Chronic exposure to vibration has been studied only in the occupational setting. Some negative side effects have been identified, including spinal degeneration, vestibular disturbances, and vascular and neurological conditions (34). Guidelines have been published to limit the exposure to industrial WBV, but intermittent exposure while exercising on a platform has not been addressed (16). Although WBV uses frequencies and amplitudes lower than occupation vibration, a recent study (1) estimated that the vibration dose in typical vibration training regimens (10 minutes a day at 30 Hz, 4-mm displacement) exceed the recommendations (16). They also concluded that vertical vibration, a fully upright position, and full-squat exercises were potentially harmful and that knee flexion of 26 to 30 degrees should be encouraged to minimize head vibration (1). Exercises that involve lying or sitting on the platform (e.g., doing push-ups) should be avoided. In addition, recent work showed that amplitudes above 0.5 mm can lead to unpredictable high peak accelerations and may pose a risk to fragile bone and cartilage (19).
The most common reported side effects are transient itching and tingling (feet, legs, and nose), skin redness (legs), and muscle soreness. Incorrect exercise technique also could result in headache, motion sickness (if too much vibration is transmitted to the head), and anterior knee pain (if squatting is involved). However, no serious adverse effects were reported in recent reviews that included clinical populations (24,35).
Before starting a vibration exercise program, the participant should be screened for possible contraindications. Exclusion criteria used in clinical trials are likely good standards to follow (8,24). A nonexhaustive list is provided in Table 2.
HOW VIBRATION EXERCISE WORKS
Vibration massage and application of local vibration on the muscles have been used extensively in rehabilitation. Vibration massage has documented circulatory effects, whereas applying a vibrating stimulus to a muscle belly has been shown to facilitate motor responses, even under pathological circumstances. This reflex muscle contraction is known as the tonic vibration reflex (12). Although it was studied with localized vibration rather than WBV, and with higher frequencies than those usually used in vibration exercise, it is thought to be one of the primary mechanisms to explain the increased neuromuscular activation during and following vibration. There are several ways vibration may potentiate muscular contraction. Together with enhancing the stretch reflex, vibration also stimulates somatosensory areas of the cortex, which can facilitate subsequent voluntary movements (7). Increased muscle temperature, due to better perfusion and dampening of mechanical vibration, also may have a positive effect on force generation (29). Theoretically, with more powerful muscle contractions (during the WBV exercise), the conditioning stimulus would be stronger than conventional resistance training.
Exercise done on a vibrating platform may influence the skeleton in at least two ways. First, it may potentiate muscle contractions that are known to be important osteogenic stimuli. Second, vibration transmitted by the platform is perceived as a strain-activating mechanism that promotes bone formation, ultimately leading to an increase in bone mineral density (BMD) (29). Vibration also has been shown to influence pain perception, possibly by a “gate-control theory”–mediated effect, similar to transcutaneous electric nerve stimulation (22,29).
The improvement of flexibility after stretching while on a vibrating platform can be attributed to diverse causes, namely, heat-related facilitation, circulatory factors, and increased pain threshold (17,29). While on the platform at lower frequencies (up to 12 Hz), one experiences rapid cyclic transition between concentric and eccentric contractions, underlying attempts to maintain balance, and dampen the vibration. The mechanical oscillation provides valuable sensory information to cutaneous and joint receptors, and the vestibular system, likely improving proprioception (25).
Hormonal responses to WBV exercise have been identified but not consistently replicated. Some studies reported acute increases of growth hormone, insulin-like growth factors, and testosterone that could corroborate the anabolic effect of vibration training on muscle and bone (6,9,20).
Little is known about the cumulative effects of WBV exercise, whether “more is better” or whether there is a plateau after which no further benefit is seen. In most studies, follow-up assessments occurred soon after the end of the intervention, so the long-term safety and duration of benefits still have to be established for this type of training regimen. Whole body vibration exercise has the potential to positively influence motor response, strength, proprioception, bone quality, and pain control, which could benefit millions of patients by leading to an overall improvement in quality of life.
Whole body vibration exercise has been studied in patients with different central nervous system disorders such as Parkinson’s disease, stroke, multiple sclerosis, cerebral palsy, and spinal cord injury. A recent review of seven trials concluded that “there was weak to moderate evidence for positive effects on postural control, mobility, motor function and strength after a single application of WBV” (44). No conclusion could be made about long-term treatment as long-term studies are scarce. In Parkinson’s disease patients, five acute bouts of 60 seconds of WBV (6 Hz, 6 mm peak-to-peak displacement, random vibration platform) resulted in reduced tremor, rigidity (38), and body sway (15), but no differences in knee proprioception (14). A protocol with 12 sessions over 5 weeks (five bouts of 1 minute at 6 Hz, 26 mm of peak-to-peak displacement, side-alternating platform) failed to show differences in gait, balance, hand dexterity, and disease severity between intervention and control groups (5), whereas a more intense program, with two daily sessions of 15 minutes for 3 weeks (25 Hz, 14 to 28 mm of peak-to-peak displacement, side-alternating platform) had similar effects on equilibrium and gait compared with conventional physiotherapy with a balance board (11).
In a 4-week crossover study, multiple sclerosis patients performed 10 exercises for 30 seconds on the platform (40 to 50 Hz, 4mm of peak-to-peak displacement, vertical oscillating platform) after a “massage”/warm-up period. No differences were detected between exercise with or without vibration for disease severity, spasticity, and functional measures (33). In respect to acute exposure, five 1-minute bouts, (2 to 4.4 Hz, 6 mm of peak-to-peak displacement, random vibration platform) improved “timed-get-up-and-go” test performance and reduced body sway (32). Positive acute effects on postural control also were shown in stroke patients, with four 45-second periods of exposure (30 Hz, 6 mm of peak-to-peak displacement, side-alternating platform) (39). A transient increase in knee extension strength was shown with a similar protocol (six bouts of 1 minute at 20 Hz, 5 mm of peak-to-peak displacement), showing the capability of WBV to influence the motor response of affected limbs (36). A longer regimen of 6 weeks with subacute patients (four bouts of 45 seconds, 5 days a week, at 30 Hz, 6 mm of peak-to-peak displacement, side-alternating platform) failed to show any additional recovery in terms of balance or activities of daily living (40).
In adult cerebral palsy patients, an 8-week WBV regimen (3 days a week, 3 to 8 bouts of 30 to 110 seconds at 25 to 40 Hz, vertical oscillating platform) was as good as leg press for improving quadriceps strength without negative effects on spasticity (2).
A 6-month study (10 minutes a day, 5 days a week at 90 Hz, 0.1 mm of peak-to-peak displacement) of disabled children with cerebral palsy or muscular dystrophy reported a significant increase in tibial BMD, despite poor compliance. However, no significant benefit was found for spinal BMD (42).
Whole body vibration exercise has been studied in different joint and musculoskeletal conditions including low back pain, knee osteoarthritis, total knee arthroplasty, fibromyalgia, chronic fatigue syndrome, anterior cruciate ligament‐reconstructed knee, low BMD, and osteogenesis imperfecta. Although occupational vibration has been associated with disk degeneration and low back pain (34), WBV decreased low back pain in patients with chronic back pain and osteoporosis, perhaps by better spinal proprioception and trunk muscle conditioning induced by vibration. An additional reason for the pain relief may be the analgesic effect of mechanical oscillations via a “gate-control theory.” One intervention, a 3-month study of vibration exercise versus traditional resistance training (4 to 7 minutes, 1 to 2 times a week at 18 Hz, 12 mm of peak-to-peak displacement, side-alternating platform) used supplementary weight on the shoulders or upper arm while on the platform (30). The protocol involved standing with different foot positions, slow amplitude squatting, and slow movements of the hips and waist such as bending sideways, tilting back and forward, and left and right trunk torsions. Both types of training increased lumbar extension torque and reduced pain sensation.
Improved proprioception after 1 month of whole body vibration training also has been documented in patients recovering from an anterior cruciate ligament reconstruction (25). The vibration exercise group (4 to 16 minutes, 3 days a week at 30 to 60 Hz, 5 to 10 mm of peak-to-peak displacement, vertical oscillating platform) did a variety of static and dynamic exercises such as mini-squats, single leg mini-squat, lunges, and toe standing. Results were significantly better than conventional rehabilitation, consisting of lower body strengthening and tilt/wobble board training.
Vibration training has been used in fibromyalgia and chronic fatigue syndrome patients with promising results. A 6-week randomized controlled trial (4.5 to 18 minutes, 2 times a week at 30 Hz, 4 mm of peak-to-peak displacement, vertical oscillating platform) reported less pain and fatigue with WBV training, whereas with exercise alone, there was no amelioration. The protocol consisted of static and dynamic squats, unilateral squats, and calf raises after 90 minutes of traditional exercise (4). The addition of WBV exercise to a conventional exercise protocol resulted in additional benefits on disease symptoms.
WBV may be a promising modality to enhance bone density and lessen postmenopausal bone loss (28,35,37). Among subjects with low BMD, with diagnosed osteoporosis (18,31) or osteopenia (13), vibration has shown promising results. In patients not using osteoporosis medication, regular WBV exposure at 30 Hz over six (10 minutes, 5 times a week at 30 Hz, 10 mm of peak-to-peak displacement) and 12 months (10 minutes daily, at 30 Hz, 0.05 mm of peak-to-peak displacement, vertical oscillating platform) led to increases in femoral and spinal BMD (13,31). However, in a 12-month study with patients on alendronate, a biphosphonate drug that increases bone mass, there was no additional benefit of 4 minutes of exposure to vertical whole body vibration (12 Hz, once per week, 1.4 to 8.2 mm peak-to-peak displacement, side-alternating platform) (18). In populations known to have increased risk of bone loss (postmenopausal women, disabled patients), there are conflicting results, with some studies reporting benefits in femoral cortical bone, whereas others failed to show benefits (28,35,37).
Vibration exercise may be an alternative form of exercise for people who cannot or will not undertake other types of physical activity because of their medical conditions. WBV exercise has been shown to acutely increase oxygen consumption in healthy young and older people and overweight/obese patients, although this increase may not be enough to induce cardiovascular training or weight loss (8,10). Even with the use of additional weight and at higher frequency and amplitude, the oxygen uptake does not approach the values elicited by traditional aerobic exercise. Although perceived exertion may be high and fatigue can occur in just a few minutes, the conditioning stimulus may be insufficient to load the cardiovascular system (8).
IMPLICATIONS FOR PRACTICE
There have been aggressive marketing campaigns advocating for WBV platforms. The cost of a device can range from $200 (home units) up to $12,500 for a fitness/clinical facility unit. The money spent purchasing this device is not currently reimbursed because there is no prototype that is approved by the U.S. Food and Drug Administration as a medical device.
When purchasing a device, one should look for a certified machine, with peer-reviewed published data. Preferably, acceleration, frequency, and amplitude of the prototype should have been confirmed by an independent party. Not all devices allow manipulation of the frequency or peak-to-peak displacement; rather, they are limited to pre-defined “programs,” and the characteristics of the vibration being delivered are not well described. A machine that delivers more acceleration is not necessarily better, as too much acceleration can be detrimental. The lowest effective dose should be used.
Practitioners should choose published exercise protocols and vibration settings for their patients/clients, with proven safety and efficacy rather than accept those recommended by vendors, which might not have strong scientific rationale. Some examples of protocols are given in Table 3 (3,4,15,41). The selection of participants should follow rigorous criteria (Table 2), and when working with clinical populations, one should seek medical clearance before participation.
When initiating a training regimen, the fitness professional should advise the client to wear shoes with thin hard soles to avoid too much dampening of the vibration by the footwear during the exercise session. The first few sessions should be of shorter duration at a lower frequency and peak-to-peak displacement to ensure that the client can tolerate WBV. Duration of an exercise should not exceed 20 to 30 seconds initially with plenty of time for recovery (this principle may not apply when simple standing is being performed). As with any type of exercise, the progression should consider the client’s tolerance and clinical status, being mindful of any preexisting conditions and contraindications. Increases in intensity can be achieved by increasing the frequency, amplitude, duration, and number of repetitions of the exercise and decreasing recovery time.
Correct foot placement is very important. Feet should be placed symmetrically on the platform, with toes pointed slightly outward. Some exercises can be performed with a single leg (squats, calf raises). The handrail should be used to enhance safety; however, some balance exercises may not be useful if performed while holding it. During all exercises, a locked knees position should be avoided to limit transmission of the vibration to the trunk and head.
The provider should look for the more common side effects, such as transient itching and skin redness, muscle soreness, headache, mild knee pain, and forefoot pain, and monitor them closely. In weighing the potential benefits and the known risks, WBV exercise in clinical populations may be useful when other forms of exercise are not feasible (time constraints, lack of motivation for conventional programs, limited human resources, not able to do weight-bearing impact exercise).
There is no current consensus on the efficacy of vibration exercise, but there have been some very promising results. The potential to improve lower body muscle power, bone strength, proprioception, balance, and pain warrants further investigation. Studies with extended duration and follow-up periods are needed to better define long-term benefits and risk.
This novel type of exercise has been well tolerated by people with chronic conditions and even perceived by some patients as pleasant and easy. This training could be an alternative for people who otherwise would not be able to perform conventional exercise or just want to diversify their training.
Using published protocols when prescribing WBV (e.g., volume, exercises, and device settings) should minimize unwanted side effects and increase the likelihood of effectiveness.
CONDENSED VERSION AND BOTTOM LINE
Vibration exercise is a type of exercise that has recently gained in popularity and may benefit clinical populations. There have been trials with patients with neurological and musculoskeletal disorders that showed improvements in muscle power, bone strength, proprioception, balance, and pain. Although these results are promising, caution is warranted because of its injurious potential. The use of this type of training should follow published guidelines that have been shown to be safe and efficacious.
1. Abercromby AF, Amonette WE, Layne CS, McFarlin BK, Hinman MR, Paloski WH. Vibration exposure and biodynamic responses during whole-body vibration training
. Med Sci Sports Exerc
2. Ahlborg L, Andersson C, Julin P. Whole-body vibration training
compared with resistance training
: effect on spasticity, muscle strength and motor performance in adults with cerebral palsy. J Rehabil Med
3. Albasini A, Krause M, Rembitzki I. Using Whole Body Vibration in Physical Therapy and Sports
. 1st ed. London (UK): Churchill Livingstone; 2010.
4. Alentorn-Geli E, Padilla J, Moras G, Lazaro Haro C, Fernandez-Sola J. Six weeks of whole-body vibration exercise improves pain and fatigue in women with fibromyalgia. J Altern Complement Med
5. Arias P, Chouza M, Vivas J, Cudeiro J. Effect of whole body vibration
in Parkinson’s disease: a controlled study. Mov Disord
6. Bosco C, Iacovelli M, Tsarpela O, et al.
Hormonal responses to whole-body vibration in men. Eur J Appl Physiol
7. Cardinale M, Bosco C. The use of vibration as an exercise intervention. Exerc Sport Sci Rev
8. Cardinale M, Rittweger J. Vibration exercise makes your muscles and bones stronger: fact or fiction? J Br Menopause Soc
9. Cardinale M, Soiza RL, Leiper JB, Gibson A, Primrose WR. Hormonal responses to a single session of whole body vibration
exercise in elderly individuals. Br J Sports Med
10. Cardinale M, Wakeling J. Whole body vibration
exercise: are vibrations good for you? Br J Sports Med
. 2005;39(9):585–9; discussion 9.
11. Ebersbach G, Edler D, Kaufhold O, Wissel J. Whole body vibration
versus conventional physiotherapy to improve balance and gait in Parkinson’s disease. Arch Phys Med Rehabil
12. Eklund G, Hagbarth KE. Normal variability of tonic vibration reflexes in man. Exp Neurol
13. Gilsanz V, Wren TA, Sanchez M, Dorey F, Judex S, Rubin C. Low-level, high-frequency mechanical signals enhance musculoskeletal development of young women with low BMD. J Bone Miner Res
14. Haas CT, Buhlmann A, Turbanski S, Schmidtbleicher D. Proprioceptive and sensorimotor performance in Parkinson’s disease. Res Sports Med
15. Haas CT, Turbanski S, Kessler K, Schmidtbleicher D. The effects of random whole-body-vibration on motor symptoms in Parkinson’s disease. Neurorehabilitation
16. International Organization for Standardization. Mechanical Vibration and Shock — Evaluation of Human Exposure to Whole-Body Vibration — Part 1: General Requirements. 2nd ed. Geneva (Switzerland): International Organization for Standardization; 1997.
17. Issurin VB, Liebermann DG, Tenenbaum G. Effect of vibratory stimulation training
on maximal force and flexibility. J Sports Sci
18. Iwamoto J, Takeda T, Sato Y, Uzawa M. 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 Clin Exp Res
19. Kiiski J, Heinonen A, Jarvinen TL, Kannus P, Sievanen H. Transmission of vertical whole body vibration
to the human body. J Bone Miner Res
20. Kvorning T, Bagger M, Caserotti P, Madsen K. Effects of vibration and resistance training
on neuromuscular and hormonal measures. Eur J Appl Physiol
21. Lorenzen C, Maschette W, Koh M, Wilson C. Inconsistent use of terminology in whole body vibration
exercise research. J Sci Med Sport
22. Lundeberg T, Abrahamsson P, Bondesson L, Haker E. Effect of vibratory stimulation on experimental and clinical pain. Scand J Rehabil Med
23. Marin PJ, Rhea MR. Effects of vibration training
on muscle strength: a meta-analysis. J Strength Cond Res
24. Merriman H, Jackson K. The effects of whole-body vibration training
in aging adults: a systematic review. J Geriatr Phys Ther
25. Moezy A, Olyaei G, Hadian M, Razi M, Faghihzadeh S. A comparative study of whole body vibration training
and conventional training
on knee proprioception and postural stability after anterior cruciate ligament reconstruction. Br J Sports Med
26. Nordlund MM, Thorstensson A. Strength training
effects of whole-body vibration? Scand J Med Sci Sports
27. Rauch F, Sievanen H, Boonen S, et al
. Reporting whole-body vibration intervention studies: recommendations of the International Society of Musculoskeletal and Neuronal Interactions. J Musculoskelet Neuronal Interact
28. Rehn B, Nilsson P, Norgren M. Effects of whole-body vibration exercise on human bone density — systematic review. Phys Ther Rev
29. Rittweger J. Vibration as an exercise modality: how it may work, and what its potential might be. Eur J Appl Physiol
30. Rittweger J, Just K, Kautzsch K, Reeg P, Felsenberg D. Treatment of chronic lower back pain with lumbar extension and whole-body vibration exercise: a randomized controlled trial. Spine (Phila Pa 1976)
31. Ruan XY, Jin FY, Liu YL, Peng ZL, Sun YG. Effects of vibration therapy on bone mineral density in postmenopausal women with osteoporosis
. Chin Med J (Engl)
32. Schuhfried O, Mittermaier C, Jovanovic T, Pieber K, Paternostro-Sluga T. Effects of whole-body vibration in patients with multiple sclerosis: a pilot study. Clin Rehabil
33. Schyns F, Paul L, Finlay K, Ferguson C, Noble E. Vibration therapy in multiple sclerosis: a pilot study exploring its effects on tone, muscle force, sensation and functional performance. Clin Rehabil
34. Seidel H. Selected health risks caused by long-term, whole-body vibration. Am J Ind Med
35. Slatkovska L, Alibhai SM, Beyene J, Cheung AM. Effect of whole-body vibration on BMD: a systematic review and meta-analysis. Osteoporos Int
36. Tihanyi TK, Horvath M, Fazekas G, Hortobagyi T, Tihanyi J. One session of whole body vibration
increases voluntary muscle strength transiently in patients with stroke. Clin Rehabil
37. Totosy de Zepetnek JO, Giangregorio LM, Craven BC. Whole-body vibration as potential intervention for people with low bone mineral density and osteoporosis
: a review. J Rehabil Res Dev
38. Turbanski S, Haas CT, Schmidtbleicher D, Friedrich A, Duisberg P. Effects of random whole-body vibration on postural control in Parkinson’s disease. Res Sports Med
39. van Nes IJ, Geurts AC, Hendricks HT, Duysens J. Short-term effects of whole-body vibration on postural control in unilateral chronic stroke patients: preliminary evidence. Am J Phys Med Rehabil
40. van Nes IJ, Latour H, Schils F, Meijer R, van Kuijk A, Geurts AC. 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
41. Verschueren SM, Roelants M, Delecluse C, Swinnen S, Vanderschueren D, Boonen S. Effect of 6-month whole body vibration training
on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study. J Bone Miner Res
42. Ward K, Alsop C, Caulton J, Rubin C, Adams J, Mughal Z. Low magnitude mechanical loading is osteogenic in children with disabling conditions. J Bone Miner Res
43. Whedon GD, Deitrick JE, Shorr E. Modification of the effects of immobilization upon metabolic and physiologic functions of normal men by the use of an oscillating bed. Am J Med
44. Wunderer K, Schabrun SM, Chipchase LS. The effect of whole body vibration
in common neurological conditions — a systematic review. Phys Ther Rev
Albasini A, Krause M, Rembitzki I. Using Whole Body Vibration in Physical Therapy and Sports
. 1st ed. London (UK): Churchill Livingstone; 2010.
Rittweger J. Vibration as an exercise modality: how it may work, and what its potential might be. Eur J Appl Physiol
Slatkovska L, Alibhai SM, Beyene J, Cheung AM. Effect of whole-body vibration on BMD: a systematic review and meta-analysis. Osteoporos Int
Wunderer K, Schabrun SM, Chipchase LS. The effect of whole body vibration
in common neurological conditions — a systematic review. Phys Ther Rev
Keywords:© 2011 American College of Sports Medicine.
Whole Body Vibration; Training; Rehabilitation; Neurological Disorders; Osteoporosis