Whole Body Vibration Therapy Jared Berger Objectives After

Whole Body Vibration Therapy Jared Berger

Objectives After this presentation, you will better understand… Uses of Whole Body Vibration Therapy (WBVT) History of WBVT How WBVT can be used in physical therapy practice Parameters of WBVT Evidence concerning WBVT in various patient populations Cost of WBVT equipment

What is WBVT?

What is WBVT?

What is WBVT? Users lay, sit, or stand on a platform that vibrates rapidly in one or more directions 1 Advocates state that whole-body vibration can aid in weight loss, burn fat, improve flexibility, enhance blood flow, reduce muscle soreness after exercise, build strength, and decrease cortisol 2 Increases bone density

Popularity Whole body vibration used to be heralded as a tool for weight loss or body fat reduction, now it is being investigated for improving athletic performance, for neurological disorders such as Parkinson’s, MS, and post-stroke pts 3 Olympic athletes are starting to incorporate WBV into training and rehab 3 Professional teams such the Denver Broncos, Oakland Raiders, Los Angeles Dodgers, and Chicago Bears among others are using WBV 4 Celebrities are taking part such as Mark Wahlberg, Cindy Crawford, and Clint Eastwood 4 Tied to Russian astronauts staying in space for 420 days vs American astronauts being limited to only 120 days 4 Has been featured on Good Morning America and The Doctors 5

History of Vibration Used by ancient Greeks by using a bow and vibrating the string over the wounds of soldiers, led to faster healing 5 Dr. Jonas Gustav Zander designed, and John Kellogg improved the original design in 18955 Whole body vibration was used and researched by the former Soviet Union in the 1960’s for cosmonaut use to fight muscle and bone loss while in space 4 Russian Olympians used WBV in the 1980’s during their Olympic dominance 5 Research using modern WBVT machines is from the past 15 years 1

Premise of WBVT As the machine vibrates, it forces the muscles to contract and relax dozens of times each second 2 Wolff’s Law – bone is constantly altering its shape, strength, and density in response to external factors 6 Bone reacts to stress by building more bone

Indications & Contraindications Indications Reduce back pain, improve strength and balance in older adults 2 Neuropathic pain, muscle pain 7 *Increase bone mineral density (BMD)8 Contraindications Blood thinning medications, advanced diabetes, heart disease, pregnancy 7 Relative 9 epilepsy, gall/bladder/kidney stones, tumors (excluding metastases in musculoskeletal system), spondylolisthesis, lymphatic edema, acute RA Absolute 9 Acute or chronic DVT, spondylosis, severe osteoporosis, tumors with metastases in musculoskeletal system), vertigo or positional dizziness

Use for Physical Therapy Billing Could Ther not find a specific CPT code for vibration therapy Ex: 97110 Neuromuscular Re-ed: 97112

Use for Physical Therapy Exercises Strengthening, stabilization, balance, flexibility

Parameters 2 types of vibration: both of which can be used high or low frequency 1 Lineal refers to up and down movement of the platform Pivotal or reciprocating refers to “teeter-totter” movement Intensity is determined by amplitude, frequency, and magnitude of oscillations 10 Amplitude: peak to peak displacement (mm) Frequency: repetition rate of the cycle of oscillations (Hz) Magnitude: indicated by the acceleration (m/s 2 or g=9. 8 m/s 2) Acceleration: how fast the plate moves up and down

Recommendations for Use 11 Fundamental starting position: feet ER 7º (same as gait), feet shoulder width apart, knees and hips slightly bent Use non-slip socks or shoes, shoes with thin hard soles, no shoe with cushioned or soft soles as these absorb the vibrations Start with low frequency 5 -12 Hz, and increase to 18 -40 Hz when acclimated Start at 1 min of low frequency -> 1 min of high frequency -> 3 min of low frequency Possible Side-Effects (could be a result that training intensity it too high) Blisters, headache, itchiness, nausea and dizziness, short-term drop in blood pressure, hypoglycemia Frequency Side alternating 10 -30 Hz for improving back pain, balance, muscle mass, and muscle power in elderly patients

Evidence: Whole-body vibration exercise in postmenopausal osteoporosis 8 Literature review of WBVT with 7 randomized trials focusing on BMD Theory is that WBV is a form of physical activity that can regulate bone maintenance and stimulate bone formation including accumulation of minerals, in addition to strengthening muscles and improving balance, thus reducing risk of falls and fractures Most effective in women weighing under 65 kg (143 lbs) Parameters: 30 -40 Hz, acceleration of 2 m/s 2, 1. 7 -12 mm amplitude, daily to 3 x/week, 5 -15 mins

Whole-body vibration exercise in postmenopausal osteoporosis 8 (cont) The majority of the 7 studies show improvement in BMD, specifically to femoral neck and lumbar spine when compared to no vibrational training Minimal period used to evaluate a difference of BMD using active exercise (including WBV) is 12 months, studies ranged from 6 -12 months Vibration therapy does not replace pharmacological and dietary treatment methods, but can supplement BMD increase

The effects of whole body vibration therapy on bone mineral density and leg muscle strength in older adults: a systematic review and meta-analysis 12 Systematic review and meta-analysis, 18 articles, 13 randomized trials (4 focused primarily on BMD) No significant overall effect on hip and lumbar spine bone mineral density in older women, but has significant treatment effect on enhancing certain aspects of leg muscle strength in older adults Parameters: 10 -54 Hz, . 05 -8 mm, acceleration. 05 -32. 2 units of g, 30 sec-10 mins), 1 -7 x/week, 6 weeks – 18 months, most studies combined movements while standing on vibration platform (squats, lunges, standing with heel raised)

The effects of whole body vibration therapy on bone mineral density and leg muscle strength in older adults: a systematic review and meta-analysis 12 (cont) Whole body vibration was effective in maintaining lumbar spine BMD in individuals who were under 65 kg (143 lbs) BMD studies only used female participants Significant improvement in knee extension dynamic and isometric strength and functional measures of leg muscle strength (jumping height and sit-to-stand) in 6 -10 weeks in some cases, comparable to other active forms of exercise (resistance training) May provide a safe and viable alternative for enhancing leg muscle strength for those who cannot tolerate other forms of exercise

Efficacy of whole body vibration in older people: a systematic review 13 Systematic Review 16 included randomized control trials Compared to a conventional exercise showed that the only significant difference in bone density was found in the femoral neck WBV significantly improved knee muscle isometric strength, muscle power, and balance control (using Tinetti)

Low-frequency vibratory exercise reduces the risk of bone fracture more than walking: a randomized controlled trial 14 Aim: Compare effects of WBV using a reciprocating platform at frequencies lower than 20 Hz vs a walkingbased program 28 physically, untrained postmenopausal women WBV group: 3 x/week for 8 months, 6 bouts of 1 min, 12. 6 Hz, 3 cm amplitude with 60º of knee flexion, 1 min rest between bouts

Low-frequency vibratory exercise reduces the risk of bone fracture more than walking: a randomized controlled trial 14 (cont) Walking: 55 mins of walking and 5 mins of stretching, 3 x/week for 8 months After 8 months, BMD at femoral neck of WBV group increased 4. 3 % compared to walking group, lumbar spine BMD unaltered in both, balance improved by 29% for WBV group, no change in walking group (blind flamingo test)

Impact of Whole-Body Vibration Training Versus Fitness Training on Muscle Strength and Muscle Mass in Older Men: A 1 -Year Randomized Controlled Trial 15 97 60 -80 y/o community dwelling men 3 groups WBV Exercised a max of 40 mins on a vibration platform 3 x/week for 1 year Squat, deep squat, wide stance squat, toes-stand deep, one-legged squat, lunge Fitness (FIT) Performed cardiovascular, resistance, balance, and flexibility exercises 1. 5 hours 3 x/week for 1 year Cardio at 70 -85% of HRR included walking/running, cycling, or stepping, resistance 1 -2 sets of 8 -15 reps of exercises for whole body such as leg press and leg extension, balance on one or both legs, eyes open/closed, stable/unstable surfaces, stretching at end of session Control: advised to not change lifestyle or physical activity

Impact of Whole-Body Vibration Training Versus Fitness Training on Muscle Strength and Muscle Mass in Older Men: A 1 -Year Randomized Controlled Trial 15 (cont) Isometric knee extension strength via isokinetic dynamometer, explosive strength measured via jump height, muscle mass via CT scan Isometric knee extension strength increased in both WBV and FIT groups vs control with no significant difference between the two Explosive strength increased in both WBV and FIT groups vs control with no significant difference between the two Muscle mass increased in both WBV and FIT groups vs control with no significant difference between the two

Impact of Whole-Body Vibration Training Versus Fitness Training on Muscle Strength and Muscle Mass in Older Men: A 1 -Year Randomized Controlled Trial 15 (cont) Compared these results to women in the same study with similar results May reverse/reduce sarcopenia (loss of muscle due to aging)

Conclusion from the Evidence The jury is still out regarding WBVT More research still needs to be done to confirm the beneficial effects of WBVT for the purpose of increasing BMD WBVT can be utilized to strengthen the lower extremities of various patient populations as well as improve balance, but not any more than regular active exercise

Clinical Applications of WBVT Increase BMD, especially in femoral neck region Improve balance leading to less falls and reduced risk of fracture LE strengthening

Cost of Equipment “Using Whole Body Vibration in Physical Therapy and Sport E-Book: Clinical practice and treatment exercises” Ingo Rembitzki, 2010 (see [11 th] reference) Specifically have a chapter on “Exercise Programs for Patients with Osteoporosis”, “Prevention of Osteoporosis by Physical Signals”, and “Inhibition of Osteoporosis by Biophysical Intervention” $41 online Preview with limited access found online

Cost of Equipment Merax Full Body Crazy Fit Vibration Platform Fitness Machine (top) Gforce Pro Cardio – 1500 W Dual Motor Whole Body Vibration Exercise Machine by healthandmed (middle) $182. 99 $1374. 98 Body Vibration Machine Platform Massager Fitness Slim with Bluetooth (bottom) $92. 98

Cost of Equipment Power Plate Pro 7 Vibration Trainer (top) $12995. 00 Personal Power Plate Vibration Trainer (bottom) $1400. 00

Other Providers in the Area Center for Healing Arts (CAM center) $5 for vibration 3993 Broadview Road, Richfield, Ohio 44286 Chagrin Natural Health Clinic 16716 Chillicothe Rd #1000, Chagrin Falls, OH 44023 Sometimes found at fitness centers (could not locate any near the area)

Questions?

References 1. Whole Body Vibration Therapy. Science-Based Medicine. https: //sciencebasedmedicine. org/whole-body-vibration-therapy/. Published October 14, 2015. Accessed April 19, 2018. 2. Laskowski E. Is whole-body vibration an effective workout? Mayo Clinic. https: //www. mayoclinic. org/healthy-lifestyle/fitness/expert-answers/wholebody-vibration/faq-20057958. Published April 12, 2017. Accessed April 20, 2018. 3. Colino S. Good Vibrations: the Perks and Pitfalls of Whole Body Vibration Therapy. U. S. News & World Report. https: //health. usnews. com/healthnews/patient-advice/articles/2016 -06 -08/good-vibrations-the-perks-andpitfalls-of-whole-body-vibration-therapy. Accessed April 21, 2018. 4. Taylor M. Work Out Like Celebrities And Professional Athletes With Power Plate. Forbes. https: //www. forbes. com/sites/meggentaylor/2016/09/08/power-upyour-work-out-like-celebrities-and-professional-athletes-with-power-plate/. Published September 9, 2016. Accessed April 21, 2018. 5. History of Whole Body Vibration. Biomedical News & Health Blog. http: //biomedj. org/vibration-machines/history-whole-body-vibration/. Published January 28, 2018. Accessed April 21, 2018. 6. Neumann DA. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2 nd ed. St. Louis, MO: Mosby/Elsevier; 2010.

References (cont) 7. Vibration and pain management. Physiopedia. https: //www. physiopedia. com/Vibration_and_pain_management. Accessed April 20, 2018. Weber-Rajek M, Mieszkowski J, Niespodziński B, Ciechanowska K. Whole-body vibration exercise in postmenopausal osteoporosis. [serial online]. 2015; Available from: BASE, Ipswich, MA. Accessed April 21, 2018. 9. Contraindications. BC Vibrant Health. https: //bcvibranthealth. com/whole-bodyvibration/contraindications/. Accessed April 20, 2018. 10. Cardinale M, Bosco C. The Use of Vibration as an Exercise Intervention. Exercise and Sport Sciences Reviews. 2003; 31(1): 3 -7. doi: 10. 1097/00003677 -20030100000002. 11. Whole body vibration - an overview | Science. Direct Topics. https: //www. sciencedirect. com/topics/medicine-and-dentistry/whole-bodyvibration. Accessed April 20, 2018. 12. Ricky WK L, Lin-Rong L, Felix Y, Tilda T, Raymond CK C, Marco YC P. The effects of whole body vibration therapy on bone mineral density and leg muscle strength in older adults: a systematic review and meta-analysis. Clinical Rehabilitation [serial online]. 2011; (11): 975. Available from: Journals@OVID, Ipswich, MA. Accessed April 21, 2018.

References (cont) 13. Sitja-Rabert M, Rigau D, Fort Vanmeerghaeghe A, Romero-Rodriguez D, Bonastre Subirana M, Bonfill X. Efficacy of whole body vibration in older people: a systematic review. Disability and Rehabilitation [serial online]. 2012; 34: 11, 883 -893. Accessed April 21, 2018. 14. Leal A, Raimundo A, Gusi N. Low-frequency vibratory exercise reduces the risk of bone fracture more than walking: a randomized controlled trial. [serial online]. 2006; Available from: Open. AIRE, Ipswich, MA. Accessed April 21, 2018. 15. Bogaerts A, Delecluse C, Claessens AL, Coudyzer W, Boonen S, Verschueren SMP. Impact of Whole-Body Vibration Training Versus Fitness Training on Muscle Strength and Muscle Mass in Older Men: A 1 -Year Randomized Controlled Trial. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2007; 62(6): 630 -635. doi: 10. 1093/gerona/62. 6. 630.