Archives of Gerontology and Geriatrics 59 (2014) 305–311

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Effect of stochastic resonance whole body vibration on functional performance in the frail elderly: A pilot study Jessica Kessler, Lorenz Radlinger, Heiner Baur, Slavko Rogan * Bern University of Applied Sciences, Discipline Physiotherapy, Bern, Switzerland

A R T I C L E I N F O

A B S T R A C T

Article history: Received 24 December 2013 Received in revised form 13 June 2014 Accepted 20 June 2014 Available online 9 July 2014

The aim of this pilot study was to evaluate the feasibility and the effect size of a four-week stochastic resonance whole body vibration (SR-WBV) intervention on functional performance and strength in frail elderly individuals. Twenty-seven participants have been recruited and randomly distributed in an intervention group (IG) and a sham group (SG). Primary outcomes were feasibility objectives like recruitment, compliance and safety. Secondary outcomes were short physical performance battery (SPPB), isometric maximum voluntary contraction (IMVC) and isometric rate of force development (IRFD). The intervention was feasible and safe. Furthermore it showed significant effects (p = 0.035) and medium effect size (0.43) within the IG in SPPB. SR-WBV training over four weeks with frail elderly individuals is a safe intervention method. The compliance was good and SR-WBV intervention seems to improve functional performance. Further research over a longer time frame for the strength measurements (IMVC and IRFD) is needed to detect potential intervention effects in the force measurements as well. Clinical Trial register: NTC01704976. ß 2014 Elsevier Ireland Ltd. All rights reserved.

Keywords: Short physical performance battery Isometric maximum voluntary contraction Isometric rate of force development

1. Introduction Aging is associated with a decline in functional performance. This includes loss of muscle strength, muscle mass, and physical capacity (Doherty, 2001; Doherty, Vandervoort, Taylor, & Brown, 1993; Rogers & Evans, 1993). In the literature this process is defined as sarcopenia (Rosenberg, 1997) or dynapenia (Manini & Clark, 2012). Manini and Clark (2012) characterize sarcopenia as the loss of muscle mass, whereas dynapenia is described as the loss of muscle mass and muscle strength. The loss of muscle strength is also accompanied by the loss of number and recruitment of motor units (Doherty et al., 1993), decreased physical activity (Amigues et al., 2013) and contractile quality (Manini & Clark, 2012). Manini and Clark (2012) stated age-related loss of muscle mass is weakly associated with the loss of muscle strength, because functional performance of the muscular skeletal system is dependent on other factors than muscle mass alone. The loss of muscle strength and functional capacity leads to the loss of muscle function and results in frailty and increased risk of falling (Clark et al., 2013; de Vries, Peeters, Lips, & Deeg, 2013).

* Corresponding author at: BUAS, Slavko Rogan Lindenrain 4, 3010 Bern, Switzerland. Tel.: +41 31 848 35 36; fax: +41 31 848 35 21. E-mail address: [email protected] (S. Rogan). http://dx.doi.org/10.1016/j.archger.2014.06.005 0167-4943/ß 2014 Elsevier Ireland Ltd. All rights reserved.

Sensorimotor and strength exercises are known as intervention methods to increase muscle strength and to prevent falls in elderly individuals (Granacher, Gollhofer, Hortobagyi, Kressig, & Muehlbauer, 2013). Skelton and Dinan (1999) developed a falls management exercise program (FaME) which divides the training structure in three parts: first, ‘‘skilling up’’, second, ‘‘training the gain’’ and third, ‘‘maintaining the gain’’. The first phase starts with the aim ‘‘to improve neuromuscular function, technique and safety during exercise’’ (Skelton & Dinan, 1999). The two following parts aim at further developing the training effects of the previous part. The final purpose is to keep the learned skills and to progressively raise intensity and load of the training step by step from one part to the next. The considerations of the FaMe are about to be added to the new classification Physical Performance Classification for Elderly (PPCfE). This classification makes it possible to distinguish between pre-frail and frail, mobile and trained elderly (Rogan & de Bruin, 2013; Rogan, Schmidtbleicher, & Radlinger, 2014). Evidence is still lacking for what kind of exercise is most suitable and effective for frail elderly individuals (Rogan, Hilfiker, Schmid, & Radlinger, 2012; Rogan, Radlinger, et al., 2012). Frail elderly individuals with severe physical limitations who want to start a training program are advised to first complete a ‘‘skilling up’’ prior to the implementation of more traditional forms of exercise (Rogan, Hilfiker, et al., 2012; Rogan, Radlinger, et al., 2012).

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One possibility for skilling up could be stochastic resonance whole-body vibration (SR-WBV). A stochastic resonance dynamic has been applied in a variety of neurophysiological and perceptual systems (Collins, Imhoff, & Grigg, 1996) and human muscle spindles (Cordo et al., 1996). SR-WBV has the characteristic of executing a lot of small impulses (vibrations) on the body in a short period of time, in contrast to sinusoidal WBV (S-WBV). Furthermore the vibration is random, which means that the direction of the vibrations and the force load are not predictable, and the body will be constantly challenged to adapt to the muscle reactions. This kind of stimulus triggering muscle spindles can improve the functionality of the nerve-muscle system (Rogan, Hilfiker, et al., 2012), even more than other conventional S-WBV. An additional advantage is that the subjects stand on two separate platforms that oscillate independently during SR-WBV while the subjects stand with two feet on a single S-WBV platform. Due to its simplicity, the SR-WBV device seems to be convenient for frail elderly individuals. Since it is known as a form of exercise with only low impact on the cardiovascular system (Herren, Ha¨nga¨rtner, Oberli, & Radlinger, 2009), it also seems suitable for elderly individuals with mild vascular pathology. Following this rationale, one can assume that it is possible to stimulate the neuromuscular systems by applying SRWBV. SR-WBV could be used for sensorimotor training in frail elderly individuals in the context of skilling up, since they might not be prepared for an exposure to the load and long training sessions normally applied in regular training routines (Rogan, Radlinger, et al., 2012). It seems justified in this context to perform a pilot study and to assess the feasibility of applying SR-WBV in frail elderly individuals, because no study investigating the effects on functional performance or strength of SR-WBV training in frail elderly individuals has been published so far. The findings of such a study may give important information about feasibility before conducting a larger trial (Thabane et al., 2010).

The aim of this pilot study was to evaluate the feasibility of the intervention process and assess the implication of four weeks of SR-WBV training on physical performance, isometric maximal voluntary contraction (IMVC) and rate of force development (IRFD) in frail elderly individuals.

2. Methods 2.1. Design This is a randomized controlled pilot study with blinded frail elderly individuals, randomly divided into an intervention group (IG) and a sham group (SG) and non-blinded supervisors. It follows the publication guideline of Thabane et al. (2010), which states that the main goal of a pilot study is to assess feasibility and to avoid failure of a large study (Fig. 1). 2.2. Participants From August to October 2012, 27 frail elderly individuals were recruited in a retirement home in Switzerland (Table 1). In this pilot study (pre-)frail was defined using the Physical Performance Classification for Elderly (PPCfE) proposed by Rogan et al. (2014). The PPCfE was determined by the total score of the short physical performance battery (SPPB). Status pre-frail & frail: 0–6 points; status mobile: 7–10 points; status trained: 11–12 points. Pre-frail & frail were defined if 6 points was confirmed. The following inclusion criteria had to be fulfilled: aged over 65 years, able to stand with or without aids, a score of at least 16 points in the mini mental test (MMT) and a score of 16 in the MMT as an inclusion criterion. Especially in the measurements procedure it was quite difficult for the participants to realize what they were asked to do. Here, it should be favored to practice the measurement movement to familiarize the participants with the setting and to improve the standardization of the tasks. Third, the reasons for two participants quitting the training were fear and lack of motivation. For them, it would have been helpful to provide a longer introduction and preparation on the SRWBV device prior to the start of the investigation. But this prior training could have influenced the results afterwards. All other participants were extremely motivated or could have been kept motivated using the MoVo model (Fuchs et al., 2011). Fourth, to have a more standardized intervention protocol. The intervention augmentation of the IG should be standardized more precisely; for example the possible use of the bars during the vibration sequence. 5. Conclusion This pilot study indicates that the study protocol is feasible and safe for the frail elderly. Resources and compliance could be managed safely. The effects of the intervention on functional capacity parameters are shown in the significant results of the SPPB in the within-group comparison of the IG. For Fsub, IRFDmax and IRFDsub there are trends of an improvement, which can be associated with a positive influence on dynapenia. This appears mainly in the effects of the IRFDmax and IRFDsub. Small-to-large effects are apparent in all variables. The assumption of the authors is that it is not so important to calculate IMVC because it is not expected to have effects after a time period of four weeks. Furthermore IRFD is to be preferred to IMVC because RFD is lost more rapidly in older age than Fmax (Granacher & Gollhofer, 2005). Therefore RFD seems to be more essential in the fight against dynapenia in old age. The findings from the results allowed a sample-size calculation for a larger study. The IRFDmax left extension test, for example, showed that the effect size of the intervention was moderate at 0.31. For a further study with 80% power at a-level 0.05, an estimated sample size of 401 participants for a 2-group RCT-design would be necessary. Before conducting further research on this topic, it is recommended that a reliability analysis of the force data of the force measurement device be executed. Conflict of interest No conflict of interest. Funding No funding for this pilot study was required from any source.

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Effect of stochastic resonance whole body vibration on functional performance in the frail elderly: A pilot study.

The aim of this pilot study was to evaluate the feasibility and the effect size of a four-week stochastic resonance whole body vibration (SR-WBV) inte...
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