Whole Body Vibration:A new exercise approach: Whole Body Vibration: A new exercise approach Presented by: Martha R. Hinman, P.T., Ed.D. Department of Physical Therapy Hardin-Simmons University Abilene, Texas


What are we talking about?: What are we talking about? WBV is a mechanical stimulus characterized by oscillatory motion that is delivered to the entire body (usually in a vertical manner) a.k.a., vibration exercise (VE) or vibration training (VT) Biomechanical parameters include amplitude, frequency, magnitude, and duration


Effects of WBV depend on the training parameters used:: Effects of WBV depend on the training parameters used: Amplitude (mm or cm) = the extent of the vertical displacement Frequency (Hz) = number of impulses delivered per second Magnitude (G) = the acceleration power/force of the movement Duration (sec. or min.) = the amount of time one spends on the apparatus


Commercial devices that deliver WBV:: Commercial devices that deliver WBV: Galileo and Vibraflex platforms manufactured by Novtec (Germany) distributed in US by OrthoMetrix Inc. (White Plains, NY) NEMES and NBS platforms manufactured by Nemesis (The Netherlands) and FitMed Corp. (Cleveland Heights, OH) Power Plate Power Plate of North America (Culver City, CA) Vibrafit manufactured by Fysiomed (Belguim) Pneu-vibe manufactured by Pneumex (Sandpoint, ID)


Commercial devices that deliver WBV:: Commercial devices that deliver WBV: Soloflex platform manufactured by Soloflex (Hillsboro, OR) Vibrogym platform manufactured by Power Products Global Ltd (London) Fitvibe manufacuted by FITVIBE USA (Los Angeles, CA) Bodypulse manufactured by Mediflex (New Zealand) Juvent 1000 manufactured by Juvent Inc. (approved for osteoporosis treatment in Australia/New Zealand; still awaiting FDA approval in USA)


Galileo Vibrating Platform: Galileo Vibrating Platform Works as a teeterboard with 0 -5 mm amplitude (medial to distal) and variable frequency; sometimes referred to as rotational vibration 25 - 27 Hz seems optimal for increasing muscle power This frequency corresponds with time required for a single up-down movement to cause a natural stretch reflex plus relaxation of the agonists and antagonists www.galileo-training.com/en/news.php


The Galileo 2000: The Galileo 2000 www.orthometrix.net


Gallileo 100(handheld dumbbell for UE exercise): Gallileo 100 (handheld dumbbell for UE exercise)


VibraFlex 500, VibraFlex Rx, and Mini-VibraFlex: VibraFlex 500, VibraFlex Rx, and Mini-VibraFlex Newer models of Galileo equipment Have preset frequencies and treatment times Widely marketed to athletic clubs/teams www.vibraflex.com


NEMES Vibrating Platform: NEMES Vibrating Platform NEMES is the abbreviation for NEuro-MEchanical-Stimulation Provides vertical vibration in the 30-50 Hz range Shown effective in several muscle strengthening studies www.nemesis-europe.nl/index.php?option=content&task=category§ionid=2&id=7&Itemid=27


NBS (Nemes Bosco System) : NBS (Nemes Bosco System) FitMed products are based on Bosco’s original design Home units also available www.fit-med.com


Power Plate Vibrating Platform: Power Plate Vibrating Platform Developed by an Olympic coach in The Netherlands Vibrates at 30 –50 Hz Similar in design to the NEMES; claims to be a multi-planar motion Personal units have fixed 35 Hz frequency www.powerplateusa.com


Beware of marketing ploys!: Beware of marketing ploys! “Overall, the PowerPlate contributes to a more youthful feeling due to an increase in oxygenation, increased secretion of serotonin (the happiness hormone), mental stimulation and improved basic brain functions (such as better concentration). Almost immediately you will notice positive influences to your overall strength and well-being. By decreasing cortisol levels the Power Plate helps eliminate the effects of stress making the Power Plate a great tool for relaxation.”


Many companies overstate the health benefits of WBV exercise!: Many companies overstate the health benefits of WBV exercise! “The NBS® is considered as The Golden Standard of the Whole Body Vibration Training…It takes just 2 weeks to reach your optimal level of training.” “Amazing! By just standing passively on the machine's vibrating base, you dramatically improve: Strength and physical performance Flexibility and stability Body shape and solidification Being awake at day and sleep well at night Burning of fat tissue (healthy way of dieting)”


Let’s look at some of the evidence…: Let’s look at some of the evidence…


Physiology of WBV - stretch reflex: Physiology of WBV - stretch reflex from Cardinale & Bosco, Ex Sport Sci Rev, 2003, 31:3-7


Conditions treated in Europe with WBV: Conditions treated in Europe with WBV strength and power training for athletes ligamentous knee injuries/repairs acute back problems osteoporosis neuromuscular disorders obesity (via hormonal effects) PVD/diabetes (to improve circulation) incontinence (via muscle strengthening) postural stability


Contraindications/Precautions: Contraindications/Precautions pregnancy recent or possible thrombosis cardiovascular complaints, e.g. valve disorder advanced arthrosis, arthropathy, acute RA recent sutures, scars and fresh wounds foot, knee and hip implants any metal/synthetic implants, e.g. pacemaker lumbar disc problems acute inflammations or infections migraine headaches epilepsy


How much research has been done to support the efficacy of WBV?: How much research has been done to support the efficacy of WBV? WBV to enhance the performance of Soviet athletes began in the ‘60s & ‘70s by Nazarov; studies continued by the Israeli scientist, Issurin. Introduced in Western Europe ~ 1994 Carmelo Bosco, Italian physiologist, studied neuromuscular & hormonal effects of high-magnitude WBV (developed NEMES platform) Jörn Rittweger (Germany) and Saila Torvinen (Finland) have also published several studies using the Galileo platform


How much research has been done to support the efficacy of WBV?: How much research has been done to support the efficacy of WBV? Clinton Rubin, anatomist and biomechanist at SUNY @ Stony Brook, NY, has studied skeletal effects of very low magnitude vibrations mostly on animal subjects Two pilot studies on human subjects using Rubin’s platform have also been conducted Children with disabilities (e.g., CP) (Ward, et al) Post-menopausal women (Rubin, et al) Currently conducting a bed rest study for NASA at UTMB-Galveston


Immediate and Short-Term Effects of WBV: Immediate and Short-Term Effects of WBV Muscle strength and power Motor performance Vertical jump Running speed Balance Other measures Hormone concentrations Cardiovascular changes


Effect of WBV on Muscle Strength and Motor Performance: Effect of WBV on Muscle Strength and Motor Performance Torvinen tested 16 young adults who performed a single bout of WBV x 4 min. on 2 days (WBV vs. none) Used Galileo platform: amplitude = 28 mm; frequency increased from 15 – 30 Hz; est. acceleration force = 3.5 – 14 g Torvinen et al, Clin Physiol & Func Im, 22:145-152


Changes in leg extension strength: Changes in leg extension strength Torvinen et al, Clin Physiol & Func Im, 22:145-152


Changes in vertical jump: Changes in vertical jump Torvinen et al, Clin Physiol & Func Im, 22:145-152


Changes in Balance (using Biodex Stability Index;  = improvement): Changes in Balance (using Biodex Stability Index;  = improvement) Torvinen et al, Clin Physiol & Func Im, 22:145-152


Changes in Tandem Walk: Changes in Tandem Walk Torvinen et al, Clin Physiol & Func Im, 22:145-152


Changes in Shuttle Run: Changes in Shuttle Run Torvinen et al, Clin Physiol & Func Im, 22:145-152


Effects of WBV on Muscle Power: Effects of WBV on Muscle Power Bosco examined effect of WBV on vertical jump in 14 active young adults who underwent 5, 90-120 sec. bouts of WBV x 10 days Used Galileo platform: amp. = 10 mm, frequency = 26 Hz Bosco et al, 1998, Biol Sport, 15:157-164


Effect of WBV on Vertical Jump: Effect of WBV on Vertical Jump Bosco et al, 1998, Biol Sport, 15:157-164


Effect on UE muscle activity: Effect on UE muscle activity McBride et al, exercised 8 men to fatigue using vibrating and non-vibrating dumbbells (1 week apart) EMG patterns observed with vibration indicated “more efficient and effective recruitment of high threshold motor units during fatiguing contractions.” McBride et al, 2004, J Strength Cond Res, 18:777-781


Hormonal Responses to WBV: Hormonal Responses to WBV Bosco observed changes in neuro- muscular performance and plasma hormone levels in 14 young, athletic men following WBV 60 sec. WBV followed by 60 sec. rest, repeated 10 times Used NEMES platform: amp.= 4 mm @ 26 Hz; est. acceleration force = 17 g Bosco et al, Eur J Appl Physiol, 2000, 81:449-454


Hormonal Changes after WBV : Hormonal Changes after WBV Bosco et al, Eur J Appl Physiol, 2000, 81:449-454


Other Findings and Conclusions: Other Findings and Conclusions Mechanical work output of leg extensor muscles was significantly  while EMG activity was  Jumping performance also improved  plasma concentrations of T and GH suggest “neural potentiation effect” similar to power weight training but without the general stress response (i.e., decreased cortisol levels)


Acute Physiological Effects of WBV: Acute Physiological Effects of WBV Rittweger examined HR, BP, oxygen uptake, lactate levels, and perceived exertion in 37 young adults who exercised (using WBV) to exhaustion with weights added to their waists Results of two WBV exercise sessions compared to bicycle ergometry Used Galileo platform @ 26 Hz; est. acceleration force = 15 g Rittweger et al, Clin Physiol, 2000, 20(2):134-142


Cardiovascular Effects of WBV: Cardiovascular Effects of WBV Rittweger et al, Clin Physiol, 2000, 20(2):134-142


Exercise Effects of WBV: Exercise Effects of WBV Rittweger et al, Clin Physiol, 2000, 20(2):134-142


Other Findings and Conclusions:: Other Findings and Conclusions: Comparable perceptions of fatigue Some subjects experienced leg edema, erythema, and itching from WBV Fatigue associated with intense WBV attributed to neuromuscular system, not cardiovascular insufficiency Cardiovascular risk for this exercise with elderly considered “negligible.”


Other Short-Term Systemic Effects: Other Short-Term Systemic Effects Temporary vestibular impairment and motion sickness with high-amplitude vibration of long duration. Increased gastric secretions, but no effect on rate of stomach emptying. Decreased attention to other stimuli, but no sig. reduction in reaction time, eye-hand coordination, or visual acuity. Kjellberg et al, Ergonomics, 1985, 28(3):535-544


Long-Term Effects of WBV: Long-Term Effects of WBV Muscle strength/performance Motor control Balance Chronic pain Bone density/strength


Long-Term Effects of WBV: Long-Term Effects of WBV Torvinen studied physical performance effects of a 4-month WBV program in 56 young adults who trained 2-4 min., 3-5 times/week, in various positions Platform vibration amp. = 2 mm; frequencies ranged from 25 to 40 Hz; est. acceleration force = 2.5 – 6.4 g Torvinen et al, Med Sci Sports Exerc, 2002,34:1523:1528


Changes in Muscle Strength: Changes in Muscle Strength Torvinen et al, Med Sci Sports Exerc, 2002,34:1523:1528


Changes in Motor Performance: Changes in Motor Performance Torvinen et al, Med Sci Sports Exerc, 2002,34:1523:1528


Changes in Bone: Changes in Bone Torvinen continued study for a total of 8 months; results presented at ASBMR meeting in Sept. 2002 Bone mass, structure, and strength of tibia measured with pQCT; BMD in other sites measured with DEXA No significant change reported in BMD or bone biomarkers Overall 7.8% improvement in vertical jump but no other performance benefits


Summary of Rubin’s work on vibration and bone : Summary of Rubin’s work on vibration and bone Has used 10-20 min. of low-magnitude (0.2-0.3 g), high-frequency (~20-90 Hz) vibration with various animal models 2 pilot studies with humans Conducting bedrest studies for NASA


Percent differences in bone parameters for vibrated vs. control sheep (after 1 yr.): Percent differences in bone parameters for vibrated vs. control sheep (after 1 yr.) Rubin, et al, Nature, 2001, 412:603-604


Percent of Bony Ingrowth @ 8 wks. (titanium implant in turkey ulna): Percent of Bony Ingrowth @ 8 wks. (titanium implant in turkey ulna) Rubin & McLeod, Clin Orthop Rel Res, 1994, 298:165-174


Rubin’s overall findings suggest:: Rubin’s overall findings suggest: Doubling of bone formation rates 25% increase in strength of trabecular (vs. cortical) bone Inhibition of disuse and post-menopausal bone loss Postulated relationship between age-related sarcopenia and osteoporosis Rubin et al, Drug Discov Today, 2001, 6(16):848-858 (overview of work; has numerous other publications)


Other animal studies of bone loss: Other animal studies of bone loss Fleiger, et al (1998) studied ovariectomized rats vibrated at 50 Hz, 2 g, 30 min./day for 12 weeks; vibrated rats demo. significantly less bone loss than sham & non-vibrated rats Oxlund, et al (2003) compared vibration frequencies in ovariectomized rats and found that 45 Hz increased bone formation and inhibited resorption the most and preserved biomechanical strength of bone.


Human Pilot Studies: Prevention of bone loss in postmenopausal women: Human Pilot Studies: Prevention of bone loss in postmenopausal women RCT of 67 postmenopausal women in US who underwent 20 min./day WBV for 1 year (vs. placebo) Placebo group lost 3.8% in spine and 5.5% in femur WBV group only lost 1.0% in spine and 1.5% in femur Rubin et al,Bone, 1998, 23:S174 (abstract)


Human Pilot Studies: Treatment of low BMD in disabled children: Human Pilot Studies: Treatment of low BMD in disabled children RCT on 20 British children with disabilities (e.g., CP) who underwent 10 min./day WBV for 6 mo. (vs. placebo) Observed net gains in trabecular BMD in subjects exposed to WBV +3.8 mg/nl in spinal vertebrae +18.2 mg/nl in proximal tibia Ward et al, J Bone Miner Res, 2001, 16:S1, #1148


Effect of WBV on lumbar BMD in osteoporotic women: Effect of WBV on lumbar BMD in osteoporotic women Iwamoto et al, compared alendronate (Fosamax) to combined meds-WBV in 50 post-menopausal women with osteoporosis WBV group used Galileo platform @ 20 Hz, once a week x 4 min. for 12 months No sig. difference in BMD but back pain was  more in WBV group. Iwamoto et al, Aging Clin Exp Res, 2005, 17(2):157-163.


Effect of WBV on Back Pain: Effect of WBV on Back Pain Rittweger compared effects of WBV and isometric exercise on lumbar strength, pain, and disability ratings in 60 patients with chronic LBP Used Galileo platform: amp. = 6 mm @ 18 Hz; progressed from 4 to 7 min. Twice a week x 6 weeks, then weekly Rittweger et al, Spine, 2002, 27(17):1829-1834


Effect of WBV on LBP : Effect of WBV on LBP Subjects demonstrated significant, but comparable reductions in pain and disability ratings. Exercise group demonstrated greater increases in lumbar extension torque than vibration group. Vibration did not aggravate pain or limitations in any subjects.


Geriatric Studies: Geriatric Studies Runge conducted a crossover study involving 34 older adults in Germany who underwent 6 min. of WBV 3 times/week x 6 months Used Galileo platform: amp. = 7-14 mm @ frequency of 27 Hz Preliminary data (n=19) – chair rise time decreased by 18% in WBV group; no adverse effects reported Runge et al, J Musculoskel Neuron Interact, 2000, 1:61-65


Effect on Urinary Incontinence: Effect on Urinary Incontinence Runge, et al are also investigating the effects of WBV on incontinence in older adults; no published studies yet Hypothesized mechanism is strengthening of pelvic floor muscles via activation of the stretch reflex Runge et al, Der Hausarzt, 2002, 2:56-61


Effect on Fall Risk: Effect on Fall Risk Bruyere et al, conducted a RCT to compare effects of 6 weeks of WBV + PT vs. PT alone in 42 nursing home residents. WBV group had significantly greater improvements in balance & gait (based on Tinetti test and TUGT) as well as quality of life ratings. Bruyere et al, Arch Phys Med Rehabil, 2005, 86(2):303-307


Fall and Fracture Prevention: Fall and Fracture Prevention Iwamoto et al, enrolled 25 older women in a 3-mo., weekly exercise program that included WBV (using Galileo), one-legged standing, and half-squats. Step length, knee ext. strength, and OLST  significantly, but no change in walking speed or hip flexor strength. No adverse effects reported. Iwamoto et al, Keio J Med, 2004, 53(2):85-89


Effect on Postural Control: Effect on Postural Control van Nes, et al studied short-term postural changes in 23 stroke patients who received 4, 45-sec. bouts of WBV (Galileo platform @ 30 Hz). Small, significant improvements in sway velocity (AP) and weight- shifting accuracy in most subjects. No adverse effects reported. van Nes et al, Am J Phys Med Rehabil, 2004, 83:867-873


Effect on Postural Control: Effect on Postural Control Schuhfried, et al studied effects of low-frequency (2.0-4.4 Hz) WBV in 12 patients with multiple sclerosis; 6 assigned to WBV and 6 received placebo. WBV group’s postural sway and TUGT improved, but not their functional reach. Improvements persisted 1-2 weeks. No adverse effects reported. Schuhfried et al, Clin Rehabil, 2005; 19:834-842


There is fertile ground for more research…: There is fertile ground for more research…


Potential benefits for children with CP: Potential benefits for children with CP Pilot study being conducted at Hardin-Simmons University (Abilene, TX) to determine effects of WBV exercise on children with spastic diplegia. Will assess changes in muscle tone, posture, and functional balance. Funded by the Texas Physical Therapy Foundation (ML Garret & MR Hinman, investigators)


Potential benefits of WBV for children with spastic diplegia: Potential benefits of WBV for children with spastic diplegia LE muscle tone via fatigue and inhibition of H-reflex  postural stability via proprioceptive feedback Repetitive, high-frequency, mechanical stimuli


Potential benefits of WBV post-burn: Potential benefits of WBV post-burn Repetitive, high-frequency mechanical stimuli Strengthen LE muscles via repetitive activation of stretch reflex and muscle spindle Increase LE circulation via capillary dilation and reduced peripheral resistance Stabilize posture via enhanced proprioceptive feedback Strengthen bone via osteogenic response and trabecular remodeling Reduce pain via inhibition of slow-conducting pain fibers


Potential benefits for young athletes: Potential benefits for young athletes Build bone to prevent osteoporosis in later life Augment muscle strength and power without over-stressing joints Repetitive, high-frequency, mechanical stimuli


Potential benefits for people with peripheral vascular disease and/or neuropathy: Potential benefits for people with peripheral vascular disease and/or neuropathy Compare effects on extremity circulation with more traditional exercise approaches such as walking. Can repetitive vibratory stimulus also improve sensation?


For more information…: For more information… Contact: Dr. Martha Hinman, Professor Department of Physical Therapy 2200 Hickory, HSU Box 16065 Hardin-Simmons University Abilene, TX 79698-6065 Phone: (325) 670-5828 e-mail: mhinman@hsutx.edu