Bone Density, Muscle Performance and Balance

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. [email protected]

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.

Low-frequency vibratory exercise reduces the risk of bone fracture more than walking: a randomized controlled trial.

Gusi N, Raimundo A, Leal A.

Faculty of Sports Sciences, University of Extremadura, Cáceres, Spain. [email protected]

BACKGROUND: Whole-body vibration (WBV) is a new type of exercise that has been increasingly tested for the ability to prevent bone fractures and osteoporosis in frail people. There are two currently marketed vibrating plates: a) the whole plate oscillates up and down; b) reciprocating vertical displacements on the left and right side of a fulcrum, increasing the lateral accelerations. A few studies have shown recently the effectiveness of the up-and-down plate for increasing Bone Mineral Density (BMD) and balance; but the effectiveness of the reciprocating plate technique remains mainly unknown. The aim was to compare the effects of WBV using a reciprocating platform at frequencies lower than 20 Hz and a walking-based exercise programme on BMD and balance in post-menopausal women. METHODS: Twenty-eight physically untrained post-menopausal women were assigned at random to a WBV group or a Walking group. Both experimental programmes consisted of 3 sessions per week for 8 months. Each vibratory session included 6 bouts of 1 min (12.6 Hz in frequency and 3 cm in amplitude with 60 degrees of knee flexion) with 1 min rest between bouts. Each walking session was 55 minutes of walking and 5 minutes of stretching. Hip and lumbar BMD ( were measured using dual-energy X-ray absorptiometry and balance was assessed by the blind flamingo test. ANOVA for repeated measurements was adjusted by baseline data, weight and age. RESULTS: After 8 months, BMD at the femoral neck in the WBV group was increased by 4.3% (P = 0.011) compared to the Walking group. In contrast, the BMD at the lumbar spine was unaltered in both groups. Balance was improved in the WBV group (29%) but not in the Walking group. CONCLUSION: The 8-month course of vibratory exercise using a reciprocating plate is feasible and is more effective than walking to improve two major determinants of bone fractures: hip BMD and balance.

Gusi N, Raimundo A. & Leal A. (2006). Low-frequency vibratory exercise reduces the risk of bone fracture more than walking: a randomized controlled trial. BMC Musculoskeletal Disorders. 30;7-92.

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.

Low-level, high-frequency mechanical signals enhance musculoskeletal development of young women with low BMD.

Gilsanz V, Wren TA, Sanchez M, Dorey F, Judex S, Rubin C.

Department of Radiology, Childrens Hospital of Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California 90027, USA. [email protected]

The potential for brief periods of low-magnitude, high-frequency mechanical signals to enhance the musculoskeletal system was evaluated in young women with low BMD. Twelve months of this noninvasive signal, induced as whole body vibration for at least 2 minutes each day, increased bone and muscle mass in the axial skeleton and lower extremities compared with controls. INTRODUCTION: The incidence of osteoporosis, a disease that manifests in the elderly, may be reduced by increasing peak bone mass in the young. Preliminary data indicate that extremely low-level mechanical signals are anabolic to bone tissue, and their ability to enhance bone and muscle mass in young women was investigated in this study. MATERIALS AND METHODS: A 12-month trial was conducted in 48 young women (15-20 years) with low BMD and a history of at least one skeletal fracture. One half of the subjects underwent brief (10 minutes requested), daily, low-level whole body vibration (30 Hz, 0.3g); the remaining women served as controls. Quantitative CT performed at baseline and at the end of study was used to establish changes in muscle and bone mass in the weight-bearing skeleton. RESULTS: Using an intention-to-treat (ITT) analysis, cancellous bone in the lumbar vertebrae and cortical bone in the femoral midshaft of the experimental group increased by 2.1% (p = 0.025) and 3.4% (p < 0.001), respectively, compared with 0.1% (p = 0.74) and 1.1% (p = 0.14), in controls. Increases in cancellous and cortical bone were 2.0% (p = 0.06) and 2.3% (p = 0.04) greater, respectively, in the experimental group compared with controls. Cross-sectional area of paraspinous musculature was 4.9% greater (p = 0.002) in the experimental group versus controls. When a per protocol analysis was considered, gains in both muscle and bone were strongly correlated to a threshold in compliance, where the benefit of the mechanical intervention compared with controls was realized once subjects used the device for at least 2 minute/day (n = 18), as reflected by a 3.9% increase in cancellous bone of the spine (p = 0.007), 2.9% increase in cortical bone of the femur (p = 0.009), and 7.2% increase in musculature of the spine (p = 0.001) compared with controls and low compliers (n = 30). CONCLUSIONS: Short bouts of extremely low-level mechanical signals, several orders of magnitude below that associated with vigorous exercise, increased bone and muscle mass in the weight-bearing skeleton of young adult females with low BMD. Should these musculoskeletal enhancements be preserved through adulthood, this intervention may prove to be a deterrent to osteoporosis in the elderly.

Gilsanz V., Wren T.A., Sanchez M., Dorey F., Judex S. & Rubin C. (2006). Low-level, high frequency mechanical signals enhance musculoskeletal development of young women with low bmd. Journal of Bone and Mineral Research. 21(9). 1464-1474.

Balance training and exercise in geriatric patients.

Runge M, Rehfeld G, Resnicek E.

Aerpah-Klinik Esslingen, Germany. [email protected]

Objective measures of gait and balance which meet the criteria of reliability and validity are required as a basis for exercise regimens. We established reference values of clinically relevant locomotor and balance performances for geriatric patients. We are using these data for evaluating the effects of different therapeutic approaches to locomotor and balance disorders. Reference values for chair rising. We administered a battery of five tests concerning neuromuscular function, locomotion and balance to a sample of 212 participants without apparent locomotor deficits (139 women, 73 men, mean age 70,5 years, SD 6,78 , median 70 years, range 60 to 90 years, recruited by public announcements). The test battery comprised the 'chair rising test' for measuring lower extremity neuromuscular function (five repetitions of rising from a chair as quickly as possible with arms crossed over the chest). The test has been proven reliable, valid, sensible and predictive for falls and future locomotor status and ADL-status. Chair rising [sec/5x], Range: 5.4-19.4, Mean: 9.1 (women:9.2, men:9.0), SD: 1.97, Median: 8.9. Training of balance and muscle power with Galileo 2000 - preliminary results. Galileo is a device for whole body vibration/oscillatory muscle stimulation. The subject stands with bended knees and hips on a rocking platform with a sagittal axle, which thrusts alternatively the right and left leg 7-14 mm upwards with a frequency of 27 Hz, thereby lengthening the extensor muscles of the lower extremities. The reflexive reaction of the neuromuscular system is a chain of rapid muscle contractions. We conducted a randomized controlled trial, n=34 (age: mean 67y, range 61-85, 11 female), cross-over design, intervention group 2 months training program three times a week (each session 3x2 minutes), performance tests of all participants every two weeks). The first 19 subjects have finished the intervention period. They reached mean performance gains in chair rising of 18%, strikingly different to the constant values of the controls. We interpret the findings as improvements in muscle power by the oscillative muscle stimulation.

Runge M., Rehfeld G. & Resnicek E. (2000). Balannce training and exercise in geriatric patients. Journal of Musculoskeletal and Neuronal Interactions. 1(1). 61-65.

Transmission of Vertical Whole Body Vibration to the Human Body.

Kiiski J, Heinonen A, Jarvinen T, Kannus P, Sievanen H.

According to experimental studies, low-amplitude high-frequency vibration is anabolic to bone tissue, whereas in clinical trials, the bone effects have varied. Given the potential of whole body vibration in bone training, this study aimed at exploring the transmission of vertical sinusoidal vibration to the human body over a wide range of applicable amplitudes (from 0.05 to 3 mm) and frequencies (from 10 to 90 Hz). Vibration-induced accelerations were assessed with skin-mounted triaxial accelerometers at the ankle, knee, hip and lumbar spine in four males standing on a high-performance vibration platform. Peak vertical accelerations of the platform covered a range from 0.04 to 19 in units of G (Earth's gravitational constant). Substantial amplification of peak acceleration could occur between 10-40 Hz for the ankle, 10-25 Hz for the knee, 10-20 Hz for the hip, and at 10 Hz for the spine. Beyond these frequencies, the transmitted vibration power declined to 1/10th-1/1000th of the power delivered by the platform. Transmission of vibration to the body is a complicated phenomenon due to nonlinearities in the human musculoskeletal system. Present results may assist in estimating how the transmission of vibration-induced accelerations to body segments is modified by amplitude and frequency, and how well the sinusoidal waveform is maintained. While the attenuation of vertical vibration at higher frequencies is fortunate from the aspect of safety, amplitudes above 0.5 mm may result in greater peak accelerations than imposed at the platform, and thus pose a potential hazard for fragile musculoskeletal system.

Kiiski J., Heinonen A., Jarvinen T., Kannus P. & Sievanen H. (2008). Transmission of vertical whole body vibration to the human body. Journal of Bone and Mineral Research. [Epub ahead of print].

Effect of 8-month vertical whole body vibration on bone, muscle performance, and body balance: a randomized controlled study.

Torvinen S, Kannnus P, Sievanen H, Jarvinen TA, Pasanen TA, Kontulainen S, Nenonen A, Jarvinen TL, Paakkala T, Jarvinen M, Vuori I.

Bone Research Group, UKK Institute, Tampere, Finland.

Recent animal studies have given evidence that vibration loading may be an efficient and safe way to improve mass and mechanical competence of bone, thus providing great potential for preventing and treating osteoporosis. Randomized controlled trials on the safety and efficacy of the vibration on human skeleton are, however, lacking. This randomized controlled intervention trial was designed to assess the effects of an 8-month whole body vibration intervention on bone, muscular performance, and body balance in young and healthy adults. Fifty-six volunteers (21 men and 35 women; age, 19-38 years) were randomly assigned to the vibration group or control group. The vibration intervention consisted of an 8-month whole body vibration (4 min/day, 3-5 times per week). During the 4-minute vibration program, the platform oscillated in an ascending order from 25 to 45 Hz, corresponding to estimated maximum vertical accelerations from 2 g to 8 g. Mass, structure, and estimated strength of bone at the distal tibia and tibial shaft were assessed by peripheral quantitative computed tomography (pQCT) at baseline and at 8 months. Bone mineral content was measured at the lumbar spine, femoral neck, trochanter, calcaneus, and distal radius using DXA at baseline and after the 8-month intervention. Serum markers of bone turnover were determined at baseline and 3, 6, and 8 months. Five performance tests (vertical jump, isometric extension strength of the lower extremities, grip strength, shuttle run, and postural sway) were performed at baseline and after the 8-month intervention. The 8-month vibration intervention succeeded well and was safe to perform but had no effect on mass, structure, or estimated strength of bone at any skeletal site. Serum markers of bone turnover did not change during the vibration intervention. However, at 8 months, a 7.8% net benefit in the vertical jump height was observed in the vibration group (95% CI, 2.8-13.1%; p = 0.003). On the other performance and balance tests, the vibration intervention had no effect. In conclusion, the studied whole body vibration program had no effect on bones of young, healthy adults, but instead, increased vertical jump height. Future human studies are needed before clinical recommendations for vibration exercise.

Torvinen S., Kannus P., Sievanen H., Jarvinen T.A., Pasanen T.A., Kontulainen S., Nenonen A., Jarvinen T.L. Paakkala T., Jarvinen M. & Vuori I. (2003). Effect of 8-month vertical whole body vibration on bone, muscle performance, and body balance: a randomized controlled study. Journal of Bone and Mineral Research. 18(5). 876-884.

Effect of 6-month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study.

Verschueren SM, Roelants M, Delecluse C, Swinnen S, Vanderschueren D, Boonen S.

Laboratory of Motor Control, Department of Kinesiology, Faculteit Lichamelijke Opvoeding en Kinesitherapie, Katholieke Universiteit, Leuven, Belgium.

High-frequency mechanical strain seems to stimulate bone strength in animals. In this randomized controlled trial, hip BMD was measured in postmenopausal women after a 24-week whole body vibration (WBV) training program. Vibration training significantly increased BMD of the hip. These findings suggest that WBV training might be useful in the prevention of osteoporosis. INTRODUCTION: High-frequency mechanical strain has been shown to stimulate bone strength in different animal models. However, the effects of vibration exercise on the human skeleton have rarely been studied. Particularly in postmenopausal women-who are most at risk of developing osteoporosis-randomized controlled data on the safety and efficacy of vibration loading are lacking. The aim of this randomized controlled trial was to assess the musculoskeletal effects of high-frequency loading by means of whole body vibration (WBV) in postmenopausal women. MATERIALS AND METHODS: Seventy volunteers (age, 58-74 years) were randomly assigned to a whole body vibration training group (WBV, n = 25), a resistance training group (RES, n = 22), or a control group (CON, n = 23). The WBV group and the RES group trained three times weekly for 24 weeks. The WBV group performed static and dynamic knee-extensor exercises on a vibration platform (35-40 Hz, 2.28-5.09g), which mechanically loaded the bone and evoked reflexive muscle contractions. The RES group trained knee extensors by dynamic leg press and leg extension exercises, increasing from low (20 RM) to high (8 RM) resistance. The CON group did not participate in any training. Hip bone density was measured using DXA at baseline and after the 6-month intervention. Isometric and dynamic strength were measured by means of a motor-driven dynamometer. Data were analyzed by means of repeated measures ANOVA. RESULTS: No vibration-related side effects were observed. Vibration training improved isometric and dynamic muscle strength (+15% and + 16%, respectively; p < 0.01) and also significantly increased BMD of the hip (+0.93%, p < 0.05). No changes in hip BMD were observed in women participating in resistance training or age-matched controls (-0.60% and -0.62%, respectively; not significant). Serum markers of bone turnover did not change in any of the groups. CONCLUSION: These findings suggest that WBV training may be a feasible and effective way to modify well-recognized risk factors for falls and fractures in older women and support the need for further human studies.

Verschueren S.M., Roelants M., Delecluse C., Swinnen S., Vanderschueren D. & Boonen S. (2004). Effect of 6-month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study. Journal of Bone and Mineral Research. 19(3). 352-359.

Whole-body vibration can reduce calciuria induced by high protein intakes and may counteract bone resorption: A preliminary study.

Cardinale M, Leiper J, Farajian P, Heer M.

Olympic Medical Institute, Northwick Park Hospital, Harrow, UK. [email protected]

Excess protein intake can adversely affect the bone via an increase in calcium excretion, while suitable mechanical loading promotes osteogenesis. We therefore investigated whether vibration exposure could alleviate the bone mineral losses associated with a metabolic acidosis. Ten healthy individuals aged 22 - 29 years (median = 25) underwent three 5-day study periods while monitoring their dietary intake. The study consisted of recording the participants' usual dietary intake for 5 consecutive days. Participants were then randomly divided into two groups, one of which received a protein supplement (2 g x kg(-1) body mass x day(-1); n = 5) and the other whole-body low-magnitude (3.5 g), low-frequency (30 Hz) mechanical vibration (WBV) delivered through a specially designed vibrating plate for 10 min each day (n = 5). Finally, for the third treatment period, all participants consumed the protein supplement added to their normal diet and were exposed to WBV exercise for 10 min per day. Daily urine samples were collected throughout the experimental periods to determine the excretion of calcium, phosphate, titratable acid, urea, and C-telopeptide. As expected, when the participants underwent the high protein intake, there was an increase in urinary excretion rates of calcium (P < 0.001), phosphate (P < 0.003), urea (P < 0.001), titratable acid (P < 0.001), and C-telopeptide (P < 0.05) compared with baseline values. However, high protein intake coupled with vibration stimulation resulted in a significant reduction in urinary calcium (P = 0.006), phosphate excretion (P = 0.021), and C-telopeptide (P < 0.05) compared with protein intake alone, but did not affect titratable acid and urea output. The participants showed no effect of WBV exercise alone on urinary excretion of calcium, phosphate, urea, titratable acid, or C-telopeptide. The results indicate that vibration stimulation can moderate the increase in bone resorption and reduction in bone formation caused by a metabolic acidosis.

Cardinale M., Leiper J., Farajian P. & Heer M. (2007). Whole-body vibration can reduce calciuria induced by high protein intakes and may counteract bone resorption: a preliminary study. Journal of Sports Sciences. 25(1). 111-119.

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