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We read with interest the article entitled “Noninvasive Induction of Muscle Fiber Hypertrophy and Hyperplasia: Effects of High-Intensity Focused Electromagnetic Field Evaluated in an In-Vivo Porcine Model: A Pilot Study.” 1 The authors aimed to measure the cellular effects of high-intensity focused electromagnetic (HIFEM) field technology on skeletal muscle in a porcine model. This is a timely study that advances our understanding of the biological effects of HIFEM, and the authors should be commended for their thoughtful approach to answering the following question: what histological changes underlie the effects of HIFEM?

The authors begin with a concise overview of the mechanism whereby HIFEM affects skeletal muscle tissue, namely through the induction of secondary electric current within skeletal muscle, causing depolarization and supraphysiologic muscle contraction. This “supramaximal” contraction is believed to result in muscle toning and strengthening beyond what could normally be achieved through conventional exercise alone. The authors then briefly review the current literature on HIFEM, which shows an increase in muscle thickness as measured by computed tomography, ultrasound, and magnetic resonance imaging.2-4 These findings provide the impetus for their study: to determine what cellular changes in skeletal muscle tissue underlie the increase in muscle thickness seen clinically and on imaging.

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