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Title: Effects of whole body vibration – a systematic review of randomized,
controlled trials.
Authors:
Lohse Georg RPT, MSc (corresponding)
Centre for Assessment of Medical Technology in Örebro
SE- 701 85 Örebro
Sweden
Nilsagård Ylva, RPT, PhD
Centre for Assessment of Medical Technology in Örebro
University Hospital
SE- 701 85 Örebro
Sweden
ABSTRACT
PURPOSE: The aim was to investigate the scientific evidence of effects using WBV
regarding muscular function, balance, spasticity, and bone mass.
METHOD: A systematic review was conducted. A database search was performed including
April 2009 using the Cochrane Controlled Trials Register, PubMed and Physiotherapy
Evidence Database (PEDro). Search terms were whole-body alternatively whole body in
combination with vibration and vibration exercise. Only RCTs in English and Nordic
languages were included. A limitation of methodological quality was set at ≥5 points
according to PEDro-scale for further inclusion. RESULTS: The studies evidence value was
determined as high, medium or low according to the definitions declared by the Swedish
council on technology assessment in health care. Only one study was of high methodological
quality and four were of medium quality. The remaining studies were of low quality. Whole
body vibration exercise has no or little effect on muscle or balance function or bone mass and
is not superior to other interventions (Level of evidence 3). CONCLUSIONS: This review
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showed that the evidence level was limited. Regarding muscular function, balance and bone
mass WBV exercise seems to have little or no effect, and has not been shown superior to
other interventions.
Keywords: balance, bone mass, evidence based medicine, muscular function, spasticity,
whole body vibration.
Introduction
The use of whole body vibration (WBV) as an exercise method has rapidly increased over the
last decade. The method has been marketed extensively and consumers now request WBV
exercise. Professionals such as physiotherapists and physical trainers are showing an
increasing interest in WBV both within and outside public health care. Whole body vibration
exercise originated in the sixties in Russia where it was believed to provide an advantage to
elite sportsmen. Cosmonauts also used it to restore lost bone mass due to weightlessness in
space flight. Astronauts from the National Aeronautics and Space Administration use WBV
similarly [1]. The first commercial vibration plate was constructed in the 1990s by Professor
C. Bosco and research on WBV was then initiated [2].
Within sports medicine, WBV is believed to prevent injuries and contribute to
healing by increasing blood circulation facilitating oxygen supply to inflamed areas [3]. The
neuromuscular system is affected mechanically through a rapid change in length of the
muscle-tendon complex. Sensors, reflexively modulating muscle stiffness to moderate
vibration waves, register this change in length. One possible effect of stimulation by vibration
is related to reflex-activation of the alpha-motor neurons. Increased EMG-activity is
commonly observed during WBV. This activity is greater than that observed during voluntary
muscular contraction alone [4-10]. Even an osteogenic response of vibration has been seen
and discussed [4]. Cardiovascular effects and effects on energy consumption have been
reported [4-5]. Delayed onset of muscle soreness has also been reported as one possible effect
[6]. Furthermore, there have been reports of hormonal changes during WBV [7].
Several contraindications are described for WBV [4,8-10]. The responsibility of awareness of
these contraindications and of informing patients is obvious especially when licensed
healthcare professionals offer WBV. The possibility of adverse events using WBV has been
discussed. Jordan et al offer considerable evidence for negative effects, for example, on
peripheral nerves, joints, blood vessels and perception when exposed to vibration [11]. These
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negative effects are dependent on variables such as amplitude, frequency, intensity, duration,
and position. Structured exercise taking these negative effects into consideration is, therefore,
emphasized by Cardinale et al [12].
The interest in and use of WBV is increasing but the extent of effects based on
scientific evidence, as pointed out in previous reviews [11,13-14], is unclear. The focus of
two systematic reviews was on effects of WBV regarding muscle strength [15-16]. Rehn et al
included studies, regardless of design, evaluating the effect of strength or power in the lower
extremities [16]. The studies were methodologically evaluated using a modified version [17]
of a criteria list developed by van Tulder et al [18]. Nordlund et al used stricter inclusion
criteria including only controlled studies but failed to report how quality of the included
studies was assessed [15]. These two reviews cover the published literature until August 2005
[15] and February 2006 [16] but neither used randomised, controlled trials (RCTs) as an
inclusion criteria. The emerging interest of WBV is, however, not only reflected in clinical
practice but also by an increasing amount of published studies evaluating WBV.
The aim of the present systematic review was to investigate and update the
scientific evidence of WBV regarding muscular function, balance, spasticity, and bone mass.
A second aim was to describe the samples studied regarding intensity and duration of WBV,
as well as which outcome measures and follow-up intervals were used and if adverse events
were reported.
METHODS
A systematic review was conducted to answer the questions according to the PICO-model
[19].
P (population) – no age limits, inclusion of both children and adults.
I (intervention) – WBV exercise regardless of manufacturer, type of exercise or total time for
WBV.
C (control) – comparison with no exercise or other exercise methods.
O (outcome) – reflecting muscular function, spasticity, balance or bone mass within all
components of the International Classification of Functioning, Disability and Health (ICF)
[20].
The International Classification of Functioning, Disability, and Health was created to offer a
common language for health and health related issues and to facilitate international
comparisons. The first part consists of Functioning and Disability including Body Function,
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Body Structure, Activities, and Participation. Part two consists of Contextual Factors
including Environmental and Personal factors. Activity is the performance of a task or activity
while participation is a person’s engagement in a life situation. Outcomes at the level of
activity and participation can be interpreted as being patient related outcomes. The ICF
structure is used when reporting the results of this review.
Literature search
Electronic database searches were conducted repeatedly from September 2007 with the last
search performed in April 2009. Databases used were the Cochrane Controlled Trials
Register, PubMed, and the Physiotherapy Evidence Database (PEDro). Search terms were
whole-body or whole body in combination with vibration and vibration exercise. References
in previously published systematic reviews covering effects of WBV were scrutinised [15-
16].
Inclusion criteria, Exclusion criteria
Limits were by design, including only RCTs, and linguistic, including only English and
Nordic languages. A time limit was used including studies published from 1995.
Study selection
Two evaluators read all titles and abstracts. Abstracts either evaluator found relevant were
acquired as full text articles. Articles were divided between the two reviewers who read them
in their entirety and separately graded the methodological quality using the PEDro-scale. The
PEDro-scale contains 11 items that judge the methodological quality as seen in Table 1. A
total score was set from 0-10 [21]. A methodological quality limitation was set at 5 points
according to the PEDro-scale for further inclusion in the present review. Information
regarding a priori power calculations was examined. No other quality criteria were used. The
evaluators’ scoring was validated in two ways. If ratings of the papers were found in the
PEDro database, the score was compared with the respective evaluator’s scoring. When no
rating was available, scores were compared between evaluators and potential discrepancies
were discussed until consensus was reached. The differences in scoring were primarily the
interpretation of the use of intention-to-treat analysis (item 9) but also the reporting of results
(items 10-11), which led to consulting a statistician. There were disagreements in a few cases
compared to PEDro’s rating concerning intention-to-treat (item 9). In these cases the PEDro
score was chosen as seen in Table 1.
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Quality assessment
The quality of the studies was graded and their evidence value was determined as high,
medium or low as seen in table 1. High quality was defined as being equivalent to a PEDro-
score of seven or more. Moderate quality was defined as being equivalent to 6 points
combined with a reported a priori power calculation. Low quality was defined as being
equivalent to a PEDro-score of 6 or less without an a priori power calculation. This grading
of quality was used in another systematic review [22]. The criteria defined by The Swedish
council on technology assessment in health care (SBU) for strength of evidence as seen in
appendix, expressing the entire scientific basis for a conclusion, was used [23].
RESULTS
A total of 69 possibly relevant studies were found, 68 by electronic database search and one
using references of previous reviews. Ten studies did not fulfil the criteria after reading the
titles and abstracts. After scrutinising the remaining 59 studies, fourteen were believed not to
have the required focus for inclusion in the review or were not RCTs [5,7,24-35] as shown in
Table 2 and 20 of the studies scoring <5 using PEDro as seen in flow chart Figure 1.
Figure 1.
69 possible relevant RCTs
identified
10 excluded after reading abstract
59 RCTs methodologically
evaluated
20 PEDro <5
8 not RCT
4 irrelevant focuses
1 not WBV
1 only a poster at a congress
25 RCTs finally included
(Table 1)
Flow chart of included and excluded studies in the review.
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A total of 25 studies were finally included in the review, as seen in Table 3. Only one study
was rated having high methodological quality [36]. The effect of six weeks WBV in adjunct
to physiotherapy was compared to WBV and physical training to music for persons with
stroke (acute stage). Four studies were rated having medium quality [39-42] and the
remaining studies low quality as seen in Table 3.
Population
The samples within the 25 studies consisted of healthy persons of different ages, persons with
different neurological diagnoses or, persons having had knee surgery. Older men and women
(mean age 74-84) living in nursing homes (36 men, 60 women) were investigated in three
studies [40,42-43]. A total of 214 women (mean age 61-72) were included in four studies
[41,44-46]. Additionally, 341 young (age range 18 to 40), healthy persons have been studied
[37-46]. In one study, ten elite child gymnasts were included [47]. Six studies investigated the
effect of WBV in persons with different neurological diagnoses, Parkinson’s disease (n=95)
[48-49], multiple sclerosis (n=12) [50], stroke (n=71) [36,51], cerebral palsy and hereditary
spastic paresis (n=14) [52] as seen in Table 3.
Intervention
Whole body vibration exercise was described as having been conducted from one to five
times weekly. The treatment period varied considerably from a single session to eight months
of WBV. The total vibration stimulation period varied from 4 to 590 minutes and, within a
single repetition, between 30 and 60 seconds as seen in Table 3.
Outcome measures
Outcome measures had been used both at the level of Body Function, Body Structure and
Activities and Participation as seen in Table 3. Only one study presented outcomes referring
to Personal Factors: health related quality of life using 36-item Short Form Health Survey
(SF-36) [53].
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Muscle function
Muscle strength was measured in different ways and used as outcomes within the area of
muscle function (body function and structure), maximal grip strength [42-45,54], isokinetic
strength [52], dynamic strength [37-38,54-55], ballistic strength [37], isometric strength
[37,42-45,55] and, measure of muscular cross sectional area [56]. Flexibility was measured
for thigh musculature [39,47] and evaluated by functional tests for the extremities [54]. Russo
et al investigated the speed of the reaction force by floor jumping using a force plate [57].
Muscle activity was registered using electromyography [41-42] and spasticity was graded
using the modified Ashworth scale [52]. Examples of functional tests (activity) are different
jumps [37-38,40,42-45]. Walking had been evaluated using a 6-minute walk test [52], 10m
walking speed [48] and by classifying dependence on assistive devices when walking
according to Functional Ambulatory Category [36]. Moreover, different running tests were
used (5, 10, 20m) [40]. The Barthel Index was used to measure independence in daily
activities [36] as seen in Table 3.
Most studies investigating muscle function reported no statistically significant
improvements for WBV compared to control groups however, significant improvements were
reported within groups receiving exercise with WBV as an adjunct regarding spasticity and
improved muscle function [37-38,41-43,51-52,54-55]. An exception is that of improved
muscle flexibility, which was reported in two studies [39,47] as seen in Table 3.
Balance
Balance was evaluated at the level of body function using postural sway [42-45,55], dynamic
posturography [48,50], deviation of centre of pressure [46] and, Stability Basic Master [58].
Several balance tests had been used at the level of activity and some contained different
components of transfers: the Timed Up and Go test [50,52-54], Tinetti test [48,53-54], Bergs
Balance scales [36], Functional Reach test [50,58], Blind flamingo test [59], tandem walk
backwards 6m [42,44], Shuttle run test 30m [42-45], Gross Motor Function Measure [52],
Trunk Control test [36] and Rivermead Mobility Index [36].
No significant differences were found in three studies either between or within
groups regarding postural sway [48,55,58]. However, improvement in directional control and
sway during arm abduction or anteflexion was reported. Postural stability measured by the
deviation of centre of pressure (COP) test was significantly greater in the WBV group
compared with the control group in the study by Moezy et al [46]. Statistical improvements
were found for balance function evaluated using Timed Up and Go test and the Tinetti test
[53-54] in older samples, as well as in a sample of persons with multiple sclerosis using the
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Timed Up and Go test [50]. However, there was no significant improvement reported using
the Tinetti test in the study by Ebersbach et al [48]. Some significant improvements were
reported within WBV-groups in five studies [36,49,53-54,59] as seen in Table 3.
Bone density and bone strength
Methods used to evaluate the effects on bone density and bone strength (body function and
structure) were Dual Energy X-ray (DXA) [45], peripheral quantitative computed tomography
(pQCT) [45], serum markers [40,45,55], bone mass density (BMD) [55,59], C -telepeptide
levels (CTX) [55], blood and urinary samples and bone density, mass and geometry measured
using computed tomography (XCT2000) [57]. Magnetic resonance imaging (MRI) scans to
evaluate spine morphology (length, sagittal disc area and height, and intervertebral angles)
[56]. Effects on bone were reported after WBV in two studies and solely for increase of bone
mineral density in the femur [59] and hip bone [55], as seen in Table 3.
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Adverse events
Adverse events were reported in some of the 24 finally included studies [54,57-58]. One
female presented with groin pain and one became frightened of going to the rehabilitation
room [54]. Transient, slight, lower leg itching and erythema were reported by six of 17
persons (35%) in one study [57]. Six persons reported muscle soreness and one person
headache during WBV, but these symptoms vanished after approximately ten treatment
sessions [58].
Discussion
This systematic review offers an updated compilation of the scientific evidence regarding
whole body vibration in order to answer the question whether WBV is a treatment option if
the aim is to improve muscle function, balance function or bone mass. Only RCTs evaluating
muscle function such as different qualities of strength, spasticity, balance function, and bone
density were included. Potential effects on other outcomes have not been included in this
review. The choice of inclusion and exclusion criteria is transparent with explanations shown
in the flow chart as seen in Figure 1.
Methodological quality is a very important criterion for inclusion/ exclusion of
studies in systematic reviews in order to gain a reliable result. The use of this criterion is
considered a strength in the present review. The quality rating was performed using a
standardised model, the PEDro scale, believed to provide a means to validate quality rating
[21]. A PEDro score equivalent of five of ten items was determined as a methodological
standard for further inclusion. We did not include weighting of questions in the PEDro scale
as seen in Table 1. Other criteria could have been used. Acknowledged definitions of high,
moderate, or low quality for the PEDro-scale are not explicit to our knowledge. Thus,
previously published criteria were used [22]. Only four studies reported an a priori power
calculation to ensure a sufficiently large sample [37,58,60]. Potentially positive effects using
whole body vibration may be present although not detectable in the included studies due to
insufficiently large samples, or type II-errors.
The participants were heterogeneous regarding age ranging from young children
[47] to elderly persons [53-55,57-60] as well as diagnosis. By looking at the studies
withholding an older population there is some indication towards a benefit of WBV especially
for balance. Still, the studies are of low or mean quality indicating that the overall level of
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evidence remains low. Hopefully, there will soon be enough RCTs to synthesize study results
exclusively for separate diagnosis.
A meta-analysis could not be calculated due to the heterogeneity in design and
choice of outcomes of the included studies. For example, the total intervention time varied
between 4 [42,44] and 690 minutes [45] and the exercise was performed either at a single
session [42,44,47,50-51] or up to eight months of regular exercise [45,59]. The results of the
present review would probably not differ even when excluding studies with WBV of a single
session. Vibration frequency varied between 1Hz [50] and 50Hz [54] with frequencies
between 25 to 30 Hz most commonly reported. Long-term effects after a completed period of
WBV were not presented in any study.
The result of this review can be compared with previously published reviews
regarding the effects of WBV on muscle function. Rehn et al concluded that the evidence of
beneficiary effects on muscle function in the lower extremities for unfit persons and older
women is moderate to strong [16]. The difference in their conclusions compared to those
presented in this review could possibly be a result of different inclusion criteria regarding
design and methodological quality where demands were higher in the present review.
Nordlund et al reported no or small differences for muscle strength after whole body
vibration, a conclusion in line with the conclusion of the present review [15].
The results of the included studies revealed small or no overall effects. The
strength of the evidence is no higher than 3 for any of the investigated variables. In general,
discussions of whether reported statistically significant results were of clinical relevance were
lacking. The heterogeneity of treatment period length, frequency, amplitude, follow-up time,
and position when performing whole body vibration complicates any conclusions regarding
effects. Likewise, the differences in characteristics between the samples complicate any
attempt to generalise results. Most studies include only healthy persons so results cannot be
transferred to persons with different health issues or diseases. The amount of studies including
persons with particular diagnoses is increasing and these studies are of particular interest to
public health care. This is without doubt an area where more research is needed. An
interesting area of research is presented in the study by Balavý et al, namely in people
immobilized for longer periods of time [56], and Moezy et al in the rehabilitation of anterior
cruciate ligament reconstruction [46]. In the neurological field diagnoses such as Parkinson,
Stroke, and MS are being investigated [36,48-52]. Research on whole body vibration exercise
is rapidly increasing and updates reassessing the scientific evidence are called for. Preferably,
coming reviews should use stringent methodological criteria.
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Conclusion
Whole body vibration exercise was studied in several randomised, controlled trials where the
methodological quality was generally rated low. Only one study was of high quality and four
were of moderate quality. The scientific evidence shows that whole body vibration as an
exclusive intervention or used in combination with other interventions is more effective
compared to other interventions regarding muscular or balance function or where bone
density is considered weak. Accordingly, the conclusion is that whole body vibration exercise
has no or little effect on muscle function, balance function or, bone mass and is not superior
to other interventions (Level of evidence 3) as seen in the appendix.
There are effects of whole body vibration on these areas but they seem to be equivalent to that
of other interventions. The majority of studies involved healthy persons and are thus of less
value to health care. The interpretation of the result must be made with great caution due to
sample heterogeneity and generally low methodological quality. More studies with high
methodological quality, including samples representing persons with different diagnoses and
using outcomes at the level of activity and participation, are warranted. The optimal dosage
and treatment period time remains to be established. The scientific evidence of the
intervention is not sufficient at this point for it to be used in health care. Whole body vibration
exercise directed at non-healthy persons should be used only within randomised, controlled
studies until sufficient evidence has been gathered.
Conflict of interest
None of the authors are connected in any way due to funding received or other commercial
interests related to the topic.
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50. 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
2005;19:834-42.
- 16 -
16
51. 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 2007;21:782-93.
52. 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 2006;38:302-8.
53. Bruyere O, Wuidart MA, Di Palma E, Gourlay M, Ethgen O, Richy F, et al.
Controlled whole body vibration to decrease fall risk and improve health-related
quality of life of nursing home residents. Arch Phys Med Rehabil 2005;86:303-7.
54. Bautmans I, Van Hees E, Lemper JC, Mets T. The feasibility of Whole Body
Vibration in institutionalised elderly persons and its influence on muscle performance,
balance and mobility: a randomised controlled trial [ISRCTN62535013]. BMC
Geriatrics 2005;5.
55. 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 2004;19:352-9.
56. Belavy DL, Hides JA, Wilson SJ, Stanton W, Dimeo FC, Rittweger J, et al. Resistive
simulated weightbearing exercise with whole body vibration reduces lumbar spine
deconditioning in bed-rest. Spine 2008;33:E121-31.
57. Russo CR, Lauretani F, Bandinelli S, Bartali B, Cavazzini C, Guralnik JM, et al.
High-frequency vibration training increases muscle power in postmenopausal women.
Arch Phys Med Rehabil 2003;84:1854-7.
58. Cheung WH, Mok HW, Qin L, Sze PC, Lee KM, Leung KS. High-frequency whole-
body vibration improves balancing ability in elderly women. Arch Phys Med Rehabil
2007;88:852-7.
59. Gusi N, Raimundo A, Leal A. Low-frequency vibratory exercise reduces the risk of
bone fracture more than walking: a randomized controlled trial. BMC Musculoskeletal
Disorders 2006;7.
60. Rees SS, Murphy AJ, Watsford ML. Effects of whole-body vibration exercise on
lower-extremity muscle strength and power in an older population: a randomized
clinical trial. Phys Ther 2008;88:462-70.
- 17 -
17
Table 1.
Methodological evaluation with PEDro scale (11 items, question no. 1 is excluded in the total sum score) of the total 25 studies included in the
review.
Study Eligible Random
allocation
Concealed
allocation
Similar
at
baseline
Blinding
of all
subjects
Blinding
of all
therapists
Blinding
of all
assessors
>85% of
subject
at least
at one
key
outcome
Intention
to treat
Between-
group
comparison
Point
measurem
ent and
measures
of
variability
Total Power Quality
Ahlborg et al,
2006 [52]
Yes Yes No Yes No No No Yes No No Yes 5/10¤ No low
Balavý et al,
2008 [56]
Yes Yes No Yes No No Yes Yes No Yes Yes 6/10¤¤ No low
Bautmans et
al, 2005 [54]
Yes Yes No Yes Yes No Yes Yes No Yes Yes 7/10¤ No medium
Bruyere et al,
2005 [53]
Yes Yes No Yes No No No Yes Yes Yes Yes 6/10¤ No low
Cheung et al,
2007 [58]
No Yes Yes Yes No No No Yes No Yes Yes 6/10¤ Yes medium
Cochrane et
al, 2004 [40]
Yes Yes No Yes No No No No No No Yes 5/10¤¤ No low
Delecluse et
al, 2003 [37]
Yes Yes No Yes No No No Yes No Yes Yes 5/10¤¤ Yes low
Ebersbach et
al, 2008 [48]
No Yes No Yes No No Yes No No Yes Yes 5/10¤¤ No low
- 18 -
18
Gusi et al,
2006 [59]
Yes Yes No Yes No No No No Yes Yes Yes 5/10¤ No low
Haas et al,
2006 [49]
Yes Yes No Yes No No Yes Yes No Yes Yes 6/10¤ No low
Kvorning et
al, 2006 [41]
No Yes No No No No No Yes Yes Yes Yes 5/10¤¤ No low
Moezy et al,
2008 [46]
Yes Yes No Yes No No No Yes No Yes Yes 5/10¤ No low
Rees et al,
2008 [60]
No Yes No Yes No No No Yes Yes Yes Yes 6/10¤¤ Yes medium
Russo et al,
2003 [57]
Yes Yes No Yes No No No Yes No Yes Yes 5/10¤¤ No low
Rönnestad,
2004 [38]
Yes Yes No Yes No No No Yes No Yes Yes 5/10¤¤ No low
Sands et al,
2006 [47]
Yes Yes No Yes No No No Yes No Yes Yes 5/10¤¤ No low
Schuhfried et
al, 2005 [50]
Yes Yes No Yes No No Yes Yes No Yes Yes 6/10¤ No low
Tihanyi et al,
2007 [51]
Yes Yes Yes Yes No No No Yes No No Yes 6/10¤ No low
Torvinen et al,
2002 [42]
No Yes No Yes No No No Yes No Yes Yes 5/10¤¤ No low
Torvinen et
al, 2001 [44]
No Yes No Yes No No No Yes No Yes Yes 5/10¤¤ Yes low
- 19 -
19
Torvinen et al,
2002 [43]
No Yes No Yes No No No Yes No Yes Yes 5/10¤¤ No low
Torvinen et
al, 2003 [45]
No Yes No Yes No No Yes Yes Yes Yes Yes 7/10¤ No medium
van den Tillaar et
al, 2006 [39]
No Yes No Yes No No No Yes No Yes Yes 6/10¤¤ No low
van Nes et al,
2006 [36]
Yes Yes Yes Yes No No Yes Yes Yes Yes Yes 8/10¤ No high
Verscheueren et
al, 2004 [55]
No Yes No Yes No No Yes No No Yes Yes 5/10¤ No low
¤ Rating confirmed by PEDro ¤¤ Rating confirmed by two assessors.
- 20 -
20
Table 2 Fourteen studies were excluded due to focus or study design
Study Cause for exclusion
Turbanski et al, 2005 [34] Not RCT
Haas et al, 2006 [29] Not RCT
Gilsanz et al, 2006 [28] Not RCT
De Ruiter et al, 2003 [27] Not RCT
Roelants et al, 2004 [32] Not RCT
Cardinale et al, 2003 [24] Not RCT
Kerschan-Schindl et al, 2001 [30] Not RCT
Slota et al, 2008 [33] Not RCT
Cardinale et al, 2007 [25] Not WBV
Cardinale et al, 2006 [26] Endocrine system
Di Loreto et al, 2004 [7] Endocrine system
Lohman et al, 2007 [31] Skin blood flow
Da Silva et al, 2007 [5] Energy expenditure
Verchueren et al, 2007 [35] Congress poster
- 21 -
21
Table 3. Numbers of randomized/lost to follow-up, number of measurements, characteristics, intervention, placebo, sham, or control treatment,
outcomes and study quality for the 24 included studies and outcome differences between groups.
Study No randomized/
lost to follow up,
No of
measurements
Characteristics Technical device/
Intervention
Placebo, sham or
control
treatment
Frequency and
duration of
intervention
Outcomes Differences between groups Quality
Ahlborg et
al, 2006
[52]
Sweden
14/0
WBV: 7/0
CG: 7/0
At baseline and
after intervention.
13 with cerebral
palsy with spastic
diplegia and one
hereditary spastic
diplegia; 6
women, 8 men.
Incl: walk without
assistive device.
Excl: pain,
pregnancy,
medication
against spasticity.
WBV: 32 years
CG: 30 years
NEMES-LSC
25-40Hz,
5min. warm-up,
6min. WBV
including rest and
stretching.
5min warm-up,
progressive
resistance
training, leg press
10-15 reps 2min
rest between,
stretching.
3/wk for 8 wks.
Total 144min
Spasticity
using Modified
Ashworth
Scale,
isokinetic
muscle
strength,
6-minute Walk
Test, Timed
Up and Go
test,
Gross Motor
Function
For spasticity not reported
Muscle strength ns.
Gross Motor Function Measure
ns.
Balance (body function) ns.
low
Balavý et 20/1 20 highly Galileo space Bed rest with 30° 8 wks of bed rest MRI Less atrophy*of multifidus low
- 22 -
22
al, 2008
[56]
Germany
WBV: 10/1
CG: 10
At baseline and at
6 months.
motivated healthy
men.
Excl: Smoking,
current
medication, any
relevant medical
disorder, current
competitive sports
and a BMI <20 or
>28
WBV: 32.6 (4.8)
years.
CG: 33.4 (6.6)
years.
exercise device
Novotec, Germany,
19-26Hz,
amp 3,5-4mm. Bed
rest with 30° head-
up tilt. All hygiene
performed in supine
position. Force
sensors and video
was used to monitor
activities.
2 exercise sessions
daily for
approximately 5-
10min including
squatting from 90°
full to almost full
extension, heel
raises, toe raises and
“kicks”, on the
platform.
head-up tilt. All
hygiene
performed in
supine position.
Force sensors and
video used to
monitor activities.
No activity.
with 2
treatments/day
5-10min
exercises.
Unable to
calculate total
time.
measurements
of muscle
cross-sectional
area for erector
spinae,
multifidus,
antero-lateral
abdominals,
iliopsoas,
quadratus
lumborum and
rectus
abdominis at
level L4.
Lumbar spine
morphology
(length,
sagittal disc
area and height
and
intervertebral
angles).
muscle for WBV compared to
CG.
In the long-term multifidus
atrophy did not persist ** for
WBV compared to CG.
Reduction of spinal
lengthening* and of increased
disc area* for WBV compared
to CG.
Bautmans
et al, 2005
[54]
Belgium
24/3
WBV: 13/3
CG: 11/0
Institutionalised
elderly persons;
15 women, 9
men.
Power-Plate.
Progressive using 6
static exercises with
WBV targeting
Exercises as
intervention
without WBV but
with tape-
3/wk for 6 wks.
21 completed
the program.
Attendance rate
Maximal grip
strength
Tinetti test,
Timed Up and
Muscle function ns.
Tinetti test total**
Tinetti balance test**.
Timed up and Go test* for
medium
- 23 -
23
At baseline and
after intervention.
Incl: Within
dependence
categories O, A
and B according
to Katz.
Excl: contra
indicators for
WBV and
cognitive or
physical
dysfunction
interfering with
test and training
procedures.
WBV: 76.6 (11.8)
years.
CG: 78.6 (10.4)
years.
lower limb muscles.
30-50Hz,
amp 2-5mm.
Series of 30-60s.
training with
30-60s rest between
series.
In addition to 2
weekly seated
gymnastic sessions.
recorded sound of
vibration
imitating WBV.
In addition to 2
weekly, seated
gymnastic
sessions.
96% in WBV,
and 86% in the
CG.
Total: 118min.
Go, back
scratch and
chair sit-and-
reach test.
Closed chain,
bilateral leg
extension
using a linear
isokinetic
multi-joint
dynamometer
at 40 and 60
cm/s.
WBV compared with CG.
Bruyere et
al, 2005
[53]
Belgium
42/2
WBV: 22/2
CG: 20/0
At baseline and
after intervention.
Nursing home
residents; 31
women, 11 men.
Incl: Ambulatory
Excl: no major
cognitive
disorders, high
risk of
4 series of 1min.
WBV alternating
with 90s of rest.
Serie 1 and 3:
10Hz amp 3mm.
Serie 2 and 4:
26Hz amp 7mm.
In addition to PT
PT (gait and
balance and
strengthening
exercises) 10min
3/wk.
3/wk for 6 wks.
Total 72min.
Tinetti test,
Timed Up and
Go, Medical
Outcome
Study 36-item
Short-Form
Health Survey.
Tinetti gait test**.
Tinetti balance test**
Tinetti total**
Timed Up and Go test** for
WBV compared to CG.
low
- 24 -
24
thromboembolism
or history of hip
or knee joint
replacement.
WBV: 84.5 (5.9)
years.
CG: 78.9 (6.9)
years.
(gait, balance and
strengthening
exercises) 10min,
3/wk.
Cheung et
al, 2007
[58]
Hong Kong
75/6
WBV: 50/5
CG: 25/1
At baseline and
after intervention.
Women >60 years
Incl: standing
without support.
Excl: having any
hormonal
replacement
therapy or drug
treatment that
could affect
normal
metabolism of
musculoskeletal
system, having
any hypo- or
hyperparathyroidi
sm, renal, liver or
chronic disease,
being previous or
Galileo 900,
20Hz, amp 0-
5.3mm.
Standing bare feet
for 3min/day for 3/
wk for 3 months.
No treatment 3/wk for 3
months.
Total 108min.
The mean
compliance for
treatment was
93.3%.
Stability
(Basic Balance
Master system)
Subjects were
instructed to
sway the body
toward 8
surrounding
target
positions.
The measured
parameters
included
reaction time,
movement
velocity,
directional
control,
Movement velocity**
Maximal excursion**
Directional control* for WBV
compared to CG.
Functional reach test ns.
medium
- 25 -
25
current smokers
or drinkers and
having habitual
exercise or
participate in any
supervised
exercise.
endpoint
excursion, and
maximum
excursion.
Functional
teach test.
Cochrane
et al, 2004
[40]
New
Zealand
24/0
WBV: 12/0
CG: 12/0
At baseline and
after 9 days.
Healthy
participants
within non-
competitive team
sports with a
training frequency
of at least once a
week and little
experience in
power, speed and
agility training.
Age 23.9 (5.9)
years.
WBV 8 men, 4
women.
CG 8 men, 4
women.
Galileo 2000,
26Hz, amp 11mm.
2min exposures
separated by 40s
rest in 5 different
body positions.
These positions
were 1) standing
upright, 2) squatting
knee angel 90°, 3)
squat at knee at 90°
with feet externally
rotated, 4) single
right leg standing at
a knee angel of 90°,
and 5) single left leg
standing at knee
angel of 90°.
On the floor and
performing
exactly the same
body positions
and time without
vibration
9 days treatment
composed of 5
consecutive days
separated by 2
days of recovery
followed by
another 4
consecutive days
of treatment.
2min exposures
separated by
40s rest of in 5
body positions.
Total 90min.
CMJ, sprint
test, agility-
505, Up and
Back test and
discomfort
with CRPD.
CMJ, agility, and sprint test ns. low
Delecluse 74/7 Young female Power Plate PL: the same 3/wk for 12 wks. With motor- Muscle strength** for WBV low
- 26 -
26
et al,
2003 [37]
Belgium
WBV: 20/2
RES: 20/2
PL: 21/2
CG: 13/1
At baseline and
after 12 wks (at
least 72 hours
after training
termination).
adults, none
engaged in
regularly
organized
physical activities
or in sports or
strength training.
Excl: pregnancy,
acute hernia,
diabetes, epilepsy,
and any history of
severe
musculoskeletal
problems.
WBV: 21.5 (2.1)
years.
RES: 21:4 (2.1)
years.
PL: 22.2 (1.4)
years.
CG: 20.6 (1.7)
years.
35-40Hz,
amp 2.5-5mm.
Progressive load
training in squat,
deep squat, wide-
stance squat, one
legged squat and
lunge.
program as WBV
but without
vibrations but on
the platform.
RES: 20min.
warm-up and a
progressive
program similar
to the WBV
program but at a
gym.
CG did not
participate in any
training program.
Unable to
calculate total
time.
driven
dynamometer
isometric,
dynamic and,
ballistic tests
for knee
extensors.
CMJ.
and RES compared to CG and
PL.
Ballistic strength ns.
CMJ*.
Ebersbach
et al, 2008
[48]
Germany
27/6
WBV: 14/4
CG: 13/2
Patients with
idiopathic
Parkinson`s
disease.
Galileo Novotec
Medical Systems,
Germany.
25Hz,
Standard balance
training including
exercises on a tilt
board in addition
2 times 15min 5
days/wk for 3
wks.
The plate
Tinetti Balance
Scale score,
Walking
velocity
All measurements ns. low
- 27 -
27
At baseline after
3 wks and 4 wks
after termination
of treatment.
Incl: Scoring at
least 1 point on
item 30 of the
UPDRS.
Excl: Severe
response
fluctuations or
other conditions
requiring
modification of
medication,
dementia, balance
impairment due to
graphic
assessments
WBV: 7 men/3
women.
72.5 (6.0) years.
CG: 7 men/ 4
women.
75.0 (2.7) years.
amp 7-14mm.
2 times 15min
WBV/day 5 days/
wk in addition to 3
times 40min
training consisting
relaxation
techniques, muscle-
stretching speech
therapy and
occupational
therapy.
5/wk for 3wks.
to 3 x 40min.
training
consisting of
relaxation
techniques,
muscle-stretching
speech therapy
and occupational
therapy.
5/wk for 3 wks.
changes the
vibrations
between right
and left leg.
Total 45min.
(10m walk),
stand-walk-sit
test and
UPDRS.
Gusi et al,
2006 [59]
Spain
36/8
WBV: 18/4
CG: 18/4
Postmenopausal
women.
Incl: at least 5
years from last
menstruation;
Novotc GmBH,
Pforrzheim,
Germany
12,6Hz,
amp 3mm.
Walking group
Each 1-hour
session of
walking was
interspaced with
3/wk for 8
months.
Total 549min.
Blind flamingo
test.
Blind flamingo test*
BMD in femur**.
BMD in lumbar spine ns.
low
- 28 -
28
At baseline and
after treatment
termination.
adequate
nutritional status
according to
WHO norms; non
smoker;
consumption of
no more than four
alcoholic
beverages per
week; the ability
to follow the
protocol; free
from disease or
medication
known to affect
bone metabolism
or muscle
strength.
Excl: Acute
hernia,
thrombosis, any
pharmacologic
intervention for
osteopenia within
the previous 6
months, any
10min warm up.
Standing at 60°
knee angel barefoot
on the plate.
Wk 1-2: 1min x 3
with 1min rest.
Wk 3: 1min x 4
Wk 4: 1min x 5
Wk 5-32: 1min x 6.
two periods of
5min each
including
stretching
exercises.
- 29 -
29
history of severe
musculoskeletal
problems,
engaged in high-
impact activity at
least twice a
week.
Haas et al,
2006 [49]
Germany
68/ 0
(Cross-over
design)
At baseline and
after treatment.
Persons with med
Parkinson’s
disease; 15
women, 53 men.
Incl: standing
without
assistance.
Excl: dementia,
diseases affecting
walking ability,
standing or
coordination.
WBV: 64.1 (7.0)
years.
CG: 65.8 (8.3)
years.
ZEPTOR®
Mean 6Hz,
amp 3mm.
Resting. One occasion
with 5 series of
VT taking 1min.
with 1min. rest
between each
series.
Total 5min.
UPDRS motor
score
and subscales
reflecting
tremor,
rigidity,
bradykinesia,
gait and
posture and
cranial
symptoms.
Not reported. low
Kvorning
et al, 2006
[41]
28/0
WBV: 9/0
28 moderately
trained young
men with no or
Galileo 2000
20-25Hz,
amp 4mm.
Squat 6 sets of 8
reps of weight
loaded squats on
1-3/wk for 9
wks.
Total 61.5min.
1) One leg
isometric
MVC
MVC ns.
EMG ns.
CMJ ns.
low
- 30 -
30
Denmark WBV + Squat:
10/0
Squat: 9/0
1) At baseline and
after 9wks.
2) At baseline
after 1wk and
after 9wks.
minor experience
of resistance
training.
Excl: angina
pectoris, low back
pain, prescribed
heart or lung
medicine, trauma
to any part of the
body.
S: 24 (1.7) years.
WBV: 23 (0.7)
years.
WBV + S: 23
(0.6) years.
20Hz during wk 1-5
and 25Hz during wk
6-9.
WBV: 6 sets of 8
reps of 30s squat
without weight load
on the vibrating
platform with 2min.
rest between sets.
WBV + S: 6 sets
with med 10RM
squad at the
vibrating platform
with 2min. rest
between sets. The
training loads were
adjusted every fifth
training session
Wk 1: ½ training
session
Wk 2: 1 training
session
Wk 3-4: 2 training
floor with 2min.
rest between sets.
performed in a
custom-built
leg press
device. During
MVC test
EMG signals
were
measured.
CMJ on a
force platform.
2) Blood
samples for
analysis of
testosterone,
GH and
cortisol.
Power* in S compared with
WBV.
- 31 -
31
sessions
Wk 5-9: 3 training
sessions
Moezy et
al, 2008
[46]
Iran
23/3
WBV: 12/2
CG: 11/1
At baseline and
after 4wks.
Competitive
athletes on
national or
international level
with anterior
cruciate ligament
reconstructive
surgery 3 months
before,
Excl: previous or
concomitant
injury or surgery
of the relevant
knee, and other
joints, history of
surgery or
traumatic injuries
to the contra-
lateral limb, not
full range of
motion in the
reconstructed
knee, history of
Powerplate USA.
30-50Hz,
amp 2.5-5mm.
10min warming-up
in addition to 3
times/wk training
from session 1 30s
with 60s in different
positions total 4min.
to a total of 16min.
at session 12.
10min warm-up
in addition to
conventional
strengthening
exercises
program.
3/wk for 4 wks.
Total 139.5min.
Postural
stability by
Biodex
stability
system that
measures the
deviation of
the
COP. Knee
position sense
test with
Biodex
dynamometer.
Position test at 60°** for
operated and non-operated knee
in WBV compared to CG. At
30° only** for operated knee
for WBV compared to CG.
Postural stability* for WBV
compared to CG.
low
- 32 -
32
medical problems
such as heart
disease that
limited activities
and history of
contraindication
for WBV.
WBV: 24.51
(3.38) years.
CG: 22.7 (3.77)
years.
Rees et al,
2008 [60]
Australia
30/2
WBV: 15/0
CG: 15/2
At baseline and
after 4wks and
8wks.
Older healthy
volunteers; 16
men, 14 women.
Excl: <65 years,
prosthesis, any
neurological,
musculoskeletal
or other chronic
disease,
participation in a
resistance training
program, a recent
fracture or bone
injury and any
Galileo Sport
platform.
26Hz,
amp 5-8mm.
5min warm-up
Two 4 wks blocks
consisted of 6 sets
static squats max
100° flexion.
Block 2: 6 sets
dynamic squatting
and then calf raise.
WBV and rest 45s
The same
program as WBV
but without
vibration.
3/wk in
8 wks.
Total 150min.
Bilateral
strength and
power of the
hips, knees and
ankles with
isokinetic
dynamometer
at angular
velocity of 60°
for hip and
knee and 30°
for the ankle.
Hip joint ns.
Knee joint ns.
Ankle joint dorsiflexors ns.
Ankle joint plantarflexors** for
WBV compared to CG.
.
medium
- 33 -
33
medication that
could affect
strength
adaptation and
adverse effects as
a result of the
study.
WBV: 74.3 (5)
years.
CG: 73.1 (4.1)
years.
first wk increase by
5s every wk to 80s.
Russo et al,
2003 [57]
Italy
33/4
WBV: 17/3
CG: 16/1
At baseline and
after 6 month.
Women
belonging to a
hospital
volunteers
association. At
least 1 year
postmenopausal
and not affected
by conditions that
contraindicated
vibration training.
Excl: metabolic
bone disorders.
WBV: 67.7 (6.1)
years.
Galileo 2000
Uniterm.
12-28Hz during the
first month
progressively
increased to 28Hz,
during the following
5 months 28Hz.
Amp not stated.
WBV. Standing on
the board with
knees slightly flexed
receiving 3 1min.
bouts of vibration
separated by 1min.
No training. 2/wk for 6
months.
Total 264min.
Power, force
and, velocity
obtained by
jumping on a
force plate.
Blood and
urine tests.
Bone
characteristics
measured by
computed
tomography.
Velocity** and power* in
WBV compared to CG. Muscle
force ns.
Bone characteristics ns.
low
- 34 -
34
CG: 61.4 (7.3)
years.
resting period.
During the
following 5 months
of 2min. bouts.
Average 34 sessions
of 44 corresponding
to about 200min of
treatment.
Rönnestad,
2004 [38]
Norway
16/2
VT: 8/1
Kon: 8/1
At baseline and
after 5wks.
Healthy men 21-
40 years. Incl:
able to lift at least
2.2 times their
body weight in a
1RM squat and
regularly
participating in
resistance training
minimum 3/wk
during the last
year.
NEMES-LC
40Hz,
amp not stated.
Conventional squats
on platform 3/wk.
during wk. 1,3 and 5
and 2 times/wk.
during wk. 2 and 4.
Conventional
squats without
vibration. All
subjects were
supervised by the
investigator at
every workout
during the first 2
wks and thereafter
at least once a
week.
5 wks exercise 3
times/wk. during
wk 1, 3 and 5.
3 times/wk
during wk 2 and
4. A total of 13
workouts.
The volume and
intensity were
altered similarly
in both groups
Total vibration
time not stated.
Strength
measured with
1RM and
CMJ.
1RM ns.
CMJ ns.
low
Sands et al,
2006 [47]
United
Kingdom
10/0
WBV: 5/0
CG: 5/0
At baseline and
Young male
gymnasts
participating in
intensive
gymnastics
Custom built
vibration device
30Hz,
amp 2mm.
Standard warm-up
Standard warm-
up and the same
stretch but
without vibration.
Acute and long
Acute 4min
Long term 5
times/wk for 4
wks.
Total 4min and
Forward splint
test
measurement
taken of the
height of the
Acute effect increased ** for
right rear split and* for left rear
split. After 4 wks
increased*only for right rear
split compared with CG.
low
- 35 -
35
after 1 and after 4
wks of treatment.
training 5 days a
week 3-4 hours at
the US Olympic
Training Centre,
Colorado Springs.
Total sample 10.1
(1.5) years.
Forward split
stretching on the
vibration device in
two positions.
Stretching to
discomfort for 10s
followed by 5s rest
for 1min (i.e., left
and right forward
leg and rearward
leg) total 4min.
Acute only 4min
Long term 5
days/wk for 4 wks.
term. 80min. anterior
superior iliac
spine via
palpation and
comparison
with a vertical
meter stick.
Schuhfried
et al, 2005
[50]
Austria
12/0
WBV: 6/0
CG: 6/0
At baseline and
15min, 1wk and
2wks. after
termination of
intervention.
Persons with
Multiple
Sclerosis; 9
women 3 men.
Incl: balance
problems, gait
disability and/ or
ataxia, Expanded
Disability Status
Scale ≤ 5.
Excl: pregnancy,
pacemaker,
ZEPTOR®
Beginning with 1Hz
slowly increasing
until not tolerated
more increase.
Amp 3mm.
Standing on the
platform in squat
position
One occasion with 5
series x 1min,
1min between each
Same position
without vibration
but with
Application of
Burst-TENS on
non-dominant
forearm as
placebo.
One occasion
with 5 series x.
1min, 1min
between each
series.
Dynamic
posturography
(SOT) with a
SMART
Equitest
System, Timed
Up and Go
test,
Functional
Reach test
Significant improvement for
Timed Up and Go test* in
WBV-group 1 wk after
intervention.
All other tests were ns.
low
- 36 -
36
epilepsy, malign
tumours,
endoprostesis, etc.
WBV: 49.3 years
(13.3).
CG: 46 years
(12.7).
series.
Tihanyi et
al, 2007
[51]
Hungary
18/2
WBV: 9/1
CG: 9/1
At baseline and
after intervention.
Persons with first
stroke (within 15-
50 days); 9
women, 9 men.
Incl: Functional
Independence
Measure 60-110.
Excl: angina
pectoris,
congestive heart
failure, peripheral
arterial disease,
severe dementia,
language
problems, painful
orthopaedic
conditions during
vibration
treatment.
Nemes-Bosco
20Hz,
amp 5mm in
addition to daily
rehabilitation.
Standing on the
platform with 40° of
knee flex for one
min. and sitting on
chair during the
resting time.
Same exercises
but vibrations not
turned on.
One occasion
with 6 series x
1min, 2min
between each
series.
Strength using
a computerized
dynamometer;
Maximum
isometric and
eccentric
torque of the
knee extensors
in the affected
leg
Myoelectrical
activity
affected leg.
Not reported. low
- 37 -
37
Total sample:
58.2 (9.4) years.
Torvinen et
al, 2002
[44]
Finland
16/0
At baseline and
2min, 60min after
termination of
intervention
Young healthy
volunteers, 8
women and 8
men.
Excl. Any
cardiovascular,
respiratory,
abdominal,
urinary,
gynaecological,
prosthesis,
medication that
could affect the
musculoskeletal
system, menstrual
irregularities and
regular
participation in
impact-type
exercise more
than 3/wk.
Total sample 18-
35 years.
Kuntotäry, Erka Oy
Min 1 = 25Hz,
min 2 = 30Hz,
min 3 = 35Hz,
min 4 = 40Hz.
Amp 2mm.
4min warm-up on a
bicycle ergo meter.
4min of intervention
on the plate subjects
repeated 4 times a
60s light exercise
programme.
4min warm-up on
a bicycle
ergometer.
4min of
intervention on
the plate subjects
repeated 4 times
in a 60s light
exercise
programme.
One
occasion/day
Total 4min.
Day 1.
Postural sway
on a biodex
platform. Leg
extensor
strength.
Grip strength.
Day 2.
6m tandem
walk
backwards,
CMJ and
shuttle run test.
Performance test or balance test
after 2 or 60min ns.
low
Torvinen et 16/0 Young healthy Galileo, 2000. 4min warm-up on One Day 1. After 2min isometric strength, low
- 38 -
38
al, 2002
[42]
Finland
At baseline and
2min, 60min.
after termination
of intervention.
volunteers 8
women and 8
men.
Excl: Any
cardiovascular,
respiratory,
abdominal,
urinary,
gynaecological,
neurological,
musculoskeletal,
or other chronic
diseases,
pregnancy,
prosthesis,
medication that
could affect the
musculoskeletal
system, menstrual
irregularities and
regular
participation in
impact-type
exercise more
than 3/wk.
Total sample 24-
Min 1=15 Hz,
min 2=20 Hz,
min 3=25 Hz,
min 4=30 Hz.
Amp 10mm.
4min warm-up on a
bicycle ergo meter.
4min of intervention
on the plate subjects
repeated 4 times a
60s light exercise
programme.
a bicycle
ergometer.
4min of
intervention on
the plate without
vibration subjects
repeated 4 times a
60s light
exercises.
occasion/day.
Total 4min.
Postural sway
on a Biodex
platform. Leg
extensor
strength.
Day 2.
6m tandem-
walk
backwards,
CMJ, and
shuttle run test.
CMJ and body sway* for WBV
compared to CG.
Shuttle run and grip strength
ns.
At 60min all tests were ns.
- 39 -
39
33 years.
Torvinen et
al, 2002
[43]
Finland
56/4
WBV: 28/2
CG: 28/2
At baseline and at
2 and 4 months.
Non athletic
volunteers; 35
women, 21 men,
Excl:
cardiovascular,
respiratory,
abdominal,
urinary,
gynaecological,
neurological,
musculoskeletal
or other chronic
disease;
medications that
could affect the
musculoskeletal
system; menstrual
irregularities;
participation in
impact-type
exercises more
than 3/wk.
WBV: 23.2 years
(4.4).
CG: 25.5 years
Kuntotäry, Erka Oy
25-40Hz,
amp 2mm.
4min warm up
bicycle ergometer.
Standing on the
platform repeating
four times a 60s
light program.
Wk. 1-2: 2min
loading.
1min 2Hz,
1min 30Hz.
Wk 3-8: 3min
loading
25Hz/60s +
30Hz/60 s +
35Hz/60s.
Wk 9-16: 4min
loading
25Hz/60s +
30Hz/60s +
35Hz/60s +
40Hz/60s.
Not stated
3-5/wk for
4 months
(in average
3.1 (0.9)
times/wk).
Total 183 to
370min.
Postural sway
on platform,
Shuttle run test
CMJ, Grip
strength and
isometric leg
extension test.
CMJ** at 2 and 4 months for
WBV compared to CG.
Extension strength* at 2
months for WBV compared to
CG, at 4 months ns.
All other tests were ns.
low
- 40 -
40
(5.8).
Torvinen et
al, 2003
[45]
Finland
56/3
WBV: 28/1
CG: 28/2
(1-3) At baseline
and after
termination of
intervention.
2) At baseline and
at 3, 6 and 8
months.
Non-athletic
volunteers; 35
women, 21 men.
Excl:
cardiovascular,
neurological,
musculoskeletal
or other chronic
diseases;
pregnancy,
prostheses;
medications that
could affect the
musculoskeletal
system; menstrual
irregularities;
participation in
impact-type
exercises more
than 3 times/ wk.
WBV: 23.1 years
(4.3)
CG: 25.5 years
(5.8)
Kuntotäry, Erka Oy.
25-45Hz,
amp 2mm.
4min warm up
bicycle ergometer
Wk 1-2: 2min.
loading,
1min 25Hz,
1min. 30Hz.
Wk 3-8: 3min.
loading 25Hz +
30Hz + 35Hz/60s.
Wk 9-16: 4min.
loading 25Hz +
30Hz + 35Hz +
40Hz/60s.
Last 4 months:
30Hz + 35Hz +
40Hz + 45Hz/60s.
Not stated 3-5/wk for 8
months.
Reported mean
vibration
training
attendance 2.8
(0.8)/ wk.
Total between
375min and
690min.
1) Bone mass,
structure and
strength by
DXA (lumbar
spine, right
proximal
femur,
calcaneus,
nondominant
distal radius)
and pQCT
(tibia).
2) Serum
markers of
bone turnover
3) Vertical
countermovem
ent jump test
for lower limb
explosive
performance
capacity.
Static body
balance by
CMJ** at 8 months in WBV
compared to CG.
All other tests were ns.
medium
- 41 -
41
postural sway
platform. Grip
strength by
grip strength
meter.
Maximal
isometric
strength of leg
extensors by
dynamometer
Dynamic
balance or
agility by a
Shuttle run
test.
Van den
Tillaar,
2006 [39]
Norway
19/1
WBV: 10/0
CG: 9/1
At baseline and
after each training
wk.
19 undergraduate
students from
department of
Sports and
Exercise
Sciences, Sogn
and Fjordane
University
College Sogndal,
Norway.
21.5 (2.0) years.
Nemes Bosco
system.
28Hz, amp 10mm.
5min warm-up,
systematically
stretching of
hamstring 3/leg
according to method
by Bandy and Iron.
Before each
stretching exercise
5min. warm-up,
systematically
stretching of
hamstring 3 times
per leg according
to method by
Bandy and Iron.
3/wk for 4 wks.
Total 36min.
Passive stretch
of the
hamstrings
measured with
a goniometry.
ROM in
degrees. An
average of 3
measurements
was used.
Range of motion** in WBV
compared to CG.
low
- 42 -
42
30s of vibration in
90° of knee squat.
Van Nes et
al, 2006
[36]
The
Nether-
lands
53/ 2
WBV: 27
CG: 26/2
At baseline, after
intervention and 6
wks after
termination of
intervention.
Persons within 6w
from first acute
stroke; 23
women, 30 men.
Incl: 40 or less at
Berg Balance
Scale.
Excl: motor or
sensory
dysfunctions not
related to stroke.
Use of medication
affecting postural
control, severe
cognitive
problems + contra
indicators for
WBV.
WBV: 59.7 (12.3)
years.
CG: 62.6 (7.6)
years.
Galileo 900
30Hz, amp 3mm.
In addition to PT
they had WBV for 4
sessions of 45s,
1min rest between
sessions.
In addition to PT
they received
EMT for 4
sessions 45s,
1min rest between
sessions.
5 days/wk for 6
wks.
Total 90min.
Bergs Balance
scale. Trunk
Control test,
Barthel Index,
Rivermead
Mobility
Index, FAC.
All tests were ns. high
- 43 -
43
Verscheuer
en et al,
2004 [55]
Belgium
70/ 0
WBV: 25
RES: 22
CG: 23
At baseline and 6
months after
termination
Seventy
postmenopausal
women.
23 age-matched
controls.
Incl: Between 60
and 70 years of
age, non-
institutionalized
and free from
diseases or
medications
known to affect
bone metabolism
or muscle
strength.
Excl: Total body
BMD T-score of
less than –2.5.
WBV: 64.6 (3.3)
years.
RES: 63.9 (3.8)
years.
CG: 64.2 (3.1)
years.
Power Plate,
35-40Hz,
amp 1.7-2.5mm.
Static and dynamic
knee-extensor
exercises (squat,
deep squat, wide
stance squat, one-
legged squat and
lunge) on the plate.
Max 30min.
including warming
up and cooling
down.
CG did not
participate in any
training.
RES. Trained
3/wk for 24 wks
with a knee-
extensor exercise
program.
Duration
maximum of
30min including
warm up and
cooling down.
Unable to
calculate total
time.
Postural sway,
isometric and
dynamic
strength of
knee
extensors.
BMD of total
hip and total
body. Serum
osteocalcin
and CTX.
Isometric strength** for WBV
and RES compared to CG.
Isotonic strength** for WBV
and* for RES compared to CG.
Between WBV and RES ns in
either isometric or isotonic
strength.
Antero-posterior sway after
arm abd ** and mediolateral
sway after anteflexion* for
WBV compared to CG.
Total hip BMD**for WBV
compared to both RES and CG.
Total body BMD ns between
any group.
low
- 44 -
44
* p<0.05; ** p>0.01; ns non-significant change, amp = amplitude, BMC=Bone Mineral Content, BMD=Bone Mineral Density, jump, COP = centre of pressure, CMJ=
countermovement jump, CG=control group, CRPD= category-ratio scale, CTX = C-teleopeptide, DAX = dual energy X-ray absorptiometry, EG= exercise group,
EMG=electromyography, EMT = exercise therapy to music , FAC = Functional Ambulatory Category, GH = Growth hormone, MVC = Maximal voluntary contraction
PL=placebo, PT=physiotherapy, pQCT = peripheral quantitative computed tomography, RES=resistance training program, RM=repetition maximum, SOT=sensory
organization test, UPDRS= Unified Parkinson’s Disease Rating Scale, WBV= whole body vibration.
- 45 -
45
Appendix
Evidence Grade refers to the total scientific evidence for a conclusion.
Evidence Grade 1 – Strong Scientific Evidence
A conclusion assigned Evidence Grade 1 is supported by at least two studies with high study
quality and relevance among the total scientific evidence. If some studies are at variance with
the conclusion, the Evidence Grade may be lower.
Evidence Grade 2 – Moderately Strong Scientific Evidence
A conclusion assigned Evidence Grade 2 is supported by at least one study with high study
quality and relevance, as well as two studies with medium study quality and relevance, among
the total scientific evidence. If some studies are at variance with the conclusion, the Evidence
Grade may be lower.
Evidence Grade 3 – Limited Scientific Evidence
A conclusion assigned Evidence Grade is supported by at least two studies with medium
study quality and relevance among the total scientific evidence. If some studies are at variance
with the conclusion, the Evidence Grade may insufficient or contradictory.
Insufficient Scientific Evidence
If no studies meet the study quality and relevance criteria, the scientific evidence is rated as
insufficient to draw any conclusions.
Contradictory Scientific Evidence
If different studies are characterized by equal study quality and relevance but generate
conflicting results, the scientific evidence is rated as contradictory and no conclusions can be
drawn [23].