Category Archives: COPD / Heart / Lung

Galileo Improves Exercise Capacity in Pulmonary Arterial Hypertension

Heart, 2017; (): , PMID: 28100544 external link

Oscillatory whole-body vibration improves exercise capacity and physical performance in pulmonary arterial hypertension: a randomised clinical study.

Gerhardt F, Dumitrescu D, Gartner C, Beccard R, Viethen T, Kramer T, Baldus S, Hellmich M, Schonau E, Rosenkranz S
Klinik III fur Innere Medizin, Herzzentrum der Universitat zu Koln, Cologne, Germany.

Abstract

OBJECTIVE: In patients with pulmonary arterial hypertension (PAH), supportive therapies may be beneficial in addition to targeted medical treatment. Here, we evaluated the effectiveness and safety of oscillatory whole-body vibration (WBV) in patients on stable PAH therapy.

METHODS: Twenty-two patients with PAH (mean PAP>/=25 mm Hg and pulmonary arterial wedge pressure (PAWP)</=15 mm Hg) who were in world health organization (WHO)-Functional Class II or III and on stable PAH therapy for>/=3 months, were randomised to receive WBV (16 sessions of 1-hour duration within 4 weeks) or to a control group, that subsequently received WBV. Follow-up measures included the 6-min walking distance (6MWD), cardiopulmonary exercise testing (CPET), echocardiography, muscle-power, and health-related quality of life (HRQoL; SF-36 and LPH questionnaires).

RESULTS: When compared to the control group, patients receiving WBV exhibited a significant improvement in the primary endpoint, the 6MWD (+35.4+/-10.9 vs -4.4+/-7.6 m), resulting in a net benefit of 39.7+/-7.8 m (p=0.004). WBV was also associated with substantial improvements in CPET variables, muscle power, and HRQoL. The combined analysis of all patients (n=22) indicated significant net improvements versus baseline in the 6MWD (+38.6 m), peakVO2 (+65.7 mL/min), anaerobic threshold (+40.9 mL VO2/min), muscle power (+4.4%), and HRQoL (SF-36 +9.7, LPH -11.5 points) (all p<0.05). WBV was well tolerated in all patients, and no procedure-related severe adverse events (SAEs) occurred.

CONCLUSIONS: WBV substantially improves exercise capacity, physical performance, and HRQoL in patients with PAH who are on stable targeted therapy. This methodology may be utilised in structured training programmes, and may be feasible for continuous long-term physical exercise in these patients. TRIAL REGISTRATION NUMBER: NCT01763112; Results.

Cardiopulmonary response during severe COPD

ERJ Open Res, 2017; 3:00101-2016:

Cardiopulmonary response during whole-body vibration training in patients with severe COPD

Gloeckl R, Richter P, Winterkamp S, et al.
Dept of Respiratory Medicine and Pulmonary Rehabilitation, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany. 2Dept of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Muni

Abstract

Background: Several studies in patients with chronic obstructive pulmonary disease (COPD) have shown
that whole-body vibration training (WBVT) has beneficial effects on exercise capacity. However, the acute cardiopulmonary demand during WBVT remains unknown and was therefore investigated in this study.

Method: Ten patients with severe COPD (forced expiratory volume in 1 s: 38}8% predicted) were examined on two consecutive days. On day one, symptom-limited cardiopulmonary exercise testing was performed on a cycle ergometer. The next day, six bouts of repeated squat exercises were performed in random order for one, two or three minutes either with or without WBVT while metabolic demands were simultaneously measured.

Results: Squat exercises with or without WBVT induced comparable ventilatory efficiency (minute ventilation (VE)/carbon dioxide production (VŒCO2): 38.0}4.4 with WBVT versus 37.4}4.1 without, p=0.236). Oxygen uptake after 3 min of squat exercises increased from 339}40 mLEmin.1 to 1060}160 mLEmin.1 with WBVT and 988}124 mL min.1 without WBV (p=0.093). However, there were no significant differences between squat exercises with and without WBVT in oxygen saturation (90}4% versus 90}4%, p=0.068), heart rate (109}13 bpm versus 110}15 bpm, p=0.513) or dyspnoea (Borg scale 5}2 versus 5}2, p=0.279).

Conclusion: Combining squat exercises with WBVT induced a similar cardiopulmonary response in patients with severe COPD compared to squat exercises without WBVT. Bearing in mind the small sample size, WBVT might be a feasible and safe exercise modality even in patients with severe COPD.

Benefits of WBV with COPD

Respiratory Medicine, 2017; 126: 17-24

What’s the secret behind the benefits of whole-body vibration training in patients with COPD? A randomized, controlled trial

Gloeckl R, Jarosch I, Bengschc U, Claus M, Schneeberger T, Andrianopoulos V, Christle JW, Hitzl W, Kenn K
a Department of Respiratory Medicine & Pulmonary Rehabilitation, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany b Department of Prevention, Rehabilitation and Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich

Background: Several studies have shown that whole-body vibration training (WBVT) improves exercise capacity in patients with severe COPD. The aim of this study was to investigate the determinants of improved exercise capacity following WBVT.

Methods: Seventy-four COPD patients (FEV1: 34 ± 9%predicted) were recruited during a 3-week inpatient pulmonary rehabilitation (PR) program. Conventional endurance and strength exercises were supplemented with self-paced dynamic squat training sessions (4bouts*2min, 3times/wk). Patients were randomly allocated to either a WBVT-group performing squat training on a side-alternating vibration platform (Galileo) at a high intensity (24–26 Hz) or a control group performing squat training without WBVT.

Results: Patients in the WBVT group significantly improved postural balance in several domains compared to the control-group (i.e. tandem stance: WBVT +20% (95%CI 14 to 26) vs. control -10% (95%CI 6 to 15), p < 0.001; one-leg stance: WBVT +11% (95%CI 4 to 19) vs. control -8% (95%CI -19 to 3), p = 0.009). Six-minute walk distance and muscle power but not muscle strength were also significantly improved compared to control group.

Conclusions: Implementation of WBVT improves postural balance performance and muscle power output. The neuromuscular adaptation related to improved balance performance may be an important mechanism of the improvement in exercise capacity after WBVT especially in COPD patients with impaired balance performance and low exercise capacity.

Whole body vibration training in patients with COPD: A systematic review.

Chron Respir Dis, 2015; (): , PMID: 25904085 external link

Gloeckl R, Heinzelmann I, Kenn K
Department of Respiratory Medicine and Pulmonary Rehabilitation, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany rainer.gloeckl@gmx.de.

Abstract

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.

Training after Lung Transplantation

Respiratory Medicine (2012) 106, 75e83

Effects of a complementary whole body vibration training in patients after lung transplantation during pulmonary rehabilitation – a randomized controlled trial

Rainer Gloeckl, Inga Heinzelmann, Thomas Damisch, Stella Seeberg, Klaus Kenn
Schoen Klinik Berchtesgadener Land, Department of Respiratory Medicine, Schoenau am Koenigssee, Germany

Rationale

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.

Methods

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).

Results

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.

Conclusions

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.

LungSitPeakQuad

Health Improvements in COPD

Respir Med. 2012 Jan;106(1):75-83. doi: 10.1016/j.rmed.2011.10.021. Epub 2011 Nov 21.

Effects of whole body vibration in patients with chronic obstructive pulmonary disease–a randomized controlled trial.

Gloeckl R, Heinzelmann I, Baeuerle S, Damm E, Schwedhelm AL, Diril M, Buhrow D, Jerrentrup A, Kenn K.

Source: Department of Respiratory Medicine, Schoen Klinik Hospital, Schoenau am Koenigssee, Germany. rainer.gloeckl@gmx.de

Abstract:

INTRODUCTION: To date endurance and strength training are established and evidence-based exercise methods in patients with chronic obstructive pulmonary disease (COPD). There is an unmet need for further research in new and complementary exercise modalities. Additional whole body vibration training during pulmonary rehabilitation may be such a new approach that has not yet been investigated in patients with COPD.

METHODS: Eighty-two patients (65 ± 9 yrs, FEV(1) pred. 38 ± 11%, female 51%) with COPD in GOLD stage III to IV assessed for a 3-week inpatient multidisciplinary rehabilitation program were on top randomly assigned to one of two intervention groups: (1) 3 × 3 min of bilateral dynamic squat exercises on a side-alternating vibration platform at 24-26 Hz three times per week (WBV) and (2) a control group (CON) with the same amount of exercise time without WBV.

RESULTS: Thirty-six patients completed the study in each group. The improvement in 6-min walking distance was significantly higher in the WBV-group when compared to the CON-group (WBV: 64 ± 59 m, CON: 37 ± 52 m with a between-group difference of 27 m [95% CI, 1-53], p = 0.046). The time required for a sit-to-stand test also decreased more markedly in the WBV-group than in the CON-group (WBV: -4.0 ± 4.8 s, CON: -2.0 ± 3.1 s with a between-group difference of -1.9 s [95% CI, -4.0 to 0.1], p = 0.067). Improvements in health-related quality of life were similar in both groups.

COPD 6MinTest

COPDSit2Stand

CONCLUSIONS: WBV training seems to be a promising new exercise modality for patients with COPD and may enhance the effects of a multidisciplinary rehabilitation program.

Vibration Benefits

Int J Sports Med. 2011 Feb;32(2):75-99. doi: 10.1055/s-0030-1268010. Epub 2010 Dec 16.

Vibration exercise: the potential benefits.

Cochrane DJ

Source: Massey University, Palmerston North, New Zealand. d.cochrane@massey.ac.nz

Abstract

Purpose: The aim of this review was to examine the physiological effects of vibration exercise (VbX), including the cardiovascular indices and to elucidate its potential use for those with compromised health.

Results:

VbX has long been acknowledged as a potential modality in sport, exercise, and health sectors.
Muscle force and power have been shown to increase after VbX for athletes, the aged and those with diseases, where neural factors are thought to be the main contributor.
Further, similarities to the tonic vibration reflex have been used to propose that the muscle spindle plays a role in activating the muscle which could benefit those with compromised health.
There is strong evidence that acute VbX can enhance upper and lower-body muscle power, and there is some indication that longer-term VbX can augment muscle power of upper and lower body extremities, although this is less convincing.
It is not conclusive whether VbX increases force attributes. This has been fraught by the type and parameters used for various muscle contractions, and the different sample populations that have varied in chronological age, experience and training status.
VbX provides an insufficient stimulus to enhance cardiovascular indices, where VbX cannot increase heart rate to the same extent as conventional aerobic exercise.
But when conventional aerobic exercise is not possible, for example, in aged, cardiovascular compromised persons, VbX could be implemented at an early stage because it could provide a safe induction of a slight elevation of cardiovascular function indices while providing neural and myogenic benefits.

Conclusion: In conclusion, VbX is a safe modality to increase physiological responses of reflex and muscle activity, and muscle function, for athletes, the aged and compromised health. However, further research should focus on the optimum dose relationship of frequency, amplitude and duration for the various populations.

PMID: 21165804

Children with Cystic Fibrosis

J Clin Med Res. 2013 Jun;5(3):205-16. doi: 10.4021/jocmr1137w. Epub 2013 Apr 23.

The effect of whole body vibration exposure on muscle function in children with cystic fibrosis: a pilot efficacy trial

O’Keefe K, Orr R, Huang P, Selvadurai H, Cooper P, Munns CF, Singh MA.

Source

Exercise, Health and Performance, Faculty Research Group, Faculty of Health Sciences, University of Sydney, Australia.

Abstract

BACKGROUND:

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.

METHODS:

The setting was home-based WBV exposure. The participants were children (8 – 15 years) with CF (n = 7).

INTERVENTION:

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.

RESULTS:

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)).

CONCLUSIONS:

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.

KEYWORDS:

Children, Cystic Fibrosis, Muscle function, Muscle power, Vibration

Heart Transplant Recipients Found Galileo Safe

Phys Rehab Kur Med, 2003; 13: 286-290

Safety of Whole-Body Vibration Exercise for Heart Transplant Recipients

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

Abstract

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.

COPD

Side-alternating vibration has minimal effect on cardiovascular response while doing intense, high-repetition muscle training

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:

An increase in muscle power, force, and performance.
Improvements in exercise capacity after Galileo training may be related to an increase in neuromuscular activation.
One possibility of Galileo’s effect is through the vibratory stretch reflex in which the mechanical vibration elicits a myostatic stretch reflex mediated by the muscle spindle and Ia-afferents.⁴
Other possible mechanisms of benefits include enhancing postural control and improving quality of inter-muscular coordination like the complex interplay of agonists and antagonists which are often disabled in patients with COPD. ^5,6

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.