Entrenamiento con ejercicios de vibración corporal total para la fibromialgia
Referencias
References to studies included in this review
References to studies excluded from this review
Additional references
References to other published versions of this review
Characteristics of studies
Characteristics of included studies [ordered by study ID]
Ir a:
| Methods | 3 groups: mixed exercise (AE + FX + Relax) + WBV; mixed exercise (AE + FX + Relax) + placebo WBV; control (medication as usual) Setting: not specified Length: 6 weeks Study design: randomized clinical trial with parallel groups | |
| Participants | Female:Male: 33:0 Age: 55.2 (SE 3.4); 53.7 (SE 2.7); 59.3 (SE 2.3) years, respectively Duration of diagnosis (years): 9.8 (SE 0.8) to 10.5 (SE 0.8) Inclusion: women with diagnosis of FM (ACR 1990) ≥ 3 years Exclusion: any orthopedic limitation, or cardiovascular, pulmonary, or metabolic disease that would preclude exercise | |
| Interventions | Mixed exercise, relaxation, vibration (n = 11): "The total duration (over 12 sessions) of aerobic exercise, stretching, and relaxation was 9 hours, 6 hours, and 4 hours, respectively" (page 977) • exercise protocol ‐ total frequency: 2/wk: duration: 90' (warm‐up 15', AE 30', FX 25', Relax 20') ‐ AE intensity: moderate to vigorous (65%‐85% HR max); mode: AE primarily level ground walking with games dance ‐ FX to stop point: mode: FX 5 × 5 whole body stretches, 30 s hold, 30 s relax, involving hamstrings, calves, Achilles tendons, shoulders, arms, gluteals, cervical spine, low back, upper back, chest, hip adductors • relaxation exercise ‐ mode: diaphragmatic respiration, progressive muscular relaxation, contraction – relaxation and imagery techniques, pharmacologic care as usual • vibration protocol ‐ frequency: 2/wk; duration: 4‐5' sessions 1' and 2', 18' sessions 3‐12; intensity: body weight resistance; mode: six 30 s lower extremity exercises (static and dynamic), vibratory stimulus: vibration frequency 30 Hz with 2 mm amplitude Mixed exercise, relaxation, placebo vibration (n = 12) • exercise protocol ‐ as per mixed exercise, relaxation, vibration group • relaxation exercise ‐ as per mixed exercise, relaxation, vibration group • placebo vibration ‐ as per mixed exercise, relaxation, vibration group, but apparatus did not produce vibrations Control (n = 10): pharmacologic care as usual | |
| Outcomes | Health‐related quality of life (FIQ total), Pain intensity (FIQ VAS), Fatigue (FIQ VAS), Stiffness (FIQ VAS) Other: depression (FIQ VAS). Measurements at baseline and at 6 weeks post treatment | |
| Adherence (monitoring, adherence criteria, adherence) | Monitoring methods: none stated; adherence criteria: "100% adherence = all sessions attended"; adherence in mixed exercise, relaxation, vibration group: attendance 93%; adherence in mixed exercise, relaxation, placebo vibration group: 92% (0% dropout) | |
| Congruence of exercise protocol with ACSM criteria for aerobic, resistance or flexibility | Both intervention groups AE ‐ exercise did not meet ACSM criteria based on frequency (only 2×/wk) FX ‐ met criteria | |
| Notes | Country: Spain Language: English Trial author contact: yes (no response to our email) Data extraction: point estimates and variability estimates extrapolated from graphs Funding sources: "no grant supported the investigation. ... There was no conflict of interest" (page 980) | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Insufficient information to permit judgement: "Women were randomized into three treatment groups" (page 976) |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement |
| Blinding of participants and personnel (performance bias) | Low risk | In addition to implementing a "sham" intervention (vibratory apparatus was turned on yet did not produce vibration (page 977), steps were taken to reduce contact between intervention groups |
| Blinding of self reported outcome (detection bias) | Low risk | All outcomes (HRQL, pain intensity, fatigue, stiffness) were self‐reported "The administration and analysis of the questionnaires were performed by an investigator who was blind to the treatment group" (page 977) Individuals not aware of placebo effect: "We informed both EVG and EG that they would receive a perceptible and imperceptible vibratory stimulus, respectively, thus maintaining the potential of a placebo effect consistent in both groups" (page 977) |
| Blinding of objectively measured outcome (detection bias) | Low risk | Not measured |
| Incomplete outcome data (attrition bias) | Low risk | Study has no dropouts. Attrition was attributed to "a no‐show on testing day" (page 978). Intention‐to‐treat not used; however, it is unlikely that attrition affected results |
| Selective reporting (reporting bias) | High risk | Trial authors used the FIQ but did not report all subscales. Assuming FIQ was used, outcomes physical function, anxiety, and sleep were not reported. Furthermore, we searched the protocol available on ClinicalTrials.gov (NCT00650715), but it does not provide further insight into selective reporting related to outcomes examined in this review. Trial authors specified their primary outcome only (serum IGT‐1); no other planned outcomes are available in the trial protocol |
| Other bias | Low risk | Study appears to be free of other sources of bias |
| Methods | 2 groups: whole body vibration; control (standard care) Setting: program implemented at the local fibromyalgia association (unclear whether group or individual) Length of Intervention: 12 weeks Study design: randomized clinical trial, parallel groups | |
| Participants | Female:Male: 41:0 Age: mean 52.4 (SD 10.8); mean 53 (SD 12) years, respectively Duration of symptoms: 12.7 (6.7); 13.7 (6.2) years, respectively Inclusion: participants in a local fibromyalgia association; condition diagnosed by a rheumatologist (ACR 1990 diagnostic criteria) Exclusion: history of severe trauma, frequent migraines, peripheral nerve entrapment, inflammatory rheumatic disease, severe psychiatric illness, other diseases that prevent physical loading, pregnancy, participation in another psychological or physical therapy program, participation in regular physical exercise more often than 1×/wk for ≥ 30 minutes during any 2‐week period in past 5 years | |
| Interventions | Whole body vibration (n = 21): frequency: 3×/wk; duration: 18‐21' per session. 10' warm‐up of slow walking and slight movement; total 6 reps of WBV at 12.5 Hz with 60 s rest interval; wk 1‐4 each rep was 30 s; wk 5‐8 each rep was 45 s; wk 9‐12 each rep was 60 s; at each repetition, the stance of the participant on the platform was alternated between stance 'A' (feet planted perpendicular to midline axis of the platform; right foot ahead of left; lift the toes of the platform; bend the knees and maintain a 45‐degree knee angle; keep back ahead straight) and 'B' (same as stance 'A' but left foot ahead). Intensity: not given. Mode: sustained squat on vibration platform Control (n = 20): Participants received standard care that included medical attention and social support through the local fibromyalgia association: "Participants continue their daily activities which did not include any form of physical exercise that resembled the exercises performed by participants in the vibration group, and they not receive a weekly phone call" (page 1074) | |
| Outcomes | Health‐related quality of life (FIQ total), Balance (Biodex Balance System dynamic and static balance ‐ degrees of tilt) Other: HRQL (15D questionnaire), Number of falls in the past year (baseline only), Tender points (baseline only) Measurements taken at baseline and at 12 weeks post treatment | |
| Adherence (monitoring, adherence criteria, adherence) | Monitoring methods: logbooks and research assistance, 3‐minute weekly phone call; adherence criteria: none stated; adherence: program was completed by 85.7% of participants | |
| Congruence of exercise protocol with ACSM criteria for aerobic, resistance or flexibility | Not applicable | |
| Notes | Country: Spain, Language: English Trial author contact: no Funding sources: not specified | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Participants were "randomly and sequentially assigned to either the vibration group (n = 21) or the control group (n = 20) by a research assistant, according to a random number table" (page 1073) |
| Allocation concealment (selection bias) | Low risk | Participants were "allocated by research assistant, participants were blinded to allocation until after assignment, research team members were blinded to assignment" (page 1073) |
| Blinding of participants and personnel (performance bias) | High risk | "Participants were blinded to group assignment before baseline measurements, after which all participants were informed of their assignment" (page 1073) |
| Blinding of self reported outcome (detection bias) | High risk | Self‐reported outcome measures |
| Blinding of objectively measured outcome (detection bias) | Low risk | "Research team members (JAP and PRO) who were also blinded to the group assignments of the participants conducted the measurements of dynamic balance at baseline and 12 weeks. Different members of the research team (NG and JCA) administered the intervention and performed the statistical analysis" (page 1073) |
| Incomplete outcome data (attrition bias) | Low risk | ITT analysis and ITT data reported in Gusi 2010, but in Adsuar, analysis was based on "as treated" data (n = 18 per group) |
| Selective reporting (reporting bias) | High risk | Study protocol (www.controlled‐trials.com/ISRCTN16950947) states that FIQ was used at baseline and at 3 months, yet HRQL, physical function, and pain intensity were not reported |
| Other bias | Low risk | Study appears to be free of other sources of bias |
| Methods | 2 groups: mixed exercise (AE + RT + FX) + WBV; mixed exercise (AE + RT + FX) Setting: group ‐ supervised Length: 6 weeks Follow‐up: none Study design: randomized clinical trial with parallel groups | |
| Participants | Female:Male: 30:0 Age: 57.89 (6.23); 60.13 (9.42) years, respectively Duration of illness: not stated Inclusion: postmenopausal women with diagnosis of fibromyalgia (ACR 1990) Exclusion: inflammatory rheumatic disorders or degenerative joint disease, psychiatric disorders, respiratory or cardiovascular diseases that would preclude exercise. Individuals under psychiatrist care or performing structured physical activity ≥ 2 days a week or had psychological therapy during the 6 months before the study | |
| Interventions | Mixed exercise (AE + RT + FX) + WBV (n = 15) • exercise protocol: frequency 2×/wk ‐ AE intensity: 50%‐69% max HR, major muscle groups; mode: short intervals (4‐6 intervals of 2‐3', 1‐2' rest in between) ‐ RT intensity: 8 exercises: 1×1‐8 reps with 1‐3 kg; mode: not stated ‐ FX intensity: 8‐9 exercises: 1×3 reps, keeping the stretch position for 30 s; mode: not stated • vibration protocol: frequency 3×/wk; duration 3 sets of 45 s with 120 s recovery (amplitude = 3 mm) and 4 sets of 15 s; intensity: frequency of 20 Hz and variable amplitude of 2‐3 mm; mode: using a platform (Novotec, Pforzheim, Germany), the first 3 sets were performed bilaterally for 45 s at a frequency of 20 Hz (amplitude 3 mm) after 120 s recovery between sets. Participants completed 4 sets of unilateral static squats at a frequency of 20 Hz (A = 2 mm) for 6 wk. Participants completed 15 s of exercise with right leg, then immediately completed 15 s on the left leg ‐ this was considered 1 set. During vibration session, participants stood with both knees in 120 isometric knee flexion (half‐squatting position) as measured by a goniometer Mixed exercise (AE + ST + FX) (n = 15) performed as in Mixed exercise (AE + RT + FX) + WBV group, no vibration training. Frequency 2×/wk; duration 60 minutes | |
| Outcomes | Health‐related quality of life (FIQ total), Muscle strength (newtons), Balance (Biodex Bal System – overall stability index, eyes closed, degree displacement 0‐20 scale) Other: muscle endurance (number of squat reps in 60 s and fatigue index), power (maximum power; squats), HRQL (SF‐36) Measurements at baseline and at 6 weeks post treatment | |
| Adherence (monitoring, adherence criteria, adherence) | Monitoring methods: none stated; adherence criteria: none stated; adherence: none stated | |
| Congruence of exercise protocol with ACSM criteria for aerobic, resistance or flexibility | Both intervention groups AE ‐ did not meet ACSM criteria based on frequency (only 2×/wk for about 15') RT ‐ met criteria FX ‐ not enough info to judge; unclear which muscles were stretched | |
| Notes | Country: Spain Language: primary and companion articles in English Funding sources: none stated Trial author contact: yes, responses received (March 18, 2012) with regard to reasons for dropout, fatigue ratio calculation, sessions of vibration training, allocation concealment, and combined exercise sessions | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "participants were randomized into one of two groups (by a computer generated random number table). Randomization was carried out by LC, who was not directly involved in the day‐to‐day running of the study…" (page S‐41) |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgment of "yes" or "no" |
| Blinding of participants and personnel (performance bias) | Unclear risk | No information provided to indicate measurements to blind study participants or personnel |
| Blinding of self reported outcome (detection bias) | Unclear risk | Self‐reported outcomes: head‐to‐head intervention; it is possible that both groups may have overestimated reporting of the outcome. No information about participant awareness of the intervention |
| Blinding of objectively measured outcome (detection bias) | Low risk | "Data were collected….by an outcome assessor who was blind to group allocation" (page S‐41) |
| Incomplete outcome data (attrition bias) | Low risk | No missing outcome data |
| Selective reporting (reporting bias) | Low risk | Study protocol is not available, but it is clear that published reports include all expected outcomes |
| Other bias | Low risk | Study appears to be free of other sources of bias |
| Methods | 3 groups: mixed exercise (AE + RT + FX) + WBV; mixed exercise (AE + RT + FX); control (usual care) Setting: community based ‐ supervised Length: 8 weeks Follow‐up: none Study design: randomized controlled trial, 3 parallel groups | |
| Participants | Female:Male: 46:0 Age: 57.15 (SD 6.8); 62.3 (SD 9.8); 55.6 (SD 7.9) years, respectively Duration of illness: not specified Inclusion: participants in a local fibromyalgia support group (Seville, Spain) and physician practices; met ACR 1990 diagnosis criteria Exclusion: no previous experience with vibratory training; ≥ 1 possible contraindications (acute hernia; thrombosis; diabetes; epilepsy; metabolic or neuromuscular disease; osteoporosis; osteoarthritis; orthopedic injuries and prosthesis); respiratory or cardiovascular disease that prevents physical exertion; taking drugs that could interfere with balance control; receiving psychological or physical therapy (to avoid possible interaction) | |
| Interventions | Mixed exercise (AE + RT + FX) + WBV (n = 15) • exercise protocol: duration: 45‐60 min (WU 10 min, AE 10‐15 min, RT 15‐20 min, FX 10 min) ‐ AE: frequency: 2×/wk; mode: AE ‐ walking mode not specified; intensity: moderate (65%‐70% HR max) ‐ RT: 1 set of 8‐10 reps for 8 different muscle groups; load 1‐3 kg ‐ FX: mode: 1 set of 3 reps for 8‐9 different exercises, maintained for 30 s; mode: focused on main areas of pain (deltoids, biceps, neck, hips, back, and chest) • vibration protocol: frequency: 3×/wk progressive training (2‐leg stance with knees @120° of knee flexion), 30 Hz, peak to displacement 4 mm (71.1 m/s‐2˜7.2 g); duration: weeks 1‐2: 6 sets of 30 s, 45 s recovery between sets with participants standing with both feet on platform, and 4 sets of 30 s single leg (right and left immediately following each other); weeks 3‐4: 7 sets 30 s/45 s rest (bilateral squat), and 5 sets of 30 s/45 s rest (unilateral squat). Weeks 5‐6: 8 sets of 30 s/45 s rest (bilateral squat), and 6 sets of 30 s/45 s rest (unilateral squat), weeks 7‐8: 9 sets of 30 s/45 s rest (bilateral squat), and 7 sets of 30 s/45 s rest (unilateral squat) Mixed exercise (AE + RT + FX) (n = 15) Frequency: 2×/wk; duration: 45‐60 min (WU 10 min, AE 10‐15 min, RT 15‐20 min, FX 10 min) • exercise protocol: performed as in Mixed exercise (AE + RT + FX) + WBV group Usual care (n = 16): usual care, no additional information provided | |
| Outcomes | Balance (Biodex F1C Stability System: overall stability index open eyes, overall stability index closed eyes) Other: power (number of reps of half squats in 1') Measurements taken at baseline and at 8 weeks post treatment | |
| Adherence (monitoring, adherence criteria, adherence) | Monitoring methods: not stated; adherence criteria: not stated; adherence: women in mixed plus whole body vibration group attended 77%, and in mixed exercise 79% of sessions | |
| Congruence of exercise protocol with ACSM criteria for aerobic, resistance or flexibility | Both intervention groups AE ‐ did not meet ACSM criteria for frequency and duration RT ‐ not enough information to determine FX ‐ met ACSM criteria | |
| Notes | Country: Spain Language: English Funding sources: none stated Trial author contact: email received March 17, 2014, provided clarification regard sample size (only 5 participants in CG dropped out, 11 participants were assessed at post‐test and assessor blinding) | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "Participants were randomly assigned by using a computer generated random number sequence" (page 679) |
| Allocation concealment (selection bias) | Low risk | "Randomization was undertaken by a member of the research team not directly involved in the recruitment or assessment of patients" (page 679) |
| Blinding of participants and personnel (performance bias) | High risk | Unspecified blinding of participants or personnel |
| Blinding of self reported outcome (detection bias) | Low risk | Not measured |
| Blinding of objectively measured outcome (detection bias) | Low risk | Research team members (JAP and PRO) who were also blinded to group assignments of participants conducted measurements of dynamic balance at baseline and at 12 weeks. Different members of research team (NG and JCA) administered the intervention and performed statistical analysis (trial author communication) |
| Incomplete outcome data (attrition bias) | Low risk | ITT analysis, and ITT data reported |
| Selective reporting (reporting bias) | Low risk | Study protocol is not available, but results for all outcomes specified in the methods section of the paper were reported |
| Other bias | Unclear risk | Baselines differences in medial lateral mean defection (page 680) |
Characteristics of excluded studies [ordered by study ID]
Ir a:
| Study | Reason for exclusion |
| Diagnosis does not meet requirements | |
| Outcomes were serum insulin‐like growth factor‐1 (IGF‐1) levels in women with fibromyalgia. None of the primary or secondary outcomes of the review were measured in this study | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Randomization does not allow analysis of effects of exercise | |
| Exercise requirements not met | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Designated outcomes not measured | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| RCT protocol (physical activity intervention did not meet requirements for vibration training) | |
| RCT protocol (physical activity intervention did not meet requirements for vibration training) | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| Exercise requirements not met | |
| Physical activity intervention did not meet requirements for vibration training | |
| Exercise requirements not met | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| RCT protocol (physical activity intervention did not meet requirements for vibration training) | |
| Not an RCT | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| RCT protocol (physical activity intervention did not meet requirements for vibration training) | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| RCT protocol (physical activity intervention did not meet requirements for vibration training) | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| Follow‐up study, randomization lost | |
| Diagnosis did not meet requirements | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| RCT protocol (physical activity intervention did not meet requirements for vibration training) | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Randomization does not allow analysis of effects of exercise | |
| Randomization does not allow analysis of effects of exercise | |
| RCT protocol (physical activity intervention did not meet requirements for vibration training) | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Exercise requirements not met | |
| Not an RCT | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Diagnosis did not meet requirements | |
| Not an RCT | |
| Not an RCT | |
| Diagnosis did not meet requirements | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Study did not include exercise | |
| Exercise requirements not met | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Data for FM not isolated | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| Problem with implementation of study design ‐ randomization lost | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| Physical activity intervention did not meet requirements for vibration training | |
| Exercise requirements not met | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Exercise requirements not met | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| RCT protocol (physical activity intervention did not meet requirements for vibration training) | |
| Study did not allow analysis of fibromyalgia only | |
| Diagnosis did not meet requirements | |
| Not an RCT | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Diagnosis did not meet requirements | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Exercise requirements not met | |
| Not a physical activity RCT; analysis did not isolate effects of exercise | |
| Not an RCT | |
| Exercise requirements not met | |
| Not an RCT | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Study did not include exercise | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training (companion) | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Physical activity intervention did not meet requirements for vibration training | |
| Exercise requirements not met | |
| Physical activity intervention did not meet requirements for vibration training | |
| RCT protocol (physical activity intervention did not meet requirements for vibration training) | |
| Diagnosis did not meet requirements | |
| Physical activity intervention did not meet requirements for vibration training | |
| Exercise requirements not met | |
| Not an RCT | |
| Physical activity intervention did not meet requirements for vibration training | |
| Not an RCT |
Data and analyses
| 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 | |
| Analysis 1.1  Comparison 1 WBV vs C, Outcome 1 HRQL, 1‐100 scale, lower means better HRQL. | ||||
| 2 Balance, degrees of displacement, lower is best Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| Analysis 1.2  Comparison 1 WBV vs C, Outcome 2 Balance, degrees of displacement, lower is best. | ||||
| 3 Withdrawal Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| Analysis 1.3  Comparison 1 WBV vs C, Outcome 3 Withdrawal. | ||||
| 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 | |
| Analysis 2.1  Comparison 2 WBV + MX vs C, Outcome 1 WBV + MX vs C: HRQL, 0‐100 scale, lower is best. | ||||
| 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 | |
| Analysis 2.2  Comparison 2 WBV + MX vs C, Outcome 2 WBV + MX vs C: pain, 0‐100 scale, lower is best. | ||||
| 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 | |
| Analysis 2.3  Comparison 2 WBV + MX vs C, Outcome 3 WBV + MX vs C: fatigue, 0‐100 scale, lower is best. | ||||
| 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 | |
| Analysis 2.4  Comparison 2 WBV + MX vs C, Outcome 4 WBV + MX vs C: stiffness, 0‐100 scale, lower is best. | ||||
| 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 | |
| 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). | ||||
| 6 Withdrawal Show forest plot | 2 | 46 | Risk Ratio (M‐H, Random, 95% CI) | 0.25 [0.06, 1.12] |
| Analysis 2.6  Comparison 2 WBV + MX vs C, Outcome 6 Withdrawal. | ||||
| 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] |
| Analysis 3.1  Comparison 3 WBV + MX vs Other, Outcome 1 WBV + MX vs Other: HRQL, 0‐100 scale, lower is best. | ||||
| 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 | |
| Analysis 3.2  Comparison 3 WBV + MX vs Other, Outcome 2 WBV + MX vs Other: pain, 0‐100 scale, lower is best. | ||||
| 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 | |
| Analysis 3.3  Comparison 3 WBV + MX vs Other, Outcome 3 WBV + MX vs Other: fatigue, 0‐100 scale, lower is best. | ||||
| 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 | |
| Analysis 3.4  Comparison 3 WBV + MX vs Other, Outcome 4 WBV + MX vs Other: stiffness, 0‐100 scale, lower is best. | ||||
| 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] |
| 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. | ||||
| 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] |
| 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). | ||||
| 7 Withdrawal Show forest plot | 3 | 77 | Risk Ratio (M‐H, Random, 95% CI) | 0.72 [0.17, 3.11] |
| Analysis 3.7  Comparison 3 WBV + MX vs Other, Outcome 7 Withdrawal. | ||||
Study flow diagram for vibration training interventions.
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
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.
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.
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.
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.
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).
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.
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.
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.
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.
| Whole body vibration versus control | ||||||
| Patient or population: individuals with fibromyalgia | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | No. of participants | Quality of the evidence | Comments | |
| Risk with control | Risk with WBV | |||||
| Health‐related quality of life 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 | ♁◯◯◯ | 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 | 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 | Study population | RR 1.43 (0.27 to 7.67) | 41 | ♁◯◯◯ | 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) | ||||||
| GRADE Working Group grades of evidence | ||||||
| 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) | ||||||
| Whole body vibration plus mixed exercise versus control | ||||||
| Patient or population: individuals with fibromyalgia | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | No. of participants | Quality of the evidence | Comments | |
| Risk with control | Risk with WBV + MX | |||||
| Health‐related quality of life | 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 | ♁◯◯◯ | 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 | 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 | ♁◯◯◯ | Absolute difference: 28% (95% CI 43% to 13%). Relative difference: 39% (95% CI 18% to 60%) NNTBd: 2 (1 to 4) |
| Fatigue | 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 | ♁◯◯◯ | Absolute difference: 33% (95% CI 49% to 16%). Relative difference: 47% (95% CI 23% to 70%) NNTBd: 2 (1 to 4) |
| Stiffness | 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 | ♁◯◯◯ | 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 | 33 per 100 (7 of 21) | 8 per 100 | RR 0.25, 95% CI 0.06 to 1.12 | 46 | ♁◯◯◯ | 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) | ||||||
| GRADE Working Group grades of evidence | ||||||
| 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) | ||||||
| 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° |
| 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 |
| 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) | |||||||
| 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 | |||||||||
| 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 | ||
| 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’ | ||
| Study name/year | Name of device | Vibration frequency and amplitude | Position of participant | Stabilizing support | Footwear | Static/Dynamic; unilateral/bilateral |
| 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 | |
| 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 | |
| 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 | |
| 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 |
| 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 | ⊕⊝⊝⊝ | CRITICAL | |
| Pain intensity, 0‐100, lower is best | ||||||||||
| 1 | Randomized trial | Serious3 | Not serious | Not serious | Serious2 | One very small study | 11 | 12 | ⊕⊝⊝⊝ | CRITICAL |
| Fatigue, 0‐100, lower is best | ||||||||||
| 1 | Randomized trial | Serious1 | Not serious | Not serious | Serious2 | One very small study | 11 | 12 | ⊕⊝⊝⊝ | IMPORTANT |
| Stiffness, 0‐100, lower is best | ||||||||||
| 1 | Randomized trial | Serious1 | Not serious | Not serious | Serious2 | One very small study | 11 | 12 | ⊕⊝⊝⊝ | IMPORTANT |
| Physical function, not reported | ||||||||||
| Withdrawals | ||||||||||
| 3 | Randomized trial | Very serious4 | Not serious | Not serious | Serious2 | 3/39 (7.69%) | 4/38 (10.52%) | ⊕⊝⊝⊝ | 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) | ||||||||||
| 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 | |
| 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] |
| 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] |
