some added blood flow restriction. One group combined both. 

After six weeks, the combined group showed greater improvements in measured muscle strength than training alone. EMS was associated with higher muscle activation. Blood flow restriction supported muscle size.

This suggests strength is not only about lifting heavier. It is also about motor unit recruitment and neural drive.

For serious lifters, EMS may support activation during deloads, recovery phases, or joint-friendly training blocks.

Introduction – Why We Write These Research Digests

At ORIEMS FIT Research Digest, our mission is simple:

We take real, peer-reviewed research from universities and medical journals and translate it into clear, everyday language.

Many studies are difficult to read. They use technical words and complex statistics. We simplify them so that anyone — whether 14 or 70 — can understand what the science actually says. 

This article is for educational purposes only. It does not provide medical advice.
It does not recommend treatment. We encourage all readers to consult a qualified health professional before starting any new training or stimulation program.  Links to original studies will always be provided at the end of each article.

What Is This Study About?

This study examined whether combining:

• Low-intensity squat training

• Blood Flow Restriction Training (BFRT)

• Electrical Muscle Stimulation (EMS)

could improve:

• Muscle size

• Muscle activation

• Muscle strength

The full study is available here:

DOI: https://doi.org/10.3389/fphys.2023.1182249
Journal link: https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2023.1182249/full

Who Conducted the Research?

• Conducted by researchers from:

  • Chengdu Sport University

  • West China Hospital, Sichuan University

• Country of research: China

• Published in: Frontiers in Physiology

• Publisher: Frontiers Media SA (Switzerland)

This was a randomized controlled trial, which is considered a strong research design.

What Type of Electrical Stimulation Was Used?

The study used EMS (Electrical Muscle Stimulation).

This is different from TENS.

EMS

• Causes muscle contraction

• Used for strengthening

• Stimulates motor nerves

TENS

• Primarily used for pain relief

• Does not create strong muscle contractions

• Targets sensory nerves

This study investigated EMS for muscle performance, not TENS.

Who Was Studied?

• 40 healthy young men

• Average age: ~20 years

• Irregular exercise background

• No prior EMS or BFRT experience

They were randomly divided into 4 groups (10 per group):

1. Control group (low-intensity squats only)

2. BFRT group

3. EMS group

4. Combined BFRT + EMS group (CMB)

How Did They Study It?

Duration

• 6 weeks

• 5 sessions per week

• 30 total sessions

• 19 minutes per session

Exercise Protocol

• Low-intensity squat training

• Load: 25% of 1-repetition maximum (1RM)

EMS Parameters

• Frequency: 75 Hz

• Pulse width: 400 microseconds

• Intensity: 50 mA

• Duty cycle: 3 seconds ON / 3 seconds OFF

BFRT Protocol

• Tourniquet cuffs applied at groin

• Pressure based on leg circumference (200–350 mmHg)

• 5 minutes inflation, 2 minutes rest cycles

What Did They Measure?

1. Muscle size

   • Measured using ultrasound

   • Cross-sectional area (CSA) of rectus femoris

2. Muscle activation

   • Measured using surface electromyography (sEMG)

   • Root Mean Square (RMS)

3. Muscle strength

   • Measured using isokinetic dynamometer

   • Peak Torque (PT) of knee extension

What Did They Find?

1️⃣ Muscle Size

• BFRT increased muscle size more than control

• Combined BFRT + EMS increased muscle size more than EMS alone

• EMS alone did not significantly outperform control

2️⃣ Muscle Activation

• EMS increased muscle activation more than control

• Combined BFRT + EMS increased activation more than BFRT alone

• BFRT alone did not significantly increase activation

3️⃣ Muscle Strength

The combined group (BFRT + EMS):

• Showed significantly greater strength gains than:

  • Control

  • EMS alone

  • BFRT alone

This suggests that combining both methods may enhance both:

• Muscle hypertrophy (size increase)

• Neuromuscular activation

The authors concluded that the combination compensated for limitations of each method when used alone.

What Does This Mean for Someone Considering EMS?

Mechanism

EMS stimulates motor nerves directly.
This can increase muscle fiber recruitment.

Muscle strength improvements appear associated with:

• Increased muscle activation

• Improved neuromuscular coordination

Safety

This study involved:

• Healthy young men

• Supervised environment

• Controlled intensity

EMS should be used cautiously if you have:

• Cardiac devices

• Neurological conditions

• Recent surgery

• Vascular disorders

Always consult a qualified professional.

Realistic Expectations

This was:

• 6 weeks

• 5 sessions per week

• Combined with exercise

EMS is not a passive solution.
It works best when combined with proper training.

What Does This Mean for Someone Already Using EMS?

Consistency matters.

Results were observed after:

• 30 supervised sessions

• Structured protocol

• Measured intensity

Muscle stimulation works by:

• Recruiting muscle fibers

• Supporting strength development

• Complementing resistance training

It is not a shortcut.
It is a training tool.

Detailed Research Summary Table

Like this Research Digest? 📚

Share it with your friends 💬👇
https://bit.ly/3OpWdxX

Disclaimer

This article is for educational and informational purposes only.

It does not constitute medical advice.
It does not provide diagnosis.
It does not provide treatment recommendations.
It does not make therapeutic claims.

ORIEMS FIT does not claim to cure, prevent, reverse, or treat any disease.

Individual results vary.
No guarantee of outcomes is expressed or implied.

Readers are responsible for their own health decisions.

Consult a qualified healthcare professional before:

• Beginning EMS use

• Beginning resistance training

• Using stimulation devices if you have medical conditions

This content does not replace professional medical care.

Research discussed may not apply to:

• Women

• Older adults

• Clinical populations

• Individuals with cardiovascular or neurological conditions

ORIEMS FIT is not affiliated with:

• Chengdu Sport University

• West China Hospital

• Frontiers Media SA

• Any researchers mentioned

This blog does not endorse specific medical outcomes.

No liability is accepted for:

• Misuse of electrical devices

• Misinterpretation of content

• Personal injury resulting from independent application

This content is written in accordance with Australian TGA compliance standards.
No therapeutic claims are made.

Reproduction of this material is not permitted without written consent.

Final Thoughts

This study suggests that combining low-intensity resistance training with EMS may enhance muscle activation and strength compared to training alone.

It does not suggest replacement of traditional training.

It supports the idea that EMS can be a structured training tool when used properly.

We encourage readers to review the full research paper and discuss any decisions with a qualified professional.

Science should guide decisions — not hype.

ORIEMS FIT Research Digest makes complex research from top scientists and universities easy for anyone to understand—clear, simple, and never medical advice, just trustworthy science.

Interested in a certain topic? Let us know! We'll help you find solid studies and turn them into easy-to-read summaries, always linking to the original source so you can explore further or verify it yourself.