Elsevier

Maturitas

Volume 72, Issue 3, July 2012, Pages 206-213
Maturitas

Review
The effect of whole body vibration on balance, mobility and falls in older adults: A systematic review and meta-analysis

https://doi.org/10.1016/j.maturitas.2012.04.009Get rights and content

Abstract

This systematic review aimed to examine the effect of WBV on balance, mobility and falls among older adults. The databases used included MEDLINE, the Excerpta Medica database, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library Databases of Systematic Reviews, Physiotherapy Evidence Database (PEDro), PubMed, and Science Citation Index (last search in October 2011). Randomized controlled trials that investigated the effect of WBV on balance, mobility or falls in older adults were included in this review. The PEDro score was used to examine the methodological quality of the selected studies. The effect of WBV on balance, mobility and fall-related outcomes were extracted. The data extraction and rating were performed by a researcher and the results were confirmed by the principal investigator. Meta-analysis was done if 3 or more studies measured the same outcome of interest. Among 920 articles screened, fifteen articles (thirteen trials) satisfied the criteria and were included in this review. Methodological quality was good for six of the studies (PEDro score = 6–7). Meta-analysis revealed that WBV has a significant treatment effect in Tinetti Total Score (p < 0.001), Tinetti Body Balance Score (p = 0.010) and Timed-Up-and-Go test (p = 0.004). No significant improvement was noted in Tinetti Gait Score after WBV training (p = 0.120). The effect of WBV on other balance/mobility outcomes and fall rate remains inconclusive. To conclude, WBV may be effective in improving relatively basic balance ability and mobility among older adults, particularly frailer ones. More good-quality WBV trials are required.

Introduction

Reduced balance and mobility function is common in advancing age [1], [2]. Poor balance and mobility compromise independence in activities of daily living and may lead to an increase in fall risk [3]. Falls may cause fragility fractures and hence give rise to reduced quality of life, increased disability and increased economic strain on the health care system [4], [5], [6], [7], [8]. The deleterious consequences arising from falls have driven researchers to seek effective interventions to modify fall-related risk factors in older adults.

Recently, whole body vibration (WBV) is gaining popularity in rehabilitation of various populations. A good number of studies have examined the effects of WBV on muscle strength [9], [10], [11], [12], [13], [14], [15], and a recent meta-analysis paper [16] has demonstrated that WBV training can significantly improve various aspects of leg muscle strength among older adults. As leg muscle strength is highly correlated with balance and mobility [17], [18], [19], [20], it is postulated that WBV may also have potential benefits on balance and mobility function. Additionally, there is some preliminary evidence that WBV can improve proprioceptive function [21] and modulate the gain of the spinal reflex pathways [22], [23], [24]. Thus, WBV training may be a viable treatment approach to reduce the fall risk among older adults through improving muscle strength, balance ability and mobility. Although Howe et al. [25] included WBV as a form of exercise in their review of the effect of exercise on balance, only three WBV studies were incorporated in their review. To date, no comprehensive review has been performed to specifically examine the effect of WBV on balance, mobility, and falls among older adults in a systematic manner. This systematic review aimed to determine whether WBV is better than conventional therapy or no intervention in improving balance ability, mobility performance and reducing fall risk in older adults.

Section snippets

Data sources and searches

An extensive literature search of electronic databases, including MEDLINE, the Excerpta Medica database (EMBASE) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) was done to identify relevant articles. The keywords used included: vibration, whole body vibration, vibratory exercise, age, aging, elder, older adult, old men, old women, postmenopause, postmenopausal, strength, muscle strength, balance, postural, body posture, clinical trial, controlled clinical trial,

Results

Our search yielded a total of 920 articles but only 15 met all eligibility criteria (Fig. 1). Amongst these, the reports by Gusi et al. [27] and Raimundo et al. [28] were based on the same trial. Rees et al. produced 2 articles from their trial [29], [30]. To summarize, 15 articles [9], [10], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39] (13 trials) were selected for this systematic review.

Static standing balance

The evidence on the effect of WBV on static balance is conflicting. All studies investigating balance in standing on both legs reported no significant results while all studies evaluating single-leg-standing balance favoured WBV. It is possible that single-leg-standing is more compromised among older adults and thus has more room for improvement. Another possible explanation could be the use of different vibration devices. All four studies [31], [32], [37], [38] reporting non-significant effect

Conclusion

This review revealed that WBV is effective in improving relatively basic dynamic balance ability and functional mobility in older adults, particularly the frailer ones. Its effect on falls, however, remains uncertain. WBV may be a viable alternative for those older adults who are unable to participate in other forms of exercise training. Further research is required to identify the optimal protocol of WBV for improving balance and mobility in older adults. The effect of WBV among older adults

Contributors

FML involved in analysis and interpretation of data, drafting the article and revised it critically for important intellectual content, final approval. RWL involved in acquisition of data, drafting the article, and final approval. RCC involved in analysis of data, drafting the article, and final approval. MYP involved in conception and design, revising the article critically for important intellectual content, final approval.

Competing interests

All authors declare no conflict of interest.

Provenance and peer review

Not commissioned and externally peer reviewed.

Role of funding source

The funding source did not have any role in the design, data collection, analysis and interpretation of data, writing of the report or decision to submit this paper for publication.

Acknowledgements

F.M.H. Lam was granted a full-time research studentship by the Hong Kong Polytechnic University. R.W.K. Lau was supported by the Hang Seng Bank Golden Jubilee Research Endowment Fund.

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