Prof. Dr. med. Uwe Nixdorff in an Expert Interview: EMS as a Preventive Measure

The Cardiovascular Health is an important topic for many people: After all, it is not only about the current well-being, but above all about the future quality of life! Do you want to climb the professional ladder in top shape? Enjoy a retirement with a healthy Heart? Play Soccer with your grandchildren? It pays to take precautions in good time! We talk to Prof. Uwe Nixdorff, a proven expert in preventive Cardiology, about the best way to do this. Find out how informative an ECG is, why imaging procedures are so important and how you can protect your Heart with EMS training.

myostyle: Professor Dr. Nixdorff, you are a Specialist in the field of Preventive Cardiology. Can you explain your field as simply as possible for our readers?

Prof. Dr. Nixdorff: Prevention is very important, but unfortunately it is still not really implemented in health care medicine. It is primarily important because today we expect people to live longer, which means that they are increasingly suffering from chronic diseases. Something we didn't know in the past. Just 150 years ago, in the days of Chancellor Bismarck, people had a life expectancy of less than 50 years, and they didn't have the opportunity to develop many of the diseases that we are experiencing so frequently today.

This includes, quite significantly, the Heart Attack - in the past there was almost no such thing, because Atherosclerosis, i.e. the vessel wall calcification and thickening, which forms the basis for the Heart Attack, evolves over decades. It's not something you get quickly at the age of 20 if you smoke too much, for example. Rather, such a disease is built up over years, decades. As physicians, we naturally have to respond to this increased life expectancy and the associated diseases. Today, we have a technically very advanced Cardiology, so that we can treat infarcts well, i.e. with good chances of survival for the patients. But - and this is the key point - the Patients are no longer healthy afterwards.

A certain amount of the heart muscle tissue remains dead, and this causes them to develop heart failure, i.e. Cardiac insufficiency. That's what we have to respond to, and that's precisely why prevention is so important. That is the first point, and the second is that today we know very precisely what the risk factors for a heart attack are. This can be clearly demonstrated today, and so we can also actively address and control them, especially with regard to our lifestyle.

myostyle: In addition to being a Physician and Researcher, you also work at the University of Erlangen. How do you reconcile all these responsibilities?

Prof. Dr. Nixdorff: That is a very personal question and I can only answer it personally. For me, it is extremely dependent on the interest and motivation one has for a cause. My philosophy in life is that dedicated work is conducive to a high quality of life. In Generation Y and also Z, work-life balance is a big topic, but I think that's a misconception: Work doesn't mean not living, rather work is part of life and should be fun - and if I find that it's not fun, then I just have to change that.

We are the architect of our own fortune, and I appeal to a person's ability to perform and the opportunity to realize his or her potential. I have worked a lot in my life, especially when you have a post-doctoral degree, and you are on hospital duty during the day and then work on publications at night and on weekends. And that gives you much more satisfaction when you do something that is recognized and can help people, when you take on social responsibility. Yes, and then it works! I don't see it as a burden, otherwise I wouldn't have done it - after all, it's a voluntary decision whether you commit yourself to your profession in this way.

This applies both to my work in Erlangen, where I used to be a Senior Physician and now Lecturer at the University, and to the Management of my own Center: The European Prevention Center is a project that I could not realize in this way in the Clinic, because there it is more about acute care and there is often little space and time for prevention. And there you really need to have enough time, because you have to deal with people and advise them on how they should change their lifestyle. And that's just a lot of fun, and because of that fun I'm also sufficiently motivated and can - as they say - also move mountains.

I would like to interject here very briefly, because this is precisely our topic: How widely used are such prevention centers?

Unfortunately, there are very few such centers. I am certainly a pioneer here, but you can really count these centers on the fingers of your hand. I also know the competition quite well - of course, I am also an entrepreneur today, constantly doing benchmarking, and there are really few such centers.

Of course, prevention has always been done in the field of Family Medicine - although certainly not at the level that I claim for myself. Many chief physicians also hold consultations in which they prefer to address the topic of prevention. But what you are asking for, i.e. a dedicated Cardiology Prevention Center, such as the one I have founded and successfully run, is very rare.

And that is already a qualitative difference in Prevention work: In my center, I work with algorithms and evidence, and above all with much more time and effort - this is not always done in such detail in practical medicine, where it is also a matter of working quickly in practice. I, on the other hand, have allowed myself to take more time for the patients and to carry out a detailed, so-called Risk Evaluation within the framework of my foundation. This is not just a bit of Blood pressure and Diabetes treatment, but a highly complex procedure based on formulas, with which we predict the risk of heart attack.

This then determines which further examinations are necessary - and here I primarily use imaging methods that are significantly more informative than some common methods, such as the stress ECG. Imaging allows us to directly see the developing Atherosclerosis, for example by ultrasound in the Carotid arteries or by cardiac CT in the coronary arteries or also with the whole-body MRI, which allows an insight into all arteries.

I also show these images to my Patients, because this has a fantastic Preventive Effect, which has been proven by several studies: When people see such images, it improves their life expectancy compared to the control group, who have not seen such images. In these images, you can see the plaques, the very thickenings and calcifications that can form clots or block arteries, so that you can have a heart attack or stroke...and when I as a doctor then explain to the Patient what the images are saying, I can often, literally see it click.

People do not come without a reason, but you really must explain and illustrate what is happening in the body and what the consequences might be, before I realize: Oh, now it's worked, the person will really question his way of life and think about what might have to be changed. And unfortunately, there is often no time for that in the normal hectic world of medicine.

myostyle: Heart attacks and Strokes are the most common causes of death in the western world. The reasons and factors are incredibly varied. What are your best tips on how to protect yourself from them - besides eating healthy and not smoking?

Prof. Dr. Nixdorff: Allow me to counter that - the causes are not incredibly complex, there is a very clear pathology. That is, there is ONE very clear cause for the disease process, which always proceeds in the same way: Inflammation of the Endothelium leads to a change in the arterial walls, so that blood cells can penetrate the walls and lipid pools form, so to speak small " Fat lakes" in the arterial walls. This is called plaque, and these plaques are covered by a thin layer of tissue. If this tears due to external influences, a clot forms and the vessel closes - this is how the Heart Attack or Stroke occurs.

You have already mentioned two risk factors:

• Smoking- Cigarette smoking is basically the most serious risk factor, it must be said clearly.
• Nutrition – you also mentioned this, which is extremely important, especially in Western countries. There has also been a paradigm shift. In the past, Cardiologists always propagated a low-fat diet, but this is no longer the case. There are huge studies¹ on this. We have recognized that it is the carbohydrates, i.e. foods with a high glycemic index, which not only includes sweets, but also cakes and bread to pizza and hamburgers, which are all carbohydrates. If you manage to keep a little distance in your daily diet, you have an absolutely fantastic gain.
• Fitness or Exercise – you ask about other prevention topics, and I would like to put that before nutrition. It doesn't have to be a high-performance sport; on the contrary, the most physiological form of exercise that humans have is sufficient - walking, simply walking at a brisk pace, but of course also jogging, cycling, swimming, in other words all the endurance sports. It is best to add Strength Training at least two days a week.
• Relaxation – many people today suffer from Stress, both professionally and privately. Today, we can also measure this stress via heart rate variability - and of course also alleviate it, for example through Relaxation Exercises such as Mindfulness Training. In addition, I would like to remind you again of the topic of Attitude to Life: It is not necessarily inevitable that you have an unsatisfactory or stressful job, and I also recommend that everyone think about the meaning of life and then use the power that arises from this to proactively shape their lives.

myostyle: You often give insights into your research and your field on your YouTube channel. One video is about the effectiveness of EMS. Can you briefly explain what EMS is and what it is used for?

Prof. Dr. Nixdorff: EMS is the abbreviation for Electrical Muscle Stimulation and that actually tells you what it's all about: In Strength Training, you work by lifting, pulling or other forms of movement on equipment or weights, whereby the muscles are voluntarily energized by the brain, thus creating the stimulus for the muscle to contract. In EMS, electricity is applied externally to large muscle groups, virtually bypassing this cerebral command pattern. In classic EMS training, several large muscle groups are often stimulated simultaneously, so that a higher efficiency can be achieved than in classic Strength Training, where usually only one muscle group is activated.

The Method is not new, but has been used under the name of Stimulation Current Therapy for decades in Health Clinics and Rehabilitation Clinics, especially for people who are no longer so efficient. In my field of expertise, cardiovascular medicine, this mainly concerns stroke patients, who often also have paralysis and can undergo muscle training in this way.

In recent years, this has become a bit of a lifestyle trend, and there's nothing wrong with that. I myself visited an EMS Studio for a few years and also found it good. There are also several Studies, which were carried out at Sports Universities and positively assess the EMS training, among others at my faculty in Erlangen, at the Sports University Cologne, also in Bayreuth and Hamburg. The effectiveness was proven, the muscle cross-section was actually expanded, and no damaging influences were also observed.

In my field, Preventive Cardiology, I would like to emphasize the importance of regular Strength Training. In the past, we always recommended Cardio training, i.e. Endurance training, but today we clearly state that Strength training is also necessary, because lack of exercise leads to Muscle atrophy: If you don't do much exercise, you can lose about 3 kilograms of muscle within 10 years, and of course that's also unfavorable because muscle is very much involved in metabolism. Increased muscle cross-sections also burn increased amounts of sugar and fatty acids, and this naturally reduces the risk of atherosclerosis.

Of course, this also applies vice versa, i.e. purely isolated Strength Training is also not optimal from a sports medicine point of view, we always recommend a warm-up training, i.e. Cardio Training on the stepper, ergometer or treadmill. This mobilizes the tendons, pre-stretches them and reduces the risk of accidents when you then start Strength training.

The ideal combination is regular Endurance Training, i.e. half an hour per day, and then Strength Training - 2x per week is sufficient for classic Strength Training. With EMS, you can get by with 1x per week due to the higher effectiveness of the simultaneous training of several muscle groups. This is not a pure marketing argument, with which many EMS studios advertise - "only 20 min per week", that is quite proven by scientific studies. During my check-ups, I talk to a lot of Managers who don't have a lot of time, and this is of course a convincing argument for EMS - this very time-effective training.

From a sports medicine point of view, however, it would make sense not to start directly with the EMS Strength Training - as is usual in most studios - but to warm up for 15 minutes beforehand, e.g. on the Ergometer.

myostyle: Can EMS also help strengthen the Heart? And are there also negative effects from the electromagnetic Currents?

Prof. Dr. Nixdorff: Yes, so EMS training is cardioprotective because it provides very effective Metabolic Activation.

I'll have to take a quick refresher on this one: In Preventive Cardiology today, we talk a lot about the "Cardiometabolic Syndrome", which is a very current term that describes the consequences of Obesity or Overweight. After all, obesity is not a purely aesthetic issue, but rather the fact that fat cells (Adipocytes) have highly unfavorable metabolic activity, especially visceral, i.e. in the Abdominal area. These swollen adipocytes produce namely interleukins and cytokines, which are inflammatory substances that are released into the blood, reach the arterial walls and lead to Atherosclerosis. In addition, a really obese person often also has Diabetes, usually at least Pre-Diabetes or at least an insulin resistance, and then there are also Lipid Metabolism Disorders and usually also High Blood Pressure - in other words, all things that are not good for the heart.

But if you do Strength Training, including EMS training, then the increased Muscle cross-section burns more Fatty acids and sugar, and this is an ideal way to lose excess weight and maintain a healthy weight. If you then accompany this, as mentioned above, with a Low-Carb diet, then you are already on a very good path in terms of health.

With regard to the second part of your question, i.e. harmfulness, as already noted, nothing is actually known.

You should apply these electromagnetic currents as high-frequency as possible, because low-frequency currents below 1000 Hertz can cause discomfort, it feels like pinpricks and that is of course unpleasant.

Otherwise, the same applies to EMS training as to classic Strength Training: You must not overdo it. I also see this in the laboratory values, more precisely in the Creatine Kinase value. If you train really hard - and with EMS this is the case because, as I said, you stimulate several muscle groups at the same time - then the CK value increases. This indicates that muscle fibers are broken, which is even desired by real bodybuilders and heals immediately, but you absolutely need at least a one-day rest period between training sessions.

myostyle: Last year, you were among the Top 10 Internists in Düsseldorf and among the Top Doctors 2022 in Focus. What sets you apart from your colleagues in your specialty?

Prof. Dr. Nixdorff: Yes, we already talked about this a bit at the beginning, on the subject of Attitude to Life and Meaning of Life. And for me, the meaning of life is to be socially active and to be socially effective. I am not an advocate of Work-Life Balance, I do not seek my life satisfaction in the so-called leisure area, but precisely in relation to my work.

And maybe that is what distinguishes me from some other colleagues: The really in-depth knowledge of the Theory of disease and the Self-image as a Scientist. I don't just do an ECG because that's how it's done, but I always start by thinking fundamentally: What's actually going on with the disease? And is the ECG sufficient here, or do I need a more modern method such as Computerized Tomography?

It is basically a certain scientific curiosity and also a scientific foundation, which is also not an objective in itself, but ultimately benefits the patient, because it allows for much more thorough and also more adequate diagnosis and ultimately also therapy.

And this is the only way to gain new insights, and the only way to recognize future developments or problems in the first place. And I am not only a Practitioner, but also a Researcher.

And another important point: I treat each Patient individually. That is an important keyword today, personalized medicine. Off-the-shelf treatment is not enough; unfortunately, that has not yet arrived in Healthcare medicine. But that's exactly what I do, because I've established myself and can simply offer that in my center.

I also do this in my lectures at the University of Erlangen - of course I have to complete a certain Curriculum, but I have always created space for myself to point out these things. That's another level at which things first have to hit the mark - after all, these are all intelligent Students, and it's definitely worthwhile to set the appropriate impulses in the direction of prevention and personalization. I was able to implement this even more intensively in my role as Head of the Master of Science in Preventive Medicine program at Dresden International University.

myostyle: Finally, do you have any helpful tips for people who are challenged physically? Can EMS be a good alternative here to still engage in sports or at least support Muscle Maintenance?

Prof. Dr. Nixdorff: I already briefly explained this when I talked about the history of EMS - keyword Stimulating Current Therapy. Especially for people who can hardly move, EMS offers a good solution - I'm thinking of people with Paresis, i.e. Paralysis of the Skeletal Musculature, especially people with Paraplegia, who can't do any training on their own. This is the original application of EMS technology in the rehabilitative and medical field, before it expanded into the lifestyle sector.

About the Author

Prof. Dr. med. Uwe Nixdorff is a specialist in internal medicine and cardiology, as well as a recognized expert in prevention. After initial training stations in Frankfurt and Mainz, Nixdorff took on a (initially assistant) professorship at Friedrich-Alexander University in Erlangen-Nürnberg in 1998. In addition to teaching students and caring for cardiology patients at the university hospital, he dedicated himself to clinical research, particularly focusing on the possibilities of non-invasive cardiovascular imaging. His desire for a consistently early detection and personalized preventive medicine led him to establish the European Prevention Centers in 2005, which he continues to lead. Since 2011, he has also run a cardiology private practice in Düsseldorf and is driving the development of digital preventive solutions with the Hanako GmbH.

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