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Cochrane Database of Systematic Reviews

Whole body vibration exercise training for fibromyalgia

Information

DOI:
https://doi.org/10.1002/14651858.CD011755.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 26 September 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Musculoskeletal Group

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Julia Bidonde

    Correspondence to: Norwegian Institute of Public Health, Oslo, Norway

    [email protected]

    [email protected]

  • Angela J Busch

    School of Physical Therapy, University of Saskatchewan, Saskatoon, Canada

  • Ina van der Spuy

    School of Physical Therapy, University of Saskatchewan, Saskatoon, Canada

  • Susan Tupper

    Saskatoon Health Region, Saskatoon, Canada

  • Soo Y Kim

    School of Physical Therapy, University of Saskatchewan, Saskatoon, Canada

  • Catherine Boden

    Leslie and Irene Dube Health Sciences Library, University Library, University of Saskatchewan, Saskatoon, Canada

Contributions of authors

Initials correspond to authors as they are listed under the review title.

JB: leading WBV exercise training review team, designing and reviewing review protocol, assessing eligibility of studies, participating in discussion regarding review design and methods, screening studies for eligibility for inclusion in the review, conducting data extraction, conducting methodological and statistical analyses, drafting and reviewing the manuscript, collaborating with consumers throughout creation of the plain language summary, and reading and approving the final manuscript.

AJB: responsible for leading and coordinating Fibromyalgia and Exercise Team, designing and reviewing review protocol, assessing eligibility of studies, supporting and managing data extraction, supervising methodological and statistical analyses, and collaborating in meetings regarding plain language summary, discussion, and conclusions. Read and approved the final manuscript.

IVDS: designing and reviewing review protocol, extracting data, assessing risk of bias, contributing to creation of tables, and participating in discussion and conclusions. Reading and approving the final manuscript.

ST: designing and reviewing review protocol, collaborating on data extraction, providing content expertise on pain, supporting interpretation of findings and contributing to creation of tables, and writing and reviewing discussion and conclusions. Reading and approving the final manuscript.

SYK: designing and reviewing review protocol, collaborating on data extraction, providing content expertise on musculoskeletal matters, writing and reviewing drafts, and approving the final manuscript.

CB: performing literature searches, participating in discussion regarding methods, working on plain language summary with consumers, working on tables and figures, conducting searches to support background and discussion sections of the manuscript, and writing and reviewing the manuscript. Reading and approving the final manuscript.

Sources of support

Internal sources

  • No funding support has been received, Canada.

External sources

  • No funding support has been received, Canada.

Declarations of interest

We confirm that we have listed below any present or past affiliations or other involvement in any organization or entity with an interest in the review that might lead me/us to have a real or perceived conflict of interest.

Initials correspond to authors as they are listed under the review title.

JB: none known; AJB: none known; IVDS: none known; ST: none known; SYK: none known; CB: none known.

Acknowledgements

We would like to acknowledge the following.

  • Exercise for Fibromyalgia Cochrane Review Team.

    • The review team contributed to various tasks related to reviews of exercise and fibromyalgia (screening of citations, abstracts, and full‐text articles for inclusion/exclusion and related consensus activities; data extraction and related consensus activities; regular attendance at monthly meetings; contributing to discussion regarding relevant concepts; interpretation and discussion of results; translation of knowledge gained; presentation of workshops or seminars when possible).

    • Currently, the review team is led by Dr. Angela Busch, and is made up of 14 members, including two consumers (Janet Gunderson and Anne Lyddiatt), one librarian/information specialist (Catherine Boden), and 11 reviewers (kinesiologists ‐ Julia Bidonde, Suelen Goés, Heather Foulds; physical therapists ‐ Tom Overend, Candice Schachter, Sandra Webber, Kristen Musselman, Susan Tupper, Soo Kim, Ina van der Spuy, and Vanina Dal Bello Haas). Former members of the team include Mary Brachaniec, Tamara Rader, Rachel Richards, Laurel Schafer, Adrienne Danyliw, Mary Brachaniec, Joelle Harris, and Christopher Ross.

  • The following individuals voluntarily helped in translating publications and communicating with study authors in their original languages: Julia Bidonde, Nora Chavarria, Beliz Arcan, Patricia Mancini, and Suelen Gomez, translating from Spanish, German, Turkish, and Portuguese (not all articles were used in this review).

  • Renea Johnston and Rachelle Buchbinder, members of the editorial team of the Cochrane Musculoskeletal Group (Monash, Australia).

  • The team gratefully acknowledges the assistance of JoAnn Nilson, PT (Saskatoon Health Region), for her thoughtful comments and insight into important clinical aspects of this review.

Version history

Published

Title

Stage

Authors

Version

2017 Sep 26

Whole body vibration exercise training for fibromyalgia

Review

Julia Bidonde, Angela J Busch, Ina van der Spuy, Susan Tupper, Soo Y Kim, Catherine Boden

https://doi.org/10.1002/14651858.CD011755.pub2

2015 Jun 17

Whole body vibration exercise for fibromyalgia

Protocol

Angela J Busch, Ina van der Spuy, Susan Tupper, Soo Y Kim, Julia Bidonde, Tom J Overend

https://doi.org/10.1002/14651858.CD011755

Differences between protocol and review

This review is one of a series of reviews undertaken to update previous reviews completed in 2002 and 2007 on exercise for fibromyalgia. Given the growth in literature, this review has been split into several reviews (ie, resistance, aquatic, mixed, aerobic, flexibility, and vibration).

Differences between the protocol (Busch 2015) and this review included the following.

  • Revisions to search terms and databases: three HTA‐specific databases added.

  • Changes in membership of the review team (change in the lead author (AJB/JB), dropout of one review author (TO), addition of a new review author (CB) and two consumers (AL and JG).

  • Addition of the word "training" to the title of the review.

  • Use of new software in addition to electronic forms for selection of studies; this software, which is called Covidence, was recently developed to conduct screening for creating and maintaining systematic reviews (https://www.covidence.org/).

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram for vibration training interventions.
Figures and Tables -
Figure 1

Study flow diagram for vibration training interventions.

Galileo Fitness Platform (Copyright © 2008‐2015 Novotec Medical GmbH; reproduced with permission)
Figures and Tables -
Figure 2

Galileo Fitness Platform (Copyright © 2008‐2015 Novotec Medical GmbH; reproduced with permission)

Copyright © 2012 Wellsports GmbH Krefeld ‐ PowerPlate International B.V., The Netherlands ‐ awaiting response.Sept15
Figures and Tables -
Figure 3

Copyright © 2012 Wellsports GmbH Krefeld ‐ PowerPlate International B.V., The Netherlands ‐ awaiting response.Sept15

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 4

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 5

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Comparison 1 WBV vs C, Outcome 1 HRQL, 1‐100 scale, lower means better HRQL.
Figures and Tables -
Analysis 1.1

Comparison 1 WBV vs C, Outcome 1 HRQL, 1‐100 scale, lower means better HRQL.

Comparison 1 WBV vs C, Outcome 2 Balance, degrees of displacement, lower is best.
Figures and Tables -
Analysis 1.2

Comparison 1 WBV vs C, Outcome 2 Balance, degrees of displacement, lower is best.

Comparison 1 WBV vs C, Outcome 3 Withdrawal.
Figures and Tables -
Analysis 1.3

Comparison 1 WBV vs C, Outcome 3 Withdrawal.

Comparison 2 WBV + MX vs C, Outcome 1 WBV + MX vs C: HRQL, 0‐100 scale, lower is best.
Figures and Tables -
Analysis 2.1

Comparison 2 WBV + MX vs C, Outcome 1 WBV + MX vs C: HRQL, 0‐100 scale, lower is best.

Comparison 2 WBV + MX vs C, Outcome 2 WBV + MX vs C: pain, 0‐100 scale, lower is best.
Figures and Tables -
Analysis 2.2

Comparison 2 WBV + MX vs C, Outcome 2 WBV + MX vs C: pain, 0‐100 scale, lower is best.

Comparison 2 WBV + MX vs C, Outcome 3 WBV + MX vs C: fatigue, 0‐100 scale, lower is best.
Figures and Tables -
Analysis 2.3

Comparison 2 WBV + MX vs C, Outcome 3 WBV + MX vs C: fatigue, 0‐100 scale, lower is best.

Comparison 2 WBV + MX vs C, Outcome 4 WBV + MX vs C: stiffness, 0‐100 scale, lower is best.
Figures and Tables -
Analysis 2.4

Comparison 2 WBV + MX vs C, Outcome 4 WBV + MX vs C: stiffness, 0‐100 scale, lower is best.

Comparison 2 WBV + MX vs C, Outcome 5 WBV + MX vs C: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best).
Figures and Tables -
Analysis 2.5

Comparison 2 WBV + MX vs C, Outcome 5 WBV + MX vs C: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best).

Comparison 2 WBV + MX vs C, Outcome 6 Withdrawal.
Figures and Tables -
Analysis 2.6

Comparison 2 WBV + MX vs C, Outcome 6 Withdrawal.

Comparison 3 WBV + MX vs Other, Outcome 1 WBV + MX vs Other: HRQL, 0‐100 scale, lower is best.
Figures and Tables -
Analysis 3.1

Comparison 3 WBV + MX vs Other, Outcome 1 WBV + MX vs Other: HRQL, 0‐100 scale, lower is best.

Comparison 3 WBV + MX vs Other, Outcome 2 WBV + MX vs Other: pain, 0‐100 scale, lower is best.
Figures and Tables -
Analysis 3.2

Comparison 3 WBV + MX vs Other, Outcome 2 WBV + MX vs Other: pain, 0‐100 scale, lower is best.

Comparison 3 WBV + MX vs Other, Outcome 3 WBV + MX vs Other: fatigue, 0‐100 scale, lower is best.
Figures and Tables -
Analysis 3.3

Comparison 3 WBV + MX vs Other, Outcome 3 WBV + MX vs Other: fatigue, 0‐100 scale, lower is best.

Comparison 3 WBV + MX vs Other, Outcome 4 WBV + MX vs Other: stiffness, 0‐100 scale, lower is best.
Figures and Tables -
Analysis 3.4

Comparison 3 WBV + MX vs Other, Outcome 4 WBV + MX vs Other: stiffness, 0‐100 scale, lower is best.

Comparison 3 WBV + MX vs Other, Outcome 5 WBV + MX vs Other: strength, measured in newtons and number of reps, higher values are best.
Figures and Tables -
Analysis 3.5

Comparison 3 WBV + MX vs Other, Outcome 5 WBV + MX vs Other: strength, measured in newtons and number of reps, higher values are best.

Comparison 3 WBV + MX vs Other, Outcome 6 WBV + MX vs Other: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best).
Figures and Tables -
Analysis 3.6

Comparison 3 WBV + MX vs Other, Outcome 6 WBV + MX vs Other: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best).

Comparison 3 WBV + MX vs Other, Outcome 7 Withdrawal.
Figures and Tables -
Analysis 3.7

Comparison 3 WBV + MX vs Other, Outcome 7 Withdrawal.

Summary of findings for the main comparison. Whole body vibration versus control

Whole body vibration versus control

Patient or population: individuals with fibromyalgia
Setting: community
Intervention: whole body vibration (WBV)
Comparison: control

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with control

Risk with WBV

Health‐related quality of life
assessed by FIQ total scale, 0 to 100, 0 is best

Follow‐up: 12 weeks

Mean health‐related quality of life was 59 points

Mean health‐related quality of life in intervention group was 3.73 points lower (10.81 lower to 3.35 higher) at post‐test than in control group

41
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute improvement: 4% (95% CI 11% better to 3% worse)

Relative change: 6.7% improvement (95% CI 19.6% improvement to 6.1% worse)

NNTB: n/ac

Pain intensity

Not measured

Not measured

Not measured

Not measured

Not measured

Fatigue

Not measured

Not measured

Not measured

Not measured

Not measured

Stiffness

Not measured

Not measured

Not measured

Not measured

Not measured

Physical function

Not measured

Not measured

Not measured

Not measured

Not measured

Adverse events
(narrative)

Gusi 2010: "The program was reasonably safe: only 5% of the participants (n = 1) dropped out of the program because of acute pain in the legs. The program was completed by 85% of the participants, without secondary adverse effects" (page 1076; 1 study)

All‐cause withdrawal
assessed by number of people who dropped out

Study population

RR 1.43 (0.27 to 7.67)

41
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute risk difference: 4% more events (95% CI 16% fewer to 24% more)

Relative change: 43% more (73% fewer to 667% more)

NNTH: n/ac

10 per 100

(2 of 20)

14 per 100

(3 of 21)

*Risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI)

CI: confidence interval; NNTB: number needed to treat for an additional beneficial outcome; NNTH: number needed to treat for an additional harmful outcome; OR: odds ratio; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aImpresicion: number of participants lower than 400 rule of thumb; wide confidence interval (downgraded twice)

bHigh risk of biases including detection, performance, and reporting biases

cNumber needed to treat for an additional beneficial outcome (NNTB) or number needed to treat for an additional harmful outcome (NNTH) not applicable (n/a) when result is not statistically significant. NNT for dichotomous outcomes calculated with Cates NNT calculator (http://www.nntonline.net/visualrx/). NNT for continuous outcomes calculated with Wells calculator (CMSG Editorial Office)

Figures and Tables -
Summary of findings for the main comparison. Whole body vibration versus control
Summary of findings 2. Whole body vibration plus mixed exercise versus control

Whole body vibration plus mixed exercise versus control

Patient or population: individuals with fibromyalgia
Setting: unspecified
Intervention: WBV + MX
Comparison: control

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with control

Risk with WBV + MX

Health‐related quality of life
assessed by FIQ total scale, 0‐100, 0 is best

Mean health‐related quality of life was 59.64 points at the end of the study

Mean health‐related quality of life in the intervention group was 16.02 points lower (31.57 lower to 0.47 lower) at post‐test than in the control group

21
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute difference: 16% improvement (95% CI 32% to 0.5% improvement). Relative change: 24% (47% to 0.7%)c

NNTBd: 3 (2 to 237)

Pain Intensity
assessed by FIQ scale, 0 to 100 mm, 0 is no pain

Mean pain intensity was 69.38 mm in the control group at the end of the study

Mean pain Intensity in the intervention group was 28.22 mm lower (43.26 lower to 13.18 lower) at post‐test than in the control group

21
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute difference: 28% (95% CI 43% to 13%). Relative difference: 39% (95% CI 18% to 60%)

NNTBd: 2 (1 to 4)

Fatigue
assessed by FIQ scale, 0 to 100 mm, 0 is best

Mean fatigue was 75.17 mm at the end of the study

Mean fatigue in the intervention group was 32.84 mm lower (49.2 lower to 16.48 lower) at post‐test than in the control group

21
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute difference: 33% (95% CI 49% to 16%). Relative difference: 47% (95% CI 23% to 70%)

NNTBd: 2 (1 to 4)

Stiffness
assessed by FIQ scale, 0 to 100 mm scale, 0 is best

Mean stiffness was 68.71 mm at the end of the study

Mean stiffness in the intervention group was 26.27 mm lower (42.96 lower to 9.58 lower) at post‐test than in the control group

21
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute difference 26% (95% CI 43% to 10%). Relative difference: 36.5% (95% CI 60% to 23%)

NNTBd: 2 (1 to 6)

Physical function

Not measured

Not measured

Not measured

Not measured

Not measured

Adverse events (narrative)

Alentorn‐Geli 2008: "This program neither exacerbated FM‐related symptoms nor resulted in musculoskeletal injuries; however, 1 patient exhibited a mild anxiety attack on the first session of WBV" (page 978)

Sañudo 2013: "This study, however, demonstrated that WBV training is safe (no adverse events)..." (page 683)

All‐cause withdrawal
assessed by number of people who dropped out

33 per 100

(7 of 21)

8 per 100
(2 of 25)

RR 0.25, 95% CI 0.06 to 1.12

46
(2 RCTs)

♁◯◯◯
VERY LOWa,b

Absolute risk difference: 24% (95% CI 3 to 51)

NNTHd: n/a

*Risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI)

CI: confidence interval; NNTB: number needed to treat for an additional beneficial outcome; NNTH: number needed to treat for an additional harmful outcome; OR: odds ratio; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aImprecision: Number of participants lower than 400 rule of thumb; wide confidence interval. Need for more studies with more participants to reach optimal information size (downgraded twice)

bHigh risk of biases including reporting and selection biases. Need for methodologically better designed and executed studies

cBaseline control group mean (SD) = 67 (15.81), n = 10

dNumber needed to treat for an additional beneficial outcome (NNTB) or number needed to treat for an additional harmful outcome (NNTH) not applicable (n/a) when result is not statistically significant. NNT for dichotomous outcomes calculated with Cates NNT calculator (http://www.nntonline.net/visualrx/). NNT for continuous outcomes calculated with Wells calculator (CMSG Editorial Office)

Figures and Tables -
Summary of findings 2. Whole body vibration plus mixed exercise versus control
Table 1. Glossary of terms

Term

Definition

Allodynia

Pain resulting from a stimulus that would not normally provoke pain

Amplitude

Absolute value of maximum displacement from a zero value during 1 period of an oscillation

Damping

Energy dissipation properties of a material or system under cyclic stress

Endurance

Two forms of endurance that refer to health‐related physical fitness include cardiorespiratory endurance (also known as cardiovascular endurance, aerobic fitness, aerobic endurance, exercise tolerance), which "relates to the ability of the circulatory and respiratory systems to supply fuel during sustained physical activity and to eliminate waste products after supplying fuel," and muscle endurance, which "relates to the ability of muscle groups to exert external force for many repetitions" (Caspersen 1985)

Frequency

Number of cycles or completed alternations per unit time of a wave or oscillation

Hertz

One hertz is 1 cycle per second; therefore, when an individual is exposed to a vibration of 30 Hz, targeted muscles receive 30 cycles of vibration per second, which makes muscles contract and relax 30 times in the same period

Hyperalgesia

Increased pain from a stimulus that normally provokes pain

Natural frequency

Frequency at which a system oscillates when not subjected to continuous or repeated external forces

Paresthesia

Abnormal sensation that is spontaneous or is evoked by a stimulus (eg, numbness)

Phase angle

Particular stage or point of advancement in a cycle; fractional part of the period through which time has advanced, measured from some arbitrary origin often expressed as an angle (phase angle); the entire period being taken is 360°

Figures and Tables -
Table 1. Glossary of terms
Table 2. List of Abbreviations

Abbreviation

Description

A

amplitude

ACR

American College of Rheumatology

ACSM

American College of Sports Medicine

AE

aerobic exercise

EMG

electromyography

f

frequency

FIQ

Fibromyalgia Impact Questionnaire

FX

flexibility

g

gravitational load (G‐force) = 1 cm/s2

HR

heart rate

HRQL

health‐related quality of life

hz

Hertz

ITT

intention‐to‐treat

kg

kilogram

m/s2

unit of acceleration: 1 Gal = 0.01 m/s2

MCID

minimal clinically important difference

MD

mean difference

MX

mixed intervention (includes more than 1 mode of physical activity)

n

number of studies

N

number of individuals

RD

risk difference

Relax

relaxation

RT

resistance training

s

seconds

SD

standard deviation

SE

standard error

SMD

standardized mean difference

sTNFR1 and sTNFR2

soluble tumor necrosis factor receptor 1 and 2

VAS

visual analogue scale

WBV

whole body vibration

wk

week(s)

WU

warm‐up

Figures and Tables -
Table 2. List of Abbreviations
Table 3. Mixed exercise FITT (frequency, intensity, time, and type) parameters

Vibration + Mixed vs Mixed + Placebo vs Control

Author, year

Intervention

Frequency (times per week | length in weeks)

Total duration

Supervised or home program

Aerobic component

Resistance component

Flexibility Component

Other

I (intensity): ACSM classification and physiological measure; M (mode): mode of exercise; T (time): duration of aerobic component in minutes

M (muscle groups, joints or areas of body); I (intensity resistance, repetitions, sets); T (type), T (time)

M (muscle groups, joints or areas of body); T (type of stretch, repetition, set), T (time)

Alentorn‐Geli 2008

AE + FX + Relax

2 times/wk

6 weeks

90’

Not specified

I: moderate to vigorous (65%‐85% HR max), T: primarily level ground walking with games and dance, T: 30'

Not applicable

M: 5 whole body stretches involving lower and upper limbs, neck, back; T: dynamic, 5 reps held for 30 s with 30 s rests, T: 25'

Relaxation

Vibration + Mixed vs Mixed

Sañudo 2010

AE + RT + FX

2 times/wk

6 weeks

60’

Supervised

I: light to moderate (50%‐69% HR max), M: not specified, T: 4‐6 intervals of 2‐3’, 1‐2’ rest between intervals

M: major muscle groups, I: 8 exercises, 1 × 8‐10 reps with 1‐3 kg, T: not specified

M: not specified, I: 1x 3 reps holding for 30s, T: not specified

Sañudo 2013

AE + RT + FX

2 times/wk

8 weeks

45‐60’

Supervised

I: moderate (65%‐70% HR max), M: not specified, T: 10‐15’

M: deltoids, biceps, neck, hips, back, and chest, I: 1 set of 8‐10 reps for 8 different muscle groups against 1‐3 kg, T: 15‐20’

M: deltoids, biceps, neck, hips, back, and chest

I: 1 set of 3 reps for 8‐9 different ex, maintained for 30 s, T: 10’

Figures and Tables -
Table 3. Mixed exercise FITT (frequency, intensity, time, and type) parameters
Table 4. Vibration specifications

Study name/year

Name of device

Vibration frequency and amplitude

Position of participant

Stabilizing support

Footwear

Static/Dynamic; unilateral/bilateral

Alentorn‐Geli 2008

PowerPlate

(PowerPlate International B.V., Badhoevendorp,

The Netherlands)

30 Hz; 2 mm vertical amplitude

The following 6 exercises were performed for 30 s each during whole body vibration (WBV) and were repeated 6 times with recovery of 3 minutes between repetitions

(a) static squat at 100° of knee flexion

(b) dynamic squat between 90° and 130° of knee flexion

(c) maintained ankle plantar‐flexion with legs in extension

(d) flexion‐extension of right leg between 100° and 130° of knee flexion

(e) flexion‐extension of left leg between 100° and 130° of knee flexion

(f) squat at 100° of knee flexion shifting body weight from 1 leg to the other

For adaptation purposes, only tasks (a), (b), and (c) (repeated 3 times) were performed during first 2 sessions

Yes ‐ for all tasks, individuals held onto the supporting bar

Does not state

Static bilateral

Gusi 2010

Galileo Fitness Platform

(Novotec Medical, Pforzheim, Germany)

12.5 Hz; 3 mm vertical amplitude

Participants alternated between 2 stances for each repetition

Stance A: feet perpendicular to midline axis of the platform with right foot placed slightly ahead of left foot. Toes of right foot and heel of left foot lifted 4 mm above surface of the platform. Knees bent to 45° angle. Back and head kept straight

Stance B: as per Stance A, except with left foot placed slightly ahead of right foot

Not reported and not pictured in Figure 2

Balance testing was performed barefoot. Does not specify that exercise was done barefoot, but Figure 2 indicates this

Static and dynamic both unilateral and bilateral

Sañudo 2010

Galileo Fitness Platform

(Novotec Medical, Pforzheim, Germany)

20 Hz; variable amplitude of 2‐3 mm

Three sets of 45 s of bilateral static squat with 120 s recovery between sets (amplitude = 3 mm) followed by 4 sets of 15 s of unilateral static squat on each leg (amplitude = 2 mm).

During WBV, participants stood with both knees in 120° isometric knee flexion (half‐squatting position) as measured by a goniometer

Does not state

Does not state

Static unilateral and bilateral

Sañudo 2013

PowerPlate,

North America Inc.,

Northbrook, IL,

United States

30 Hz; vertical displacement of 4 mm (71.1 m/s‐2 ≈ 7.2 g)

Standing on the platform, with knees in 120º isometric knee flexion (measured by a goniometer) and trunk upright

Bilateral static squat: 6 sets of 30 s, with 45‐s recovery between sets

Unilateral static squat: 4 sets of 30 s each leg

Does not state

All participants wore sport shoes for vibration exercises

Static unilateral and bilateral

Figures and Tables -
Table 4. Vibration specifications
Table 5. Quality of evidence. GRADE assessment for WBV + MX vs Other

Quality assessment

No. of participants

Quality

Importance

No. of studies

Study design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

Aerobic exercise (AE) intervention

AE control

Health‐related quality of life (HRQL), 0‐100, lower is best

2

Randomized trial

Very serious1

Not serious

Not serious

Serious2

23

26

⊕⊝⊝⊝
very low

CRITICAL

Pain intensity, 0‐100, lower is best

1

Randomized trial

Serious3

Not serious

Not serious

Serious2

One very small study

11

12

⊕⊝⊝⊝
very low

CRITICAL

Fatigue, 0‐100, lower is best

1

Randomized trial

Serious1

Not serious

Not serious

Serious2

One very small study

11

12

⊕⊝⊝⊝
very low

IMPORTANT

Stiffness, 0‐100, lower is best

1

Randomized trial

Serious1

Not serious

Not serious

Serious2

One very small study

11

12

⊕⊝⊝⊝
very low

IMPORTANT

Physical function, not reported

Withdrawals

3

Randomized trial

Very serious4

Not serious

Not serious

Serious2

3/39 (7.69%)

4/38 (10.52%)

⊕⊝⊝⊝
very low

IMPORTANT

Adverse events:Alentorn‐Geli 2008: "This program neither exacerbated FM‐related symptoms nor resulted in musculoskeletal injuries; however, one patient exhibited a mild anxiety attack on the first session of WBV" (page 978); Sañudo 2010: Trial authors clarified that one person in the comparison group ("other exercise group") dropped out owing to an injury that was not an injury related to the program (participant fell down on the street); Sañudo 2013: "This study, however, demonstrated that WBV training is a safe (no adverse effects), suitable (no dropouts due to the intervention), and effective (increased lower limb muscle strength) way to exercise the musculoskeletal system, and potentially a feasible intervention for those patients who cannot participate in conventional strength training" (page 683)

Figures and Tables -
Table 5. Quality of evidence. GRADE assessment for WBV + MX vs Other
Comparison 1. WBV vs C

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 HRQL, 1‐100 scale, lower means better HRQL Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Balance, degrees of displacement, lower is best Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 Withdrawal Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 1. WBV vs C
Comparison 2. WBV + MX vs C

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 WBV + MX vs C: HRQL, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

2 WBV + MX vs C: pain, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 WBV + MX vs C: fatigue, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 WBV + MX vs C: stiffness, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

5 WBV + MX vs C: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

6 Withdrawal Show forest plot

2

46

Risk Ratio (M‐H, Random, 95% CI)

0.25 [0.06, 1.12]

Figures and Tables -
Comparison 2. WBV + MX vs C
Comparison 3. WBV + MX vs Other

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 WBV + MX vs Other: HRQL, 0‐100 scale, lower is best Show forest plot

2

49

Mean Difference (IV, Random, 95% CI)

‐6.67 [‐14.65, 1.31]

2 WBV + MX vs Other: pain, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3 WBV + MX vs Other: fatigue, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 WBV + MX vs Other: stiffness, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5 WBV + MX vs Other: strength, measured in newtons and number of reps, higher values are best Show forest plot

2

54

Std. Mean Difference (IV, Random, 95% CI)

0.77 [0.20, 1.35]

6 WBV + MX vs Other: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best) Show forest plot

2

54

Mean Difference (IV, Random, 95% CI)

‐0.22 [‐1.56, 1.11]

7 Withdrawal Show forest plot

3

77

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.17, 3.11]

Figures and Tables -
Comparison 3. WBV + MX vs Other