Whole Body Vibration Treatments in Postmenopausal Women Can Improve Bone Mineral Density: Results of a Stimulus Focussed Meta-Analysis

Effects of intermittent hypoxia and whole-body vibration training on health-related outcomes in older adults

BACKGROUND

Aging is associated with a health impairment and an increase of the vulnerability of the older people. Strength training under intermittent hypoxic conditions has been shown to have therapeutic effects on individual's health.

AIMS

The aim of this study was to investigate the effects of a combined intermittent hypoxia (IH) and whole-body vibration (WBV) training program on health-related outcomes in older people.

METHODS

A total of 60 adults (over the age of 65) voluntarily participated in an intervention that lasted 20 weeks (three 30-min sessions per week). The participants were divided into four experimental groups subjected to different environmental conditions (IH vs normoxia) and exercise (non-exercise vs WBV). Functional fitness, body composition, metabolic parameters, inflammatory biomarkers, and bone turnover were evaluated before and after the intervention. A multifactorial ANOVA with repeated measures was performed to explore differences within and between groups.

RESULTS

The results showed that IH and WBV had a positive synergistic effect on inflammatory parameters (CRP and IL-10), bone formation biomarker (PINP), and body composition (muscle and bone mass).

CONCLUSION

In conclusion, a combined IH and WVB training could be a useful tool to prevent the deterioration of health-related outcomes associated with aging. Clinical trial registration NCT04281264. https://clinicaltrials.gov/ .

The Efficacy of Whole-Body Vibration in Managing Postburn Victims' Complications: A Systematic Review

Burn injury is a complicated traumatic event with both systemic and local consequences. These complications include long periods of bed rest, pain, muscle weakness, vitamin D deficiency, and bone mineral density loss. Whole-body vibration demonstrated effectiveness in improving muscle power and bone mineral density in various musculoskeletal populations. This systematic review of randomized controlled trials aims to assess evidence for the effectiveness of using whole-body vibration on postburn survivors with at least 1% total body surface area on sensory and motor outcomes. A systematic search was conducted across six databases, which are, PubMed, Cochrane, PEDro, Scopus, Web of Science, and Google Scholar, from inception till March 2022. Retrieved studies were screened by title and abstract and full-text in two stages using Rayyan web-based. Included studies were assessed for risk of bias using the Cochrane risk of bias tool ROB 2.0. Six randomized controlled trials with 203 participants were included. Five of the included studies demonstrated an overall high risk of bias. Compared to conventional physiotherapy programs, whole-body vibration demonstrated improvement in functional mobility and balance using timed up and go and Biodex balance assessment, respectively. However, there were no differences between whole-body vibration and conventional physiotherapy program alone in bone mineral density and muscle power. Although the current evidence of whole-body vibration is limited, whole-body vibration combined with traditional physical therapy programs may improve functional mobility and balance in postburn survivors compared to physical therapy programs alone.

Whole-body vibration may not affect bone mineral density and bone turnover in persons with chronic spinal cord injury: A preliminary study

CONTEXT

Spinal-cord injury (SCI) induces bone loss and dramatically increases the risk of fracture.

OBJECTIVES

Determine the effects of whole-body vibration (WBV) on areal bone mineral density (aBMD), whole body composition and bone biological parameters in individuals with chronic-state SCI.

DESIGN

Randomized study.

SETTING

Centre Neurologique PROPARA.

PARTICIPANTS

Fourteen subjects were randomly assigned to a WBV or a control group.

INTERVENTIONS

WBV (20-45 min, 30-45 Hz, 0.5 g) was performed in verticalized persons twice weekly for 6 months.

OUTCOME MEASURES

aBMD was measured by DXA at baseline and 6 months and bone biological parameters at baseline, 1, 3 and 6 months.

RESULTS

No significant aBMD change was found in either the WBV or control group after 6 months of follow-up. Similarly, periostin, sclerostin and bone turnover markers remained relatively stable throughout follow-up and no difference in variation was observed within-group and between groups. Except for whole-body fat mass, which showed a significant decrease in the WBV group compared to controls, no difference in changes was observed, whatever the localization for fat and lean body mass.

CONCLUSIONS

During the chronic phase, aBMD and bone remodeling reach a new steady state. However, the DXA technique and the bone markers, including sclerostin and periostin, both of which reflect bone cell activity influenced by mechanical strain, showed that the bone tissue of individuals with SCI was insensitive to 6 months of WBV training at the study dose. Nevertheless, results of this preliminary study that was underpowered need to be confirmed and other modalities of WBV may be more effective in improving aBMD of this population.

TRIALS REGISTRATION

N°IDRCB:2011-A00224-37.

Developing an exercise intervention to improve bone mineral density in traumatic amputees: protocol for a Delphi study

INTRODUCTION

Lower limb amputation results in reduced bone mineral density (BMD) on the amputated side. Exercise interventions have proven effective in improving BMD. However, such interventions have not been attempted in an amputee population. Exercises designed for people with intact limbs may not be suitable for amputees, due to joint loss and the mechanical interface between the exercise equipment and the femoral neck being mediated through a socket. Therefore, prior to intervention implementation, it would be prudent to leverage biomechanical knowledge and clinical expertise, alongside scientific evidence in related fields, to assist in intervention development. The objective of this study is to elicit expert opinion and gain consensus to define specific exercise prescription parameters to minimise/recover BMD loss in amputees.

METHODS AND ANALYSIS

The Delphi technique will be used to obtain consensus among international experts; this will be conducted remotely as an e-Delphi process. 10-15 experts from ≥2 continents and ≥5 countries will be identified through published research or clinical expertise. Round 1 will consist of participants being asked to rate their level of agreement with statements related to exercise prescription to improve amputee BMD using a 5-point Likert Scale. Agreement will be deemed as ≥3 on the Likert Scale. Open feedback will be allowed in round 1 and any statement which less than 50% of the experts agree with will be excluded. Round 2 will repeat the remaining statements with the addition of any input from round 1 feedback. Round 3 will allow participants to reflect on their round 2 responses considering statistical representation of group opinion and whether they wish to alter any of their responses accordingly. Statements reaching agreement rates of 70% or above among the experts will be deemed to reach a consensus and will be implemented in a future exercise interventional trial.

ETHICS AND DISSEMINATION

Ethical approval was received from Imperial College Research Ethics Committee (reference: 6463766). Delphi participants will be asked to provide digital informed consent. The findings will be disseminated through peer-reviewed publications.

Effectiveness of whole-body vibration on bone mineral density in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials

The present study observed significant effects of whole-body vibration (WBV) on bone mineral density (BMD) in postmenopausal women, with high-quality evidence for high-frequency, low-magnitude, and high-cumulative-dose use. The aim was to update a previous systematic review with meta-analysis to observe the effects of WBV on BMD in postmenopausal women. For the meta-analysis, the weighted mean difference between WBV and control groups, or WBV and conventional exercise, was used for the area of bone mineral density (aBMD) of the lumbar spine, femoral neck, total hip, trochanter, intertrochanter, and Ward's area, or volumetric trabecular bone mineral density (vBMDt) of the radius and tibia. Methodological quality was assessed using the PEDro scale and the quality of evidence using the GRADE system. In total, 23 studies were included in the systematic review and 20 in the meta-analysis. Thirteen studies showed high methodological quality. WBV compared with control groups showed significant effects on aBMD in the primary analysis (lumbar spine and trochanter), sensitivity (lumbar spine), side-alternating vibration (lumbar spine and trochanter), synchronous vibration (lumbar spine), low frequency and high magnitude (lumbar spine and trochanter), high frequency and low magnitude (lumbar spine), high frequency and high magnitude (lumbar spine, trochanter, and Ward's area), high cumulative dose and low magnitude (lumbar spine), low cumulative dose and high magnitude (lumbar spine and trochanter), and positioning with semi-flexed knees (trochanter). Of these results, only high frequency associated with low magnitude and high cumulative dose with low magnitude showed high-quality evidence. At this time, considering the high quality of evidence, it is possible to recommend WBV using high frequency (≈ 30 Hz), low magnitude (≈ 0.3 g), and high cumulative dose (≈ 7000 min) to improve lumbar spine aBMD in postmenopausal women. Other parameters, although promising, need to be better investigated, considering, when applicable, the safety of the participants, especially in vibrations with higher magnitudes (≥ 1 g).

Functional quality assessment of whole-body vibration training devices based on instantaneous amplitude and frequency of photogrammetric vibration measurements

The practical use of whole-body vibration training (WBVT) and such research may be negatively influenced by generated vibrations with amplitudes, frequencies, and/or patterns that deviate from preset adjustments on WBVT devices. This study examined whether prolonged regular use can generate respective deviations. Four WBVT devices, used for 19 months in a research project on the effects of WBVT, were analyzed using photogrammetry before start of the research project and after 19 months. Divergences between preset and measured amplitudes and frequencies were calculated for all measurements. To quantify how well the output of devices correlates with the target setting, the vibration characteristics were calculated. In particular, exact long-term measurements related to the vibration amplitude is conducted and analyzed for the first time, which has been found as an important measure of the device functional quality. One device had a significantly (p<0.01) larger machine run time than the other three. This one showed the most pronounced signs of functional impairments concerning instantaneous amplitudes, frequencies and the mode of vibration after prolonged use. These results based on photometric measurements underline again that prolonged use can result in divergences between preset and actual applied amplitudes, frequencies, mode of vibration and other accuracy measurement metrics.

Effects of physical exercise on bone mineral density in older postmenopausal women: a systematic review and meta-analysis of randomized controlled trials

Osteoporosis or decreased bone mineral density (BMD) is the most important risk factor for fractures, especially in older postmenopausal women (PMW). However, the interactions between exercise training and bone mineral density are not completely understood. We evaluated the effects of physical exercise on BMD in women aged ≥ 60 years postmenopausal.

PURPOSE

This systematic review and meta-analysis sets out to determine the effects of physical exercise on BMD in older postmenopausal women.

METHODS

A systematic search was conducted in Medline, Science Direct, Cochrane, PubMed, CINAHL, Google Scholar, Scopus, and ProQuest up to December 25, 2021. Fifty-three studies, which assessed a total of 2896 participants (mean age: between 60 and 82 years), were included and analyzed using a random-effects model to estimate weighted mean differences (WMD) with 95% confidence intervals (CI).

RESULTS

The meta-analysis found that exercise training significantly (p < 0.05) increased femoral neck (WMD: 0.01 g/cm²; 95% CI, 0.00 to 0.01], p = 0.0005; I² = 57%; p < 0.0001), lumbar spine (WMD: 0.01 g/cm², 95% CI, 0.01 to 0.02], I² = 81%; p = 0.0001), and trochanter (WMD: 0.01 g/cm², 95% CI 0.00, 0.02]; p = 0.009; I² = 17%; p = 0.23). There were no significant differences between the intervention and control groups for total body and total hip BMD.

CONCLUSION

Our findings suggest that exercise training may improve bone mineral density in older PMW. This improvement is mediated by increases in the femoral neck, lumbar spine, and trochanter BMD. Further long-term studies are required to confirm these findings.

Effects of whole body vibration in postmenopausal osteopenic women on bone mineral density, muscle strength, postural control and quality of life: the T-bone randomized trial

Purpose

Osteopenia is common in postmenopausal women and effective interventions increasing or stabilizing bone mineral density (BMD) to prevent fractures are urgently needed.

Methods

Sixty-five postmenopausal women diagnosed with osteopenia (T-score between -1.0 and -2.5) were randomly assigned to either a vibration training group (VT), a resistance training group (RT), or a control group (CG). BMD T-score values (primary endpoint) were assessed at baseline (T0) and after 12 months (T12), secondary endpoints (muscle strength, postural control, and health-related quality of life) at baseline (T0), after 6 months (T6), after 12 months (T12), and as follow-up after 15 months (T15).

Results

After the intervention period, neither the VT nor the RT showed any significant changes in BMD T-score values compared to the CG. Isokinetic strength improved significantly within all training groups, with the exception of the flexors of VT at an angular velocity of 240°/s. Health-related quality of life as well as postural control improved significantly for the RT only.

Conclusions

We conclude that participants of all three groups were able to maintain their BMD. The improvements in quality of life and postural control after resistance training are nevertheless meaningful for postmenopausal osteopenic women and support the importance of regular loadings of the musculoskeletal system.

This study was retrospectively registered in January 2022 at the DRKS (S00027816) as clinical trial.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00421-022-05010-5.

Effect of 50-Hertz Sinusoidal Vibration on the Uterus in Ovariectomy-Induced Osteoporotic Rats

Objective

To evaluate the influence of sinusoidal vibration (50-Hertz) stimulation on the uterus of osteoporotic rats.

Methods

We constructed an osteoporosis rat model by ovariectomy (OVX). 36 3-month-old Sprague Dawley rats were randomly divided into the control group, vibrating group, sham operation group, sham operation vibrating group, OVX group, and OVX vibrating group (n = 6 per group). Rats started to vibrate one week after the operation: one 10 minutes 50-Hertz sinusoidal vibration per day, except for Saturday and Sunday. In the second, 8, and 12 week after vibration stimulation, rats were sacrificed in batches. And then, the uteruses were taken out to measure the wet weight and calculate uterus relative wet weight.

Results

Compared with the control group, OVA induced a significant increase in wet weight and relative wet weight in rat uterus. The vibration was to the uterus wet weight and the uterus relative wet weight in ovariectomized rats and at the same time had no significant effect, but the 12-week prolonged vibration can significantly reduce the uterus wet weight and the uterus relative wet weight in ovariectomized rats than 2 weeks.

Conclusions

The uterus wet weight and the uterus relative wet weight were increased in the OVA-induced osteoporosis rats. The 50-Hertz sinusoidal vibration had no significant effect on the uterus wet weight and the uterus relative wet weight in the ovariectomized rats at the same time, but 12 weeks of vibration can significantly reduce the uterine wet weight and uterine relative wet weight of ovariectomized rats. And the uterus relative wet weight can be used as a new indicator of stimulating the uterus.

Effect of External Mechanical Stimuli on Human Bone: a narrative review

Bone is a living composite material that has the capacity to adapt and respond to both internal and external stimuli. This capacity allows bone to adapt its structure to habitual loads and repair microdamage. Although human bone evolved to adapt to normal physiologic loading (for example from gravitational and muscle forces), these same biological pathways can potentially be activated through other types of external stimuli such as pulsed electromagnetic fields, mechanical vibration, and others. This review summarizes what is currently known about how human bone adapts to various types of external stimuli. We highlight how studies on sports-specific athletes and other exercise interventions have clarified the role of mechanical loading on bone structure. We also discuss clinical scenarios, such as spinal cord injury, where mechanical loading is drastically reduced, leading to rapid bone loss and permanent alterations to bone structure. Finally, we highlight areas of emerging research and unmet clinical need.

Long-term effect of full-body pulsed electromagnetic field and exercise protocol in the treatment of men with osteopenia or osteoporosis: A randomized placebo-controlled trial

Background: Osteoporosis is the most prevalent metabolic disease affecting bones. Objective: To investigate the long-term effect of pulsed electromagnetic field (PEMF) combined with exercise protocol on bone mineral density (BMD) and bone markers in men with osteopenia or osteoporosis. Methods: Ninety-five males with osteopenia or osteoporosis (mean age, 51.26 ± 2.41 years; mean height, 176 ± 2.02 cm; mean weight, 83.08 ± 2.60 kg; mean body–mass index (BMI), 26.08 ± 1.09 kg/m ²) participated in the study, and they were randomly assigned to one of three groups: Group 1 received a full-body PEMF and exercise protocol (PEMF +EX), Group 2 received a placebo full-body PEMF and exercise protocol (PPEMF +EX), and Group 3 received a full-body PEMF alone (PEMF). PEMF was applied for the whole body using a full-body mat three times per week for 12 weeks, with an exercise protocol that includes flexibility, aerobic exercise, strengthening, weight-bearing, and balance exercises followed by whole-body vibration (WBV) training. Outcome measures include BMD of total hip and lumbar spine and bone markers [serum osteocalcin (s-OC), Serum amino-terminal cross-linking telopeptide of type I collagen (s-NTX), Serum carboxy-terminal cross-linking telopeptide of type I collagen (s-CTX), Parathyroid hormones (PTH), Bone-specific Alkaline Phosphatase (BSAP), and 25-hydroxy vitamin D (Vit D)]. Results: The BMD of total hip and lumbar spine was significantly increased post-treatment in all groups, and more so in Group 1 and Group 2 than Group 3. There was a significant difference in bone markers in all groups, more so in Group 1 and Group 2 than in Group 3. Conclusion: PEMF combined with exercise protocol exerts a potent role for treating OP, is more effective than exercise and PEMF alone for increasing BMD and enhancing bone formation, and suppresses bone-resorption markers after 12-weeks of treatment with the impact lasting up to 6 months.

Age, Sex, and Race/Ethnicity Associations between Fat Mass and Lean Mass with Bone Mineral Density: NHANES Data

Rising rates of obesity and osteoporosis have public health implications; hence, understanding the relationships between body composition (fat mass (FM) and lean mass (LM)) and bone mineral density (BMD) is important. The purpose of this study is to investigate these associations in a large representative sample. A cross-sectional analysis was conducted using National Health and Nutrition Examination Survey participants (n = 1717, age 44.1 ± 14.2 years) who had complete dual energy x-ray absorptiometry (total BMD g/cm², FM kg, and LM kg) and covariate data. Hierarchical linear regression models were fitted, controlling for demographic and behavioral covariates. Stratum-specific models were fitted by race, sex, and age group. Significant negative associations were found for FM and BMD (β = −0.003) and significant positive associations for LM and BMD (β = 0.007). Stratum-specific analyses by race were consistent between groups, while variations in negative association magnitudes were seen in FM for sex (males β = −0.005 vs. females β = −0.002) and age (under 45 years of age β = −0.005 vs. 45 years and older β = −0.002). Consistent positive linear associations in total and stratum-specified models between LM and BMD could suggest a potential mechanical influence on bone health. The biological mechanisms driving the magnitude variations between FM and BMD by sex and age require more investigation.

The effect of whole-body vibration training with different amplitudes on bone mineral density in elderly women

BACKGROUND: The effects of whole-body vibration training (WBVT) with same frequency and different amplitudes on bone mineral density (BMD) in the elderly is not reported. OBJECTIVE: To compare the effect of 45-Hz WBVT with different amplitudes on the BMD in elderly women. METHODS: Age-, height-, and weight-matched patients were assigned to a low-amplitude group (n= 19, amplitude of 2 mm), medium-amplitude group (n= 18, amplitude of 3 mm), high-amplitude group (n= 19, amplitude 4 mm), and control group (n= 20). The WBVT was conducted for 24 weeks in the three amplitude groups. The BMD at lumbar vertebrae L2-4 and the proximal femur was measured at 0 and 24 weeks. RESULTS: The BMD at lumbar vertebrae L2-4 was higher in the high-amplitude group than in the low-amplitude and middle-amplitude groups, and the BMD of the greater trochanter was significantly higher than that in the low-amplitude group (p< 0.05). The BMD of the greater trochanter was significantly higher in the middle- than low-amplitude group (p< 0.05). CONCLUSION: A higher amplitude should be considered when WBVT is performed in elderly patients to increase bone density and prevent osteoporosis.

Osteoporosis Prevention, Screening, and Diagnosis: ACOG Clinical Practice Guideline No. 1

PURPOSE

To provide updated evidence-based recommendations for the prevention, screening, and diagnosis of postmenopausal osteoporosis.

TARGET POPULATION

Postmenopausal patients without identified risk factors for fracture, low bone mineral density, or secondary osteoporosis related to medication or a medical condition.

METHODS

This guideline was developed using an a priori protocol in conjunction with a writing team consisting of two specialists in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines-Gynecology and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within the Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team on the basis of standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations, Assessment, Development and Evaluations) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements.

RECOMMENDATIONS

This Clinical Practice Guideline includes updated recommendations on the role of exercise, calcium, and vitamin D in osteoporosis prevention; osteoporosis screening and diagnosis; rescreening intervals; and interventions to prevent falls. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.

Effect of Low-Intensity Vibration on Bone Strength, Microstructure, and Adiposity in Pre-Osteoporotic Postmenopausal Women: A Randomized Placebo-Controlled Trial

There has been evidence that cyclical mechanical stimulation may be osteogenic, thus providing opportunities for nonpharmacological treatment of degenerative bone disease. Here, we applied this technology to a cohort of postmenopausal women with varying bone mineral density (BMD) T-scores at the total hip (-0.524 ± 0.843) and spine (-0.795 ± 1.03) to examine the response to intervention after 1 year of daily treatment with 10 minutes of vibration therapy in a randomized double-blinded trial. The device operates either in an active mode (30 Hz and 0.3 g) or placebo. Primary endpoints were changes in bone stiffness at the distal tibia and marrow adiposity of the vertebrae, based on 3 Tesla high-resolution MRI and spectroscopic imaging, respectively. Secondary outcome variables included distal tibial trabecular microstructural parameters and vertebral deformity determined by MRI, volumetric and areal bone densities derived using peripheral quantitative computed tomography (pQCT) of the tibia, and dual-energy X-ray absorptiometry (DXA)-based BMD of the hip and spine. Device adherence was 83% in the active group (n = 42) and 86% in the placebo group (n = 38) and did not differ between groups (p = .7). The mean 12-month changes in tibial stiffness in the treatment group and placebo group were +1.31 ± 6.05% and -2.55 ± 3.90%, respectively (group difference 3.86%, p = .0096). In the active group, marrow fat fraction significantly decreased after 12 months of intervention (p = .0003), whereas no significant change was observed in the placebo group (p = .7; group difference -1.59%, p = .029). Mean differences of the changes in trabecular bone volume fraction (p = .048) and erosion index (p = .044) were also significant, as was pQCT-derived trabecular volumetric BMD (vBMD; p = .016) at the tibia. The data are commensurate with the hypothesis that vibration therapy is protective against loss in mechanical strength and, further, that the intervention minimizes the shift from the osteoblastic to the adipocytic lineage of mesenchymal stem cells. © 2020 American Society for Bone and Mineral Research (ASBMR).

Effects of whole-body vibration on bone properties in aged rats

OBJECTIVE

This study aimed to explore optimal conditions of whole-body vibration (WBV) for improving bone properties in aged rats.

METHODS

Eighty-week-old rats were divided into baseline control (BC), age-matched control (CON) and experimental groups, which underwent WBV (0.5 g) at various frequencies (15, 30, 45, 60 or 90 Hz) or WBV (45 Hz) with various magnitudes (0.3, 0.5, 0.7 or 1.0 g) for 7 weeks. After interventions, femur bone size, bone mechanical strength and circulating bone formation/resorption markers were measured, and trabecular bone microstructure (TBMS) and cortical bone geometry (CBG) of femurs were analyzed by micro-CT.

RESULTS

Several TBMS parameters and trabecular bone mineral content were significantly lower in the 15 Hz WBV (0.5 g) group than in the CON group, suggesting damage to trabecular bone. On the other hand, although frequency/magnitude of WBV did not influence any CBG parameters, the 0.7 g and 1.0 g WBV (45 Hz) group showed an increase in tissue mineral density of cortical bone compared with the BC and CON groups, suggesting the possibility of improving cortical bone properties.

CONCLUSION

Based on these findings, it should be noted that WBV conditions are carefully considered when applied to elderly people.

Whole body vibration training improves depression-like behaviors in a rat chronic restraint stress model

Major depressive disorder (MDD) is a prevalent psychiatric disorder that brings great harm and burden to both patients and society. This study aimed to examine the effects of whole-body vibration (WBV) training on a chronic restraint stress (CRS) induced depression rat model and provide an initial understanding of related molecular mechanisms. Adult Sprague-Dawley male rats were randomly divided into the following three groups: a) control group, b) depressive disorder group, and c) depression with WBV training treatment group. Daily food intake, body weight, sucrose preference test, open field test, elevated plus maze, forced swimming test, and Barnes maze task tests were performed. Immunofluorescence staining and ELISA analysis were used to assess neuronal damage, synaptic proteins, glial cells, and trophic factors. The data of behavioral tests and related biochemical indicators were statistically analyzed and compared between groups. Rats undergoing CRS showed increased anxiety-like behavior and memory impairment, along with synaptic atrophy and neuronal degeneration. WBV could reverse behavioral dysfunction, inhibit the degeneration of neurons, alleviate the damage of neurons and the pathological changes of glial cells, enhance trophic factor expression, and ameliorate the downregulation of dendritic and synaptic proteins after CRS. The effect of WBV in rats may be mediated via the reduction of hippocampal neuronal degeneration and by improving expression of synaptic proteins. WBV training exerts multifactorial benefits on MDD that supports its use as a promising new therapeutic option for improving depression-like behaviors in the depressive and/or potentially depressive.

Effects of whole-body vibration training with the same amplitude and different frequencies on the proximal femoral bone density in elderly women

BACKGROUND

This study investigated the whole-body vibration training with the same amplitude and different vibration frequencies was used to compare the difference in bone mineral density (BMD) of the proximal femurs in elderly women.

METHODS

This study included three age-, height-, and weight-matched groups; the medium-frequency group (N.=19) received 24 weeks of whole-body vibration training with a vibration frequency of 20 Hz; the high-frequency group (N.=18) received 24 weeks of whole-body vibration training with a vibration frequency of 40 Hz; and the control group (N.=19) received no intervention. Changes in the BMD of the proximal femur on the dominant side in the three groups were measured using dual-energy X-ray absorptiometry.

RESULTS

According to the between-group comparison, the BMD of the greater trochanter and Ward's triangle in the middle-frequency group increased by 7.6% and 13.3%, respectively (P<0.05), while the BMD of the greater trochanter and Ward's triangle in the high-frequency group increased by 10.6% and 16.9%, respectively (P<0.05). There was no significant difference in BMD between the medium-frequency group and the high-frequency group at 24 weeks (P>0.05).

CONCLUSIONS

Whole-body vibration training with a frequency of 20 Hz and 40 Hz improved the BMD of the proximal femurs in elderly women to varying degrees but had no significant effect on femoral neck BMD. Under the same amplitude conditions, an increase in vibration frequency did not cause further changes in BMD.

Morphometric Effects of Whole-Body Vibration on the Bone in a Rat Model of Postmenopausal Osteoporosis

OBJECTIVE

The purpose of this study was to analyze the morphometric effects of mechanical vibration with a duration of 4 or 8 weeks on the femur of oophorectomized Wistar rats.

METHODS

Sixty-four female rats were submitted to oophorectomy or a sham operation, and each of those 2 groups were randomized into 4 groups: untreated and euthanized at week 12, untreated and euthanized at week 16, treated for 4 weeks and euthanized at week 12, and treated for 8 weeks and euthanized at week 16. The vibration treatment was performed for 10 min/d, with a frequency of 60 Hz, 3 d/wk. The rats were then euthanized and the right femur dissected. Subsequently, histomorphometric analysis was performed on the proximal epiphysis and diaphysis of the spongy and cortical bone, respectively.

RESULTS

As expected, the oophorectomy groups presented reduction of spongy and cortical bone tissue. Further, the vibration therapy of 4 and 8 weeks' duration in the oophorectomized groups led to increased bone mass, observed as an increased percentage of spongy tissue, and increased thickness and percentage of cortical tissue. However, the variables of femoral neck diameter, mean area of the shaft, and number of osteocytes were not altered by oophorectomy and vibration.

CONCLUSION

The mechanical vibration was effective in increasing the bone mass of the femur of oophorectomized Wistar rats, observed by increasing the percentage of spongy bone and increasing the percentage and thickness of cortical bone.

The Impact of Different Modes of Exercise Training on Bone Mineral Density in Older Postmenopausal Women: A Systematic Review and Meta-analysis Research

Effectiveness of exercise on bone mass is closely related to the mode of exercise training regimen, as well as the study design. This study aimed to determine the effect of different modes of exercise training on lumbar spine and femoral neck bone mineral density (BMD) in older postmenopausal women (PMW). PubMed, CINAHL, Medline, Google Scholar, and Scopus databases and reference lists of included studies were searched up until March 25, 2019 for randomized controlled trials (RCTs) that evaluated the effectiveness of various modes of exercise training in PMW. Sixteen RCTs with 1624 subjects were included. Our study found no significant change in both lumbar spine and femoral neck BMD following exercise training (MD: 0.01 g/cm²; 95% confidence interval (CI) [- 0.01, 0.02] and MD: 0.00 g/cm²; 95% CI [- 0.01, 0.01], respectively). However, subgroup analysis by type of exercise training revealed that lumbar spine BMD (MD: 0.01; 95% CI [0.00, 0.02]) raised significantly when whole-body vibration (WBV) was employed as intervention compared with RCTs that utilized aerobic (MD: - 0.01; 95% CI [- 0.02, - 0.01]), resistance (MD: 0.01; 95% CI [- 0.04, 0.06]), and combined training (MD: 0.03; 95% CI [- 0.01, 0.08]). On the other hand, lumbar spine BMD (MD: - 0.01; 95% CI [- 0.02, - 0.01]) reduced significantly when aerobic exercise training was used as intervention compared with RCTs that utilized resistance training, combined training, and WBV. By contrast, these analyses did not have significant effect on change in femoral neck BMD. WBV is an effective method to improve lumbar spine BMD in older PMW.

Exercise-based correlates to calcaneal osteogenesis produced by a chronic training intervention

Thirty workouts on a gravity-independent device (Impulse Training Systems, Newnan GA) evoked significant calcaneal bone mineral content (BMC, +29%) and density (BMD, +33%) gains. High speeds and impact loads were produced per repetition. We examined exercise performance variables from the 30-workout intervention to identify correlates to delta (∆) calcaneal BMC and BMD variance. Workouts included hip extension and seated calf press exercises done with subject's left legs. ∆ values were obtained from the first and 12th workouts for the hip extension movement, and for the first and 24th workouts for the seated calf press exercise. Per exercise the following variables were quantified: peak force (∆PF), peak acceleration (∆PA), impulse (∆I), and dwell times (∆DT). Dwell times are the elapsed time between the end of the eccentric phase, and the start of the next repetition's concentric phase. Pearson Coefficients assessed correlations between performance and criterion variables. With hip extension ∆DT calculated with data from the first and 12th workouts, there were significant correlations with calcaneal ∆BMC (r = -0.64) and ∆BMD (r = -0.63). With seated calf press ∆DT derived as the difference from the first and 24th workouts, there was a significant correlation with calcaneal ∆BMC (r = -0.48), but only a trend (r = -0.45) with ∆BMD as the criterion. No other variables correlated with significant amounts of calcaneal ∆BMC and ∆BMD variance. Negative correlations infer shorter dwell times evoked greater gains. The gravity-independent device warrants continued inquiry to treat and abate calcaneal losses.

Effects of Whole-Body Vibration Training Combined With Cyclic Hypoxia on Bone Mineral Density in Elderly People

Prevention and treatment of osteoporosis are an issue of great concern in public health so that the increase/maintenance of whole-body bone mineral density (BMD) is clinically relevant and could reduce the financial burden. Whole-body vibration (WBV) has been recently proposed as a potential alternative to bone stimulation, which combined with therapies, could provide a new treatment for osteoporosis prevention. In this sense, moderate cyclic hypoxia protocols may help to restrain osteoclastic activity and/or stimulate osteoblastic activity, enhance the effects of whole-body vibration alone. So, the present study investigated the effects of cyclic hypoxic exposure combined with WBV training on BMD of the elderly. Healthy elderly persons (n = 30) were randomly assigned to a (1) Hypoxia-Whole Body Vibration group (HWBV; n = 10), (2) Normoxic-Whole Body Vibration group (NWBV; n = 10) or (3) Control group (CON; n = 10). During 18 weeks, HWBV performed WBV treatment under normobaric hypoxic conditions (16.1% FiO₂). A vibration session included 4 bouts of 30 s (12.6 Hz–4 mm) with 1 min rest between bouts. NWBV performed the same vibration treatment as HWBV but under normoxic conditions. Whole-body and proximal femur BMD (g⋅cm⁻²) were measured using dual-energy X-ray absorptiometry. Two-way ANOVA indicated a borderline significant (p = 0.07) time x group interaction for total BMD; post hoc analysis revealed a slight but significant (p = 0.021) increase of BMD after treatment in the HWBV group. In conclusion, 18-week WBV training with hypoxic stimuli has shown positive effects for the participants of the current study. As changes did not differ significantly between groups, future large-scale studies will be necessary to confirm these findings.

Effects of Two Different Neuromuscular Training Protocols on Regional Bone Mass in Postmenopausal Women: A Randomized Controlled Trial

Background: Osteoporosis is a condition associated with a greater incidence of fractures, and one of the main health-related concerns in postmenopausal women. To counteract possible reductions in bone properties, physical exercise has been proposed as an effective strategy. Particularly, training interventions with a high osteogenic potential are recommended. Purpose: To analyze the effect of 24 weeks of whole-body vibration and multi-component training on lumbar spine and femoral neck bone mass, and to determine what type of training produces greater adaptations in postmenopausal women. Methods: A total of 38 women completed the study (Clinical Gov database ID: NCT01966562). Participants were randomly assigned to one of the study groups: whole-body vibration group (WBVG), multi-component training group (MTG), or control group (CG). The experimental groups performed a progressive 24-week training (3 sessions/week) program. Bone mineral density (BMD) and bone mineral content (BMC) at the lumbar spine and femoral neck were assessed by Dual-energy X-ray absorptiometry. Results: Significantly and clinically relevant increases in lumbar spine bone mass (BMD: F = 3.29; p = 0.03; +5.15%; BMC: F = 2.90; p = 0.05; +10.58%) were observed in WBVG. MTG showed clinically important pre-post-changes on lumbar spine BMC (+7.78%), although there was no statistical significance (F = 1.97; p = 0.14). At the femoral neck, no statistically significant increases on bone mass were obtained in either training group. No changes were obtained in any variable in the CG. Additionally, no statistically significant differences were found between groups. Conclusion: The results indicated that 24 weeks of supervised WBV and MT may counteract the rapid loss of bone mass after the cessation of menstruation, thus improving postmenopausal women bone health. However, in the absence of statistically significant differences between groups, it is not possible to determine which training protocol produces greater adaptations. Clinical Trial Registration: www.ClinicalTrialsgov, identifier: NCT01966562.

Sclerostin and parathyroid hormone responses to acute whole-body vibration and resistance exercise in young women

Whole-body vibration (WBV) has been shown to improve bone mineral density, and muscle strength and power. No studies to date have examined sclerostin and parathyroid hormone (PTH) responses to WBV combined with resistance exercise (RE). This randomized crossover study compared acute serum sclerostin and PTH responses to RE and WBV + RE in young women (n = 9) taking oral contraceptives. Participants were exposed to 5 1-min bouts of vibration (20 Hz, 3.38 peak-peak displacement, separated by 1 min of rest) before high intensity resistance exercise. Fasting blood samples were obtained before (PRE), immediately after WBV (POSTWBV), immediately post RE (IP) and 30 min post RE (30P). Pre-exercise sclerostin and PTH levels were not significantly different between conditions. Sclerostin levels significantly (p < 0.05) increased from PRE to IP for the WBV + RE condition, then decreased back to the pre-exercise level. PTH significantly decreased from PRE to 30P (p < 0.05) and IP to 30P (p < 0.01) for both conditions. Correcting for hemoconcentration eliminated the significant sclerostin responses, but the significant decrease in PTH remained (p < 0.05). There were no significant relationships found between sclerostin and PTH. In conclusion, sclerostin concentrations increased in response to the WBV + RE condition, which may have been mediated by plasma volume shifts. There was no transient PTH increase, but it showed a large decrease at 30P for both conditions. Based on these findings, the addition of WBV exposures prior to high intensity RE did not alter sclerostin and PTH responses to RE in young women.

Lower Body Acceleration and Muscular Responses to Rotational and Vertical Whole-Body Vibration at Different Frequencies and Amplitudes

Aim:

The aim of this study was to characterize acceleration transmission and neuromuscular responses to rotational vibration (RV) and vertical vibration (VV) at different frequencies and amplitudes.

Methods:

Twelve healthy males completed 2 experimental trials (RV vs VV) during which vibration was delivered during either squatting (30°; RV vs VV) or standing (RV only) with 20, 25, and 30 Hz, at 1.5 and 3.0 mm peak-to-peak amplitude. Vibration-induced accelerations were assessed with triaxial accelerometers mounted on the platform and bony landmarks at ankle, knee, and lumbar spine.

Results:

At all frequency/amplitude combinations, accelerations at the ankle were greater during RV (all P < .03) with the greatest difference observed at 30 Hz, 1.5 mm. Transmission of RV was also influenced by body posture (standing vs squatting, P < .03). Irrespective of vibration type, vibration transmission to all skeletal sites was generally greater at higher amplitudes but not at higher frequencies, especially above the ankle joint. Acceleration at the lumbar spine increased with greater vibration amplitude but not frequency and was highest with RV during standing.

Conclusions/Implications:

The transmission of vibration during whole-body vibration (WBV) is dependent on intensity and direction of vibration as well as body posture. For targeted mechanical loading at the lumbar spine, RV of higher amplitude and lower frequency vibration while standing is recommended. These results will assist with the prescription of WBV to achieve desired levels of mechanical loading at specific sites in the human body.

The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients

Physical exercise is considered an effective means to stimulate bone osteogenesis in osteoporotic patients. The authors reviewed the current literature to define the most appropriate features of exercise for increasing bone density in osteoporotic patients. Two types emerged: (1) weight-bearing aerobic exercises, i.e., walking, stair climbing, jogging, and Tai Chi. Walking alone did not appear to improve bone mass; however it is able to limit its progressive loss. In fact, in order for the weight-bearing exercises to be effective, they must reach the mechanical intensity useful to determine an important ground reaction force. (2) Strength and resistance exercises: these are carried out with loading (lifting weights) or without (swimming, cycling). For this type of exercise to be effective a joint reaction force superior to common daily activity with sensitive muscle strengthening must be determined. These exercises appear extremely site-specific, able to increase muscle mass and BMD only in the stimulated body regions. Other suggested protocols are multicomponent exercises and whole body vibration. Multicomponent exercises consist of a combination of different methods (aerobics, strengthening, progressive resistance, balancing, and dancing) aimed at increasing or preserving bone mass. These exercises seem particularly indicated in deteriorating elderly patients, often not able to perform exercises of pure reinforcement. However, for these protocols to be effective they must always contain a proportion of strengthening and resistance exercises. Given the variability of the protocols and outcome measures, the results of these methods are difficult to quantify. Training with whole body vibration (WBV): these exercises are performed with dedicated devices, and while it seems they have effect on enhancing muscle strength, controversial findings on improvement of BMD were reported. WBV seems to provide good results, especially in improving balance and reducing the risk of falling; in this, WBV appears more efficient than simply walking. Nevertheless, contraindications typical of senility should be taken into account.

Relevance of Whole-Body Vibration Exercises on Muscle Strength/Power and Bone of Elderly Individuals

Beneficial effects are associated with whole-body vibration exercises (WBVEs). Increases in muscular strength/power, flexibility, and gait speed; improvements in bone mineral density, balance, and the quality of life; and decreased pain and risk of falls are reported. The aim is to present a review about the importance of WBVE for elderly individuals, considering clinical studies and meta-analyses, on bone and muscle strength/power. There is evidence supporting beneficial effect of WBVE in postmenopausal women (PW); however, effects in PW with osteoporosis are unclear. Age-related decrease in muscle mass and function contribute to undesirable health conditions, including death risk. The WBVEs improve muscle strength/power, functional independence measure, balance, and various fall risk factors, and mobility, measured by Timed Up and Go test, increased significantly after WBVE. An explanation for the absence of positive effects in some outcomes could be related to discrepancies in WBVE protocols as well as the populations tested. It is concluded that WBVE is effective for counteracting the loss of muscle strength associated with sarcopenia in elderly individuals. Balance and leg and plantar flexor strength improvements due to WBV indicate benefit to reduce risk and incidence of falls, frailty, and fracture risks. However, long-term feasibility of WBVE for musculoskeletal and bone health in elderly individuals needs further investigation.

Exercise for the prevention of osteoporosis in postmenopausal women: an evidence-based guide to the optimal prescription

BACKGROUND

Osteoporosis and related fragility fractures are a global public health problem in which pharmaceutical agents targeting bone mineral density (BMD) are the first line of treatment. However, pharmaceuticals have no effect on improving other key fracture risk factors, including low muscle strength, power and functional capacity, all of which are associated with an increased risk for falls and fracture, independent of BMD. Targeted exercise training is the only strategy that can simultaneously improve multiple skeletal and fall-related risk factors, but it must be appropriately prescribed and tailored to the desired outcome(s) and the specified target group.

OBJECTIVES

In this review, we provide an overview of the general principles of training and specific loading characteristics underlying current exercise guidelines for the prevention of osteoporosis, and an update on the latest scientific evidence with regard to the type and dose of exercise shown to positively influence bone mass, structure and strength and reduce fracture risk in postmenopausal women.

Whole-body vibration training and bone health in postmenopausal women: A systematic review and meta-analysis

BACKGROUND

The aims of the present systematic review and meta-analysis were to evaluate published, randomized controlled trials that investigate the effects on whole-body vibration (WBV) training on total, femoral neck, and lumbar spine bone mineral density (BMD) in postmenopausal women, and identify the potential moderating factors explaining the adaptations to such training.

METHODS

From a search of electronic databases (PubMed, Web of Science, and Cochrane) up until September 2017, a total 10 studies with 14 WBV groups met the inclusion criteria. Three different authors tabulated, independently, the selected indices in identical predetermined forms. The methodological quality of all studies was evaluated according to the modified PEDro scale. For each trial, differences within arms were calculated as mean differences (MDs) and their 95% confidence intervals between pre- and postintervention values. The effects on bone mass between exercise and control groups were also expressed as MDs. Both analyses were performed in the total sample and in a specific class of postmenopausal women younger than 65 years of age (excluding older women).

RESULTS

The BMD of 462 postmenopausal women who performed WBV or control protocol was evaluated. Significant pre-post improvements in BMD of the lumbar spine were identified following WBV protocols (P = .03). Significant differences in femoral neck BMD (P = .03) were also found between intervention and control groups when analyzing studies that included postmenopausal women younger than 65 years.

CONCLUSIONS

WBV is an effective method to improve lumbar spine BMD in postmenopausal and older women and to enhance femoral neck BMD in postmenopausal women younger than 65 years.

Whole Body Vibration Exposure on Markers of Bone Turnover, Body Composition, and Physical Functioning in Breast Cancer Patients Receiving Aromatase Inhibitor Therapy: A Randomized Controlled Trial

Introduction: Women with breast cancer are often prescribed aromatase inhibitors, which can cause rapid loss of bone mass leading to significant potential for morbidity. Vibration training has been shown to be helpful in reducing bone turnover in postmenopausal women without cancer. Aim: To examine the effect of vibration stimulus on markers of bone turnover in breast cancer patients receiving aromatase inhibitors. Methods: Thirty-one breast cancer survivors undergoing treatment with aromatase inhibitors were randomized to vibration stimulus (n = 14) or usual care control (n = 17). Low-frequency and low-magnitude vibration stimulus (27-32 Hz, 0.3g) was delivered in supervised sessions via standing on a vibration platform for 20 minutes, 3 times per week for 12 weeks. The primary outcome was blood markers of bone resorption (serum N-telopeptide X/creatine) and formation (serum type 1 procollagen N-terminal propeptide; P1NP). Other study outcomes body composition as well as measures of physical functioning. Outcomes were compared between groups using analysis of covariance adjusted for baseline values as well as time on aromatase inhibitors. Outcomes: On average, participants were 61.5 years old and overweight (ie, body mass index = 28.5 kg/m²). Following vibration training, there was no significant difference between groups for bone resorption (adjusted group difference 0.5, P = .929) or formation (adjusted group difference 5.3, P = .286). There were also no changes in any measure of physical functioning body composition. Conclusions: Short-term low-magnitude vibration stimulus does not appear to be useful for reducing markers of bone turnover secondary to aromatase inhibitors in breast cancer patients; nor is it useful in improving physical function or symptoms. However, further investigations with larger samples and higher doses of vibration are warranted. Trial Registration: Australian and New Zealand Clinical Trials Registry (ACTRN12611001094965).

Low-1 level mechanical vibration improves bone microstructure, tissue mechanical properties and porous titanium implant osseointegration by promoting anabolic response in type 1 diabetic rabbits

Type 1 diabetes mellitus (T1DM) is associated with reduced bone mass, increased fracture risk, and impaired bone defect regeneration potential. These skeletal complications are becoming important clinical challenges due to the rapidly increasing T1DM population, which necessitates developing effective treatment for T1DM-associated osteopenia/osteoporosis and bone trauma. This study aims to investigate the effects of whole-body vibration (WBV), an easy and non-invasive biophysical method, on bone microstructure, tissue-level mechanical properties and porous titanium (pTi) osseointegration in alloxan-diabetic rabbits. Six non-diabetic and twelve alloxan-treated diabetic rabbits were equally assigned to the Control, DM, and DM with WBV stimulation (WBV) groups. A cylindrical drill-hole defect was established on the left femoral lateral condyle of all rabbits and filled with a novel non-toxic Ti2448 pTi. Rabbits in the WBV group were exposed to 1h/day WBV (0.3g, 30Hz) for 8weeks. After sacrifice, the left femoral condyles were harvested for histological, histomorphometric and nanoindentation analyses. The femoral sample with 2-cm height above the defect was used for qRT-PCR analysis. The right distal femora were scanned with μCT. We found that all alloxan-treated rabbits exhibited hyperglycemia throughout the experimental period. WBV inhibited the deterioration of cancellous and cortical bone architecture and tissue-level mechanical properties via μCT, histological and nanoindentation examinations. T1DM-induced reduction of bone formation was inhibited by WBV, as evidenced by elevated serum OCN and increased mineral apposition rate (MAR), whereas no alteration was observed in bone resorption marker TRACP5b. WBV also stimulated more adequate ingrowths of mineralized bone tissue into pTi pore spaces, and improved peri-implant bone tissue-level mechanical properties and MAR in T1DM bone defects. WBV mitigated the reductions in femoral BMP2, OCN, Wnt3a, Lrp6, and β-catenin and inhibited Sost mRNA expression but did not alter RANKL or RANK gene expression in T1DM rabbits. Our findings demonstrated that WBV improved bone architecture, tissue-level mechanical properties, and pTi osseointegration by promoting canonical Wnt signaling-mediated skeletal anabolic response. This study not only advances our understanding of T1DM skeletal sensitivity in response to external mechanical cues but also offers new treatment alternatives for T1DM-associated osteopenia/osteoporosis and osseous defects in an economic and highly efficient manner.