Supplementary Material

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This systematic review aimed to produce a meta-analysis summarizing the efficacy and safety of electrical myostimulation (EMS) for sedentary elderly people at risk of primary sarcopenia. PubMed (OVID), EMBASE (OVID) and Cochrane Central Register for Randomized Controlled Trials (CENTRAL) were searched for randomized controlled trials (RCTs) from the inception of the databases to March 2019 to identify applicable studies that involved sedentary elderly people and compared EMS as a sole or adjunct intervention with no treatment, a placebo, or an active control. Two researchers reviewed the literature independently for eligibility and methodological quality and extracted outcome data for the meta-analysis. Nine studies involving a total of 508 elderly participants met the inclusion criteria. Analysis showed that, compared to the control group, EMS groups showed significant improvements in muscle strength (MD 1.68, 95% CI 0.66 to 2.69), and only marginal improvements in appendicular skeletal muscle mass (ASMM) (SMD 0.24, 95% CI -0.11 to 0.59), lean body mass (LBM) (SMD 0.11, 95% CI -0.29 to 0.50), the Timed Up and Go Test (TUGT) (MD 0.13, 95% CI -1.18 to 1.43) and the cross-sectional area (CSA) of the rectus femoris (MD 0.47 95% CI -0.11 to 1.05). The results suggest that EMS may be an effective treatment for the elderly population to prevent the loss of muscle mass and function. However, definite conclusions cannot be drawn based on the available evidence due to a limited amount of pooled data and heterogeneity across studies.