Review Article | Open Access
Danúbia da Cunha Sá-Caputo, Pedro Ronikeili-Costa, Rafaelle Pacheco Carvalho-Lima, Luciana Camargo Bernardo, Milena Oliveira Bravo-Monteiro, Rebeca Costa, Janaina de Moraes-Silva, Dulciane Nunes Paiva, Christiano Bittencourt Machado, Paula Mantilla-Giehl, Adriano Arnobio, Pedro Jesus Marin, Mario Bernardo-Filho, "Whole Body Vibration Exercises and the Improvement of the Flexibility in Patient with Metabolic Syndrome", Rehabilitation Research and Practice, vol. 2014, Article ID 628518, 10 pages, 2014. https://doi.org/10.1155/2014/628518
Whole Body Vibration Exercises and the Improvement of the Flexibility in Patient with Metabolic Syndrome
Vibrations produced in oscillating/vibratory platform generate whole body vibration (WBV) exercises, which are important in sports, as well as in treating diseases, promoting rehabilitation, and improving the quality of life. WBV exercises relevantly increase the muscle strength, muscle power, and the bone mineral density, as well as improving the postural control, the balance, and the gait. An important number of publications are found in the PubMed database with the keyword “flexibility” and eight of the analyzed papers involving WBV and flexibility reached a level of evidence II. The biggest distance between the third finger of the hand to the floor (DBTFF) of a patient with metabolic syndrome (MS) was found before the first session and was considered to be 100%. The percentages to the other measurements in the different sessions were determined to be related to the 100%. It is possible to see an immediate improvement after each session with a decrease of the %DBTFF. As the presence of MS is associated with poorer physical performance, a simple and safe protocol using WBV exercises promoted an improvement of the flexibility in a patient with MS.
1.1. Physical Inactivity and Physical Activity
Physical inactivity is a strong health problem, mainly in developed countries with undesirable consequences to the society due to several facilities. On the other hand, physical activity has important consequences to the health [1–3]. Investigations have shown a strong inverse relationship between physical activity, as habitual exercise, and the risk of coronary disease, cardiac events, and cardiovascular death prevention [1, 4, 5]. Moreover, authors [6, 7] have suggested that exercise may provide some protection against breast, intestinal, prostate, endometrial, and pancreatic cancer.
1.2. Physical Activity, the Prevention of Diseases, and the Importance to Patient with Metabolic Syndrome
Considering the patients with osteoporosis, exercise is associated with a decreased risk of hip fractures [8, 9]. Compared to a weight loss diet alone, diet related exercise or exercise and resistance training brings a relevant and important reduction in body fat and enhanced preservation of body lean mass . Metabolic syndrome is defined by an interconnected physiological, biochemical, clinical, and metabolic factors that directly increase cardiovascular risks, such as alterations in the level of the lipids in the plasma, arterial hypertension, central adiposity, and insulin resistance and hyperglycemia [11, 12]. It is well know that regular exercise is a nonpharmacological therapeutic intervention with an enormous range of benefits, including reduced morbidity and mortality of atherosclerotic disease, heart failure, type 2 diabetes, and chronic obstructive pulmonary disease, as well as many other age-related chronic disorders [11, 13, 14]. In addition, the changes in lifestyle and especially in the level of physical activity may help in the treatment and prevention of metabolic syndrome . Other authors have pointed out that aerobic exercise may improve glycemic control and insulin sensitivity and may prevent the development of type 2 diabetes in high-risk groups [16, 17].
Physical fitness components related to health, such as muscle strength and mass, play a significant role in carrying out motor tasks, reducing the risk of falls, and having repercussions in health, longevity, and quality of life of elderly people [18, 19]. Consequently, some studies showed a possible association between muscle strength and decreasing in cardiovascular risk factors, metabolic syndrome, high blood pressure, obesity, and early death [18–22].
It is important to consider the investigation reported by Beavers et al.  who have suggested that the presence of metabolic syndrome is significantly associated with poorer physical performance in older adults. In addition, Leite Vieira et al.  have reported in an investigation that elderly women with the metabolic syndrome have higher metabolic risk profile and lower functional capacity, muscle strength, lower limb power, and flexibility as compared to women without the metabolic syndrome.
1.3. Physical Activities and the Risk of Injuries
Although a wide range of physical activities is available to patients with diseases and the exercises, only a limited number of scientific information had shown the superiority of a kind of activity that would lead to relevant health benefits [25, 26]. Moreover, the undesirable risks related to some types of exercises  determine investigations about new possibilities of exercises that could bring benefits to the individual without risks or with minimal possibilities of injuries.
1.4. Whole Body Vibration Exercise and Biomechanical Parameters
The exercises in the whole body due to the exposition to energy as vibrations (whole body vibrations exercise—WBV) generated in oscillating/vibratory platform that is transferred to a subject that is in direct contact with the platform seem to bring various benefits [28–30].
There are various devices of platforms that can be used to transfer energy when the individual, in general, is with the feet on the teeterboard of the platform. However, two of them are widely used, as (i) the teeterboard of the platform goes up and down synchronously and (ii) the right side of the teeterboard goes up when the left side goes down in a side-alternating way (and vice versa) [28, 30].
Vibrations, defined as an oscillatory motion, can be generated in oscillating platforms and transmitted, in general, by the feet to whole body of a person [28, 30]. Biomechanical parameters, as frequency and amplitude of the sinusoidal vibration, can be manipulated by the professional that is supervising the clinical procedure. The duration of the work, as well as the time to rest, the number of sets in a session, and the number of sessions, is also controlled. All these conditions depend on, mainly, the clinical and physical conditions of the patient . In sport, Issurin  has reported that mechanical vibration can be used as a massage tool and/or for training purposes. This author discusses that two varieties of vibration training can be distinguished: strength exercises with superimposed vibratory stimulation and motor tasks performed under whole body vibration (the WBV training).
1.5. Whole Body Vibration Exercise, Potential Biological Effects, and Improvement of Various Clinical Disorders
Authors have demonstrated that WBV exercises might improve muscle strength , bone mineral density [34, 35], postural control , and muscle power . Moreover, the health-related quality of life is increased and the fall risk is decreased . Improvement of gait and balance with WBV has been shown in a population of nursing home residents . The exercises produced by these vibrations in the human body have also been used successfully to treat patients with some diseases related to the impairments involving the central nervous system, as cerebral palsy , multiple sclerosis , spinal cord injury , and stroke . Fuermaier et al.  have published a very important finding that may be of interest to the patient with attention deficit hyperactivity disorder (ADHD). These authors have demonstrated that WBVE improves cognitive performance of healthy individuals as well as of individuals with ADHD. They suggest that the WBV treatment is relatively inexpensive and easy to apply and might therefore be of potential relevance for clinical use. Regterschot et al.  have investigated acute effects of passive WBV on executive functions in healthy young adults. Participants underwent passive WBV sessions and nonvibration control sessions while sitting on a chair mounted on a vibrating platform. A passive WBV session was alternated with a control session. After each session, performance on the Stroop color-block test, Stroop color-word interference test, Stroop difference score, and digit span backward task was measured. It is demonstrated that passive WBV has positive acute effects on attention and inhibition in young adults, notwithstanding their high cognitive functioning which could have hampered improvement.
1.6. Whole Body Vibration Exercise and the Improvement of the Flexibility
Flexibility is related to the ability to move joints through their full range of motion (ROM), from a flexed to an extended position and this physical characteristic is highly desired and relevant to a subject to do their daily activities. The flexibility of a joint depends on conditions related to the muscles, ligaments, bones, and cartilage which form the joint. Although the flexibility of a joint can be genetic, it can also be improved by stretching and appropriated exercises . In addition, it is suggested by Rittweger  that the stretching could reduce the stiffness and hysteresis of the (i) tendon , (ii) alter properties of the intramuscular connective tissue , and (iii) possibly alter those of other passive skeletal structures that together define the ROM for a specific joint .
Cardinale and Bosco  have suggested that the muscle activation due to the WBV may induce improvements in strength and power performance similar to those observed with strength training. As the WBV exercise involves mechanical stretching [52, 53], this fact could justify the increase of the flexibility by the exercise generated by vibration produced in oscillating/vibratory platform and the improvements observed in subjects that have performed WBV [52, 54, 55]. Moreover, an improvement of 8.2% in the sit and reach test has been reported after acute WBV exercise . Similarly, vibration-assisted stretching enhanced the forward split in competitive female gymnasts , suggesting improved flexibility in these elite athletes. Di Giminiani et al.  have reported that individualized WBV without superimposing other exercises is an effective method of acutely increasing lower back and hamstring flexibility.
Putting together all the information about the potential effects of the WBV and the limitations of the patient with syndrome metabolic, it is important to consider studies involving this kind of exercise and syndrome metabolic patient. The aim of this investigation is to present a short review, using information of the PubMed database, about the findings related to the flexibility in subjects that have performed WBV exercises, and to present a case report of a patient with metabolic syndrome that has improved her trunk flexibility due to a protocol of WBV exercises using lower frequencies.
2. Material and Methods
2.1. Criteria Used to Find Publications Related to the Utilization of Whole Body Vibration Exercises and Investigations Involving Flexibility
2.1.1. Database Used in This Study
PubMed database was searched on August 7, 2014. PubMed comprises more than 24 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites (http://www.ncbi.nlm.nih.gov/pubmed).
2.1.2. Search Strategy Used to Find the Publications Involving WBV and MS
Searches were performed using the following keywords: (i) flexibility, (ii) “whole body vibration,” (iii) flexibility and “whole body vibration,” (iv) “whole body vibration” and diabetes, (vi) “whole body vibration” and hypertension, (vii) “whole body vibration” and heart, (ix) “whole body vibration” and metabolic syndrome, (x) flexibility and “whole body vibration exercises,” (xi) flexibility and “oscillating platform,” and (xii) flexibility and “vibratory platform.”
2.1.3. Inclusion and Exclusion Criteria to Select the Publications
Papers were included for analysis if they described a study using whole body vibration generated by an oscillating or vibratory platform in the flexibility of subjects, independently on the clinical conditions. Moreover, the papers must be available in English and reviews were excluded. Articles published before the year 2000 were excluded. Studies involving occupational findings were not also considered. Investigations using medications and whole body vibration were deleted. The publication in which the flexibility was used as a modality of exercise was also deleted. These searches were supplemented with material identified in the references and in the authors’ personal files. Data were independently abstracted by four of the authors and disagreements were resolved by consensus.
2.1.4. Level of Evidence of the Selected Papers
The determination of the level of evidence of the selected papers has followed the publication of the “NHMRC additional levels of evidence and grades for recommendations for developers of guidelines” .
2.2. Case Report and the Protocol Used to Verify the Effect of the Whole Body Vibration Exercises in the Trunk Flexibility of a Patient
2.2.1. Characteristics of the Patient
A 50-year-old patient Caucasian female is an outpatient of the Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Brazil. She has declared to be neither tabagist nor elitist. The clinical examinations (involving physical and laboratory determination) have suggested the diagnosis of metabolic syndrome (MS). This diagnosis of the patient was established for a clinical physician of this multiprofessional team involved in the project who has followed, as inclusion criteria for metabolic syndrome, the guidelines described by the International Diabetes Federation . The patient was not doing another modality of exercise; she was under medication and has followed the recommendations of this clinical physician. As some authors [59, 60] have suggested that the WBV exercises might interfere in some clinical conditions of the patient with MS, participating in an investigation involving the effect of vibrations generated in an oscillating platform was suggested to her.
2.2.2. Ethic Committee and “Written Informed Consent”
This investigation was approved by Ethic Committed under the reference CEP/HUPE 2874/2011, CAAE 0025.0.228.000-11, and the authors have followed the concepts of the Declaration of Helsinki and this research has protected the life, health, privacy, and dignity of the human. All the patients, as well as this patient of this work, read and signed a written informed consent.
2.2.3. Characteristics of the Platform
The oscillating platform (Novaplate fitness evolution, DAF Produtos Hospitalares Ltda, São Paulo) used in the study is based in a reciprocating vertical displacements system. It is a side-alternating vibration device working as a teeterboard (28 cm × 58 cm) with amplitude of 0 (zero) in the center of the platform up to the maximum (7.07 mm) in the edge. The displacements are on the left and right side of a fulcrum; while one is up, the other side is down and vice versa. The position of the feet of the subject on the platform will define the amplitude that is used in the exercise and it is controlled during the exercise.
2.2.4. Protocol Used
Sessions of the whole body vibration protocol: in the first session, to aid in the proprioception, the subject was sat in a chair  with the feet under the teeterboard of the platform. The frequency used was 5 Hz during 1 min and both feet were in position with amplitude of 2.07 mm in both sides of the teeterboard with a rest of 1 min. This procedure was repeated once again. Then, the patient changed her feet to the amplitude of 4.04 mm in both sides of the teeterboard. The frequency used was the same during 1 min with a rest of 1 min. This procedure was repeated once again. Then, the patient changed her feet to amplitude of 7.07 mm in both sides of the teeterboard, using the 5 Hz of frequency during 1 min, with a rest of 1 min. This procedure was repeated once again.
In the second session, the subject was stood up with both feet under the platform in the amplitude of 2.07 mm of the teeterboard and the frequency used was 5 Hz during 1 min. In this step the man was instructed to be in a comfortable squat position for 1 min of rest. It was repeated once again with a rest of 1 min. Then, the patient still stood up and changing her feet to the amplitude of 4.04 mm sustained the squat comfortable position for 1 min rest. The procedure was repeated once again at the same frequency and amplitude with 1 min of rest. Finally, the patient stood up and changing her feet to the amplitude of 7.07 sustained the squat comfortable position with 1 min of rest. The procedure was repeated once again at the same frequency and amplitude with 1 min of rest.
In the next sessions, the procedures of the second session were repeated in the same conditions in the next sessions; however, in each session, the frequency used was increased in one Hz up to 14 Hz.
In the several steps of the protocol, a physiotherapist was close to the subject.
2.2.5. Measurement of the Anterior Trunk Flexion
Anterior trunk flexion  was assessed with the subject in orthostatic position with the knees passively extended followed by carefully of an anterior flexion of the trunk. The distance between the third finger of the hand to the floor (DBTFF) was determined, in each session, just before starting the session and just after the end of each session, as described in the protocol reported in the Section 2.2.4.
The biggest DBTFF was found just before the first session and was considered 100%. The percentages to the other measurements in the different session were determined related to the 100% of the first session.
2.2.6. Determination of Blood Pressure and Heart Rate
An automated device (OMRON, model HEM-7113, China) was used to verify the systolic blood pressure (SBP) and diastolic blood pressure (DBP) (mmHg) and the heart rate (HR) (beats per min-bpm), which were measured on the right arm of seated subjects after a 10-minute rest. These determinations were done just before the first session and just after the last session. Means of three readings of SBP, DBP, and HR were used in the analyses.
2.2.7. Statistical Analysis
Statistical analysis was performed to compare the change in anterior trunk flexibility, SBP and DBP and HR before the first and after the last session of WBV exercise. The level of significance was set at .
3. Results and Discussion
The findings of this investigation, using information of the PubMed database, reveal that there is interest in evaluating the effect of WBV exercises in the flexibility of subjects. Moreover, a case report of a patient with metabolic syndrome is presented which has significantly () improved her trunk flexibility due to a protocol of WBV exercises using lower frequencies. The SBP, DBP, and HR were not significantly altered (). Although other clinical parameters of metabolic syndrome such as blood exam and weight were not determined, these considerations can aid to stimulate the patient with metabolic syndrome to perform WBV exercises. Considering the findings reported by Bogaerts et al.  they observed in a community-dwelling elderly that WBV is safe and appears to be efficient to improve the cardiorespiratory fitness and muscle strength. Moreover, Figueroa et al.  suggest that WBV may decrease cardiovascular risk in postmenopausal women by improving wave reflection and muscle strength.
Table 1 shows the searches performed in PubMed database. The keyword flexibility rendered more than forty-six thousands publications. The search with the keyword “whole body vibration” rendered more than one thousand publications with general approaches and applications of the WBV. Although no publications were found with “whole body vibration” and “metabolic syndrome,” some publications were found with keywords related to metabolic syndrome, as diabetes and hypertension. Moreover, an important number of articles are observed with the keywords “whole body vibration” and heart. No articles were found in the search in the PubMed with the keywords (a) flexibility and “whole body vibration exercises”, (b) flexibility and “oscillating platform,” and (c) flexibility and “vibratory platform.”
In this study the publications searched with the keywords flexibility and “whole body vibration” that has rendered thirty-two publications were considered. Considering the exclusion criteria, (a) one of these papers was in Russian, (b) three publications before the year 2000, (c) two studies involving occupational findings, (d) four publications involving revisions, (e) one investigation evaluating the effect of medication (alendronate) and whole body vibration , (f) two publications [66, 67] in which the flexibility was used as a modality of exercise, (g) two publications, in which the parameter about flexibility was not clearly presented [68, 69], (h) one paper where the effect of the WBV on the flexibility was not clear , and (i) one investigation with myoblasts  were excluded.
Fifteen publications that reached the inclusion criteria were analyzed considering the effect of the WBV on the flexibility. The frequency and amplitudes used and the mean age and sex of the subjects in the studies and the findings are shown in Table 2.
|WBV: whole body vibration.|
LE: level of evidence.
The level of evidence of the selected papers is also shown in the Table 2.
Sixteen papers involving the flexibility and whole body vibration were analyzed and eight of them were with level of evidence II.
The findings concerning to the systolic blood pressure (SBP) and diastolic blood pressure (DBP) indicated that before the first session, SBP and DBP were mmHg and mmHg, respectively, and after the last session they were and mmHg and no significant difference () was found. The heart rate (HR) before the first session was bpm and after the last session was bpm. No significant difference () was found in the HR. These results indicated that with the protocol used no cardiovascular effect was found in the patient investigated. This fact could be associated with the safety [72, 73] of the WBV exercise and/or the medication that the patient was using.
Figure 1 shows the values of the %DBTFF in the various sessions. It is possible to see an immediate improvement after each session with a decrease of the %DBTFF. However, it is also shown that the improvement is not maintained. In the next session the %DBTFF increases again. It is highly important to consider that the decrease of the %DBTFF is continuous, as Figure 1 also shows. The difference of the %DBTFF before the first session in comparison with the last session is significant (). Moreover, an important reduction is observed up to the 15th day. After this day, the flexibility is maintained up to the end of the protocol. This patient was not evaluated more after the last session.
WBV generated a type of exercise in an oscillating platform that, in appropriated conditions, is safe [72, 73] and has been proposed as clinical intervention in the treatment of several disorders [28–30, 73, 74] as well as to improve the performance of athletes [32, 75–77]. This kind of exercise improves the strength of the muscle [35, 56, 78, 79], bone density [35, 65], cardiovascular parameters [63, 64], body balance , flexibility [46, 52, 54, 55, 79–86], and cognition [42, 43] and is a promising treatment method for patients with acute unstable inversion ankle sprains . Some of these improvements might be useful to patients with metabolic syndrome.
Flexibility is regarded as a major component of physical ability and good physical health, particularly the anterior flexibility of the truck . An important number of publications (about fifty thousand) are found in the database PubMed with the keyword “flexibility” (Table 1). Although, there is a relevant number of articles with this keyword, it is necessary to consider that some of them are not related to studies of the flexibility of human beings. Moreover, twelve articles reached the inclusion criteria to be analyzed involving flexibility and whole body vibration and eight of them were with level of evidence II. These papers are discussed in Table 2.
Beavers et al.  have suggested that the presence of metabolic syndrome is significantly associated with poorer physical performance in older adults. Considering the risks associated with the physical activity in general [88, 89], the WBV exercises generated by the vibrations obtained in the oscillating platform can be used, under appropriated supervising, without risks in trained and untrained people [30, 32, 90, 91]. Moreover, the clinical findings reveal that WBV exercises might improve muscle strength [29, 90–92], postural control [29, 90], muscle power [30, 36], flexibility [44, 45, 52, 54, 55, 78], and gait and balance . Putting together these findings, the use of this kind of exercises could be useful for patient with metabolic syndrome. The trunk flexibility of a patient with metabolic syndrome has improved after WBV exercises using vibrations generated in oscillating platform with low frequencies (5 up to 14 Hz) (Figure 1). This result is in agreement with other authors that have submitted subjects to similar vibration with high frequencies (15 to 50 Hz) [32, 44, 54].
Although the mechanisms of this effect related to the flexibility are not fully known, previous studies suggest that the improvement in flexibility by WBV is associated with several mechanisms, such as suppression of the central nervous system owing to a decrease in motor neuron pool excitability increasing the blood flow [93–95], decrease in pain sensation , and a decrease in musculoskeletal stiffness and inhibition of muscular antagonist . These considerations are relevant and WBV may be favorable for patients with metabolic syndrome.
An important number of publications (more than forty-six thousand) were found in the database PubMed with the keyword “flexibility.” Eight of the selected papers involving the flexibility and whole body vibration had level of evidence II. This fact could be due to the flexibility be a major component of physical ability and good physical health. WBV is a modality of exercise in an oscillating platform that, in appropriated conditions, is safe and has been proposed as clinical intervention in the treatment of several disorders as well as to improve the performance of subjects, as the improvement of the flexibility. A poor physical performance is observed in the patient with metabolic syndrome and with a simple and safe protocol using WBV exercises, an improvement of the flexibility in a patient with this syndrome was obtained. It is concluded that the WBV exercises could be useful to aid the patient with metabolic syndrome.
Conflict of Interests
The authors declare that there is no conflict of interests regarding the publication of this paper.
The authors thank the support of the Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).
- S. Kodama, K. Saito, S. Tanaka et al., “Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis,” The Journal of the American Medical Association, vol. 301, no. 19, pp. 2024–2035, 2009.
- C. Huy, K. Steindorf, D. Litaker, A. Thiel, and C. Diehm, “Physical activity in German adults: types, settings, and patterns of association by cardiovascular risk status,” European Journal of Sport Science, vol. 11, no. 6, pp. 375–385, 2011.
- W. Byun, M. Dowda, and R. R. Pate, “Associations between screen-based sedentary behavior and cardiovascular disease risk factors in Korean youth,” Journal of Korean Medical Science, vol. 27, no. 4, pp. 388–394, 2012.
- J. Myers, A. Kaykha, S. George et al., “Fitness versus physical activity patterns in predicting mortality in men,” The American Journal of Medicine, vol. 117, no. 12, pp. 912–918, 2004.
- S. Yusuf, S. Hawken, S. Ounpuu et al., “INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study,” The Lancet, vol. 364, pp. 937–952, 2004.
- D. S. Michaud, E. Giovannucci, W. C. Willett, G. A. Colditz, M. J. Stampfer, and C. S. Fuchs, “Physical activity, obesity, height, and the risk of pancreatic cancer,” The Journal of the American Medical Association, vol. 286, no. 8, pp. 921–929, 2001.
- L. H. Kushi, C. Doyle, M. McCullough et al., “American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the Risk of Cancer with Healthy Food Choices and Physical Activity,” CA Cancer Journal for Clinicians, vol. 62, no. 1, pp. 30–67, 2012.
- B. Shahnazari, A. Keshtkar, A. Soltani et al., “Estimating the avoidable burden of certain modifiable risk factors in osteoporotic hip fracture using Generalized Impact Fraction (GIF) model in Iran,” Journal of Diabetes and Metabolic Disorders, vol. 12, no. 1, article 10, 2013.
- K. M. Winters-Stone, M. C. Leo, and A. Schwartz, “Exercise effects on hip bone mineral density in older, post-menopausal breast cancer survivors are age dependent,” Archives of Osteoporosis, vol. 7, no. 1-2, pp. 301–306, 2012.
- M. F. Harris, “The metabolic syndrome,” Australian Family Physician, vol. 42, pp. 524–527, 2013.
- J. Kaur, “A comprehensive review on metabolic syndrome,” Cardiology Research and Practice, vol. 2014, Article ID 943162, 21 pages, 2014.
- K. G. M. M. Alberti, R. H. Eckel, S. M. Grundy et al., “Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; National heart, lung, and blood institute; American heart association; World heart federation; International atherosclerosis society; And international association for the study of obesity,” Circulation, vol. 120, no. 16, pp. 1640–1645, 2009.
- S. Dixit, A. Maiya, and B. Shastry, “Effect of aerobic exercise on quality of life in population with diabetic peripheral neuropathy in type 2 diabetes: a single blind, randomized controlled trial,” Quality of Life Research, vol. 23, pp. 1629–1640, 2014.
- Y. Lacasse, L. Brosseau, S. Milne et al., “Pulmonary rehabilitation for chronic obstructive pulmonary disease,” Cochrane Database of Systematic Reviews, no. 3, Article ID CD003793, 2002.
- S. N. Blair, Y. Cheng, and J. Scott Holder, “Is physical activity or physical fitness more important in defining health benefits?” Medicine and Science in Sports and Exercise, vol. 33, no. 6, pp. S379–S399, 2001.
- T. P. Solomon, S. K. Malin, K. Karstoft, S. R. Kashyap, J. M. Haus, and J. P. Kirvan, “Pancreatic beta-cell function is a stronger predictor of changes in glycemic control after an aerobic exercise intervention than insulin sensitivity,” Journal of Clinical Endocrinology and Metabolism, vol. 98, pp. 4176–4186, 2013.
- B. A. Gordon, S. R. Bird, R. J. MacIsaac, and A. C. Benson, “Glycemic response varies between resistance and aerobic exercise in inactive males with long-term type 2 diabetes,” Applied Physiology, Nutrition and Metabolism, vol. 38, no. 8, pp. 900–904, 2013.
- D. L. Farias, R. A. Tibana, T. G. Teixeira et al., “Elderly women with metabolic syndrome present higher cardiovascular risk and lower relative muscle strength,” Einstein (Sao Paulo), vol. 11, pp. 174–179, 2013.
- A. B. Newman, V. Kupelian, M. Visser et al., “Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort,” Journals of Gerontology A: Biological Sciences and Medical Sciences, vol. 61, no. 1, pp. 72–77, 2006.
- World Health Organization, Global Status Report on Noncommunicable Diseases 2010, World Health Organization, Geneva, Switzerland, 2011.
- The Global Burden of Disease: 2004 Update, World Health Organization, Geneva, Switzerland, 2008.
- C. Sossa, H. Delisle, V. Agueh, R. Sodjinou, G. Ntandou, and M. Makoutodé, “Lifestyle and dietary factors associated with the evolution of cardiometabolic risk over four years in West-African adults: the Benin study,” Journal of Obesity, vol. 2013, Article ID 298024, 9 pages, 2013.
- K. M. Beavers, F.-C. Hsu, D. K. Houston et al., “The role of metabolic syndrome, adiposity, and inflammation in physical performance in the health ABC study,” Journals of Gerontology A, vol. 68, no. 5, pp. 617–623, 2013.
- D. C. Leite Vieira, R. Alsamir Tibana, and V. Tajra, “Decreased functional capacity and muscle strength in elderly women with metabolic syndrome,” Clinical Interventions in Aging, vol. 8, pp. 1377–1386, 2013.
- K. Galaviz, L. Lévesque, and J. Kotecha, “Evaluating the effectiveness of a physical activity referral scheme among women,” Journal of Primary Care & Community Health, vol. 4, pp. 167–171, 2013.
- H. J. Fokkenrood, B. L. Bendermacher, G. J. Lauret, E. M. Willigendael, M. H. Prins, and J. A. Teijink, “Supervised exercise therapy versus non-supervised exercise therapy for intermittent claudication,” Cochrane Database of Systematic Reviews, vol. 8, Article ID CD005263, 2013.
- S. Golbidi and I. Laher, “Exercise and the aging endothelium,” Journal of Diabetes Research, vol. 2013, Article ID 789607, 12 pages, 2013.
- M. Cardinale and J. Wakeling, “Whole body vibration exercise: are vibrations good for you?” British Journal of Sports Medicine, vol. 39, no. 9, pp. 585–589, 2005.
- R. D. Prisby, M.-H. Lafage-Proust, L. Malaval, A. Belli, and L. Vico, “Effects of whole body vibration on the skeleton and other organ systems in man and animal models: what we know and what we need to know,” Ageing Research Reviews, vol. 7, no. 4, pp. 319–329, 2008.
- J. Rittweger, “Vibration as an exercise modality: how it may work, and what its potential might be,” European Journal of Applied Physiology, vol. 108, no. 5, pp. 877–904, 2010.
- E. Bressel, G. Smith, and J. Branscomb, “Transmission of whole body vibration in children while standing,” Clinical Biomechanics, vol. 25, no. 2, pp. 181–186, 2010.
- V. B. Issurin, “Vibrations and their applications in sport: a review,” Journal of Sports Medicine and Physical Fitness, vol. 45, no. 3, pp. 324–336, 2005.
- S. Rees, A. Murphy, and M. Watsford, “Effects of vibration exercise on muscle performance and mobility in an older population,” Journal of Aging and Physical Activity, vol. 15, no. 4, pp. 367–381, 2007.
- C. T. Rubin, R. Recker, D. Cullen, J. Ryaby, J. McCabe, and K. McLeod, “Prevention of postmenopausal bone loss by a low-magnitude, high-frequency mechanical stimuli: a clinical trial assessing compliance, efficacy, and safety,” Journal of Bone and Mineral Research, vol. 19, no. 3, pp. 343–351, 2004.
- S. M. Verschueren, M. Roelants, C. Delecluse, S. Swinnen, D. Vanderschueren, and S. Boonen, “Effect of 6-month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study,” Journal of Bone and Mineral Research, vol. 19, no. 3, pp. 352–359, 2004.
- C. R. Russo, F. Lauretani, S. Bandinelli et al., “High-frequency vibration training increases muscle power in postmenopausal women,” Archives of Physical Medicine and Rehabilitation, vol. 84, no. 12, pp. 1854–1857, 2003.
- O. Bruyere, M.-A. Wuidart, E. Di Palma et al., “Controlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents,” Archives of Physical Medicine and Rehabilitation, vol. 86, no. 2, pp. 303–307, 2005.
- O. Semler, O. Fricke, K. Vezyroglou, C. Stark, and E. Schoenau, “Preliminary results on the mobility after whole body vibration in immobilized children and adolescents,” Journal of Musculoskeletal Neuronal Interactions, vol. 7, no. 1, pp. 77–81, 2007.
- O. Schuhfried, C. Mittermaier, T. Jovanovic, K. Pieber, and T. Paternostro-Sluga, “Effects of whole-body vibration in patients with multiple sclerosis: a pilot study,” Clinical Rehabilitation, vol. 19, no. 8, pp. 834–842, 2005.
- L. L. Ness and E. C. Field-Fote, “Whole-body vibration improves walking function in individuals with spinal cord injury: a pilot study,” Gait and Posture, vol. 30, no. 4, pp. 436–440, 2009.
- S. D. Santos-Filho, M. O. B. Monteiro, D. N. Paiva et al., “Possible benefits of the whole body vibration in the treatment of complications in stroke patients,” British Journal of Medicine and Medical Research, vol. 4, pp. 1539–1551, 2014.
- A. B. Fuermaier, L. Tucha, J. Koerts et al., “Good vibrations—effects of whole body vibration on attention in healthy individuals and individuals with ADHD,” PLoS ONE, vol. 9, no. 2, Article ID e90747, 2014.
- G. R. Regterschot, M. J. van Heuvelen, E. B. Zeinstra et al., “Whole body vibration improves cognition in healthy young adults,” PLoS ONE, vol. 9, no. 6, Article ID e100506, 2014.
- A. Gómez-Cabello, A. González-Agüero, I. Ara, J. A. Casajús, and G. Vicente-Rodríguez, “Effects of a short-term whole body vibration intervention on physical fitness in elderly people,” Maturitas, vol. 74, pp. 276–278, 2013.
- R. Di Giminiani, R. Manno, R. Scrimaglio, G. Sementilli, and J. Tihanyi, “Effects of individualized whole-body vibration on muscle flexibility and mechanical power,” The Journal of Sports Medicine and Physical Fitness, vol. 50, no. 2, pp. 139–151, 2010.
- V. B. Issurin, D. G. Liebermann, and G. Tenenbaum, “Effect of vibratory stimulation training on maximal force and flexibility,” Journal of Sports Sciences, vol. 12, no. 6, pp. 561–566, 1994.
- B. Dadebo, J. White, and K. P. George, “A survey of flexibility training and hamstring strains in professional football clubs in England,” British Journal of Sports Medicine, vol. 38, no. 4, pp. 388–394, 2004.
- K. Kubo, H. Kanehisa, Y. Kawakami, and T. Fukunaga, “Influence of static stretching on viscoelastic properties of human tendon structures in vivo,” Journal of Applied Physiology, vol. 90, no. 2, pp. 520–527, 2001.
- C. I. Morse, H. Degens, O. R. Seynnes, C. N. Maganaris, and D. A. Jones, “The acute effect of stretching on the passive stiffness of the human gastrocnemius muscle tendon unit,” Journal of Physiology, vol. 586, no. 1, pp. 97–106, 2008.
- S. P. Magnusson, E. B. Simonsen, P. Aagaard, J. Boesen, F. Johannsen, and M. Kjaer, “Determinants of musculoskeletal flexibility: viscoelastic properties, cross-sectional area, EMG and stretch tolerance,” Scandinavian Journal of Medicine and Science in Sports, vol. 7, no. 4, pp. 195–202, 1997.
- M. Cardinale and C. Bosco, “The use of vibration as an exercise intervention,” Exercise and Sport Sciences Reviews, vol. 31, no. 1, pp. 3–7, 2003.
- T. Tsuji, N. Kitano, K. Tsunoda, E. Himori, T. Okura, and K. Tanaka, “Short-term Effects of whole-body vibration on functional mobility and flexibility in healthy, older adults. A Randomized Crossover Study,” Journal of Geriatric Physical Therapy, vol. 37, pp. 58–64, 2014.
- A. Figueroa, R. Gil, A. Wong et al., “Whole-body vibration training reduces arterial stiffness, blood pressure and sympathovagal balance in young overweight/obese women,” Hypertension Research, vol. 35, no. 6, pp. 667–672, 2012.
- K. Karatrantou, V. Gerodimos, K. Dipla, and A. Zafeiridis, “Whole-body vibration training improves flexibility, strength profile of knee flexors, and hamstrings-to-quadriceps strength ratio in females,” Journal of Science and Medicine in Sport, vol. 16, no. 5, pp. 477–481, 2013.
- A. A. Wheeler and B. H. Jacobson, “Effect of whole-body vibration on delayed onset muscular soreness, flexibility, and power,” Journal of Strength & Conditioning Research, vol. 27, pp. 2527–2532, 2013.
- D. J. Cochrane and S. R. Stannard, “Acute whole body vibration training increases vertical jump and flexibility performance in elite female field hockey players,” British Journal of Sports Medicine, vol. 39, no. 11, pp. 860–865, 2005.
- A. M. Kinser, M. W. Ramsey, H. S. O'Bryant, C. A. Ayres, W. A. Sands, and M. H. Stone, “Vibration and stretching effects on flexibility and explosive strength in young gymnasts,” Medicine and Science in Sports and Exercise, vol. 40, no. 1, pp. 133–140, 2008.
- “NHMRC additional levels of evidence and grades for recommendations for developers of guidelines,” 2013, http://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/levels_grades05.pdf.
- L. Behboudi, M.-A. Azarbayjani, H. Aghaalinejad, and M. Salavati, “Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males,” Asian Journal of Sports Medicine, vol. 2, no. 2, pp. 83–90, 2011.
- C. di Loreto, A. Ranchelli, P. Lucidi et al., “Effects of whole-body vibration exercise on the endocrine system of healthy men,” Journal of Endocrinological Investigation, vol. 27, no. 4, pp. 323–327, 2004.
- S. D. Santos-Filho, N. S. Pinto, M. B. Monteiro et al., “Effectiveness of a protocol involving acute whole-body vibration exercises in an adult and health individual with delayed-onset muscle soreness observed after running: a case report,” International Journal of Medical Sciences, vol. 2, pp. 612–617, 2011.
- N. Lamari, L. C. Marino, J. A. Cordeiro, and A. M. Pellegrini, “Trunk anterior flexibility in adolescents after height growth speed peak,” Acta Ortopedica Brasileira, vol. 15, no. 1, pp. 25–29, 2007.
- A. C. G. Bogaerts, C. Delecluse, A. L. Claessens, T. Troosters, S. Boonen, and S. M. P. Verschueren, “Effects of whole body vibration training on cardiorespiratory fitness and muscle strength in older individuals (a 1-year randomised controlled trial),” Age and Ageing, vol. 38, no. 4, pp. 448–454, 2009.
- A. Figueroa, R. Kalfon, T. A. Madzima, and A. Wong, “Effects of whole-body vibration exercise training on aortic wave reflection and muscle strength in postmenopausal women with prehypertension and hypertension,” Journal of Human Hypertension, vol. 28, pp. 118–122, 2014.
- J. Iwamoto, Y. Sato, T. Takeda, and H. Matsumoto, “Whole body vibration exercise improves body balance and walking velocity in postmenopausal osteoporotic women treated with alendronate: galileo and alendronate intervention trail (GAIT),” Journal of Musculoskeletal Neuronal Interactions, vol. 12, no. 3, pp. 136–143, 2012.
- E. B. Lohman III, J. S. Petrofsky, C. Maloney-Hinds, H. Betts-Schwab, and D. Thorpe, “The effect of whole body vibration on lower extremity skin blood flow in normal subjects,” Medical Science Monitor, vol. 13, no. 2, pp. CR71–CR76, 2007.
- B. Sañudo, L. Carrasco, M. de Hoyo, Á. Oliva-Pascual-Vaca, and C. Rodríguez-Blanco, “Changes in body balance and functional performance following whole-body vibration training in Patients with fibromyalgia syndrome: a Randomized controlled trial,” Journal of Rehabilitation Medicine, vol. 45, no. 7, pp. 678–684, 2013.
- D. C. Dickin, K. A. Faust, H. Wang, and J. Frame, “The acute effects of whole-body vibration on gait parameters in adults with cerebral palsy,” Journal of Musculoskeletal Neuronal Interactions, vol. 13, no. 1, pp. 19–26, 2013.
- D. C. Dickin and J. E. Heath, “Additive effect of repeated bouts of individualized frequency whole body vibration on postural stability in young adults,” Journal of Applied Biomechanics, 2014.
- L. C. Marshall and M. A. Wyon, “The effect of whole-body vibration on jump height and active range of movement in female dancers,” The Journal of Strength & Conditioning Research, vol. 26, no. 3, pp. 789–793, 2012.
- C.-Z. Wang, G.-J. Wang, M.-L. Ho, Y.-H. Wang, M.-L. Yeh, and C.-H. Chen, “Low-magnitude vertical vibration enhances myotube formation in C2C12 myoblasts,” Journal of Applied Physiology, vol. 109, no. 3, pp. 840–848, 2010.
- D. Perchthaler, S. Grau, and T. Hein, “Evaluation of a six-week whole-body vibration intervention on neuromuscular performance in older adults,” Journal of Strength and Conditioning Research, 2014.
- C. Cristi, P. S. Collado, S. Márquez, N. Garatachea, and M. J. Cuevas, “Whole-body vibration training increases physical fitness measures without alteration of inflammatory markers in older adults,” European Journal of Sport Science, 2013.
- E. Pleguezuelos, M. E. Pérez, L. Guirao et al., “Effects of whole body vibration training in patients with severe chronic obstructive pulmonary disease,” Respirology, vol. 18, no. 6, pp. 1028–1034, 2013.
- K.-S. Chan, C.-W. Liu, T.-W. Chen, M.-C. Weng, M.-H. Huang, and C.-H. Chen, “Effects of a single session of whole body vibration on ankle plantarflexion spasticity and gait performance in patients with chronic stroke: a randomized controlled trial,” Clinical Rehabilitation, vol. 26, no. 12, pp. 1087–1095, 2012.
- F. Naclerio, A. D. Faigenbaum, E. Larumbe-Zabala, N. A. Ratamess, and J. Kang, “Effectiveness of different post activation potentiation protocols with and without whole body vibration on jumping performance in college athletes,” Journal of Strength and Conditioning Research, vol. 28, pp. 232–239, 2014.
- C.-F. Cheng, K.-H. Cheng, Y.-M. Lee, H.-W. Huang, Y.-H. Kuo, and H.-J. Lee, “Improvement in running economy after 8 weeks of whole-body vibration training,” Journal of Strength and Conditioning Research, vol. 26, no. 12, pp. 3349–3357, 2012.
- D. J. Bunker, M. R. Rhea, T. Simons, and P. J. Marin, “The use of whole-body vibration as a golf warm-Up,” Journal of Strength and Conditioning Research, vol. 25, no. 2, pp. 293–297, 2011.
- J. B. Feland, M. Hawks, J. T. Hopkins, I. Hunter, A. W. Johnson, and D. L. Eggett, “Whole body vibration as an adjunct to static stretching,” International Journal of Sports Medicine, vol. 31, no. 8, pp. 584–589, 2010.
- V. Gerodimos, A. Zafeiridis, K. Karatrantou, T. Vasilopoulou, K. Chanou, and E. Pispirikou, “The acute effects of different whole-body vibration amplitudes and frequencies on flexibility and vertical jumping performance,” Journal of Science and Medicine in Sport, vol. 13, no. 4, pp. 438–443, 2010.
- P. L. Jacobs and P. Burns, “Acute enhancement of lower-extremity dynamic strength and flexibility with whole-body vibration,” The Journal of Strength & Conditioning Research, vol. 23, no. 1, pp. 51–57, 2009.
- F. Fagnani, A. Giombini, A. di Cesare, F. Pigozzi, and V. di Salvo, “The effects of a whole-body vibration program on muscle performance and flexibility in female athletes,” The American Journal of Physical Medicine and Rehabilitation, vol. 85, no. 12, pp. 956–962, 2006.
- R. van den Tillaar, “Will whole-body vibration training help increase the range of motion of the hamstrings?” Journal of Strength and Conditioning Research, vol. 20, no. 1, pp. 192–196, 2006.
- T. Despina, D. George, T. George et al., “Short-term effect of whole-body vibration training on balance, flexibility and lower limb explosive strength in elite rhythmic gymnasts,” Human Movement Science, vol. 33, pp. 149–158, 2014.
- T. Horstmann, H. M. Jud, V. Fröhlich, A. Mündermann, and S. Grau, “Whole-body vibration versus eccentric training or a wait-and-see approach for chronic Achilles tendinopathy: a randomized clinical trial,” Journal of Orthopaedic & Sports Physical Therapy, vol. 43, pp. 794–803, 2013.
- T. Y. Lee and D. H. Chow, “Effects of whole body vibration on spinal proprioception in normal individuals,” in Proceedings of the Conference of the IEEE Engineering in Medicine and Biology Society, pp. 4989–4992, 2013.
- S. F. Baumbach, M. Fasser, H. Polzer et al., “Study protocol: the effect of whole body vibration on acute unilateral unstable lateral ankle sprain—a biphasic randomized controlled trial,” BMC Musculoskeletal Disorders, vol. 14, article 22, 2013.
- J. M. Conn, J. L. Annest, and J. Gilchrist, “Sports and recreation related injury episodes in the US population, 1997–99,” Injury Prevention, vol. 9, no. 2, pp. 117–123, 2003.
- E. C. Falvey, J. Eustace, B. Whelan et al., “Sport and recreation-related injuries and fracture occurrence among emergency department attendees: implications for exercise prescription and injury prevention,” Emergency Medicine Journal, vol. 26, no. 8, pp. 590–595, 2009.
- C. Delecluse, M. Roelants, and S. Verschueren, “Strength increase after whole-body vibration compared with resistance training,” Medicine & Science in Sports & Exercise, vol. 35, no. 6, pp. 1033–1041, 2003.
- M. Roelants, C. Delecluse, M. Goris, and S. Verschueren, “Effects of 24 weeks of whole body vibration training on body composition and muscle strength in untrained females,” International Journal of Sports Medicine, vol. 25, no. 1, pp. 1–5, 2004.
- L. Zhang, C. Weng, M. Liu, Q. Wang, L. Liu, and Y. He, “Effect of whole-body vibration exercise on mobility, balance ability and general health status in frail elderly patients: a pilot randomized controlled trial,” Clinical Rehabilitation, vol. 28, pp. 59–68, 2014.
- N. Lythgo, P. Eser, P. De Groot, and M. Galea, “Whole-body vibration dosage alters leg blood flow,” Clinical Physiology and Functional Imaging, vol. 29, no. 1, pp. 53–59, 2009.
- C. Maloney-Hinds, J. S. Petrofsky, and G. Zimmerman, “The effect of 30 Hz vs. 50 Hz passive vibration and duration of vibration on skin blood flow in the arm,” Medical Science Monitor, vol. 14, no. 3, pp. CR112–CR116, 2008.
- J. Mester, H. Kleinöder, and Z. Yue, “Vibration training: benefits and risks,” Journal of Biomechanics, vol. 39, no. 6, pp. 1056–1065, 2006.
- T. Lundeberg, P. Abrahamsson, L. Bondesson, and E. Haker, “Vibratory stimulation compared to placebo in alleviation of pain,” Scandinavian Journal of Rehabilitation Medicine, vol. 19, no. 4, pp. 153–158, 1987.
- M. Bove, A. Nardone, and M. Schieppati, “Effects of leg muscle tendon vibration on group Ia and group II reflex responses to stance perturbation in humans,” The Journal of Physiology, vol. 550, no. 2, pp. 617–630, 2003.
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