Whole-body vibration training – better care for COPD patients: a systematic review and meta-analysis

Figures & data

Table 1 Characteristics of the included RCTs

Study	WBVT group	Control group	Inclusion criteria	WBVT application	WBVT mode and settings	WBVT-related adverse events	WBVT exercise training regime	Findings
Gloeckl et al,^Citation7 2012	36 Age: 64±1 1 FEV1 (% pred): 39±1 1	36 Age: 65±7 FEV1 (% pred): 38±1 2	1) Assured diagnosis of COPD stage III or IV according to GOLD, 2) given written informed consent	9 sessions (3 sessions/week for 3 weeks)	Side-alternating WBVT platform, 24–26 Hz, 6 mm peak-to-peak displacement	None reported	WBVT group: 3×3 minutes of self-paced dynamic squatting exercise during WBVT Control group: 3×3 minutes of self-paced dynamic squatting exercise on the floor without WBVT	WBVT seems to be a promising new exercise modality for patients with COPD and may enhance the effects of a multidisciplinary rehabilitation program
Pleguezuelos et al,^Citation10 2013	26 Age: 68.4±8.9 FEV1 (% pred): 37.11±11.9	25 Age: 71.3±8 FEV1 (% pred): 32.0±6.8	1) Severe COPD defined as FEV/FVC C0.7/FEV1 <50% predicted, 2) stable disease, 3) hospital admission or change in treatment in the previous 3 months	18 sessions (3 sessions/week for 6 weeks)	Side-alternating WBVT platform, 35 Hz, 2 mm peak-to-peak displacement	Nonereported	WBVT group: six series, of four 30 seconds repetitions with 60 seconds of rest between each series Control group: 30 minutes of moderate intensity daily walking	WBVT significantly improved the functional capacity of severe COPD patients
Greulich et al,^Citation9 2014	20 Age: 66.4±9.93 FEV1 (% pred): 32.71 ± 13.18	20 Age: 70.4± 10.1 FEV1 (% pred): 38.4± 17.82	1) Hospitalized due to severe COPD exacerbations, 2) pneumonia was ruled out by chest X-ray	Related to hospitalized days	Not mentioned	None reported	WBVT group: supervised manner 3×2 min/d on the vibrating platform with physiotherapy program Control group: physiotherapy program (5 minutes mobilization, 5 minutes passive movement, and 10 minutes respiratory exercises)	WBVT is safe, feasible, and may exhibit positive effects on clinical parameters in COPD patients hospitalized due to an exacerbation of their underlying disease
Braz Junior et al,^Citation6 2015	11 Age: 62.9±8.82 FEV1 (% pred): 14.63± 11.14		1) Diagnosis of COPD according to GOLD, 2) FEV1 <30% predicted, 3) stable disease, 4) smoking history, environmental or occupational exposure to pollutants, former smoker for at least 1 year, 5) a sedentary lifestyle and preserved cognitive functioning	36 sessions (3 sessions/12 week)	Side-alternating WBVT platform, 35 Hz, 2 mm (low intensity)/4 mm (high-intensity) peak- to-peak displacement	None reported	WBVT group: 30 seconds of semi-squatting training interspersed with 60 seconds of standing rest. 60 seconds of semi-squatting training interspersed with 30 seconds of standing rest Control group: no intervention	WBVT may potentially be a safe and feasible way to improve functional capacity in the 6-MWT of patients with COPD undergoing a training program on the vibrating platform as well as in all domains of the SGRQ quality of life
Salhi et al," 201 1	26 Age: 58±4.5 FEV1 (% pred): 38±4.25	25 Age: 63±2.75 FEV1 (% pred): 39±4	1) Either the FEV1 <50% pred or diffusion capacity (DL,CO) <50% pred, 2) Wmax <90 Watt, a 6-MWD <70% pred a QoL < 100 points on the CRDQ or <20 points on the domain dyspnea of the CRDQ, 3) a QF <70% pred or respiratory muscle force <70% pred	36 sessions (3 sessions/week for 12 weeks)	Side-alternating WBVT platform, 27 Hz, 2 mm peak-to-peak displacement	Comparable to previous studies.	WBVT group: 30-60 seconds lower-body exercises and upper-body exercises on WBVT on top of 15 minutes endurance training RT group: muscle training on multigym equipment with endurance training	WBVT after 15 minutes aerobic training enhances 6-MWD, Wmax, and QoL in COPD patients
Spielmanns et al,^Citation12 201 7	14 Age: 69± 1.925 FEV1 (% pred): 63±7.925	13 Age: 70±3 FEV1 (% pred): 52±7.5	1) Stable CO PD in stage I-III according to the GOLD classification, 2) written informed consent, 3) age >65 years 4) no involvement in any kind of regular exercise training (at least once per week) within the last 3 months before study	26 sessions (2 sessions/week during 3 months)	Side-alternating WBVT platform, 6-10 Hz (1–4 weeks)/12-18 Hz (5-8 weeks)/21 -24 Hz (9-12 weeks), 2-6 mm peak-to-peak displacement	None reported	WBVT group: 10 minutes warm-up + 15 minutes WBVT +5 minutes cool-down, training was performed for 3×2 minutes Calisthenics group: 30 minutes of relaxation and breathing retraining in combination with calisthenics exercises	A low-volume WBVT program resulted in significantly and clinically relevant larger improvements in exercise capacity compared with calisthenics exercises in subjects with mild-to-severe COPD
Gloeckl et al,^Citation8 2017	36 Age: 65±8 FEV1 (% pred): 25.2±5.2	36 Age: 63±9 FEV1 (% pred): 36.6±1 1.7	Patients aged 50-80 years with COPD stage III or IV according to GOLD	9 sessions (3 sessions/week for 3 weeks)	Side-alternating WBVT platform, 24—26 Hz, 5 mm peak-to-peak displacement	None reported	WBVT group: squat exercise on WBVT with endurance training and strength training Control group: squat exercise without WBVT with endurance training and strength training	WBVT may be highly beneficial when incorporated into PR programs for COPD patients, especially in those with impaired balance performance and low exercise capacity
Spielmanns et al,^Citation13 2017	12 Age: 62.4±20.3 FEV1 (% pred): 48.4±20.9	16 Age: 68.0±9.1 FEV1 (% pred): 51.2±17.3	1) Patients with COPD at stages II—IV according to GOLD guideline, 2) they had to participate in pre- and postassessments at the outpatient center	13 sessions (1 session/week for 3 months)	Side-alternating WBVT platform, 24–26 Hz, 3 mm peak-to-peak displacement	During or after the training	WBVT group: 90 minutes squat exercises on WBVT Control group: 90 minutes squat exercises without WBVT	WBVT was feasible and safe in patients with COPD during an outpatient low-frequency exercise program

Abbreviations: 6-MWD, 6-minute walking distance; WBVT, whole-body vibration training; GOLD, Global Initiative for Chronic Obstructive Lung Disease; PR, pulmonary rehabilitation; FEV₁, forced expiratory volume in 1 seconds; FVC, forced vital capacity; SGRQ, St George’s Respiratory Questionnaire; W_max, maximal workload; QoL, quality of life; CRDQ, Chronic Respiratory Disease Questionnaire; QF, quadriceps force; RT, resistance training.

Figure 1 The PRISMA flow diagram of literature retrieval.

Note: Reproduced from Moher D, Liberati A, Tetzlaff J, Altman DG; The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7):e1000097. doi:10.1371/journal.pmed1000097.³⁶
Abbreviation: WBVT, whole-body vibration training.

Table 2 Risk of bias assessment

	Sequence generation	Concealment of allocation	Blinding of participants and personnel	Blinding of outcome assessors	Incomplete outcome data addressed	Free of selective reporting	Other bias
Gloeckl et al,^Citation7 2012	Low	Low	Low	Low	Low	Low	Low
Pleguezuelos et al,^Citation10 2013	Low	Unclear	Low	Low	Low	Low	Low
Greulich et al,^Citation9 2014	Low	Low	Low	Low	Low	Low	Low
Braz Júnior et al,^Citation6 2015	Low	Low	Low	Low	Low	Low	Low
Salhi et al,^Citation11 2015	Low	Low	Unclear	Unclear	Low	Low	Low
Spielmanns et al,^Citation12 2016	Low	Unclear	Unclear	Unclear	Low	Low	Low
Gloeckl et al,^Citation8 2017	Low	Low	Low	Low	Low	Low	Low
Spielmanns et al,^Citation13 2017	Low	Low	Low	Low	Low	Low	Low

Figure 2 Assessment of risk of bias.

Notes: (A) Graph of the risk of bias for the included studies, (B) graph of the risk of bias summary for the included studies.

Figure 3 Meta-analysis of the effect of WBVT or control group on (A) change of 6-MWD; (B) 6-MWD; (C) change of SST.

Abbreviations: 6-MWD, 6-minute walking distance; SST, sit-to-stand test; WBVT, whole-body vibration training.

Figure 4 Meta-analysis of the effect of WBVT or control on (A) SST; (B) FEV₁ (% predicated); (C) SGRQ.

Abbreviations: FEV₁, forced expiratory volume in the first second; SGRQ, St George’s Respiratory Questionnaire; SST, sit-to-stand test; WBVT, whole-body vibration training.

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