Whole body vibration and the effect on flexibility: a review 145 The authors explained their results with three possible mechanisms. One possibility would be enhanced local blood flow which takes place immediately (9 min) after VT (Kerschan-Schindl et al 2001). Increased blood flow can generate additional heat which can facilitate ROM during stretching exercise because muscle elasticity is enhanced. The second mechanism may be related to the tonic vibration reflex. Vibration can cause soft-tissue deformation which is capable of activating muscle spin- dles (Wakeling et al 2003) and may lead to an enhancement of the stretch– reflex loop (Cardinale & Bosco 2003). The frequency used in the present study was 28 Hz, which reflects the natural frequency of the quadriceps (Wakeling et al 2003), and therefore the authors hypothesized that the stretch reflex of the quadriceps muscles was stimulated to damp the induced frequency. Cardinale and Lim (2003) demonstrated that WBV transmitted through a vibrating platform at 30 Hz, in half-squat position, was able to produce the highest electromyograph (EMG) activity in vastus lateralis of the quadriceps compared with non-vibrating conditions. Car- dinale and Bosco (2003) suggested that VT appears to inhibit activation of the antagonist muscles through Ia-inhibitory neurones. Thus, activating the quadriceps muscles would relax the hamstring muscles and thereby have a positive influence on the stretching exercise. Cardinale and Lim (2003) also stated that vibrations were perturbations perceived by the central nervous systems which modulates the stiffness of the stimulated muscle groups. The reflex muscle activity could then be considered a neuromuscular tuning response to minimize soft-tissue vibrations. These responses are individual and therefore related to individual capabilities in damping external perturbations in order to avoid resonance effects. The third mechanism mentioned by Van den Tillaar (2006) is the propriocep- tive feedback potentiation of inhibition of pain and increased pain thresh- old. As stated already by Issurin et al (1994), subjects reported that the sensation of pain was reduced within 10–15 s of beginning the static stretching during vibration. Sands et al (2006) in their study wanted to determine whether vibra- tion-aided static stretching could enhance ROM more than static stretch- ing alone, in the forward split position. Ten young male gymnasts, participating in intensive gymnastics training (age = 10.1 ± 1.5 years), were randomly assigned to experimental (n = 5) and control (n = 5) groups. The test consisted of performing what is called the ‘forward split position’ for stretching on the vibration devices in two different positions. In the first position the athlete places their forward leg on the vibrating device such that the posterior calf area is supported by the device (Figure 6.1). In the second position the gymnast assumes a lunge position with the rear thigh directly on top of the vibrating device (Figure 6.2). The height of the ante- rior iliac spine of the pelvis was measured at the lowest split position.
6 WBV as a warm-up prior to sport 146 Figure 6.1 Forward split stretching position on the vibration device. The targeted leg in this position is the forward leg. Reprinted from Sands WA, McNeal JR, Stone MH et al (2006) Flexibility enhancement with vibration: acute and long-term. Medicine and Science in Sports and Exercise 38:720–725, with permission. Figure 6.2 Forward split stretching position on the vibration device. The targeted leg in this position is the rear leg. Reprinted from Sands WA, McNeal JR, Stone MH et al (2006) Flexibility enhancement with vibration: acute and long-term. Medicine and Science in Sports and Exercise 38:720–725, with permission.
Whole body vibration and the effect on flexibility: a review 147 The protocol consisted in stretching of the forward and rear legs to the point of discomfort for 10 s followed by 5 s of rest, repeated four times on each leg (right and left) resulting in 1 min of total stretching in each posi- tion, for a total of 4 min for one complete session of stretching. The experi- mental group stretched with the device turned on; the control group stretched with the device turned off. The devices were floor units which consisted of a heavy base to which was attached an upper section that was vibrated by an electric motor that resulted in a sinusoidal vibration fre- quency of approximately 30 Hz and an approximate displacement of 2 mm. A pre-test was followed by an acute phase post-test; thereafter, a second post-test measurement was performed following 4 weeks of treat- ment. The acute effect of the vibration treatment resulted in immediate and dramatic increases in forward split flexibility for both legs (p < 0.05). The long-term effects showed that one split side reached a statistically significant increase in ROM only on the right rear leg (p < 0.05), whereas the other did not. Sands et al (2006) stated in their analysis that the lack of statistical significance on one side during the long-term post-test may have been the result of the increased variability of the splits observed in the control group. The present study is similar to that of Issurin et al (1994) regarding the period of time and the protocol of stretching used. Sands et al (2006) concluded the study, mentioning that vibration effects on range of motion enhancement are incompletely understood and may provide a window into further understanding of the role of muscle spin- dles, Golgi tendon organs and the importance of higher central nervous system influence on polysynaptic reflexes, and other aspects of motor control. Kinser et al (2008) wanted to test the effects of simultaneous vibration stretching on flexibility and explosive strength in competitive female gym- nasts. Twenty-two female athletes (age = 11.3 ± 2.6 years) composed the experimental vibration stretching (VS) group, which performed two tests: flexibility and jumping. There were four control groups whose constitu- ents were subpopulations of the VS group who did stretching only (SF) (n = 7) and vibration only (VF) (n = 8). Explosive strength-control groups were stretching only (SES) (n = 8) and vibration only (VES) (n = 7). The vibration device [similar to that used by Sands et al (2006)], 30 Hz, 2-mm displacement, was applied to four sites, four times for 10 s, with 5 s of rest in between as in based on the same protocol [Sands et al (2006)]. Right and left forward split (RFS and LFS) flexibility was measured by the dis- tance between the ground and the anterior superior iliac spine. A force plate (sampling rate, 1000 Hz) recorded countermovement and static jump characteristics. Explosive strength variables included flight time, jump height, peak force, instantaneous forces and rates of force development. The results demonstrated a statistically significant increased flexibility (p)
6 WBV as a warm-up prior to sport 148 with large effect sizes (d) in both the right forward split (p =1.28, d = 0.67) and left forward split (p = 2.35, d = 0.72) (Figure 6.3, Table 6.1). A very interesting finding in this research is that the addition of vibration to stretching not only increases flexibility but also maintains explosive strength (e.g., jumping ability). This observation is important considering that the athletes were already warmed up, as evidenced by the lack of change in ROM among the groups not receiving any vibration. As a pos- sible mechanism affecting flexibility by vibration and stretching, the author mentioned decreased musculotendinous stiffness, muscular antag- onist inhibition and increased pain threshold. It is important to note that, in the present study, stretching alone resulted in a loss of jump perfor- mance; however, the addition of acute vibration seems to have preserved the ability to express explosive strength (Tables 6.1 and 6.2). This has already been seen in previous studies in which stretching resulted in decreased explosive strength in force production and rate of force development. Similar findings were described by Cardinale and Lim (2003). In their study, vibration combined with stretching did not increase the jumping performance. Moreover it caused no loss of explosive strength, which means that vibration and stretching are enhancing flexibility while not impairing explosive strength. The authors concluded the paper advo- 35.0 Mean 30.0 28.2 * Distance from ASIS-ground (cm) 25.2 * 23.5 * 21.2 21.1 25.0 20.2 22.0 20.0 18.9 20.1 18.0 18.0 17.3 15.0 10.0 5.0 0.0 Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post Favoured leg Non-favoured Favoured leg Non-favoured Favoured leg Non-favoured leg leg leg Vibration only Stretch only Vibration–stretching (VF group) (SF group) (VS group) (n=8) (n=22) (n=7) Figure 6.3 Changes in flexibility in relation to the athlete’s favoured leg, dictated by the rearward leg in the split position. Statistically different means before vs after, Bonferroni adjusted p value. Reprinted from Kinser AM, Ramsey MW, O’Bryant HS et al (2008) Vibration and stretching effects on flexibility and explosive strength in young gymnasts. Medicine and Science in Sports and Exercise 40(1):133–140.
Table 6.1 Flexibility results Group Test Trial Mean height Effect size t-test (p) (cm) (d) VS (N = 22) Right forward split Pre vibration–stretching 26.2 ± 7.1 VS (N = 22) Post vibration–stretching 21.4 ± 7.0* 0.67 1.28 × 10-7* Whole body vibration and the effect on flexibility: a review VS (N = 22) Left forward split Pre vibration–stretching 27.5 ± 7.1 VS (N = 22) Post vibration–stretching 22.6 ± 6.8* 0.72 2.35 × 10-7* SF (N = 7) Right forward split Pre stretch, no vibration 19.4 ± 5.0 SF (N = 7) Post stretch, no vibration 19.0 ± 4.9 0.08 2.49 × 10-1 SF (N = 7) Left forward split Pre stretch, no vibration 20.3 ± 5.4 SF (N = 7) Post stretch, no vibration 20.6 ± 5.6 0.05 6.37 × 10-1 VF (N = 8) Right forward split Pre vibration, no stretch 20.2 ± 6.8 VF (N = 8) Post vibration, no stretch 18.5 ± 6.7* 0.25 6.98 × 10-3* VF (N = 8) Left forward split Pre vibration, no stretch 20.8 ± 5.9 VF (N = 8) Post vibration, no stretch 18.9 ± 6.7 0.30 2.6 × 10-2* *Statistically different before vs after treatment (Bonferroni adjusted P value). Table (mean ± SD) represents results of the flexibility tests from all groups: vibration–stretching (VS), 149 stretching only (SF), and vibration only (VF). Reprinted from Kinser AM, Ramsey MW, O’Bryant HS et al (2008) Vibration and stretching effects on flexibility and explosive strength in young gymnasts. Medicine and Science in Sports and Exercise 40(1):133–140, with permission from
Table 6.2 Static jumps explosive strength WBV as a warm-up prior to sport Group Trial Mean Effect t-Test Mean Effect t-test Mean peak Effect t-test 6150 jump size (p ) flight time size (p ) force (N) size (p ) height (d ) (ms) (d ) (± SD) (d ) (cm) (± SD) (± SD) VS (N = 22) Pre 20.0 ± 3.0 402.9 ± 30.0 847.5 ± 248.0 VS (N = 22) Post 19.9 ± 3.5 0.05 0.65 400.1 ± 34.2 0.08 0.48 839.4 ± 278.4 0.03 0.47 SES (N = 8) Pre 19.9 ± 4.0 400.3 ± 40.6 815.8 ± 243.4 SES (N = 8) Post 18.5 ± 3.4 0.37 0.05 389.0 ± 40.2 0.28 0.14 803.8 ± 249.7 0.49 0.42 VES (N = 7) Pre 19.2 ± 2.6 395.1 ± 26.2 843.1 ± 304.2 VES (N = 7) Post 19.0 ± 2.7 0.09 0.75 392.6 ± 27.3 0.09 0.74 834.6 ± 312.0 -0.002 0.97 Table represents static jumps’ explosive strength data from all groups: vibration stretching (VS), stretching only (SF) and vibration only (VF). Reprinted from Kinser AM, Ramsey MW, O’Bryant HS et al (2008) Vibration and stretching effects on flexibility and explosive strength in young gymnasts. Medicine and Science in Sports and Exercise 40(1):133–140, with permission from
Whole body vibration and the effect on flexibility: a review 151 cating that future research may require a change from the stretch– vibration protocol using a longer duration of vibration than the 10-s period used by themselves and by Sands et al (2006). Future investigations should address the addition of vibration to stretching as a warm-up programme. The purpose of the study by Wakeling et al (2002) was to identify how the lower extremity muscles minimize the soft-tissue resonance that occurs in response to pulsed and continuous mechanical vibration. In their study two hypotheses were tested: muscle activity increases the natural fre- quency to minimize resonance when the excitation frequency is close to the natural frequency of the soft tissues. The second hypothesis was how muscle activity would increase the damping to minimize resonance when the excitation frequency is close to the natural frequency of the soft tissues. Ten male (age 25.6 ± 1.2 years) and 10 female (age 23.1 ±) athletic subjects were tested, while standing on a vibration platform driven by a hydraulic actuator. Continuous vibrations and pulsed bursts of vibrations were presented, across the frequency range of 10–65 Hz and with peak-to-peak amplitude of the platform displacement of 5 mm. The test consisted of a cycle of 3 s of vibration followed by 3 s of no platform movement. During each vibration period, the frequency and amplitude of the platform vibra- tion were kept constant. Frequencies of 10, 13.1, 17.1, 22.3, 29.1, 38.1, 49.7 and 65.0 Hz were tested. These eight frequencies were presented in a randomized block. The randomized block was then repeated five times so that the subject experienced a total of 40 periods of vibration in each test. Soft-tissue vibrations were measured with triaxial accelerometers, and muscle activity was measured by using surface electromyography from the quadriceps, hamstrings, tibialis anterior and triceps surae muscle groups. The measurements were taken with the subjects standing with a knee-flexion angle of 23°, which would mimic the knee posture at heel strike during running. The results demonstrate an elevated muscle activity in the EMG and an increased damping of vibration power which occurred when the frequency of the input was close to the natural frequency of each respective soft tissue. However, the natural frequency of the soft tissues did not change in a manner that correlated with the frequency of the input. The natural frequencies of the quadriceps, tibialis anterior and triceps surae range from 10 Hz for the relaxed condition to 50 Hz in a fully active state (Wakeling & Nigg 2001). The soft tissues are expected to reso- nate if the excitation frequency of a mechanical stimulus is close to the natural frequency of the soft tissues. It has been proposed that during walking and running the soft tissues of the lower extremity have a strategy of minimizing the soft-tissue vibrations (Nigg 1997). The body has a strat- egy of tuning muscle activity, in this case of the lower limb, in order to respond to the excitation frequency of the impact shock at heel strike during walking or running. It appears, as a result of this study, that
6 WBV as a warm-up prior to sport 152 soft-tissue damping may be the mechanism by which resonance is mini- mized at heel strike during running and the changes in frequency may have been a consequence of the altered muscle activity. Impact forces during heel–toe running typically have a major frequency component between 10 and 20 Hz. This frequency range spans the natural frequencies of the soft tissues measured in this study, which were 15 Hz. Thus there is potential for vibrations in the soft tissues to occur as a result of the impact forces. In order for the soft tissues to vibrate in such a manner they must have viscoelastic properties. During soft-tissue vibrations mechani- cal energy can be stored and returned from the elastic structures of the tendon and the attached cross-bridges. Damping of the vibrations results in a net dissipation of mechanical energy which can be absorbed by acti- vated muscle. Conclusion These preliminary results offer convincing evidence that WBV has a role to play as a warm-up to ballistic weight-bearing high-impact sports, in which muscle length, temperature and resonance frequencies can have an impact on sporting achievement as well as playing a role in the reduction in the incidence of injury. Exercise proposals: stretching section Figure 6.4 Stretching of quadriceps and iliopsoas muscles.
Exercise proposals: stretching section 153 Figure 6.5 Stretching of hamstring Figure 6.6 Stretching of gastrocnemius muscles. muscles. Figure 6.7 Stretching of soleus muscles.
6 WBV as a warm-up prior to sport 154 References Cardinale M, Bosco C (2003) The effects of vibration as an exercise intervention. Exercise and Sport Sciences Reviews 31:3–7. Cardinale M, Lim J (2003) Electromyography activity of vastus lateralis muscle during whole body vibrations of different frequencies. Journal of Strength & Conditioning Research 17(3):621–624. Issurin V, Liebermann DG, Tenenbaum G (1994) Effect of vibratory stimulation training on maximal force and flexibility. Journal of Sports Sciences 12:561–566. Kerschan-Schindl K, Grampp S, Henk C (2001) Whole-body vibration exercise leads to alterations in muscle blood volume. Clinical Physiology 21:377–382. Kinser AM, Ramsey MW, O’Bryant HS et al (2008) Vibration and stretching effects on flexibility and explosive strength in young gymnasts. Medicine and Science in Sports and Exercise 40(1):133–140. Lycholat T (1990) The Complete Book of Stretching. Crosswood Press, Aylesbury. Nazarov V, Zilinsky L (1984) Enhanced development of athletes strength abilities by means of biomechanical stimulation method. Theory and Practice of Physical Culture Moscow 10:28–30. Nigg BM (1997) Impact forces in running. Current Opinion in Orthopaedics 8:43–47. Sands WA, McNeal JR, Stone MH et al (2006) Flexibility enhancement with vibration: acute and long-term. Medicine and Science in Sports and Exercise 38:720–725. Van den Tillaar R (2006) Will whole-body vibration training help increase the range of motion of the hamstrings? Journal of Strength & Conditioning Research 20(1):192–196. Wakeling JM, Nigg BM (2001) Modification of soft tissue vibrations in the leg by muscular activity. Journal of Applied Physiology 90:412–420. Wakeling JM, Bigg BM, Rozitis AI (2002) Muscle activity damps the soft tissue resonance that occurs in response to pulsed and continuous vibrations. Journal of Applied Physiology 93(3):1093–1103. Wakeling J, Liphardt A, Nigg BM (2003) Muscle activity reduces soft-tissue resonance at heel-strike during walking. Journal of Biomechanics 36:1761–1769.
Appendix: Synopsis of research into WBV Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini Researchers, Type of Dose Exercise Methodology Outcome names research Abercromby et al Vertical forces to both 30 Hz; 4 mm, Slow unloaded squats n = 16, comparative Vertical forces to both feet simultaneously exceeds (2007), Med Sci feet vs upward forces 10 min recommended daily vibration exposure (ISO 2631-1). Effects Sports Exerc to one leg at a time may be lower in half squats than Appendix: Synopsis of research into WBV full squats; and may be less in one 39(10):1794–1800 legged loading. Abercromby et al Vertical vibration 30 Hz, 4 mm Static and dynamic n = 16, comparative EMG response in leg extensors (2007), Med Sci versus rotational squatting was significantly greater in the Sports Exerc vibration rotational vibration group. 39(9):1642–1650 Amonette et al Neuromuscular Power plate–vertical Dynamic squat; 2 × 2 repeated Vibraflex elicits greater response in vibration 30 Hz, stance 21.6 cm, measures (MANOVA), the gastrocnemius (92 vs 49%), (2005), NSCA responses to two 4 mm: Vibraflex 10–40° knee flexion; univariate ANOVAS tibialis anterior (31 vs 16%), vastus (rotates around an 4 s down and 4 s up and t-test (Sidak lateralis (49 vs 32%), EMGrms in conference WBV modalities axis) at 30 Hz and adjustment) Vibraflex was greater than in 4 mm PowerPlate in vastus lateralis presentation, 7 July during dynamic (13%) and gastroc soleus (29%). University of squats Houston and University of Texas 155
Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini—cont’d WBV as a warm-up prior to sport Researchers, Type of Dose Exercise Methodology Outcome 6156 names research Bautmans et al The feasibility of WBV 30–40 Hz, 2–5 mm, 6 static exercises n = 24, nursing home Completion rate 96% with WBV (2005), BMC in institutionalized 3× per week, targeting lower patients, randomized and 86% controls. Training induced Geriatrics 5:17 elderly persons and minimum 1 rest day limbs–exercise control, static exercise changes timed up-and-go and its influence on between exercise volume and intensity ± WBV Tinetti-test were better for WBV muscle performance, were increased based (p = 0.029 and p = 0.002 resp.). balance and mobility on overload principle Leg extensor work, power, explosive power, and maximal force, lower body flexibility improved significantly. Baum et al (2007), Efficiency of vibration Vibrogym swinging Vibration, 3 days per n = 40, randomized Decrease in systolic blood pressure Int J Med Sci control, flexibility in all interventions. No sign 4:159–163 exercise for glycaemic platform, 2 mm, week for 12 weeks, group, strength group changes in endurance capacity. vs vibration group However, at 4 mmol lactate control in patients 30 Hz weeks 1–9, volume and intensity threshold heart rate was less for vibration group. Increase by 14% with type 2 diabetes 35 Hz weeks 9–12, increased stepwise at in max isometric torque in resistance training and vibration duration of single 6 and 12 weeks; group. Small decrease in HbA1c values in vibration group potentially bout of exercise strength training 12 due to translocation of GLUT-4 to the sarcolemmal membrane which 30 s, 8 different reps 70% 1RM, then enhances glucose transport capacity. exercises. Total 3 sets 10 reps at duration was 20 min 80% 1RM for approx in last 3 weeks 45 min. Flexibility, group positions kept for 20 s, weeks 6–9 progression by 1 more set. Last 2 weeks, stretches for 30 s, total of 15 min
Researchers, Type of Dose Exercise Methodology Outcome names research Bazett-Jones et al WBV and Power Plate 45 s, WBV at 2.16g n = 11, healthy males Women performed significantly (2008), J Sports countermovement (30 Hz, 2–4 mm), Sci Med jump 2.80g (40 Hz, and females, random better after 2.8g and 5.83g on 7:144–150 2–4 mm), 4.87g (35 Hz, 4–6 mm), allocation of CMJ (9.8 and 8.3%, resp). No 5.83g (50 Hz, 4–6 mm) acceleration, with at change in men. least 2 days of rest between sessions Belavy et al (2008), Resistive simulated Galileo, 19–26 Hz, Squats to 90° flexion, n = 20, randomized Limited lumbar multifidus atrophy Spine weight-bearing amplitude heel raises (with control, 8 weeks of and atrophy did not persist in long 33(5):E121–E131 exercise with WBV 3.5–4 mm, term as in the control group, spinal 1.2–1.8g via elastic knees in extension), strict bed rest with lengthening and increases in disc Appendix: Synopsis of research into WBV reduces lumbar spine shoulder straps area were reduced in the exercise deconditioning in bed toe raises (knee 6-month follow-up, group. Multifidus (MF) and erector rest spinae demonstrated contrasting extension and ankle after 8 weeks of bed relationships in CSA with MF increasing CSA with increased dorsiflexion), each rest, n = 1 attrition lordosis angle and disc height and exercise >60 s, due to MRI phobia only marginal correlation with spinal length, whereas LES 10 reps explosive increased CSA with spinal lengthening and disc area but is kicks at 10 s intervals unaffected by lordosis angle or disc height. (from near full hip and knee flexion). Vibration increased if subject could perform exercise for >100 s. Afternoon sessions were between 60 and 80% of static morning force 157
Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini—cont’d WBV as a warm-up prior to sport Researchers, Type of Dose Exercise Methodology Outcome 6158 names research WBV training is as efficient as Bogaerts et al 1 year WBV on Comparative, WBV fitness training and therefore (n = 31) vs fitness suggests it could prevent or (2007), J Gerontol isometric and group (n = 30), vs reverse sarcopenia. sedentary (n = 36) A Biol Sci Med Sci, explosive muscle Increased height of best jump (1.6%, p < 0.05), mechanical 62(6):630–635 strength and muscle power of best jump (3.1%, p < 0.05), average jumping height mass during 5 s (12%, p < 0.01). No change in CMJ potentially due to Bosco et al (n.d.) The influence of WBV Gallieo 2000, 26 Hz, 10 days, 5 sets of n = 14, physically its larger angular displacement and University of Rome on the mechanical 10 mm, acceleration vertical sinusoidal active randomized slow stretching speed (3–6 rad/s) behaviour of skeletal 27 m/s2, standing vibrations lasting 90 s control (handball and vs counter jump which has a faster muscle stretch speed that is likely to on toes, half-squat, each, 40 s break water polo players) enhance the gamma dynamic fusimotor response: feet rotated between sets for a • Increasing synchronization of externally, single total of 10 min/day, motor units • Improvement in co-contraction right leg 90° squat, every day 5 s was of synergistic muscles? single left leg 90° added until 2 min per • M uscle spindles and Golgi squat (for the last position was reached. tendon organ. two positions Total = WBV of subjects could 100 min at 2.7g = maintain balance intensity of 200 drop using a bar) jumps from 60 cm twice a week for 12 months (total time for drop jump is only 200 ms and the acceleration developed cannot reach 2.7g)
Researchers, Type of Dose Exercise Methodology Outcome names research Bosco et al Influence of vibration Gallileo 2000, Static biceps curl, n = 12, international Enhanced muscle power and boxers, randomly decreased EMG/power relationship, (1999a), Eur J Appl on mechanical power 30 Hz, 6 mm 5× 60 s, with 60 s assigned opposite EMGrms activity increased up to arm as control more than twice baseline values Physiol and EMG activity in (acceleration rest in between. during the activity. 34 m/s2), vibrating 79:306–311 human arm flexor dumbbell, with upper Total = 300 s = 600 elbow flexion moves muscles arms resting on at a load equal to 5% plate in seated body mass = 3× per Appendix: Synopsis of research into WBV position week with 50 reps each time would take 1 month Bosco et al Adaptive responses of Gallileo 2000, WBV in one leg 100° n = 6, national–level Shift to the right of the force– (1999b), Clin flexion, 10 times female volleyball velocity curve similar to those Physiol human skeletal 26 Hz, 10 mm, 60 s, with 60 s rest players, leg randomly observed after several weeks of 19(2):183–18 in between assigned heavy resistance training (Hakkinen muscle to vibration acceleration = & Komi 1985) 54 m/s2 Total = 10 min WBV at 5.4g = 150 leg presses or half squats with extra loads (3× BW), × 2/week for 5 week 159
Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini—cont’d WBV as a warm-up prior to sport Researchers, Type of Dose Exercise Methodology Outcome 6160 names research Vertical sinusoidal Bosco et al (2000), Hormonal responses 10× for 60 s, with Fourteen male Significant increase in the plasma Eur J Appl Physiol to WBV in men 60 s rest between the subjects (mean age concentration of testosterone and 81:449–454 vibration sets (a rest 25), non-randomized GH, whereas cortisol levels between the vibration controlled decreased. An increase in the Bruyere et al (n.d.) Controlled WBV to 10 Hz 1st and 3rd sets lasting 6 min mechanical power output of the leg conference decrease fall risk and series, 27 Hz 2nd was allowed after five extensor muscles was observed presentation WHO improve health-related and 4th series vibration sets) with a reduction in EMGrms quality of life in elderly activity. Neuromuscular efficiency patients 6 weeks WBV, 4× n = 42, randomized improved, as indicated by the 1 min, 3× per week, control decrease in the ratio between Galileo 900 EMGrms and power. Jumping performance, which was measured using CMJ test, was also enhanced. Seven items of the SF-36 improved significantly: physical function (143%), pain (41%), vitality (60%), and general health (23%); also improvements in quality of walking (57%), equilibrium (77%), get up and go test (39%)
Researchers, Type of Dose Exercise Methodology Outcome names research Bruyere et al Controlled WBV to 10 Hz 1st and 3rd 6 weeks WBV, 4× n = 42, randomized Body balance improved 3.5% ± (2005), Arch Phys decrease fall risk and session, 26 Hz at 1 min, 3× per week, control, n = 69 2.1, TUG decreased by 11.0 ± 8.6, Med Rehab improve health-related 2nd and 4th session, Galileo 900 improvements in eight of nine 86:303–307 items in SF-36. Enhanced stability quality of life in elderly peak to peak 30 and in movement velocity (p < 0.01), maximum point excursion patients. High- 7 mm respectively. (p < 0.01), and directional control (p < 0.05). frequency WBV on Side alternating balancing ability in 20 Hz, 3 min/day, 3 older women days/week for 3 Appendix: Synopsis of research into WBV months Cheug et al (2007), High-frequency WBV Side alternating n = 69, randomized Enhanced stability in movement control velocity (p < 0.01), maximum point Arch Phys Med on balancing ability in 20 Hz, 3 min/day, excursion (p < 0.01), and directional control (p < 0.05). Rehab older women 3 days/week for 88(7):852–857 3 months Cardinale (2002), Effect of vibration on 6–10 mm peak to 1) 1 0 days n = 62, physically 1) A verage jumping height during PhD thesis human performance peak, 26–30 Hz 2) 5 min static active and involved in 5 s continuous jumping and hormonal profile position in regular exercise improved by 11.5%; no change professional volleyballer 1) C hronic exposure to counter-jump; no change in players for 10/7 (n = 14) muscle bulk, suggesting neural 2) A cute effects of effect, particularly as stiffness vibration on force/ increased probably due to Ia velocity loop feedback relationship (n = 6) 161
Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini—cont’d WBV as a warm-up prior to sport Researchers, Type of Dose Exercise Methodology Outcome 6162 names research 3) D umbbell vibration 2) Shift of force/power and power/ in boxers (n = 12) velocity relationship to the right 4) V erify acute (p < 0.05)–neural as there was hormonal not increase in cross-sectional response, 7 min area for well-trained 3) Also shown to increase (by handball players 13%) arm flexor mechanical (n = 14) power using a similar protocol 5) H ormonal (EMGrms increase by 200%) response but total 4) Vertical jumping ability declined 10 mins, divided together with increases in in two sets of five serum testosterone and serum subsets lasting cortisol concentrations, 1 min each, 6 min suggesting 7 min protocol as a rest between sets stressful treatment 6) F atiguing exercises 5) Testosterone levels improved by with/without WBV 7%, growth hormone levels increased 460%, and cortisol reduced by 32%, vertical jump increased 4%, leg press increased 7%, EMG knee extensors decreased 10%
Researchers, Type of Dose Exercise Methodology Outcome names research Static squatting for 110 s 6) D ynamic exercise with superimposed WBV increased average power output by 8%, whereas arm action was 14% higher due to large motor unit recruitment. Cardinale et al Literature review Not superior to traditional training (2005), Br J Sports methods in highly trained athletes. Med 39:585–589 More appropriate for sedentary and elderly. Cardinale et al Gastrocnemius 30, 40 and 50 Hz n = 20, randomized TOI of VL decreased by 2.8% at Appendix: Synopsis of research into WBV (2007), Med Sci medialis (GM) and Fitwave crossover design, (10 90 s in control, decreased by 3.3% Sports Exerc vastus lateralis (VL) sedentary, 10 at 110 s at 30 Hz; TOI of VL 39(4):694–700 oxygenation (TOI) athletes) decreased by 2.1 and 3.0% at 110 s at 40 and 50 Hz, respectively; GM TOI decreased by 3.2% at 60 s, 4.1% at 90 s and 4.3% in control, and by 5.5% at 110 s at 30 Hz. Therefore, not a significant difference in WBV compared with controls. Cochrane et al Acute effects of Electric power n = 12, comparative Vibration increased concentric peak (2008), J Sci Med vibration exercise on dumbbell, 26 Hz, between vibration, power 4.8% vs increase by 3% for Sport concentric muscular amplitude 3 mm, arm cranking (25 W) cranking over control. No change in 11(6):527–534 characteristics 30 s exposure at and control on EMG. five different maximal prone bench shoulder positions pull capacity 163
Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini—cont’d WBV as a warm-up prior to sport Researchers, Type of Dose Exercise Methodology Outcome 6164 names research 30 Hz, 8 mm Five sets of 10 reps, n = 17, comparative, Energy expenditure and perceived Da Silva et al Influence of vibration amplitude 2-min recovery half-squat with/ exertion were significantly greater (2007), J Strength training on energy between sets, half Cond Res expenditure in active squats without WBV, random with WBV. 21(2):470–475 men sequence order De Ruiter et al The effects of (2003), Eur J Appl 11 weeks’ WBV 3× per week and 10 subjects belonging Quadriceps femoris isometric Physiol training on jump stood bare-foot with a to the experimental muscle force [105.4 (6.2)%, 99.9 90:595–600 height, contractile properties and 110° knee angle on a group trained, another (2.0)%; p = 0.69], voluntary activation of human vibration platform. 10 subjects were in activation [107.1 (6.0)%, 101.1 knee extensors Not progressive the control group (2.3)%; p = 0.55] and maximal training as required rate of voluntary force rise [95.4 for progressive (6.0)%, 103.3 (7.7)%; p = 0.57] overload training did not improve. The maximal rate of force rise during electrical stimulation was increased [102.3 (4.5)%, 123.6 (7.5)%; p = 0.02]. CMJ height was not affected by WBV [103.7 (1.8)%, 103.0 (2.8)%; p = 0.71].
Researchers, Type of Dose Exercise Methodology Outcome names research 35–40 Hz, Static and dynamic n = 67, randomized Isometric and dynamic knee- Delecluse et al Strength increase 2.28–5.09g knee extensor control, untrained extensor strength increased (2003), Med Sci after WBV compared significantly (p < 0.001) in both the Sports Exerc with resistance exercises, 3× per females, comparative WBV group (16.6 ± 10.8%; 9.0 ± 35(6):1033–1041 training week. Resistance WBV vs RES versus 3.2%) and the RES group (14.4 ± 5.3%; 7.0 ± 6.2%), respectively, training (RES) group placebo (PL) whereas the PL and CO groups showed no significant (p > 0.05) performed 10–20 RM increase. CMJ height enhanced significantly (p < 0.001) in the Delecluse et al Effects of WBV on 35–40 Hz, 5 weeks, unloaded n = 20, randomized WBV group (7.6 ± 4.3%) only. Appendix: Synopsis of research into WBV (2005), Int J Sports muscle strength and 1.7–2.5 mm Power static and dynamic control There was no effect of any of the Med 26:662–668 sprint performance in Plate leg exercises interventions on maximal speed of movement, as measured by means sprint-trained athletes of ballistic tests. Di Loreto et al Effects of WBV 30 Hz Volunteers were 10 healthy men [age Specific WBV protocol had no (2004), J exercise on the studied on two 39 ± 3, body mass surplus value upon the Endocrinol Invest endocrine system of occasions before and index (BMI) of 23.5 ± conventional training programme to 27:323–327 healthy men after standing for 0.5 kg/m2, mean ± improve speed strength 25 min on a ground SEM] performance in sprint-trained athletes Vibration slightly reduced plasma glucose (30 min: vibration 4.59 ± 0.21, control 4.74 ± 0.22 mM, p = 0.049) and increased plasma norepinephrine concentrations 165
Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini—cont’d WBV as a warm-up prior to sport Researchers, Type of Dose Exercise Methodology Outcome 6166 names research 60 min: vibration 1.29 ± 0.18, plate in the absence control 1.01 ± 0.07 nM, (p = (control) or in the 0.038), but did not change the presence (vibration) circulating concentrations of other hormones (insulin, cortisol, Erskine et al Acute hormonal 30 Hz, 3.5g, 10 sets of half n = 7, comparative epinephrine, GH, IGF-1, free and 10 min total testosterone. (2007), Clin Physiol response to WBV isometric squats for control Acute reduction in MVC, which Funct Imaging 1 min, with 1 min rest recovered after 24 hours. No change in testosterone or cortisol 27(4):242–248 between sets concentration. Fagnani et al Muscle performance 8-week protocol, 3 n = 26, randomized Improved maximal knee extension (2006), Am J Phys and flexibility in days per week vertical control, female strength, CMJ and flexibility. Med Rehab female athletes vibration platform athletes 85:956–962 Gain was calculated at five force levels ranging from 5 to 25% of Feltham et al Changes in joint Mechanical vibration n = 10 Max grip force (MF) and a trend for (2006), J stability with muscle at 45, 50 and 55 Hz 15% MF and higher at 55 Hz; Biomechanics contraction measured to styloid process of transfer function gain increases 39:2850–2856 from transmission of radius and distal end with muscle co-contraction of mechanical vibration of metacarpal bone antagonist muscles and most likely of index finger due to increased joint stiffness.
Researchers, Type of Dose Exercise Methodology Outcome names research Fontana et al The effect of 18 Hz (Rittweger Single 5-min static n = 25, randomized Experimental group demonstrated (2005), Aust J weight-bearing et al 2002), feet semi-squat control, young healthy 39% improvement in re-positioning Physiol exercise with 25 cm apart, pelvis 51:259–263 low-frequency, WBV rotated forward and accuracy (mean 0.78°). on lumbosacral backward. Galileo Garataachea et al proprioception: a pilot 2000 (2007), J Strength study on normal Cond Res subjects Appendix: Synopsis of research into WBV 21(2):594–598 Effects of movement 30 Hz, 4 mm, Three squatting n = 9, comparative, Squatting at greater frequency Gusi et al (2006), helps to maximize energy BMC velocity during 3 min, with exercises in execution WBV vs non WBV, expenditure during exercise with/ Musculoskeletal without vibration and therefore Disorders, squatting on energy additional load of frequency cycles of 6, two-way ANOVA cycle time duration must be 7(92):1–8 controlled when prescribing WBV. expenditure and 30% body weight 4 and 2 s to 90° substrate utilization in WBV Low-frequency Lower than 20 Hz Three sessions per n = 28, randomized BMD femoral neck increased 4.3% vibratory exercise week for 8 months, reduces the risk of six bouts of 1 min control trial, untrained more than walking group. BMD bone fracture more (12.6 Hz, 3 cm than walking amplitude, 60° knee postmenopausal lumbar spine unaltered in both flexion) healthy women groups. Balance improved in WBV (average age 66) by 29%. 167
Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini—cont’d WBV as a warm-up prior to sport Researchers, Type of Dose Exercise Methodology Outcome 6168 names research Haas et al (2006), The effects of random ZEPTORmed system, Five series of WBV, n = 68, randomized Well tolerated. UPDRS motor score crossover design reduced by 5.2 and 4.8 NeuroRehabilitation WBV on motor Scisens, Germany. 60 s each representing reductions of 16.8 n = 10, using EMG and 14.7%. Highest improvements 21:29–36 symptoms in 6 Hz, amplitude RMS frequencies as in tremor and rigidity (25 and %MVC 24%). Gait and posture items show Parkinson’s disease 3 mm 15% improvement. Bradykinesia scores were reduced by 12%. Hazell et al (2007), The effects of WBV Vertically oscillating Static semi-squat, Higher WBV amplitude (4 mm) and Appl Physiol Nutr on upper and lower platform– and dynamic squat frequencies (35, 40, 45 Hz) resulted in greatest increases in Metab body EMG during determination of EMG activity (increase VL by 2.9–6.7% in static and 3.7–8.7% 32(6):1156–1163 static and dynamic optimal WBV in dynamic conditions). contractions stimulus (frequency × amplitude), 2 and 4 mm at 25, 30, 35, 40 and 45 Hz Hopkins et al Changes in peroneus n = 22, two-way No changes. ANOVAs comparison (2007), Int J Sports longus activation over three time intervals Med, Sep 18 following ankle inversion perturbation after WBV
Researchers, Type of Dose Exercise Methodology Outcome names research Iwamato et al Effects of WBV on 20 Hz, once per n = 50, randomized WBV using Galileo appears to be (2005), Aging Clin lumbar bone mineral week, 4 min, Galileo to alendronate ± useful for LBP, probably by relaxing Exp Res density and low back system, lasting 12 17(2):157–63 pain in post- months WBV, (25 each group) the back muscles. No differences menopausal osteoporotic women in BMD, neither N-terminal, treated with alendronate telopeptides type I collagen nor serum alkaline phosphatase (ALP), were seen. Issurin & Acute and residual 44 Hz, acceleration Vibratory stimulation n = 14 elite and n = Increase by 30.1 and 29.8 W Appendix: Synopsis of research into WBV 30 m/s2 (10.4 and 10.2%) in max and Tenenbaum (1999), effects of vibratory during biceps curl, 14 amateur athletes mean power in elite athletes, 20 and 25.9 W (7.9 and 10.7%) in J Sports Sci stimulation on three sets: 8–10 with/without vibration amateur athletes. Vibratory stimulation resulted in an 17:177–182 explosive strength in repetition biceps curls in random sequence insignificant residual effect. elite and amateur low to medium load of exercises athletes (20–40% BW), then 3–5 attempts at increasing weight. A weight of 65–70% 1RM was selected. Two series of exercises with 8–15 min recovery. Period of rest between sets was 2–3 min 169
Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini—cont’d WBV as a warm-up prior to sport Researchers, Type of Dose Exercise Methodology Outcome 6170 names research Judex et al (2007), Low-magnitude 45 vs 90 Hz, 10 min n = 12, comparative Bone morphology at 90 Hz significantly greater trabecular J Biomechanics mechanical signals per day volume (22 and 25%) and thicker trabecular (11 and 12%) over 40:1333–1339 that stimulate bone controls of 45 Hz in epiphysis of distal femur, despite strain rates formation in and magnitudes being significantly lower at 90 than at 45 Hz. ovariectomized rat are dependent on the applied frequency but not strain magnitude Kawanabe et al Effect of WBV 12–20 Hz, 4 mins, Standing on both legs n = 67 elderly Walking speed (-14.9%), step length (+6.5%), maximum standing (2007), Keio J Med exercise and muscle once per week for 2 with bent knees and non-randomized time on one leg (right +65%, left +88.4%) improved significantly in 56(1):28–33 strengthening, months, Galileo hips active ± WBV WBV + exercise group. No serious adverse events occurred during the balance, and walking 2000 study period. exercises on walking ability in the elderly Kemertzis et al Ankle flexors produce 26 Hz, 5 × 1 min Passive ankle stretch n = 20 young males; No change in the ROM; significant (2008), Med Sci peak torque at longer Galileo 900 of the plantar flexors between treatment 7.1° shift in the angle of peak Sports Exerc muscle lengths after at end of range, and within treatment plantar flexor toque production 40(11), WBV followed by the same outcomes were corresponding with longer muscle 1977–1983 stretch with assessed using lengths; some DOMS was superimposed WBV MANOVA experienced.
Researchers, Type of Dose Exercise Methodology Outcome names research Kinser et al (2008), Vibration and 30 Hz, 2 mm 10 s vibration- n = 22 young female Simultaneous stretching and J Athletic Training stretching effects on amplitude vibration stretching at four athletes (age = 11.3 vibration may greatly increase 41(3):286–293 flexibility and box (vertical loaded/ different sites (quads, ± 2.6 years), flexibility while not altering cyclic manner) hamies hamstrings, randomized four explosive strength. explosive strength in calves, adductors), groups–flexibility young gymnasts 5 s rest between group and explosive stretches, four strength group repetitions each consisting of Appendix: Synopsis of research into WBV stretching only, vibration only Mahieu et al Improving strength WBV platform Fitvibe Squatting, deep n = 33, randomized Significant (statistical and (2006), J Athletic Training and posture control in squatting, wide stance control, Belgian functional) difference in high box 41(3):286–293 young skiers: WBV squatting, 1-legged competitive skiers, test and plantar flexion torque at versus equivalent squatting, calf raises, control group had 30°/s. resistance training skiing movements, significantly lower jumps onto the plate, knee torque and ankle and light jumping. 3× torque prior to 30 min per week. training. Week 1 training: three Knee exercises 30 s each, • E xtension 92.35 vs 60 s rest. Training 78.5 intensity increased • F lexion 66.35 vs over 6/52 with 53.33 171
Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini—cont’d WBV as a warm-up prior to sport Researchers, Type of Dose Exercise Methodology Outcome 6172 names research Maloney-Hinds increased amplitude Ankle et al (2008), Med • E xtension 70.82 vs Sci Monit 2–4 mm and 14(3):CR112–116 Mark et al– increased frequency 60.62 conference • F lexion 11.2 vs presentation 24–28 Hz. Also increased duration and 7.76 number of repetitions. Week 6 training: four exercises, 250 s total duration, 60 s rest. Resistance training group had exactly same protocol minus the WBV The effect of 30 Hz vs 30 vs 50 Hz to the Passive vibration Randomized 30 or 5 min of 30 and 50 Hz vibration 50 Hz passive arms for 10 min 50 Hz for n = 18 and produced significant increases in vibration and duration both frequencies for skin blood flow, 50 Hz appeared to of vibration on skin n=7 be more beneficial as there was blood flow in the arm not vasoconstriction during the recovery period. Metabolic and Increasing vibration 3-min stages of n=6 Moderate intensity WBV results in cardiovascular challenge by varying vibration followed by increased femoral artery blood flow responses during frequency (19.6 Hz 3 min rest (2–4 mL/min); no change in MAP WBV–a pilot study stages 2 and 4; or in femoral artery diameter. 27.8 Hz stages 1 and Significantly high variable 3) of WBV and foot psychological stress (effort placement (which perception).
Researchers, Type of Dose Exercise Methodology Outcome names research Superimposed 10 Hz at 35%MVC varies displacement speed up the rate of vastus amplitude and lateralis deoxygenation, modest gravitational load improvements in peak torque using Galileo 2000) WBVT improved proprioception and Mileva et al (2006), Acute effects of a 10 Hz superimposed 1RM 35% and 70% n = 9, four trials of balance in ACL reconstructed 1RM athletes. Med Sci Sports vibration-like stimulus stimulus to knee MVC No change mean angular velocity, Exerc during knee extension extension at 35 (low) peak angular velocity, mean Appendix: Synopsis of research into WBV moment, peak moment, mean 38(7):1317–1328 exercise and 70% (high power, peak power. intensity), Vibrex system, Exoscience, Technogym Ltd UK Moezy et al (2008), WBVT vs conventional n = 20, comparative Br J Sports Med, training on Jan 8 proprioception and knee stability after ACL reconstruction Moran et al (2007), Effect of vibration 65 Hz, 1.2 mm 1RM 70%MVC biceps n = 14, crossover Med Sci Sports training in 70%MVC Exerc dynamic biceps curl strapped over biceps curl design 39(3):526–533 tendon 173
Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini—cont’d WBV as a warm-up prior to sport Researchers, Type of Dose Exercise Methodology Outcome 6174 names research Prevented bed rest atrophy and Mulder et al High-density surface 18 Hz Supine lying 10 Comparative, improved maximal amplitude on ‘explosive’ squats, randomized, control EMG by 30% from day 10 (2007), J EMG, CNS and PNS 8 10 s rest a.m. onwards; however, this was task Progressive training specific at the peripheral motor unit Electromyogr Kines weeks’ bed rest with/ based on ‘overload’ site and hence did not prevent principle, adjusted task-non-specific loss of function. 19(2):208–218 without resistive weekly, 10–17 repetitions H-reflex increased suggesties an vibration exercise a.m. (60–100 s) and increase in excitability of the motor 70%MVC p.m. (60 s) neurone pool Nishihira et al Effect of WBV 25 Hz, static knee Three sets of 3 min, n = 17, EMG of Borg scale perceived exertion 18, (2002), Adv Exerc 10-min break soleus muscle and HR 128 beats/min, blood pressure Sports Physiol stimulus and voluntary angle 100–120° between sets, using H-reflex 132/52, lactate 3.5 mM, oxygen 8(4):83–86 Gallileo 2000 48.8% of max. vol, knee extension contraction on reduced by 9.2%, jump height 9.1%, and decreased mEMG was motoneurone pool attenuated. Rittweger et al Acute physiological 26 Hz, feet 15 cm Squatting + additional n = 37 (2000), Clin Physiol effects of exhaustive from rotation axis, load 40% body 20(2):134–142 WBV exercise in man vibration amplitude weight, 3 s down, 3 s 1.05 cm, peak up acceleration 147 m/s2 = 15g
Researchers, Type of Dose Exercise Methodology Outcome names research Rittweger et al Oxygen uptake during 26 Hz, 6 mm, feet 3 min squatting in n = 12 Vibration elicits a metabolic (2001), Eur J Apl WBV exercise: 24 cm apart, (approx cycles of 6 s, simple muscular response and therefore is Physiol not a passive form of exercise. 86:169–173 comparison with 18g based on standing, squatting Oxygen consumption increased 4.5 mL/min/kg. Using oxygen at squatting as a slow 30 Hz, acceleration with an additional 20.9 J/mL = 1.6 W (kg body mass). Walking speed at 0.4 m/s voluntary movement 35% body weight load requires 2.3 mL/min/kg and therefore WBV is metabolically for females and 40% comparable to walking. load for males Rittweger et al Treatment of chronic 18 Hz, 6 mm, 18 exercise units n = 60, randomized Significant reduction in pain Appendix: Synopsis of research into WBV (2002a), Spine low back pain with 4 min in beginning sensation and pain-related disability 27(17):1892–1834 lumbar extension and and gradually were performed within control, WBV vs back observed in both groups. increased to 7 min WBV exercise 12 weeks, two units extension exercises in first 6 weeks and then one unit per week thereafter, Galileo 2000, in static slight knee flexion, bending in frontal and saggital plane and rotating in the horizontal plane, 5 kg was added to the shoulders in later sessions 175
Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini—cont’d WBV as a warm-up prior to sport Researchers, Type of Dose Exercise Methodology Outcome 6176 names research Vibration amplitude of 5 mm a Rittweger et al Oxygen uptake in 18–34 Hz, 5 mm, n = 10 changing linear increase in oxygen (2002b), Int J WBV–influence of addition of 40% lean frequencies, n = 8 consumption from 18 to 34 Hz; at Sports Med frequency, amplitude body mass attached changing amplitude 26 Hz the oxygen consumption 23:428–432 and external load to waist and later increased more than proportionally shoulders with amplitudes from 2.5 to 7.5 mm. Addition of loads Rittweger et al The neuromuscular 26 Hz (used because Galileo 2000 n = 19, randomized increased the oxygen consumption significantly. (2003), Clin Physiol effects of hard below 20 Hz induces prototype, 0–90° cross-over study, EMG median frequency increased Funct Imaging squatting with or relaxation; whereas knee flexion, plus ANOVA over VL and was greater after WBV, attenuation of stretch reflex 23(2):81–86 without WBV above 50 Hz can 40% lean body mass amplitude suggesting CNS recruitment, and spinal reflex induce severe at hips, 3 s down and pathways muscle damage), 3 s up, exercise until Isometric and dynamic knee extensor strength increased in WBV 6 mm (12 mm from exhaustion (15 ± 2.1 and 16.1 ± 3.1%) and resistance training (18.4 ± 2.8 and top to bottom) 13.9 ± 2.7% groups; p = 0.558). CMJ increased sign in WBV Roelants et al WBV training 35–40 Hz 24 weeks WBV, n = 89, randomized (2004a), J Am increases strength control, Geriatr Soc and speed of 2.5–5.0 mm Power unloaded static and postmenopausal 52(6):901–908 movement in older women, WBV, women Plate. Total duration dynamic knee resistance training, control 5–30 min at the end extensor exercises of training
Researchers, Type of Dose Exercise Methodology Outcome names research (19.4 ± 2.8%) and resistance training (12.9 ± 2.9%). Most effects within 12 weeks. n = 6 left the resistance training group due to anterior knee pain vs 1 in WBV group. Roelants et al Effects of 24 weeks 35–40 Hz Unloaded static and n = 48, comparative Fat-free mass increased in WBV (2004b), Int J of WBV on body 2.5–5.0 mm Power dynamic exercises 3× WBV training vs group only (+2.2%). Significant Sports Med composition in Plate. Total duration weekly fitness training, vs increases in strength in WBV 24.4 25(1):1–5 untrained females 5–30 min at the ± 5.1% and training group 16.5 ± end of training control, elderly 1.7%. women Appendix: Synopsis of research into WBV Rubin et al (2001), Ability of extremely 10 min per day at Daily exposure to Comparative six Bone formation rate (BFR) in the FASEB low-magnitude, 90 Hz, 0.25g peak vibration vs disuse different groups proximal tibia in the vibration group 15:2225–2229 high-frequency to peak for 28 days compared with the other group mechanical signals to increased +97%. restore anabolic bone cell activity inhibited by disuse Rubin et al (2003), Determine the degree Transcutaneous pins Vibration data were The participants were With subjects standing erect, Spine of transmissibility of 28:2621–2627 high-frequency were placed in recorded at 2-Hz standing in three transmissibility at the hip exceeded low-magnitude mechanical signals, spinous process of intervals beginning at different postures: 100% at 20 Hz. At more than delivered through • E rect with knee 25 Hz transmissibility decreased to plantar surface of the L4 and greater 15 Hz and ending at foot to the hip and spine trochanter of the 30 Hz extended and 80% at the hip and spine in femur of six locked relaxed stance, transmission • Relaxed with knees decreased to 60% with 20° of volunteers Standing on an straight knee flexion • Knees flexed at 20° oscillating platform 177
Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini—cont’d WBV as a warm-up prior to sport Researchers, Type of Dose Exercise Methodology Outcome 6178 names research data were collected from accelerometers fixed to the pins while a platform vibrated Rubin et al (2004), Bone mineral density Two 10-min Each day vibration n = 70, randomized, Treatment group demonstrated an J Bone Miner Res double-blind and improvement of 2.17% in the 19:343–351 treatments, low just standing placebo-controlled femoral neck and 1.5% in the trial of lumbar spine. magnitude 2.0g postmenopausal women peak to peak, 30 Hz vertical acceleration for 1 year Rubin et al (2005), Molecular pathways Review considers the Gene 367:1–16 mediating mechanical mechanical factors signalling in bone generated by loading in the skeleton, including strain, stress and pressure. Mechanosensitive cells which recognize these forces in the skeleton are reviewed. The identity of the mechanoreceptors is approached.
Researchers, Type of Dose Exercise Methodology Outcome names research Rubin et al (2007), Adipogenesis is 5 days per week, 15 weeks of brief n = 40, comparative, Inhibition of adipogenesis by 27%, Proc Natl Acad Sci daily exposure to mice reduced non-esterified free fatty USA 104(45): inhibited by brief daily 15 min, 90 Hz, 0.2g vibration, vs walking acids and triglycerides by 43 and 17879–17884 39%. Over 9 weeks fat production exposure to was suppressed by 22% in C3HB6-6T accelerated age-related high-frequency, mice. Mesenchymal stem cell differentiation into adipocytes extremely low- reduced by 19%. magnitude mechanical signals Appendix: Synopsis of research into WBV Sands et al (2000) Flexibility enhanced 30 Hz 2 mm Stretching protocol n = 10, randomized Promising means of attaining ROM Med Sci Sports with vibration: acute displacement box over 4 weeks, 5 days/ young males beyond that achieved by static Exerc and long term week, in forward/rear gymnasts (age = stretching in highly trained 38(4):720–725 splits for calf and 10.1 ± 1.5 yrs) gymnasts. quads, 10 secs stretch, 50 secs off repeated four times which equaled 1 min of fatal stretching 179
Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini—cont’d WBV as a warm-up prior to sport Researchers, Type of Dose Exercise Methodology Outcome 6180 names research Isometric knee Savelberg et al WBV increase in extension n = 28, randomized Weaker subjects responded better (2007), J Strength muscle length results four groups, each (10–50% increase strength). Cond Res in muscle strength group received 4/52 Training at shorter lengths resulted 21(2):589–593 of WBV at one of in optimal angle shifts to greater three different lengths in both stronger and Spitzpfeil et al Mechanical impacts Galileo 2000 vs 15 s frequencies (20, 27, weaker subjects. (2006), J 34 Hz) or one of two Biochemanics to the human body by Power Plate, 25, 30, different lengths of Acceleration to head by Power 39(Suppl 1):S196, knee extensors Plate was 02–06g which was sign 5931 higher than Galileo 2000 of n = 8, randomized 01–02g different vibration 35, 40, 50 Hz; 0, training devices 60, 80% body weight, knee angle 110° and 150° Stewart et al Plantar vibration 0, 15, 45 Hz, at 35° Passive tilt at 35° n = 18 Enhanced peripheral and systemic tilt, 0.2g, 0.2 m2 from horizontal perimenopausal blood flow (25–35%), improved (2004), Am J improves leg fluid women lymphatic flow and better venous drainage. Postulated this would be Physiol Regul Integr flow in necessary for preventing osteopenia due to bone orthostasis. Comp Physiol perimenopausal 288(3):R623–R629 women
Researchers, Type of Dose Exercise Methodology Outcome names research Gallileo 26 Hz, Static? Stewart et al Differential effects of 4 mm, 2, 4 or n = 12, comparative 2 min increased peak torque by (2007), J Sci Med WBV durations on 6 min 90 min cycling 3.8%, 4 and 6 min decreased Sport 12(1):50–53 knee extensor n = 12, cycling in peak torque by –2.7 and –6%, strength 30 Hz, 4-mm normobaric hypoxia, respectively amplitude and normoxia with/ Vibration significantly increased Suhr et al (2006) Short-term vibration without vibration, vascular endothelial growth factor J Biomechanics stimuli during altitude of 2400 m, (VEGF). Appendix: Synopsis of research into WBV 39(Suppl 1) S196, intensive cycling four weekly training 5174 performance on sessions at weekly Over and under-correction of initial angiogenesis intervals in position. randomized order Thompson et al Effect of bilateral 30 s of tendon Static? n = 12, comparative; (2007), Clin Achilles vibration on vibration before, during, 5 and Neurophysiol posture 25 s after vibration 118(11):2456– 2467 WBV and strength 20 Hz, 5 mm, 6× Static n = 16, randomized Isometric and knee extensor torque after stroke 1 min control increase by 36.6% and 22.2 Tihanyi et al respectively (2007), Clin Rehabil 21(9):782–793 181
Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini—cont’d WBV as a warm-up prior to sport Researchers, Type of Dose Exercise Methodology Outcome 6182 names research Torvinen et al Effect of a vibration 4 min, feet 0.28 m Repeated 4× n = 16, randomized 2.5% net benefit in jump height (2002a), Clin exposure on muscular from centre of multidirectional crossover study (p = 0.019), 3.2% benefit in Physiol Funct isometric strength (p = 0.020), Imaging performance and platform, 15 Hz 1st movement on 15.7% improvement in body 22:145–152 balance (p = 0.049) 2 min body balance minute, 20 Hz 2nd platform–light after WBV. Torvinen et al (2002b), Med Sci minute, 25 Hz 3rd squatting (0–10 s), Sports Exerc 34(9):1523–1528 minute, 30 Hz last standing in erect minute, peak-to- posture (10–20 s), peak amplitude standing in relaxed 10 mm, acceleration posture (20–30 s), was 3.5g at 15 Hz, light jumping 6.5g at 20 Hz, 10g (30–40 s), alternating at 25 Hz, 14g at body weight one leg 30 Hz to the other (40–50 s), and standing on heels (50–60 s) Effect of 4-month Vertical WBV, 4 months, 4 min/day Randomized No direct influence on body vertical WBV on Kuntotary, Erka Oy, 3–5× per week, 4× controlled, young balance, vertical jump improved performance and Finland. First 2 60 s, light squatting healthy non-athletic 2 cm (10.2% improvement) at 2 balance weeks, 25 Hz for (0–10 s), standing in adults, n = 56, n = 4 months, 2.5 cm improvement in 1 min, then 30 Hz the erect position dropout (n = 2 in vertical jump (8.5% increase) at for another minute. (10–20 s), standing WBV unrelated to 4 months. Isometric strength Next 1.5 months, relaxed knees slightly training regimen) increase by 11.2 kg at 2 months
Researchers, Type of Dose Exercise Methodology Outcome names research 3 min at 25 Hz/60 s flexed (20–30 s), light (3.7% net benefit). No change in shuttle tests. + 30 Hz/60 s + jumping (30–40 s), 35 Hz/60 s. alternating the body Remaining 2 weight one leg to the months, 4 min at other (40–50 s), 25 Hz/60 s + standing on the heels 30 Hz/60 s + (50–60 s) 35 Hz/60 s + 40 Hz/60 s. Acceleration 2.5g at 25 Hz, 3.6g at Appendix: Synopsis of research into WBV 30 Hz, 4.9g at 35 Hz, and 6.4g at 40 Hz Van den Tillaar Will WBV training help Repeated measures Significant increases in hamstring (2006), J Strength increase the range of ANCOVA, n = 19 (10 flexibility. WBV group showed a Cond Res motion of the in WBV and 9 significant increase (30%) in ROM 20(1):192–196 hamstrings? controls) randomly compared with 14% for controls. allocated men and women Van Nes et al Short-term effects of Commercial 4× 45 s WBV in n = 23, chronic Reduction in root mean square (2004), Am J Phys WBV on postural platform, 30 Hz, standing stroke patients centre-of-pressure velocity in Med Rehab control in unilateral 3-mm amplitude anterior–posterior direction with 83(11):867–873 chronic stroke eyes shut, increase in weight patients: preliminary shifting speed, precision remained evidence constant. No adverse side-effects observed. 183
Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini—cont’d WBV as a warm-up prior to sport Researchers, Type of Dose Exercise Methodology Outcome 6184 names research Verschueren et al Effect of 6-month 35–40 Hz, 3× weekly for n = 70, randomized No vibration-related side-effects. (2004), J Bone WBV training on hip 2.28–5.09g 24 weeks. WBV group controlled, WBV vs WBV improved isometric and Miner Res density, muscle dynamic muscle strength (+15 and 19(3):352–359 strength, and postural performed static and resistance training +16%, respectively). Increases in control in BMD of hip (+0.93%); no change postmenopausal dynamic knee of BMD observed in resistance women: a randomized training group. controlled pilot study extensor exercises; Resistance group started with low (20RM) to high (8RM) resistance. Control group, no exercise von der Heide et al Effects on muscles of 5–30 Hz; oscillations Physical Therapy n = 29, crossover WBV with PT improves subjective with average cycle (2004), Dept WBV (Gallileo 2000) length 40 ms, random design using and objective parameters of stress 5 mm, 4 min Gynecology and in combination with three groups all urinary incontinence. Obstetrics, physical therapy for receiving George-August- treating female stress combinations of University, urinary incontinence therapy in varying Gottingen, Germany sequencing (PT and Gal, PT then Gal, Gal then PT), two training units of 30 min PT per week, and vibration training 2× 4 min, over 24 weeks with 12-week follow-up
Researchers, Type of Dose Exercise Methodology Outcome names research Elevated muscle activity and Wakeling et al Muscle activity damps 10–65 Hz, 5 mm, a Standing on a n = 20, 10 male, 10 increased damping of vibration (2002), J Appl power occurred when the Physiol, the soft-tissue cycle of 3 s of vibrating platform with female frequency of the input was close to 93:1093–1103 the natural frequency of each soft resonance that occurs vibration followed by slight knee-flexion tissue. Natural frequency of the soft tissues did not change in a in response to pulsed 3 s of no platform angle of 23° manner that correlated with the frequency of the input. It is and continuous movement. During suggested that soft-tissue damping may be the mechanism by which vibration each vibration resonance is minimized at heel strike during running. period, the frequency and amplitude of the platform vibration were kept constant. Appendix: Synopsis of research into WBV Frequencies of 10.0, 13.1, 17.1, 22.3, 29.1, 38.1, 49.7 and 65.0 Hz were tested. These eight frequencies were presented in a randomized block. The randomized block was then repeated five times so that the subject experienced a total of 40 periods of vibration in each test 185
Table 6.3 Synopsis of research into WBV, compiled by Martin Krause and Alfio Albasini—cont’d WBV as a warm-up prior to sport Researchers, Type of Dose Exercise Methodology Outcome 6186 names research WBV 45 Hz (0.3g) 8-week-old female 3 weeks of WBV did not negatively Xie et al (2006), Low-level vibrations for 15 min per day, mice, n = 18 influence body mass, bone length Bone influence on bone and WBV with 10 s or chemical bone matrix properties 39:1059–1066 resorption and rest of the tibia. Inhibition of bone formation resorption, site-specific attenuation of declining levels of bone Yamazaki et al Vibratory loading 2, 4, 6 and 8 hours Passive loading on Rabbit formation, maintain a high level of (2002), Spinal J decreases of vibration loading, annulus cells in vitro matrix quality. 2:415–420 extracellular matrix 0.1g, 6 Hz and matrix Aggrecan, collagen type III, matrix metalloproteinase metalloproteinase-3 expression gene expression in was suppressed. rabbit annulus cells
Appendix: Synopsis of research into WBV 187 The Activities-specific Balance Confidence (ABC) Scale* Instructions to Participants: For each of the following, please indicate your level of confidence in doing the activity without losing your balance or becoming unsteady from choosing one of the percentage points on the scale form 0% to 100%. If you do not currently do the activity in question, try and imagine how confident you would be if you had to do the activity. If you normally use a walking aid to do the activity or hold onto someone, rate your confidence as you were using these supports. If you have any questions about answering any of these items, please ask the administrator. The Activities-specific Balance Confidence (ABC) Scale* For each of the following activities, please indicate your level of self- confidence by choosing a corresponding number from the following rating scale: 0% 10 20 30 40 50 60 70 80 90 100% no confidence completely confident “How confident are you will not lose your balance or become unsteady when you… 1. …walk around the house? ___% 2. …walk up or down stairs? ___% 3. …bend over and pick up a slipper from the front of a closet floor ___% 4. …reach for a small can off a shelf at eye level? ___% 5. …stand on your tiptoes and reach for something above your head? ___% 6. …stand on a chair and reach for something? ___% 7. …sweep the floor? ___% 8. …walk outside the house to a car parked in the driveway? ___% 9. …get into or out of the car? ___% 10. …walk across a parking lot to the mall? ___% 11. …walk up or down a ramp? ___% 12. …walk in a crowded mall where people rapidly walk past you? ___% 13. …are bumped into by people as you walk through the mall? ___% 14. …step onto or off an escalator while you are holding onto a railing? ___% 15. …step onto or off an escalator while holding onto parcels such that you cannot hold onto the railing? ___% 16. …walk outside on icy sidewalks? ___% * Powell, LE & Myers AM. The Activities-specific Balance Confidence (ABC) Scale. J Gerontol Med Sci 1995; 50(1): M28-34 Figure 6.8
6 WBV as a warm-up prior to sport 188 TINETTI BALANCE ASSESSMENT TOOL Tinetti ME, Williams TF, Mayewski R, Fall Risk Index for elderly patients based on number of chronic dis- ablities. Am J Med 1986:80:429-434 PATIENTS NAME ________________ D.o.b ___________ Ward ___________ BALANCE SECTION Patient is seated in hard, armless chair; Date Sitting Balance Leans or slides in chair =0 Steady, safe =1 Unable to without help =0 Rises from chair Able, uses arms to help =1 Able without use of arms =2 Unable to without help =0 Attempts to rise Able, requires >1 attempt =1 Able to rise, 1 attempt =2 Immediate standing Unsteady (staggers, moves feet, trunk sway) =0 Balance (first 5 seconds) Steady but uses walker or other support =1 Steady without walker or other support =2 Standing balance Unsteady =0 Nudged Steady but wide stance and uses support Eyes closed Narrow stance without support =1 Turning 360 degrees =2 Begins to fall Sitting down Staggers, grabs, catches self =0 Steady =1 Unsteady =2 Steady =0 Discontinuous steps =1 Continuous =0 Unsteady(grabs, staggers) =1 Steady =0 Unsafe (misjudge distance, falls into chair) =1 Uses arms or not a smooth motion =0 Safe, smooth motion =1 =2 Balance score /16 /16 Figure 6.9
Appendix: Synopsis of research into WBV 189 Berg Balance Scale Description: 14-item scale designed to measure balance of the older adult in a clinical setting. Equipment needed: Ruler, 2 standard chairs (one with the arm rests, one without) Footstool or step, Stopwatch or wristwatch, 15 ft walkway Completion: 15-20 minutes Time: A five-point ordinal scale, ranging from 0-4. “0” indicates the lowest level Scoring: of function and “4” the highest level of function. Total Score = 56 Interpretation: 41-56 = low fall risk 21- 40 = medium fall risk 0 - 20 = high fall risk Criterion Validity: “Authors support a cut off score of 45/56 for independent safe ambulation”. Riddle and Stratford, 1999, examined 45/56 cutoff validity and concluded: • Sensitivity = 64% (Correctly predicts fallers) • Specificity = 90% (Correctly predicts non-fallers) • Riddle and Stratford encouraged a lower cut off score of 40/56 to assess fall risk Comments: Potential ceiling effect with higher leve l patients. Scale does not include gait items Norms: Lusardi, M.M. (2004). Functional Performance in Community Living Older Adults. Journal of Geriatric Physical Therapy, 26(3), 14-22. Table 4. Berg Balance Scale Scores: Means, Standard Deviations, and Confidence Intervals by Age, Gender, and Use of Assistive Device Age(y) Group N Mean SD CI 60-69 Male 1 51.0 –– 35.3 - 66.7 70-79 Female 5 54.6 0.5 47.6 - 61.6 Overall 6 54.0 1.5 52.4 - 55.6 Male 9 53.9 1.5 48.7 - 59.1 Female 10 51.6 2.6 46.6 - 56.6 Overall 19 52.7 2.4 51.5 - 53.8 80-89 Male 10 41.8 12.2 36.8 - 46.8 Female 24 42.1 8.0 38.9 - 45.3 No Device 24 46.3 4.2 44.1 - 48.5 Device 10 31.7 10.0 28.3 - 35.1 Overall 34 42.0 9.2 38.8 - 45.3 90-101 Male 2 40.0 1.4 28.9 - 51.1 Female 15 36.9 9.7 32.8 - 40.9 No Device 7 45 4.2 40.9 - 49.1 Device 10 31.8 7.6 28.4 - 35.2 Overall 17 37.2 9.1 32.5 - 41.9 Figure 6.10
6 WBV as a warm-up prior to sport 190 Berg Balance Scale Name: _______________________________________ Date: _________________________ Location: _____________________________________ Rater: _________________________ ITEM DESCRIPTION SCORE (0-4) Sitting to standing __________ Standing unsupported __________ Sitting unsupported __________ Standing to sitting __________ Transfers __________ Standing with eyes closed __________ Standing with feet together __________ Reaching forward with outstretched arm __________ Retrieving object from floor __________ Turning to look behind __________ Turning 360 degrees __________ Placing alternate foot on stool __________ Standing with one foot in front __________ Standing on one foot __________ Total ___________ GENERAL INSTRUCTIONS Please document each task and/or give instructions as written. When scoring, please record the lowest response category that applies for each item. In most items, the subject is asked to maintain a given position for a specific time. Progressively more points are deducted if: • the time or distance requirements are not met • the subject’s performance warrants supervision • the subject touches an external support or receives assistance from the examiner Subject should understand that they must maintain their balance while attempting the tasks. The choices of which leg to stand on or how far to reach are left to the subject. Poor judgment will adversely influence the performance and the scoring. Equipment required for testing is a stopwatch or watch with a second hand, and a ruler or other indicator of 2, 5, and 10 inches. Chairs used during testing should be a reasonable height. Either a step or a stool of average step height may be used for item # 12. Figure 6.11
Appendix: Synopsis of research into WBV 191 Berg Balance Scale SITTING TO STANDING INSTRUCTIONS: Please stand up. Try not to use your hand for support. ( ) 4 able to stand without using hands and stabilize independently ( ) 3 able to stand independently using hands ( ) 2 able to stand using hands after several tries ( ) 1 needs minimal aid to stand or stabilize ( ) 0 needs moderate or maximal assist to stand STANDING UNSUPPORTED INSTRUCTIONS: Please stand for two minutes without holding on. ( ) 4 able to stand safely for 2 minutes ( ) 3 able to stand 2 minutes with supervision ( ) 2 able to stand 30 seconds unsupported ( ) 1 needs several tries to stand 30 seconds unsupported ( ) 0 unable to stand 30 seconds unsupported If a subject is able to stand 2 minutes unsupported, score full points for sitting unsupported. Proceed to item #4. SITTING WITH BACK UNSUPPORTED BUT FEET SUPPORTED ON FLOOR OR ON A STOOL INSTRUCTIONS: Please sit with arms folded for 2 minutes. ( ) 4 able to sit safely and securely for 2 minutes ( ) 3 able to sit 2 minutes under supervision ( ) 2 able to able to sit 30 seconds ( ) 1 able to sit 10 seconds ( ) 0 unable to sit without support 10 seconds STANDING TO SITTING INSTRUCTIONS: Please sit down. ( ) 4 sits safely with minimal use of hands ( ) 3 controls descent by using hands ( ) 2 uses back of legs against chair to control descent ( ) 1 sits independently but has uncontrolled descent ( ) 0 needs assist to sit TRANSFERS INSTRUCTIONS: Arrange chair(s) for pivot transfer. Ask subject to transfer one way toward a seat with armrests and one way toward a seat without armrests. You may use two chairs (one with and one without armrests) or a bed and a chair. ( ) 4 able to transfer safely with minor use of hands ( ) 3 able to transfer safely definite need of hands ( ) 2 able to transfer with verbal cuing and/or supervision ( ) 1 needs one person to assist ( ) 0 needs two people to assist or supervise to be safe STANDING UNSUPPORTED WITH EYES CLOSED INSTRUCTIONS: Please close your eyes and stand still for 10 seconds. ( ) 4 able to stand 10 seconds safely ( ) 3 able to stand 10 seconds with supervision ( ) 2 able to stand 3 seconds ( ) 1 unable to keep eyes closed 3 seconds but stays safely ( ) 0 needs help to keep from falling STANDING UNSUPPORTED WITH FEET TOGETHER INSTRUCTIONS: Place your feet together and stand without holding on. ( ) 4 able to place feet together independently and stand 1 minute safely ( ) 3 able to place feet together independently and stand 1 minute with supervision ( ) 2 able to place feet together independently but unable to hold for 30 seconds ( ) 1 needs help to attain position but able to stand 15 seconds feet together ( ) 0 needs help to attain position and unable to hold for 15 seconds Figure 6.12
6 WBV as a warm-up prior to sport 192 Berg Balance Scale continued…… REACHING FORWARD WITH OUTSTRETCHED ARM WHILE STANDING INSTRUCTIONS: Lift arm to 90 degree. Stretch out your fingers and reach forward as far as you can. (Examiner places a rule at the end of fingertips when arm is at 90 degrees. Fingers should not touch the ruler while reaching forward. The recorded measure is the distance forward that the fingers reach while the subject is in the most forward lean position. When possible, ask subject to use both arms when reaching to avoid rotation of the trunk.) ( ) 4 can reach forward confidently 25 cm (10 inches) ( ) 3 can reach forward 12 cm (5 inches) ( ) 2 can reach forward 5 cm (2 inches) ( ) 1 reaches forward but needs supervision ( ) 0 loses balance while trying/requires external support PICK UP OBJECT FROM THE FLOOR FROM A STANDING POSITION INSTRUCTIONS: Pick up the shoe/slipper, which is place in front of your feet. ( ) 4 able to pick up slipper safely and easily ( ) 3 able to pick up slipper but needs supervision ( ) 2 unable to pick up but reaches 2-5 cm (1-2 inches) from slipper and keeps balance independently ( ) 1 unable to pick up and needs supervision while trying ( ) 0 unable to try/needs assist to keep from losing balance or falling TURNING TO LOOK BEHIND OVER LEFT AND RIGHT SHOULDERS WHILE STANDING INSTRUCTIONS: Turn to look directly behind you over the left shoulder. Repeat to the right. Examiner may pick an object to look at directly behind the subject to encourage a better twist turn. ( ) 4 looks behind from both sides and weight shifts well ( ) 3 looks behind one side only other side shows less weight shift ( ) 2 turns sideways only but maintains balance ( ) 1 needs supervision when turning ( ) 0 needs assist to keep from losing balance or falling TURN 360 DEGREES INSTRUCTIONS: Turn completely around in a full circle. Pause. Then turn a full circle in the other direction. ( ) 4 able to turn 360 degrees safely in 4 seconds or less ( ) 3 able to turn 360 degrees safely one side only 4 seconds or less ( ) 2 able to turn 360 degrees safely but slowly ( ) 1 needs close supervision or verbal cuing ( ) 0 needs assistance while turning PLACE ALTERNATE FOOT ON STEP OR STOOL WHILE STANDING UNSUPPORTED INSTRUCTIONS: Place each foot alternately on the step/stool. Continue until each foot has touch the step/stool four times. ( ) 4 able to stand independently and safely and complete 8 steps in 20 seconds ( ) 3 able to stand independently and complete 8 steps in > 20 seconds ( ) 2 able to complete 4 steps without aid with supervision ( ) 1 able to complete > 2 steps needs minimal assist ( ) 0 needs assistance to keep from falling/unable to try STANDING UNSUPPORTED ONE FOOT IN FRONT INSTRUCTIONS: (DEMONSTRATE TO SUBJECT) Place one foot directly in front of the other. If you feel that you cannot place your foot directly in front, try to step far enough ahead that the heel of your forward foot is ahead of the toes of the other foot. (To score 3 points, the length of the step should exceed the length of the other foot and the width of the stance should approximate the subject’s normal stride width.) ( ) 4 able to place foot tandem independently and hold 30 seconds ( ) 3 able to place foot ahead independently and hold 30 seconds ( ) 2 able to take small step independently and hold 30 seconds ( ) 1 needs help to step but can hold 15 seconds ( ) 0 loses balance while stepping or standing STANDING ON ONE LEG INSTRUCTIONS: Stand on one leg as long as you can without holding on. ( ) 4 able to lift leg independently and hold > 10 seconds ( ) 3 able to lift leg independently and hold 5-10 seconds ( ) 2 able to lift leg independently and hold ≥ 3 seconds ( ) 1 tries to lift leg unable to hold 3 seconds but remains standing independently. ( ) 0 unable to try of needs assist to prevent fall ( ) TOTAL SCORE (MAXIMUM = 56) Figure 6.12—cont’d
Appendix: Synopsis of research into WBV 193 Guidelines for the Six-Minute Walk Test The following elements should be present on the 6MWT worksheet and report: Lap Counter: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Patient name: _________________ Patient ID# _____________ Walk# __ _____ Tech ID: _________ Date: ___________ Gender: M F Age: ___ Race: ____ Height: ___ft __ ____in, _____meters Weight: ____ ____ lbs, __ ____kg Blood pressure: _______/ _____ Medications taken before the test (dose and time): _____________________ Supplemental oxygen during the test: No Yes, flow ___ ___ L/min, type _ ____ Baseline End of Test Time ___:___ ___:____ Heart Rate ____ __ __ _____ Dyspnea __ ____ ___ ___ (Borg CR10 Scale®) Fatigue ____ __ ___ ___ (Borg CR10 Scale®) SpO2 ____ __ % ___ ___% Stopped or paused before 6 minutes? No Yes, reason: ____ _____ _____ ___ Other symptoms at end of exercise: angina dizziness hip, leg, or calf pain Number of laps: __ __ (x 60 meters ) + final partial lap: _____ __ meters = Total distance walked in 6 minutes: _______ __ meters Predicted distance: ___ ____ meters Percent predicted: _____ __% Tech comments: Interpretation (including comparison with a preintervention 6MWD): Figure 6.13 Guidelines for the Six-Minute Walk Test (American Journal of Respiratory and Critical Care Medicine, 166/111-117, American Thoracic Society (2002))
6 WBV as a warm-up prior to sport 194 *The Borg CR10 Scale® (© Gunnar Borg) 0 Nothing at all 0.5 Very, very slight (just noticeable) 1 Very slight 2 Slight (light) 3 Moderate 4 Somewhat severe 5 Severe (heavy) 6 7 Very severe 8 9 10 Very, very severe (maximal) Figure 6.13—cont’d This Borg scale should be printed on heavy paper (11 inches high and perhaps laminated) in 20-point type size. At the beginning of the 6-min exercise, show the scale to the patient and ask the patient: ‘Please grade your level of shortness of breath using this scale.’ Then ask: ‘Please grade your level of fatigue using this scale.’ At the end of the exercise, remind the patient of the breathing number that they chose before the exercise and ask the patient to grade their breathing level again. Then ask the patient to grade their level of fatigue, after reminding them of their grade before the exercise. *For basic information about scale construction, metric properties, correct administration etc., it’s necessary to read the book (Borg, G. 1998, Borg’s Perceived Exertion and Pain Scales, Human Kinetics) and relevant folder. Scales and Instructions can be obtained for a minor fee from Dr. G. Borg and his company, Borg Perception, Rädisvägen 124, 16573 Hässelby, Stockholm, Sweden. Phone: 46-8-271426 or E-mail: [email protected].
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