Vol.3, No.10, 656-662 (2011)
doi:10.4236/health.2011.310110
C
opyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
Health
Cystic fibrosis and the relevance of the whole-body
vibration exercises in oscillating platforms:
a short review
Adalgisa Ieda Maiworm1, Milena B. Monteiro2, Sebastião D. Santos-Filho3 *, Agnaldo J. Lopes4,
Leandro Azeredo5, Sotiris Missail idis6, Pedro J. Marín7,8, Mario Bernar do-Filho2,9
1Hospital Universitário Pedro Ernesto, Setor de Fisioterapia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil;
2Clínica de Fisioterapia e Biomedicina, Rio de Janeiro, Brazil;
3Universidade do Estado do Rio de Janeiro, Instituto de Biologia Roberto Alcantara Gomes, Departamento de Biofísica e Biometria,
Rio de Janeiro, Brazil; *Corres ponding Author: santos-filho@uerj.br
4Departamento de Pneumologia e Coordenação do Centro de Referência de Fibrose Cística em Adultos do Estado do Rio de Janeiro,
Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil;
5Hospital da Polícia Militar, Niterói, Brazil;
6The Open University, Milton Keynes, UK;
7Laboratory of Physiology, European University Miguel de Cervantes, Valladolid, Spain;
8Research Center on Physical Disability, ASPAYM, Castilla y León, Spain;
9Coordenadoria de Pesquisa, Instituto Nacional do Câncer, INCa, Rio de Janeiro Brazil.
Received 29 May 2011; revised 20 July 2011; accepted 8 September 2011.
ABSTRACT
Objective: The aim is to present a review about
the whole-body vibration (W B V ) exercises in the
management of cystic fibrosis (CF). Methods:
Computerized literature searches were per-
formed using the PubMed databases. Results: A
strong interest in studies, considering the
number of publications, involving CF and lung
was found. Although, the exercises and physi-
cal activities seem to have a high relevance in
the management of the patients with CF, the
number of publications involving these proce-
dures is limited. Moreover, a modality of exer-
cise involving WBV seems to be poorly utilized
by the patients with CF and only two papers
were found with positive actions. Conclusion:
Oscillating platform is a promising technique to
manage patients with CF. Moreover, as 1) the
use of the oscillating plat forms is inexpensiv e, 2)
the vibration exercise requires less technical
abilities as compared to the performance of
conventional resistance training and 3) positive
clinical findings have been noticed with the use
of WBV in CF, it is suggested to implement the
studies involving the application of the exer-
cises with WBV in oscillating platforms to
manage the patients with CF.
Keywords: Cystic fibrosis; whole body vibration;
PubMed
1. INTRODUCTION
Cystic fibrosis (CF), also known as mucoviscidosis
[1], is the most common fatal inherited chronic disease
most frequent in white populations [2-4] and affects one
in every 2,500 Europeans, with a similar incidence in
Brazil [1,3,5]. Further more, CF Foundation [6 ] con siders
that CF affects the lungs and digestive system of about
30,000 children and adults in the United States (70,000
worldwide).
CF is a congenital and multi-systemic disease and there
are several clinic manifestations due to the cystic f ibro sis
genetic characteristic with more than 1000 acknowl-
edged mutations so far, though there is always a triad of
symptoms in the pulmonary and digestive tracts and in
the sweat glands [4]. However, the primary clinical
manifestations usually occur in the lungs and include
cough, excess sputum, shortness of breath and respira-
tory muscle fatigue, resulting in progressive lung dam-
age and eventual death from respir atory failure [2].
CF also affects the mucus production of exocrine
glands, which become thick an d obstruct the channels in
which it is secreted. This manifestation can occur in nu-
merous epithelial cells including sweat, pancreatic and
bile ducts, airways, intestinal and deferent vessels [4].
The CF can be considered a stigmatizing disease be-
cause it marks those who live with it. People with CF
can have a variety of symptoms, including 1) very salty-
A. I. Maiworm et al. / Health 3 (2011) 656-662
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
657657
tasting skin, 2) persistent coughing, at times with phlegm,
3) frequent lung infections, 4) wheezing or shortness of
breath, 5) poor growth/weight gain in spite of a good ap-
petite; and 6) frequent greasy, bulky stools or d iffic u lty i n
bowel movements [6]. Furthermore, there is body de-
formity caused by the evolution of the disease, which
marks the body in a characteristic way, including pro-
ducing a barrel chest and clubbing of the feet. Addition-
ally, there are daily and constan t care rituals, wh ich of ten
times impede children and adolescents from performing
activities common to their age group [7].
The therapies for CF involve drugs to help clear the
thick CF fibrosis mucus from airways, reduce inflamma-
tion and aerosolized antibiotics for CF. People with CF
do airway clearance techniques to loosen and get rid of
the mucus from the lungs. Clearing mucus helps to re-
duce the severity of lung infections and improve lung
function. Inhaled drugs are commonly used in CF care
be- cause they reach the airways quickly and easily. An-
tibiotics are used to fight infection-causing bacteria. In-
fections are common in the lungs of people with CF, so
antibiotics are an important part of regular care [3,6]. In
the general population, the nutrition needs change with
age, however, a special attention would be addressed for
people with CF. Children and teens with CF need extra
calories to grow and develop. Everyone with CF, no
matter their age, need good nutrition to stay strong
against lung infections and other challenges [6].
Another important procedure to be used in the patients
with CF is the exercises. Not surprisingly, CF physio-
therapists and people with CF need clear information
and guidance on how to incorporate exercise into an
already stressful and arduous daily regime. In addition,
exercises and physical activities seem to be important to
contribute to increase the life expectancy of the patients
with CF [2,8-10].
There is evidence of the benefit for the patients with
CF in increasing the participation in the daily activities,
improving the quality of life and reducing the hospital
admissions. Bradley et al. [11] demonstrated that exer-
cises have positive effects on exercise capacity, strength
and lung function in CF. It is generally accepted that
exercise tolerance is linked to a decline in lung disease
and it is an independent pred ictor of survival [12-15].
Vibrations, defined as an oscillatory motion, can be
generate in oscillating p latforms and transmitted, in gen-
eral, by the feet to whole body of a person [16]. The
frequency and the amplitude of the sinusoidal vibration
can be manipulated by the professional that is supervise-
ing the clinical procedure. The duration of the work, as
well as, the time to rest, the number of sets in a session,
the number of sessions is also controlled. All these con-
ditions depend on, mainly, th e clinical and physical con-
ditions of the patient [17,18]. Moreover, Marin et al. [19]
have also studied the neuromuscular activity during
whole-body vibration (WBV) of different amplitudes,
besides the footwear cond itions.
The mechanisms responsible for the WBV benefits are
not conclusive, however Santos-Filho et al. [17] have
suggested that these effects are probably related to direct
and indirect actions. Prisby et al. [20] have suggested
that the indirect effects might to be associated with the
neuroendocrine system. Whole body mechanical vibra-
tion on the muscle performance would be due to the in-
duction of a myotatic reflex contraction referred as the
tonic vibration reflex [21,22]. Furthermore, some au-
thors have described that, potentially, repeated muscle
contractions might exert endocrine and/or metabolic
effects [23]. Furthermore, WBV would act through re-
petitive sensorial-motor stimulation [24].
Authors have demonstrated that the exercises due to
the WBV improve walking function [25], muscle
strength [27], bone mineral density [27], cardiovascular
fitness [26] and body balance [28]. Moreover, the
health-related quality of life is in creased and the fall risk
is decreased. Improvement of gait and balance with
WBV has been shown in a population of nursing home
residents [29].
Some works considering the use of the whole body
vibrations produced in oscillating platforms to manage
patients with C F have been reported [30,31].
Putting together th e findings reported in the literature,
investigations about the effectiveness of the action of the
vibration produced in oscillating platforms that is a low
cost physiologic strategy to treat CF would be welcome.
Citations found in the PubMed have been used as tool
to obtain various scientific informations [32,33]. More-
over, to our knowledge no previous suitable revisions
have been published involving WBV and CF. As the re-
levance of exercise in the management of CF has been
well recognized [34], the aim of this work is to present a
suitable review about the published papers found in the
PubMed databank in which there are information about
the use of the WBV exercises in the management of pa-
tients with CF.
2. METHODS
PubMed is a service of the United States National Li-
brary of Medicine of the National Institutes of Health
[35]. PubMed is a databank that comprises more than 19
million citations for biomedical articles from MEDLINE
and life science journals. These citations may include
links to full-text articles from PubMed Central or pub-
lisher web sites.
Strateg y to search in the PubMed
The number of publications (NP) was determined
A. I. Maiworm et al. / Health 3 (2011) 656-662
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658
using the follow strategy. 1) All the papers were
searched in the PubMed on April 21st 2010. 2) A search
involving the terms “cystic fibrosis” and mucoviscido sis
was performed considering a) mucoviscidosis, b) mu-
coviscidosis or “cystic fibrosis” and c) cystic fibrosis. 3)
A search was performed using the keywords a) “cystic
fibrosis”, b) “cystic fibrosis” and lungs, c) “cystic fibro-
sis” and kidneys, d) “cystic fibrosis” and stomach, e)
“cystic fibrosis” and liver, f) “cystic fibrosis” and “sweat
glands”, g) “cystic fibrosis” and pancreas and h) “cystic
fibrosis” and heart. 4) A search involving cystic fibrosis
and gender was carried out using the keywords a) “cystic
fibrosis” and male, b) “cystic fibrosis” and female. 5) A
search involving cystic fibrosis and the human develop-
ment was carried out using the keywords a) “cystic fi-
brosis” and adult, b) “cystic fibrosis” and children, c)
“cystic fibrosis” and adolescents, d) “cystic fibrosis” and
older and e) “cystic fibrosis” and pregnancy. 5) A search
involving CF and so me possible typ es of treatments was
carried out using the keywords a) “cystic fibrosis” and
antibiotics, b) “cystic fibro sis” and medications, c) “cys-
tic fibrosis” nutrition, d) “cystic fibrosis” and exercises
and e) “cystic fibrosis” and physical activ ity.
The selected publications involving “whole body vi-
bration” and CF were read and considered to be dis-
cussed in this work.
3. RESULTS
The number of publications found in the PubMed in-
volving the terms “cystic fibrosis” and mucoviscidoses
are shows in Table 1 an d it is almost the same.
Table 2 shows the number of publications involving
“cystic fibrosis” and some organs that could be related
with some consequences of the “cystic fibrosis”. The
publications involving CF present the highest number of
scientific citations. Although, an interest it is found in
the studies related to the pancreas, heart and liver.
Table 3 shows the number of publications involving
“cystic fibrosis” and the gender. The number of publica-
tions is practically the same, although the number of
publications related the sex is slightly bigger for the fe-
male, about 50.5%.
Table 4 shows the number of publications involving
“cystic fibrosis” and steps of the human development.
There is a strong scientific interest in investigations re-
lating to CF and children. However, an important inter-
est is found in the studies with adult and adolescents. A
limited interest is found to the works involving old er and
cystic fibrosis.
Table 5 shows the number of publications involving
“cystic fibrosis” and some possible modalities of treat-
ments. The use of antibiotics has had a strong interest of
the scientific community as an option to treat the symp-
toms associated with CF. A small number of publications
are found to exercises and physical activity. Moreover,
only the authors of 2 papers have used the WBV to ma-
nage patients with cystic fibrosis.
The two papers that have described the use of the
WBV to treat patients with CF were read and analyzed
in Ta bles 6 and 7. In the Table 6 are shown information
about the device of the oscillating platform, the subjects
(number, sex and age), the frequency and the amplitude
used in the oscillating platforms. In the Table 7 are
shown information about the conditions of protocols
used in the treated and control groups, as well as the
clinical findings.
Tab le 1. Number of publications found in the PubMed involv-
ing “cystic fibrosis” and mucoviscidosis.
Search Number of publications
“cystic fibrosis” 31,938
Mucoviscidosis 32,843
“cystic fibrosis” or mucoviscidosis 32,843
Tab le 2. Number of publications found in the PubMed involv-
ing “cystic fibrosis” and some organs.
Search Number of publications
“cystic fibrosis” and lungs 7976
“cystic fibrosis” and pancreas 1786
“cystic fibrosis” and kidneys 750
“cystic fibrosis” and heart 1264
“cystic fibrosis” and “sweat glands” 228
“cystic fibrosis” and stomac h 128
“cystic fibrosis” and liver 1290
Tab le 3. Number of publications found in the PubMed involv-
ing “cystic fibrosis” and the gender.
Search Number of publications
“cystic fibrosis” and male 10,888
“cystic fibrosis” and female 11,111
Tab le 4. Number of publications found in the PubMed involv-
ing “cystic fibrosis” and some steps of the human develop-
ment.
Search Number of publications
“cystic fibrosis” and children 11,321
“cystic fibrosis” and adolescents 7664
“cystic fibrosis” and adult 8904
“cystic fibrosis” and older 547
“cystic fibrosis” and pregnancy 1353
A. I. Maiworm et al. / Health 3 (2011) 656-662
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659659
Tab le 5. Number of publications found in the PubMed involv-
ing “cystic fibrosis” and possible modalities of treatments.
Search Number of publications
“cystic fibrosis” and antibiotics 3105
“cystic fibrosis” and medications 1171
“cystic fibrosis” and exercises 557
“cystic fibrosis” and nutrition 967
“cystic fibrosis” and “physical activity” 91
“cystic fibrosis” and “whole body vibration” 2
Table 6. Information about the device of the oscillating plat-
form, the subjects, the frequency and the amplitude used in the
oscillating platforms.
Reference Device of the
platform Number of
subjects/sex/age Frequency Amplitude
Rietschel
et al., 2008
Galileo 2000,
Novotec
GmbH,
Pforzheim,
Germany
10 clinically stable
patients (3 males and
7 female, 24 - 47
years
20 - 25 Hz0.5 mm
Roth et al.,
2008
GalileoTM
platform
(Novotec
Medical,
Pforzheim,
Germany)
11 adult patients,
21 - 41 years old 12 Hz and
26 Hz No
specified
Table 7. Information about the conditions of protocols used in the treated and control groups and the clinical findings.
Reference Condition of the treated groups Clinical finding Conclusion
Rietschel
et al,
2008
The training schedule consisted of 3 ses-
sions of 3 min twice a day, 5 days per week
for 3 months. The patients were standing in
the platform with flexed knees (20 - 45
degrees). In addition, exercises were per-
formed (trunkrotation and trunklateral flex-
ions for abdominal, trunkextension for
abdominal and trunkflexion for mobility of
spine)
After 3 months of WBV all parameters in
the CRT significantly improved: chair-rising
time, maximal force, maximal power and
velocity. The peak jump force and velocity
of the two-leg jump significantly improved.
Parameters in the one-leg jump as well as
maximal isometric grip force showed no
significant improvement. Weight and body
mass index showed a slightly positive trend
whereas FEV1 and FVC did not signifi-
cantly change. Any change in mech-
anographic parameters did not correlate
with FEV1 or FVC in this study.
These results demonstrate that WBV can
improve muscle function in CF patients.
Roth
et al,
2008
On five days per week, one unit of six
minutes duration at a frequency of 12 Hz
was carried out to improve the range of
motion of the thorax, s p i n e a n d e x t r emities.
On three days per week, one unit of six
minutes duration at frequencies up to 26 Hz
(according to the individual patient’s capa-
bilities) was performed including additional
weights of up to nine kilograms to increase
muscle power and force.
During each unit (12 Hz and 26 Hz), the
patient performed standardized manoeuvers
including leg bends, trunk bends and exten-
sion and rotation of the trunk while standing
on the device.
Cardiovascular monitoring did not show
any critical drop in oxygen saturation or
blood pressure. Lung function remained
relatively constant with a median FEV1
change [% of norm] of –3.1% (range –7 -
20). Trabecular density at the spine and
parameters of bone density and geometry at
the radius and tibia did not show consistent
changes. A median decrease of –0.3%
(–31.0 - 17.9) for muscle force and a median
increase of 4.7% (–16.4 - 74.5) for muscle
power and 6.6% (–0.9 - 48.3) for velocity
was noted in the two-leg jump. In the
one-leg jump, a median increase of 6.7%
(–8.5 - 24.3) for muscle force was meas-
ured.
Whole body vibration was well tolerated
in the majority of the study participants.
Most patients were able to increase peak
force in the one-leg jump.
In the two-leg jump, velocity and muscle
power increased with equal or decreased
muscle force. This may indicate an im-
provement in neuromuscular and intramus-
cular co-ordination (and therefore effi-
ciency) with less muscle force necessary to
generate the same power.
A. I. Maiworm et al. / Health 3 (2011) 656-662
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660
4. DISCUSSION
CF can be considered a stigmatizing disease, which
marks the body of the patient, including producing a
barrel chest and clubbing of the f eet. Mor eove r, th ere ar e
daily and constant care rituals, which can limit the par-
ticipation of these patien t in common d aily activ ities that
are common to their age [7]. CF is also known as mu-
coviscidosis [7] and in a search in the databank PubMed,
it is found no difference in the number of publications
using the keywords “cystic fibrosis” or mucoviscidosis,
alone or together (Table 1).
The primary symptoms of the CF involve the lungs
however an important increase in the life expectancy [2]
has been noticed. In consequence, co-morbidities affect-
ing organ systems other than the lungs have been re-
ported. The data shown in the Ta ble 2 revealed a strong
interest in studies, considering the number of publica-
tions, involving CF and lung as it was expected. How-
ever, an important scientific interest was found to inves-
tigations involving CF and pancreas, heart or liver that
could be justified due to the increase in the life expec-
tancy. Moreover, the predicted median age of survival
for a person with CF is more than 37 years [2,3,6].
Within the CF population, there are some evidences
that females with CF may be less active than males [13,
14]. These differences in physical activity levels be-
tween males and females may contribute to the greater
decline in lung function in female with CF [36]. This
finding could justify the statemen t of Courtney et al. [37]
that female gender is an important predictor of increased
risk of death, although the mechanisms causing this are
unclear. However, the prevalence of potential risk factors
is not higher among females than males [38] and this
fact could justify the almost the same number of publi-
cations in CF in male and female (Table 3).
The prognosis of patients with CF has improved sub-
stantially over the last three decades [37]. Although the
majority of the patients still die in early adulthood [39],
the life expectancy for patients has increased from 31 to
37 years over the last decade [40]. Nick et al. [41], have
reported that long-term CF survivors (age > 40 years)
are a growing population comprised of both patients
diagnosed with classic manifestations in childhood, and
non-classic phenotypes typically diagnosed as adults.
Little is known concerning disease progression and out-
comes in these cohorts. These findings and statements
aid to explain the elevated number of publications in-
volving CF and children, as well as an important number
of publications involving adolescents and adults (Table
4). A UK model predicting that a child born with CF
today will typically live to be 50 years or more seems to
be realistic [39] and this model aids to justify the nu mber
of studies with CF and pre g nancy (Table 4).
The daily treatment burden of CF is high and people
may spend up to 2 h per day on a wide range of CF
therapies, including taking medications and undergoing
physiotherapy treatments such as regular airway clear-
ance and exercise. The therapy with antib io tics is high ly
important and this f act can be reinforced with the strong
number of publication with these drugs when a com-
parison with other therapy is done. Naturally the studies
with medications in general are welcome and an impor-
tant number of publications is found. The benefits of
maintaining good nutrition for the patients with CF have
been reported by several authors [3,42,43] and this fact
could justify the elevated number of publications in-
volving CF and nutrition (Table 5).
Although, the exercises and physical activities [2,34],
seem to have a high relevance in the management of the
patients with CF, the number of publications involving
these procedures is still limited and the general adher-
ence to treatments in CF is challenging and the adher-
ence to exercise is lower compared with other treatments
[8,44,45]. Moreover, a modality of exercise involving
whole body vibrations seems to be poorly utilized by the
patients with CF and only two papers were found in the
PubMed data b a nk (Table 5).
Vibrations produced in the oscillating platforms and
transmitted to be whole body have been considered as a
kind of exercise that is useful and safe to be used with
elderly [26,28], as well as in patients with some neuron-
logical disorders [24,25]. Furthermore, this kind of exer-
cises has been considered to be of a low cost physiologic
strategy [46]. Furthermore, the vibration exercise re-
quires less technical abilities as compared to the per-
formance of correct conventional resistance training [21,
24].
The two papers found after a search in the PubMed
using the keywords “cystic fibrosis” and “whole body
vibration” have reported positive actions in the patients
with cystic fibrosis (Table 6). Although the protocols, as
well as the parameters used by Rietschel et al. [30] and
Roth et al. [31] are well different, the conclusion of both
works is that the exercises in oscillating platforms are
suitable to manage patients with CF.
It is highly relevant the development of clinical pro-
cedures to the management of patients with CF. Oscil-
lating platform is a promising technique to improve
muscle power and to a certain extent force in patients
with CF. The advantage is that the amount of time that
has to be spent for the training is fairly minimal. More-
over, as 1) the use of the oscillating platforms is very
inexpensive [46] and 2) positive clinical findings have
been noticed with the use of whole body vibration in
patients with CF, it is suggested to implement the studies
involving the application of the exercises with whole
A. I. Maiworm et al. / Health 3 (2011) 656-662
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
661661
body vibration in oscillating platforms to manage the
patients with CF.
5. ACKNOWLEDGEMENTS
We thank CNPq (Conselho Nacional de Desenvolvimento Científico
e Tecnológico), FAPERJ (Fundação de Amparo à Pesquisa do Rio de
Janeiro), UERJ (Universidade do Estado do Rio de Janeiro) and INCa
(Instituto Nacional do Câncer).
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