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Journal of Medicine and Medical Science Vol. 2(1) pp. 594-600 January 2010
Available online@http://www.interesjournals.org/JMMS
Copyright ©2011 International Research Journals
Review
The effects of whole-body-vibration exercises in
Parkinson´s disease: a short review
Nelson S. Pinto1, Milena B. Monteiro2, Patricia Froes Meyer3, Sebastião D. Santos-Filho1,
Fabiana Azevedo-Santos1, Raquel M. Bernardo1, Dulciane Paiva4, Daiane Thompson5, Sotiris
Missailidis6, Pedro J. Marín7,8, Christian T. Haas9, Mario Bernardo-Filho1,10
1Universidade do Estado do Rio de Janeiro, Instituto de Biologia Roberto Alcantara Gomes, Departamento de Biofísica
e Biometria, Rio de Janeiro, RJ, Brazil.
2Clínica de Fisioterapia e Biomedicina, Rio de Janeiro, RJ, Brazil.
3Universidade Potiguar, Natal, RN.
4Universidade Santa Cruz do Sul, RS, Brasil.
5The Queen's Medical Center, Cancer Center Program Medical Director, Women's Health Center, Honolulu, HI, USA.
6The Open University, UK.
7Laboratory of Physiology, European University Miguel de Cervantes, Valladolid, Spain.
8Research Center on Physical Disability, ASPAYM, Castilla y León, Spain.
9University of Applied Sciences, Idstein, Germany.
10Coordenadoria de Pesquisa, Instituto Nacional do Câncer, INCa, Rio de Janeiro, RJ, Brazil.
Accepted 17 January, 2011
Parkinson’s disease (PD) is a complex, progressive and disabling neurodegenerative disorder marked
by progressive loss of nigrostriatal dopaminergic neurons which is related to a continuous impairment
of motor functions. As pharmacological treatments (L-Dopa, Dopamin Agonists) are lowly effective with
respect to postural disturbance, and furthermore they lose effectiveness with disease progression
potent nonpharmacologic therapies, are of crucial importance for the management of impairments.
Besides traditional types of exercise, like strength or endurance training, whole body vibration was
found having positive influence on PD motor symptoms. The aim of this work is to present a suitable
review about the published papers found in the PubMed in which there are information about the use of
the whole body vibration in patients with PD. Using the keywords “Parkinson’s disease” or
“Parkinson’s disease” associated with “whole body vibration” six publications were found. One
publication among the six, it was about vibration delivered in the entire body produced by a
physioacoustic chair and it was also not analyzed in this work. Five papers among six were selected
after a search in the PubMed using the keywords “Parkinson´s disease” and “whole body vibration”.
The frequency used in four of these five papers is the same (6Hz). Only a paper presents a frequency of
25Hz. The positive findings indicated in the papers seem in depend on the frequency and they were
found with 6 or 25 Hz. Only in a publication has not presented difference between the clinical conditions
in the experimental (whole body vibration) and control (placebo). All the other authors have noticed
positive clinical findings using the oscillating platform. It is highly relevant in the development of
clinical procedures to the management of patients with PD. As the use of the oscillating platforms is
very inexpensive and positive clinical findings have been noticed with the use of whole body vibration
in patients with PD, it is suggested to implement the studies involving the application of the exercises
with whole body vibration in oscillating platforms to manage the patients with PD.
Keywords: Parkinson’s disease; Whole body vibration, PubMed, review.
Pinto et al 595
INTRODUCTION
Parkinson’s disease (PD) is a complex, progressive and
disabling neurodegenerative disorder marked by
progressive loss of nigrostriatal dopaminergic neurons
leading to loss of motor functions (Hirsch and Farley,
2009; Diaz and Waters, 2009). Moreover, it affects over
one million people in the USA and an estimated five
million people in the world (Strickland and Bertoni, 2004;
de Lau LM and Breteler, 2006; Pahwa and Lyons, 2010).
PD is comprised of motor and non-motor signs and
symptoms (Chen, 2010). The clinical course of PD often
starts with non-motor symptoms, as gastrointestinal
disturbances (constipation), hyposmia and rapid eye
movement sleep behavior disorder. Patients are normally
not diagnosed at this stage of the disease. The diagnosis
occur when they exhibit clear and obvious motor
symptoms, as retting tremor, rigidity, impaired postural
reflexes and/or bradykinesia. At a larger stage with the
progress of the disease, they present disability due to
bradykinesia, rigidity, gait and balance difficulty, and falls
(Diaz and Waters, 2009; Chen, 2010). In addition,
dopaminergic-related side effects from medications like
dykineasia become more problematic. In more advanced
stages of the disease, disabling cognitive symptoms, as
dementias, are more common (Chen, 2010).
Furthermore, the more the disease proceeds, the lower is
effectiveness and efficiency of pharmaceutical
interventions. Especially, postural and gait disorders
become stronger and more frequent and L-dopa
administration is lowly effective to treat these symptoms.
This is - among other things - of crucial importance since
mobility deficits like gait impairment, postural instability,
and history are of highest concern for the quality of life in
PD (Schrag et al., 2000). Moreover, maintaining a critical
level of mobility is necessary in order to avoid, nursing at
home, loosing independence and social contacts.
The cause of PD remains unknown and no cure or
prevention exists so far and this disease primarily affects
people over the age of 50 years old, and the prevalence
and incidence increase with age. In consequence, the
aging of the general population in the world will result in a
dramatic number of people diagnosed with PD (Dorsey et
al., 2007). The incidence of the disease rises steeply with
age, from 17·4 in 100 000 person years between 50 and
59 years of age to 93·1 in 100 000 person years between
70 and 79 years, with a lifetime risk of developing the
*Corresponding author E-mail: santos-filho@uerj.br and
sdsfilho@terra.com.br
disease of 1·5% (de Rijk et al., 1995; Bower et al., 1999;
Lees et al., 2009).
Pharmacologic and nonpharmacologic interventions
are suggested being able to treat the symptoms of the
patients with PD (Hirsch and Farley, 2009; Pahwa and
Lyons, 2010).
The most potent for efficacy therapeutic for symptoms
of the PD is levodopa, which is converted to dopamine
through decarboxylation (Olanow et al., 2009). But its use
has been implicated in the development of motor
complications (wearing "off" and dyskinesias). Evidence
from preclinical studies suggests that these complications
are related to pulsatile stimulation of the striatal
dopamine receptors due to multiple orally administered
levodopa intake (Klivenyi and Vecsei, 2010).
Furthermore, levodopa is lowly effective to treat postural
disturbances and gait disorders or it might even worsen
these symptoms (Bronte-Stewart et al., 2002;
O'Suilleabhain et al., 2001). However, these symptoms
are of highest concern for the quality of life in PD (Schrag
et al., 2000; Karlsen et al., 2000).
Nonpharmacologic therapies are widely recommended
for the management of impairments that are not
responsive to pharmacologic treatment (Ebersbach et al.,
2008). Furthermore, Hirsch and Farley, 2009 consider the
importance of the exercises, as a non-pharmacological
approach, to management of people living with PD.
The effects of vibratory stimulation in PD were first
described by the neurophysiologist Jean Marie Charcot in
the 19th century. He found that PD patients show less
symptoms when they were travelling with the train and he
concluded in a further step that these effects result
vibratory stimuli that were generated by the train.
Nowadays various vibrating platforms are available that
are used for exercise and therapeutic reasons. However,
the frequencies and the amplitudes of the generated
vibratory stimuli vary whereby different physiological
reactions occur (Haas, 2008). Furthermore different
effects can result from the number of trainings sets and
its duration and well as the time to rest intervals, etc. All
these conditions depend on, mainly, the clinical and
physical conditions of the patient (Cardinale and
Wakeling, 2005).
The effects of the whole body vibration are probably
related to direct and indirect actions (Santos-Filho et al.,
2010). Obviously the best analyzed effect of vibratory
stimuli is a reflectory neuromuscular activity known as
“tonic-vibration-reflex” (TVR). This phenomenon was
firstly described in 1966 Matthews (Matthews, 1996) as
well as by Hagbarth and Eklund (Hagbarth KE and
596 J. Med. Med. Sci.
Table 1. Number of publications found in the PubMed involving Parkinson´s disease and whole body vibration.
Search Number of publications
Parkinson 49415
“Parkinson’s disease” 35776
“Parkinson’s disease” and “whole body vibration” 7
“Parkinson’s disease” and “whole body vibration exercises” 2
“Parkinson disease” 40355
“Parkinson disease” and “whole body vibration” 6
“whole body vibration” 628
Eklund, 1966). From a functional point of view, the TVR is
characterized by a transfer of vibrations to the muscular
tendon system which is accompanied by repetitive
muscle spindle stretches which leads in a further step to
reflex answers. However, further studies showed that this
TVR varied in strength from one subject to the next which
might also explain a huge effect variety on different
physiological levels. For instance besides direct effects
on the neuromuscular level (Torvinen et al., 2002)
reactions occur also within the neuroendocrine system
(Prisby et al., 2008).
Other authors have demonstrated that whole body
vibration exercises might improve muscle strength (Rees
et al., 2008) bone density (Rubin et al., 2003;
Verschueren et al., 2004), postural control (Rees et al.,
2009) and muscle power (Russo et al., 2003). Moreover,
the health-related quality of life is increased and the fall
risk is decreased (Bruyere et al., 2005). Improvement of
gait and balance with WBV has been shown in a
population of nursing home residents (Bruyere et al.,
2005). 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
(Semler et al., 2007), multiple sclerosis (Schuhfried et al.,
2005), spinal cord injury (Ness and Field-Fote, 2009) and
stroke (Nes et al., 2004). Some studies considered also
the effects of whole body vibrations on motor symptoms
in PD (Ebersbach et al., 2008; Turbanski et al., 2005;
Haas et al., 2006a; Haas et al., 2006b).
Putting together the findings reported in the literature,
investigations about the effectiveness of the action of the
vibration produced in oscillating platforms that is a low
cost physiologic strategy to treat PD would be welcome.
PubMed is a service of the United States National Library
of Medicine of the National Institutes of Health
(http://www.ncbi.nlm.nih.gov/PubMed/). PubMed is a
databank that comprises more than 19 million citations
for biomedical articles from MEDLINE and life science
journals. These citations may include links to full-text
articles from PubMed Central or publisher web sites.
Moreover, these citations have been used as tool to
obtain various scientific informations (Santos-Filho et al.,
2004, Fontenelle et al., 2009).
To our knowledge, no previous systematic revisions
have been published and indexed in the PubMed
involving only whole body vibration and Parkinson´s
disease. The aim of this work is to present a suitable
review about the published papers found in the PubMed
databank in which there are information about the use of
the whole body vibration in the management of patients
with Parkinson´s disease.
MATERIALS AND METHODS
Strategy for PubMed search
The papers were searched in the PubMed on April 21st
2010. The search was performed using the keywords (i)
Parkinson (ii) “Parkinson’s disease” (iii) “Parkinson’s
disease” and “whole body vibration”, (iv) “Parkinson’s
disease” and “whole body vibration exercises”, (v)
“Parkinson disease”, (vi) “Parkinson disease” and whole
body vibration” and (vii) “whole body vibration”.
The number of publications (NP) was determined using
the strategy above.
The selected publications concerning to the use of
“whole body vibration” and Parkinson’s disease and
published in English, they were read and considered to
be discussed in this work.
RESULTS
Table 1 above shows the number of publications
involving PD and whole body vibration. The keyword
“Parkinson” has a strong number of citations; however,
Pinto et al 597
Table 2. Information about the device of the oscillating platform, the subjects, the frequency and the amplitude used in the
oscillating platforms
Reference Device of the platform Number of subjects/sex/age Frequency Amplitude
Turbanski
et al, 2005
Zeptor med System, Fa.
Scisens, Germany
52 patients (38 male and 14 female,
69.1±8.9 years divided in control
group and experimental group (whole
body vibration)
6±1 Hz 3mm
Haas et al,
2006a
Zeptor med System, Fa.
Scisens, Germany
63 patients (53 male and 15 female,
65.0±7.8 years divided in control
group and experimental (whole body
vibration) group)
6±1 Hz 3mm
Haas et al,
2006b
Srt-medical system
(human mobility,
Germany
28 patients (63.1±7.3 years divided in
control group and experimental
(whole body vibration) group)
6±1 Hz No informed
Ebersbach
et et al,
2008
Galileo device,
Germany
Control group (7 men/4women,
75.0±6.8 years) and treated group (7
men/3women, 72.5±6.0 years)
25Hz 7 to 14 mm
Arias et al,
2009
Fit Massage, PYC
Fitness International,
Inc.
Control group (6 men/5women,
66.0±5.57 years) and treated group
(6 men/4women, 66.90.5±11.11
years)
6 Hz No informed
an important number of them are also considering the
name of the author in the publications.
The search performed also with the keywords
“Parkinson’s disease” and “Parkinson disease” has
shown 35776 and 40355 publications, respectively. Both
searches performed with the keywords “Parkinson’s
disease” or “Parkinson disease” associated with “whole
body vibration” has shown the same six publications.
However, with the search involving “Parkinson’s disease”
and “whole body vibration” an additional reference was
found. As it is written in Russian, this citation was not
considered in this work. Moreover, one publication (King
et al., 2009) among the six, it was about vibration
delivered in the entire body produced by a physioacoustic
chair and it was also in Table 2 and 3. Table 2 shows
information about the device of the oscillating not
analysed in this work. An important number of
publications related with whole body vibration were
found.
The five selected publications found with "whole body
vibration" and Parkinson’s disease were analyzed
platform, the subjects (number, sex and age), the
frequency and the amplitude used in the oscillating
platforms.
Table 3 shows information about the conditions of
protocols used in the treated and control groups, as well
as the clinical findings.
DISCUSSION
The search strategy regarding studies which analyzed
the effects of WBV in PD can be seen in the Table 1. It
seems necessary to discuss the type search strategy
which led to the results. There are differences in the
number of publications, if it is searched “Parkinson’s
disease” or “Parkinson disease”. Moreover, if the
keyword “Parkinson” is used in the search, it is necessary
to see carefully the results. In this case, publications,
considering the name of the author “Parkinson” will
appear.
Pharmacologic treatments to manage symptoms of the
patients with PD have been suggested (Hirsch and
Farley, 2009; Pahwa and Lyons, 2010). However, side
effects from these medications have been reported
(Chen, 2010). Moreover, some impairment related to the
PD is not responsive to the pharmacologic treatment
(Bloem et al., 1996; Pinto et al., 2004). In consequence,
the use of alternative treatment strategies, e.g. as
different types of exercises, in patients with PD is
desirable and welcomes (Hirsch and Farley, 2009).
Some authors have utilized the whole body vibration
produced to manage some symptoms in patients with PD
(Ebersbach et al., 2008; Turbanski et al., 2005; Haas et
al., 2006a; Haas et al., 2006b; Arias et al., 2009). Five
papers among six were selected after a search in the
598 J. Med. Med. Sci.
Table 3. Information about the conditions of protocols used in the treated and control groups and the clinical findings
Reference Condition of the treated and control
groups
Clinical finding
Turbanski et
al, 2005
Treated group (5 series lasting 60
seconds)
Whole body vibration improved postural stability in
Parkinson´s disease spontaneously.
Haas et al,
2006a
Treated group (5 series lasting 60
seconds)
A highly significant imporvement of 16.8% in the
Unified Parkinson´s Disease Rating Scale motor
score was found in the treated group. Tremor and
rigidity scores were improve by25 and 24%,
respectively.
Haas et al,
2006b
Treated group (5 series lasting 60
seconds)
Proprioceptive performance was analyzed using a
tracking task basing on knee extension and flexion
movements. No significant differences became
evident between experimental and control group. The
authors consider that spontaneous improvements in
postural control are not directly connected with
proprioceptive changes.
Ebersbach et
et al, 2008
Control group (conventional balance
training including exercises on a tilt
board), Treated group (whole body
vibration on an oscillating platform).
Patients received 30 sessions (two
15min sessions a day, 5 day a week)
Quantitative dynamic posturography only improved in
patients with WBV whereas there was no significant
change in controls.
Arias et al,
2009
Control group (same conditions of the
treated group, however vibration was
not applied exercises on a tilt board),
Treated group (whole body vibration on
an oscillating platform).
Patients received 12 stimulations (5
sets of stimulation of 1 min each, with
an interset rest period of 1 min) over 5
weeks, on non consecutive days
No difference between the clinical conditions in the
experimental (whole body vibration) and control
(placebo) was found.
Pubmed using the keywords “Parkinson´s disease” and
“whole body vibration”. The scientific information about
these papers is shown in the Table 2 and Table 3. The
frequency used in four of these five papers is the same (6
Hz). Only one paper presents a frequency of 25Hz. The
positive findings indicated in the papers seem in depend
on the frequency and they were found with 6 or 25Hz
(Table 2).
Only Arias et al., 2009 have not found difference
between the clinical conditions in the experimental (whole
body vibration) and control (placebo). All the other
authors have noticed some positive clinical findings using
the oscillating platform (Table 3).
Ebersbach et al., 2008 have concluded that the
postural control and the gait improved in patients with PD
receiving whole body vibration or conventional
physiotherapy in the setting of a comprehensive
rehabilitation program. Although, the positive findings
obtained by these authors, they suggest that there was
no conclusive evidence for superior efficacy of WBV
compared with conventional balance training.
Firstly, Haas et al (2006a) found a randomized
controlled trial significant improvement in the Unified PD
Rating Scale motor score in the treated group (~15%). In
subcomponents (tremor, rigidity) improvements of 25 and
24% respectively became evident. However no changes
could be identified in facial expression or speech. Haas et
al (2006b) have tried to justify the findings reported by
Haas et al (2006a) as due proprioceptive changes
induced by the whole body vibrations. Proprioceptive
performance was analyzed using a tracking task basing
on knee extension and flexion movements. Treatment
consisted of 5 series of random whole-body vibration
taking 60 seconds each. Prominent over- and
undershooting errors were found in both groups (with or
without whole body vibration) representing proprioceptive
impairments. No significant differences became evident,
however, either between pre- and post-tests or between
experimental and control group. These authors
concluded that (i) spontaneous improvements in postural
control are not directly connected with proprioceptive
changes and (ii) nevertheless, one also should keep in
mind the general aspects and difficulties of analyzing
proprioception.
Chen (2010) and O´Brien et al (2009) have reported
that, overall, the annual economic impact of PD in the
United States is estimated at $10.8 billion, 58% of which
is related to direct medical costs. As the clinical use of
the oscillating platforms is very inexpensive, the whole
body vibration could be an excellent alternative to treat
the patients with PD. In this case, further investigations
must be stimulated to provide a suitable and safe clinical
procedure, besides a better understanding of the
biological mechanisms involved in the improving of the
motor symptoms of the PD patient that are under
treatment in an oscillatory platform.
CONCLUSION
Whole body vibration exercises is highly relevant in the
development of clinical procedures to the management of
patients with PD. As (i) the use of the oscillating platforms
is very inexpensive (Alentorn-Geli et al, 2008) and (ii)
positive clinical findings have been noticed with the use
of whole body vibration in patients with PD, it is
suggested to implement the studies involving the
application of the exercises with whole body vibration in
oscillating platforms to manage the patients with PD.
ACKNOWLEDGEMENTS
This work was supported by CNPq, FAPERJ, UERJ and
INCa.
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