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Wha does he ib a ion he apy add? A quasi-
expe imen al, pilo s udy on he sho e m e ec s
o whole-body ib a ion as mode o exe cise o
nu sing home esiden s aged 80+
FRANCISCO ÁLVAREZ BARBOSA1, ROSA MARIA ALFONSO ROSA2
1
, JESÚS DEL POZO CRUZ2
1Ca denal Spinola Uni e si y S udies Cen e (CEU), Uni e si y o Se illa, Spain
2Facul y o Educa ion Sciences, Uni e si y o Se illa, Spain
ABSTRACT
Aims: To compa e he esponses o nu sing home esiden s aged 80+ o an 8 weeks exe cise p og am
pe o med on a ib a o y de ice and o he same exe cise p og am p e o med wi hou ib a ion on lowe limb
pe o mance, unc ional dependence and quali y o li e. Me hods: Lowe limb pe o mance was e alua ed
using he 30 seconds Chai Si o S and es . Func ional mobili y was assessed using he imed up and go
es . Pos u al s abili y was measu ed using a o ce pla o m. The Ba hel Index was used o assess unc ional
dependence and he Eu oQol was used o e alua e Heal h-Rela ed Quali y o Li e. 44 pa icipan s we e
alloca ed o he whole-body ib a ion g oup (n= 15), non- ib a ion g oup (n= 15) o o he con ol g oup (n=
14). Resul s: Signi ican di e ences we e de ec ed in a ou o he whole-body ib a ion g oup in lowe limb
muscle pe o mance (p = 0.001), mobili y (p = 0.001), unc ional independence (p = 0.009) and quali y o li e
(p < 0.001) as compa ed o he con ol and non- ib a ion g oups. Conclusions: Whole body ib a ion based
in e en ions may add addi ional bene i s o con en ional exe cise p og ams in e ms o lowe limb muscle
pe o mance, unc ional dependence and quali y o li e among nu sing home esiden s o e 80 yea s.
Keywo ds: Whole body ib a ion; Nu sing home; Quali y o li e; Func ional mobili y.
1
Co esponding au ho . Facul y o Educa ion Sciences, Uni e si y o Se illa, Spain
E-mail: oal [email protected]
Submi ed o publica ion Ma ch 2018
Accep ed o publica ion June 2018
Published in p ess July 2018
JOURNAL OF HUMAN SPORT & EXERCISE ISSN 1988-5202
© Facul y o Educa ion. Uni e si y o Alican e
doi:10.14198/jhse.2018.134.09
O iginal A icle
Ci e his a icle as:
Ál a ez, F., Al onso, R.M., & del Pozo, J. (2018). Wha does he ib a ion he apy add? A quasi-
expe imen al, pilo s udy on he sho e m e ec s o whole-body ib a ion as mode o exe cise o
nu sing home esiden s aged 80+. Jou nal o Human Spo and Exe cise, 13(4), 810-822.
doi:h ps://doi.o g/10.14198/jhse.2018.134.09
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INTRODUCTION
Aging is associa ed wi h a numbe o changes in he unc ionali y o lowe limbs such as a loss o muscle
s eng h, poo e balance, a mino pos u al con ol o a dec ease o gai abili y (Kadono & Pa ol, 2013; Sousa-
Vic o e al., 2015; Wol son, 2001). Aging causes a high p e alence in he numbe o alls su e ed by olde
people, being e en mo e p e alen in ins i u ionalized olde people (Rubens ein & Josephson, 2002), since
hey ha e lowe limb pe o mance when compa ed wi h hei pee s li ing in he communi y (Ni z & Josephson,
2011). This leads hem o be mo e dependen and o ha e a lowe quali y o li e (Almomani e al., 2014).
Hence, physical pe o mance among nu sing home esiden s aged o e 80 is impe a i e.
The e is s ong e idence ha exe cise could imp o e physical unc ion, inc easing he speed o gai and
balance, mobili y and abili y o pe o m ac i i ies o daily li ing (ADLs) independen ly (Chou, Hwang & Wu,
2012; Gine-Ga iga e al., 2014), bu an adequa e in ensi y and du a ion is equi ed (She ing on e al., 2008;
She ing on e al., 2011). Such p og ams migh no be well ole a ed by ail people due o a igue (Pollock,
Ma in & Newham, 2012). Thus, he e is a need o al e na i es o imp o e modi iable ac o s such as s eng h
and mobili y and ul ima ely imp o e he unc ional dependence and quali y o li e o nu sing home esiden s
aged o e 80.
Whole-body ib a ion (WBV) aining has become inc easingly popula o e he pas se e al yea s as an
al e na i e o con en ional exe cise p og ams. I is hypo hesized ha WBV enhances he neu omuscula
sys em by inc easing he sensi i i y o he s e ch e lex. Fu he mo e, ib a ion appea s o inhibi ac i a ion
o an agonis muscles h ough inhibi o y neu ons, hus al e ing he in amuscula coo dina ion pa e ns
leading o a dec eased b aking o ce a ound he join s s imula ed by ib a ion (Ca dinale & Bosco, 2003).
Hence, WBV has he po en ial o imp o e unc ional mobili y, muscle s eng h and pos u al con ol (Ca dinale
& Bosco, 2003), sugges ing ha whole-body ib a ion migh be an e ec i e in e en ion o alls. Fu he mo e,
WBV aining minimizes he need o conscious exe ion (Bogae s e al., 2009), which makes his kind o
exe cise he apies a sui able al e na i e o indi iduals unable o unwilling o do s eng h and balance aining
(Lam e al., 2012) such as nu sing home esiden s aged 80+.
Di e en s udies ha e epo ed on he easibili y and e ec i eness o WBV o imp o e mobili y, s eng h,
balance, unc ional dependence o quali y o li e among olde adul s li ing in nu sing homes when compa ed
o non-exe cise con ol g oups (Bau mans e al., 2005; Bogae s e al., 2011; B uye e e al., 2005; Sie anen
e al., 2012) o physio he apy pa ien s (B uye e e al., 2005). Howe e , whe he he po en ial posi i e e ec s
o WBV p og ams a e due o ib a ion o due o he exe cises pe o med on he pla o m i sel emain unclea
(Ál a ez-Ba bosa e al., 2014). Recen ly, Sie anen e al. (2012) epo ed no signi ican ea men e ec on
mobili y a e compa ing 10 weeks o an exe cise p og am pe o med a ei he low- equency (12Hz) o high-
equency (16 Hz) wi h he same exe cise p og am pe o med on he ib a o y de ice bu wi hou he ib a ion
componen among nu sing home esiden s. Bau mans e al. (2005) epo ed on he bene i s o 6 weeks s a ic
WBV exe cise on balance and mobili y when compa ed o he same s a ic exe cises pe o med wi hou
ib a ion among nu sing home esiden s. In o de o con ibu e o he ongoing discussion on whe he WBV
is a sui able aining me hod o nu sing home esiden s aged 80+, he aim o his quasi-expe imen al, pilo
ial was o compa e he sho e m esponses o nu sing home esiden s aged 80+ o an exe cise (dynamic)
p og am pe o med on a ib a o y de ice and o he same exe cise p og am (pe o med on a s ep o he
same dimensions as he ib a o y de ice) wi hou he ib a ion componen on lowe limb pe o mance,
unc ional dependence and heal h- ela ed quali y o li e.
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MATERIALS AND METHODS
Pa icipan s and s udy design
A quasi-expe imen al s udy was conduc ed. The s udy was app o ed by he esea ch E hics Commi ee o
he Uni e si y o Se ille and was conduc ed in acco dance wi h he Decla a ion o Helsinki. All pa icipan s
ecei ed w i en and o al in o ma ion on he s udy’s aims and p ocedu es. In o med consen was ob ained
om all indi idual pa icipan s included in he s udy. Pa icipan s in he s udy we e ec ui ed om wo nu sing
home acili ies in Se ille (Sou he n Spain). Residen s we e eligible o he s udy i hey we e ins i u ionalized
in he nu sing home whe e he s udy was ca ied ou , i hey we e a leas 80 yea s old and i hey had no
majo physical (including ca dio ascula disease) o cogni i e diso de ha could p e en hem om s anding
sa ely on a WBV pla o m o on a s ep pla o m. Po en ial pa icipan s we e excluded i hey had a pacemake ,
knee o hip p os hesis o any o he physical, unc ional o cogni i e impai men in e e ing wi h es ing and
aining p o ocols.
Figu e 1. Flow diag am o he pa icipan s in he s udy
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Ou o 60 eligible pa icipan s in one o he acili ies, 35 showed ini ial in e es in he s udy. Howe e , only 29
ul illed he inclusion/exclusion c i e ia and we e alloca ed ei he in o he whole-body ib a ion g oup (WBV)
o in o a con ol g oup (CG) using a compu e gene a ed andom alloca ion da a p ocessing p og am.
Randomiza ion was pe o med by a membe o he esea ch eam no di ec ly in ol ed in he ec ui men
p ocess o assessmen o pa icipan s. The hi d s udy g oup was ec ui ed om ano he nu sing home
acili y. Ou o 42 po en ial pa icipan s in ha acili y, 23 showed ini ial in e es in he s udy. Finally, 15
indi iduals om ha acili y we e included in he s udy and alloca ed in o he non- ib a ion g oup (nV). A o al
o 44 subjec s pa icipa ed in he s udy (Fig 1).
Expe imen al p o ocol
Bo h he WBV and he nV g oups pa icipa ed in an 8-week exe cise-based p og am consis ing o h ee
sessions pe week wi h a es pe iod o a leas one day be ween sessions, wi h he same exe cises in each
ea men session. To wa m-up, pa icipan s s ood h ee imes in an isome ic squa posi ion wi h knees lexed
a 100° o 30s wi h a es pe iod o 30s be ween each. This exe cise was epea ed h ee imes. A e ha ,
pa icipan s we e asked o pe o m 6 exe cises (s ep up and down, lunge, squa , cal aises, le and igh
pi o in a on and la e al posi ions) wi h slow mo emen s a a a e o 3 s o bo h concen ic and eccen ic
phases (Table 1). The exe cises included ha e been p e iously used among olde people li ing in nu sing
homes (del Pozo-C uz e al., 2014). The WBV g oup pe o med hei exe cise sessions on a e ical ib a o y
pla o m (YV20RS 700, BH, Spain (Table 1). In addi ion, equency and ampli ude used du ing he
in e en ion ha e been p e iously epo ed o be sa e among his popula ion g oup (Bau mans e al., 2005;
Bogae s e al., 2011). On he o he hand, he non- ib a ion g oup pe o med hei exe cise sessions on a
s ep pla o m wi h he same dimensions as he ib a o y de ice. In bo h cases, he exe cise sessions we e
supe ised by one o he esea che s o he s udy and he physio he apis o he nu sing home. Pa icipan s
we e asked o main ain hei usual le el o ac i i y ou o he in e en ion sessions. Likewise, he con ol g oup
was ins uc ed o main ain hei usual le els o physical ac i i y and hei no mal daily li e ac i i ies o e he
s udy pe iod. All pa icipan s in he s udy had access o he usual nu sing home ca e a ailable in public
nu sing homes in Spain (i.e. nu sing ca e and physio he apy –mainly mobili y exe cise sessions).
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Ou come measu es
Socio-demog aphic a iables we e eco ded. The body-mass index and wais o hip a io we e calcula ed.
Body- a pe cen age was also es ima ed using an impedance analyse (Om on BF-306, Om on Heal hca e
Eu ope BV, Hoo ddo p, The Ne he lands) (Table 2).
Func ional mobili y was assessed using he Time Up and Go (TUG) es (Podsiadlo & Richa dson, 1991).
Pa icipan s had o s and up om a s anda d chai , walk 3 me e s o and a ound a cone, and hen e u n o
he chai in a com o able and sa e walking speed (Podsiadlo & Richa dson, 1991). The bes ime o wo ials
(1-minu e es pe iod be ween each ial) was eco ded. An inc ease equal o o g ea e han 0.8-1.2 seconds
o Time Up and Go (TUG) es has been es ablished as minimal clinically impo an di e ence (W igh e al.,
2011).
Lowe limb muscle pe o mance was assessed using he 30 seconds Chai Si o S and (30-s CSTS) es
(Ál a ez-Ba bosa e al., 2014; Rikli & Jones, 2013; Thapa e al., 1994). The ask s a ed and inished in a
sea ed posi ion. Pa icipan s we e allowed a p ac ice ial be o e he beginning o he es . The numbe o
imes wi hin 30 s ha he pa icipan could aise o a ull s and om a sea ed posi ion as as as possible, wi h
hei back s aigh and ee la on he loo wi hou pushing o using hei a ms, was coun ed. The maximum
speed o each epe i ion as well as he a e age speed while s anding-up we e eco ded wi h a Linea Encode
(Model TF-100, T-Fo ce Sys em E go ech, Mu cia, Spain) and he peak o ce was eco ded using a Kis le
o ce pla o m, ype 9281A (Kis le Ins umen s AG, Win e hu , Swi ze land). The maximum powe du ing

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he es could hen be calcula ed. An inc ease equal o o g ea e han 2-2.6 imes o 30-s CSTS es has
been es ablished as minimal clinically impo an di e ence (W igh e al., 2011).
Pos u al s abili y was measu ed using a Kis le o ce pla o m by eco ding he an e io –pos e io (AP) and
medial–la e al (ML) cen e o p essu e (COP) excu sions while in a quie s anding pos u e. Sway ellipse a ea
(cm2) was calcula ed 3 imes each wi h inc easing pos u al di icul y: (i) s anding on he o ce pla o m wi h
he eyes open, (ii) s anding on he o ce pla o m wi h he eyes open (cogni i e ask) and (iii) s anding on he
o ce pla o m wi h he eyes closed. Fo each condi ion, 3 ials we e pe o med. Each ial las ed o 30 s and
was ollowed by a es pe iod o 1 min. In his case, only he inal 20 s we e analysed (P ie o e al., 1996).
The cogni i e ask was coun ing backwa ds as as and as accu a ely as possible by 3 while pe o ming he
s anding ask, beginning wi h a andomly selec ed numbe om a ange o 100–200. Da a we e sampled a
1000 Hz and ans o med o ob ain COP a ea alues.
The Ba hel Index (BI) o ac i i ies o daily li ing (Mahoney & Ba hel, 1965) was used o measu e
pe o mance in ADLs o he pa icipan s in he s udy and he Eu oQol-5D (EQ-5D) (Eu oQol G oup, 1990)
was used o assess pa icipan s heal h- ela ed quali y o li e (HRQoL).
S a is ical analysis
Da a analysis was ca ied ou using he s a is ical so wa e p og am SPSS o Windows V.17.0 (SPSS Inc.,
Chicago, IL). The Shapi o Wilk es was used o es he no mali y o da a. A e non-pa ame ic dis ibu ion
was con i med, di e ences a baseline be ween g oups we e analysed using ei he K uskal-Wallis H es o
chi-squa e es . Be ween-g oups compa isons a e ea men we e analysed using K uskal-Wallis H es and
pos hoc compa ison we e pe o med wi h Mann-Whi ney U es wi h Bon e oni co ec ion. Wilcoxon es
was pe o med o de e mina e he p e o pos ea men in a-g oup di e ences. Median (IQR) was used as
a desc ip i e s a is ic. Signi icance le el was se a p <.05 o all analyses.
RESULTS
Fo y- ou nu sing home esiden s we e inally included in he s udy (Figu e 1). None o he pa icipan s in
he in e en ion g oups epo ed any ad e se heal h e ec s du ing he ea men . In he WBV g oup, 73% (11
ou o 15) o pa icipan s comple ed a leas 80% o he sessions o e ed in he p og am. In he nV g oup,
80% (12 ou o 15) o pa icipan s comple ed a leas 80% o he sessions o e ed and 1 pa icipan declined
o pa icipa e be o e he s udy began, so inally 73% o pa icipan s in he nV we e included in he analysis.
In he CG, 78% o he pa icipan s we e assessed a baseline and a e he p og am and we e included in he
s a is ical analysis. Only hose pa icipan s wi h p e and pos ea men da a on all assessed ou comes (i.e.
33/44) we e included in he s a is ical analysis. No signi ican di e ences be ween g oups we e de ec ed a
baseline o any o he s udy a iables (Table 2).
Be ween g oup compa isons
S a is ically signi ican di e ences a e an 8-week ea men we e de ec ed be ween g oups in lowe limb
muscle pe o mance [i.e. CSTS-numbe o imes (p = 0.001)], mobili y [TUG (p = 0.001)], unc ional
independence [Ba hel index (p = 0.009) and Ba hel in e p e a ion (p=0.012)] and quali y o li e [EQ-5d u ili y
(p < 0.001), EQ-5D as (p=0.046)] ( igu e 2a and 2b). No signi ican di e ences be ween g oups in pos u al
s abili y we e ound ( igu e 2c). Pai wise compa isons e ealed signi ican imp o emen on TUG (p=0.001
and p<0.000), CSTS (numbe o imes; p=0.006 and p<0.000), EQ-5D (u ili y; p=0.003 and p<0.000) in he
WBV g oup when compa ed wi h nV g oup and CG.
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Median changes (IQR) in 30-s Chai Si o S and es ela ed a iables and Time Up and Go es sco e o e
he 8-wk ea men . a deno es posi i e (i.e., he sco e ge ing be e wi hin he g oup a e he ea men
pe iod) in a-g oup s a is ically signi ican di e ences. b deno es nega i e (i.e., he sco e ge ing wo se wi hin
he g oup a e he ea men pe iod). c deno es signi ican changes as compa ed o he o he wo g oups
a e pai wise compa ison.
Fig 2a. Lowe limb pe o mance and mobili y ou comes. Median changes (IQR) in 30-s Chai Si o S and es
ela ed a iables and Time Up and Go es sco e o e he 8-wk ea men . a deno es posi i e (i.e., he sco e
ge ing be e wi hin he g oup a e he ea men pe iod) in a-g oup s a is ically signi ican di e ences. b
deno es nega i e (i.e., he sco e ge ing wo se wi hin he g oup a e he ea men pe iod). c deno es
signi ican changes as compa ed o he o he wo g oups a e pai wise compa ison.
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Figu e 2b. Func ional dependence and quali y o li e ou comes. Median changes (IQR) in ac i i y o daily i e
pe o mance as assessed by The Ba hel Index) and heal h- ela ed quali y o li e as assessed by The Eu oQol
o e he 8-wk ea men . a deno es posi i e (i.e., he sco e ge ing be e wi hin he g oup a e he ea men
pe iod) in a-g oup s a is ically signi ican di e ences. b deno es nega i e (i.e., he sco e ge ing wo se wi hin
he g oup a e he ea men pe iod). c deno es signi ican changes as compa ed o he o he wo g oups
a e pai wise compa ison.
Figu e 2c. Pos u al s abili y ou comes. Median changes (IQR) in pos u al s abili y assessed wi h he o ce
pla o m du ing eyes-open es (OA), eyes-closed (OC) and cogni i e in e e ence (IC) o e he 8-wk
ea men .
Wi hin-g oup compa isons
In addi ion, in a-g oup analysis showed ha , a e 8 weeks o aining, he e was a s a is ically signi ican
imp o emen in TUG sco e es in he WBV g oup (-2.71s; p= 0.006) as well as in non- ib a ion g oup (-2.12s;
p= 0.008). Imp o emen s we e also de ec ed in CSTS-numbe o imes (+3.54; p=0.002), CSTS-powe
(+50.49N; p=0.012) CSTS- o ce (+42.63N; p=0.048), and EQ-5Du ili y index (+0.08; p=0.002) and EQ-5D as
(+16.27; p=0.022) in pa icipan s in he WBV g oup (Figu e 2a, 2b).
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Median changes (IQR) in ac i i y o daily i e pe o mance as assessed by The Ba hel Index) and heal h-
ela ed quali y o li e as assessed by The Eu oQol o e he 8-wk ea men . a deno es posi i e (i.e., he sco e
ge ing be e wi hin he g oup a e he ea men pe iod) in a-g oup s a is ically signi ican di e ences. b
deno es nega i e (i.e., he sco e ge ing wo se wi hin he g oup a e he ea men pe iod). c deno es
signi ican changes as compa ed o he o he wo g oups a e pai wise compa ison.
Median changes (IQR) in pos u al s abili y assessed wi h he o ce pla o m du ing eyes-open es (OA), eyes-
closed (OC) and cogni i e in e e ence (IC) o e he 8-wk ea men .
DISCUSSION
The p esen s udy aimed a con ibu ing o he ongoing discussion on he use o WBV as an al e na i e
aining me hod o ail elde ly people (in his case, nu sing home esiden s aged 80+) by conduc ing a small,
quasi-expe imen al s udy compa ing he sho e m esponses o nu sing home esiden s aged 80+ o an
exe cise (dynamic) p og am pe o med on a ib a o y de ice and o he same exe cise p og am (pe o med
on a s ep o same dimensions as he ib a o y de ice) wi hou he ib a ion componen on lowe limb muscle
pe o mance, heal h- ela ed quali y o li e and unc ional dependence. The main indings we e ha hose
pa icipan s ha exe cised on he ib a ion pla o m imp o ed hei lowe limb muscle pe o mance, mobili y
and heal h- ela ed quali y o li e when compa ed o bo h he nV g oup and CG.
In a-g oup analysis shows ha WBV and he nV g oup signi ican ly (clinical imp o emen s) lowe ed he ime
spen in pe o m TUG es . Howe e , only WBV g oup showed signi ican imp o emen s compa ed wi h CG
(p<0.001). Bau mans e al. (2005), also ound ha WBV is easible and migh p o ide be e bene i s o
mobili y han s a ic exe cise in nu sing home esiden s. This could be jus i ied by he e idence sugges ing
ha ib a ion is e ec i e in enhancing s eng h and powe capaci y in humans (Ca dinale & Bosco, 2003).
This could explain he dec ease in ime o he WBV g oup compa ed o he CG (+0.59s). Se e al s udies
ha e also epo ed he e ec i eness o WBV o imp o e gai and mobili y as assessed by he TUG es among
nu sing home elde ly people (Bogae s e al., 2011; B uye e e al., 2005). None heless, he ac ha
pa icipan s in he WBV g oup sco ed be e in he TUG es han pa icipan s in he nV g oup sugges s ha
WBV may be a p omising he apy o clinically imp o e gai unc ion and mobili y among nu sing home
esiden s aged 80+ (Shimada e al., 2011).
We obse ed in a-g oup imp o emen s in lowe limb muscle s eng h and powe in he WBV g oup. Howe e ,
we ailed o obse e any imp o emen o hose ou comes in ei he he nV g oup o he CG a e he p og am.
Thus, he WBV g oup did mo e si o s and cycles in he 30-s CSTS es (+3.54; p=0.002) as compa ed o
he o he wo g oups a e he ea men . This absolu e change o he WBV g oup is conside ed clinically
ele an acco ding o p e ious s udies since he imp o emen was mo e han 2-2.6 imes g ea e (W igh e
al., 2011). These esul s a e consis en wi h hose ob ained in ano he s udy ha concluded ha he addi ion
o ib a ion o esis ance exe cise esul ed in be e unc ional ou comes han he same exe cise p og am
pe o med wi hou ib a ion in a g oup o ail olde adul s (Pollock e al., 2012) . The e o e, ou indings
ein o ce he idea ha WBV may induce u he bene i s on lowe limb muscle pe o mance as compa ed o
con en ional aining. One po en ial explana ion may be ha ib a ion causes changes in muscle leng h so
muscle spindles ac i a ed alpha mo o neu ons, hus inc easing he ec ui men and ac i a ion o he agonis
muscles ha enhances he neu omuscula sys em (Bu ke & Schille , 1976; Ri wege , 2010). On he o he
hand, a ela ionship be ween muscle weakness (i.e. educed s eng h) and all isk had been p e iously
epo ed (Ma ques e al., 2013). Thus, we hypo hesise ha imp o emen s in lowe limb muscle pe o mance