A Primary Care–Based Randomized Controlled Trial of 12-Week Whole-Body Vibration for Balance Improvement in Type 2 Diabetes Mellitus

The Clinical Utility of Whole Body Vibration: A Review of the Different Types and Dosing for Application in Metabolic Diseases

Whole body vibration (WBV) is an innovative exercise mimetic that utilizes a vibrating platform to transmit mechanical vibrations throughout the body. WBV has been a popular area of research in recent years due to its potential physiological and therapeutic benefits in both health and disease. The utility of WBV is rooted in the various parameters (i.e., frequency, amplitude, duration) that affect the overall dose of vibration delivered to the body. Each type of WBV, coupled with these aforementioned parameters, should be considered when evaluating the use of WBV in the clinical setting. Thus, the purpose of this review is to provide an overview of recent literature detailing the different types of WBV, the various parameters that contribute to WBV efficacy, and the evidence of WBV in metabolic disease. A systematic search was conducted using Medline, Embase, Cochrane, CINAHL, and PubMed. All types of study designs were considered, with exclusions made for animal studies, duplicates, and study protocols without data. Thirty-four studies were included. In conclusion, as a modern exercise mimetic with therapeutic potential for metabolic diseases, understanding the interplay between the types and dosing of WBV is critical for determining its utility and efficacy. Further studies are certainly needed to elucidate the full therapeutic potential of WBV in metabolic diseases.

Association Between Physical Exercise Interventions Participation and Functional Capacity in Individuals with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Controlled Trials

Background

The prevalence of type 2 diabetes mellitus increases with age, and people with type 2 diabetes are more affected by reductions in functional performance. Although exercise interventions are recommended for people with diabetes, it is relevant to assess the effects of different training modes on the available functional outcomes. Therefore, our purpose was to systematically assess the effect of different physical exercise modalities in patients with type 2 diabetes with an average age of 45 years or older on outcomes used to measure functional capacity.

Methods

A systematic review and meta-analysis of controlled trials was conducted. Seven databases were searched from January 1987 to December 2021 (PubMed, Physiotherapy Evidence Database, Cochrane Library, SPORTDiscus, and in grey literature: Open Grey and Google Scholar). Eligible studies should last 8 weeks or longer, comparing structured exercise training and non-exercise control for one out of six pre-specified functional capacity outcomes (Timed Up and Go test, chair stands, walking performance, upper-limb muscle strength, lower-limb muscle strength, physical fitness parameter), in patients with type 2 diabetes, aged ≥ 45 years. The risk of bias was assessed with the Downs & Black checklist. Pooled mean differences were calculated using a random-effects model, followed by sensitivity and meta-regression analyses.

Results

Of 18,112 references retrieved, 29 trials (1557 patients) were included. Among these, 13 studies used aerobic training, 6 studies used combined training, 4 studies used resistance training, 3 studies had multiple intervention arms and 3 studies used other types of training. Exercise training was associated with an increase in functional capacity outcomes, as reflected by changes in 6-min walk test (n = 8) [51.6 m; 95% CI 7.6% to 95.6%; I² 92%], one-repetition maximum leg-press (n = 3) [18.0 kg; 95% CI 4.0% to 31.9%; I² 0%], and maximum oxygen consumption (VO_2max) (n = 20) [2.41 mL/kg·min; 95% CI 1.89% to 2.92%; I² 100%] compared with control groups. In sensitivity and subgroup analyses using VO_2max as outcome and stratified by type of study (randomized and non-randomized controlled clinical trials), duration of diabetes diagnosis, and sex, we observed overlapping confidence intervals. Meta-regression showed no association between glycated hemoglobin (HbA1C) levels and VO_2max [p = 0.34; I² 99.6%; R² = 2.6%]. In addition, the quality of the included studies was mostly low.

Conclusion

The results indicate that structured physical exercise programs might improve functional capacity in patients with type 2 diabetes, except for the upper-limb muscle strength. However, we could not identify potential effect predictors associated with directional summary estimates.

Trial registration This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42020162467); date of registration: 12/15/2019. The review protocol is hosted at the Open Science Framework (OSF) (Preprint https://doi.org/10.31219/osf.io/kpg2m).

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-022-00422-1.

The immediate effect of a single whole-body vibration session on balance, skin sensation, and pain in patients with type 2 diabetic neuropathy

Purpose

Patients with diabetic neuropathy usually suffer from impaired balance, pain, and decreased sole-foot sensation. The present research was designed to appraise the relic of whole-body vibration (WBV) on balance, pain, and sole-foot sensation in diabetic neuropathy patients.

Methods

Present study was a single-blind randomized controlled clinical trial. Thirty-four patients with type 2 diabetic neuropathy were randomly divided into intervention groups (n=17) and control (n=17). The therapeutic program in the intervention group included standing on the platform of the WBV device, and in the control group included using the device in off mode. Dynamic balance (including overall, anterior-posterior, and medial-lateral stability indices) was measured using Biodex device, functional balance with timed up and go (TUG) test, pain using the visual analog scale (VAS), and sole-foot sensation of both feet with a monofilament. The outcomes were measured in both groups before and after the interventions.

Results

Sixteen people in each group were analyzed. Intra-group comparison showed a significant improvement in the mean pain (P = 0.000), functional balance (P = 0.011), right and left sole-foot sensation (P = 0.001), and overall (P = 0.000), anterior-posterior (P = 0.000) and medial-lateral (P = 0.000) stability indices for the intervention group in post-intervention compared to pre-intervention. However, changes in the control group were not statistically significant. Results of inter-group comparison indicated a significant improvement in all parameters in the intervention group, except for functional balance.

Conclusion

WBV can be effective in reducing pain and improving the sole-foot sensation and dynamic balance.

Effects of 12-week whole-body vibration exercise on fatigue, functional ability and quality of life in women with systemic lupus erythematosus: A randomized controlled trial

BACKGROUND

Systemic lupus erythematosus (SLE) is a complex rheumatic autoimmune disease characterized by periods of exacerbations that can present damage in organs with important clinical manifestations.

OBJECTIVE

The aim of this study was to evaluate the effect of 12-week whole-body vibration exercise (WBVE) on the fatigue, functional ability and quality of life of women with systemic lupus erythematosus (SLE) in chronic glucocorticoids use (CGU).

METHODS

Twenty-one women were allocated randomly in the WBVE group or isometry group. The participants of WBVE group were positioned on the vibrating platform with 130° knee flexion and received the intervention twice a week for 12 weeks. The isometry group performed the same position and time, but without the stimulus of mechanical vibration. Fatigue, functional ability and the quality of life were evaluated at weeks 0, 6, and 12.

RESULTS

From a sample of seventy-seven individuals, seventeen participants completed the study, 8 in WBVE group and 9 in isometry group. Fatigue reduced in the WBVE group at 6 and 12 weeks of intervention (p = 0.04) and (p = 0.03) respectively. There was a significant improvement in the functional ability evaluated by the Health Assessment Questionnaire in the WBVE group compared to the isometry group (p = 0.03).

CONCLUSION

WBVE would be a useful intervention for control of fatigue and improvement of the functional ability of women with SLE in CGU.

Low Vibrational Training as an Additional Intervention for Postural Balance, Balance Confidence and Functional Mobility in Type 2 Diabetic Patients with Lower Limb Burn Injury: A Randomized Clinical Trial

PURPOSE

Burn injury with pre-existing diabetes has poorer outcomes and complications. Balance and functional mobility are disturbed in diabetic patients with burn injury which increase the risk of total morbidity. The aim of the current study was to evaluate the impact of vibrational training as an additional intervention on postural balance, balance confidence and functional mobility in type 2 diabetic patients with lower limb burn injury.

PATIENTS AND METHODS

Thirty-eight type 2 diabetic patients of both sexes with healed lower limb burn were randomly assigned into two equal groups: the vibration group and the control group. The vibration group received whole body vibration (WBV), 3 sessions a week for 8 weeks, in addition to the selected exercise program (balance exercises and resisted exercises), while the control group only received the selected exercise program. Biodex Balance System was used to assess the dynamic balance score, the Activities-specific Balance Scale to assess balance confidence and the timed up and go test to assess the functional mobility. All measurements were obtained before and at the end of the study after 8 weeks of treatment.

RESULTS

Marked improvement in all dynamic balance indices; overall stability index, antero-posterior stability index and medio-lateral stability index, balance confidence and the functional mobility were obtained in both the vibration and the control groups (P< 0.05), whereas post-treatment comparison between groups revealed a statistically significant difference in favor of the vibration group in all measured variables.

CONCLUSION

Based on the results of the current study, it is possible to conclude that adding WBV training for an 8-week duration to a selected exercise program (balancing and resisted exercises) seems to be effective; in improving postural balance, balance confidence, as well as improving the functional mobility in type 2 diabetic patients with lower limb burn injury.

A Systematic Review and Meta-analysis on Efficacy of Exercise on Posture and Balance in Patients Suffering from Diabetic Neuropathy

BACKGROUND

Peripheral neuropathy is a major and chronic complication of diabetes mellitus affecting more than 50% patients suffering from diabetes. There is the involvement of both large and small diameter nerve fibres leading to altered somatosensory and motor sensations, thereby causing impaired balance and postural instability.

OBJECTIVE

The aim of this study is to assess the effects of exercises on posture and balance in patients suffering from diabetes mellitus.

METHODS

Mean changes in Timed Up and Go test (TUGT), Berg Balance Scale and Postural Sway with eyes open and eyes closed on Balance System were primary outcome measures. RevMan 5.3 software was used for the meta-analyses. Eighteen randomized controlled trials met the selection criteria and were included in the study. All the studies ranked high on the PEDro Rating scale. The risk of bias was assessed by the Cochrane collaboration tool of risk of bias. Included studies had a low risk of bias. Sixteen RCT's were included for the meta-analysis.

RESULTS

Results of meta-analysis showed that there was a statistically significant improvement in TUGT with p≤ 0.05 and substantial heterogeneity (I2 = 84%, p < 0.00001) in the experimental group as compared to control group. There was a statistically significant difference in Berg Balance Scale scores and heterogeneity of I2 = 62%, p < 0.00001 and significant changes in postural stability (eyes open heterogeneity of I2 = 100%, p =0.01 and eyes closed, heteogeneity I2 = 0%, p =0.01). Sensitivity analysis causes a change in heterogeneity.

CONCLUSION

It can be concluded that various exercises like balance training, core stability, Tai-Chi, proprioceptive training, etc. have a significant effect on improving balance and posture in diabetic neuropathy.

Effects of Vibration Training in Interstitial Lung Diseases: A Randomized Controlled Trial

BACKGROUND

Numerous studies have reported positive effects of exercise training in patients with interstitial lung disease (ILD) on physical capacity and quality of life. However, evidence is rare on the effects of specific forms of training and further pathophysiological mechanisms in these patients.

OBJECTIVES

In this multicenter study we aimed to explore the clinical effects of whole-body vibration training (WBVT) in patients with ILD on various outcome measures, including proinflammatory cytokines and myostatin.

METHODS

We randomly assigned 26 patients with different forms of multidisciplinary confirmed fibrotic ILDs either to the WBVT group (n = 11; 55% male, 61 ± 14 years old, forced vital capacity 83.2 ± 29.3% predicted, 6-min walking distance [6MWD] 478 ± 79 m) performing 3 months of a standardized training (3 times per week), or to a control training group (CTG, n = 15; 60% male, 63 ± 9 years old, FVC 74.6 ± 20.5% predicted, 6MWD 455 ± 85 m) performing sham WBV training. Training in the two groups was performed on a GalileoTM vibration plate (6-20 vs. 5 Hz). The functional assessments before and after the intervention period included pulmonary function, 6MWD test, chair rise test, ultrasonographic measurement of quadriceps muscle thickness (cross-sectional area), quality of life questionnaires, and serum samples.

RESULTS

We observed a significant increase in 6MWD (∆Training = 30 m [12-67], p = 0.024) and a decrease of myostatin (∆Training = -465 pg/mL [-713 to -166], p = 0.008) in the WBVT group. In contrast, no significant differences were observed in the CTG.

CONCLUSIONS

The present study demonstrates that WBVT is able to significantly increase 6MWD and decrease myostatin in patients with fibrotic ILDs. Therefore, WBVT seems to be a beneficial and feasible training modality in ILD patients. Clinical Trial Registry: German Clinical Trials Registry (DRKS00012930).

Is the Wii balance board a valid and reliable instrument to assess postural stability in older adults with type 2 diabetes mellitus?

AIMS

Evaluate the validity and reliability of the data from the Wii balance board (WBB), against a force platform (FP) in patients with type 2 diabetes mellitus (T2DM).

METHODS

Forty-three adults with T2DM (age 62.1 ± 12.1 yrs) in the validity trial and 27 (age 63.5 ± 10.8 yrs) in the reliability study, were tested. Total COP area (mm) and range of antero-posterior (AP) and medio-lateral (ML) COP excursion were collected simultaneously on a FP and a WBB.

RESULTS

Mean CoP sway path values were similar in all conditions in the FP when compared with the WBB. Regression model shows that WBB is able to explain most of the variation in CoP sway path data of the FP (between 42 and 72%) for all testing conditions, indicating that the WBB has good concurrent validity. Test-retest reliability for WBB was excellent, except for the COP sway area in the 'eyes open' condition (ICC = 0.55). Both conditions showed modest to excellent reliability in the AP (0.73-0.90) and the ML (0.77-0.91) directions.

CONCLUSION

The WBB has been shown to be a valid and reliable method to quantify the COP displacement during different balance tests in older adults with T2DM.

Immediate Effect of Whole-Body Vibration on Skin Temperature and Lower-Limb Blood Flow in Older Adults with Type 2 Diabetes: Pilot Study

The purpose of this study was to evaluate the response of a single whole-body vibration (WBV) training session to peripheral skin temperature and peripheral blood flow of older adults with type 2 diabetes. A double-blind, controlled clinical trial was conducted following the Consolidated Standards of Reporting Trials (CONSORT) guidelines. A single session of WBV (24 Hz; amplitude 4 mm; vibration time 45 s, with a series of eight repetitions with recovery between repetitions of 30 s; total time of 10 min) or sham vibration on the Kikos P204 Vibrating Platform was employed. To assess skin temperature, the FLIR E40bxs thermographic camera and the ultrasonic vascular Doppler for flow velocity were used. Evaluation occurred before and after a WBV or sham intervention. The sample consisted of three men and 17 women. In the WBV group, there was a decrease in the temperature from 29.7 °C (±1.83) to 26.6 °C (±2.27), with p = 0.01. Temperature following sham decreased from 28.6 °C (±1.84) to 26.3 °C (±2.49), with p = 0.01. Regarding blood flow, there was a decrease in the analyzed arteries, especially the left posterior tibial artery, where there was a statistically significant flow reduction from 27.1 m/s (±25.36) to 20.5 m/s (±19.66), post WBV (p = 0.01). In the sham group, an increased flow velocity was observed for all the arteries analyzed, except for the left dorsal artery. Immediately following a full-body vibration session, peripheral skin temperature and lower-limb blood flow tend to decrease in diabetic patients. However, from the design of study developed, we cannot infer the maintenance of this effect in the medium and long term.

Whole body vibration showed beneficial effect on pain, balance measures and quality of life in painful diabetic peripheral neuropathy: a randomized controlled trial

Purpose

The aim of the study was to determine the efficacy of whole body vibration (WBV) therapy on pain, neuropathy disability score, balance, proprioception and quality of life (QOL) in patients with painful diabetic peripheral neuropathy (PDPN).

Methods

Twenty-six (16 males and 10 females) patients with PDPN were selected on the basis of inclusion and exclusion criteria. Subjects were randomly allocated to an experimental group (n = 13, age = 60.69 ± 5.08) and a control group (n = 13, age = 59.54 ± 4.25). The experimental group was given WBV therapy for six weeks (3 days/week) in addition to standard medical care, dietary advice and lifestyle modifications. Control group was provided only standard medical care, dietary advice and lifestyle modifications. Outcome measures included numeric pain rating scale (NPRS), Leeds assessment of neuropathic symptoms and signs (LANSS), vibration perception threshold (VPT), neuropathy disability score (NDS), proprioception, single-leg stance test (SLST), timed up and go test (TUGT) and short form 36 questionnaire (SF-36).

Results

NPRS, LANSS, NDS, SLST and TUGT showed significant time effect (p ≤ 0.022) and time×group interaction (p ≤ 0.007), whereas group effect was found to be significant only in LANSS (p = 0.001). VPT showed significant group effect (p ≤ 0.045) and time×group interaction (p ≤ 0.007) at great toe, metatarsal head and total average score. SF-36 was found to be significant time effect (p ≤ 0.024) in all domains except limitations due to physical health (p = 0.461). SF-36 average score was found be significant for group effect (p = 0.002) and time×group interaction (p < 0.001).

Conclusion

WBV improves sensory sensations like pain and vibration perception, neuropathy disability score, balance measures and health-related QOL in PDPN.

Effects of Whole-Body Vibration in Older Adult Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

OBJECTIVES

The aim of this systematic review and meta-analysis was to determine the effects of whole-body vibration training on metabolic abnormalities, mobility, balance and aerobic capacity in older adult patients with type 2 diabetes mellitus.

METHODS

We searched PubMed, Cochrane Library, PEDro, LILACS and SciELO (from the earliest date available to March 2018) for controlled trials that evaluated the effects of whole-body vibration on the health-related outcomes of patients with type 2 diabetes. Two reviewers independently selected the studies and performed statistical analyses of the studies. Weighted mean differences, standard mean differences and 95% confidence intervals (CIs) were calculated.

RESULTS

In total, 7 studies, involving 279 patients who had type 2 diabetes, that compared whole-body vibration with other exercises and/or controls were included. Individual studies suggested that whole-body vibration was associated with improvements in pain levels, blood flow in the legs, glycated hemoglobin levels and fasting blood glucose levels. Whole-body vibration improved mobility weighted mean differences (-.24 seg; 95% CI -2.0, -0.5; n=96); balance standard mean differences (2.34; 95% CI 1.16, 3.5; n=57); and aerobic capacity standard mean differences (0.7; 95% CI 0.2, 1.3; n=59).

CONCLUSIONS

Whole-body vibration could be a useful strategy in the management of the symptoms and disabilities associated with type 2 diabetes; however, it is necessary to perform further studies to reinforce the reported findings.

Comparing the Acute Effects of Intermittent and Continuous Whole-Body Vibration Exposure on Neuromuscular and Functional Measures in Sarcopenia and Nonsarcopenic Elderly Women

This investigation examined the acute effects of continuous whole-body vibration (CWBV) and intermittent whole-body vibration (IWBV) on neuromuscular and functional measures in women with sarcopenia and nonsarcopenic women. Continuous whole-body vibration was one 6-minute exposure, while IWBV consisted of six 60-second exposures to rest intervals (30 Hz, 2-4 mm amplitude). Factorial analyses revealed group × exposure × time interactions for jump height (JH; F = 10.8, P = .002), grip strength (GS; F = 15.5, P < .001), timed up and go test (F = 11.7, P = .002), and sit and reach test (S&R; F = 9.7, P = .004). Both JH and GS significantly improved post-WBV in women with sarcopenia (P < .001), with post-IWBV significantly greater (P < .001) than post-CWBV. Timed up and go test and S&R significantly improved post-IWBV in both the groups (P < .001) with post-IWBV significantly better than post-CWBV (P < .001). Bench press power at 20% one repetition maximum (1RM) revealed an exposure × time interaction (F = 4.6, P = .04) illuminating that IWBV significantly improved muscular power (P < .001). Bench press power at 40% 1RM revealed group × exposure (F = 6.4, P = .016) and exposure × time interactions (F = 5.8, P = .022). Individuals with sarcopenia significantly increased power output (P < .001) post-IWBV which was significantly greater than post-CWBV (P = .037). Bench press power at 60% 1RM revealed an exposure × time interaction (F = 8.6, P = .006), indicating that power was significantly improved post-IWBV (P = .027) and decreased post-CWBV. Berg Balance scale revealed a time main effect (F = 6.64, P = .015), and pain discomfort was significantly lower post-IWBV. These data indicate IWBV may provide a more efficacious exposure pattern in older women when compared to CWBV.

Effectiveness of Exercise Interventions to Improve Postural Control in Older Adults: A Systematic Review and Meta-Analyses of Centre of Pressure Measurements

Background

Previous reviews have shown balance in older adults to be improved with exercise. However, it is currently unclear whether postural control, indicated by centre of pressure (COP) measurement, can be improved in older adults and thus whether postural control could be a mechanism to improve balance.

Objectives

The purpose of this systematic review was to assess the effectiveness of force platform COP variables to identify changes in postural control following exercise interventions in older adults. In addition, a secondary purpose was to determine whether the exercise types (balance, resistance or multi-component exercise interventions) are equally effective to improve postural control.

Methods

Randomised controlled trials were identified using searches of databases and reference lists (PROSPERO registration number CRD42014010617). Trials performing exercise interventions, reporting force platform COP measurements, in participants with a mean age of ≥60 years were included. Risk of bias assessments were performed following the Cochrane guidelines. Data were pooled in meta-analyses, and standardised mean differences (SMDs) with 95 % confidence intervals (CIs) were calculated.

Results

Twenty-three trials met the inclusion criteria for the systematic review. Twenty-two trials could be defined as either utilising a balance, resistance or multi-component exercise intervention. These 22 trials were used in the meta-analyses. All trials reported measurements of double leg stance; eight trials reported additional stance conditions. The meta-analyses of double leg stance showed that balance exercise interventions significantly decreased total sway path length/velocity [SMD −1.13, 95 % CI −1.75 to −0.51 (eyes open); SMD −0.79, 95 % CI −1.33 to −0.26 (eyes closed)] and anterior-posterior sway path length/velocity [SMD −1.02, 95 % CI −2.01 to −0.02 (eyes open); SMD −0.82, 95 % CI −1.46 to −0.17 (eyes closed)] in both eyes open and eyes closed conditions. Balance exercise interventions also decreased sway area in eyes closed conditions (SMD −0.57, 95 % CI −1.01 to −0.13) and medio-lateral sway path length/velocity in eyes open conditions (SMD −0.8, 95 % CI −1.48 to −0.12). In contrast, neither resistance nor multi-component exercise interventions affected any of the included COP measurements.

Conclusions

Postural control is improved by balance exercise interventions. In contrast, strength or multi-component exercise interventions did not influence postural control measurements in older adults. In addition, a lack of standardisation in collection protocol and COP variables calculated across trials was identified.

Electronic supplementary material

The online version of this article (doi:10.1007/s40279-016-0559-0) contains supplementary material, which is available to authorized users.

Design, Implementation, and Wide Pilot Deployment of FitForAll: An Easy to use Exergaming Platform Improving Physical Fitness and Life Quality of Senior Citizens

Many platforms have emerged as response to the call for technology supporting active and healthy aging. Key requirements for any such e-health systems and any subsequent business exploitation are tailor-made design and proper evaluation. This paper presents the design, implementation, wide deployment, and evaluation of the low cost, physical exercise, and gaming (exergaming) FitForAll (FFA) platform system usability, user adherence to exercise, and efficacy are explored. The design of FFA is tailored to elderly populations, distilling literature guidelines and recommendations. The FFA architecture introduces standard physical exercise protocols in exergaming software engineering, as well as, standard physical assessment tests for augmented adaptability through adjustable exercise intensity. This opens up the way to next generation exergaming software, which may be more automatically/smartly adaptive. 116 elderly users piloted FFA five times/week, during an eight-week controlled intervention. Usability evaluation was formally conducted (SUS, SUMI questionnaires). Control group consisted of a size-matched elderly group following cognitive training. Efficacy was assessed objectively through the senior fitness (Fullerton) test, and subjectively, through WHOQoL-BREF comparisons of pre-postintervention between groups. Adherence to schedule was measured by attendance logs. The global SUMI score was 68.33±5.85%, while SUS was 77.7. Good usability perception is reflected in relatively high adherence of 82% for a daily two months pilot schedule. Compared to control group, elderly using FFA improved significantly strength, flexibility, endurance, and balance while presenting a significant trend in quality of life improvements. This is the first elderly focused exergaming platform intensively evaluated with more than 100 participants. The use of formal tools makes the findings comparable to other studies and forms an elderly exergaming corpus.

The effect of whole body vibration therapy on the physical function of people with type II diabetes mellitus: a systematic review

[Purpose] To review and assess the effectiveness of whole body vibration therapy on the physical function of patients with type II diabetes mellitus. [Subjects and Methods] A computerized database search was performed through PubMed, Medline, EMBASE, the Cochrane Central Register of Controlled Trials, the Physiotherapy Evidence Database, and the reference lists of all relevant articles. The methodological quality was evaluated using the Physiotherapy Evidence Database scale. [Results] Five articles (four studies) with a combined study population of 154 patients with type II diabetes qualified for the inclusion criteria. Our review shows that whole body vibration therapy may have a positive impact on the muscle strength and balance of people with type 2 diabetes mellitus, whereas the effect on their mobility is still under discussion. [Conclusion] There was no sufficient evidence to support the premise that whole body vibration therapy is beneficial for the physical function of people with type II diabetes. Larger and higher-quality trials are needed.

The effects of whole body vibration in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Whole body vibration (WBV) has been used to increase physical activity levels in patients with type 2 diabetes mellitus (T2DM).

OBJECTIVE

To carry out a systematic review of the effects of WBV on the glycemic control, cardiovascular risk factors, and physical and functional capacity of patients with T2DM.

METHOD

MEDLINE, LILACS, PEDro, and Cochrane Central Register of Controlled Trials were searched up to June 1st, 2015. Randomized controlled trials investigating the effects of WBV, compared to control or other intervention, on blood glucose levels, blood and physical cardiovascular risk factors, and physical and functional capacity in adult individuals with T2DM. Two independent reviewers extracted the data regarding authors, year of publication, number of participants, gender, age, WBV parameters and description of intervention, type of comparison, and mean and standard deviation of pre and post assessments.

RESULTS

Out of 585 potentially eligible articles, two studies (reported in four manuscripts) were considered eligible. WBV interventions provided a significant reduction of 25.7 ml/dl (95% CI:-45.3 to -6.1; I²: 19%) in 12 hours fasting blood glucose compared with no intervention. Improvements in glycated hemoglobin, cardiovascular risk factors, and physical and functional capacity were found only at 12 weeks after WBV intervention in comparison with no intervention.

CONCLUSION

WBV combined with exercise seems to improve glycemic control slightly in patients with T2DM in an exposure-dependent way. Large and well-designed trials are still needed to establish the efficacy and understand whether the effects were attributed to vibration, exercise, or a combination of both.