全身振动训练对膝关节骨性关节炎的作用

全身振动训练是通过机械振动,外部抵抗负荷引起神经反射,从而促进肌肉产生不自主收缩,用于改善肌肉功能,并通过对骨骼进行反复性压力刺激进而促进肌肉-骨骼系统结构和功能的完善,是一种全新的非药物、无创伤的治疗膝关节骨性关节炎的康复训练方法。本文对全身振动训练治疗膝关节骨性关节炎的作用机制进行简要综述,期望该技术能在临床的应用和推广上提供参考。     

全身振动训练在老年康复领域应用的研究进展

全身振动训练是一种新兴的应用于老年人群肌肉-骨骼系统退行性疾病的康复治疗技术,在改善骨质疏松、增强骨骼肌肌肉力量、提高平衡和步态功能以及老年人群代谢综合征、骨关节炎和肌少症的康复治疗中发挥独特优势。本文对其应用于老年人群肌肉-骨骼-关节系统康复的疗效和安全性进行综述,以期为该技术的临床应用提供指导和参考。     

全身振动训练在儿童康复的应用

全身振动训练(Whole-body vibration training,WBV)是一种神经肌肉训练方法,主要包含振动频率、振动强度和振动方式三个参数调控。训练过程中训练者站立、坐或半蹲在振动平台上,平台通过对人体施加振动波(通常使用5~60 Hz频率),刺激肌肉纺锤体和α运动神经元等感受器,使神经系统、肌肉-骨骼系统以及心血管系统产生适应性反应进而提高部分身体功能[1]。     

全身振动训练治疗慢性踝关节不稳的研究进展

全身振动训练(WBVT)作为一种新兴的运动治疗手段,通过向机体传递振动刺激影响神经肌肉活动,从而达到改善肌肉骨骼功能和运动表现的目的。本文通过系统回顾相关文献,对WBVT治疗慢性踝关节不稳的临床疗效、作用机制以及参数设置进行综述,以期为该技术临床应用提供理论依据。     

肌骨共生相关信号通路研究进展

骨质疏松症是一种以骨量降低、骨组织微结构损坏、骨脆性增加、易发生骨折为特征的全身代谢性骨病,而肌少症是以进行性全身肌量减少和功能减退为主要特征的综合征。基于二者共同的病理生理机制及密切相关性,逐渐衍生出“肌少-骨质疏松症”这一概念,以描述肌肉与骨骼同时发生衰减的现象。信号通路作为肌肉与骨骼之间重要的信号传递途径,如发生异常,则会导致肌少-骨质疏松症的发生。因此,本文就Hedgehog、Hippo、mTOR和MAPK等成骨与成肌相关信号通路进行综述,以期为肌少-骨质疏松症的靶向治疗提供新思路。     

脑卒中患者髂腰肌拉伸振动训练的研究进展

脑卒中患者步行能力受限是造成日常活动能力下降的重要原因,大部分患者将恢复步行能力作为康复治疗过程中的首要康复目标。脑卒中患者进行髂腰肌拉伸振动训练时,振动机械波可刺激肌肉和骨骼,提高髂腰肌肌肉兴奋性,进而改善患者肌肉痉挛状况,增加关节活动度,同时可减缓患者疼痛,提高步行能力和日常生活能力。     

全身振动改善脑卒中患者肢体运动功能障碍：目前证据不足

背景：全身振动训练作为新兴的神经肌肉训练方法,经研究发现能有效提高老年人肌力和姿势控制能力。近年来研究者将全身振动训练应用于脑卒中患者,探索其是否能减轻患者的运动功能障碍。目的：阐述全身振动对脑卒中患者患侧肢体肌力、肢体肌张力及平衡与步态的影响国内外研究的进展。方法：通过检索PubMed、EBSCO、Medline等数据库2002年1月至2014年6月与全身振动训练干预脑卒中患者肢体功能障碍的相关研究,选择34篇文献进行分别探讨。结果与结论：全身振动训练干预脑卒中患者具有较强的可行性和安全性。在疗效方面,研究主要关注肌力、肌张力、平衡功能、姿势控制能力,但目前全身振动训练改善脑卒中患者运动功能障碍的证据不足。在具体的振动干预方案方面,振动的类型、频率、振幅、时间暂无公认的标准,也待进一步研究。目前临床疗效观察研究较多,缺乏对全身振动训练影响机制的研究,其疗效有待更多大样本、多中心随机对照实验验证。     

脑性瘫痪儿童青少年全身振动干预的健康和功能结局：基于WHO-FICs的系统综述

目的 基于世界卫生组织国际分类家族(WHO-FICs)的理论与方法,构建脑瘫儿童青少年全身振动训练的健康和功能结局研究架构,系统综述脑瘫儿童青少年的主要健康状况和身体功能、全身振动训练的干预方案以及振动干预的健康和功能结局。方法 基于WHO-FICs方法,构建系统综述的PICO架构,检索中国知网、万方、PubMed、Web of Science、EBSCO、Embase等数据库,收集建库至2022年9月30日关于全身振动训练对脑瘫儿童青少年健康状况与功能效果的随机对照试验,进行系统综述。结果 最终纳入文献8篇,其中英文7篇,中文1篇,分别来自5个国家,主要来源于临床康复、神经康复、物理医学与康复等相关领域期刊,发表时间集中在2010年以后,涉及227例参与者(3～12.3岁)。纳入文献物理治疗证据数据库量表评分平均6分。诊断ICD-11编码涉及08神经系统疾病、8D20痉挛型脑瘫、8D20.1痉挛型双侧脑瘫、8D20.10痉挛型四肢瘫脑瘫、8D2Z未特指的脑瘫。主要功能障碍在身体功能方面表现为肌肉痉挛、骨骼发育异常、关节畸形和肌肉无力,选择性运动控制下降以及步态异常;在活动和参与方面表...     

运动与运动方式对骨密度的影响

不同的运动形式对骨密度的影响各异，高冲击性的训练优于低强度的耐力训练。振动训练作为新兴的运动形式，备受科学界的关注，而且对其与骨密度的研究也日益深入。但是由于运动强度、时间、频率等因素的不同研究结果存在一定的差异，尤其是对老年人的抗阻训练研究国内鲜有报道，急需在这方面多做研究。振动训练可以提高肌肉的力量从而对骨骼产生积极的影响，因此振动训练在预防骨质疏松方面可能会发挥重要作用。随着分子生物学技术的进步，有关骨代谢调控基因的研究日益增多，但是与运动结合进行研究的较少，有待深入探索。     

11种运动对老年肌少症患者身体功能改善效果的网状Meta分析

目的 通过网状Meta分析评价11种运动训练对老年肌少症患者身体功能、肌肉力量和肌肉质量改善效果的影响。方法 检索Web of Science、Pub Med、Embase、Cochrane Library、CINAHL、中国知网、中国生物医学文献数据库、万方数据库和维普数据库中关于运动训练对老年肌少症患者身体功能、肌肉力量和肌肉质量改善效果的随机对照试验。检索时限为建库至2022年1月。采用Stata 15.0软件进行网状Meta分析。结果 纳入34项研究,共2 199例患者。网状Meta分析结果表明,与非运动对照组相比,阻力训练、小组综合训练、八段锦、全身振动训练、家庭综合训练可改善老年肌少症患者的身体功能（P<0.05）;阻力训练和壶铃训练可改善老年肌少症患者的握力（P<0.05）;阻力训练可改善老年肌少症患者的骨骼肌指数（P<0.05）。结论 在改善老年肌少症患者身体功能、肌肉力量和质量方面,阻力训练是目前最优的运动干预措施,其次为小组综合训练和全身振动训练,但仍需更多研究进一步论证。     

本体感觉神经肌肉促进法和全身振动训练对功能性踝关节不稳干预效果的比较

目的 比较本体感觉神经肌肉促进法(PNF)和全身振动训练(WBVT)对功能性踝关节不稳(FAI)患者的干预效果。方法 2021年5月至7月,于北京体育大学招募FAI男大学生17例,随机分为PNF组(n=8)和WBVT组(n=9),分别接受PNF训练和WBVT,共6周。干预前后采用Y平衡测试仪、动态平衡仪、三维测力台和运动捕捉系统进行测试。结果 训练方法对Y平衡成绩、平均轨迹误差以及各落地后动力学参数的主效应均不显著(F <4.090, P> 0.05),训练方法和时间对落地后踝关节屈伸活动范围的交互效应显著(F=6.232, P=0.030),PNF的效应量更大;时间和训练方法对左右地面反作用力峰值出现时间交互效应显著(F=10.674, P=0.008),WBVT组峰值出现时间更晚(P <0.05)。结论 PNF和WBVT对FAI患者的效果总体相当。     

全身振动训练对延迟性肌肉酸痛影响的Meta分析

目的:系统评价全身振动训练(WBVT)对延迟性肌肉酸痛(DOMS)的临床疗效.方法:系统检索Scoups、Springer link、Web of Science、ProQuest等中英文数据库,搜索关于全身振动训练治疗延迟性肌肉酸痛的随机对照试验(RCT).根据Cochrane手册对纳入文献进行风险偏倚评价,并在数据...     

Effects of Whole-Body Vibration Training on Body Composition,Cardiometabolic Risk,and Strength in the Population Who Are Overweight and Obese: A Systematic Review With Meta-analysis

ObjectivesTo assess the effects of whole-body vibration training (WBVT) on body composition, metabolic and cardiovascular risk variables, and lower limb strength in participants who are overweight/obese.Data SourcesA systematic review with meta-analysis was conducted in 3 databases (PubMed-MEDLINE, Web of Science, and Cochrane Library) from inception through to January 26, 2020.Study Selection: Studies analyzing the effect of WBVT on body composition variables, metabolic profile, blood pressure, heart rate, and lower limb strength in the population who are overweight/obese, with interventions of a minimum length of 2 weeks were included.Data ExtractionAfter applying the inclusion and exclusion criteria, 23 studies involving 884 participants who were obese/overweight (experimental group: 543; weight=79.9 kg; body mass index (BMI) =31.3 kg/m², obesity class I according to World Health Organization) were used in the quantitative analysis. The sex of the participants involved in the studies were as follows: (1) 17 studies included only female participants; (2) 1 study included only boys, and (3) 5 studies included both sexes. Meta-analysis, subgroup analysis, and meta-regression methods were used to calculate the mean difference and standardized mean difference (SMD; ± 95% confidence intervals [CIs]) as well as to analyze the effects of pre-post intervention WBVT and differences from control groups.Data SynthesisWBVT led to a significant decrease in fat mass (−1.07 kg, not clinically significant). In addition, WBVT reduced systolic blood pressure (−7.01 mmHg, clinically significant), diastolic blood pressure (−1.83 mmHg), and heart rate (−2.23 bpm), as well as increased the lower extremity strength (SMD=0.63; range, 0.40-0.86). On the other hand, WBVT did not modify the weight, BMI, muscle mass, cholesterol, triglycerides, or glucose.ConclusionsWBVT could be an effective training modality to reduce blood pressure (clinically relevant) and resting heart rate. In addition, WBVT led to improved lower limb strength. However, these findings were not consistent with significant improvements on other variables associated with metabolic syndrome (body composition, cholesterol, triglycerides, glucose).     

A comparison between whole-body vibration and conventional training on pain and performance in athletes with patellofemoral pain

IntroductionPatellofemoral pain (PFP) is the most common cause of anterior knee pain in athletes, which affects their performance especially during single leg activities. The aim of this study was to compare the effects of whole-body vibration training (WBVT) and conventional training (CT) on pain and performance in athletes with PFP.Methods30 athletes with unilateral PFP were randomly assigned to the WBVT (6 women, 9 men) or CT (7 women, 8 men) group. All participants received training for 4 weeks in 12 sessions. The outcomes of pain and performance were measured at three points in time: baseline, immediately after training and 2 weeks after training. Pain was assessed with the Numeric Pain Rating Scale (NPRS). Performance was measured with the leg-press test and the Kujala Patellofemoral Score (KPS).ResultsIn both groups, pain intensity decreased significantly (p < 0.001) and the KPS and number of leg presses increased significantly (p < 0.001) with time. There was no significant difference between groups for changes in the pain score (p = 0.896), KPS (p = 0.463) or leg press (p = 0.796) results.ConclusionWhole-body vibration training had the same effect as exercise therapy on pain reduction and on improvements in performance in athletes with PFP.     

Effects of Conservative Interventions on Static and Dynamic Balance in Individuals With Chronic Ankle Instability: A Systematic Review and Meta-analysis

ObjectiveTo determine which conservative interventions are effective for static and dynamic balance in patients with chronic ankle instability (CAI).Data SourcesPubMed, Cochrane Library, Web of Sciences, and CINAHL databases were searched up to March 20, 2022.Study SelectionRandomized controlled trials investigating the effects of conservative interventions on static and/or dynamic balance in patients with CAI compared with those of different conservative interventions or controls were included.Data ExtractionTwo independent reviewers extracted the data. Certainty of the evidence was assessed using the GRADE approach.Data SynthesisForty-eight studies (1906 participants) were included. Whole-body vibration training (WBVT) was significantly more effective than controls for both static (standardized mean difference, 1.13; 95% confidence interval [CI], 0.58-1.68; moderate-certainty evidence) and dynamic balance (0.56; CI, 0.24-0.88; low-certainty evidence). Balance training (BT) and joint mobilization were significantly more effective than controls for dynamic balance (0.77; CI, 0.41-1.14; and 0.75; CI, 0.35-1.14, respectively), but not for static balance (very low to low-certainty evidence). Adding other interventions to BT had no significant effect on either type of balance compared with that of BT alone (moderate to low-certainty evidence). Strength training (ST) and taping had no significant effect on either type of balance (very low- to low-certainty evidence). Multimodal interventions were significantly effective in improving dynamic balance (0.76; CI, 0.32-1.20; low-certainty evidence). Adding transcranial direct current stimulation to ST was significantly more effective for dynamic balance than ST (0.81; CI, 0.08-1.53; moderate-certainty evidence). The effects on balance were not significantly different among BT, ST, and WBVT (very low- to low-certainty evidence).ConclusionsThe significantly effective interventions reviewed may be treatment options for balance impairments associated with CAI. However, interventions should be chosen carefully, as much of the certainty of evidence is very low to low.     

Effects of surface variability in whole-body vibration platform on knee osteoarthritis: A scoping review

IntroductionWhole body vibration (WBV) has received much attention in recent years but there is a lack of consensus as far as its effects are concerned. It is usually applied on the stable surface but its effects on the unstable surface are also being explored. However, only a few studies have described the efficacy of using the unstable surface on WBV platform in knee osteoarthritis (KOA) and this lack of information generates uncertainties regarding the efficacy of stable and unstable WBV training in KOA.ObjectiveTo identify the efficacy of stable and unstable surface WBV training in KOA.MethodsComprehensive searches, combining “whole body vibration”, “knee osteoarthritis”, and “unstable surface” were conducted on PubMed, Web of Science, Science Direct, Cochrane library, and Google Scholar. Randomized control trials focusing on outcomes of muscle activity, strength, proprioception, balance, and pain using unstable and stable platform WBV in KOA were included. Data were charted and narrative synthesis was applied.Results17 studies were included. There is no consensus on the effects of stable surface WBV in KOA. Only limited studies used unstable platform WBVT in KOA. Majority of studies in KOA either using stable or unstable surface WBV failed to provide the exact mechanism of WBV.ConclusionsStable surface WBV improve strength, balance, sEMG activity, proprioception, and provide a mild degree of instability while higher degree of instability would be given when WBV is performed on an unstable surface and may positively stress the neuromuscular system to a greater extent than the stable WBV by various mechanisms.     

复合振动对卵巢切除大鼠骨质量的作用

背景:目前所使用的全身振动防治骨质疏松所需振动强度较大,人体不适感较强.作者设计了复合振动,前期实验发现复合振动可在更低强度下有效预防卵巢切除大鼠的骨密度下降. 目的:课题创新性提出低强度复合振动可维持生长期卵巢切除SD大鼠骨质量的理论假设,并期望实验结果加以验证.方法:SPF级4月龄雌性未育SD大鼠32只,随机分为正常对照组、卵巢切除组以及振动1、振动2组,每组大鼠均为8只.振动1组接振45～55Hz,0.05～0.1 g;振动2组接振45～55Hz,0.12～0.21 g.振动20min/次,1次/d,5次/周,休息间隔不大于2d.实验时间13周.观察振动干预前后大鼠活体骨密度,体外标本骨微结构以及生物力学性能. 结果与结论:卵巢切除组腰椎骨密度下降(P<0.05),而正常对照组与两振动组有显著性增加,股骨骨密度均增加,组间差异无显著性意义;卵巢切除各组骨微结构参数均明显下降,但振动2组骨小梁数量、骨小梁厚度、骨小梁间距、骨体积分数相对于卵巢切除组有显著改善:腰椎骨强度值两振动组较卵巢切除组显著增加(P=0.025、0.006),与正常对照组比较差异无显著性意义.实验结果证明,特定的复合振动舒适感较好的低强度下可以有效预防卵巢切除SD大鼠骨密度下降,减轻骨微结构破坏程度,维持骨强度,具有改善卵巢切除大鼠骨质量的作用和潜在的预防骨质疏松作用.     

骨质疏松症治疗中的运动疗法

背景：骨质疏松症是以骨量减少、骨组织显微结构退化为特征,以致骨的脆性增高而骨折危险性增加的一种全身骨病,通常治疗的首要手段为药物治疗。而单纯药物治疗无法提高肌肉力量,改善平衡功能,进而预防跌倒的发生,因此已不能满足骨质疏松症的综合管理。运动作为一种重要的非药物治疗手段,在骨质疏松症的预防中公认应作为首选,在骨质疏松症的治疗中的重要性逐渐被认识。目的：结合最新的一些研究文献,探讨运动在骨质疏松症治疗中的作用。方法：以“骨质疏松症,骨密度,骨强度,治疗,运动,应力,太极,肌肉,骨组织构建”为中文检索词,以“osteoporosis,bonemineraldensity,bonestrength,treatment,exercise,stress,taichi,muscle,bonearchitecture”为英文检索词,检索中国知网（CNKI）期刊全文数据库和Medline2001年1月至2013年2月有关不同运动类型对人骨强度的影响特别是对骨质疏松症患者的治疗作用的临床报道及机制研究。排除重复性研究和不典型报道。结果与结论：治疗性运动包括有氧运动、抗阻运动、冲击性运动、振动运动等类型,可以安全的提高骨强度,提高肌肉力量,改善平衡功能,预防跌倒和骨折。对于脊柱畸形者适当选用矫形器可提高安全性、促进运动治疗。与药物治疗一样,运动治疗也遵循个体化原则,在良好的依从性和安全性条件下进行运动方案的选择,各种运动的效果均较小,包含高应变速率的运动似乎更有效,但均需要长期坚持运动以维持疗效。     

The effect of whole-body vibration therapy on bone metabolism,motor function,and anthropometric parameters in women with postmenopausal osteoporosis

Purpose: To review the research literature on the effectiveness of whole-body vibration (WBV) therapy in women with postmenopausal osteoporosis.

Methods: A systematic review was conducted by two independent reviewers. Mean differences (MDs), standardized mean differences (SMDs), and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed with the I² test. The Cochrane risk of bias tool was used to assess the methodological quality of the selected studies.

Results: Nine randomized controlled trials involving 625 patients met the inclusion criteria. No significant improvement was found in bone mineral density (BMD) (SMD?=??0.06, 95%CI=??0.22–0.11, p?=?0.50); bone turnover markers (MD?=??0.25, 95%CI=??0.54–0.03, p?=?0.08); anthropometric parameters, including muscle mass, fat mass, body mass index (BMI), and weight (SMD?=?0.02, 95%CI=??0.16–0.21, p?=?0.81); or maximal isotonic knee extensor strength (SMD?=?0.16, 95%CI=??0.63–0.95, p?=?0.69). However, maximal isometric knee extensor strength improved (SMD?=?0.71, 95%CI?=?0.34–1.08, p?=?0.0002).

Conclusions: WBV is beneficial for enhancing maximal isometric knee extensor strength, but it has no overall treatment effect on BMD, bone turnover markers, anthropometric parameters, or maximal isotonic knee extensor strength in women with postmenopausal osteoporosis.

• Implication of rehabilitation

• Osteoporosis is the leading underlying cause of fractures in postmenopausal women, whole body vibration (WBV) has received much attention as a potential intervention for the management of osteoporosis in recent years.

• Whole body vibration is beneficial for enhancing maximal isometric knee extensor strength in women with postmenopausal osteoporosis.

• Whole body vibration has no overall treatment effect on bone mineral density, bone turnover markers, anthropometric parameters and maximal isotonic knee extensor strength in women with postmenopausal osteoporosis.

     

Vibration measurements predict the mechanical properties of human tibia

Background

Vibration analysis is a promising technique in diagnosing metabolic bone diseases such as osteoporosis and monitoring fracture healing. The aim of this study is to observe the structural dynamic property changes of the tibia extracted from the vibration analysis data.

Methods

In this study, bone mineral density and vibration measurements were made both in in vivo and in vitro conditions. The relationship between structural dynamic properties, obtained and bone mineral densities measured were investigated. Also, the effect of soft tissues on measured structural dynamic properties was analyzed.

Findings

Natural frequency of the tibia decreased with decreasing bone mineral density that presented a weak correlation with the bone mineral density values measured by dual energy X-ray densitometer of the femur. In the case of in vitro experiments, it was observed that the effect of muscles on measurement results is higher than that of the effect of the skin and the fibula which makes the modal identification procedure difficult. However, having very large percentage changes in the loss factors when mineral content and collagen are reduced is an encouraging result to believe that damping measurements may yield a promising technique in diagnosing progressing osteoporosis and monitoring fracture healing period.

Interpretation

The utilization of natural frequency alone as a diagnosing tool does not seem to be a sufficient method although there is a correlation between this parameter and bone mineral density. However, in vitro experiments showed that the identification of the loss factor is a promising technique in diagnosing progressing osteoporosis.