Effect of whole body vibration on low extremity functions and chronic diseases in the elderly

doi:10.3969/j.issn.2095-4344.2017.08.024

Abstract

Abstract:

BACKGROUND: Whole body vibration (WBV) training has gained increased attention at the beginning of 21st century as a sort of exercise. WBV instruments are popularized gradually; in the meanwhile, WBV training has showed its values especially for people who are too feeble to attend conventional exercises, among whom, the elderly accounts a lot.
OBJECTIVE: To summarize the effects of WBV training on low extremity functions and chronic diseases in older individuals, and to explore the underlying mechanism, thus providing reference for the study on WBV training.
METHODS: Web of Science, PubMed and CNKI databases were searched for the literatures addressing WBV training published between 1998 and 2015 with the subject word of “whole body vibration” and the keywords of “older adult, elderly, seniors, aging” in English and Chinese, respectively. The articles related to the lung diseases were excluded. The subjects were more than 60 years old, the low extremity functions included neuromuscular function, balance and walking abilities, and the chronic diseases included stroke, type 2 diabetes mellitus, hypertension and Parkinson disease.
RESULTS AND CONCLUSION: WBV training is likely to increase muscle strength, body balance and functional mobility. In terms of chronic diseases, WBV training contributes to muscle strength, relieving muscle stiffness, amyostasia, enancing improving some indexes of chronic diseases. WBV training is a safe and feasible exercising way for elderly people scheduled for improving the muscle strength, balance and walking abilities. Considering the existed evidences, WBV cannot replace the conventional therapy to treat chronic diseases in the elderly. Furthermore, a large number of high quality trials should be conducted in the future to clarify its effectiveness and application values.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Tissue Engineering, Vibration, Aged

CLC Number:

R318

Tan Jing-wang, Wu Xue-ping. Effect of whole body vibration on low extremity functions and chronic diseases in the elderly[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(8): 1288-1293.

Figures/Tables 1

2.1 全身振动训练对老年人下肢功能的影响 2.1.1 神经肌肉功能肌肉力量是指神经肌肉系统工作时克服或对抗阻力(如重力、惯性力、外力等)的能力[2]，以绝对力量和爆发力为两种主要表现形式。在全身振动训练对老年人下肢功能产生的影响中肌力提升是相对明确的一种，近十年国外学者通过实验发现，不管是在等速肌力测试还是在功能性肌力测试(如坐下-站立功能测试)上，全身振动训练都显示出了提高效应[3-4]，且Meta分析结果也表明老年人下肢肌力在全身振动训练中提高显著，其中各个关节肌力提高的程度不尽相同，伸膝肌力的提高程度较伸髋肌力明显[5-6]，踝关节跖屈肌力提高程度高于伸膝肌力和伸髋肌力[7]。基于“神经源性因素”的TVR (Tonic Vibration Reflex，振动牵张反射)[8]适应增强理论是目前众多学者比较认可的导致老年人下肢肌力提升的原因。研究表明等长收缩条件下本体感觉输入对肌力提升有很大帮助[9]，当老年人以微蹲姿势站在振动台接受振动刺激时，肌梭被反复牵拉使得Ia传入纤维兴奋性加强，兴奋通过单突触闭合传导途径能够激活高阈值快运动单位[10]。同时，振动刺激触发的多突触传导途径也能够增强神经中枢系统对协同肌的支配，这两者导致的结果是主动肌收缩效率的提高，进而肌力被增强[11]。另一方面，肌力提升在“肌源性因素”方面也有证据支持，Bogaerts的研究中82例老年男性在经过为期1年的全身振动训练(35-40 Hz，2.5-5.0 mm，30-60 s/次)后，肌肉含量增加了3.4%[12]，Machado进行的10周全身振动训练(20-40 Hz，2-4 mm，30-60 s/次)实验中受试者股内侧肌和股二头肌的肌肉含量都有显著性提高[3]，这些研究表明全身振动训练同样能够使肌肉发生明显的形态学变化。进行肌力训练时一个普遍的规律是在训练初期增速明显，之后增速会逐渐减慢，原因是肌力增强会先从神经适应开始，然后过渡到形态学变化，Roelants发现全身振动条件下(35-40 Hz，2.5-5.0 mm，60 s/次)受试者肌力的增长也同样遵循先快后慢的规律[6]，说明全身振动训练和常规训练在改变肌肉功能和结构方面具有相似性。在比较全身振动训练和常规训练对老年人下肢肌力的提高效果时，Delecluse认为2.5-5.0 mm，35-40 Hz的振动刺激所达到的效果与中等强度的阻力训练相当[13]，但更多研究认为全身振动训练可以达到与常规训练相近的效果但并不具有明显优越性[5，14]，部分研究还发现常规训练与全身振动训练组合使用时比单纯使用其中任何一种更容易取得显著效果[4，15]。 2.1.2 平衡功能姿势控制是指控制身体在空间的位置以达到稳定性和方向性的目的，平衡属于其稳定性目的，是指控制身体中心与支撑面关系的能力[16]。姿势控制是神经系统和肌肉骨骼系统共同作用的结果，前人对描述姿势控制的内容进行总结后形成了如图2的概念模式，其中肌肉骨骼成分包括关节活动度、脊柱柔韧性等，神经成分包括神经肌肉协同、感觉系统及认知过程。因为不同的任务和环境对稳定性、方向性的需求会有所不同，如守门员有时会因为接住球而摔倒，即为了方向性而损失了稳定性，故不同环境和任务对图1各因素的需要会有所不同。由于全身振动训练主要是垂直方向上的机械运动，几乎不涉及水平方向上的位置变化，因此只需探讨姿势控制的稳定性目的即平衡。众多研究结果显示，全身振动训练导致老年人平衡功能提高体现在静态平衡、动态平衡以及功能性平衡3方面。静态平衡方面，Iwamoto等[17]的研究表明全身振动训练能提高单脚站立成绩；动态平衡方面，Beck等[18]采取的是脚跟贴脚尖行走测试，发现实验前后平衡成绩有10.4%的提高；功能性平衡方面，TUGT(起立-行走计时测试)[19]、Berg平衡测试[20]、Tinetti平衡测试、FRT(功能性前伸测试)[20]，以及各种姿势描记法都表明全身振动训练能够提高受试者的平衡功能[21]。并且，Meta分析显示老年人在全身振动训练中动态平衡的提高程度要优于静态平衡[22]。以上结果表明，老年人的平衡功能可以在全身振动训练中得到提高。在机制上全身振动训练导致老年人平衡功能提高的原因可能有以下几个方面(图2中深颜色部分[16])：①肌肉骨骼成分方面：已有研究表明下肢肌肉力量与平衡能力关系密切[23]，全身振动训练导致下肢肌力增加的状况在上文已有叙述，因此可以认为老年人能够在增强下肢肌力的基础上提高克服重心偏移的能力进而改善平衡功能，同时全身振动训练增加膝关节稳定性的实验结果进一步解释了这种训练方法在提高机体稳定性上的作用[24]；②神经肌肉协同方面：在进行全身振动训练时，肌梭会被反复牵伸，使得振动后肌肉感知牵伸的敏感度提升[25]，长期训练后老年人能够对身体重心的偏移快速做出反应，进而提高平衡能力；③感觉系统：已有研究发现全身振动训练能够对前庭系统及本体感觉系统产生作用[26-27]，使这些系统在感知外界刺激后能快速做出反应，提高机体主动运动时的效率。"

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