Whole-body vibration training and bone health in postmenopausal women

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Abstract

Background:

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

Methods:

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

Results:

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

Conclusions:

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

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Most cited references 39

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American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults.

J.P. Despres, G Ewing, R.K. Dishman … (1998)

ACSM Position Stand on The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Adults. Med. Sci. Sports Exerc., Vol. 30, No. 6, pp. 975-991, 1998. The combination of frequency, intensity, and duration of chronic exercise has been found to be effective for producing a training effect. The interaction of these factors provide the overload stimulus. In general, the lower the stimulus the lower the training effect, and the greater the stimulus the greater the effect. As a result of specificity of training and the need for maintaining muscular strength and endurance, and flexibility of the major muscle groups, a well-rounded training program including aerobic and resistance training, and flexibility exercises is recommended. Although age in itself is not a limiting factor to exercise training, a more gradual approach in applying the prescription at older ages seems prudent. It has also been shown that aerobic endurance training of fewer than 2 d.wk-1, at less than 40-50% of VO2R, and for less than 10 min-1 is generally not a sufficient stimulus for developing and maintaining fitness in healthy adults. Even so, many health benefits from physical activity can be achieved at lower intensities of exercise if frequency and duration of training are increased appropriately. In this regard, physical activity can be accumulated through the day in shorter bouts of 10-min durations. In the interpretation of this position stand, it must be recognized that the recommendations should be used in the context of participant's needs, goals, and initial abilities. In this regard, a sliding scale as to the amount of time allotted and intensity of effort should be carefully gauged for the cardiorespiratory, muscular strength and endurance, and flexibility components of the program. An appropriate warm-up and cool-down period, which would include flexibility exercises, is also recommended. The important factor is to design a program for the individual to provide the proper amount of physical activity to attain maximal benefit at the lowest risk. Emphasis should be placed on factors that result in permanent lifestyle change and encourage a lifetime of physical activity.

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Wolff's Law and bone's structural adaptations to mechanical usage: an overview for clinicians.

H. Frost (1994)

Basic Multicellular Unit-based bone remodeling can lead to the removal or conservation of bone, but cannot add to it. Decreased mechanical usage (MU) and acute disuse result in loss of bone next to marrow; normal and hypervigorous MU result in bone conservation. Bone modeling by resorption and formation drifts can add bone and reshape the trabeculae and cortex to strengthen them but collectively they do not remove bone. Hypervigorous MU turns this modeling on, and its architectural effects then lower typical peak bone strains caused by future loads of the same kind to a threshold range. Decreased and normal MU leave this modeling off. Where typical peak bone strains stay below a 50 microstrain region (the MESr) the largest disuse effects on remodeling occur. Larger strains depress it and make it conserve existing bone. Strains above a 1500 microstrain region (the MESm) tend to turn lamellar bone modeling drifts on. By adding to, reshaping and strengthening bone, those drifts reduce future strains under the same mechanical loads towards that strain region. Strains above a 3000 microstrain region (the MESp) can turn woven bone drifts on to suppress local lamellar drifts but can strengthen bone faster than lamellar drifts can. Such strains also increase bone microdamage and the remodeling that normally repairs it. Those values compare to bone's fracture strain of about 25,000 microstrain.

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Prevention of postmenopausal bone loss by a low-magnitude, high-frequency mechanical stimuli: a clinical trial assessing compliance, efficacy, and safety.

Clinton T. Rubin, Rodney McCabe, D. Cullen … (2004)

A 1-year prospective, randomized, double-blind, and placebo-controlled trial of 70 postmenopausal women demonstrated that brief periods (<20 minutes) of a low-level (0.2g, 30 Hz) vibration applied during quiet standing can effectively inhibit bone loss in the spine and femur, with efficacy increasing significantly with greater compliance, particularly in those subjects with lower body mass. Indicative of the anabolic potential of mechanical stimuli, animal models have demonstrated that short periods (<30 minutes) of low-magnitude vibration (<0.3g), applied at a relatively high frequency (20-90 Hz), will increase the number and width of trabeculae, as well as enhance stiffness and strength of cancellous bone. Here, a 1-year prospective, randomized, double-blind, and placebo-controlled clinical trial in 70 women, 3-8 years past the menopause, examined the ability of such high-frequency, low-magnitude mechanical signals to inhibit bone loss in the human. Each day, one-half of the subjects were exposed to short-duration (two 10-minute treatments/day), low-magnitude (2.0 m/s2 peak to peak), 30-Hz vertical accelerations (vibration), whereas the other half stood for the same duration on placebo devices. DXA was used to measure BMD at the spine, hip, and distal radius at baseline, and 3, 6, and 12 months. Fifty-six women completed the 1-year treatment. The detection threshold of the study design failed to show any changes in bone density using an intention-to-treat analysis for either the placebo or treatment group. Regression analysis on the a priori study group demonstrated a significant effect of compliance on efficacy of the intervention, particularly at the lumbar spine (p = 0.004). Posthoc testing was used to assist in identifying various subgroups that may have benefited from this treatment modality. Evaluating those in the highest quartile of compliance (86% compliant), placebo subjects lost 2.13% in the femoral neck over 1 year, whereas treatment was associated with a gain of 0.04%, reflecting a 2.17% relative benefit of treatment (p = 0.06). In the spine, the 1.6% decrease observed over 1 year in the placebo group was reduced to a 0.10% loss in the active group, indicating a 1.5% relative benefit of treatment (p = 0.09). Considering the interdependence of weight, the spine of lighter women (<65 kg), who were in the highest quartile of compliance, exhibited a relative benefit of active treatment of 3.35% greater BMD over 1 year (p = 0.009); for the mean compliance group, a 2.73% relative benefit in BMD was found (p = 0.02). These preliminary results indicate the potential for a noninvasive, mechanically mediated intervention for osteoporosis. This non-pharmacologic approach represents a physiologically based means of inhibiting the decline in BMD that follows menopause, perhaps most effectively in the spine of lighter women who are in the greatest need of intervention.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: August 2018

Publication date (Electronic): 24 August 2018

Volume: 97

Issue: 34

Electronic Location Identifier: e11918

Affiliations

[a ]Research Center for High Performance Sport

[b ]Faculty of Sport Sciences – Catholic University of Murcia, UCAM, Murcia

[c ]Department of Analytical Chemistry Nutrition and Food Science – University of Alicante, Alicante, Spain.

Author notes

[∗ ]Correspondence: Pedro E. Alcaraz, Research Center for High Performance Sport and Faculty of Sport Sciences – Catholic University of Murcia, UCAM, Campus de los Jerónimos, No 135, 30107, Guadalupe, Murcia, Spain (e-mail: palcaraz@ 123456ucam.edu ); Elena Marín-Cascales, Research Center for High Performance Sport – Catholic University of Murcia, UCAM, Campus de los Jerónimos, No 135, 30107, Guadalupe, Murcia, Spain (e-mail: emarin@ 123456ucam.edu ).

Article

Publisher ID: MD-D-17-07791 Accession ID: 11918

DOI: 10.1097/MD.0000000000011918

PMC ID: 6112924

PubMed ID: 30142802

SO-VID: db4a9734-10cd-4b77-a241-d04eba4aeaad

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

History

Date received : 11 December 2017

Date accepted : 20 July 2018

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Keywords: bone mass,exercise,perimenopause,whole-body vibration training,women

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Keywords: bone mass, exercise, perimenopause, whole-body vibration training, women

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

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Women in Science

Most cited references 39

American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults.

Wolff's Law and bone's structural adaptations to mechanical usage: an overview for clinicians.

Prevention of postmenopausal bone loss by a low-magnitude, high-frequency mechanical stimuli: a clinical trial assessing compliance, efficacy, and safety.

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