Physiological, psychological and functional changes with whole body vibration exercise in the frail elderly : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy (PhD) in Sport & Exercise at Massey University, Wellington, New Zealand

Abstract

Background The frail elderly endure comprehensive reductions in health, function, independence, wellbeing and Quality of Life. Conventional training attenuates declines but is restricted by requisite intensities and supervisory-requirements. Whole Body Vibration (WBV) exercise presents as a safe and effective training-tool for the mobile elderly, yet a paucity of research exists on its application in the frail elderly, who could benefit most.

Methods After pre-screening for contraindications, 117 male and female volunteers (82.5 ± 7.9 years) from residential-care-facilities were randomly allocated to Control (CON), Simulated-exercise (SIM) or WBV-exercise (WBV) groups. Continuing regular-care, WBV- and SIM-participants also underwent thrice-weekly exercise sessions for 16 weeks. Delivered by overload principle, WBV-training began with 5*1-min bouts of rotational-WBV at 6 Hz/2 mm (1:1min exercise:rest), progressing ad libitum to 10*1-min at up-to 26 Hz/4 mm, maintaining knee-flexion. Training for SIM-participants mimicked exercise stance and duration. Pre- and post-measures of function (Timed-Up-and-Go (TUG), Parallel Walk (PWT) and 10-m Timed-Walk tests), psychometrics (ABC-UK falls confidence, EURO-QoL-5-D and Barthel Index) and cardiovascular-health (Blood Pressures, resting Heartrate, Augmentation Index (AIx)) were completed up-to 12-months post-intervention. Twenty-participants (84.5 ± 1.7 years) from WBV- and SIM-groups underwent further bone-health assessments (serum Osteocalcin and Vitamin D, urinary Pyridinoline/Deoxypyridinoline, and Bone Mineral Density (BMD)).

Results High levels of compliance and ease-of-use were reported, with no adverse-effects. Compared to baseline-levels, 8- and 16-weeks of WBV-training elicited clinically-important treatment-effects on participants’ functionality, psychometrics and cardiovascular-health. Notably, improvements of 7.3% and 14.9% were seen in TUG- and PWT-performance, respectively, whilst falls-confidence increased by 17.4% and AIx reduced by 23.3%. Many treatment-effects remained in-place up-to 12-months post-intervention. No treatment-effects were observed for BMD-levels, but beneficial treatment-effects were detected on osteocalcin levels. Findings showed low-level WBV-exercise to be an effective and easily-accessible exercise for the frail elderly. The exercise-intervention delivered sufficient-stimulus to significantly increase functionality, independence, confidence and Quality of Life. Furthermore, the novel vascular-health findings offer insight into the safe use of low-level WBV-exercise in patients with poor cardiovascular-health. Bone-deposition rates increased, albeit not sufficiently to enhance BMD-levels. However, the lack of adverse-effects suggest WBV-exercise is a safe and effective training-tool for this population when other training-goals are the focus.