Effect of whole body vibration training on bone mineral density and bone quality in adolescents with Down syndrome: a randomized controlled trial

Effect of Physical Activity Interventions on Health Parameters in Children and Adolescents with Intellectual Disabilities: A Systematic Review

Intellectual disability (ID) encompasses diverse challenges that affect daily life and health. Sedentary behaviors, prevalent in this population, contribute to alarming health concerns, notably obesity and musculoskeletal issues. This review examines the role of physical activity (PA) interventions in addressing these health challenges among children and adolescents with ID. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted in the Cochrane Library, PubMed, Scopus, and SPORTDiscus databases, using specific keywords aligned with the PICO framework (population, intervention, comparison, and outcome). From January 2013 to October 2024, a total of 5236 studies were identified, of which 17 met the inclusion criteria for this review according to PRISMA procedures. Randomized controlled trials (RCTs) focusing on the impact of PA on body composition, physical fitness, bone health, metabolic indicators, and overall quality of life were included. The study cohort consisted of individuals aged 13-24 diagnosed with ID. The findings consistently highlight the positive relationship between PA interventions and improved health markers in individuals with ID. Diverse PA interventions, ranging from strength training to high-intensity exercises, demonstrated significant improvements in body composition, physical fitness, and bone mineral density. Notably, higher-frequency PA programs (minimum three sessions per week) yielded more substantial benefits. This review underscores the potential of adapted PA interventions to address health concerns and enhance the quality of life for individuals with ID. Further comprehensive research is needed to establish standardized guidelines for effective PA interventions in this population.

Effects of whole-body vibration exercise on sleep disorders, body composition and clinical parameters in down syndrome children: A study protocol for a randomized cross-over trial

Down-syndrome (DS) the most common genetic disorder worldwide. Whole-body-vibration-exercise (WBVE) has been recommended for individuals with DS. To verify the efficacy of WBVE on sleep disorders, body-composition (BC) and clinical parameters of children with DS. It is a randomized cross-over-trial. Children with DS, 5-12 years, both-genders will be selected. The sleep disorders will be evaluated by the "Infant sleep questionnaire Reimão and Lefevre" and by the "Sleep disturbance scale in children". The BC will be measure by bioimpedance and the skin temperature using infrared-thermography. WBVE will be performed seating in an ancillary-chair or sitting on the base of the vibrating platform, with 2.5 mm, 5Hz. Each session (5 series, 30-seconds on vibration, 1-minute of rest). It is expected improvement responses on sleep, BC and some clinical parameters. It is expected that this WBVE protocol will bring important clinical contributions for children with DS.

Effects of the Whole-Body Vibration Exercise on Sleep Disorders, Body Temperature, Body Composition, Tone, and Clinical Parameters in a Child with Down Syndrome Who Underwent Total Atrioventricular Septal Defect Surgery: A Case-Report

BACKGROUND

The health and developmental issues of people with Down syndrome (DS) are complex and are associated with many medical, psychological, and social problems from childhood through into adulthood. DS children have an increased risk of multiorgan comorbidities, including congenital heart disease. Atrioventricular septal defect (AVSD) is a congenital heart malformation that often occurs in DS people.

AIM

Physical activity and exercise are recommended for patients with cardiovascular disease and are considered to be the gold standard of cardiac rehabilitation. Whole-body vibration exercise (WBVE) is considered a form of exercises. The aim of this case report is to show the effects of WBVE on sleep disturbances, body temperature, body composition, tone, and clinical parameters in a child with DS with corrected total AVSD. The subject is a 10-year-old girl, with free-type DS, who underwent surgery to correct a total AVSD at 6 months. She underwent periodic cardiological monitoring and was released to perform any type of physical exercise, including WBVE. WBVE improved sleep quality and body composition.

CONCLUSION

WBVE leads to physiological effects that benefit the DS child.

Effects of exercise training on obesity-related parameters in people with intellectual disabilities: systematic review and meta-analysis

BACKGROUND

Efforts to synthesise existing knowledge concerning the effects of exercise interventions on obesity (i.e. changes in body weight and composition) have been made, but scientific evidence in this matter is still limited. This systematic review and meta-analysis aims to identify and critically analyse the best available evidence regarding the use of physical exercise as a strategy to attenuate obesity through its effects on adiposity-related anthropometric parameters in people with intellectual disability (ID).

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was performed using PubMed, Scopus, SPORTDiscus, CINAHL and the Cochrane Library through specific keywords up to July 2020. The search adhered to the population, intervention, comparison and outcome strategy. Randomised controlled trials addressing the effects of the exercise intervention on adiposity-related anthropometric parameters (body mass index, waist circumference, waist-hip ratio, fat percentage or body weight) in children, adolescents and adults with ID were included. The methodological quality of the studies found was evaluated through the PEDro scale.

RESULTS

A total of nine investigations with children and/or adolescents (10-19 years) and 10 investigations with adults (18-70 years) were selected, mostly experiencing mild and moderate ID. Methodological quality was fair in 13 of these publications, good in five and excellent in one. Seventeen trials reported comparable baseline and post-intervention data for the intervention and control groups and were included in the meta-analysis. In nine studies, the intervention group performed a cardiovascular training programme. Five papers described a combined training programme. Two trials executed whole-body vibration training programmes, and one publication proposed balance training as the primary intervention. According to the meta-analysis results, the reviewed studies proposed exercise modalities that, in comparison with the activities performed by the participants' in the respective control groups, did not have a greater impact on the variables assessed.

CONCLUSIONS

While physical exercise can contribute to adiposity-related anthropometric parameters in people with mild and moderate ID, these findings show that exercise alone is not sufficient to manage obesity in this population. Multicomponent interventions appear to be the best choice when they incorporate dietary deficit, physical activity increase and behaviour change strategies. Finding the most effective modality of physical exercise can only aid weight loss interventions. Future research would benefit from comparing the effects of different exercise modalities within the framework of a multicomponent weight management intervention.

Jumping rope and whole-body vibration program effects on bone values in Olympic artistic swimmers

INTRODUCTION

Artistic swimming seems not to benefit bone development like other out-of-water physical activities. To increase bone acquisition, artistic swimming should combine water training with weight-bearing impact or strength activities. Artistic swimmers can be a population at risk of developing osteopenia and osteoporosis in later life. The aim of the present study was to evaluate the effects of a training program on bone mineral density (BMD), bone mineral content (BMC) and body composition in an Olympic artistic swimming team.

METHODS

Sixteen women aged 17-21 years, who train 30 h/week, at the Olympic Training Centre (Barcelona, Spain), were followed up over two seasons. The 1st season involved regular artistic swimming training without specific training to reduce the risk of osteopenia. The exercise intervention, jumping rope and whole-body vibration, was added in the 2nd season. The protocol included 20 min of training 2 days per week, over a 22-week period. Dual energy x-ray absorptiometry measured the bone variables and body composition. The daily diet, medical history and bone turnover markers were evaluated.

RESULTS

The intervention program increased BMD on lumbar spine (2.10%, p = 0.002), total hip (2.07%, p = 0.001), and femoral neck (2.39%, p = 0.02). Lower limb's fat mass decreased (10.17%, p = 0.038). No significant differences were found for any of the measured anthropometric characteristics between both time points in the 1st season. In conclusions, combined jump rope and vibration should be considered to reduce the risk of bone damage in artistic swimmers.

Long-term Effects of Mechanical Vibration Stimulus on the Bone Formation of Wistar Rats: An Assessment Method Based on X-rays Images

BACKGROUND

Bone is a complex living tissue that adapts itself to the demands of mechanical stimuli such as physical activity and exercise. Whole-body vibration (WBV) is a type of exercise characterized by the transmission of mechanical vibration stimuli produced by a vibrating platform. This study aimed to investigated, in experimental model, the effect of WBV exercise on the bone in different frequencies through X-ray analysis.

MATERIALS AND METHODS

Wistar rats were divided in three groups: control, exposed to WBV of 10 Hz and exposed to WBV of 20 Hz, during 8-weeks. All procedures to obtain the radiographic images were carried out before and after the experiments. The femur linear size and bone density measurements through radiographic images were performed in all animals. A factor of increase for bone density (FIBD) was determined.

RESULTS

No differences were observed in the qualitative comparison between the groups, as well as radiographic bone density before the experiment. However, after the experiment the bone density increased in the rats exposed to WBV of 10 Hz and 20 Hz compared to control group. Also, the FIBD was higher in the groups exposed to WBV in comparison with control.

CONCLUSION

These findings indicate an increase of the bone density dependent of the vibration stimulus frequency. In addition, this increase suggests a possible osteogenic effect to the mechanical vibrations of 10 and 20 Hz.

Current Analysis of Skeletal Phenotypes in Down Syndrome

PURPOSE

Down syndrome (DS) is caused by trisomy 21 (Ts21) and results in skeletal deficits including shortened stature, low bone mineral density, and a predisposition to early onset osteoporosis. Ts21 causes significant alterations in skeletal development, morphology of the appendicular skeleton, bone homeostasis, age-related bone loss, and bone strength. However, the genetic or cellular origins of DS skeletal phenotypes remain unclear.

RECENT FINDINGS

New studies reveal a sexual dimorphism in characteristics and onset of skeletal deficits that differ between DS and typically developing individuals. Age-related bone loss occurs earlier in the DS as compared to general population. Perturbations of DS skeletal quality arise from alterations in cellular and molecular pathways affected by the overexpression of trisomic genes. Sex-specific alterations occur in critical developmental pathways that disrupt bone accrual, remodeling, and homeostasis and are compounded by aging, resulting in increased risks for osteopenia, osteoporosis, and fracture in individuals with DS.

Possible Mechanisms for the Effects of Sound Vibration on Human Health

This paper presents a narrative review of research literature to “map the landscape” of the mechanisms of the effect of sound vibration on humans including the physiological, neurological, and biochemical. It begins by narrowing music to sound and sound to vibration. The focus is on low frequency sound (up to 250 Hz) including infrasound (1–16 Hz). Types of application are described and include whole body vibration, vibroacoustics, and focal applications of vibration. Literature on mechanisms of response to vibration is categorized into hemodynamic, neurological, and musculoskeletal. Basic mechanisms of hemodynamic effects including stimulation of endothelial cells and vibropercussion; of neurological effects including protein kinases activation, nerve stimulation with a specific look at vibratory analgesia, and oscillatory coherence; of musculoskeletal effects including muscle stretch reflex, bone cell progenitor fate, vibration effects on bone ossification and resorption, and anabolic effects on spine and intervertebral discs. In every category research on clinical applications are described. The conclusion points to the complexity of the field of vibrational medicine and calls for specific comparative research on type of vibration delivery, amount of body or surface being stimulated, effect of specific frequencies and intensities to specific mechanisms, and to greater interdisciplinary cooperation and focus.

The Effects of 20 Weeks of Side-Alternating Vibration Therapy on Physical Function, Bone and Muscle Health in Adolescents with Down Syndrome

AIMS

To evaluate the effects of side-alternating vibration therapy on physical function and body composition in adolescents with Down syndrome.

METHODS

Fourteen adolescents (8 males) with Down syndrome (mean ± SD age: 15.5 ± 2.3 years) performed vibration treatment nine minutes daily, four times per week, for 20 weeks on a Galileo vibration platform. Data were collected at baseline and after 20 weeks of intervention. Assessments included six-minute walk test, muscle function (force plate), whole-body dual-energy X-ray absorptiometry and peripheral quantitative computed tomography of the non-dominant tibia.

RESULTS

After 20 weeks, participants increased their distance walked in the six-minute walk test (p = 0.009), 2-leg single jump efficiency (p = 0.024) and jump velocity (p = 0.046). Participants also increased their power (p = 0.034) and reduced the time taken during the chair rise test (p < 0.001). At the total body level, increases were seen in bone mineral density (p = 0.004), bone mineral content (p = 0.043), fat free mass (p = 0.013) and lean mass (p = 0.021).

CONCLUSION

Side-alternating vibration therapy was associated with increases in physical function and muscle mass with no effects on bone health in adolescents with Down syndrome.

CLINICAL TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trial Registry (ACTRN12615000092594) - registered on 4^th February 2015.

Acute effect of whole-body vibration on acceleration transmission and jumping performance in children

BACKGROUND

Whole-body vibration (WBV) has emerged as a potential intervention paradigm for improving motor function and bone growth in children with disabilities. However, most evidence comes from adult studies. It is critical to understand the mechanisms of children with and without disabilities responding to different WBV conditions. This study aimed to systematically investigate the acute biomechanical and neuromuscular response in typically developing children aged 6-11 years to varying WBV frequencies and amplitudes.

METHODS

Seventeen subjects participated in this study (mean age 8.7 years, 10 M/7F). A total of six side-alternating WBV conditions combining three frequencies (20, 25, and 30 Hz) and two amplitudes (1 and 2 mm) were randomly presented for one minute. We estimated transmission of vertical acceleration across body segments during WBV as the average rectified acceleration of motion capture markers, as well as lower-body muscle activation using electromyography. Following WBV, subjects performed countermovement jumps to assess neuromuscular facilitation.

FINDINGS

Vertical acceleration decreased from the ankle to the head across all conditions, with the greatest damping occurring from the ankle to the knee. Acceleration transmission was lower at the high amplitude than at the low amplitude across body segments, and the knee decreased acceleration transmission with increasing frequency. In addition, muscle activation generally increased with frequency during WBV. There were no changes in jump height or muscle activation following WBV.

INTERPRETATION

WBV is most likely a safe intervention paradigm for typically developing children. Appropriate WBV intervention design for children with and without disabilities should consider WBV frequency and amplitude.

Safety, feasibility and efficacy of side-alternating vibration therapy on bone and muscle health in children and adolescents with musculoskeletal disorders: A pilot trial

AIMS

A pilot study was performed to establish the safety, feasibility and efficacy of vibration therapy (VT) on bone and muscle health in children and adolescents with a range of musculoskeletal disorders.

METHODS

Seventeen participants (15.7 years ± 2.9 years), with conditions that impacted on their musculoskeletal health, completed 20 weeks of side-alternating VT for 9 min/session, 4 times/week at 20 Hz. Data were collected at baseline and after 20 weeks of intervention. Assessments included whole-body dual-energyX-ray absorptiometry, muscle function (force plate) and 6-min walk test.

RESULTS

Compliance with the prescribed VT training protocol was relatively high overall at 78% and there were no adverse events reported. After 20 weeks intervention, functional assessments showed time taken to perform the chair test was reduced by 15% (P = 0.018), leg balance improved with standard ellipse area decreasing by 88% (P = 0.006) and distance walked in the 6-min walk test improved by 9% (P = 0.002). Participants displayed increased total body mass (1.94 kg; P = 0.018) with increased lean mass (1.20 kg; P = 0.019) but not fat mass (P = 0.19). There was no change in total body bone mineral density (P = 0.44) or bone mineral content (P = 0.07).

CONCLUSIONS

Twenty weeks of side-alternating VT was a feasible protocol that was associated with improvements in physical function and no detrimental effects on lean mass, bone mass or density in children and adolescents with musculoskeletal disorders.

Bone mineral density from early to middle adulthood in persons with Down syndrome

BACKGROUND

While accelerated ageing is recognised among individuals with Down syndrome (DS), the trajectory of their bone health across adulthood remains poorly understood.

METHODS

This study aimed to determine the age-related loss of bone mineral density (BMD) of the lumbar spine in 128 adults with DS aged 18 to 54 years compared with 723 counterparts without DS.

RESULTS

Men and women with DS had lower level of BMD than counterparts without DS across age groups. Magnitude of decrement in BMD as reflected in the z-scores was similar between younger and older men with DS. Older women with DS, on the contrary, showed greater decrement in older ages especially in their fourth decade of life. Osteopenia and osteoporosis as defined using age-specific and gender-specific T-scores affected greater number of men with DS (38% and 25%) than women (17% and 17%) aged 40-49 years.

CONCLUSIONS

Findings supported adults with DS, especially men, to have early bone mineral testing.

Bone quality in young adults with intellectual disability involved in adapted competitive football

The objective of this study was to analyse bone quality parameters of football players with intellectual disability (ID) participating in adapted competitive football. Sixty-seven male football players with ID were studied: 22 with Down syndrome (DS) and 45 without DS. The average age was 26 years (range: 16 ̶ 50 years). A group of 25 age-matched sedentary individuals with ID (11 DS and 14 non-DS) and another group of 20 healthy participants of the same age group not involved in competitive football were comparatively analysed. There were no differences in the bone quality parameters when the healthy sedentary individuals were compared with both the sedentary and the football players with ID. However, the speed of sound (SOS), T-score, and estimated bone mineral density (BMD) were of higher values in the football players with ID than in the sedentary ID group (p < 0.05). On comparing the football players with non-DS ID with the sedentary non-DS individuals, significant differences were noted in SOS (p < 0.01), T-scores (p < 0.01), and estimated BMD (p < 0.01). Four of the 45 non-DS (8.9%) and none of the football players with DS had T-scores less than -1.5. Two of the 14 sedentary non-DS participants (14.3%) had T-scores indicating osteoporosis. In summary, the ID population actively involved in football showed higher values of bone mass parameters than their sedentary ID and healthy peers. The participants with non-DS ID showed a higher prevalence of osteoporosis than the football players with DS. Participation in sports seems to prevent bone loss in individuals with ID.

Is Vibration Training Good for Your Bones? An Overview of Systematic Reviews

Whole-body vibration (WBV) intervention studies and reviews have been increasing lately. However, the results regarding its effects on bone tissue in different populations are still inconclusive. The goal of this overview was to summarize systematic reviews assessing the effects of WBV training on bone parameters. Three electronic databases were scanned for systematic reviews and meta-analyses evaluating the effects of WBV on bone tissue. The search had no time restrictions and was limited to articles written in English. Vibration protocols and the main bone parameters included in each review were extracted. Methodological quality was assessed and analyses were conducted stratifying by age. 17 reviews and meta-analyses fulfilled the inclusion criteria. No increase or small improvements in bone mineral density (BMD) after WBV interventions were observed in reviews regarding postmenopausal women. One intervention study regarding young adults was included and reported no bone-related benefits from WBV. Most reviews including children and adolescents with compromised bone mass showed an improvement of BMD at lower limbs, lumbar spine, and whole body. In conclusion, WBV interventions seem to help children and adolescents with compromised bone mass to increase their BMD, but these improvements are limited in postmenopausal women and there is insufficient evidence for young adults. Further research is also needed to identify the ideal parameters of WBV training focused on bone health.

Current evidence does not support whole body vibration in clinical practice in children and adolescents with disabilities: a systematic review of randomized controlled trial

BACKGROUND

Whole body vibration has been used alone or combined with other interventions in rehabilitation of children and adolescents with disabilities; however, there is limited evidence to support this approach.

OBJECTIVES

To review the strength, quality, and conclusiveness of evidence supporting the use of whole body vibration in children and adolescents with disabilities.

METHODS

Electronic database search included Medline, AMED, Embase, Cochrane, SportDiscus, CINAHL and PEDro from the inception to June 2018. Studies investigating the effects of whole body vibration, alone or combined with other interventions, compared to minimal intervention or other interventions were included. The outcomes measured were: body structure and function (lean body mass, bone mineral density, knee muscle strength and overall stability) and activity and participation (gait speed, walking distance, gross motor function, self-care and mobility).

RESULTS

Fifteen randomized trials involving 403 participants were included. Methodological quality of eligible trials was moderate (mean of 5.5 points on the 10-point PEDro scale). Overall, whole body vibration was no better than minimal intervention. In all comparisons where additional effect of whole body vibration was better than other interventions, the effect size ranged from low to high in the trials, but ranged from very-low to low quality at short and medium-term follow-up. Sensitivity analysis for health condition and low-quality studies showed impact on trunk bone mineral density of additional effect of whole body vibration at medium-term compared to other interventions.

CONCLUSION

The low to very-low quality of evidence suggests caution in recommending the use of this approach. New studies could change the findings of this review. PROSPERO registration: CRD42017060704.

The Outcomes of Posterior Arthrodesis for Atlantoaxial Subluxation in Down Syndrome Patients: A Meta-Analysis

STUDY DESIGN

This is a meta-analysis.

OBJECTIVE

To establish rates of (1) neurological complications, (2) bony-related complications, (3) complications delaying recovery, (4) reoperation, and (5) fatalities following posterior cervical arthrodesis in Down syndrome (DS) patients with atlantoaxial subluxation. To determine if presenting symptoms had any relationship to postoperative complications.

SUMMARY OF BACKGROUND DATA

Posterior arthrodesis is commonly utilized to correct cervical instability secondary to atlantoaxial instability in DS patients. However, there has never been a global evaluation of postoperative complications associated with posterior cervical spinal arthrodesis in DS patients.

METHODS

A comprehensive search of Medline/PubMed, EMBASE, and Ovid databases between January 1980 and July 2017 was utilized to identify DS patients with atlantoaxial subluxation who underwent posterior cervical arthrodesis. Data were sorted by neurological complications, complications delaying recovery, bony-related complications, reoperations, and fatalities. Patients were sorted into 2 groups based on presentation with or without neurological deficits.

RESULTS

Twelve studies met inclusion criteria, including 128 DS patients. Mean age was 13.8 years (range: 6.7-32.7 y; 47.8% male). Mean follow-up was 31.7 months (range: 14.9-77 mo). All patients underwent primary posterior cervical arthrodesis with an average of 2.5 vertebrae fused. A total of 39.6% of patients had bony-related complications [95% confidence interval (CI), 31.4%-48.5%], 23.3% had neurological deficits (95% CI, 16.6%-31.6%), and 26.4% experienced complications delaying recovery (95% CI, 19.4%-34.9%). The reoperation rate was 34.9% (95% CI, 25.5%-45.6%). The mortality rate was 3.9% (95% CI, 1.5%-9.7%). Neurological complications were 4-fold (P<0.05) and reoperation was 5.5-fold (P<0.05) more likely in patients presenting with neurological deficits compared with those without.

CONCLUSIONS

This study detailed global complication rates of posterior arthrodesis for DS patients, identifying bony-related complications and reoperations among the most common. Patients presenting with neurological symptoms and cervical instability have increased postoperative rates of neurological complications and reoperations than patients with instability alone. Further investigation into how postoperative complications effect patient independence is warranted.

Effects of whole-body vibration on muscle strength, bone mineral content and density, and balance and body composition of children and adolescents with Down syndrome: a systematic review

The aim of this study is to verify the effects of whole-body vibration (WBV) training on the muscle strength of children and adolescents with Down syndrome. We searched MEDLINE, Cochrane, SciELO, Lilacs and PUBMED databases and included manual searches to identify randomised controlled trials to investigate the effects of WBV on the structure and body function of children and adolescents with Down syndrome. Two reviewers independently selected the studies and performed statistical analysis. In total, five studies with 171 patients that compared WBV with exercise and/or control were included. Two studies demonstrated a significant difference between the muscle strength of children and adolescents with Down syndrome who received WBV training and that of those who did not receive the intervention. The studies included in this systematic review showed that WBV training has positive effects on bone mineral density (BMD), body composition and balance. Results of this study showed that WBV training improves muscle strength, BMD, body composition and balance of children and adolescents with Down syndrome, and a more in-depth analysis of its effects on other variables in this population is required, as well as of parameters to be used.

Endocrine manifestations of Down syndrome

PURPOSE OF REVIEW

To summarize the recent developments in endocrine disorders associated with Down syndrome.

RECENT FINDINGS

Current research regarding bone health and Down syndrome continues to show an increased prevalence of low bone mass and highlights the importance of considering short stature when interpreting dual energy x-ray absorptiometry. The underlying cause of low bone density is an area of active research and will shape treatment and preventive measures. Risk of thyroid disease is present throughout the life course in individuals with Down syndrome. New approaches and understanding of the pathophysiology and management of subclinical hypothyroidism continue to be explored. Individuals with Down syndrome are also at risk for other autoimmune conditions, with recent research revealing the role of the increased expression of the Autoimmune Regulatory gene on 21st chromosome. Lastly, Down-syndrome-specific growth charts were recently published and provide a better assessment of growth.

SUMMARY

Recent research confirms and expands on the previously known endocrinopathies in Down syndrome and provides more insight into potential underlying mechanisms.

Do 6 months of whole-body vibration training improve lean mass and bone mass acquisition of adolescent swimmers?

Swimming has little effect on bone mass. Therefore, adolescent swimmers should complement their water training with a short and intense weight-bearing training, aiming to increase their bone acquisition. Forty swimmers performed a six-month whole-body vibration (WBV) training. WBV had no effect on adolescent swimmers' bone mass or lean mass.

PURPOSE

The aims of the present study were to evaluate the effects of a whole-body vibration (WBV) intervention on bone mineral density (BMD), bone mineral content (BMC) and lean mass (LM) in adolescent swimmers.

METHODS

Forty male and female adolescent swimmers (VIB; mean age 14.2 ± 1.9 years) completed the WBV protocol that consisted of 15 min of training 3 days per week during a 6-month period (ranging from 3.6 to 11.6 g), while 23 swimmers (SWI; mean age 15.0 ± 2.2 years) continued with their regular swimming training alone. VIB were divided into tertiles according to training compliance in order to evaluate if any dose-effect relation existed. BMD, BMC and LM were measured longitudinally by dual energy X-ray at the whole body, lumbar-spine and hip.

RESULTS

No group by time interactions and no differences in change percentage were found for BMD, BMC or LM in any of the measured variables. The mean change percentage of the subtotal body (whole body minus the head) for VIB and SWI, respectively, was 2.3 vs. 2.4% for BMD, 5.7 vs 5.7% for BMC and 7.3 vs. 8.0% for lean mass. Moreover, no indication for dose-response was observed.

CONCLUSIONS

The proposed WBV protocol had no effect on BMD, BMC and LM in adolescent swimmers. Other types of training should be used in this population to improve both bone and lean mass.

Physical activity and bone mineral density at the femoral neck subregions in adolescents with Down syndrome

BACKGROUND

Low bone mineral density (BMD) has been frequently described in subjects with Down syndrome (DS). Reduced physical activity (PA) levels may contribute to low BMD in this population. The objective of the study was to investigate whether PA levels were related to the femoral neck bone mass distribution in a sample of 14 males and 12 females with DS aged 12-18 years.

METHODS

BMD was evaluated by dual energy X-ray absorptiometry (DXA) at the integral, superolateral and inferomedial femoral neck regions and PA levels were assessed by accelerometry. The BMDs between the sexes and PA groups (below and above the 50th percentile of the total PA) were compared using independent t-tests and analyses of covariance (ANCOVAs) controlling for age, height and body weight.

RESULTS

No differences were found between the BMDs of males and females in any femoral neck region (p>0.05). Females with higher PA levels demonstrated increased integral (0.774 g/cm2 vs. 0.678 g/cm2) and superolateral femoral neck BMDs (0.696 g/cm2 vs. 0.595 g/cm2) compared to those with lower PA levels (p<0.05). In males, no differences (p<0.05) were found in the BMDs between the PA groups.

CONCLUSIONS

This investigation shows that females accumulating more total PA presented increased BMDs at the integral and superolateral femoral neck regions (14.1% and 17.0%, respectively) when compared to their less active peers. These data highlight the importance of PA in females with DS to counteract their low bone mass and to improve their bone health.

Interventions to prevent and treat corticosteroid-induced osteoporosis and prevent osteoporotic fractures in Duchenne muscular dystrophy

BACKGROUND

Corticosteroid treatment is considered the 'gold standard' for Duchenne muscular dystrophy (DMD); however, it is also known to induce osteoporosis and thus increase the risk of vertebral fragility fractures. Good practice in the care of those with DMD requires prevention of these adverse effects. Treatments to increase bone mineral density include bisphosphonates and vitamin D and calcium supplements, and in adolescents with pubertal delay, testosterone. Bone health management is an important part of lifelong care for patients with DMD.

OBJECTIVES

To assess the effects of interventions to prevent or treat osteoporosis in children and adults with DMD taking long-term corticosteroids; to assess the effects of these interventions on the frequency of vertebral fragility fractures and long-bone fractures, and on quality of life; and to assess adverse events.

SEARCH METHODS

On 12 September 2016, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL Plus to identify potentially eligible trials. We also searched the Web of Science ISI Proceedings (2001 to September 2016) and three clinical trials registries to identify unpublished studies and ongoing trials. We contacted correspondence authors of the included studies in the review to obtain information on unpublished studies or work in progress.

SELECTION CRITERIA

We considered for inclusion in the review randomised controlled trials (RCTs) and quasi-RCTs involving any bone health intervention for corticosteroid-induced osteoporosis and fragility fractures in children, adolescents, and adults with a confirmed diagnosis of DMD. The interventions might have included oral and intravenous bisphosphonates, vitamin D supplements, calcium supplements, dietary calcium, testosterone, and weight-bearing activity.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed reports and selected potential studies for inclusion, following standard Cochrane methodology. We contacted study authors to obtain further information for clarification on published work, unpublished studies, and work in progress.

MAIN RESULTS

We identified 18 potential studies, of which two, currently reported only as abstracts, met the inclusion criteria for this review. Too little information was available for us to present full results or adequately assess risk of bias. The participants were children aged five to 15 years with DMD, ambulant and non-ambulant. The interventions were risedronate versus no treatment in one trial (13 participants) and whole-body vibration versus a placebo device in the second (21 participants). Both studies reported improved bone mineral density with the active treatments, with no improvement in the control groups, but the abstracts did not compare treatment and control conditions. All children tolerated whole-body vibration treatment. No study provided information on adverse events. Two studies are ongoing: one investigating whole-body vibration, the other investigating zoledronic acid.

AUTHORS' CONCLUSIONS

We know of no high-quality evidence from RCTs to guide use of treatments to prevent or treat corticosteroid-induced osteoporosis and reduce the risk of fragility fractures in children and adults with DMD; only limited results from two trials reported in abstracts were available. We await formal trial reports. Findings from two ongoing relevant studies and two trials, for which only abstracts are available, will be important in future updates of this review.

Effect of whole-body vibration training on bone mass in adolescents with and without Down syndrome: a randomized controlled trial

Whole-body vibration training (WBV) attracts great interest as osteoporosis prevention strategy. Twenty-six adolescents with and without Down syndrome (DS) (13 DS; 12-18 years) performed 20 weeks of WBV. The results indicate that WBV seems to provoke a lesser response in adolescents with DS than in those without DS.

INTRODUCTION

This study aims to observe the differences between adolescents with and without DS in the effects of 20 weeks of WBV training, on bone mineral content (BMC) and density (BMD).

METHODS

Twenty-six adolescents (13 DS; 12-18 years) were measured with dual-energy X-ray absorptiometry before and after the intervention (3/week, 10 repetitions (30-60 s) and 1-min rest, frequency 25-30 Hz and peak-to-peak displacement of 2 mm (peak acceleration 2.5-3.6 g)). Both, an intention-to-treat (ITT) analysis designed to assess the effects on bone mass and a per-protocol analysis, designed to compare poor and high compliers, were performed.

RESULTS

The ITT analysis revealed significant increases in all BMC and BMD parameters (dz = 0.66 to 1.64; all p < 0.05) in the non-DS group, whilst DS group improved whole-body, subtotal (whole-body less head), upper limbs (ULIMBS), pelvis, lower limbs (LLIMBS) and spine BMC (dz = 0.75 to 1.76; all p < 0.05) and subtotal, pelvis, LLIMBS and spine BMD (dz = 0.73 to 1.28; all p < 0.05). Significantly greater increases were evident in the absolute and percent changes of the non-DS group over DS group (d = 0.88 to 3.85; all p < 0.05). ULIMBS BMD showed a tendency towards an interaction (f = 0.41 and p = 0.086) with higher increase for non-DS group. When a per-protocol analysis was considered, high-complier adolescents had 8.1 versus 5.3 % of gains in the spine BMC over poor-complier adolescents (d = 0.93; p < 0.05).

CONCLUSIONS

Twenty weeks of WBV training may improve BMC and BMD in clinically relevant skeletal sites in both groups. Nevertheless, this type of training seems to provoke a lesser response in adolescents with DS than in those without DS.