Whole-body vibration training increases physical fitness measures without alteration of inflammatory markers in older adults

Effect of whole-body vibration stimulation on plasma soluble TNF receptors in elderly with sarcopenia: a randomized controlled trial

Sarcopenia is a pathology resulting from a progressive and severe loss of muscle mass, strength, and function in the course of aging, which has deleterious consequences on quality of life. Among the most widespread studies on the issue are those focused on the effect of different types of physical exercise on patients with sarcopenia. This randomized controlled study aimed to compare the effects of a whole-body vibration exercise (WBV) session on the inflammatory parameters of non-sarcopenic (NSG, n=22) and sarcopenic elderly (SG, n=22). NSG and SG participants were randomly divided into two protocols: intervention (squat with WBV) and control (squat without WBV). After a one-week washout period, participants switched protocols, so that everyone performed both protocols. Body composition was assessed by dual-energy radiological absorptiometry (DXA) and function through the six-minute walk test (6MWD) and Short Physical Performance Battery (SPPB). Plasma soluble tumor necrosis factor receptors (sTNFR) were determined by enzyme-linked immunosorbent assay (ELISA) and measured before and immediately after each protocol. After exercise with WBV, there was an increase in sTNFR2 levels in the NSG (P<0.01; d=-0.69 (-1.30; -0.08) and SG (P<0.01, d=-0.95 (-1.57; -0.32) groups. In conclusion, an acute session of WBV influenced sTNFr2 levels, with sarcopenic individuals showing a greater effect. This suggested that WBV had a more pronounced impact on sTNFr2 in those with loss of muscle strength and/or physical performance. Additionally, WBV is gaining recognition as an efficient strategy for those with persistent health issues.

Effects of whole-body vibration or resistive-vibration exercise on blood clotting and related biomarkers: a systematic review

Whole-body vibration (WBV) and resistive vibration exercise (RVE) are utilized as countermeasures against bone loss, muscle wasting, and physical deconditioning. The safety of the interventions, in terms of the risk of inducing undesired blood clotting and venous thrombosis, is not clear. We therefore performed the present systematic review of the available scientific literature on the issue. The review was conducted following the guidelines by the Space Biomedicine Systematic Review Group, based on Cochrane review guidelines. The relevant context or environment of the studies was "ground-based environment"; space analogs or diseased conditions were not included. The search retrieved 801 studies; 77 articles were selected for further consideration after an initial screening. Thirty-three studies met the inclusion criteria. The main variables related to blood markers involved angiogenic and endothelial factors, fibrinolysis and coagulation markers, cytokine levels, inflammatory and plasma oxidative stress markers. Functional and hemodynamic markers involved blood pressure measurements, systemic vascular resistance, blood flow and microvascular and endothelial functions. The available evidence suggests neutral or potentially positive effects of short- and long-term interventions with WBV and RVE on variables related to blood coagulation, fibrinolysis, inflammatory status, oxidative stress, cardiovascular, microvascular and endothelial functions. No significant warning signs towards an increased risk of undesired clotting and venous thrombosis were identified. If confirmed by further studies, WBV and RVE could be part of the countermeasures aimed at preventing or attenuating the muscular and cardiovascular deconditioning associated with spaceflights, permanence on planetary habitats and ground-based simulations of microgravity.

Effects of Exercise and Omega-3-Supplemented, High-Protein Diet on Inflammatory Markers in Serum, on Gene Expression Levels in PBMC, and after Ex Vivo Whole-Blood LPS Stimulation in Old Adults

Inflammaging is related to cell senescence and reflects an erratic immune system, which promotes age-associated diseases. Exercise and nutrition, particularly omega-3 fatty acids, are able to affect inflammation. Therefore, we examined the effects of an 8-week exercise and dietary intervention on the inflammatory response in community-dwelling old adults. All participants received weekly vibration and home-based resistance exercise. Furthermore, participants were randomized to either a control, high-protein (1.2-1.5 g/kg), or high-protein, omega-3-enriched (2.2 g/day) diet. Before and after treatment, inflammatory markers in fasting serum and after whole-blood ex vivo lipopolysaccharide (LPS) stimulation were assessed. Gene expression levels of inflammatory markers were quantified in peripheral blood mononuclear cells (PBMC). Sixty-one participants (age: 70.6 ± 4.7 years; 47% men) completed the study. According to generalized linear mixed models, a high-protein, omega-3-enriched diet decreased circulating anti-inflammatory interleukin (IL-) 10 and IL-1 receptor antagonist (IL-1RA). Sex-stratified analyses showed also significantly reduced pro-inflammatory markers in men with a high-protein, omega-3-enriched diet. Gene expression of IL-1RA was significantly reduced after both protein-enriched diets compared with controls. In comparison to a high-protein diet, exercise alone showed lower LPS-induced release of c-c motif chemokine ligand-2 (CCL-2), which tended to be more pronounced in men compared with women. Eight weeks of a high-protein, omega-3-enriched diet combined with exercise decreased circulating anti-inflammatory markers, and pro-inflammatory markers in men. A high-protein diet attenuated anti-inflammatory markers on gene expression level in PBMC. Exercise alone resulted in a lower pro-inflammatory response to LPS-exposure in whole-blood cultures.

Effect of Whole-Body Vibration Training on Selected Intrinsic Risk Factors in Women Aged 60+ at Fall Risk: A Randomized Controlled Trial

The aim of the study was to determine whether Whole Body Vibration Training (WBVT) affects intrinsic risk factors for falls in women aged 60+ at fall risk.

DESIGN

Randomized controlled clinical trial. Blinding was applied to the persons in charge of evaluating the intervention's clinical results and statistical analysis.

METHODS

Forty-two women over 60 years old were randomly assigned to an experimental group (EG-12-week WBVT; n = 22) and a control group (CG-no additional physical activities; n = 20). Fear of falling was measured by the FES-I questionnaire, gait and dynamic balance using the Time-Up and Go test (TUG), aerobic endurance with the 6-Minute Walk Test (6MWT), and the functional strength of the lower body muscles with the 30-s Chair Stand Test (30SCST) at baseline and post-intervention. Additionally assayed were participants' blood concentrations of interleukin-6 (IL-6).

RESULTS

The 12-week WBVT improves gait and balance (TUG, p = 0.009), exercise tolerance (6MWT, p = 0.001), and functional strength (30SCST; p = 0.027) but does not reduce the intensity of fear of falling (FES-I, p = 0.655) and the IL-6 serum concentration (p = 0.377).

CONCLUSIONS

WBVT affects selected fall risk factors in women aged 60+ at fall risk.

Effect of whole-body vibration on neuromuscular activation and explosive power of lower limb: A systematic review and meta-analysis

OBJECTIVE

The review aimed to investigate the effects of whole-body vibration (WBV) on neuromuscular activation and explosive power.

METHODS

Keywords related to whole-body vibration, neuromuscular activation and explosive power were used to search four databases (PubMed, Web of Science, Google Scholar and EBSCO-MEDLINE) for relevant studies published between January 2000 and August 2021. The methodology of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used. The eligibility criteria for the meta-analysis were based on PICOST principles. Methodological assessment used the Cochrane scale. Heterogeneity and publication bias were assessed by I2 index and funnel plots, respectively. The WBV training cycle is a random effect model. Publication bias was also assessed based on funnel plots. This study was registered in PROSPERO (CRD42021279439).

RESULTS

A total of 156 participants data in 18 studies met the criteria and were included in the meta-analysis for quantitative synthesis. Results of the meta-analysis showed significant improvements in lower limb neuromuscular activation immediately after WBV compared with the baseline (SMD = 0.51; 95% CI: 0.26, 0.76; p<0.001), and no significant heterogeneity was observed (I2 = 38%, p = 0.07). In addition, the highest increase in lower limb explosive power was observed (SMD = 0.32; 95% CI: 0.11, 0.52; p = 0.002), and no significant heterogeneity (I2 = 0%, p = 0.80) was noted.

CONCLUSIONS

WBV training could improve neuromuscular activation and explosive power of the lower limb. However, due to different vibration conditions, further research should be conducted to determine standardized protocols targeting performance improvement in athletes and healthy personnel experienced in training.

Use of surface electromyography to evaluate effects of whole-body vibration exercises on neuromuscular activation and muscle strength in the elderly: a systematic review

PURPOSE

Reduction of muscle strength and lean mass, increase in the risk of falls, higher mortality, and morbidity are observed in geriatric syndromes. Physical activity is an effective intervention in reducing signs and symptoms of geriatric syndromes. Whole-body vibration exercise (WBVE) is an intervention with low cost and has been effective.

MATERIALS AND METHODS

The aim of this systematic review aimed to determine the effects of WBVE on neuromuscular activation and muscle strength in the elderly. Searches in PubMed, Embase, Science direct, and Scopus databases were conducted. Six studies, that analyzed the use of surface electromyography evaluating effects of WBVE on neuromuscular activation and muscle strength in the elderly, published in English, were included.

RESULTS

Six studies were included. One hundred forty-six individuals participated in the studies and 24 were males (16.43%), with an average age of 74.20 ± 7.66 years. Five publications were defined as "fair" methodological in the PEDro scale, the risk of bias was high and the risk of bias for non-randomized studies was moderate/high. In general, increased strength muscle was reported in the studies.

CONCLUSION

This systematic review suggests that WBVE might promote desirable neuromuscular responses in healthy elderly. However, it is necessary to perform further studies to reinforce the reported findings.IMPLICATIONS FOR REHABILITATIONThe reduction in lean mass and consequent reduction in muscle strength are present in healthy elderly people and the whole-body vibration exercise can reduce or alleviate these symptoms caused by the geriatric syndrome.Whole-body vibration exercise is a training modality that increases neuromuscular activation and muscle strength.Surface electromyography is a useful tool for the evaluation of the neuromuscular activation of the muscle fibers.

Non-Invasive Pulsatile Shear Stress Modifies Endothelial Activation; A Narrative Review

The monolayer of cells that line both the heart and the entire vasculature is the endothelial cell (EC). These cells respond to external and internal signals, producing a wide array of primary or secondary messengers involved in coagulation, vascular tone, inflammation, and cell-to-cell signaling. Endothelial cell activation is the process by which EC changes from a quiescent cell phenotype, which maintains cellular integrity, antithrombotic, and anti-inflammatory properties, to a phenotype that is prothrombotic, pro-inflammatory, and permeable, in addition to repair and leukocyte trafficking at the site of injury or infection. Pathological activation of EC leads to increased vascular permeability, thrombosis, and an uncontrolled inflammatory response that leads to endothelial dysfunction. This pathological activation can be observed during ischemia reperfusion injury (IRI) and sepsis. Shear stress (SS) and pulsatile shear stress (PSS) are produced by mechanical frictional forces of blood flow and contraction of the heart, respectively, and are well-known mechanical signals that affect EC function, morphology, and gene expression. PSS promotes EC homeostasis and cardiovascular health. The archetype of inducing PSS is exercise (i.e., jogging, which introduces pulsations to the body as a function of the foot striking the pavement), or mechanical devices which induce external pulsations to the body (Enhanced External Pulsation (EECP), Whole-body vibration (WBV), and Whole-body periodic acceleration (WBPA aka pGz)). The purpose of this narrative review is to focus on the aforementioned noninvasive methods to increase PSS, review how each of these modify specific diseases that have been shown to induce endothelial activation and microcirculatory dysfunction (Ischemia reperfusion injury-myocardial infarction and cardiac arrest and resuscitation), sepsis, and lipopolysaccharide-induced sepsis syndrome (LPS)), and review current evidence and insight into how each may modify endothelial activation and how these may be beneficial in the acute and chronic setting of endothelial activation and microvascular dysfunction.

Comparison of aerobic and combined aerobic and whole-body vibration training effects on physical fitness in non-alcoholic fatty liver patients

The aim of this study was to evaluate the effectiveness of exercises with whole-body vibration which was added to aerobic training on the physical fitness of patients with non-alcoholic fatty liver disease. Thirty-two patients diagnosed with non-alcoholic fatty liver (age 44.39±8.74 years) were randomly divided into an aerobic training + vibration group and an aerobic training + sham vibration group. The aerobic training was continued at 60-80% heart rate workload, 40 min per day during 3 days per week, for 8 weeks. Vibration were performed with dynamic and static exercises at 30 Hz, with a 2 mm amplitude, for 15 min. The energy expenditure responses were carried out by an exercise tolerance test system. Lower limb isometric muscle strength assessment was made with a calibrated handheld dynamometer from bilaterally knee extensors. The sit to stand test, and the time up and go test were used for physical performance evaluation. At eight weeks, both groups showed a significant reduction in the sit to stand (-1.62±1.00 vs -0.37±1.52), the time up and go test (-1.43±0.99 vs -1.39±1.06), the right lower extremity muscle strength (1.01±1.61 vs 1.22±2.82), and the energy expenditure scores (MET; 1.88 ml/kg/min, 95% confidence interval (CI) 1.19; 2.57, d=0.55, minimal clinically important difference (McID) = 0.69 vs 2.01 ml/kg/min, 95% CI 0.76; 3.24, d=0.26, McID = 1.54, respectively), however no significant differences emerged between groups (P≥0.05). The addition of vibration exercises to an aerobic program did not provide additional benefits to physical fitness in patients with non-alcoholic fatty liver.

Managing Vibration Training Safety by Using Knee Flexion Angle and Rating Perceived Exertion

Whole-body vibration (WBV) is commonly applied in exercise and rehabilitation and its safety issues have been a major concern. Vibration measured using accelerometers can be used to further analyze the vibration transmissibility. Optimal bending angles and rating of perceived exertion (RPE) evaluations have not been sufficiently explored to mitigate the adverse effect. Therefore, the aims of this study were to investigate the effect of various knee flexion angles on the transmissibility to the head and knee, the RPE during WBV exposure, and the link between the transmissibility to the head and the RPE. Sixteen participants randomly performed static squats with knee flexion angles of 90, 110, 130, and 150 degrees on a WBV platform. Three accelerometers were fixed on the head, knee, and center of the vibration platform to provide data of platform-to-head and platform-to-knee transmissibilities. The results showed that the flexion angle of 110 degrees induced the lowest platform-to-head transmissibility and the lowest RPE (p < 0.01). A positive correlation between RPE and the platform-to-head transmissibility was observed. This study concluded that a knee flexion of about 110 degrees is most appropriate for reducing vibration transmissibility. The reported RPE could be used to reflect the vibration impact to the head.

Resistance Exercise, Electrical Muscle Stimulation, and Whole-Body Vibration in Older Adults: Systematic Review and Meta-Analysis of Randomized Controlled Trials

It has been shown that resistance exercise (RT) is one of the most effective approaches to counteract the physical and functional changes associated with aging. This systematic review with meta-analysis compared the effects of RT, whole-body vibration (WBV), and electrical muscle stimulation (EMS) on muscle strength, body composition, and functional performance in older adults. A thorough literature review was conducted, and the analyses were limited to randomized controlled trials. In total, 63 studies were included in the meta-analysis (48 RT, 11 WBV, and 4 EMS). The results showed that RT and WBV are comparably effective for improving muscle strength, while the effects of EMS remains debated. RT interventions also improved some outcome measures related to functional performance, as well as the cross-sectional area of the quadriceps. Muscle mass was not significantly affected by RT. A limitation of the review is the smaller number of WBV and particularly EMS studies. For this reason, the effects of WBV and EMS could not be comprehensively compared to the effect of RT for all outcome measures. For the moment, RT or combinations of RT and WBV or EMS, is probably the most reliable way to improve muscle strength and functional performance, while the best approach to increase muscle mass in older adults remains open to further studies.

Impact of aerobic training with and without whole-body vibration training on metabolic features and quality of life in non-alcoholic fatty liver disease patients

The present study examined the effectiveness of adding exercises with whole-body vibration (WBV) to aerobic training in terms of metabolic features and quality of life. Patients with non-alcoholic fatty liver disease (NAFLD), confirmed on imaging, underwent an 8-week individualized exercise program randomized between aerobic training with and without WBV. Training was performed at 60-80% heart rate workload for 165 min/week. The WBV amplitude was 2-4mm and the training frequency was 30Hz, for 15min. Assessments were carried out on surrogate scores of steatosis and fibrosis including transient elastography (FibroScan), metabolic features (biochemical analysis) and quality of life (SF-36). Insulin resistance was markedly reduced (-2.36; 95% CI: -4.96 to -0.24; P: 0.049) in aerobic training with WBV. The decrease in serum aspartate transaminase was significantly greater in aerobic training without WBV (-14.81; 95% CI: -23.36 to -6.25; P: 0.029). There were no significant differences between groups for the other metabolic features (P<0.05). All quality of life well-being domains improved in both groups (P<0.05). Given this reduction in insulin resistance, WBV can usefully be added to aerobic training. However, WBV did not provide further benefits in improving metabolic properties or quality of life.

Pain After Whole-Body Vibration Exposure Is Frequency Dependent and Independent of the Resonant Frequency: Lessons From an In Vivo Rat Model

Occupational whole-body vibration (WBV) increases the risk of developing low back and neck pain; yet, there has also been an increased use of therapeutic WBV in recent years. Although the resonant frequency (fr) of the spine decreases as the exposure acceleration increases, effects of varying the vibration profile, including peak-to-peak displacement (sptp), root-mean-squared acceleration (arms), and frequency (f), on pain onset are not known. An established in vivo rat model of WBV was used to characterize the resonance of the spine using sinusoidal sweeps. The relationship between arms and fr was defined and implemented to assess behavioral sensitivity-a proxy for pain. Five groups were subjected to a single 30-min exposure, each with a different vibration profile, and a sham group underwent only anesthesia exposure. The behavioral sensitivity was assessed at baseline and for 7 days following WBV-exposure. Only WBV at 8 Hz induced behavioral sensitivity, and the higher arms exposure at 8 Hz led to a more robust pain response. These results suggest that the development of pain is frequency-dependent, but further research into the mechanisms leading to pain is warranted to fully understand which WBV profiles may be detrimental or beneficial.

Exercise and Chronic Obstructive Pulmonary Disease (COPD)

Systemic effects of COPD lead to cardiovascular co-morbidities, muscle wasting and osteoporosis that, in turn, lead to inactivity and physical deconditioning. This evolution has a direct influence on the health-related quality of life (HRQoL) of patients suffering from this respiratory disease. Pharmacological therapy leads to improvement in shortness of breath, but it has a limited effect on the physical deconditioning. Pulmonary rehabilitation relieves dyspnoea and fatigue, improves emotional function and enhances the sense of control that individuals have over their condition. These improvements are moderately substantial and clinically significant. Rehabilitation serves as an essential component of the management of COPD and is beneficial in improving health-related quality of life and exercise capacity.

Relevance of Whole-Body Vibration Exercises on Muscle Strength/Power and Bone of Elderly Individuals

Beneficial effects are associated with whole-body vibration exercises (WBVEs). Increases in muscular strength/power, flexibility, and gait speed; improvements in bone mineral density, balance, and the quality of life; and decreased pain and risk of falls are reported. The aim is to present a review about the importance of WBVE for elderly individuals, considering clinical studies and meta-analyses, on bone and muscle strength/power. There is evidence supporting beneficial effect of WBVE in postmenopausal women (PW); however, effects in PW with osteoporosis are unclear. Age-related decrease in muscle mass and function contribute to undesirable health conditions, including death risk. The WBVEs improve muscle strength/power, functional independence measure, balance, and various fall risk factors, and mobility, measured by Timed Up and Go test, increased significantly after WBVE. An explanation for the absence of positive effects in some outcomes could be related to discrepancies in WBVE protocols as well as the populations tested. It is concluded that WBVE is effective for counteracting the loss of muscle strength associated with sarcopenia in elderly individuals. Balance and leg and plantar flexor strength improvements due to WBV indicate benefit to reduce risk and incidence of falls, frailty, and fracture risks. However, long-term feasibility of WBVE for musculoskeletal and bone health in elderly individuals needs further investigation.

Whole body vibration training increases physical measures and quality of life without altering inflammatory-oxidative biomarkers in patients with moderate COPD

Whole body vibration training (WBVT) has been identified as an alternative intervention to improve exercise capacity and quality of life of patients with chronic obstructive pulmonary disease (COPD). However, the effect of WBVT on inflammatory-oxidative biomarkers remains unknown. The aim of this trial was to investigate the effects of WBVT on quality of life and physical and inflammatory-oxidative parameters in patients with COPD. Twenty patients were equally divided into 1) an intervention group (IG) that performed the WBVT, and 2) a control group (CG) that did not receive any intervention. Intervention consisted in performing static squatting on a vibrating platform, in six series of 30 s, 3 days/wk, for 12 wk. Patients were evaluated for plasma levels of IL-6, IL-8, IFN-γ, soluble receptors of TNF-α; white cell count; plasma levels of oxidant and antioxidant markers; 6-min walking distance (6MWD); peak oxygen uptake (V̇o2peak); handgrip strength; quality of life; timed 5-chair sit-to-stand (5STS); and timed get-up and go test (TUG). After WBVT, patients from IG showed a significant increase in the 6MWD, V̇o2peak, and handgrip strength ( P < 0.05). Furthermore, patients from the IG reached minimal clinically important difference regarding quality of life. No significant differences were found in 5STS, TUG, inflammatory-oxidative biomarkers, and white cell count in the IG. The CG did not show significant improvement in all assessments ( P > 0.05). Taken together, our results demonstrated that the WBVT induced clinically significant benefits regarding exercise capacity, muscle strength, and quality of life in patients with COPD that were not related to inflammatory-oxidative biomarker changes.

NEW & NOTEWORTHY Whole body vibration training is a new option for nonpharmacological treatment of chronic obstructive pulmonary disease (COPD). This study showed the potential of this training to improve exercise capacity, quality of life, and muscle strength in patients with COPD. Furthermore, to our knowledge this was the first study showing that vibration exercise does not modify the plasma levels of inflammatory-oxidative biomarkers, suggesting that the beneficial effects on physical measures and quality of life are independent of changes in biomarkers.

A novel vibration-induced exercise paradigm improves fitness and lipid metabolism of Caenorhabditis elegans

Exercise has been known to reduce the risk of obesity and metabolic syndrome, but the mechanisms underlying many exercise benefits remain unclear. This is, in part, due to a lack of exercise paradigms in invertebrate model organisms that would allow rapid mechanistic studies to be conducted. Here we report a novel exercise paradigm in Caenorhabditis elegans (C. elegans) that can be implemented under standard laboratory conditions. Mechanical stimulus in the form of vibration was transduced to C. elegans grown on solid agar media using an acoustic actuator. One day post-exercise, the exercised animals showed greater physical fitness compared to the un-exercised controls. Despite having higher mitochondrial reactive oxygen species levels, no mitohormetic adaptations and lifespan extension were observed in the exercised animals. Nonetheless, exercised animals showed lower triacylglycerides (TAG) accumulation than the controls. Among the individual TAG species, the most significant changes were found in mono- and polyunsaturated fatty acid residues. Such alteration resulted in an overall lower double bond index and peroxidation index which measure susceptibility towards lipid peroxidation. These observations are consistent with findings from mammalian exercise literature, suggesting that exercise benefits are largely conserved across different animal models.

Whole-body vibration improves the anti-inflammatory status in elderly subjects through toll-like receptor 2 and 4 signaling pathways

Regular physical exercise has anti-inflammatory effects in elderly subjects. Yet, the inflammatory responses after whole body vibration (WBV) training, a popular exercise paradigm for the elderly, remain to be elucidated. This study assessed the effects of WBV training on the inflammatory response associated with toll-like receptors (TLRs) signaling pathways. Twenty-eight subjects were randomized to a training group (TG) or a control group (CG). TG followed an 8-week WBV training program. Blood samples were obtained before and after the training period in both groups. Peripheral blood mononuclear cells were isolated, and mRNA and protein levels of makers involved in the TLR2/TLR4 myeloid differentiation primary response gen 88 (MyD88) and TIR domain-containing adaptor inducing interferon (TRIF)-dependent pathways were analyzed. Plasma TNFα and C-reactive protein levels were also assessed. The WBV program reduced protein expression of TLR2, TLR4, MyD88, p65, TRIF and heat shock protein (HSP) 60, while HSP70 content increased. IL-10 mRNA level and protein concentration were upregulated, and TNFα protein content decreased, after WBV training. Plasma concentration of C-reactive protein and TNFα decreased in the TG. The current data suggest WBV may improve the anti-inflammatory status of elderly subjects through an attenuation of MyD88- and TRIF-dependent TLRs signaling pathways.

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.