Whole-body vibration for fall prevention in elderly people living at home

Whole-body vibration for fall prevention in elderly people living at home has proven successful in many cases.

Falling is a frequent problem in people over 65 and is associated with significant physical, psychosocial, and financial consequences.

Whole-body vibration is an excellent alternative to strength and balance training in fall prevention for the elderly. It improves muscle strength, balance, and thus stability. This physical exercise requires relatively little effort, yet gives clear results, which is motivating for this age group.

Strength and balance disorders are significant risk factors for falls, making strength and balance training alone or in combination with other fall prevention strategies very effective.

Read on to understand how and why whole-body vibration helps to prevent falls of the elderly.

Whole-body vibration for fall prevention in elderly people living at home: Introduction

There has been increasing attention to the positive effects of whole-body vibration in the elderly in recent years.

A whole-body vibration positively influences muscle strength and balance in the elderly and could thus be an excellent alternative to classical strength and balance training within the framework of fall prevention, especially with the shorter training duration and lower intensity of the exercises.

But are the physical effects of classical strength and balance training and whole-body vibration equivalent in the context of fall prevention and health-related quality of life?

And how are classic strength and balance exercises and whole-body vibrations experienced by those over 65?  Are they the same or with significant differences in terms of comfort and effort?

Falls in home-dwelling elderly: A big problem

Falls in elderly people living at home are a major problem in our society.

Every year, about 1 in 3 of those over 65 are victims of a fall and one third of these may fall multiple times.

The main problem is that a fall incident can be accompanied by physical and psychosocial consequences and a hefty financial added cost.

There is sufficient evidence in the scientific literature about the effectiveness of fall prevention strategies in reducing the number of falls at home.

Risk factors for falls

The main risk factors for falls are strength and balance disorders.

It is known that muscle weakness due to the age-dependent decrease in muscle mass is responsible for “frailty” and carries significant functional limitations.

Muscular strength and balance can be trained through classical strength and balance exercises, which should be feasible for the elderly.

However, these exercises can often be of a reasonably long duration, with a relatively high intensity and many repetitions.

Lack of motivation and fatigue are the culprits

We are talking in the context of fall prevention for elderly people living at home, who often struggle with some obesity as well.

If these people are confronted with fairly intensive strength and balance exercises, then very often, the problems are two fold.

Fatigue and lack of motivation are the two limiting factors of classical strength and balance training, which become of greater and greater importance with advancing age.

Exercises with a lower training volume, with a shorter duration, with a lower number of repetitions, and at a lower intensity but with the same training effect could be a good alternative.

Whole-body vibration to prevent falls

Whole-body vibration is a relatively new technique for improving muscle strength and balance in fall prevention for seniors living at home.

It is a form of exercise and movement with little effort but clear results, and with even more advantages:

• A vibration plate is relatively easy to operate.
• They are usually not complicated exercises to train all the muscles sufficiently anyway.
• As part of fall prevention, exercises on the vibration plate generally do not require much time.
• Vibration plate exercises typically leave seniors feeling satisfied and fulfilled after the session.

Falls lead to physical and psychological injuries

A fall incident is an unexpected event in which the person falls to the ground, floor, or a lower level.

Falling is a frequent problem in old age. Approximately 33% of those 65 and older living at home report one fall a year. One third of them even fall several times yearly.

The rate of falls increases with age, reaching 42% in those aged 75 and over, up to 66% in the demented elderly, and an even higher rate of falls in the elderly in care homes.

Falls have a significant impact both physically and psychosocially.

Physical injuries from falls

Ten percent of falls result in physical injuries. In half of the cases, these injuries warrant medical treatment. Major physical injuries are reported in 6 to 10% of falls, with 1 to 3% of fracture incidence.

For example, about 90% of hip fractures are caused by a fall. Half of the patients over the age of 75 who break a hip due to a fall die in the year following the fall.

A non-injury fall can still be fatal if the person cannot stand up or call for help. Being on the floor for more than 12 hours gives rise to bedsores, dehydration, hypothermia, pneumonia, and death.

Indeed, the consequences of falling are sometimes disastrous and in fact, among the elderly, falling is the leading cause of death by injury.

Psychological and social consequences due to a fall

Falls can lead to physical injury and often have psychological and social consequences.

Repeated falls are a common reason for admission to a residential setting such as a retirement home for formerly independent elders.

The majority of elderly people are afraid of falling, regardless of whether they have already fallen or not.

An estimated 40-50% of older people with a fear of falling avoid certain activities, which can eventually lead to decreased mobility, increased social isolation, depression, and increased risk of falling.

The loss of confidence to move safely can result in self-imposed functional limitations.

Hence falls are associated with increased mortality, morbidity, impaired functioning, overweight, and/or obesity due to a sedentary lifestyle and early residential admission.

Financial implications of a fall incident

Finally, a fall incident increases financial costs.

A history of falls is associated with a 2 to 3 times higher risk of admission to a nursing home or assisted living facility (which costs tons of money these days).

Underreported figures due to fear

The reality is that despite these high numbers, the problem is still underrated.

A fall incident without injury is often not reported because it represents a confrontation with increased fragility, with the elderly fearing admission to a nursing home.

Many elderly people fall occasionally, but the family doctor is usually called only when the fall has serious consequences.

About one fourth of all fall incidents eventually end up in the doctor’s office, and even then, only if symptoms and injuries have occurred.

Risk factors for falls and possible interventions linked to them

A fall by an elderly person should be taken as an alarm signal of a possible underlying condition and repeated falls should be viewed as an alarming symptom.

Falls are caused by multiple risk factors in the elderly. Several determinants and risk factors play a role, and it is often difficult to determine which factor was the main contributor to a fall.

Rarely is there only one identifiable risk factor.

Several studies have shown that the risk of falling increases dramatically when the number of risk factors increases.

For example, 27% of older persons living at home with no or one risk factor would fall compared to 78% of older persons living at home with 4 or more risk factors.

The risk factors are divided into person-related and environment-related determinants.

Person-related risk factors for falls

• Urinary or fecal incontinence
• Caucasian race
• Balance and gait disorders
• Cardiovascular diseases
• Cognitive decline
• Fear of falling
• Gender
• Past history of falls
• Polypharmacy
• Depression
• Muscle weakness
• Neurological disorders
• Vision impairment
• Foot problems
• Pulmonary disorders
• Obesity
• Musculoskeletal disorders
• Malnutrition
• High degree of dependence
• Living alone
• Intake of risk medication
• Sedentarism
• Overweight
• Alcoholism
• Age

Environment-related risk factors for falls

Structural environmental risk factors

• High thresholds
• Smooth floors
• Insufficient lighting
• Dangerous stairs

Non-structural environment-related risk factors

• (Improper) use of a walking device
• Inappropriate home environment:
  • Storage areas too high or too low
  • No anti-slip mats
  • Insufficient walking space
  • Distances too long
  • Loose carpets
  • Absence of nightlights
  • Non-adapted furniture

Fall prevention interventions

Fall prevention interventions can be divided into (1) proven effective and (2) questionable or ineffective.

Proven effective interventions

• Walking aid in combination
• Evaluation of home environment with modifications (by an occupational therapist) (in people with vision problems)
• Tai-chi
• Pacemaker implantation with sinus caroticus hypersensitivity
• Non-slip shoe aid
• Measures of orthostatic hypotension
• Medication review with adjustments including tapering of benzodiazepines, sedatives, neuroleptics, or antidepressants
• Combination of strength and balance training in group or at home
• First cataract surgery

Questionable or ineffective interventions

• Cognitive Behavioral Therapy
• Visual acuity and correction (increase!)
• Medication view without adjustments
• Nutritional or moisture supplements
• Hip protector
• (Fast) walking or increasing physical activity
• Vitamin D supplementation with/without calcium supplements
• Vitamin D supplementation in hypovitaminosis D (possible)
• Second cataract surgery
• Hormonal replacement therapy and bisphosphonates
• Walking aid without additional evaluation
• Strength or balance training in a group or at home (not a combination of both)
• Education without targeting

Whole-body vibration as a motivational fall prevention strategy

Among those over 65, falls remain a significant health problem, with many potential issues resulting from a fall.

Over the years, more and more attention has been paid to fall prevention strategies, resulting in several guidelines.

However, the problem with these guidelines is that it is unclear how to implement them in day-to-day practice and how to motivate older individuals to permanently change their behavior and habits.

Falling is and remains a complex and multifactorial problem that also makes fall prevention multifactorial and preferably multidisciplinary.

There is certainly also evidence for unifactorial prevention strategies, but the results are not as strong as the multifactorial interventions.

Among unifactorial prevention strategies, classical strength and balance training is one of the most researched and studied interventions with good results.

But older individuals usually have a hard time motivating and recharging themselves for it.

Below, you will discover why whole-body vibration can be a full-fledged alternative to traditional strength and balance training. It is currently applied to the elderly with an increased risk of falling due to strength and balance disorders.

Whole-body vibration to enhance muscle activity and strength

Whole-body vibration has gained popularity in recent years as an alternative exercise modality for strengthening muscle activity and strength.

Whole-body vibration is proposed as an attractive and efficient form of exercise for athletes, the elderly, and people with health problems such as overweight or obesity.

Vibration training is a form of exercise where the whole body is exposed to vibrations generated by a vibration plate.

Whole-body vibration has its origins in local vibration therapy, where only one muscle, muscle group, or limb is exposed to the body.

Both static and dynamic exercises can be performed on a vibration plate (read our vibration plate buying guidelines to figure out the best investment for your body and goals).

Tonic vibration reflex

The positive effects of vibration training are essentially attributed to the emergence of the tonic vibration reflex, an involuntary muscular contraction responding to vibration-induced stretching.

At muscle level, muscle length and resulting changes are detected by stretch receptors or muscle spindles embedded in the muscle bundles.

There is a positive linear relationship between the stretching of the muscle and the firing frequency of these receptors.

Unlike the normal stretch reflex, almost all muscle fibers are forced to contract during a tonic vibration reflex.

In addition, this phenomenon occurs in all muscles undergoing vibration.

Squat exercise on the vibration plate and tonic vibration reflex

Performing a squat exercise on a vibration plate not only creates the voluntary muscle contraction required to complete the squat exercise.

At the level of the leg muscles, there is also an activation as a result of the tonic vibration reflex.

In other words, when a person performs a squat exercise on a vibration plate, the muscles exhibit greater activity than that activity or exercise performed alongside the vibration plate on the floor.

Side note: It is uncertain whether the increased muscle activity associated with vibration training is primarily caused by neural factors (an increase in muscle spindle activation).

Indeed, other factors may also have an influence, such as maintaining a stable position and dampening mechanical energy.

Positive effects of whole-body vibration

Whole-body vibration increases the activity of the muscle spindles, which provide a stretch-reflex response. This may be important for people with damaged tissues and neurological problems.

Also, the change in muscle activity causes a slight increase in oxygen uptake. Whole-body vibration could positively affect various cardiovascular indicators such as blood pressure, blood flow, and heart rate.

This explains the widespread use of whole-body vibration in sports, exercise programs, and health-related fields.

Two types of vibration platforms

There are essentially 2 types of vibrational platforms.

Vibration plates with vertical sinusoidal vibration

The first type of vibrating plate produces a vertical sinusoidal lateral-alternating vibration. The vibration platform rotates around an anterior-posterior horizontal axis.

When the feet are further away from the axis, a larger vibration amplitude results in a larger vibration.

This lateral alternating vibration is asynchronous so that the unilateral vibration is alternately applied to the left and right leg.

Vibration plates with vertical synchronous vibration

The second type of vibrating platform produces vertical synchronous vibrations so that both legs vibrate when the platform moves primarily in the vertical direction, resulting in simultaneous and symmetrical movement of both sides of the body.

Transmission and parameters

The majority of the vibratory plates available produce periodic sinusoidal oscillations to transfer energy from the vibratory plate to the body.

The vibration load depends on 4 parameters:

• Duration (exposure time)
• Acceleration (this determines the magnitude of the vibration)
• Amplitude (refers to the displacement of oscillatory motion)
• Frequency (the number of cycles of oscillations determines the frequency, expressed in Hertz)

Safety and health risks

Occupational exposure to vibration can be detrimental to a person’s health, especially for workers who are continuously and continuously exposed to vibration from various types of machinery.

And so, as with all therapeutic modalities, even with whole-body vibration, there is a risk of adverse effects when a vibration plate is misused.

Chronic exposure to high-magnitude whole-body vibration in an occupational setting can harm the musculoskeletal, digestive, vascular, reproductive, visual, and vestibular systems, e.g., disc herniation, osteoarthritis, hearing loss, and visual or vestibular problems.

Hence, it is important to screen patients for possible conditions or co-morbidities in therapeutic use that could increase the risk of unintended adverse effects.

Considering that most studies with vibrating plates were conducted in the form of exercise programs for a short period and through intermittent exposures, significant side effects have never been reported.

Related post: For a more in-depth discussion on who should not be using vibration plates, check our other post Who cannot use vibration plates? Exclusion criteria for vibration training

Effects and benefits of whole-body vibration

To date, the most common use of whole-body vibration has been related to improving physical performance via increasing muscle activity, strength, and power associated with traditional neuromuscular training.

Effects of whole-body vibration in pathology

MS

MS (multiple sclerosis) is a demyelinating disorder of the central nervous system which is accompanied by a decrease in strength and consequent reduction in physical function, along with loss of sensation and visual disturbances.

There are positive signs that whole-body vibration may affect MS. However, long-term studies with matched control groups are needed to validate whether a vibration plate is indeed an appropriate training modality.

CVA

A cerebrovascular accident (CVA, an accident in the brain’s blood vessels) can significantly impact motor functions, balance, and gait and affect random strength. The results of whole-body vibration in CVA patients are contradictory, with one study showing marked improvement and another showing none.

Parkinson’s

Good results are reported in Parkinson’s patients who underwent vibration training, mainly in terms of postural stability.

Effects on the elderly

In recent years, there has been increasing interest in whole-body vibration for the elderly and several scientific studies have been carried out.

They looked at the impact on bone density, muscle strength, balance, and functional mobility.

In terms of bone density, most studies demonstrated a significant improvement in bone density at the hip and tibia compared to conventional strength and balance training.

However, no study could demonstrate an improvement at the spine level.

Given that compliance, motivation, and safety are essential, it is necessary to determine at what minimum vibration dose a maximum effect can be achieved.

The same effects could be demonstrated with vibration training as with traditional strength training in terms of muscle strength.

Most studies required a shorter time for the whole-body vibration session (30 to 40 minutes versus 1 to 1.5 hours of classical strength training).

From this, we can deduce that vibration training is a potentially efficient and effective training method.

Finally, the gait, balance, and functional mobility of the elderly were also examined. Here, most studies demonstrated a significant improvement in balance and functional mobility due to whole-body vibration.

Tip: For a list of more general benefits of whole-body vibration, not limited to the elderly population, check our other post Whole-body vibration benefits in the short and long term

Frequently asked questions about vibration training as strength and balance training

Are the physical effects of classical strength and balance training and whole-body vibration equivalent in the context of fall prevention?

In terms of balance and functional mobility, both classical strength and balance training and whole-body vibration improve functions.

Physically we can conclude that both types of training outcomes are equivalent in terms of balance, functional mobility, and muscle strength.

Are the effects of classical strength and balance training and whole-body vibration equivalent in terms of health-related quality of life?

Regarding perceptions of physical health

Regarding physical function, both types of training improve physical function, but this improvement is stronger with strength and balance training.

For pain and ailments, whole-body vibration improves pain while strength and balance training produce a limited worsening.

Regarding perceptions of mental health

Both types of training produce improvements in social function.

The mental health of elderly people living at home improves thanks to whole-body vibration while remaining equal and stagnant in strength and balance training.

Regarding the health-related quality of life, we can state that both whole-body vibration and classical strength and balance exercises are equivalent.

Wherein the two forms of training differ is in the area of pain.

With whole-body vibration, there is an improvement in age-related pain symptoms, while with classical strength and balance training, there is a worsening of these symptoms.

Are classical strength and balance exercises and whole-body vibration perceived as the same by elderly people living at home?

Whole-body vibration and strength and balance training are equally enjoyable for elderly people living at home, both at the beginning and at the end of a training schedule of several months.

One study did show that over time there is a noticeable difference between the two types of training. Specifically, classical strength and balance exercises are more likely to be perceived as less enjoyable in the home environment.

What are the best practical tips for avoiding falls at home?

• Staying physically and socially active with a focus on gradually building activity levels
• Avoiding sudden changes in position
• Using walking aids
• Paying attention to indoor and outdoor hazards that could cause a fall (e.g., loose tiles or slippery surfaces)
• Wearing appropriate footwear and avoid high heels and slippery soles
• Using handrails on stairs
• Ensuring adequate lighting in the stairwell and bathrooms.

Whole-body vibration for fall prevention in elderly people living at home: Conclusion

Whole-body vibration and classical strength and balance training can be considered equally valid for physical effects, health-related quality of life, and perception within the context of fall prevention for elderly people living at home.

It is no wonder then that whole-body vibration is increasingly becoming a full-fledged alternative to strength and balance training in fall prevention for the elderly.