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The effects of whole body vibration on humans: dangerous or advantageous?

Cardinale M, Pope MH.

Department of Biomedical Sciences, University of Aberdeen, Scotland, UK. m.cardinale@abdn.ac.uk

The effects of whole body vibration (WBV) have been studied extensively in occupational medicine. In particular, it has been shown that when the body undergoes chronically to whole body vibrations spinal degeneration is likely to be one of the deleterious outcomes. Low back pain has been shown to be the leading major cause of industrial disability in the population under the age of 45 years and has been linked to whole body vibration exposure encountered in some industrial settings. Whole body vibration has been recently purposed as an exercise intervention suggesting its effectiveness in increasing force-generating capacity in lower limbs and low back. It has also been reported to be an effective non-pharmacological intervention for patients with low back pain. Relatively short exposure to whole body vibration has been also shown to increase the serum levels of testosterone and growth hormone. The combined effects on the neuromuscular system and endocrine system seem to suggest its effectiveness as a therapeutic approach for sarcopenia and possibly osteoporosis. Due to the danger of long-term exposure to whole body vibration, it is important to develop safe exercise protocols in order to determine exercise programs for different populations.

Cardinale M. & Pope M.H. (2003). The effects of whole body vibration on humans: dangerous or advantageous? Acta Physiologica Hungarica. 90(3). 195-206.

Effect of whole-body vibration exercise on lumbar bone mineral density, bone turnover, and chronic back pain in post-menopausal osteoporotic women treated with alendronate.

Iwamoto J, Takeda T, Sato Y, Uzawa M.

Department of Sports Medicine, Keio University School of Medicine, Tokyo, Japan. jiwamoto@sc.itc.keio.ac.jp

BACKGROUND AND AIMS: Exercise may enhance the effect of alendronate on bone mineral density (BMD) and reduce chronic back pain in elderly women with osteoporosis. The aim of this study was to determine whether whole-body vibration exercise would enhance the effect of alendronate on lumbar BMD and bone turnover, and reduce chronic back pain in postmenopausal women with osteoporosis. METHODS: Fifty post-menopausal women with osteoporosis, 55-88 years of age, were randomly divided into two groups of 25 patients each: one taking alendronate (5 mg daily, ALN) and one taking alendronate plus exercise (ALN+EX). Exercise consisted of whole-body vibration using a Galileo machine (Novotec, Pforzheim, Germany), at an intensity of 20 Hz, frequency once a week, and duration of exercise 4 minutes. The study lasted 12 months. Lumbar BMD was measured by dual energy X-ray absorptiometry (Hologic QDR 1500W). Urinary cross-linked N-terminal telopeptides of type I collagen (NTX) and serum alkaline phosphatase (ALP) levels were measured by enzyme-linked immunosorbent assay and standard laboratory techniques, respectively. Chronic back pain was evaluated by face scale score at baseline and every 6 months. RESULTS: There were no significant differences in baseline characteristics, including age, body mass index, years since menopause, lumbar BMD, urinary NTX and serum ALP levels, or face scale score between the two groups. The increase in lumbar BMD and the reduction in urinary NTX and serum ALP levels were similar in the ALN and ALN+EX groups. However, the reduction in chronic back pain was greater in the ALN+EX group than in the ALN group. CONCLUSIONS: The results of this study suggest that whole-body vibration exercise using a Galileo machine appears to be useful in reducing chronic back pain, probably by relaxing the back muscles in post-menopausal osteoporotic women treated with alendronate.

Iwamoto J., Takeda T., Sato Y. & Uzawa M. (2005). Effect of whole-body vibration exercise on lumbar bone mineral density, bone turnover, and chronic back pain in post-menopausal osteoporotic women treated with alendronate. Aging Clinical and Experimental Research. 17(2). 157-163.

Modeling the mechanical consequences of vibratory loading in the vertebral body: microscale effects.

Dickerson DA, Sander EA, Nauman EA.

Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA.

Osteoporosis affects nearly 10 million individuals in the United States. Conventional treatments include anti-resorptive drug therapies, but recently, it has been demonstrated that delivering a low magnitude, dynamic stimulus via whole body vibration can have an osteogenic effect without the need for large magnitude strain stimulus. Vibration of the vertebral body induces a range of stimuli that may account for the anabolic response including low magnitude strains, interfacial shear stress due to marrow movement, and blood transport. In order to evaluate the relative importance of these stimuli, we integrated a microstructural model of vertebral cancellous bone with a mixture theory model of the vertebral body. The predicted shear stresses on the surfaces of the trabeculae during vibratory loading are in the range of values considered to be stimulatory and increase with increasing solid volume fraction. Peak volumetric blood flow rates also varied with strain amplitude and frequency, but exhibited little dependence on solid volume fraction. These results suggest that fluid shear stress governs the response of the vertebrae to whole body vibration and that the marrow viscosity is a critical parameter which modulates the shear stress.

Dickerson D.A., Sander E.A. & Nauman E.A. (2008). Modeling the mechanical consequences of vibratory loading in the vertebral body: microscale effects. Biomechanics and Modeling in Mechanobiology. 7(3). 191-202.

Influence of vibration on delayed onset of muscle soreness following eccentric exercise.

Bakhitiary AH, Safavi-Farokhi Z, Aminian-Far A.

Physiotherapy Department, Rehabilitation Faculty, Semnan University of Medical Sciences, Km 5 Road to Damghan, Semnan, Iran. amir822@yahoo.com

Delayed onset muscle soreness (DOMS), which may occur after eccentric exercise, may cause some reduction in ability in sport activities. For this reason, several studies have been designed on preventing and controlling DOMS. As vibration training (VT) may improve muscle performance, we designed this study to investigate the effect of VT on controlling and preventing DOMS after eccentric exercise. METHODS: Fifty healthy non-athletic volunteers were assigned randomly into two experimental, VT (n = 25) and non-VT (n = 25) groups. A vibrator was used to apply 50 Hz vibration on the left and right quadriceps, hamstring and calf muscles for 1 min in the VT group, while no vibration was applied in the non-VT group. Then, both groups walked downhill on a 10 degrees declined treadmill at a speed of 4 km/hour. The measurements included the isometric maximum voluntary contraction force (IMVC) of left and right quadriceps muscles, pressure pain threshold (PPT) 5, 10 and 15 cm above the patella and mid-line of the calf muscles of both lower limbs before and the day after treadmill walking. After 24 hours, the serum levels of creatine-kinase (CK), and DOMS level by visual analogue scale were measured. RESULTS: The results showed decreased IMVC force (P = 0.006), reduced PPT (P = 0.0001) and significantly increased mean of DOMS and CK levels in the non-VT group, compared to the VT group (P = 0.001). CONCLUSION: A comparison by experimental groups indicates that VT before eccentric exercise may prevent and control DOMS. Further studies should be undertaken to ascertain the stability and effectiveness of VT in athletics.

Bakhitiary A.H., Safavi-Farokhi Z. & Aminian-Far A. (2007). Influence of vibration on delayed onset of muscle soreness following eccentric exercise. British Journal of Sports Medicine. 41(3). 145-148.

A comparative study of whole body vibration training and conventional training on knee proprioception and postural stability after anterior cruciate ligament reconstruction.

Moezy A, Olavaei G, Hadian M, Razi M, Faghihzadeh S.

School of Rehabilitation, Medical Sciences/Tehran University, Tehran, Iran.

OBJECTIVE: To compare the effect of a whole body vibration training (WBVT) programme with a conventional training (CT) programme on knee proprioception and postural stability after anterior cruciate ligament (ACL) reconstruction. METHODS: Twenty athletes with unilateral ACL reconstruction were randomly assigned to the WBVT or CT group; all participants received 12 sessions of WBVT or conventional training. Absolute error in joint repositioning for two target angles (30 degrees and 60 degrees ) was measured with the Biodex dynamometer; bilateral dynamic postural stability (anteroposterior, mediolateral and overall stability indices) was measured with the Biodex Stability System pre-intervention and post-intervention. RESULTS: The improvement in postural stability in the WBVT group was significantly greater than that in the CT group (p< or =0.05). The p values of the changing scores of open overall, open anteroposterior, open mediolateral, closed overall, closed anteroposterior and closed mediolateral stability indices were 0.002, 0.010, 0.0001, 0.001, 0.0001 and 0.046, respectively. In addition, there were significant differences in all averages of absolute angular error at 60 degrees and 30 degrees between the WBVT and CT groups in both knees (p = 0.001 in healthy knees and p = 0.001 and p = 0.0001 in reconstructed knees), apart from the healthy knees at the 30 degrees target position, which was not significant (p = 0.131). CONCLUSIONS: Whole body vibration training improved proprioception and balance in athletes with reconstructed ACL.

Moezy A., Olavaei G., Hadian M., Razi M. & Faghihzadeh S. (2008). A comparative study of whole body vibration training and conventional training on knee proprioception and postural stability after anterior cruciate ligament reconstruction. British Journal of Sports Medicine. 42(5). 373-378.

Effects of whole-body vibration in patients with multiple sclerosis: a pilot study.

Schufried O., Mittermaier C., Jovanovic T., Pieber K., Paternostro-Sluga T.

Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Austria. othmar.schuhfried@medunsen.ac.at

OBJECTIVE: To examine whether a whole-body vibration (mechanical oscillations) in comparison to a placebo administration leads to better postural control, mobility and balance in patients with multiple sclerosis. DESIGN: Double-blind, randomized controlled trial. SETTING: Outpatient clinic of a university department of physical medicine and rehabilitation. SUBJECTS: Twelve multiple sclerosis patients with moderate disability (Kurtzke's Expanded Disability Status Scale 2.5-5) were allocated either to the intervention group or to the placebo group. INTERVENTIONS: In the intervention group a whole-body vibration at low frequency (2.0-4.4 Hz oscillations at 3-mm amplitude) in five series of 1 min each with a 1-min break between the series was applied. In the placebo group a Burst-transcutaneous electrical nerve stimulation (TENS) application on the nondominant forearm in five series of 1 min each with a 1-min break between the series was applied as well. MAIN OUTCOME MEASURES: Posturographic assessment using the Sensory Organization Test, the Timed Get Up and Go Test and the Functional Reach Test immediately preceding the application, 15 min, one week and two weeks after the application. The statistical analysis was applied to the change score from preapplication values to values 15 min, one week and two weeks post intervention. RESULTS: Compared with the placebo group the intervention group showed advantages in terms of the Sensory Organization Test and the Timed Get Up and Go Test at each time point of measurement after the application. The effects were strongest one week after the intervention, where significant differences for the change score (p = 0.041) were found for the Timed Get Up and Go Test with the mean score reducing from 9.2 s (preapplication) to 8.2 s one week after whole-body vibration and increasing from 9.5 s (preapplication) to 10.2 s one week after placebo application. The mean values of the posturographic assessment increased from 70.5 points (preapplication) to 77.5 points one week after whole body vibration and increased only from 67.2 points (preapplication) to 67.5 points one week after the placebo application. No differences were found for the Functional Reach Test. CONCLUSION: The results of this pilot study indicated that whole-body vibration may positively influence the postural control and mobility in multiple sclerosis patients.

Schuhfried O., Mittermaier C., Jovanovic T., Pieber K. & Paternostro-Sluga T. (2005). Effects of whole-body vibration in patients with multiple sclerosis:a pilot study. Clinical Rehabilitation. 19(8). 834-842.

Results of a prospective pilot trial on mobility after whole body vibration in children and adolescents with osteogenesis imperfecta.

Semler O, Fricke O, Vezyroglou K, Stark C, Stabrey A, Schoenau E.

Children's Hospital, University of Cologne, Cologne, Germany.

OBJECTIVE: To evaluate the effect of whole body vibration on the mobility of long-term immobilized children and adolescents with a severe form of osteogenesis imperfecta. Osteogenesis imperfecta is a hereditary primary bone disorder with a prevalence from 1 in 10000 to 1 in 20000 births. Most of these children are suffering from long-term immobilization after recurrent fractures. Due to the immobilization they are affected by loss of muscle (sarcopenia) and secondary loss of bone mass. SUBJECTS: Whole body vibration was applied to eight children and adolescents (osteogenesis imperfecta type 3, N=5; osteogenesis imperfecta type 4, N=3) over a period of six months. INTERVENTIONS AND RESULTS: Whole body vibration was applied by a vibrating platform (Galileo Systems) constructed on a tilting-table. Success of treatment was assessed by measuring alterations of the tilting-angle and evaluating the mobility (Brief Assessment of Motor Function). All individuals were characterized by improved muscle force documented by an increased tilting-angle (median = 35 degrees) or by an increase in ground reaction force (median at start=30.0 [N/kg] (14.48-134.21); median after six months = 146.0 [N/kg] (42.46-245.25). CONCLUSIONS: Whole body vibration may be a promising approach to improve mobility in children and adolescents severely affected with osteogenesis imperfecta.

Semmler O., Fricke O., Vezyroglou K., Stark C., Stabrey A. & Schoenau E. (2008). Results of a prospective pilot trial on mobility after whole body vibration in children and adolescents with osteogenesis imperfecta. Clinical Rehabilitation. 22(5). 387-394.

One session of whole body vibration increases voluntary muscle strength transiently in patients with stroke.

Tihanyi TK, Horvath M, Fazekas G, Hortobagyi T, Tihanyi J.

Semmelweis University, and Department of Rehabilitation Medicine, Saint John Hospital Budapest, Hungary.

OBJECTIVE: To determine the effect of whole body vibration on isometric and eccentric torque and electromyography (EMG) variables of knee extensors on the affected side of stroke patients. DESIGN: A randomized controlled study. SETTING: A rehabilitation centre. SUBJECTS: Sixteen patients (age 58.2+/-9.4 years) were enrolled in an inpatient rehabilitation programme 27.2+/-10.4 days after a stroke. INTERVENTIONS: Eight patients were randomly assigned to the vibration group and received 20 Hz vibration (5 mm amplitude) while standing on a vibration platform for 1 minute six times in one session. Patients in the control group also stood on the platform but did not receive vibration. MAIN MEASURES: Maximum isometric and eccentric torque, rate of torque development, root-mean-squared EMG, median frequency of vastus lateralis, and co-activation of knee flexors. RESULTS: Isometric and eccentric knee extension torque increased 36.6% and 22.2%, respectively, after vibration (P<0.05) and 8.4% and 5.3% in the control group. Vibration increased EMG amplitude 44.9% and the median frequency in the vastus lateralis by 13.1% (all P<0.05) without changes in the control group (10.6% and 3.9%). Vibration improved the ability to generate mechanical work during eccentric contraction (17.5%). Vibration reduced biceps femoris co-activation during isometric (8.4%, ns) and eccentric (22.5%, P<0.05) contraction. CONCLUSION: These results suggest that one bout of whole body vibration can transiently increase voluntary force and muscle activation of the quadriceps muscle affected by a stroke.

Tihanyi T.K., Horvath M., Fazekas G., Hortobagyi T. & Tihanyi J. (2007). One session of whole body vibration increases voluntary muscle strength transiently in patients with stroke. Clinical Rehabilitation. 21(9). 782-793.

Submaximal aerobic exercise with mechanical vibrations improves the functional status of patients with chronic fatigue syndrome.

Saggini R, Vecchiet J, Iezzi S, Racciatti D, Affaitati G, Bellomo RG, Pizzigallo E.

Physical Therapy Institute, Department of Medicine and Aging, G. D'Annunzio University, Chieti, Italy.

AIM: Chronic fatigue syndrome (CFS) is an illness characterised by disabling fatigue of uncertain aetiology and other nonspecific symptoms. Typically CFS patients complain of a severe fatigue made worse by exercise, with a consistent reduction of working activity. A physical deconditioning could explain CFS features as well as a neuromuscular dysfunction, of central or peripheric origin. METHODS: Ten CFS patients were enrolled in a protocol of a rehabilitative treatment over a six-month period: they underwent a submaximal and predominantly aerobic exercise with a reduced O2 consumption using a Galileo 2000 system that provides mechanical vibrations characterised by sinusoid vertical sollecitations. Before and after such treatment, all patients underwent a pressure pain thresholds profile, an evaluation of physical and psychosocial parameters using the visual analogue scale (VAS) of Scott-Huskisson, and a muscle performance analysis by the CIBEX 6000 dynamometer. RESULTS: After the six-month period of study there was an overall improvement of the above described parameters as compared to the basal determinations. CONCLUSION: We conclude that the rehabilitative exertion provides an useful treatment for CFS patients particularly to realize an effective training of the explosive strength.

Saggini R., Vecchiet J., Iezzi S., Racciatti D., Affaitati G., Bellomo R.G. & Pizzigallo E. (2006). Submaximal aerobic exercise with mechanical vibrations improves the functional status of patients with chronic fatigue syndrome. Europa Medocophysica. 42(2). 97-102.

Human skeletal muscle structure and function preserved by vibration muscle exercise following 55 days of bed rest.

Blottner D, Salanova M, Puttmann B, Schiffl G, Felsenberg D, Buehring B, Rittweger J.

Department of Vegetative Anatomy, Center of Space Medicine Berlin, Neuromuscular Group, Charité University Medicine Berlin, Campus Benjamin Franklin, Arnimallee 22, 14195, Berlin, Germany. dieter.blottner@charite.de

Prolonged immobilization of the human body results in functional impairments and musculoskeletal system deconditioning that may be attenuated by adequate muscle exercise. In a 56-day horizontal bed rest campaign involving voluntary males we investigated the effects of vibration muscle exercise (RVE, 2x6 min daily) on the lower limb skeletal muscles using a newly designed foot plantar trainer (Galileo Space) for use at supine position during bed rest. The maximally voluntary isometric plantar flexion force was maintained following regular RVE bouts during bed rest (controls -18.6 %, P<0.05). At the start (BR2) and end of bed rest (BR55) muscle biopsies were taken from both mixed fast/slow-type vastus lateralis (VL) and mainly slow-type soleus muscle (SOL), each having n=10. RVE group: the size of myofiber types I and II was largely unchanged in VL, and increased in SOL. Ctrl group: the SOL depicted a disrupted pattern of myofibers I/II profiles (i.e., type II>140 % vs. preBR) suggesting a slow-to-fast muscle phenotype shift. In RVE-trained SOL, however, an overall conserved myofiber I/II pattern was documented. RVE training increased the activity-dependent expression of nitric oxide synthase type 1 immunofluorescence at SOL and VL myofiber membranes. These data provide evidence for the beneficial effects of RVE training on the deconditioned structure and function of the lower limb skeletal muscle. Daily short RVE should be employed as an effective atrophy countermeasure co-protocol preferentially addressing postural calf muscles during prolonged clinical immobilization or long-term human space missions.

Blottner D., Salanova M., Puttmann B., Schiffl G., Felsenberg D., Buehring B. & Rittweger J. (2006). Human skeletal muscle structure and function preserved by vibration muscle exercise following 55 days of bed rest. European Journal of Applied Physiology. 97(3). 261-271.

Strength, size and activation of knee extensors followed during 8 weeks of horizontal bed rest and the influence of a countermeasure.

Mulder ER, Stegeman DF, Gerrits KH, Paalman MI, Rittweger J, Felsenberg D, de Haan A.

Institute for Fundamental and Clinical Human Movement Sciences, Amsterdam, The Netherlands. e.mulder@neuro.umcn.nl

Changes in the quadriceps femoris muscle with respect to anatomical cross sectional area (CSA), neural activation level and muscle strength were determined in 18 healthy men subjected to 8 weeks of horizontal bed rest (BR) with (n = 9) and without (n = 9) resistive vibration exercise (RVE). CSA of the knee extensor muscle group was measured with magnetic resonance imaging every 2 weeks during bed rest. In the control subjects (Ctrl), quadriceps femoris CSA decreased linearly over the 8 weeks of bed rest to -14.1 +/- 5.2% (P < 0.05). This reduction was significantly (P < 0.001) mitigated by the exercise paradigm (-3.5 +/- 4.2%; P < 0.05). Prior to and seven times during bed rest, maximal unilateral voluntary torque (MVT) values of the right leg were measured together with neural activation levels by means of a superimposed stimulation technique. For Ctrl, MVT decreased also linearly over time to -16.8 +/- 7.4% after 8 weeks of bed rest (P < 0.01), whereas the exercise paradigm fully maintained MVT during bed rest. In contrast to previous reports, the maximal voluntary activation remained unaltered for both groups throughout the study. For Ctrl, the absence of deterioration of the activation level might have been related to the repeated testing of muscle function during the bed rest. This notion was supported by the observation that for a subset of Ctrl subjects (n = 5) the MVT of the left leg, which was not tested during BR, was reduced by 20.5 +/- 10.1%, (P < 0.01) which was for those five subjects significantly (P < 0.05) more than the 11.1 +/- 9.2% (P < 0.01) reduction for the right, regularly tested leg.

Mulder E.R., Stegeman D.F., Gerrits K.H., Paalman M.I., Rittweger J., Felsenberg D. & de Haan D. (2006). Strength, size and activation of knee extensors followed during 8 weeks of horizontal bed rest and the influence of a countermeasure. European Journal of Applied Physiology. 97(6) 706-715.

Use of vibration exercise in spinal cord injury patients who regularly practise sport.

Melchiorri G, Andreoli A, Padua E, Sorge R, De Lorenzo A.

Degree Course in Sports Sciences, Faculty of Medicine, University of Rome Tor Vergata, Italy. giovannimelchiorri@virgilio.it

The aim of this study was to evaluate the applicability and effects of mechanical vibration on body composition and mechanical properties of the arm in patients with spinal cord injury (SCI). For this purpose, ten volunteers with thoracic SCI were recruited. Measurements were performed before and after a period of treatment with mechanical vibration applied during forearm flexion in isometric condition. The subjects were tested performing forearm flexion (both right and left side) with increasing loads, corresponding to 5, 8, 10 and 15% of their own body weight. Average velocity (AV), average force (AF) and average power (AP) were calculated. The Functional Independence Measure was used to evaluate daily autonomy at baseline. Total body and segmental (arms) body composition, fat mass, fat-free mass, and bone mineral density, were studied by dual energy X-ray absorptiometry. Functional measurements (AV, AF, AP) and body composition were measured at three time points: after a medical examination and interview (T0); after an interval of 12 weeks without physical therapy or training (T1); and finally after a further 12-week period during which the patients performed segmental vibration exercise (T2). The results showed statistically significant increases in AV and AP on the right (dominant) side (p<0.05); AF also increased, but without the difference reaching statistical significance. Total body composition, did not change whereas the bone mineral density of the arms was higher after treatment, but again without the difference reaching statistical significance.

Melchiorri G., Andreoli A., Padua E., Sorge R. & De Lorenzo A. (2008). Use of vibration exercise in spinal cord injury patients who regularly practise sport. Functional Neurology. 22(3). 151-154.

Whole body vibration and dynamic restraint.

Hopkins T, Pak JO, Robertshaw AE, Feland JB, Hunter I, Gage M.

Human Performance Research Center, Brigham Young University, Provo, Utah, USA. ty_hopkins@byu.edu

The purpose of this study was to identify changes due to whole body vibration in peroneus longus (PL) activation following ankle inversion perturbation. Participants were 22 (age 22.1 +/- 1.8 yrs, ht 168.8 +/- 8.2 cm, mass 65.5 +/- 11.2 kg) physically active male and female students with no recent history of lower extremity injury. Measurements of PL electromechanical delay (EMD), reaction time, and muscle activation were collected from two groups (WBV and control) over 3 time intervals (pretreatment, posttreatment, and 30 min posttreatment). Two-way ANOVAs were used to compare groups over time for all dependent variables. No group x time interactions were detected (p < 0.05) for any of the dependent variables. Whole body vibration did not alter PL EMD, reaction time, peak EMG, or average EMG. The use of WBV for enhancing ankle dynamic stability was not supported by this study. However, more data are needed to determine if WBV is an effective intervention in other areas of injury prevention or rehabilitation. These data were not consistent with the hypothesis that WBV enhances muscle spindle sensitivity.

Hopkins T., Pak J.O., Robertshaw A.E., Feland J.B., Hunter I. & Gage M. (2008). Whole body vibration and dynamic restraint. International Journal of Sports Medicine. 29(5). 424-428.

Effect of a Whole-Body Vibration Session on Knee Stability.

Melnyk M, Kofler B, Faist M, Hodapp M, Gollhofer A.

Department of Sport and Sports Science, University of Freiburg, Freiburg, Germany.

The aim of the study was to investigate the effect of WBV on stretch reflexes involved in knee joint control. We evoked stretch reflexes of the hamstring muscles by inducing an anterior tibial translation during standing in 23 healthy subjects which were divided into a control and an intervention group. WBV with a frequency of 30 Hz and a vertical amplitude of 4 mm was induced by an uniformly oscillating platform. The WBV session lasted 60 seconds and was repeated twice. Short (SLR) and medium latency responses (MLR) of the hamstring muscles and maximum tibia translation were assessed using surface EMG and linear potentiometers. While there were no significant changes in latency, the size of the lateral and medial hamstring SLR was significantly increased after WBV (p = 0.039 and p = 0.043, respectively). No significant differences were found for the hamstring MLR size after WBV. Maximum tibial translation was significantly decreased after WBV (p = 0.031). Our results suggest that single WBV exposure has a positive effect on knee joint stability as a short-term adaptation on neuromuscular level. This appears to be directly associated with an increase of hamstring SLR size in response to the anterior tibial movement which may cause the decrease in anterior tibial translation.

Melnyk M., Kofler B., Faist M., Hodapp M. & Gollhofer A. (2008). Effect of a whole-body vibration session on knee stability. International Journal of Sports Medicine. [Epub ahead of print].

Highly demanding resistive vibration exercise program is tolerated during 56 days of strict bed-rest.

Rittweger J, Belavy D, Hunek P, Gast U, Boerst H, Feilcke B, Armbrecht G, Mulder E, Schubert H, Richardson C, de Haan A, Stegeman DF, Schiessl H, Felsenberg D.

Centre for Muscle and Bone Research, Charité-Campus Benjamin Franklin, Berlin, Germany. j.rittweger@mmu.ac.uk

Several studies have tried to find countermeasures against musculoskeletal de-conditioning during bed-rest, but none of them yielded decisive results. We hypothesised that resistive vibration exercise (RVE) might be a suitable training modality. We have therefore carried out a bed-rest study to evaluate its feasibility and efficacy during 56 days of bed-rest. Twenty healthy male volunteers aged 24 to 43 years were recruited and, after medical check-ups, randomised to a non-exercising control (Ctrl) group or a group that performed RVE 11 times per week. Strict bed-rest was controlled by video surveillance. The diet was controlled. RVE was performed in supine position, with a static force component of about twice the body weight and a smaller dynamic force component. RVE comprised four different units (squats, heel raises, toe raises, kicks), each of which lasted 60 - 100 seconds. Pre and post exercise levels of lactate were measured once weekly. Body weight was measured daily on a bed scale. Pain questionnaires were obtained in regular intervals during and after the bed-rest. Vibration frequency was set to 19 Hz at the beginning and progressed to 25.9 Hz (SD 1.9) at the end of the study, suggesting that the dynamic force component increased by 90 %. The maximum sustainable exercise time for squat exercise increased from 86 s (SD 21) on day 11 of the BR to 176 s (SD 73) on day 53 (p = 0.006). On the same days, post-exercise lactate levels increased from 6.9 mmol/l (SD2.3) to 9.2 mmol/l (SD 3.5, p = 0.01). On average, body weight was unchanged in both groups during bed-rest, but single individuals in both groups depicted significant weight changes ranging from - 10 % to + 10 % (p < 0.001). Lower limb pain was more frequent during bed-rest in the RVE subjects than in Ctrl (p = 0.035). During early recovery, subjects of both groups suffered from muscle pain to a comparable extent, but foot pain was more common in Ctrl than in RVE (p = 0.013 for plantar pain, p = 0.074 for dorsal foot pain). Our results indicate that RVE is feasible twice daily during bed-rest in young healthy males, provided that one afternoon and one entire day per week are free. Exercise progression, mainly by progression of vibration frequency, yielded increases in maximum sustainable exercise time and blood lactate. In conclusion, RVE as performed in this study, appears to be safe.

Rittweger J., Belavy D., Hunek P., Gast U., Boerst H., Feilcke B., Armbrecht G., Mulder E., Schubert H., Richardson C., de Haan A., Stegeman D.F., Schiessl H. & Felsenberg D. (2006). Highly demanding resistive vibration exercise program is tolerated during 56 days of strict bed-rest. International Journal of Sports Medicine. 27(7). 553-559.

High-density surface EMG study on the time course of central nervous and peripheral neuromuscular changes during 8weeks of bed rest with or without resistive vibration exercise.

Mulder ER, Gerrits KH, Kleine BU, Rittweger J, Felsenberg D, de Haan A, Stegeman DF.

Institute for Fundamental and Clinical Human Movement Sciences, The Netherlands; Department of Clinical Neurophysiology, Institute of Neurology, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500HB, Nijmegen, The Netherlands; Vrije Universiteit, Faculty of Human Movement Sciences, Amsterdam, The Netherlands.

The aim of the present study was to assess the time course and the origin of adaptations in neuromuscular function as a consequence of prolonged bed rest with or without countermeasure. Twenty healthy males volunteered to participate in the present study and were randomly assigned to either an inactive control group (Ctrl) or to a resistive vibration exercise (RVE) group. Prior to, and seven times during bed rest, we recorded high-density surface electromyogram (sEMG) signals from the vastus lateralis muscle during isometric knee extension exercise at a range of contraction intensities (5-100% of maximal voluntary isometric torque). The high-density sEMG signals were analyzed for amplitude (root mean square, RMS), frequency content (median frequency, F(med)) and muscle fiber conduction velocity (MFCV) in an attempt to describe bed rest-induced changes in neural activation properties at the levels of the motor control and muscle fibers. Without countermeasures, bed rest resulted in a significant progressive decline in maximal isometric knee extension strength, whereas RMS remained unaltered throughout the bed rest period. In line with observed muscle atrophy, both F(med) and MFCV declined during bed rest. RVE training during bed rest resulted in maintained maximal isometric knee extension strength, and a strong increase ( approximately 30%) in maximal EMG amplitude, from 10days of bed rest on. Exclusion of other factors led to the conclusion that the RVE training increased motor unit firing rates as a consequence of an increased excitability of motor neurons. An increased firing rate might have been essential under training sessions, but it did not affect isometric voluntary torque capacity.

Mulder E.R., Gerrits K.H., Kleine B.U., Rittweger J., Felsenberg D., de Haan A. & Stegeman D.F. (2007). High-density surface emg study on time course of central nervous and peripheral neuromuscular changes during 8 weeks of bed rest with or without resistave vibration exercise. Journal of Electromyography and Kinesiology. [Epub ahead of print].

Whole-body vibration training compared with resistance training: effect on spasticity, muscle strength and motor performance in adults with cerebral palsy.

Ahlborg L, Andersson C, Julin P.

Department of Rehabilitation Medicine Stockholm, Danderyd University Hospital, Stockholm, Sweden. lotta.ahlborg@ds.se

OBJECTIVE: The aim of this study was to evaluate the effect on spasticity, muscle strength and motor performance after 8 weeks of whole-body vibration training compared with resistance training in adults with cerebral palsy. METHODS: Fourteen persons with spastic diplegia (21-41 years) were randomized to intervention with either whole-body vibration training (n=7) or resistance training (n=7). Pre- and post-training measures of spasticity using the modified Ashworth scale, muscle strength using isokinetic dynamometry, walking ability using Six-Minute Walk Test, balance using Timed Up and Go test and gross motor performance using Gross Motor Function Measure were performed. RESULTS: Spasticity decreased in knee extensors in the whole-body vibration group. Muscle strength increased in the resistance training group at the velocity 30 degrees /s and in both groups at 90 degrees /s. Six-Minute Walk Test and Timed Up and Go test did not change significantly. Gross Motor Function Measure increased in the whole-body vibration group. CONCLUSION: These data suggest that an 8-week intervention of whole-body vibration training or resistance training can increase muscle strength, without negative effect on spasticity, in adults with cerebral palsy.

Ahlborg L., Andersson C., Julin P. (2006). Whole-body vibration training compared with resistance training: effect on spasticity, muscle strength and motor performance in adults with cerebral palsy. Journal of Rehabilitation Medicine. 38(5). 302-308.

The effects of random whole-body-vibration on motor symptoms in Parkinson's disease.

Haas CT, Turbanski S. Kessler K, Schmidtbleicher D.

Institute of Sport Sciences, Johann Wolfgang Goethe-University, Frankfurt, Germany. c.haas@sport.uni-frankfurt.de

It is well known that applying vibrations to men influences multiple physiological functions. The authors analysed post effects of whole-body-vibration (WBV) on motor symptoms in Parkinson's disease (PD). Sixty-eight persons with PD were randomly subdivided into one experimental and one control group. Motor symptoms were assessed by the UPDRS (Unified Parkinson's Disease Rating Scale) motor score. A cross-over design was used to control treatment effects. The treatment consisted of 5 series of whole-body-vibration taking 60 seconds each. On average a highly significant (p<0.01) improvement of 16.8% in the UPDRS motor score was found in the treatment group. Only marginal changes (p>0.05) were found in the control group. The cross-over procedure showed comparable treatment effects (14.7% improvement after treatment). With respect to different symptom clusters only small changes were found in limb akinesia and cranial symptoms. By contrast, tremor and rigidity scores were improved by 25% and 24%, respectively. According to the structure of symptom changes it is unlikely that these effects are explainable on peripheral sensory level, exclusively. With respect to the findings of other studies one can speculate about changes in activation of the supplementary motor area and in neurotransmitter functions.

Haas C.T., Turbanski S., Kessler K. & Schmidtbleicher D. (2006). The effects of random whole-body-vibration on motor symptoms in parkinson's disease. Neurorehabilitation. 21(1). 29-36.

Resistive simulated weightbearing exercise with whole body vibration reduces lumbar spine deconditioning in bed-rest.

Belavy DL, Hides JA, Wilson SJ, Stanton W, Dimeo FC, Rittweger J, Felsenberg J, Richardson CA.

Zentrum für Muskel- und Knochenforschung, Charité Campus Benjamin Franklin, Hindenburgdamm, Berlin, Germany. belavy@gmail.com

STUDY DESIGN: Randomized controlled trial. OBJECTIVE: Determine the effectiveness a resistive exercise countermeasure with whole-body vibration in relation to lumbo-pelvic muscle and spinal morphology changes during simulated spaceflight (bed-rest). SUMMARY OF BACKGROUND DATA: Spinal lengthening, flattening of the spinal curves, increases in disc size, and muscle atrophy are commonly seen in spaceflight simulation. This may represent a risk for low back injury. Consideration of exercise countermeasures against these changes is critical for success of long-term spaceflight missions. METHODS: Twenty healthy male subjects underwent 8-weeks of bed-rest with 6-months follow-up and were randomly allocated to an inactive control or countermeasure exercise group. Magnetic resonance imaging of the lumbo-pelvic region was conducted at regular time-points during and after bed-rest. Using uniplanar images at L4, cross-sectional areas of the multifidus, lumbar erector spinae, quadratus lumborum, psoas, anterolateral abdominal, and rectus abdominis muscles were measured. Sagittal scans were used to assess lumbar spine morphology (length, sagittal disc area and height, and intervertebral angles). RESULTS: The countermeasure group exhibited less multifidus muscle atrophy (P = 0.024) and its atrophy did not persist long-term as in the control group (up to 3-months; P < 0.006). Spinal lengthening (P = 0.03) and increases in disc area (P = 0.041) were also reduced. Significant partial correlations (P < 0.001) existed between spinal morphology and muscle cross-sectional area changes. CONCLUSION: The resistive vibration exercise countermeasure reduced, but did not entirely prevent, multifidus muscle atrophy and passive spinal tissue deconditioning during bed-rest. Atrophy of the multifidus muscles was persistent long-term in the inactive subjects. Future work could consider closer attention to spinal posture during exercise and optimizing exercise dose.

­Belavy D.L., Hides J.A., Wilson S.J., Stanton W., Dimeo F.C., Rittweger J., Felsenberg J. & Richardson C.A. (2008). Resistive simulated weightbearing exercise with whole body vibration reduces lumbar spine deconditioning in bed-rest. Spine. 1;33(5). 121-131.

Treatment of chronic lower back pain with lumbar extension and whole-body vibration exercise: a randomized controlled trial.

Rittweger J, Just K, Kautzsch K Reeg P, Felsenberg D.

Institut für Physiologie, Freie Universität Berlin, Berlin, Germany. ritmus@zedat.fu-berlin.de

STUDY DESIGN: A randomized controlled trial with a 6-month follow-up period was conducted. OBJECTIVE: To compare lumbar extension exercise and whole-body vibration exercise for chronic lower back pain. SUMMARY OF BACKGROUND DATA: Chronic lower back pain involves muscular as well as connective and neural systems. Different types of physiotherapy are applied for its treatment. Industrial vibration is regarded as a risk factor. Recently, vibration exercise has been developed as a new type of physiotherapy. It is thought to activate muscles via reflexes. METHODS: In this study, 60 patients with chronic lower back pain devoid of "specific" spine diseases, who had a mean age of 51.7 years and a pain history of 13.1 years, practiced either isodynamic lumbar extension or vibration exercise for 3 months. Outcome measures were lumbar extension torque, pain sensation (visual analog scale), and pain-related disability (pain disability index). RESULTS: A significant and comparable reduction in pain sensation and pain-related disability was observed in both groups. Lumbar extension torque increased significantly in the vibration exercise group (30.1 Nm/kg), but significantly more in the lumbar extension group (+59.2 Nm/kg; SEM 10.2; P < 0.05). No correlation was found between gain in lumbar torque and pain relief or pain-related disability (P > 0.2). CONCLUSIONS: The current data indicate that poor lumbar muscle force probably is not the exclusive cause of chronic lower back pain. Different types of exercise therapy tend to yield comparable results. Interestingly, well-controlled vibration may be the cure rather than the cause of lower back pain.

Rittweger J., Just K., Kautzsch K., Reeg P. & Felsenberg D. (2002). Treatment of chronic lower back pain with lumbar extension and whole-body vibration exercise: a randomized controlled trial. Spine. 1;27(17). 1829-1834.

Long-term effects of 6-week whole-body vibration on balance recovery and activities of daily living in the postacute phase of stroke: a randomized, controlled trial.

Van Nes IJ, Latour H, Schils F, Meijer R, van Kuijk A, Geurts AC.

Sint Maartenskliniek Research, Development & Education, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands. i.vannes@maartenskliniek.nl

BACKGROUND AND PURPOSE: The long-term effects of 6-weeks whole-body vibration, as a novel method of somatosensory stimulation, on postural control and activities of daily living were compared with those of 6 weeks of exercise therapy on music of the same intensity in the postacute phase of stroke. METHODS: Fifty-three patients with moderate to severe functional disabilities were randomized within 6 weeks poststroke and within 3 days after admission to a rehabilitation center to either whole-body vibration or exercise therapy on music in addition to a regular inpatient rehabilitation program. The whole-body vibration group received 4x45-second stimulation on the Galileo 900 (30-Hz frontal plane oscillations of 3-mm amplitude) for 5 days per week during 6 weeks. The exercise therapy on music group received the same amount of exercise therapy on music. Outcome variables included the Berg Balance Scale, Trunk Control Test, Rivermead Mobility Index, Barthel Index, Functional Ambulation Categories, Motricity Index, and somatosensory threshold at 0, 6, and 12 weeks follow up. RESULTS: At baseline, both groups were comparable in terms of prognostic factors and outcome measures. Both at 6 and 12 weeks follow up, no clinically relevant or statistical differences in outcome were observed between the groups. No side effects were reported. CONCLUSIONS: Daily sessions of whole-body vibration during 6 weeks are not more effective in terms of recovery of balance and activities of daily living than the same amount of exercise therapy on music in the postacute phase of stroke.

Van Nes I.J., Latour H., Schils F., Meijer R., van Kujik A. & Geurts A.C. (2006). Long-term effects of 6 week whole body vibration on balance recovery and activities of daily living in the postacute phase of stroke: a randomized, controlled trial. Stroke. 37(9). 2331-2335.

The effect of weight-bearing exercise with low frequency, whole body vibration on lumbosacral proprioception: a pilot study on normal subjects.

Fontana TL, Richardson CA, Stanton WR.

School of Health and Rehabilitation Science, The University of Queensland, St Lucia, QLD 4072, Australia.

Patients with low back pain (LBP) often present with impaired proprioception of the lumbopelvic region. For this reason, proprioception training usually forms part of the rehabilitation protocols. New exercise equipment that produces whole body, low frequency vibration (WBV) has been developed to improve muscle function, and reportedly improves proprioception. The aim of this pilot study was to investigate whether weightbearing exercise given in conjunction with WBV would affect lumbosacral position sense in healthy individuals. For this purpose, twenty-five young individuals with no LBP were assigned randomly to an experimental or control group. The experimental group received WBV for five minutes while holding a static, semi-squat position. The control group adopted the same weightbearing position for equal time but received no vibration. A two-dimensional motion analysis system measured the repositioning accuracy of pelvic tilting in standing. The experimental (WBV) group demonstrated a significant improvement in repositioning accuracy over time (mean 0.78 degrees) representing 39% improvement. It was concluded that WBV may induce improvements in lumbosacral repositioning accuracy when combined with a weightbearing exercise. Future studies with WBV should focus on evaluating its effects with different types of exercise, the exercise time needed for optimal outcomes, and the effects on proprioception deficits in LBP patients.

Fontana T.L., Richardson C.A. & Stanton W.R. (2005). The effect of weight-bearing exercise with low-frequency, whole body vibration on lumbosacral proprioception: a pilot study on normal subjects. The Australian Journal of Physiotherapy. 51(4). 259-263.

Will whole-body vibration training help increase the range of motion of the hamstrings?

van den Tillaar R.

Section for Human Movement Science, Faculty of Social and Technology Management, Norwegian University of Science and Technology, Trondheim. roland.tillaar@svt.ntnu.no

Muscle strain is one of the most common injuries, resulting in a decreased range of motion (ROM) in this group of muscles. Systematic stretching over a period of time is needed to increase the ROM. The purpose of this study was to determine if whole-body vibration (WBV) training would have a positive effect on flexibility training (contract-release method) and thereby on the ROM of the hamstring musculature. In this study, 19 undergraduate students in physical education (12 women and 7 men, age 21.5 +/- 2.0 years) served as subjects and were randomly assigned to either a WBV group or a control group. Both groups stretched systematically 3 times per week for 4 weeks according to the contract-release method, which consists of a 5-second isometric contraction with each leg 3 times followed by 30 seconds of static stretching. Before each stretching exercise, the WBV group completed a WBV program consisting of standing in a squat position on the vibration platform with the knees bent 90 degrees on the Nemes Bosco system vibration platform (30 seconds at 28 Hz, 10-mm amplitude, 6 times per training session). The results show that both groups had a significant increase in hamstring flexibility. However, the WBV group showed a significantly larger increase (30%) in ROM than did the control group (14%). These results indicate that WBV training may have an extra positive effect on flexibility of the hamstrings when combined with the contract-release stretching method.

van den Tillar R. (2006). Will whole-body vibration training help increase the range of motion of the hamstrings? Journal of Strength and Conditioning Research. 20(1). 192-196.

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