6.2 In Patients with Established RA, Positive Effects of a Randomized Three Month WBV Therapy Intervention on Functional Ability, Bone Mineral Density and Fatigue are Sustained for up to Six Months

Journal: PLoS ONE 11(4): e0153470, April 2016 – Prioreschi A., Makda M., Tikly M., McVeigh J.

Study Context: Functional ability is often impaired for people with rheumatoid arthritis (RA). Additionally, RA patients often take medication that is known to negatively affect bone mass. This study investigated the effects of whole body vibration (WBV) exercise in patients with stable, established RA.

Subjects were randomly assigned to a control group or a WBV group training for 15 minutes per session, twice per week for 3 months. Participants were assessed for RA disease activity, Quality of life, Physical Activity levels, and bone mineral density.

The WBV protocol had subjects standing barefoot on the vibration platform with knees slightly bent and holding the bar for support. 10 repetitions of 60 seconds were performed (3 mm displacement at 30 Hz) with a 30 second rest interval. This protocol was chosen due to previous findings of beneficial effects on bone density.

After 3 months of vibration training, researchers found that the WBV group had significantly greater functional abilities at 3 and 6 months. Fatigue was significantly improved but only over the study period of 3 months. The control group also lost a significant amount of bone density at the hip whereas the WBV exercise group had no loss of bone mineral density. RA disease activity was unchanged in both groups.

Conclusions: Intermittent WBV training demonstrated sustained improvements in functional ability, for attenuating loss of bone mass at the hip, as well as for decreasing fatigue in patients with established RA.

6.1 Effects of Whole Body Vibration Exercise associated with Quadriceps Resistance Exercise on functioning and quality of life in patients with knee osteoarthritis: a randomized controlled trial

Journal: Clinical Rehabilitation 2016, Vol 30(11):1074-1087 – Wang P. et al.

Study Context: This is the largest randomized controlled trial ever performed on osteoarthritis using whole body vibration exercise.

Subjects with osteoarthritis of the knee were randomly assigned to receive either quadriceps resistance exercises (QRE) or the same plus whole body vibration exercises (QRE + WBV). Training was 5 days per week for a total of 24 weeks.

After the 24 weeks of training, researchers found improvements in the QRE + WBV group above and beyond quadriceps exercise only. Improvements were noted in:

  • Pain: Decreased pain from 6% at 2 weeks to 46.7% after 24 weeks of training
  • Timed up and go test: Improvements of 1.9 to 8.3 seconds over 2 to 24 weeks
  • 6 Minute Walk test: Increased distance from 12 to 171 meters over 2 to 24 weeks

Researchers concluded that: over a 6 month period, WBV exercise in combination with QRE was superior to QRE alone in most outcomes

Comments: The study added an interesting element of blood (serum COMP) and urine (CTX-II) testing. These markers represent bone and cartilage activity in joints and they were noted to improve after only 2 weeks of vibration training. It is hypothesized that the improvements noted by adding WBV exercise to the usual knee strengthening exercises is related to improved turnover and remodelling of bone and cartilage in people with arthritis.

This study used a static squat position on the vibration platform – it will be interesting to see an arthritis study that considers pain free dynamic exercises such as squats and lunges on the same platform. Our experience suggests that even greater gains might be seen.

5.1 Influence of Whole-Body Vibration Training Without Visual Feedback on Balance and Lower Extremity Muscle Strength of the Elderly

Journal: Medicine (Baltimore), 2016 Feb;95(5):e2709

Study Context: Balance deficit is one of the leading causes of falls in older adults. Aging induces the gradual decline of sensory functions, central processing, musculoskeletal and motor control, and neural pathways, thus leading to poor postural stability. Previous studies have also found that poor vision, restricted vision and declining depth perception are also closely related to body postural control.

This study randomly placed participants into one of three groups:

Group 1 performed a squat exercise on a vibration platform oscillating at 20 Hz with 4 mm displacement.

Group 2 performed the same squat exercise with the same parameters except they were blindfolded (visual feedback deprived).

Group 3 was the control group and they performed the same squat exercise except without any vibration and with the eyes open.

All three groups exercised for 5 minutes at a time, 3 times per week for 3 months.

Participants were retested at the end of the 3 month trial and again at 6 months. Testers were blind to the grouping of each subject.

Balance performance improved in both vibration training groups at 3 and 6 months compared to control and was significantly better again in the visual deprived group (blindfolded vibration training).

Strength performance remained the same in the control group. In the blindfolded vibration training group, knee extensor strength increased 37.89% and knee flexor strength improved 19.4%. In the eyes open vibration training group only knee extensor strength increased (15.4%).

At the 6 month follow-up, 0% of the eyes open vibration training group, 0% of the eyes closed vibration training group reported falls, whereas 28.57% of subjects from the control group reported hospital visits due to falls. (The average fall rate in adults over 65 is around 30%)

Comments: Previous studies have shown vibration training to improve strength and balance in older adults. Eliminating visual feedback, however, significantly improved both strength and balance performance during vibration training even more that vibration training with eyes open.

This suggests that we can utilize eyes closed vibration training for people whose goals include increased leg strength, balance and falls prevention.

4.4 Short-term effects of the whole body vibration on the balance and muscle strength of type 2 diabetic patients with peripheral neuropathy: a quasi-randomized controlled study

Journal: Journal of Diabetes and Metabolic Disorders, 2015; 14:45

Study Context: The aim of this study was to assess the effects of Whole Body Vibration (WBV) on the strength and balance of patients with type 2 diabetes.

Subjects were randomly assigned to a WBV exercise or control group. The WBV group received exercise (30 Hz, 2 mm) twice per week for 6 weeks.

After 6 weeks, the WBV group significantly improved strength in their shin and quadriceps muscles and significantly improved their time in the Timed Up and Go test

Comments: This study is interesting in that the exercise performed during the 6 week trial was in fact very low. Subjects held a 30 degree squat position for 30 seconds for the first two weeks; 45 seconds for the third and fourth weeks; and 60 seconds for the final two weeks. All were barefoot and did not use any balance aid during the exercise period.

4.3 The effects of whole body vibration in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

Journal: Brazilian Journal of Physical Therapy, 2016; 20(1):4-14

Study Context: These researchers sought to carry out a systematic review of the effects of WBV training on the glycemic control, cardiovascular risk factors, and physical and functional capacity of patients with T2DM.

Out of 585 potentially eligible articles, two studies were considered eligible. WBV interventions provided significant reduction of 12 hour fasting blood glucose (A reduction of 25.7 ml/dl). Improvements in glycated hemoglobin, cardiovascular risk factors and physical and functional capacity were found at 12 weeks of WBV training. No adverse effects were reported in any of the studies.

After 12 weeks of upper and lower body exercises performed on the vibrating platform, a significant decrease (p<0.05) was found in cholesterol, triglycerides, atherogenic index, weight, waist circumference, waist to hip ratio and body fat percentages compared to the control group. Improvements (p<0.05) were found in the 6 minute walk test distance and the 30 second sit to stand test. Static balance shoed a decrease in centre of pressure excursion with eyes closed (feet apart and together) The conclusions of this study is that WBV combined with exercise seems to improve glycemic control in patients with T2DM in an exposure dependent way (ie 12 weeks of training required)

Comments: This is a rigorous study that resulted in the exclusion of most the research papers gathered. The two that were chosen both used extremely low intensity WBV exercise of 1-2 total g forces, typically achieved with high frequency and low amplitude training. This type of training is far lower in terms of intensity of many forms of WBV training that provide up to 12 g and even up to 20 g forces during the exercise session.

The improvement in eyes closed balance is an interesting finding that suggests but does not prove that WBV training likely has a role in proprioception as well as strength.

4.2 The effect of Whole Body Vibration therapy on the physical function of people with type II diabetes mellitus: a systematic review

Journal: The Journal of Physical Therapy Science, 2016; 28: 2675-2680

Study Context: The aim of this review was to systematically assess randomized controlled trials featuring application of WBV training to improve the physical function of people of type 2 diabetes mellitus (T2DM). Of 244 articles found, researchers chose only 5 to review.

Four articles assessed balance and mobility using the timed up and go test (TUG). Their results showed that the WBV groups demonstrated significant effect when compared to the control groups. This was regardless of treatment duration and parameters of WBV training. Further meta-analysis of the TUG results revealed a significant improvement in favour of six weeks of WBV training.

Researchers wrote that although the majority of studies showed favourable effects following WBV therapy, there were also inconsistencies that they did not like. For example, different strength measures were used in different studies (5 minute sit to stand, 30 second sit to stand, isometric testing, dynamometry testing). Regardless, all the results indicated that WBV with or without exercise training has positive effects of the lower extremity muscle strength of people with T2DM.

They also criticized the user of various balance assessments (Wii balance board, the Berg Balance Scale, the functional reach test (FRT), and the single leg stance test. Most studies again reported positive results in favour of WBV training except the study by Kordi Yoosefinejad et al. which reported no significant difference between WBV and control groups.

Comments: It is important to note, however that in the Yoosefinejad study, they used a low intensity of vibration (30 Hz at 2 mm of displacement), exercised only twice per week, and applied only 30 seconds of exercise to begin with and only progressed to one minute of training exercise by the 5th and 6th weeks therefore the overall intensity required for muscular adaptation was likely far too low. Despite the low intensity of exercise used in the Yoosefinejad study, they actually concluded that strength still increased and the timed up and go test decreased significantly in the WBV training group. There is no explanation as to why the authors Zhang et al. reported negative findings of this study.

Finally, these researchers noted that they excluded non-english studies that may have added more to the conversation. In conclusion, they found WBV trying to be a “novel, effective, safe and alternative approach”, however more studies are needed to take into consideration individuals with diabetic neuropathy and differences in vibration parameters. Their overall rating at the end of the study is that WBV training for T2DM is still inconclusive with more studies needed.

In this review, Zhang et al. also omitted all studies that considered the effects of WBV training on glycemic control or insulin sensitivity. For more information on this please see the recent meta-analysis from the Brazilian Journal of Physical Therapy, 2016; 20(1):4-14, and the 2017 study form the Al Ameen Journal of Medical Science, 2017; 10(1):3-9.

4.1 Improved insulin sensitivity following a short-term whole body vibration intervention

Journal: Al Ameen Journal of Medical Science, 2017; 10(1): 3-9

Study Context: This UK study was a joint project taken on by Abertay University, Dundee, the School of Medicine at the University of Dundee and Southamptom Solent University. In the UK, only 43% of diabetic men and 32% of diabetic women achieve the recommended 30 minutes of exercise 5 days per week. It had been demonstrated that 15 minutes per week of high intensity exercise can also significantly improve insulin sensitivity, however the safety of this type of exercise for certain overweight diabetics was questioned. Researchers identified Whole Body Vibration Training (WBVT) as a time and intensity efficient workout.

Five healthy sedentary individuals undertook oral glucose tolerance testing prior to and after completion of a 6-week progressive WBVT program. These individuals showed a 9% reduction in plasma glucose area under the curve post training; the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) decreased by 21%; the Cedarholm index of insulin sensitivity was increased by 18%.

The conclusion of this study is that WBVT is associated with improved insulin sensitivity in could produce clinically relevant effects on fat metabolism in sedentary young people. Large scale studies are now necessary to assess the effectiveness of WBV in diabetic populations.

Comments: It would be fair to say that vibration training for diabetic individuals is promising but that more research is certainly needed before we can say anything definitively.

3.4 Effects of Whole Body Vibration and resistance training on bone mineral density and anthropometry in obese postmenopausal women

Journal: Journal of Osteoporosis, 2014: 1-6

Study Context: One aspect of health that is particularly important for post-menopausal women is that of bone mineral density. We know that physical exercise is helpful for bone mineral density but vigorous weight bearing exercise can also increase the risk of injuries. Since recent evidence shows that low levels of mechanical vibration can be strongly anabolic, and if these mechanical signals can reach the areas of the skeleton at greatest risk of osteoporosis such as the hip and lumbar spine, then vibration exercise could be used as a unique, non-pharmacological intervention to prevent or reverse bone loss.

This Egyptian study divided 80 women (ages 50 – 68 years) with high body mass indices (BMI 30-36 kg/m2) into two groups: one group performed weight bearing exercise 3 times per week for 8 months while the second group performed Whole Body Vibration exercises 3 times per week for 8 months.

Both groups significantly improved their bone mineral density after the 8 months of exercise and both groups improved their body mass indices and waist to hip ratios. The highest values of R2 were found for the models incorporating vibration exercise plus BMI

Comments: The vibration training group spent a total of 20 minutes training of which 10 minutes was on the machine and 10 minutes were in rest intervals. The weight training group spent one hour in the gym exercises and the exercises were not the same ones used in the vibration training group. The researchers noted that the long training times such as those used in the non-training group are one reason that compliance is often low and that similar gains were made in a shorter period of time with vibration exercise.


3.3 Prevention of postmenopausal bone loss by a low magnitude, high frequency mechanical stimuli: A clinical trial assessing compliance, efficacy and safety

Journal: Journal of Bone Mineral Research. 2004; 19:343-351

Study Context: Rubin et al used 30 Hz of vibration with a tiny amplitude of 0.2 g. Subjects were given a machine for home use and they stood on it for 2 19 minute session per day for 12 months.

Results: In this study they found a decrease in bone loss of 1.5% in the spine and 2.17% at the femur. They also noted that bone mineral density gains were the greatest in women weighing less than 65 kg (143 lbs) who improved 3.35%

Comments: Researchers chose a very specific vibration machine for this study that produced peak to peak accelerations of only 0.2 g. Normally it would be very difficult to create a blinded situation where participants are unaware whether they were using a vibration platform or not. In this case because the vibration were so tiny, they were able to create a situation for the controls so that a barely minimal perception of vibration existed.  

This study used a number of statistical tools that make interpretation a bit more difficult. Since the exercises were performed at home, compliance to the protocol of standing on the machine varied quite a bit and this had to be corrected for.

3.2 Effects of vibration therapy on bone mineral density in postmenopausal women with osteoporosis.

Journal: Chinese Medical Journal (English). 2008 Jul5; 121(10):1155-1158

Study Context: A total of 116 women participated in this study. The vibration training group simply stood on a vibration platform (30 Hz, 5 mm). They did this 5 times per week, 10 minutes per session, for 6 months. Researchers also assessed the effect of vibration on back pain.

Results: The control group lost 1.7-1.9% of their bone mass by month 6 of the study. Bone mineral density was increased in the low back by 4.3% and at the femur by 3.2%. Chronic back pain was also reduced in the vibration group.

3.1 Whole-body vibration exercise in postmenopausal osteoporosis

Journal: Menopause review (Prz Menapauzalny) 2015 Mar; 14(1):41-47

Study Context: These researchers reviewed the scientific literature of vibration exercise in patients with postmenopausal osteoporosis.

Results: A number of studies were cited here that demonstrated improved bone mineral density in women with post-menopausal osteoporosis.Researchers concluded that whole body vibration exercise is indeed a useful strategy for treating and preventing bone loss and for decreasing fracture risk. Vibration exercise is also one of the elements of the ICARO (Innovative Comprehensive Active Rehabilitation of Osteoporosis) strategy, a European osteoporosis rehabilitation initiative.

Comments: Unfortunately, despite the effectiveness of vibration exercise we still do not know the optimal frequency range. Even in the animal studies there is no consensus as to the best frequency of vibration to use. It probably takes at least 6 months of training for these changes to become significant, and many of the studies lasted for one year.

2.3 Whole body vibration training improves leg blood flow and adiposity in patients with type 2 diabetes mellitus.

Journal: European Journal of Applied Physiology, 2013; 113:2245-2252

Study Context:  This study looked at the effects of a 12 week vibration exercise program on leg blood flow and body composition in people with type 2 diabetes.

Participants in the vibration exercise group attended approximately 3 times per week. The total duration of the exercise sessions went from 12 to 20 minutes over the course of the study.

Results:  Researchers made 3 primary conclusions from this study:

1.  Blood flow in the leg went up significantly (22.6%, p<.03) in the whole body vibration exercise group.

2.  Body fat decreased in the vibration training group (7.2% decrease, p<.01). This finding was similar to previous reports and is important because central body fat contributes to the development of insulin resistance and the metabolic syndrome.

3.  Changes in blood flow were associated with changes in fat mass. Vibration training exercise was an effective way to increase leg blood flow and decrease body fat in patients with type 2 diabetes mellitus.

2.2 Effects of Whole Body Vibration exercise training on aortic wave reflection and muscle strength in postmenopausal women with prehypertension and hypertension

Journal: Journal of Human Hypertension, 2014; 28: 118-122

Study Context: We Know that high pressure wave reflections predispose women to myocardial ischemia due to increased muscle demand. In addition to arterial ageing, there is greater loss of muscle strength and muscle mass in older adults. Leg muscle strength loss has been associated with increased mortality in older men. Because the age-related increase in wave reflection, and subsequent risk for heart failure, is greater in women that in men, strategies that counteract or improve the negative consequences of wave reflection and muscle weakness in older women are needed.

Thirty women volunteered for this randomized parallel design study. Participants were postmenopausal (> 1 year without menstruation), overweight (body mass index > 25 kg/m2), prehypertensive (SBP > 120 mm Hg) and sedentary (< 60 min. of regular exercise training). Subjects were randomly assigned to a control or 6 weeks of WBV exercise training. THE WBV exercise group performed exercise 3 times per week at a platform frequency of 25-35 Hz, low to high amplitude, progressive duration (30-45 sec.) and progressive sets (1-2). The training protocol was similar to those previously used in the same population of women. The main findings were that 6 weeks of WBV training decreased wave reflection magnitude and aortic blood pressure. In addition, leg muscle strength improved significantly and this muscle strength increase was correlated with the decrease in augmented pressure.

Conclusion: Whole body vibration exercise may decrease cardiovascular risk in postmenopausal women by improving wave reflection and muscle strength.

Comments: The researchers acknowledge that there was not an exercise without WBV group. They justified the study design as one used in a study by Figueroa et. al

2.1 Cardiac autonomic response during recovery from a maximal exercise using whole body vibration

Journal: Complementary Therapies in Medicine, 2013; 21:294-299

Study Context: After performing a bicycle exercise test to exhaustion, the group was divided into an active recovery group (they sat with their feet resting on a vibration platform) or a passive recovery group (resting with no vibration stimulus). Researchers looked at heart rate and heart rate variability at 2, 4, 6, 8, 10 and 12 minutes post-exercise.

Results: Whole body vibration reduced heart rate and increased total power during the recovery of intense exercise. The greatest difference in heart rate was found at the 2 minute mark post-exercise (2 min - Recovery Heart Rate 103 ppm in WBV group and 111 ppm in the control group)

Comments:  Whole body vibration recovery likely prevented venous pooling due to reflex muscle contractions and enhanced uncle pump activity. This increase in venous return would offset the need to increase heart rate to the level observed during inactive recovery.

1.4 Vibration Training: could it enhance the strength, power or speed of athletes?

Journal: Journal of Strength and Conditioning research, 2009; 23(2): 593-603

Study Context: This paper examines the literature with respect to vibration training in the athletic population, especially with respect to chronic changes in athletes. The authors conclude that there is evidence that vibration training provides a small benefit to maximal strength (1 repetition maximum) and power (countermovement jumps) but does not seem to enhance speed.

Comments: More studies are required to assess optimal vibration training protocols. Those studies that found insignificant strength improvements post- vibration training were exercising with squats but testing isometric and dynamic knee extension which may have had poor crossover. The studies that excised using vibration and squats and tested strength via leg press all found significant improvements.

In the power studies, higher intensity exercise appeared to provide the best results. For example, in the Fagnani et al. study of female athletes, they performed 8 weeks of dynamic unloaded exercises on the vibration platform at 35 Hz and 4 mm of displacement for a total of 14 g forces. The Ronnestad study used only 2-3 sessions per week for 5 weeks but each session consisted of 6 -10 repetition maximums. On the other hand, although the Owen group exercised twice per week for 6 weeks, they only performed 6-8 repetitions total at 30% RM.

1.3 Whole-body vibration training increases muscle strength and mass in older women: A randomized-controlled trial

Journal: Scandinavian Journal of Medicine and Science in Sports, 2010; 20(2): 200-207

Study Context: To determine whether 10 weeks of Whole Body Vibration (WBV) training has a significant effect on strength, muscle mass, muscle power and mobility in older women.

Twenty six women were randomly assigned to a WBV training group (n=13, avg age 79 years) or a control group (n=13, avg age 76 years). The training protocol consisted of a range of static and dynamic exercises that were progressed in vibration platform intensity (2 mm to 4 mm) and vibration frequency (20 to 40 Hz), a well as the number and sets of exercises according to the overload principle.

After the training period subjects were retested and only the WBV training group improved in strength (leg press increase 38.8%), muscle cross sectional area (Vastus medialis increased 8.7% and biceps femoris increased 15.5%). Mobility in the WBV training group also improved by 9%. All gains compared to the control group were significant. Interestingly muscle power remained the same in the WBV training group but decreased in the control group.

The researchers concluded that WBV training in older women produces a significant gain in mobility, muscle size, and strength and may be a useful training regime to counteract the loss of muscle size and strength associated with age related sarcopenia.

Comments: This study demonstrated impressive gains

1.2 Effects of quadriceps strength after static and dynamic whole-body vibration exercise

Journal: Journal of Strength and Conditioning Research, 2015, 29(5): 1367-1377

Study Context: Some studies have indicated that performing dynamic as compared with static position exercises while exposed to Whole Body Vibration might be beneficial but more evidence is required. This study looked at whether there would be any muscular strength or performance changes after a single bout of vibration exercise. Twenty one young men and women participated in 4 exercise protocols: two exercise regimens done with vibration and two without. 5 sets of 10 dynamic squats without vibration; 5 sets of 30 second static squat without vibration; 5 sets of 10 dynamic squats with 30 Hz WBV for a total of 2.5 minutes; and 5 sets of 30 second static squats with 30 HZ WBV for a total of 2.5 minutes.

The results of this interesting study showed that after exercise on a non-vibrating platform, strength was significantly decreased, whereas after performing squats on the vibrating platform, strength actually increased significantly (p = .003)

This strength gain was not observed after the isometric or static squat exercise on the vibration platform, presumably because the lack of change in muscle length meant very little stretch reflex activation.

Comments: This was the first study to compare two different types of exercise (static versus dynamic) under two different conditions (vibration or none) for effects following a single bout of exercise. Researchers were unable to say why the strength improved after the single bout of dynamic squats when usually neuromuscular responses take 1 to 4 weeks to occur. They theorize that the stretch reflex activation led to increased muscle recruitment such that a supramaximal level of strength was provoked.

1.1 Effect of Whole-Body-Vibration Training on Trunk-Muscle Strength and Physical Performance in Healthy Adults: Preliminary Results of a Randomized Controlled Trial

Journal: Journal of Sports Rehabilitation, 2016, 25: 357-363

Study Context: The purpose of this randomized cross-over study was to investigate the effects of a 4-min long, 2-mm vertically-vibrating vibration-exercise on muscle performance and body balance in healthy subjects. Sixteen volunteers (eight men and women aged 18-35 years) underwent both the 4-min vibration- and sham-interventions in a randomized order on different days. Performance- and balance-tests (stability platform, grip strength, extension strength of lower extremities, tandem-walk, vertical jump and shuttle-run) were done 10 minutes before (baseline) and 2 and 60 minutes after the intervention.

Results: Both groups improved their trunk muscle strength and balance scores but the group that combined exercise with vibration more effectively improved than the group who exercised without vibration. Vertical jump was not improved during this study

Comments: This study used 6 exercises (side plank left and right, plank, sit up, sit up plus twist left and right – each position was held for 30 seconds with a 30 second rest interval. Thus there was only 3 minutes of exercise performed in each session and the authors noted that the lack of positive outcome in vertical jump could well have to do with the very low intensity of this exercise protocol. . The intensity of the vibration platform was set to 30Hz with 1.6 g force (4 mm peak). In the Vibes Fitness studios this is a low intensity setting