Positive effects of Galileo side-alternating vibration in Cerebral Palsy
- Reduction of spasticity
- Improvement of muscle force and power
- Improved gait speed
- Improvement of mGMFM (modified gross motor function measure)
- Higher bone mass
Chron Respir Dis, 2015; (): , PMID: 25904085
Gloeckl R, Heinzelmann I, Kenn K
Department of Respiratory Medicine and Pulmonary Rehabilitation, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany firstname.lastname@example.org.
In recent years, several studies have shown that whole body vibration training (WBVT) may be a beneficial training mode in a variety of chronic diseases and conditions such as osteoporosis, fibromyalgia, multiple sclerosis, or chronic low back pain. However, a systematic review on the effects of WBVT in patients with chronic obstructive pulmonary disease (COPD) has not been performed yet.
An extensive literature search was performed using various electronic databases (PubMed, Embase, LILACS, and PEDro). They were searched from inception until September 20, 2014, using key words like “COPD” and “whole body vibration training.” A total of 91 studies could be identified and were screened for relevance by two independent reviewers. Six studies were included in a qualitative analysis.
Trials studied either the effects of WBVT versus an inactive control group, versus sham WBVT, during an acute COPD exacerbation or as a modality on top of conventional endurance and strength training.
All randomized trials reported a significantly superior benefit on exercise capacity (6-minute walking distance) in favor of the WBVT group. Although there are only few studies available, there is some preliminary evidence that WBVT may be an effective exercise modality to improve functional exercise capacity in patients with COPD.
Aerobic high-intensity interval training (HIT) improves cardiovascular capacity but may reduce the finite work capacity above critical power (W’) and lead to atrophy of myosin heavy chain (MyHC)-2 fibers. Since whole-body vibration may enhance indices of anaerobic performance, we examined whether side-alternating whole-body vibration as a replacement for the active rest intervals during a 4 x 4 min HIT prevents decreases in anaerobic performance and capacity without compromising gains in aerobic function.
Thirty-three young recreationally active men were randomly assigned to conduct either conventional 4 x 4 min HIT, HIT with 3 min of WBV at 18 Hz (HIT+VIB18) or 30 Hz (HIT+VIB30) in lieu of conventional rest intervals, or WBV at 30 Hz (VIB30). Pre and post training, critical power (CP), W’, cellular muscle characteristics, as well as cardiovascular and neuromuscular variables were determined. W’ (-14.3%, P = 0.013), maximal voluntary torque (-8.6%, P = 0.001), rate of force development (-10.5%, P = 0.018), maximal jumping power (-6.3%, P = 0.007) and cross-sectional areas of MyHC-2A fibers (-6.4%, P = 0.044) were reduced only after conventional HIT. CP, V̇O2peak, peak cardiac output, and overall capillary-to-fiber ratio were increased after HIT, HIT+VIB18, and HIT+VIB30 without differences between groups. HIT-specific reductions in anaerobic performance and capacity were prevented by replacing active rest intervals with side-alternating whole-body vibration, notably without compromising aerobic adaptations.
Therefore, competitive cyclists (and potentially other endurance-oriented athletes) may benefit from replacing the active rest intervals during aerobic HIT with side-alternating whole-body vibration.
In a former study we could show that performing whole body vibration training (WBVT) in addition to endurance and strength training was superior in increasing exercise capacity in patients with severe chronic obstructive pulmonary disease (COPD). Thus, we now used this training regime in patients after lung transplantation (LTx) to investigate if there is also an additional benefit of WBVT in this special patient cohort.
Consecutively 83 LTx-patients (mean 10.7±12.8 weeks after LTx due to interstitial lung disease: n=51 and COPD: n=32, single-/double-LTx: n=28/55, age: 56±7ys, FEV1: 71±20% pred., 6-minute-walking-distance (6MWD) 368±113m) were enrolled in this randomized controlled trial. All patients underwent a 4-week inpatient pulmonary rehabilitation (PR) program including standardized endurance and strength training on 5 days per week. Additionally patients performed a dynamic and self-paced squat training (3 times per week for 4×2 minutes each). Patients were randomly assigned to perform squat training either on a WBVT platform (Galileo®, Novotec Medical, Germany) at a high frequency of 24 to 26 Hertz with a peak-to-peak displacement of 4 to 5 mm (WBVT-group) or on the floor (control group). Primary outcome parameter was the 6MWD. Further outcome parameters were peak quadriceps force (QF), peak work rate (PWR) and the 5-repetition chair-rise-test (5-CRT).
Seventy patients completed the study and were included in the final analysis (WBVT: n=34, control: n=36). The 6MWD improved significantly more in the WBVT-group compared to the control group (84±57m versus 55±47m, delta 29m, p=0.015 (95%CI 3.1 – 53.7m). Secondary outcome parameters also improved significantly but without any significant between-group difference (PWR: WBVT 17±11watt versus control 13±10watt, QF: WBVT 10.3±9.0% versus control 8.8±5.7%, 5-CRT: WBVT -5.1±4.7 sec versus control -3.8±6.1 sec). No training related adverse events did occur.
A complementary WBVT on top of conventional endurance and strength training seems to be superior in improving 6MWD in patients after LTx compared to endurance and strength training alone.
Institute of Sport and Sport Science, University of Freiburg, Schwarzwaldstraße 175, 79117 Freiburg, Germany. email@example.com
This study aimed to assess the influence of different whole body vibration (WBV) determinants on the electromyographic (EMG) activity during WBV in order to identify those training conditions that cause highest neuromuscular responses and therefore provide optimal training conditions. In a randomized cross-over study, the EMG activity of six leg muscles was analyzed in 18 subjects with respect to the following determinants:
The results are:
In conclusion, large variations of the EMG activation could be observed across conditions. However, with an appropriate adjustment of specific WBV determinants, high EMG activations and therefore high activation intensities could be achieved in the selected muscles.
The combination of high vibration frequencies with additional load on the SV platform (Galileo) led to highest EMG activities. Regarding the body position, a knee flexion of 60° and forefoot stance appear to be beneficial for the knee extensors and the plantar flexors, respectively.
Cologne Children’s Hospital, Jan 2013
E. Schoenau, C. Stark, O. Semler – Children’s Hospital, University of Cologne, Germany
Background: Rehabilitation of children with Cerebral Palsy (CP) aims to reduce sequelae and enhance function. Physiotherapy is a rehabilitative strategy for the treatment of patients with CP, but with little supporting evidence for the different treatment concepts. The Cologne Concept “Auf die Beine” combines Interval-Rehabilitation consisting of short and intensive in-patient stays with 6 months home-based whole body vibration training. “Auf die Beine” is a routine procedure supported by the German health care system. We are presenting the gross motor function results after 6 months of training and additional 6 months follow-up.
Design: Retrospective analysis of 356 children and adolescents
Participants and Setting: 356 children and adolescents diagnosed with CP were included in the retrospective analysis. Mean age was 8.9 years (SD 4.4) and GMFCS levels were 7.3% level I, 14.9% level II, 30.3% level III, 31.2% level IV and 7.6% level V. All patients completed 6 months of home based whole body vibration training, two blocks of intensive physiotherapy and the 12 month visit (6 months follow-up).
Methods: Gross motor function was assessed with the Gross Motor Function Measure (GMFM-66) total score after 6 and 12 (Follow-up) months and the GMFM-88-Goal-Dimensions after 6 months.
Results: GMFM-66-Totalscore improved by 2.9 points (Mean 3.35; p<0.001) after 6 months and by 0.2 points (Mean 0.63; p=0.033) after 6 months follow-up. Goal dimension A (lying) improved by 2.0% (Mean 3.8; p=0.001), B (sitting) by 3.3% (Mean 5.9; p<0.001), C (crawling) by 4.8% (Mean 6.7; p<0.001), D (standing) by 5.1% (Mean 8.0; p<0.001) and E (walking) by 2.8% (Median 4.6; p<0.001).
Conclusion: The Interval-Rehabilitation combined with home-based training shows a significant positive effect on gross motor function in patients with CP. The results could be sustained after 6 months follow-up. To our knowledge this is the first retrospective evaluation of a routine health care concept for children with mobility problems.
Effect of whole-body vibration on muscle strength and balance in diplegic cerebral palsy: a randomized controlled trial.
Am J Phys Med Rehabil. 2014 Feb;93(2):114-21
The purpose of this study was to investigate the effects of whole-body vibration training on muscle strength and balance in children with diplegic cerebral palsy.
Fifteen children were assigned to the experimental group, which received whole-body vibration training (9 mins per day, 5 days per week). Another 15 were assigned to the control group, which participated in a traditional physical therapy exercise program for 3 successive months. Baseline and posttreatment assessments were performed using the Biodex isokinetic dynamometer to evaluate the knee extensors peak torque at 60 degrees per second and 90 degrees per second and using the Biodex balance system to evaluate stability index.
The children in the experimental group showed a significant improvement when compared with those in the control group (P < 0.001). The peak torque at 60 degrees per second and 90 degrees per second after treatment was 28.8 ± 0.45 and 47.5 ± 0.7 N · m and 30.9 ± 0.68 and 54.2 ± 1.7 N · m for the control and the experimental group, respectively. The overall stability index after treatment was 2.75 and 2.2 for the control group and the experimental group, respectively.
Whole-body vibration training may be a useful tool for improving muscle strength and balance in children with diplegic cerebral palsy.
PMID: 24434887 [PubMed – indexed for MEDLINE]
Clinical Rehabilitation February 14, 2013
Objective: To evaluate ambulatory function and leg muscle thickness after whole body vibration training in children with cerebral palsy.
Design: A block randomized controlled trial with two groups.
Setting: Physical therapy department laboratory.
Subjects: A total of 30 (15 experimental, mean (SD) age 10.0 (2.26) years and 15 control, 9.6 (2.58)) children with cerebral palsy, 15 males and 15 females.
Interventions: The experimental group underwent whole body vibration training combined with conventional physical therapy training; the control group underwent conventional physical therapy training three days a week for eight weeks respectively.
Main outcome measures: Three-dimensional gait analyses and ultrasonographic imaging of the leg muscles were measured at pre- and post-test of intervention for eight weeks.
Results: Whole body vibration training resulted in significantly better gait speed (P = 0.001, from 0.37 (0.04) m/s to 0.48 (0.06)), stride length (P = 0.001, from 0.38 (0.18) m to 0.48 (0.18)) and cycle time (P = 0.001, from 0.85 (0.48) s to 0.58 (0.38)) in the experimental group compared with that in the control group. The ankle angle (P = 0.019, from 7.30 (4.02) degree to 13.58 (8.79)) also showed a remarkable increase in the experimental group, but not the hip (P = 0.321) and knee angle (P = 0.102). The thicknesses of the tibialis anterior (P = 0.001, 0.48 (0.08) mm to 0.63 (0.10)) and soleus (P = 0.001, 0.45 (0.04) mm to 0.63 (0.12)) muscles were significantly higher in the experimental group than in the control group. However, no significant effect was observed in the thickness of the gastrocnemius muscle (P = 0.645).
Exercise, Health and Performance, Faculty Research Group, Faculty of Health Sciences, University of Sydney, Australia.
To examine the effects of whole body vibration (WBV) exposure on muscle function in children with Cystic Fibrosis (CF). Non-randomised controlled cross-over trial.
The setting was home-based WBV exposure. The participants were children (8 – 15 years) with CF (n = 7).
participants served as their own controls for the first four weeks (usual care), then underwent four weeks of parentally-supervised home-based WBV exposure followed by four weeks washout (usual care). The WBV exposure consisted of 20 – 30 minutes of intermittent (1 min vibration:1 min rest) exposure on a Galileo platform (20 – 22Hz, 1 mm amplitude) 3 days/week. The primary outcome measures of absolute and relative lower body (leg extension (LE), leg press (LP)), upper body (chess press (CP)) strength and power, and power were measured at baseline, and weeks 4, 8 and 12. Secondary exploratory outcomes were cardiorespiratory fitness, pulmonary function and health-related quality of life.
Six participants completed the training without adverse events. Muscle function changes following WBV exposure were not statistically significant. However, moderate-to-large relative effect sizes (ES) favouring WBV were evident for leg extension strength (ES = 0.66 (-0.50, 1.82)), LP relative strength (ES = 0.92 (-0.27, 2.11)), leg press peak power (ES = 0.78 (-0.50, 2.07)) and CMJ height (ES = 0.60 (-0.56 to 1.76)).
The results from this first controlled trial indicate that WBV may be a potentially effective exercise modality to safely increase leg strength and explosive power in children with CF. Potentially clinically relevant changes support continued investigation of the efficacy, mechanism and feasibility of this intervention in future large-scale studies.
Children, Cystic Fibrosis, Muscle function, Muscle power, Vibration
J Musculoskelet Neuronal Interact. 2013 Mar;13(1):13-8.
Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden. firstname.lastname@example.org
To study the tolerability of whole body vibration (WBV) exercise in patients with Duchenne muscular dystrophy (DMD) and its effects on muscle and bone.
WBV was performed two to three times a week for three months. Motor function, muscle strength, bone mass and biochemical markers of bone and mineral metabolism were analyzed before and after the WBV period at 0, 3, 6 and 12 months.
Six ambulatory patients with DMD aged 5.7-12.5 years completed the study. No changes in creatine kinase activity were found, indicating that the WBV exercise did not further damage the skeletal muscle. No significant changes in bone mass, muscle strength or bone markers were found. However, there was a non-significant trend for the bone formation marker, bone-specific alkaline phosphate, to increase from a mean of 59 U/L to 73 U/L after three months of WBV. The bone formation marker levels returned to baseline three months after discontinuing WBV and were still at that level after nine months.
WBV therapy appears to be safe and well tolerated among ambulatory DMD patients. The potential benefits of WBV on bone and muscle in DMD remain to be elucidated.
Vibration therapy tolerated in children with Duchenne muscular dystrophy: a pilot study.
Pediatr Neurol. 2014 Jul;51(1):126-9
Myers KA1, Ramage B2, Khan A3, Mah JK4.
Duchenne muscular dystrophy is an X-linked recessive muscular dystrophy. Clinical management primarily involves rehabilitation strategies aimed at preserving functional mobility as long as possible. Side-alternating vibration therapy is a rehabilitation intervention that has shown promise in a number of different neuromuscular disorders, and has the potential to preserve strength, functional mobility, and bone mass. There has been little research regarding the tolerance to side-alternating vibration therapy in muscle diseases such as Duchenne muscular dystrophy.
Four patients were recruited for a pilot study assessing the safety and tolerance of side-alternating vibration therapy in individuals with Duchenne muscular dystrophy. All patients participated in a 4-week training period involving side-alternating vibration therapy sessions three times per week. Serum creatine kinase was measured, and adverse effects reviewed at each session with functional mobility assessed before and after the training period.
All patients tolerated the training protocol well, and there were no major changes in functional mobility. One patient had a transient increase in creatine kinase during the study; however, levels of this enzyme were stable overall when comparing the pretraining and posttraining values. Some patients reported subjective improvement during the training period.
Side-alternating vibration therapy is well tolerated in children with Duchenne muscular dystrophy and may have potential to improve or maintain functional mobility and strength in these patients.
Copyright © 2014 Elsevier Inc. All rights reserved.
Duchenne muscular dystrophy; rehabilitation; safety; side-alternating vibration therapy; whole-body vibration therapy
PMID: 24830767 [PubMed – indexed for MEDLINE]
Phys Rehab Kur Med, 2003; 13: 286-290
Crevenna R, Fialka-Moser V, Rödler S, Keilani M, Zöch C, Nuhr M, Quittan M, Wolzt M
Department of Physical Medicine and Rehabilitation, Department of Cardiothoracic Surgery, Department of Clinical Pharmacology, Department of Cardiology, Vienna University, Vienna, Austria
Purpose: The benefits of whole-body vibration exercise (WBV) have not yet been recognized in heart transplant recipients although these patients often show a severe loss in skeletal muscle strength and bone mineral density over time. At present, WBV is not generally recommended for rehabilitation of transplant patients. The purpose of this study was to document the safety, cardiovascular responses and metabolic changes to WBV in heart transplant patients.
Material and Methods: 14 male clinically stable heart transplant recipients were included in this study. The subjects were exposed to one set of whole-body vibration using the Galileo 2000 device. Heart rate, systolic and diastolic blood pressure, blood lactate concentration and the Borg scale were used to determine objective and subjective exertion during WBV.
Results: In every patient WBV was terminated due to muscular fatigue. The mean duration of exercise was 248 seconds (range, 51 – 607 seconds). Heart rate, systolic and diastolic blood pressure, lactate concentrations and the Borg score increased during WBV to levels achieved during aerobic exercise. No patient experienced adverse events.
Conclusion: The results of this pilot study indicate that WBV is feasible and safe in heart transplant recipients. The cardiovascular and metabolic response of an acute bout of WBV is similar to that of standard aerobic exercise.
Whole body vibration training is a new and complimentary exercise modality for endurance and strength training in patients with chronic obstructive pulmonary heart disease (COPD) and provides safe exercise to improve muscle power, exercise tolerance, reduce symptoms of dyspnea, and increase HRQL.
Galileo’s side-alternating stimulation is a fast and efficient muscle tool for people with neurological diseases to improve postural control and for patients with osteoporosis to enhance bone mineral density. 1,2
In healthy subjects it has been shown that performing resistance training on Galileo induces greater neuromuscular and hormonal responses than resistance training alone by providing a more intense stimulus. 3
Major effects from peer reviewed studies are:
1. Zha DS, Zhu QA, Pei WW, Zheng JC, Wu SH, Xu ZX, et al. Does whole-body vibration with alternative tilting increase bone mineral density and change bone metabolism in senior people? Aging Clin Exp Res 2011.
2. Merkert J, Butz S, Nieczaj R, Steinhagen-Thiessen E, Eckardt R. Combined whole body vibration and balance training using vibrosphere(R): improvement of trunk stability, muscle tone, and postural control in stroke patients during early geriatric rehabilitation. Z Gerontol Geriatr 2011.
3. Ronnestad BR. Comparing the performance-enhancing effects of squats on a vibration platform with conventional squats in recreationally resistance-trained men. J Strength Cond Res 2004;18(4):839e45.
4. Nishihira Y, Iwasaki TAH. Effects of whole body vibration stimulus and voluntary contraction on motorneuron pool. Adv Exerc Sports Physiol 2002;8(4):83e6.
5. Bosco C, Colli R, Introini E, Cardinale M, Tsarpela O, Madella A, et al. Adaptive responses of human skeletal muscle to vibration exposure. Clin Physiol 1999;19(2):183e7.
6. Butcher SJ, Meshke JM, Sheppard MS. Reductions in functional balance, coordination, and mobility measures among patients with stable chronic obstructive pulmonary disease. J Cardiopulm Rehabil 2004;24(4):274e80.
Institute of Sport Sciences, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany. email@example.com
We investigated spontaneous effects of random whole-body vibration (rWBV) on postural control in Parkinsonian subjects. Effects were examined in biomechanical tests from a total of 52 patients divided equally into one experimental and one control group. Postural control was tested pre- and post-treatment in two standardized conditions (narrow standing and tandem standing).
The intervention was based on rWBV (ŷ: 3 mm, f: 6 Hz/sec) consisting of 5 series lasting 60 seconds each.
The main findings from this study were that: