The effect of low-intensity whole-body vibration with or without high-intensity resistance and impact training on risk factors for proximal femur fragility fracture in postmenopausal women with low bone mass: study protocol for the VIBMOR randomized controlled trial

Background The prevailing medical opinion is that medication is the primary (some might argue, only) effective intervention for osteoporosis. It is nevertheless recognized that osteoporosis medications are not universally effective, tolerated, or acceptable to patients. Mechanical loading, such as vibration and exercise, can also be osteogenic but the degree, relative efficacy, and combined effect is unknown. The purpose of the VIBMOR trial is to determine the efficacy of low-intensity whole-body vibration (LIV), bone-targeted, high-intensity resistance and impact training (HiRIT), or the combination of LIV and HiRIT on risk factors for hip fracture in postmenopausal women with osteopenia and osteoporosis. Methods Postmenopausal women with low areal bone mineral density (aBMD) at the proximal femur and/or lumbar spine, with or without a history of fragility fracture, and either on or off osteoporosis medications will be recruited. Eligible participants will be randomly allocated to one of four trial arms for 9 months: LIV, HiRIT, LIV + HiRIT, or control (low-intensity, home-based exercise). Allocation will be block-randomized, stratified by use of osteoporosis medications. Testing will be performed at three time points: baseline (T0), post-intervention (T1; 9 months), and 1 year thereafter (T2; 21 months) to examine detraining effects. The primary outcome measure will be total hip aBMD determined by dual-energy X-ray absorptiometry (DXA). Secondary outcomes will include aBMD at other regions, anthropometrics, and other indices of bone strength, body composition, physical function, kyphosis, muscle strength and power, balance, falls, and intervention compliance. Exploratory outcomes include bone turnover markers, pelvic floor health, quality of life, physical activity enjoyment, adverse events, and fracture. An economic evaluation will also be conducted. Discussion No previous studies have compared the effect of LIV alone or in combination with bone-targeted HiRIT (with or without osteoporosis medications) on risk factors for hip fracture in postmenopausal women with low bone mass. Should either, both, or combined mechanical interventions be safe and efficacious, alternative therapeutic avenues will be available to individuals at elevated risk of fragility fracture who are unresponsive to or unwilling or unable to take osteoporosis medications. Trial registration Australian New Zealand Clinical Trials Registry (www. anzctr.org.au) (Trial number ANZCTR12615000848505, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 368962); date of registration 14/08/2015 (prospectively registered). Universal Trial Number: U1111-1172-3652.

The neuromuscular responses in patients with Parkinson’s disease under different conditions during whole-body vibration training

Background Whole-body vibration (WBV) training can provoke reactive muscle response and thus exert beneficial effects in various neurological patients. This study aimed to investigate the muscles activation and acceleration transmissibility of the lower extremity to try to understand the neuromuscular control in the Parkinson’s disease (PD) patients under different conditions of the WBV training, including position and frequency. Methods Sixteen PD patients and sixteen controls were enrolled. Each of them would receive two WBV training sessions with 3 and 20 Hz mechanical vibration in separated days. In each session, they were asked to stand on the WBV machine with straight and then bended knee joint positions, while the vibration stimulation was delivered or not. The electromyographic (EMG) signals and the segmental acceleration from the lower extremity were recorded and processed. The amplitude, co-contraction indexes (CCI), and normalized median frequency slope (NMFS) from the EMG signals, and the acceleration transmissibility were calculated. Results The results showed larger rectus femoris (RF) amplitudes under 3 Hz vibration than those in 20 Hz and no vibration conditions; larger tibialis anterior (TA) in 20 Hz than in no vibration; larger gastrocnemius (GAS) in 20 Hz than in 3 Hz and no vibration. These results indicated that different vibration frequencies mainly induced reactive responses in different muscles, by showing higher activation of the knee extensors in 3 Hz and of the lower leg muscles in 20 Hz condition, respectively. Comparing between groups, the PD patients reacted to the WBV stimulation by showing larger muscle activations in hamstring (HAM), TA and GAS, and smaller CCI in thigh than those in the controls. In bended knee, it demonstrated a higher RF amplitude and a steeper NMFS but smaller HAM activations than in straight knee position. The higher acceleration transmissibility was found in the control group, in the straight knee position and in the 3 Hz vibration conditions. Conclusion The PD patients demonstrated altered neuromuscular control compared with the controls in responding to the WBV stimulations, with generally higher EMG amplitude of lower extremity muscles. For designing WBV strengthening protocol in the PD population, the 3 Hz with straight or flexed knee protocol was recommended to recruit more thigh muscles; the bended knee position with 20 Hz vibration was for the shank muscles.

Managing Fall Prevention through Exercise in Older Adults Afflicted by Cognitive and Strength Impairment

<b><i>Introduction:</i></b> A growing trend in medicine is older adults and increased need for geriatric services. Falls contribute heavily to hospitalizations and worsening of overall health in this frail demographic. There are numerous biological and physical culprits which, if targeted, can prevent falls. The objective was to review benefits of different types of exercises for fall prevention for older persons who are community-dwelling or living in long-term care facilities. <b><i>Methods:</i></b> A systematic review was conducted to determine the different types of exercises for fall prevention. Data extraction via a standardized protocol was performed to assess study design, outcomes, limitations, and author’s conclusions. Corroborative themes were identified and the authors responsible for the contributing research were cited as they came up. Nineteen randomized controlled trials were identified, between 1990 and 2018, using MEDLINE, PubMed, Cochrane, CINAHL, and Web of Science databases. Studies involving adults greater than age 60 in high-risk community or nursing home populations in the English language with a duration longer than or equal to 6 weeks with focuses on either low-risk balance, strength, or combination of both and whole-body vibration. <b><i>Results:</i></b> Balance exercise training increased balance at 6 and 12-month intervals involving balance, strength, and cognitive training. <b><i>Discussion:</i></b> Insignificant results were seen in whole-body vibration and differing results existed for Tai Chi. It is important to recognize that although exercises help reduce the risk of falling and play a significant role in improving mobility safely, there will always be a risk of falls.