Case Report: Whole-body electrical muscle stimulation as an adjunctive tool in cardiac rehabilitation of a patient with heart failure and reduced ejection fraction

Figures

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  Figure 1. Equipment setup. (A) The Wiems Revolution Pro WB-EMS wearable electrode suit, showing positioning of bipolar electrodes over the major muscle groups (upper arms, chest, back, abdomen, gluteal region, and thighs) used for whole-body stimulation during cardiac rehabilitation sessions. (B) Representative cardiac rehabilitation session showing cycle ergometry performed while wearing the WB-EMS suit, as used during the 5 min warm-up that preceded each stimulation protocol. Illustrations created from clinical photographs to protect patient identity. Figures created by the authors; reproduced with written informed consent from the patient.

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  Figure 2. Seated exercises (Exercises 1–3 of the WB-EMS protocol). (A) Exercise 1 — Seated forward trunk inclination with upper-limb extension. The patient is seated upright; on the 4 s “on” phase he leans the trunk forward while simultaneously extending both arms forward, then returns to upright on the 4 s “off” phase. Targets paraspinal extensors, gluteal and core musculature with concurrent upper-limb activation. (B) Exercise 2 — Seated march. Performed in a seated position; alternating hip-flexion drives lift each knee in cadence with the duty cycle. Targets hip flexors, quadriceps, and core stabilizers with minimal weight-bearing demand. (C) Exercise 3 — Partial sit-to-stand. From the seated position the patient rises to a partial standing position then returns to seated, synchronized with the duty cycle. Targets the quadriceps, hamstrings, and gluteal muscles and serves as a transition to weight-bearing exercises.

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  Figure 3. Transitional and lower-limb exercises (Exercises 4–6 of the WB-EMS protocol). (A) Exercise 4 — Calf raise with concurrent upper-limb extension. Standing, the patient rises onto the balls of the feet while extending the arms forward and overhead; returns to flat-foot stance with arms lowered on the “off” phase. Targets the gastrocnemius–soleus complex and shoulder girdle. (B) Exercise 5 — Alternating forward lunges. The patient steps forward into a controlled lunge alternately with the right and left legs. Targets the quadriceps, gluteal muscles, and hip stabilizers, recruits large lower-limb muscle mass, and adds a balance-training component. (C) Exercise 6 — Dynamic high-knee march. In place, the patient alternately drives each knee toward the chest at the highest tolerated height in cadence with the duty cycle. Targets hip flexors, quadriceps, and trunk stabilizers and provides a low-impact aerobic stimulus.

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  Figure 4. Functional multidirectional exercises (Exercises 7–9 of the WB-EMS protocol). (A) Exercise 7 — Lateral side-steps. From a half-squat stance the patient steps sideways with one foot then brings the other foot to meet it, returning in the opposite direction. Targets hip abductors and adductors, gluteal medius, and core stabilizers. (B) Exercise 8 — Cross-body knee drives. In a standing position, the patient drives one knee diagonally upward toward the opposite elbow while contracting the trunk. Targets oblique abdominal musculature, hip flexors, and adds rotational core control. (C) Exercise 9 — Alternating step-ups. The patient steps up onto a low platform alternately with each foot, mimicking stair climbing. Targets the quadriceps and gluteal muscles, recruits cardiovascular load, and serves as a functional close to the standing block.