September/October 2022

Bone Health: Vibration Therapy for Older Adults
By Jennifer E. Van Pelt, MA
Today’s Geriatric Medicine
Vol. 15 No. 5 P. 30

A Summary of Benefits and Recent Research

Numerous medical and fitness devices were invented in the 19th and early 20th centuries—some were considered quackery, while others evolved into valid therapies. During this era, many devices were introduced that promised easy ways to lose weight and/or become fit. Vintage “reducing machines” or “vibrating exercise belts” promised to tone muscles and shake off fat through the use of a large vibrating band around the abdomen that delivered vigorous vibrations to the body.

Fast-forward to the 1990s: Vibration evolved into whole-body vibration (WBV) platforms in athletic training and health club settings, followed by the availability of much less expensive devices for consumers in the 21st century. While its contribution to athletic fitness relative to other training methods is still under debate, WBV for therapeutic use is supported by decades of published evidence. However, its history of healing potential stretches back much farther.

The ancient Greeks and Romans used vibrations from modified tools and musical instruments as well as horse-drawn vehicles to heal wounds and other injuries. The therapeutic use of vibrations also was described in medical texts from various eras, including 16th-century Japan, 18th- and 19th-century France, 19th-century Scotland, and 19th- and early 20th-century America. Medical conditions for which therapeutic vibration has been used include bone fractures, rheumatic disorders, nervous system problems, muscle spasms, physical disabilities, cardiovascular problems, and digestive issues.1

WBV remained on the fringes of medical practice until the 1950s and 1960s, when Russian scientists embraced vibration—calling it “rhythmic neuromuscular stimulation”—for muscle and bone strength training and recovery applications in astronauts and Olympic athletes. In the mid-1990s, when a Russian astronaut spent more than 400 days in space without the typical large loss of bone density from zero gravity after using WBV, interest from the medical and fitness communities exploded. In the late 1990s, a Dutch Olympic coach developed the most popular commercial and therapeutic WBV device—the Power Plate.1 Since then, smaller, less expensive devices for home use have become available for consumers. These devices also are used by personal trainers, physical therapists, and rehabilitation professionals due to their much lower cost compared with the Power Plate.

How Does WBV Work?
A WBV device consists of a vibrating platform with or without a connected handle for balance while standing on it; the platform produces vibrations that can be set at various frequencies and amplitudes. Frequency is the number of vibrations per second, measured in Hertz (Hz), while amplitude is the vertical distance the platform moves during vibrations and is measured in millimeters. Frequency can range from 3 to 50-plus Hz (ie, 3 to 50 vibration cycles per second). Amplitude generally is available as low or high, depending on the model. These vibrations are transferred to the body’s tendons, muscles, and other tissues, thereby increasing muscle contractions, engaging the neuromuscular system, and helping improve muscle strength and balance. Higher frequencies and amplitudes deliver a more intense workout for muscles—for example, at a setting of 50 Hz, the muscles are contracting/relaxing 50 times per second.

WBV technology has evolved such that different types of vibration can be included in one device. Oscillating/pivotal, spiral/triplanar, and linear motions are available depending on the model. The different types of vibration are advertised for various uses, such as massage/lymphatic drainage, bone density increase, circulation improvement, muscle strength and balance, and more.

For WBV training, the user stands on the platform, which is set at a certain frequency for a few to several minutes. Alternatively, exercises such as squats, lunges, and weighted strength moves can be done while standing on the platform or stepping onto the platform. For upper body strengthening, push-ups or planks can be performed with the hands on the platform as it vibrates.

Due to the intensity of vibration delivered to the body during WBV, sessions are short, ranging from a few minutes to 15 minutes depending on the user and the desired results. For example, an older, deconditioned woman with low bone density would require a shorter session at lower frequency and amplitude than that which a competitive athlete would use for muscular strength training with WBV.

Potential Benefits for Older Adults
Aging is associated with progressive loss of muscle mass, which leads to loss of strength, mobility, balance, and functionality. Bones also change in structure with aging, becoming less dense and more prone to fracture. Loss of bone density, lower body strength, and balance contribute to an increased risk of falls and fractures and lower quality of life and independence. Animal and human studies have shown that vibration stimulates bone formation.2,3 Several clinical studies in older adults found that WBV improved muscle strength as well as conventional resistance training and also improved balance and postural control. This research also suggested that WBV alone or in combination with physical therapy may be especially beneficial for older adults with mobility, neurological, and other limitations that make traditional resistance training difficult.3

Due to its long history of use, there is a large body of research on WBV for its many therapeutic uses. Enough evidence exists for researchers to perform advanced meta-analyses to determine its benefits. And the strongest evidence is actually for therapeutic uses, not for fitness and athletic training as is the focus of many commercial advertisements.

Early studies on bone mineral density (BMD) and muscle atrophy in astronauts fueled research on the benefits in older adults with osteoporosis, arthritis, and frailty. Recent studies on WBV on bone health and falls include the following:

• A July 2021 comparative study in elderly women found that WBV training improved BMD of the proximal femur.4

• A July 2021 randomized controlled trial (RCT) comparing WBV training with quadriceps strength training in 81 older adults with knee arthritis found no significant differences in pain and functional tests. However, WBV significantly improved isokinetic muscle strength around the knee joint.5

• A June 2020 meta-analysis of 16 RCTs evaluating different types of exercise training on BMD in more than 1,600 older postmenopausal women found WBV significantly increased lumbar spine BMD compared with aerobic and resistance training.6

• A May 2020 RCT that included 43 postmenopausal women with osteoporosis found WBV training significantly increased leg muscle work as well as lumbar and femoral BMD.7

• Another May 2020 RCT that included 58 postmenopausal women found WBV training significantly increased BMD at the femoral neck and lumbar spine compared with high-impact exercise. WBV and high-impact exercise also both improved functional mobility and depression symptoms.8

• An April 2020 systematic review and meta-analysis of 10 RCTs concluded that WBV helped improve functional mobility (included gain and balance) in older adults in nursing homes.9

• A December 2017 systematic review and meta-analysis of 14 RCTs found that WBV significantly reduced the rate of falls in adults older than 50, although no effects on BMD were found.10

Recent studies of WBV to improve functioning in frail older adults include the following:

• A February 2022 RCT that included 117 frail older adults living in a residential care facility found that low-level WBV training improved functional independence, confidence related to fall prevention, and quality of life. A July 2020 trial in the same population showed that WBV improved walking performance and other functionality tests and was easily used and accepted by frail older adults with no adverse effects.11,12

• A February 2020 study found that twice-weekly WBV for 12 weeks in frail nursing home residents improved knee extension strength and other physical performance measures with no adverse effects.13

Interestingly, in addition to improving bone and muscle strength, WBV may also aid in managing type 2 diabetes, COPD, and Parkinson’s disease—three conditions common in older adults. An October 2019 meta-analysis of seven studies of 279 older adults with type 2 diabetes compared WBV training with other exercises. WBV was associated with improvements in pain, blood circulation to the legs, glycated hemoglobin levels, and fasting blood glucose levels. It also was found to improve mobility, aerobic capacity, and balance.14 An October 2018 meta-analysis of eight RCTs including 365 patients with COPD found that WBV increased walking distance and functional exercise capacity.15 A May 2021 RCT in 48 patients with severe COPD found that WBV significantly improved balance and muscular power compared with conventional balance training.16 An April 2021 meta-analysis of WBV in patients with Parkinson’s disease found that it was significantly better than standard methods for improving gait.17

Research into these and other applications of WBV training for older adults is ongoing and is expected to reveal or confirm additional therapeutic benefits for older adults. This research indicates that WBV is an exercise and therapeutic modality worth considering for geriatric care.

— Jennifer Van Pelt, MA, is a certified group fitness instructor and health care researcher in the Lancaster, Pennsylvania, area.

References
1. Kaeding TS. The historical evolution of the therapeutic application of whole body vibrations: any lessons to be learned? Austin Sports Med. 2016;1(1):1003.

2. Lachance C, Weir P, Kenno K, et al. Is whole-body vibration beneficial for seniors? Eur Rev Aging Phys Act. 2012;9:51-62.

3. Bemben D, Stark C, Taiar R, Bernardo-Filho M. Relevance of whole-body vibration exercises on muscle strength/power and bone of elderly individuals. Dose Response. 2018;16(4):1559325818813066.

4. Cheng L, Qian L, Chang S, He B. Effects of whole-body vibration training with the same amplitude and different frequencies on the proximal femoral bone density in elderly women. J Sports Med Phys Fitness. 2021;61(7):923-927.

5. Lai Z, Lee S, Chen Y, Wang L. Comparison of whole-body vibration training and quadriceps strength training on physical function and neuromuscular function of individuals with knee osteoarthritis: a randomised clinical trial. J Exerc Sci Fit. 2021;19(3):150-157.

6. Mohammad Rahimi GR, Smart NA, Liang MTC, et al. The impact of different modes of exercise training on bone mineral density in older postmenopausal women: a systematic review and meta-analysis research. Calcif Tissue Int. 2020;106(6):577-590.

7. ElDeeb AM, Abdel-Aziem AA. Effect of whole-body vibration exercise on power profile and bone mineral density in postmenopausal women with osteoporosis: a randomized controlled trial. J Manipulative Physiol Ther. 2020;43(4):384-393.

8. Sen EI, Esmaeilzadeh S, Eskiyurt N. Effects of whole-body vibration and high impact exercises on the bone metabolism and functional mobility in postmenopausal women. J Bone Miner Metab. 2020;38(3):392-404.

9. Alvarez-Barbosa F, Del Pozo-Cruz J, Del Pozo-Cruz B, García-Hermoso A, Alfonso-Rosa RM. Effects of whole-body vibration on functional mobility, balance, gait strength, and quality of life in institutionalized older people: a systematic review and meta-analysis of randomized controlled trials. J Aging Phys Act. 2020;28(2):219-230.

10. Jepsen DB, Thomsen K, Hansen S, Jørgensen NR, Masud T, Ryg J. Effect of whole-body vibration exercise in preventing falls and fractures: a systematic review and meta-analysis. BMJ Open. 2017;7(12):e018342.

11. Wadsworth D, Turnbull J, Lark S. Psychological effects of whole-body vibration training in frail older adults: an open, randomized control trial. J Aging Phys Act. 2022;30(1):54-64.

12. Wadsworth D, Lark S. Effects of whole-body vibration training on the physical function of the frail elderly: an open, randomized controlled trial. Arch Phys Med Rehabil. 2020;101(7):1111-1119.

13. Grubbs BF, Figueroa A, Kim JS, Contreras RJ, Schmitt K, Panton LB. Whole-body vibration training in frail, skilled nursing home residents. Int J Exerc Sci. 2020;13(3):140-156.

14. Gomes-Neto M, de Sá-Caputo DDC, Paineiras-Domingos LL, et al. Effects of whole-body vibration in older adult patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Can J Diabetes. 2019;43(7):524-529.e2.

15. Zhou J, Pang L, Chen N, et al. Whole-body vibration training - better care for COPD patients: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2018;13:3243-3254.

16. Gloeckl R, Schneeberger T, Leitl D, et al. Whole-body vibration training versus conventional balance training in patients with severe COPD—a randomized, controlled trial. Respir Res. 2021;22(1):138.

17. Marazzi S, Kiper P, Palmer K, Agostini M, Turolla A. Effects of vibratory stimulation on balance and gait in Parkinson's disease: a systematic review and meta-analysis. Eur J Phys Rehabil Med. 2021;57(2):254-264.