Abstract
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; I22. Hayashino Y, Jackson JL, Fukumori N, Nakamura F, Fukuhara S. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2012;98(3):349-60. http://dx.doi.org/10.1016/j.diabres.2012.10.004. PMid:23116535.
http://dx.doi.org/10.1016/j.diabres.201...
: 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.
type 2 diabetes mellitus; exercise; physical activity; whole body vibration; blood glucose; glycemic control
PROSPERO: CRD42014010495.
BULLET POINTS
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WBV plus exercise slightly decrease fasting blood glucose in T2DM.
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Evidence of WBV effects on glycemic control improvement is limited in T2DM.
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Isolated effect of WBV on outcomes in T2DM still has not been investigated.
Introduction
Physical activity plays an important role in prevention and control of type 2 diabetes mellitus (T2DM) and its related complications11. Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, et al. Exercise and type 2 diabetes. The American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):e147-67. http://dx.doi.org/10.2337/dc10-9990. PMid:21115758.
http://dx.doi.org/10.2337/dc10-9990...
. Both aerobic and resistance training improve insulin action and can assist with the management of blood glucose levels, lipids, blood pressure, cardiovascular risk, mortality, and quality of life; however, exercise must be undertaken regularly for continued benefits11. Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, et al. Exercise and type 2 diabetes. The American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):e147-67. http://dx.doi.org/10.2337/dc10-9990. PMid:21115758.
http://dx.doi.org/10.2337/dc10-9990...
,22. Hayashino Y, Jackson JL, Fukumori N, Nakamura F, Fukuhara S. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2012;98(3):349-60. http://dx.doi.org/10.1016/j.diabres.2012.10.004. PMid:23116535.
http://dx.doi.org/10.1016/j.diabres.201...
. Nevertheless, most of people with T2DM are not active, mirroring the inertia of a lifetime of habits and motivational barriers such as lack of interest, lack of time, and depression33. Morrato EH, Hill JO, Wyatt HR, Ghushchyan V, Sullivan PW. Physical activity in U.S. adults with diabetes and at risk for developing diabetes. Diabetes Care. 2007;30(2):203-9. http://dx.doi.org/10.2337/dc06-1128. PMid:17259482.
http://dx.doi.org/10.2337/dc06-1128...
. In addition, physical disabilities and perceived discomfort when exercising are challenges to adherence to physical activity33. Morrato EH, Hill JO, Wyatt HR, Ghushchyan V, Sullivan PW. Physical activity in U.S. adults with diabetes and at risk for developing diabetes. Diabetes Care. 2007;30(2):203-9. http://dx.doi.org/10.2337/dc06-1128. PMid:17259482.
http://dx.doi.org/10.2337/dc06-1128...
,44. Praet SFE, van Loon LJC. Exercise: the brittle cornerstone of type 2 diabetes treatment. Diabetologia. 2008;51(3):398-401. http://dx.doi.org/10.1007/s00125-007-0910-y. PMid:18183362.
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.
Physical therapists are able to help people plan an individualized exercise program in order to maintain good blood glucose and achieve optimal weight55. Kalra S, Kalra B, Kumar N. Prevention and management of diabetes: the role of the physiotherapist. Diabetes Voice. 2007;52(3):12-4.. To help people with diabetes improve their quality of life, physical therapists can intervene with physical treatment techniques such as manual or manipulative treatments, electrophysical agents, and mechanical agents55. Kalra S, Kalra B, Kumar N. Prevention and management of diabetes: the role of the physiotherapist. Diabetes Voice. 2007;52(3):12-4.,66. Andrade AD, Dean E. Aligning Physical Therapy practice with Brazil's leading Health priorities: a "call to action" in the 21st century. Rev Bras Fisioter. 2008;12(4):260-7. http://dx.doi.org/10.1590/S1413-35552008000400003.
http://dx.doi.org/10.1590/S1413-3555200...
.
Among the alternatives aimed to increase overall physical activity, whole body vibration (WBV) has been shown to be a new effective option in healthy subjects and individuals with several health conditions77. Cochrane DJ. Vibration exercise: the potential benefits. Int J Sports Med. 2011;32(2):75-99. http://dx.doi.org/10.1055/s-0030-1268010. PMid:21165804.
http://dx.doi.org/10.1055/s-0030-126801...
. It is assumed that vibration activates muscle spindles and evokes muscle contractions induced by a complex spinal and supraspinal neurophysiological mechanism known as tonic vibration reflex, allowing muscular activity enhancement even in static positions88. Zaidell LN, Mileva KN, Sumners DP, Bowtell JL. Experimental evidence of the tonic vibration reflex during whole-body vibration of the loaded and unloaded leg. PLoS One. 2013;8(12):e85247. http://dx.doi.org/10.1371/journal.pone.0085247. PMid:24386466.
http://dx.doi.org/10.1371/journal.pone....
.
Some systematic reviews99. Slatkovska L, Alibhai MH, Beyene J, Cheung AM. Effect of whole-body vibration on BMD: a systematic review and meta-analysis. Osteoporos Int. 2010;21(12):1969-80. http://dx.doi.org/10.1007/s00198-010-1228-z. PMid:20407890.
http://dx.doi.org/10.1007/s00198-010-12...
10. Lau RW, Liao LR, Yu F, Teo T, Chung RC, Pang MY. The effects of whole body vibration therapy on bone mineral density and leg muscle strength in older adults: a systematic review and meta-analysis. Clin Rehabil. 2011;25(11):975-88. http://dx.doi.org/10.1177/0269215511405078. PMid:21849376.
http://dx.doi.org/10.1177/0269215511405...
11. Lam FM, Lau RW, Chung RC, Pang MY. The effect of whole body vibration on balance, mobility and falls in older adults: a systematic review and meta-analysis. Maturitas. 2012;72(3):206-13. http://dx.doi.org/10.1016/j.maturitas.2012.04.009. PMid:22609157.
http://dx.doi.org/10.1016/j.maturitas.2...
12. Chanou K, Gerodimos V, Karatrantou K, Jamurtas A. Whole-body vibration and rehabilitation of chronic diseases: a review of the literature. J Sports Sci Med. 2012;11(2):187-200. PMid:24149191.
13. Zafar H, Alghadir A, Anwer S, Al-Eisa E. Therapeutic effects of whole-body vibration training in knee osteoarthritis: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2015;96(8):1525-32. http://dx.doi.org/10.1016/j.apmr.2015.03.010. PMid:25827655.
http://dx.doi.org/10.1016/j.apmr.2015.0...
-1414. Yang X, Zhou Y, Wang P, He C, He H. Effects of whole body vibration on pulmonary function, functional exercise capacity and quality of life in people with chronic obstructive pulmonary disease: a systematic review. Clin Rehabil. 2015;2:0269215515589202. PMid:26038611. summarized the effects of WBV in some outcomes of specific populations as follows: improvements in bone mineral density in postmenopausal women99. Slatkovska L, Alibhai MH, Beyene J, Cheung AM. Effect of whole-body vibration on BMD: a systematic review and meta-analysis. Osteoporos Int. 2010;21(12):1969-80. http://dx.doi.org/10.1007/s00198-010-1228-z. PMid:20407890.
http://dx.doi.org/10.1007/s00198-010-12...
; leg muscle strength1010. Lau RW, Liao LR, Yu F, Teo T, Chung RC, Pang MY. The effects of whole body vibration therapy on bone mineral density and leg muscle strength in older adults: a systematic review and meta-analysis. Clin Rehabil. 2011;25(11):975-88. http://dx.doi.org/10.1177/0269215511405078. PMid:21849376.
http://dx.doi.org/10.1177/0269215511405...
and balance improvement in older individuals1111. Lam FM, Lau RW, Chung RC, Pang MY. The effect of whole body vibration on balance, mobility and falls in older adults: a systematic review and meta-analysis. Maturitas. 2012;72(3):206-13. http://dx.doi.org/10.1016/j.maturitas.2012.04.009. PMid:22609157.
http://dx.doi.org/10.1016/j.maturitas.2...
; balance, gait, and proprioception improvement in individuals with neurological conditions such as Parkinson's disease, multiple sclerosis, and stroke1212. Chanou K, Gerodimos V, Karatrantou K, Jamurtas A. Whole-body vibration and rehabilitation of chronic diseases: a review of the literature. J Sports Sci Med. 2012;11(2):187-200. PMid:24149191.; pain intensity decrease and physical function enhancement in individuals with knee osteoarthritis1313. Zafar H, Alghadir A, Anwer S, Al-Eisa E. Therapeutic effects of whole-body vibration training in knee osteoarthritis: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2015;96(8):1525-32. http://dx.doi.org/10.1016/j.apmr.2015.03.010. PMid:25827655.
http://dx.doi.org/10.1016/j.apmr.2015.0...
; and functional exercise capacity and quality of life improvement in people with chronic obstructive pulmonary disease1414. Yang X, Zhou Y, Wang P, He C, He H. Effects of whole body vibration on pulmonary function, functional exercise capacity and quality of life in people with chronic obstructive pulmonary disease: a systematic review. Clin Rehabil. 2015;2:0269215515589202. PMid:26038611.. Furthermore, WBV requires significantly less time than conventional training and, therefore, reached a satisfactory compliance in previously inactive patients1111. Lam FM, Lau RW, Chung RC, Pang MY. The effect of whole body vibration on balance, mobility and falls in older adults: a systematic review and meta-analysis. Maturitas. 2012;72(3):206-13. http://dx.doi.org/10.1016/j.maturitas.2012.04.009. PMid:22609157.
http://dx.doi.org/10.1016/j.maturitas.2...
.
Nevertheless, the effects of WBV in patients with T2DM were infrequently reported through a case report1515. Hong J, Barnes M, Kessler N. Case study: use of vibration therapy in the treatment of diabetic peripheral small fiber neuropathy. J Bodyw Mov Ther. 2013;17(2):235-8. http://dx.doi.org/10.1016/j.jbmt.2012.08.007. PMid:23561872.
http://dx.doi.org/10.1016/j.jbmt.2012.0...
and acute1616. Yoosefinejad AK, Shadmehr A, Olyaei G, Talebian S, Bagheri H. The effectiveness of a single session of whole-body vibration in improving the balance and the strength in type 2 diabetic patients with mild to moderate degree of peripheral neuropathy: a pilot study. J Bodyw Mov Ther. 2014;18(1):82-6. http://dx.doi.org/10.1016/j.jbmt.2013.10.007. PMid:24411154.
http://dx.doi.org/10.1016/j.jbmt.2013.1...
, crossover1717. Johnson PK, Feland JB, Johnson AW, Mack GW, Mitchell UH. Effect of whole body vibration on skin blood flow and nitric oxide production. J Diabetes Sci Technol. 2014;8(4):889-94. http://dx.doi.org/10.1177/1932296814536289. PMid:24876449.
http://dx.doi.org/10.1177/1932296814536...
, or pilot1818. Kessler NJ, Hong J. Whole body vibration therapy for painful diabetic peripheral neuropathy: a pilot study. J Bodyw Mov Ther. 2013;17(4):518-22. http://dx.doi.org/10.1016/j.jbmt.2013.03.001. PMid:24139013.
http://dx.doi.org/10.1016/j.jbmt.2013.0...
,1919. Baum K, Votteler T, Schiab J. Efficiency of vibration exercise for glycemic control in type 2 diabetes patients. Int J Med Sci. 2007;4(3):159-63. http://dx.doi.org/10.7150/ijms.4.159. PMid:17554399.
http://dx.doi.org/10.7150/ijms.4.159...
studies. In the last years, few randomized controlled trials were performed2020. Behboudi L, Azarbayjani MA, Aghaalinejad H, Salavati M. Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males. Asian J Sports Med. 2011;2(2):83-90. PMid:22375223.,2121. Sañudo B, Alfonso-Rosa R, Pozo-Cruz BD, Pozo-Cruz JD, Galiano D, Figueroa A. Whole body vibration training improves leg blood flow and adiposity in patients with type 2 diabetes mellitus. Eur J Appl Physiol. 2013;113(9):2245-52. http://dx.doi.org/10.1007/s00421-013-2654-3. PMid:23657766.
http://dx.doi.org/10.1007/s00421-013-26...
with conflicting results. To summarize the current evidence, we aimed carry out a systematic review of the effects of WBV intervention on the blood glucose levels, blood and physical cardiovascular risk factors, and physical and functional capacity of individuals with T2DM in comparison with a control or other intervention group.
Method
This systematic review was performed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions2222. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. London: The Cochrane Collaboration; 2011 [cited 2015 March 15]. Available from: www.cochrane-handbook.org.
www.cochrane-handbook.org...
and the recommendations of the Brazilian Journal of Physical Therapy tutorial2323. Mancini MC, Cardoso JR, Sampaio RS, Costa LCM, Cabral CMN, Costa LOP. Tutorial for writing systematic reviews for the Brazilian Journal of Physical Therapy (BJPT). Braz J Phys Ther. 2014;18(6):471-80. http://dx.doi.org/10.1590/bjpt-rbf.2014.0077. PMid:25590440.
http://dx.doi.org/10.1590/bjpt-rbf.2014...
. The protocol of this systematic review was prospectively registered at PROSPERO under the identification CRD42014010495 and can be assessed online2424. Robinson CC, Barreto RPG, Plentz RDM, Sbrizzi G. Effects of whole body vibration in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials. Heslington: Centre for Reviews and Dissemination, University of York. PROSPERO 2014:CRD42014010495 [cited 015 March 15]. Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014010495#.VBTsCpRdWSo.
http://www.crd.york.ac.uk/PROSPERO/displ...
.
Data sources and searches
Comprehensive literature searches were performed on the following electronic databases (from inception to June 1st, 2015): MEDLINE (accessed by PubMed), LILACS, Physiotherapy Evidence Database (PEDro), and Cochrane Central Register of Controlled Trials (Cochrane CENTRAL). The search terms included 'Whole body vibration', 'Diabetes' MeSH and synonyms, and a string of terms to optimize randomized controlled trial searches on PubMed2525. Robinson KA, Dickersin K. Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using Pub Med. Int J Epidemiol. 2002;31(1):150-3. http://dx.doi.org/10.1093/ije/31.1.150. PMid:11914311.
http://dx.doi.org/10.1093/ije/31.1.150...
. In order to improve sensitivity, outcomes were not included in the search strategy. The references list of the articles identified in these searches were used as an additional source to identify other potentially eligible trials. The search strategy used on PubMed database can be fully assessed online2626. University of York. Centre for Reviews and Dissemination - CRD. Heslington [cited 2015 March 15]. Available from: http://www.crd.york.ac.uk/PROSPEROFILES/10495_STRATEGY_20140602.pdf.
http://www.crd.york.ac.uk/PROSPEROFILES/...
.
Randomized controlled trials were considered eligible if they addressed the effects of WBV on blood glucose levels, blood and physical cardiovascular risk factors, and physical and functional capacity in adult patients with T2DM, with a minimum of four weeks intervention and at least a control group not performing WBV. We considered as the primary outcome blood glucose levels, assessed by 12-hours fasting blood glucose (12-h FBG) or glycated hemoglobin (HbA1c). The secondary outcomes were blood and physical cardiovascular risk factors (blood cholesterol and triglycerides, atherogenic index, body mass index, body composition, weight, waist circumference, waist to hip ratio, blood pressure, or heart hate) and physical and functional capacity (maximal oxygen uptake, six minute walk test (6MWT) distance, muscle strength, or static and dynamic postural balance). The exclusion criteria were studies that included individuals with stated diabetic complications (e.g. diabetic peripheral neuropathy, retinopathy, or nephropathy) and studies with an unreliable description of WBV.
Study selection
Two independent reviewers screened the titles and abstracts of all studies identified through the search strategies. A standard screening checklist based on the eligibility criteria was used for each study. Studies that did not meet the eligibility criteria, according to titles or abstracts, were excluded. The two independent reviewers retrieved full text versions of the remaining studies for a second review. There were no disagreements between reviewers.
Data extraction and quality assessment
Two reviewers independently extracted the data from the eligible studies by using a standardized data extraction form. The following data were extracted: authors; year of publication; number of individuals analyzed; gender; age; parameters of WBV and description of intervention; type of comparison; mean and standard deviation of pre and post assessments of each outcome available. From articles referred to the same participants, the article with the larger sample was considered and the article with the smaller sample was excluded if outcome measurements were duplicated. There were no disagreements between reviewers. HbA1c and 12-h FBG mean and standard deviation values were not available in one published study1414. Yang X, Zhou Y, Wang P, He C, He H. Effects of whole body vibration on pulmonary function, functional exercise capacity and quality of life in people with chronic obstructive pulmonary disease: a systematic review. Clin Rehabil. 2015;2:0269215515589202. PMid:26038611., but the authors informed these estimates by email.
The studies were assessed regarding methodological quality and statistical reporting using the PEDro scale2727. Shiwa SR, Costa LO, Costa LCM, Moseley A, Hespanhol Junior LC, Venâncio R, et al. Reproducibility of the Portuguese version of the PEDro Scale. Cad Saude Publica. 2011;27(10):2063-8. http://dx.doi.org/10.1590/S0102-311X2011001000019. PMid:22031210.
http://dx.doi.org/10.1590/S0102-311X201...
. When methodological quality assessment was not available on the PEDro database, two reviewers performed the ratings using the Brazilian Portuguese version of the PEDro scale2727. Shiwa SR, Costa LO, Costa LCM, Moseley A, Hespanhol Junior LC, Venâncio R, et al. Reproducibility of the Portuguese version of the PEDro Scale. Cad Saude Publica. 2011;27(10):2063-8. http://dx.doi.org/10.1590/S0102-311X2011001000019. PMid:22031210.
http://dx.doi.org/10.1590/S0102-311X201...
items. In addition, the quality of each article was evaluated based on the recommendation of the International Society of Musculoskeletal and Neuronal Interactions (ISMNI)2828. Rauch F, Sievanen H, Boonen S, Cardinale M, Degens H, Felsenberg D, et al. Reporting whole body vibration intervention studies: recommendations of the International Society of Musculoskeletal and Neuronal Interactions. J Musculoskelet Neuronal Interact. 2010;10(3):193-8. PMid:20811143. for reporting WBV intervention studies, consisting of 13 minimal reporting items about the WBV parameters and participant positioning. The instruments were rated independently by two reviewers. There were no disagreements between reviewers.
Data synthesis and analysis
After data extraction, if the outcome values could not be transformed into a common numeric scale for quantitative synthesis, a descriptive synthesis was performed. For quantitative synthesis, pooled-effect estimates were obtained by comparing the change from baseline to study end for intervention and control group. The procedures for estimation of missing data2222. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. London: The Cochrane Collaboration; 2011 [cited 2015 March 15]. Available from: www.cochrane-handbook.org.
www.cochrane-handbook.org...
were performed to obtain the standard deviation difference. Results were presented as weighted mean difference (WMD) with their respective 95% confidence intervals (CI). Meta-analysis was performed using the random effects model. The statistical heterogeneity among studies was assessed using Cochran's Q test and the inconsistency I22. Hayashino Y, Jackson JL, Fukumori N, Nakamura F, Fukuhara S. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2012;98(3):349-60. http://dx.doi.org/10.1016/j.diabres.2012.10.004. PMid:23116535.
http://dx.doi.org/10.1016/j.diabres.201...
test, in which values above 25% and 50% were considered as indicatives of moderate and high heterogeneity, respectively. Sensitivity analysis was not possible given the number of available studies, therefore when I22. Hayashino Y, Jackson JL, Fukumori N, Nakamura F, Fukuhara S. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2012;98(3):349-60. http://dx.doi.org/10.1016/j.diabres.2012.10.004. PMid:23116535.
http://dx.doi.org/10.1016/j.diabres.201...
>25%, meta-analysis was not considered. A p value lower than 0.05 was considered statistically significant. All analyses were conducted using Review Manager, version 5.2.
Results
Description of studies
The search strategy yielded 585 articles. From these, eight1616. Yoosefinejad AK, Shadmehr A, Olyaei G, Talebian S, Bagheri H. The effectiveness of a single session of whole-body vibration in improving the balance and the strength in type 2 diabetic patients with mild to moderate degree of peripheral neuropathy: a pilot study. J Bodyw Mov Ther. 2014;18(1):82-6. http://dx.doi.org/10.1016/j.jbmt.2013.10.007. PMid:24411154.
http://dx.doi.org/10.1016/j.jbmt.2013.1...
,1919. Baum K, Votteler T, Schiab J. Efficiency of vibration exercise for glycemic control in type 2 diabetes patients. Int J Med Sci. 2007;4(3):159-63. http://dx.doi.org/10.7150/ijms.4.159. PMid:17554399.
http://dx.doi.org/10.7150/ijms.4.159...
20. Behboudi L, Azarbayjani MA, Aghaalinejad H, Salavati M. Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males. Asian J Sports Med. 2011;2(2):83-90. PMid:22375223.-2121. Sañudo B, Alfonso-Rosa R, Pozo-Cruz BD, Pozo-Cruz JD, Galiano D, Figueroa A. Whole body vibration training improves leg blood flow and adiposity in patients with type 2 diabetes mellitus. Eur J Appl Physiol. 2013;113(9):2245-52. http://dx.doi.org/10.1007/s00421-013-2654-3. PMid:23657766.
http://dx.doi.org/10.1007/s00421-013-26...
,2929. Lee K, Lee S, Song C. Whole-body vibration training improves balance, muscle strength and glycosylated hemoglobin in elderly patients with diabetic neuropathy. Tohoku J Exp Med. 2013;231(4):305-14. http://dx.doi.org/10.1620/tjem.231.305. PMid:24334483.
http://dx.doi.org/10.1620/tjem.231.305...
30. Azarbayjani MA, Behboudi L, Aghaalinejad H, Salavati M. Comparative effects of aerobic training and whole body vibration on plasma adiponectin and insulin resistance in type 2 diabetic men. Ann Biol Res. 2011;2(5):671-80.
31. Del Pozo-Cruz J, Alfonso-Rosa RM, Ugia JL, McVeigh JG, Pozo-Cruz BD, Sañudo B. A primary care based randomized controlled trial of 12-week whole-body vibration for balance improvement in type 2 diabetes mellitus. Arch Phys Med Rehabil. 2013;94(11):2112-8. http://dx.doi.org/10.1016/j.apmr.2013.05.030. PMid:23811317.
http://dx.doi.org/10.1016/j.apmr.2013.0...
-3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
http://dx.doi.org/10.1016/j.maturitas.2...
were considered as potentially relevant and retrieved for a detailed analysis. After full text reading, four articles were excluded. As three articles2121. Sañudo B, Alfonso-Rosa R, Pozo-Cruz BD, Pozo-Cruz JD, Galiano D, Figueroa A. Whole body vibration training improves leg blood flow and adiposity in patients with type 2 diabetes mellitus. Eur J Appl Physiol. 2013;113(9):2245-52. http://dx.doi.org/10.1007/s00421-013-2654-3. PMid:23657766.
http://dx.doi.org/10.1007/s00421-013-26...
,3131. Del Pozo-Cruz J, Alfonso-Rosa RM, Ugia JL, McVeigh JG, Pozo-Cruz BD, Sañudo B. A primary care based randomized controlled trial of 12-week whole-body vibration for balance improvement in type 2 diabetes mellitus. Arch Phys Med Rehabil. 2013;94(11):2112-8. http://dx.doi.org/10.1016/j.apmr.2013.05.030. PMid:23811317.
http://dx.doi.org/10.1016/j.apmr.2013.0...
,3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
http://dx.doi.org/10.1016/j.maturitas.2...
referred to the same original study (clinical trial register: ACTRN12613000021774), they were considered as a single study. From this, two studies reporting outcomes on four different articles2020. Behboudi L, Azarbayjani MA, Aghaalinejad H, Salavati M. Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males. Asian J Sports Med. 2011;2(2):83-90. PMid:22375223.,2121. Sañudo B, Alfonso-Rosa R, Pozo-Cruz BD, Pozo-Cruz JD, Galiano D, Figueroa A. Whole body vibration training improves leg blood flow and adiposity in patients with type 2 diabetes mellitus. Eur J Appl Physiol. 2013;113(9):2245-52. http://dx.doi.org/10.1007/s00421-013-2654-3. PMid:23657766.
http://dx.doi.org/10.1007/s00421-013-26...
,3131. Del Pozo-Cruz J, Alfonso-Rosa RM, Ugia JL, McVeigh JG, Pozo-Cruz BD, Sañudo B. A primary care based randomized controlled trial of 12-week whole-body vibration for balance improvement in type 2 diabetes mellitus. Arch Phys Med Rehabil. 2013;94(11):2112-8. http://dx.doi.org/10.1016/j.apmr.2013.05.030. PMid:23811317.
http://dx.doi.org/10.1016/j.apmr.2013.0...
,3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
http://dx.doi.org/10.1016/j.maturitas.2...
were included in this systematic review. Figure 1 shows the flow diagram of the studies and Table 1 summarizes their characteristics.
A total of 70 participants with T2DM were assessed. The year of publication of the included studies ranged from 2011 to 2014. Both the studies included individuals with T2DM diagnosis and excluded those with established diabetes complications and HbA1c>10% or fasting blood glucose >250 ml/dl. Age ranged from adult to elderly classification and only males were included by Behboudi et al.2020. Behboudi L, Azarbayjani MA, Aghaalinejad H, Salavati M. Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males. Asian J Sports Med. 2011;2(2):83-90. PMid:22375223. while the other study2121. Sañudo B, Alfonso-Rosa R, Pozo-Cruz BD, Pozo-Cruz JD, Galiano D, Figueroa A. Whole body vibration training improves leg blood flow and adiposity in patients with type 2 diabetes mellitus. Eur J Appl Physiol. 2013;113(9):2245-52. http://dx.doi.org/10.1007/s00421-013-2654-3. PMid:23657766.
http://dx.doi.org/10.1007/s00421-013-26...
,3131. Del Pozo-Cruz J, Alfonso-Rosa RM, Ugia JL, McVeigh JG, Pozo-Cruz BD, Sañudo B. A primary care based randomized controlled trial of 12-week whole-body vibration for balance improvement in type 2 diabetes mellitus. Arch Phys Med Rehabil. 2013;94(11):2112-8. http://dx.doi.org/10.1016/j.apmr.2013.05.030. PMid:23811317.
http://dx.doi.org/10.1016/j.apmr.2013.0...
,3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
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included both genders. All of the studies randomly allocated the individuals to a control group without additional intervention, keeping normal daily activities and medical instructions. In addition, Behboudi et al.2020. Behboudi L, Azarbayjani MA, Aghaalinejad H, Salavati M. Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males. Asian J Sports Med. 2011;2(2):83-90. PMid:22375223. randomly allocated individuals to a third group that performed an increasing aerobic exercise (AE) program only.
Regarding WBV intervention, both studies2020. Behboudi L, Azarbayjani MA, Aghaalinejad H, Salavati M. Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males. Asian J Sports Med. 2011;2(2):83-90. PMid:22375223.,2121. Sañudo B, Alfonso-Rosa R, Pozo-Cruz BD, Pozo-Cruz JD, Galiano D, Figueroa A. Whole body vibration training improves leg blood flow and adiposity in patients with type 2 diabetes mellitus. Eur J Appl Physiol. 2013;113(9):2245-52. http://dx.doi.org/10.1007/s00421-013-2654-3. PMid:23657766.
http://dx.doi.org/10.1007/s00421-013-26...
,3131. Del Pozo-Cruz J, Alfonso-Rosa RM, Ugia JL, McVeigh JG, Pozo-Cruz BD, Sañudo B. A primary care based randomized controlled trial of 12-week whole-body vibration for balance improvement in type 2 diabetes mellitus. Arch Phys Med Rehabil. 2013;94(11):2112-8. http://dx.doi.org/10.1016/j.apmr.2013.05.030. PMid:23811317.
http://dx.doi.org/10.1016/j.apmr.2013.0...
,3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
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applied an intermittent exposure to WBV and acceleration and frequency parameters were very similar. Studies kept peak acceleration between 1 and 2 g (units of gravity; 1g=1 m.s-22. Hayashino Y, Jackson JL, Fukumori N, Nakamura F, Fukuhara S. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2012;98(3):349-60. http://dx.doi.org/10.1016/j.diabres.2012.10.004. PMid:23116535.
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). In Behboudi et al.2020. Behboudi L, Azarbayjani MA, Aghaalinejad H, Salavati M. Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males. Asian J Sports Med. 2011;2(2):83-90. PMid:22375223., the peak acceleration was influenced mainly by higher vibration frequencies and lower amplitude, but in Sañudo et al.2121. Sañudo B, Alfonso-Rosa R, Pozo-Cruz BD, Pozo-Cruz JD, Galiano D, Figueroa A. Whole body vibration training improves leg blood flow and adiposity in patients with type 2 diabetes mellitus. Eur J Appl Physiol. 2013;113(9):2245-52. http://dx.doi.org/10.1007/s00421-013-2654-3. PMid:23657766.
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and Del Pozo-Cruz et al.3131. Del Pozo-Cruz J, Alfonso-Rosa RM, Ugia JL, McVeigh JG, Pozo-Cruz BD, Sañudo B. A primary care based randomized controlled trial of 12-week whole-body vibration for balance improvement in type 2 diabetes mellitus. Arch Phys Med Rehabil. 2013;94(11):2112-8. http://dx.doi.org/10.1016/j.apmr.2013.05.030. PMid:23811317.
http://dx.doi.org/10.1016/j.apmr.2013.0...
,3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
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, higher amplitude and lower vibration frequencies determined the peak acceleration.
Both the studies proposed a thrice-weekly intervention of WBV with total session duration increasing progressively from 12 (8-16) to 14 (16-24) minutes. All of the studies designed protocols in which individuals stood on the vibrating platform in a 100 to 110° squat position (considering total knee extension as 180°) and the vibratory stimulus was not isolated. Behboudi et al.2020. Behboudi L, Azarbayjani MA, Aghaalinejad H, Salavati M. Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males. Asian J Sports Med. 2011;2(2):83-90. PMid:22375223. proposed WBV in addition to an increasing AE program (WBV+AE) with a follow-up after eight weeks. The study reported by Sañudo et al.2121. Sañudo B, Alfonso-Rosa R, Pozo-Cruz BD, Pozo-Cruz JD, Galiano D, Figueroa A. Whole body vibration training improves leg blood flow and adiposity in patients with type 2 diabetes mellitus. Eur J Appl Physiol. 2013;113(9):2245-52. http://dx.doi.org/10.1007/s00421-013-2654-3. PMid:23657766.
http://dx.doi.org/10.1007/s00421-013-26...
and Del Pozo-Cruz et al.3131. Del Pozo-Cruz J, Alfonso-Rosa RM, Ugia JL, McVeigh JG, Pozo-Cruz BD, Sañudo B. A primary care based randomized controlled trial of 12-week whole-body vibration for balance improvement in type 2 diabetes mellitus. Arch Phys Med Rehabil. 2013;94(11):2112-8. http://dx.doi.org/10.1016/j.apmr.2013.05.030. PMid:23811317.
http://dx.doi.org/10.1016/j.apmr.2013.0...
,3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
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proposed a protocol of lower and upper limb exercises performed on the vibrating platform with a follow up after 12 weeks.
No adverse effects were reported in any of the studies. Loss of follow-up occurred only in the assessment after 12 weeks2121. Sañudo B, Alfonso-Rosa R, Pozo-Cruz BD, Pozo-Cruz JD, Galiano D, Figueroa A. Whole body vibration training improves leg blood flow and adiposity in patients with type 2 diabetes mellitus. Eur J Appl Physiol. 2013;113(9):2245-52. http://dx.doi.org/10.1007/s00421-013-2654-3. PMid:23657766.
http://dx.doi.org/10.1007/s00421-013-26...
,3131. Del Pozo-Cruz J, Alfonso-Rosa RM, Ugia JL, McVeigh JG, Pozo-Cruz BD, Sañudo B. A primary care based randomized controlled trial of 12-week whole-body vibration for balance improvement in type 2 diabetes mellitus. Arch Phys Med Rehabil. 2013;94(11):2112-8. http://dx.doi.org/10.1016/j.apmr.2013.05.030. PMid:23811317.
http://dx.doi.org/10.1016/j.apmr.2013.0...
,3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
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, in which five participants from the control group dropped out because of lack of interest. Six participants from the intervention group dropped out because of lack of time (five participants) and change of home address (one participant). Participants attended more than 75% of the sessions in both trials2020. Behboudi L, Azarbayjani MA, Aghaalinejad H, Salavati M. Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males. Asian J Sports Med. 2011;2(2):83-90. PMid:22375223.,2121. Sañudo B, Alfonso-Rosa R, Pozo-Cruz BD, Pozo-Cruz JD, Galiano D, Figueroa A. Whole body vibration training improves leg blood flow and adiposity in patients with type 2 diabetes mellitus. Eur J Appl Physiol. 2013;113(9):2245-52. http://dx.doi.org/10.1007/s00421-013-2654-3. PMid:23657766.
http://dx.doi.org/10.1007/s00421-013-26...
,3131. Del Pozo-Cruz J, Alfonso-Rosa RM, Ugia JL, McVeigh JG, Pozo-Cruz BD, Sañudo B. A primary care based randomized controlled trial of 12-week whole-body vibration for balance improvement in type 2 diabetes mellitus. Arch Phys Med Rehabil. 2013;94(11):2112-8. http://dx.doi.org/10.1016/j.apmr.2013.05.030. PMid:23811317.
http://dx.doi.org/10.1016/j.apmr.2013.0...
,3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
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.
Overall, the methodological quality assessed by the PEDro scale was low to moderate (Table 2). Table 3 shows the quality of each article based on the recommendation of the ISMNI2828. Rauch F, Sievanen H, Boonen S, Cardinale M, Degens H, Felsenberg D, et al. Reporting whole body vibration intervention studies: recommendations of the International Society of Musculoskeletal and Neuronal Interactions. J Musculoskelet Neuronal Interact. 2010;10(3):193-8. PMid:20811143. for reporting WBV intervention studies.
Blood glucose levels
For 12-h FBG, meta-analysis was performed and included data of two trials2020. Behboudi L, Azarbayjani MA, Aghaalinejad H, Salavati M. Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males. Asian J Sports Med. 2011;2(2):83-90. PMid:22375223.,3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
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with a total of 59 patients (29 of which were on WBV). The comparison groups did not perform any intervention. There was an improvement in 12-h FBG by reduction in 25.7 ml/dl (95% CI: -45.3 to -6.1; I22. Hayashino Y, Jackson JL, Fukumori N, Nakamura F, Fukuhara S. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2012;98(3):349-60. http://dx.doi.org/10.1016/j.diabres.2012.10.004. PMid:23116535.
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: 19%), favoring WBV intervention (Figure 2A). There was no additional effect (p=0.09) of WBV to an eight-week increasing AE program regarding 12-h FBG, but both the groups (WBV+AE and AE only) presented significantly lower 12-h FBG levels (p=0.02) than the control group2020. Behboudi L, Azarbayjani MA, Aghaalinejad H, Salavati M. Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males. Asian J Sports Med. 2011;2(2):83-90. PMid:22375223..
(A) The mean difference and 95% confidence interval (CI) of 12-hour fasting blood glucose in ml/dl for treatment with WBV (experimental) versus comparator (control); (B) Mean difference and 95% confidence interval (CI) of body mass index in Kg/cm2 for treatment with WBV (experimental) versus comparator (control).
Regarding HbA1c, a meta-analysis was not considered given an I22. Hayashino Y, Jackson JL, Fukumori N, Nakamura F, Fukuhara S. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2012;98(3):349-60. http://dx.doi.org/10.1016/j.diabres.2012.10.004. PMid:23116535.
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of 80% between studies. After the 12-week program of upper and lower limb exercises performed on the vibrating platform, participants in the intervention group exhibited significantly lower levels of HbA1c (p=0.002) at the time of follow-up when compared to the control group, with a mean difference of −0.55% (95% CI: −0.15 to −0.76)3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
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. The eight-week WBV+AE program was not sufficient to promote a significant difference in HbA1c levels compared to the control group. Furthermore, there was no additional effect of WBV on the eight-week AE program as no significant difference in HbA1c levels was found between WBV+AE and AE only. Both intervention groups did not differ significantly from controls.
Blood and physical cardiovascular risk factors
Regarding secondary outcomes, a meta-analysis was only possible for Body Mass Index (BMI). Data of two studies2020. Behboudi L, Azarbayjani MA, Aghaalinejad H, Salavati M. Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males. Asian J Sports Med. 2011;2(2):83-90. PMid:22375223.,3131. Del Pozo-Cruz J, Alfonso-Rosa RM, Ugia JL, McVeigh JG, Pozo-Cruz BD, Sañudo B. A primary care based randomized controlled trial of 12-week whole-body vibration for balance improvement in type 2 diabetes mellitus. Arch Phys Med Rehabil. 2013;94(11):2112-8. http://dx.doi.org/10.1016/j.apmr.2013.05.030. PMid:23811317.
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with a total of 59 patients (29 of which were on WBV) were included and comparison groups did not perform any intervention. A non-significant decrease of 0.67 Kg.cm-22. Hayashino Y, Jackson JL, Fukumori N, Nakamura F, Fukuhara S. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2012;98(3):349-60. http://dx.doi.org/10.1016/j.diabres.2012.10.004. PMid:23116535.
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(95% CI:-2.21 to 0.87; I22. Hayashino Y, Jackson JL, Fukumori N, Nakamura F, Fukuhara S. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2012;98(3):349-60. http://dx.doi.org/10.1016/j.diabres.2012.10.004. PMid:23116535.
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: 8%) in BMI was observed (Figure 2B).
After the 12-week program of upper and lower exercises performed on the vibrating platform, a significant decrease (p<0.050) was found in cholesterol, triglycerides, atherogenic index3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
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, weight, waist circumference, waist-to-hip ratio, and body fat percentage2121. Sañudo B, Alfonso-Rosa R, Pozo-Cruz BD, Pozo-Cruz JD, Galiano D, Figueroa A. Whole body vibration training improves leg blood flow and adiposity in patients with type 2 diabetes mellitus. Eur J Appl Physiol. 2013;113(9):2245-52. http://dx.doi.org/10.1007/s00421-013-2654-3. PMid:23657766.
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compared to the control group. However, no statistically significant changes were detected for high-density lipoprotein (LDL), low-density lipoprotein (LDL), or LDL/HDL3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
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. After the eight week WBV+AE program, no significant differences in body fat percentage were found compared to the control group or compared to the AE group2020. Behboudi L, Azarbayjani MA, Aghaalinejad H, Salavati M. Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males. Asian J Sports Med. 2011;2(2):83-90. PMid:22375223..
Physical and functional capacity
Improvements (p<0.05) were found in the 6MWT distance and muscle strength assessed by the 30-second Sit-to-Stand (30s-STS) test after the 12-week WBV program with upper and lower limb exercises compared with the control group. Regarding static balance, the same comparison showed a significant decrease in center of pressure excursions with eyes closed (feet apart and together), but TUG time did not improve significantly3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
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. Although maximal oxygen uptake increased significantly (p=0.01) after the eight-week WBV+AE and AE only programs, WBV had no additional effect on AE (p=0.3)2020. Behboudi L, Azarbayjani MA, Aghaalinejad H, Salavati M. Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males. Asian J Sports Med. 2011;2(2):83-90. PMid:22375223..
Discussion
Summary of evidence
It seems that the 12-week progressive intervention with WBV and exercise was sufficient for a statistically significant, but slight improvement in the 12-h FBG and HbA1c of individuals with T2DM, in comparison with no intervention. Furthermore, the eight-week intervention improved 12-h FBG, but did not improve HbA1c.
Because erythrocytes are freely permeable to glucose, the level of HbA1c in a blood sample provides a glycemic history of the previous 120 days, the average erythrocyte lifespan3333. Goldstein DE, Little RR, Lorenz RA, Malone JI, Nathan DM, Peterson CM, et al. Tests of glycemia in diabetes. Diabetes Care. 2004;27(7):1761-73. http://dx.doi.org/10.2337/diacare.27.7.1761. PMid:15220264.
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. It is possible that a period of eight weeks was not enough to reach modifications in blood glucose profile, as no significant alterations were found in the WBV+AE or AE only programs.
The effect size for HbA1c improvement discovered after the 12-week progressive intervention with WBV and exercise was close to the one found after aerobic or resistance training reported previously in two meta analyses3434. Umpierre D, Ribeiro PA, Schaan BD, Ribeiro JP. Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia. 2013;56(2):242-51. http://dx.doi.org/10.1007/s00125-012-2774-z. PMid:23160642.
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,3535. Chudyk A, Petrella R. Effects of exercise on cardiovascular risk factors in type 2 diabetes. Diabetes Care. 2011;34(5):1228-37. http://dx.doi.org/10.2337/dc10-1881. PMid:21525503.
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. Although the vibratory stimulation was not isolated from exercises in the proposed interventions, session duration was considerably lower in the WBV studies (8 to 24 minutes) than in the aerobic or resistance training studies (40 to 75 minutes)3434. Umpierre D, Ribeiro PA, Schaan BD, Ribeiro JP. Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia. 2013;56(2):242-51. http://dx.doi.org/10.1007/s00125-012-2774-z. PMid:23160642.
http://dx.doi.org/10.1007/s00125-012-27...
,3535. Chudyk A, Petrella R. Effects of exercise on cardiovascular risk factors in type 2 diabetes. Diabetes Care. 2011;34(5):1228-37. http://dx.doi.org/10.2337/dc10-1881. PMid:21525503.
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. This fact corroborates other studies that found similar results in WBV application compared conventional intervention, but in a shorter time of exposure3636. Delecluse C, Roelants M, Verschueren S. Strength increase after whole-body vibration compared with resistance training. Med Sci Sports Exerc. 2003;35(6):1033-41. http://dx.doi.org/10.1249/01.MSS.0000069752.96438.B0. PMid:12783053.
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37. Roelants M, Delecluse C, Goris M, Verschueren S. Effects of 24 weeks of whole body vibration training on body composition and muscle strength in untrained females. Int J Sports Med. 2004;25(1):1-5. http://dx.doi.org/10.1055/s-2003-45238. PMid:14750005.
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-3838. Bogaerts A, Delecluse C, Claessens AL, Coudyzer W, Boonen S, Verschueren SM. Impact of whole-body vibration training versus fitness training on muscle strength and muscle mass in older men: a 1-year randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2007;62(6):630-5. http://dx.doi.org/10.1093/gerona/62.6.630. PMid:17595419.
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.
The meta-analysis for BMI found no significant decrease after the WBV interventions. According to Cochrane3939. Cochrane DJ. Is vibration exercise a useful addition to a weight management program? Scand J Med Sci Sports. 2012;22(6):705-13. http://dx.doi.org/10.1111/j.1600-0838.2011.01411.x. PMid:22092513.
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, although WBV has gained popularity as a modality for weight loss, it does not have the ability to generate large energy expenditure to substitute conventional aerobic exercise. However, it had positive effects on blood flow3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
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,4040. Kerschan-Schindl K, Grampp S, Henk C, Resch H, Preisinger E, Fialka-Moser V, et al. Whole-body vibration exercise leads to alterations in muscle blood volume. Clin Physiol. 2001;21(3):377-82. http://dx.doi.org/10.1046/j.1365-2281.2001.00335.x. PMid:11380538.
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that could indirectly improve associated diseases such as hypertension. In fact, this could be seen in some of the blood and physical markers of cardiovascular risk (cholesterol, triglycerides, atherogenic index, body weight, waist circumference, and waist-to-hip ratio) that improved after 12 weeks of progressive intervention with WBV combined with exercises3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
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.
It seems that an eight-week WBV intervention was not enough to reach significant improvements in the aerobic capacity2020. Behboudi L, Azarbayjani MA, Aghaalinejad H, Salavati M. Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males. Asian J Sports Med. 2011;2(2):83-90. PMid:22375223. of patients with T2DM. In contrast, the 12-week progressive intervention with WBV and exercise improved aerobic capacity measured by the 6MWT distance, with similar values to those found in a multi-center study on fitness among healthy elderly subjects4141. Pedrero-Chamizo R, Gómez-Cabello A, Delgado S, Rodríguez-Llarena S, Rodríguez-Marroyo JA, Cabanillas E, et al. Physical fitness levels among independent non-institutionalized Spanish elderly: the elderly EXERNET multi-center study. Arch Gerontol Geriatr. 2012;55(2):406-16. http://dx.doi.org/10.1016/j.archger.2012.02.004. PMid:22424779.
http://dx.doi.org/10.1016/j.archger.201...
. The same improvement was found in lower limb strength measured through the 30s-STS. It is possible that the time of exposure in patients with T2DM must be greater than that required for the non-diabetic population. For example, a previous meta-analysis found a significant beneficial effect of WBV on lower limb strength of elderly subjects with a treatment effect comparable to other forms of active exercises (e.g. resistance training) within six to 10 weeks1010. Lau RW, Liao LR, Yu F, Teo T, Chung RC, Pang MY. The effects of whole body vibration therapy on bone mineral density and leg muscle strength in older adults: a systematic review and meta-analysis. Clin Rehabil. 2011;25(11):975-88. http://dx.doi.org/10.1177/0269215511405078. PMid:21849376.
http://dx.doi.org/10.1177/0269215511405...
.
Limitations and conclusions
This is the first systematic review to synthesize the effects of these outcomes in individuals with T2DM after WBV interventions. Analysis from data extraction of this systematic review was limited by the small number of available trials and duplicated articles. Furthermore, results from this systematic review must be interpreted with caution as most of the trials have some methodological limitations such as lack of concealed allocation and intention-to-treat analysis. Regarding the minimal items required for WBV intervention reproducibility, clear reporting is still necessary of the type of vibration, whether amplitude displacement was peak-to-peak, the peak acceleration, whether and how accuracy of vibration parameter were assessed, whether and how skidding of the feet were avoided, what was the rationale for choosing specific vibration parameters, whether and what support devices were used during vibration exposure and whether the type of footwear was controlled. Failing to report those items impairs protocol reproducibility as well as protocol comparison2828. Rauch F, Sievanen H, Boonen S, Cardinale M, Degens H, Felsenberg D, et al. Reporting whole body vibration intervention studies: recommendations of the International Society of Musculoskeletal and Neuronal Interactions. J Musculoskelet Neuronal Interact. 2010;10(3):193-8. PMid:20811143..
Despite the slight beneficial effect of WBV intervention on glycemic control, a paramount outcome for T2DM management, caution is required in extrapolating this result to practice. First, a significant reduction in glycemic values was found in comparison with no intervention and WBV was not investigated alone, but in addition to exercise. Similar caution must be taken regarding blood markers and functional capacity. Even if WBV parameters were very similar between studies, the combined exercises differed between studies and follow-up was also distinct, which may have influenced pooled effects and heterogeneity. It is necessary to highlight that these implications should only be considered for patients with T2DM without reported complications or contraindications for WBV exposure as well as glycemic profile <10% for HbA1C or <250 mg/dl for 12-h FBG. Furthermore, it seems that effectiveness of WBV is exposure-related as the 12-week intervention presented the better results.
Similarly to other studies that used WBV as an intervention in sedentary or elderly individuals1010. Lau RW, Liao LR, Yu F, Teo T, Chung RC, Pang MY. The effects of whole body vibration therapy on bone mineral density and leg muscle strength in older adults: a systematic review and meta-analysis. Clin Rehabil. 2011;25(11):975-88. http://dx.doi.org/10.1177/0269215511405078. PMid:21849376.
http://dx.doi.org/10.1177/0269215511405...
, there was good adherence and compliance in the 8-week and 12-week follow-up assessments. There was similar loss of follow-up in the intervention and control groups in the 12-week WBV program related to personal reasons2121. Sañudo B, Alfonso-Rosa R, Pozo-Cruz BD, Pozo-Cruz JD, Galiano D, Figueroa A. Whole body vibration training improves leg blood flow and adiposity in patients with type 2 diabetes mellitus. Eur J Appl Physiol. 2013;113(9):2245-52. http://dx.doi.org/10.1007/s00421-013-2654-3. PMid:23657766.
http://dx.doi.org/10.1007/s00421-013-26...
,3131. Del Pozo-Cruz J, Alfonso-Rosa RM, Ugia JL, McVeigh JG, Pozo-Cruz BD, Sañudo B. A primary care based randomized controlled trial of 12-week whole-body vibration for balance improvement in type 2 diabetes mellitus. Arch Phys Med Rehabil. 2013;94(11):2112-8. http://dx.doi.org/10.1016/j.apmr.2013.05.030. PMid:23811317.
http://dx.doi.org/10.1016/j.apmr.2013.0...
,3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
http://dx.doi.org/10.1016/j.maturitas.2...
. Adverse effects, such as hypoglycemia, discomfort, and musculoskeletal injuries, are highly reported in studies performing exercise interventions3434. Umpierre D, Ribeiro PA, Schaan BD, Ribeiro JP. Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia. 2013;56(2):242-51. http://dx.doi.org/10.1007/s00125-012-2774-z. PMid:23160642.
http://dx.doi.org/10.1007/s00125-012-27...
, however they were not reported in the studies included in this systematic review2020. Behboudi L, Azarbayjani MA, Aghaalinejad H, Salavati M. Effects of aerobic exercise and whole body vibration on glycaemia control in type 2 diabetic males. Asian J Sports Med. 2011;2(2):83-90. PMid:22375223.,2121. Sañudo B, Alfonso-Rosa R, Pozo-Cruz BD, Pozo-Cruz JD, Galiano D, Figueroa A. Whole body vibration training improves leg blood flow and adiposity in patients with type 2 diabetes mellitus. Eur J Appl Physiol. 2013;113(9):2245-52. http://dx.doi.org/10.1007/s00421-013-2654-3. PMid:23657766.
http://dx.doi.org/10.1007/s00421-013-26...
,3131. Del Pozo-Cruz J, Alfonso-Rosa RM, Ugia JL, McVeigh JG, Pozo-Cruz BD, Sañudo B. A primary care based randomized controlled trial of 12-week whole-body vibration for balance improvement in type 2 diabetes mellitus. Arch Phys Med Rehabil. 2013;94(11):2112-8. http://dx.doi.org/10.1016/j.apmr.2013.05.030. PMid:23811317.
http://dx.doi.org/10.1016/j.apmr.2013.0...
,3232. Del Pozo-Cruz B, Alfonso-Rosa RM, Pozo-Cruz JD, Sañudo B, Rogers ME. Effects of a 12-wk whole-body vibration based intervention to improve type 2 diabetes. Maturitas. 2014;77(1):52-8. http://dx.doi.org/10.1016/j.maturitas.2013.09.005. PMid:24094494.
http://dx.doi.org/10.1016/j.maturitas.2...
.
WBV performed close to the parameters presented in the primary studies and combined with low-level exercises seems to be a safe, feasible, and less time consuming intervention to help improve the glycemic control, cardiovascular risk markers, and functional capacity of individuals with T2DM in an exposure-dependent way compared to no intervention. However, given the methodological weaknesses of the primary studies and the heterogeneous protocols, confidence is limited on the decreasing effect of WBV on 12-h FBG. Further well-designed trials are still required to strengthen the current evidence and clarify whether the effect should be attributed to vibration, exercise, or the combination of both.
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41Pedrero-Chamizo R, Gómez-Cabello A, Delgado S, Rodríguez-Llarena S, Rodríguez-Marroyo JA, Cabanillas E, et al. Physical fitness levels among independent non-institutionalized Spanish elderly: the elderly EXERNET multi-center study. Arch Gerontol Geriatr. 2012;55(2):406-16. http://dx.doi.org/10.1016/j.archger.2012.02.004 PMid:22424779.
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Publication Dates
-
Publication in this collection
17 Nov 2015 -
Date of issue
Jan-Feb 2016
History
-
Received
08 Mar 2015 -
Reviewed
04 Apr 2015 -
Accepted
24 June 2015