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Research Validation

Balance, Core Strength, Bone Health and Fall Prevention in the Aging Population

The BStrong4Life® System and Protocols

Gregory S. Ellis, PhD, CNS

Background

         Falls represent one of the leading causes of injury in the aging population, and often result in early admission to nursing home, and in many cases, premature death. After a fall and hospital admission, patients are discharged (if they survive) without information or methods to reduce the potential for subsequent events. After a fall, many seniors develop a fear of falling and become less active, weaker, and less balanced over time. Quality of life declines as activities of daily living (ADL) are reduced.

Most older adults are not aware of the risks of falling. Despite the high prevalence and adverse effect of falls among older adults, prevention receives little attention in clinical practice. This neglect reflects, in part, a health care system focused on the episodic diagnosis and treatment of individual diseases rather than ongoing evaluation and management of the multiple simultaneous conditions experienced by many older adults. Physicians do not regularly question or test for risk of falling so neither the patient nor the physician attempt to reduce risks. It is typically only after a fall occurs that awareness and fear increases.

Unfortunately, most physicians don’t have the training to assess the risks of falling and even if they did, they have few guidelines to refer to in order to help their patients. Current guidelines recommend that all physicians routinely assess older patients for fall risk, but very little proactive treatment programs exist.

Fall risk assessment of people living independently, those in assisted living facilities and those in institutional environments through an evidence-based screening program should become the norm. Once the status of the individual patient is established, interventions directed at improving balance, strength and overall stability can be employed.

Epidemiology

The definition of a fall is “unintentionally coming to the ground or some lower level as a result of a fall and not because of a violent blow, loss of consciousness, sudden-onset paralysis as in stroke or an epileptic seizure” (1). Incidence rates for falls are remarkably consistent across many studies. Rates of falls vary for older individuals living in different residential community environments. The fewest occur in community-dwelling (independent living) persons and 55+ residential communities. The rate progresses to higher levels in the following groups: assisted living and nursing home, with the highest number of falls occurring in skilled nursing/hospital settings (2).

One-third of older Caucasians living in the community will fall at least once a year with many suffering the effects of multiple incidents. Falls account for 40% of injury related deaths. In people over the age of 65, falls are the leading cause of death from injury and lead to substantial morbidity among older adults. Nearly 70% of all emergency room admissions are from people over the age of 75 who have fallen (3). Hospital stays resulting from a fall average 11.6 days. For every 100 falls, 40 people will be admitted to the hospital, and 20 of those will subsequently end up in a nursing home.

Costs involved in falling include doctor visits, acute hospital and nursing home care, outpatient clinic visits, rehabilitation, diagnostic tests, medications, home care, home modifications and durable equipment purchases as well as residential care. Projected costs per fall are US$7,399 and by 2020 total US estimated costs of falling is US$32.4 billion (4).

Forty-two percent of the individuals who fall substantially reduce their activity as a result. Although there exists a great deal of evidence and emphasis on osteoporosis, it (osteoporosis) per se does not cause broken bones, the impact from the force of falling on already weakened bone tissue produces the fracture. Fifteen (15%) of all older adults will have a hip fracture in their lifetime. This complication often results in an early death.

Risk Factors

There are many causes of falls. Both intrinsic (within the person’s actions) and extrinsic factors (outside of them) are contributory (5). Both, however, have components that are amenable to alteration.  Most victims will avoid revealing to anyone details about a fall they experienced because of the fear of losing their independence. In one survey, 80% of the respondents stated they would rather be dead than be confined to a nursing home.

The following table identifies the major risks for falling in adults:

Risk Factor

Significance/Total Studies

Muscle Weakness

10/11

History of Falls

12/13

Gait Deficit

10/12

Balance Deficit

8/11

Use of Assistive Device

8/8

Visual Deficit

6/12

Arthritis

3/7

Impaired Activities of Daily Living (ADL)

3/6

Depression

4/11

Cognitive Impairment

4/11

Age > 80 Years

5/8

The following tables present the primary risk factors for falling across several categories.

*** Strong evidence of association

**   Moderate evidence of association

*     Weak evidence of association

–      Little or no evidence

Socio-Demographic Factors Associated with Falls

Factor

Strength of Association

Advanced Age

***

ADL/ Mobility Limitations

***

History of Falls

***

Female

**

Race

**

Living Alone

**

Inactivity

**

Walking Aid Use

**

Alcohol Consumption

_

Balance and Mobility Factors Associated with Falls

Factor

Strength of Association

Impaired Sit-Stand/Transfer Ability

***

Reduced Gait Velocity/Cadence/Step Length

***

Impaired Stability When Standing

**

Impaired Stability When Leaning and Reaching

**

Slow Voluntary Stepping

**

Increased Step Timing Variability

**

Inadequate Responses to External Perturbations

*

Sensory and Neuromuscular Factors Associated with Falls

Factor

Strength of Association

Vision
Poor Visual Contrast Sensitivity

***

Decreased Depth Perception

***

Poor Visual Acuity

**

Visual Field Loss

*

Increased Visual Field Dependence

*

Poor Hearing

Reduced Vestibular Function

*

Peripheral Sensation

 

Reduced Vibration Sense

***

Reduced Tactile Sensitivity

***

Reduced Proprioception

**

Muscle Strength

 

Reduced Muscle Strength

***

Reduced Muscle Power

*

Reduced Muscle Endurance

*

Reaction Time

 

Poor Simple Reaction Time

***

Poor Choice Reaction Time

***

Psychological Factors Associated with Falls

Factor

Strength of Association

Increased Fear of Falling

***

Impaired Selective Attention

**

Risk Taking

*

One of the key findings evident within the extensive body of research related to falls and falling is that vestibular function and decay is in fact not one of the critical contributory risk factors. This fact is in conflict with many who argue that functional disability related to balance as a result of dysfunction of the vestibular apparatus is a predominant contributor.

Postural sway is one of the most revealing predictors for falling.  An important tool to measure postural sway is dynamic posturograpy, an efficient and reliable system produced by Vestibular Technologies CAPS EQ. Control of postural sway when standing involves continual muscle activity (primarily the calf muscles), and requires an integrated reflex response to visual, vestibular, and somatosensory inputs.

Factors highly correlated with increased postural sway include:

  • Reduced lower extremity muscle strength
  • Reduced peripheral sensation
  • Poor near visual acuity
  • Slowed reaction time

Measurement of postural sway in a standing person has been reported to be a useful predictor of falls in older people. Studies report more postural sway in those individuals that fall vs. those who do not. The CAPS EQ tests four aspects of functional postural stability:

  • Firm surface, eyes open
  • Firm surface, eyes closed
  • Perturbed surface standing on a foam pad, eyes open
  • Perturbed surface standing on a foam pad, eyes closed

Inability to maintain balance on the foam at all is correlated with a high probability of an impending event.  There is some evidence that peripheral sensation and or sensitivity is the most important sensory system in the regulation of standing balance in older adults.

Maintenance of postural stability is a highly complex mechanism dependent upon the interplay of a vast number of neurophysiological and biomechanical variables. Normal aging results in a decreased ability to control postural stability in standing on either one or two legs. As walking is mostly done with one leg, the importance of maintaining good control over functional biomechanics is critical. Unexpected alterations in terrain or floor surface, as well as environmental obstacles are often a significant hazard to those who have lost functional ability.

Stand-alone balance tests do not adequately assess fall risk. A full battery of assessments should be employed in order to investigate all of the risk factors involved.

Strategies for Prevention

Many variables contributing to falls can be altered to positively impact vulnerability. Three primary areas to address include:

  • Medication Intake — people on four or more medications (particularly psychotropic meds) have higher fall rates
  • Environmental
  • Neurological, physiological

Medication

(6-15)

Environmental

Environmental Risk Factors for Falls

General
Slippery Floor Surfaces
Loose Rugs
Upended Carpet Edges
Raised Door Sills
Electric/Electronic Cords Across Walkways
Shelves or Cupboards too High/Low
Spilled Liquids
Pets
Obstructed Walkways
Furniture
Low Chairs
Low or Elevated Bed Height
Unstable Furniture
Use of Ladders and Step Ladders
Bathroom/Toilet/Laundry
Lack of Grab Rails Shower/Bathtub/Toilet
Low Toilet Seat
Outdoor Toilet
Slippery Surfaces
Distracting Surroundings
Use of Bath Oils
Stairs
Absent or Inadequate Handrails
Non-Contrasting Steps (Visual)
Stairs Too Steep, Tread Too Narrow
Distracting Surroundings
Unmodifiable Stairs or Individual Unable to Manage Stairs
Outdoors
Sloping, Slippery, Obstructed or Uneven Pathways, Ramps, and Stairways
Rushing Caused by Inadequate Time Allowed for Pedestrian Crossings
Crowds
Certain Weather Conditions
Unsafe Garbage Bin Use

Neurological/Physiological Factors

Individuals afflicted with peripheral neuropathy affecting the lower extremities, have altered sensation in the feet and ankles, leading to a lack of proprioceptive awareness. Peripheral neuropathy can result from complications of diabetes; however, milder forms of this condition are associated with altered weight bearing due to postural degradation. Anterior head translation or forward head posture, results in a shift of load to the anterior of the foot, loading the vascular and neural tissues to produce a mild “pressure neuropathy”. Indirect, transient neuropathy related to a reduction in blood flow (hypoxia) can result from prolonged sitting or in individuals who spend an inordinate amount of time reclining or in bed. If this habit continues unabated, atrophy of all tissues involved results. This progressive degradation leads to a steep decline in muscle strength and balance. When coupled with one or more of the other factors noted above, a grave eventuality exists.

Physical Training Programs

Many of the risk factors for falls are reduced, neutralized or eliminated by appropriate physical training programs. BStrong4Life®, Inc. provides a viable evidence-based training program incorporating current research with a primary focus of balance, core strength, structural integrity and fall prevention.

Introduction

The literature supports that one of the most significant contributors to falling is a loss of muscular strength. An additional component is muscular response time, and the ability to recruit muscle to action to stabilize the torso in various postures or positions related to activities of daily living (ADL).

Muscle strength is highly correlated with many other components of fall risk:

  • Postural sway
  • Muscle power generation
  • Muscle endurance
  • Decreased gait
  • Reduced stability when leaning and reaching
  • Impaired sit to stand from a chair

To understand the BStrong4Life® Training System, one must have a basic understanding of exercise physiology. In practice, all human movement is a combination of various actions and reactions occurring simultaneously to produce harmonious movement or actions.  For purposes of understanding the differences between muscular functions and exercise variations, these descriptions are presented to elucidate the relevant contribution each makes to human function.

Concentric exercise: The muscle being contracted shortens in response to the effort against a given load or position.  Concentric contractions therefore, result in limbs approximating one another.  This is the most common type of resistance training and is the basis of most home and commercial programs. Free weight (barbells, dumbbells, kettle bells) and bodyweight exercise such as pull ups, push- ups etc. are examples of (predominantly) concentric exercise. (16, 17)

Eccentric exercise: Eccentric muscle contraction is best described as lengthening under tension. The muscle is absorbing the load.  Walking down hill for example requires the lower extremity muscles to lengthen under tension, slowing your progress and coordinating with some level of concentric contraction to allow smooth locomotion. The lowering of a weight lifted concentrically is also an eccentric contraction. The muscle lengthens with resistance to the load imposed.

Isometric exercise: Muscle contracts absent any motion or approximation of opposing attachments.  Isometric contraction provides essential stabilization by producing tension in the tissue to resist movement as well.  Pushing or pulling against an immovable object or resisting a force without yielding are examples of this type of muscular function. Tremendous force can be generated with isometric contraction.  This form of loading does not by definition include any distraction or approximation of origin and insertion. However, the load generated does transmit force to the attachments, and associated skeletal elements.

Whole Body Vibration: Whole body vibration training, also known as “Acceleration Training” also known as “Biomechanical Stimulation” (BMS), and “Biomechanical Oscillation” (BMO) (Wikipedia), is a training method employing low amplitude, low frequency (25-55 Hz) mechanical stimulation to exercise musculoskeletal structures for the improvement of muscle strength, power, and flexibility. The addition of a vibratory stimulus to muscle tissue shortening, lengthening or tensioning, produces an additional neural reflex intensifying muscle function (18, 19).

One significant observation gleaned from current research is that conventional training programs are ineffective in comprehensively addressing the fundamental needs of human function.  This is a function of a predominant reliance on concentric strength training along with aerobic exercise in its various iterations. As the number of senior facilities continues to grow, developers build gyms into the facility using equipment based on conventional strength training and cardiovascular (aerobic) exercise leading to ineffective and minor benefit results.

Unfortunately, these types of exercises by themselves, or even in combination, do not prevent falls. For example, many seniors are encouraged to walk, and to their credit, many do. However, walking in and of itself does not reduce the risk of falling. Walking certainly has many benefits, and should be encouraged for those effects, however, it must be combined with functional training with sufficient intensity to stimulate an adaptive response as well as balance training to make a significant contribution to reducing fall vulnerability.

Functional training is commonly understood to be training, exercise and conditioning directed towards improvement in Activities of Daily Living (ADL) such as rising from a chair or climbing steps.

A physical training program must be designed according to the tenets of research defining progressive exercise. This includes:

  • Specificity of training
  • Overload principle

There are three main categories to include in an exercise prescription:

  • Intensity
  • Duration
  • Frequency

Most of the exercise training programs found useful for fall reduction used a three plus times per week program of at least 30 minutes per session. As goals were reached in respect to repetitions, intensity was further increased until specific outcomes were met such as being able to stand on one leg for 15 or more seconds.

A downside to this style of exercise is that it is time consuming, metabolically demanding often leading to sweating. The perceived level of exertion of this more “traditional” type of training is often quite high. These attributes are undesirable to most seniors or those not accustomed to athletic endeavors or training.

A review of the available research at the National Library of Medicine turned up scientific articles for all of these forms of exercise. Eccentric exercise: 2,448, Concentric exercise: 1,658, Isometric exercise: 26,443: and Vibration exercise: 852

It is evident there is a tremendous amount of scientific information on these various modalities of exercise. The research describes many facets of what researchers have studied and reported upon. The benefits to the aging population are one of the main categories. With all of the available information it is far easier to design effective protocols. One of the key features of a successful program is the use of multiple training modalities to address the various muscular functions described above, as muscles have a broad range of functional capabilities and a training system or protocol should address as many of these functions as possible. The consideration historically has been to find effective training modalities to employ. Here are key factors to look for:

  • Minimal time commitment
  • Efficient application of time versus intensity
  • Provide effective and rapid levels of improvement
  • Stimulation of the minimum effective dose, minimum demand on physiological systems

It is a significant challenge to provide maximum benefit with minimal demand of time and energy. Remember the oft stated and overly used expression “No Pain, No Gain.”? This is essentially not a true statement.

Until recently the technology that allowed us to realize the benefits we wanted and meet the objectives we established was simply not available. But new technology arrived during the last decade and some only has become available as of the time of this writing, early 2013.

BStrong4Life® Center physicians, program managers and trainers supervise every individual’s training session, providing an optimized environment to create the necessary stimulus that is measured, high intensity, and that has a low metabolic demand. Correspondingly, it also allows for full tissue recovery and rapid regeneration, thereby improving strength and reducing the most significant fall risks previously described and detailed.

Aging and Muscle

The muscle wasting and weakness that occurs with aging have been of interest since early Greek and Roman history. Muscle loss and decay, at the opposite poles of our interest in muscle strength have long been of interest in history. The Greeks despised aging as it represented a deterioration of youthful vigor. If the problem of physical frailty in aging is to be effectively slowed, a full and complete understanding of the causes and mechanisms underlying muscle weakness must be achieved.

Sarcopenia, by definition is the loss of muscle mass with aging. It is the main cause of muscle weakness in old age. This degenerative process begins around the 6th decade and by the 8th decade muscle mass accounts for 40% less than the whole body muscle level that an individual possessed in the 2nd decade of life. The causes of sarcopenia are multi-faceted, but are primarily driven by neuropathic changes leading to moto-neuron (the nerve that attaches to muscles) death along with cell death (apoptosis). During the aging process, the number of muscle fibers decreases, as well as fiber size arising from changes in hormonal growth factors, and a decrease in the level of physical activity, which is a critical component in stimulating muscle growth and repair.  Malnutrition in aging is quite common due to a progressive loss of appetite and the consequent reduction in food intake.

Loss of muscle size occurs along with the inability to generate force based on a muscle’s cross-sectional area. This is referred to as a decrease in muscle quality. These factors affect both the neuromuscular system and the tendon connective tissue system. Among the muscular changes is the inability to generate as much force output as one could perform when younger. There is a decrease in the myosin:actin cross-bridge connections, which are responsible for creating contractile force. Further, there is less neural drive. There are also changes in the actual muscle architecture that contribute to the loss of the ability to generate force which accounts for approximately 50% of the loss in muscle strength/function in the elderly.

Neuromuscular Alterations with Training in the Aged

Since the early 1990’s resistance training has been observed to slow and even reverse the detrimental effects of neuro-musculoskeletal aging. What is most significant about this body of work is that it demonstrates the adaptability of human physiology and implies that the losses attributed to the aging process are not fixed and unalterable.

Skeletal muscle has the capacity to regenerate, or hypertrophy when exposed to an appropriate stimulus. With the use of specialized technology such as computerized tomography, ultrasound, and magnetic resonance imaging, muscle cross sectional area responding to the stimulus of resistance training has been shown to increase significantly. Increases in muscle cross-sectional area after 3-month’s training, range from 5-17%, a figure comparable to the changes seen in young adults during similar periods of training. Changes in tendon stiffness also accompany changes in muscle size and the force-generating capability of trained elderly muscle. The implications of these findings are that training requiring a rapid generation of joint torque force may produce an additional functional benefit by enabling a better response time when attempting to recover from a slip or fall.

In stark contrast with published work demonstrating that neural factors are minimally involved in strength increases in the young, studies of elderly trainees indicate that maximal muscle activation (neural factors) play a dominant role in the development of strength increases. The data suggests that the effect of muscle training in the aged may in fact rest entirely on neural factors, presumably acting on various levels of the nervous system, which act to increase muscle activation (neural) in the absence of significant hypertrophy (muscle growth). Of course, as we have seen, above, muscular hypertrophy does occur: as we have also seen, increases in neural input will be a factor since sarcopenia is characterized by diminished nerve stimulation of the contractile proteins.

Several studies, that used conventional resistance training in the elderly, have shown significant increases in muscle strength in 8-12 weeks: 107.4%, 113.0%, and 174.0%.

The only conclusion that can be drawn from the above studies is that increased muscle strength in the elderly occurs as a result of the combined improvements in both activation (neural) and (muscular) hypertrophy. These two mechanisms, acting in tandem, demonstrate the extraordinary potential for rehabilitation of the loss of muscle strength and function in the elderly and the associated potential to prevent falls, improve the quality of life, and maintain independent activities of daily living (ADL).

Vibration Exercise

Whole Body Vibration (WBV) has been shown to be a very effective stimulus for creating significant improvements in overall health. It has multiple effects on all parts of the body including enhancing the functionality of both neuro-muscular and neuro-endocrine systems. Studies have shown that vibration exercise can be an effective therapeutic approach for sarcopenia (muscle loss) and also has a positive effect on osteoporosis.

Vibration exercise machines provide oscillatory motion at various levels of intensity and frequency. Vibration exercise is a contemporary topic in sport science. Yet it is even newer in respect to the prevention and recovery from various injuries, conditions and diseases particularly diseases and factors related to aging. Athletic training facilities and progressive rehabilitation centers, nursing homes and assisted living complexes all use WBV in their exercise programs.

Vibration exercise provides a powerful stimulus that causes significant adaptive changes to fascia, joint, muscles tendons and bone; the structural tissues of the body.  Positive changes in the cardiovascular and lymphatic systems are also associated with WBV training. The human body depends upon on all of these structures to control the transmission of force into and through the body.

Several recent studies have demonstrated increases in bone mineral density (BMD) following vibration training. Bone mineral density in the hip of postmenopausal women increased about 1% with six months of vibration exercise (20).

Interestingly, women who followed a traditional weight-training program had a decrease in bone mineral density of one-half percent. Weights are thought to increase density. A control group (no weights and no vibration) experienced a decrease in bone density of 0.6%. In another fascinating study, eight months of vibration exercise led to a bone mineral density increase at the top of the femur of 4.3% (21).

In another study of post-menopausal osteoporotic women (22), once weekly vibration training led to a reduction in chronic lower back pain, increased bone density, and increased muscle size.

Osteoporosis is one of the most common complications of aging. In animal studies, one year of vibration exercise increased bone volume, the thickness of internal bone scaffolding, and bone stiffness and strength. The authors concluded that vibration training offers a unique, non-pharmacological preventative for osteoporosis (23).

In young women, increases in spinal bone density of 3.9% and femur density of 2.9% occurred after twelve months of vibration training. Benefits resulted from as little as 2 minutes per day of training. The conclusion was that: “Short bouts of extremely low-level mechanical signals, several orders of magnitude below that associated with vigorous exercise, increased bone and muscle mass in the weight bearing skeleton of young adult females (24).

In a publication in December 2013, six months of whole body vibration performed for five minutes three times per week by 28 postmenopausal women increased bone mineral density by 2.032%. The researchers concluded that the results were significant (25).

It is clear from the reports listed above that vibration training is good for bone health in both younger and older women. It also worked well for those in nursing homes. Non-pharmacologic approaches to prevent bone loss are well suited for elderly patients to help them avoid using multiple drugs and the side effects of their use.

Strength

Mechanical vibrations applied to muscles and tendons create a reflex contraction known as the “tonic vibration reflex.” This is a reflex action caused by excitation of muscle spindles. The body senses vibration, not only by nerve-muscle spindles but also by skin, joints, and secondary nerve endings. Changes in the nerve-muscle system also involve all of the body’s sensory systems. Greater neural-muscular communication results in more efficient use of existing tissue, and also creates a stimulatory demand for hypertrophy and or proliferation of new contractile elements.

Often, minimal training time is required to reap significant improvements from the use of WBV. In one study, 29 postmenopausal women stood on a ground-based vibration plate for three 2-minute sessions, twice weekly for six months. Test subject’s muscle power improved by 5%.

Hormonal System Improvements

Vibration training alters hormonal profiles and will enhance performance in athletes. Vibration training will improve athlete’s responses during training. Vibrations will also help during event pre-competition by providing a warm-up (26, 27).

In another study (28), tests of performance showed increases in nerve-muscle efficiency. Jumping ability increased after one 10-minute session. Measurements of blood testosterone and growth hormone resulted in increased levels of each while cortisol levels decreased. The biological changes produced by vibration are similar to the effect produced by explosive power training. Cortisol is a hormone released by the adrenal gland due to high levels of stress; reductions in cortisol, therefore, are a good thing.

Often, training time to reap improvements from the use of vibration is very little. In one study (29), 29 postmenopausal women stood on a ground-based vibration plate for three 2-minute sessions, twice weekly for six months. Test subject’s muscle power improved by 5%.

Balance and Gait

Vibration exercise also positively impacts balance (30-33). Improvements in balance help the elderly by decreasing the risk of falling. In a study of nursing home residents, six weeks of vibration training improved gait (ability to walk) compared to no change in the control group. Body balance also improved by 3.5 points on a body balance scale test compared with a decrease of 0.3 points in the control group. A test that measures the ability to stand and walk was improved by vibration. It took the trained group 11 seconds less time to reach a point on the walk path whereas the control group moved more slowly by 2.6 seconds. The vibration group also improved on eight out of nine items when tested by the World Health Organization’s questionnaire that measures the quality of life.

The Elderly

Studies confirm the benefits of vibration exercise for osteoporosis, sarcopenia (muscle loss), and improvements in body balance. Clearly, vibration exercise should be a key strategy for both the elderly and for younger persons to avoid the ravages of aging. Vibration exercise is an effective way to change risk factors for fractures in older women. Muscle loss is avoided and slight increases in muscle mass and increases in strength are an outcome of vibration training.

One of the most important results noted from these findings is that the benefits occur without the use of drugs (34). Muscle strength in this study improved by 16.0% and bone mineral density in the hip improved approximately 1%. Yet the group of women who performed resistance (weight-training) exercise had no improvement.

This is one of the unique aspects of vibration exercise: it can often outperform resistance training. Also, vibration exercise improved bone mineral density equivalent to what the most effective drugs often accomplish, with none of the associated side effects of medication. Of course, although medication may prevent the loss of bone, it is unable to provide any of the other benefits of vibration exercise including improvements in strength, balance, neuromuscular function, and quality of life. Vibration exercise has enormous potential to improve people’s health.

Vibration exercise, therefore, is an effective intervention for reducing the effects of aging on neuro-musculo-skeletal tissues. Also, the positive effect upon the hormonal system means that this form of exercise can benefit those in training and assist in rehabilitation from different diseases or conditions.

In summary, WBV exercise provides strong stimuli that lead to adaptations in the human body that improve health and function. The body must have a well-developed internal adaptation system because the changes caused by vibration activities are so powerful. Vibration changes the structure and function of the body more effectively than both resistance and aerobic exercise. This does not suggest that one should give up those forms of exercise, but suggests that using vibration training along with the other two is a more effective approach.

Vibration Training and Mitigating Fall Risk

Researchers are beginning to look at the effects of vibration training on the aging population and the elderly. Older individuals suffer from disuse syndrome (disuse atrophy) and are often extremely de-conditioned, so vibration is a viable alternative to conventional exercise programs. Nursing home residents with limited functional capacity increased balance and mobility following a 6-week WBV training program (35). One study demonstrated increases in muscle strength, explosive muscle strength, and muscle mass (9.8%, 10.9%, and 3.4% versus a fitness trained group, 13.1%, 9.8%, and 3.8%). There were no changes in the control group. These results suggest that vibration training has the potential to prevent and reverse the commonly occurring age-related loss in muscle mass (sarcopenia) that has become an all too common hallmark of the aging population.

Fall risk was assessed with a battery of tests in 42 (forty-two) elderly volunteers. 22 (Twenty-two) were enrolled in a whole body vibration-training program with the addition of a physical therapy program and 20 (twenty) were in physical therapy alone. Those in the intervention group improved by 3.5 points on the body balance score compared with a decrease of 0.3 points in the control group (36). Controlled whole body vibration can improve elements of fall risk (37).

Balance was improved through the use of vibration training in sixty-nine community-living elderly persons. Training consisted of 3 minutes per day for 3 days per week for 3 months at 20 Hz. The protocol improved balance and reduced the risk of falls.

De-conditioned individuals improve to a greater degree, and more rapidly than those who are already in reasonable physical condition. This fact was proven once again when studying the use of vibration training. In this study (38), sedentary and elderly subjects demonstrated significant gains in most measures of muscle performance, similar to the results provided by traditional resistance exercise programs. Another study used 12-20 Hz vibration to test muscle strengthening, balance, and walking ability. Of interest is that subjects only exercised 1-day per week for 4-minutes (39). This is consistent with the design of the high intensity, short duration training programs and systems, such as the BStrong4Life® Training System.

I previously identified postural sway as strong predictor of fall risk. Muscle strength is a strong predictor of postural sway, as is tactile sensitivity. Some of the work studying Parkinson’s Disease and Multiple Sclerosis shows increased (improved) sensitivity as a result of WBV exercise. Clearly, many studies now show the value of vibration training to improve muscle strength, mass, and lower extremity performance. Increase in functional capacity is significant and the perception of little effort (low perceived levels of exertion) makes vibration training feasible and desirable for even frail elderly. Improvements can arise from as little as one 4-minute session per week; gains will be greater in those who are the most de-conditioned and are at the greatest risk of falling.

Isometric Training

Isometric training was little known, and had it not been for Charles Atlas’s salesmanship, would have continued to be ignored until 1953 when Hettinger and Muller’s classic paper on Isometric Training was first published (40). The author’s research conclusion: a maximum muscle strengthening effect was produced by one daily isometric contraction, lasting six seconds, using an effort level of two-thirds of the muscle’s maximum contractile power (41) .

The idea that so little time and effort would lead to such a profound response in so short a time led some to argue that years of dedicated resistance work, lifting weights totaling tons each year, had been a needless effort. This opinion shook the foundations of the strength establishment and it has not abated today. 

Weekly Gains in Strength Expected from Isometric Training for Muscles in Different States of Training*

State of Training

(percent of limiting strength)

Rate of Gain

(percent per week)

Training Time to Reach Limiting Strength (weeks)

98

2.0

2

95

3.6

80

5.6

3-5

85

7.5

80

8.6

75

10.0

5

<75

12.0

Bone Mass can be Increased with Osteogenic Loading

The bioDensity System developed by Performance Health Systems has created the ability to accurately measure isometric force production. The system, which isolates the body in four biomechanically efficient positions, allows for intense force production in “multiples of one’s body weight”. These forces when applied regularly create intense stimulation and adaptive response that lead to multiple benefits – including increases in bone mass. Osteogenic Loading, the term used to describe this type of exercise and force production, is a key element in developing an organic and sustainable form of fitness for a large percentage of the population in need of a solution.

High Intensity, Short Duration Isometric Training

Intensity is clearly the most important factor in the development of maximal strength and muscular power. This fact serves as one of the core tenets of the BStrong4Life® Training System. A fundamental component of this training system is measured isometric force generation from these four distinct positions/postures effectively incorporating all of the musculature and fascia of the body. An upper body press, lower body press, core pull and vertical lift all performed for a sufficient time to produce momentary muscular failure result in a positive adaptive response.

BStrong4Life® Training capitalizes on the fact that with maximum exertion recruiting the entire body as either a force generator or stabilizer, the minimum effective dose to induce adaptive change is achieved in all tissues involved. The functional outcome provides tremendous benefits to human health, including increased muscle strength and power that in turn, lead to improvements in the activities of daily living and reduce the risks of falling in the elderly.

Functional Eccentric Training

The third component of the BStrong4Life® System is functional eccentric core training. Understanding the need to provide core strength along with motion and balance training, BStrong4Life® utilizes the reACT Trainer. This apparatus allows people to perform properly coached and supervised eccentric exercise. Previously, the only machines that existed to train eccentrically were those built in labs for the purpose of studying eccentric exercise.

Many elderly individuals with cardiovascular disease and others who are de-conditioned because of many years of inactivity cannot exercise at intensities sufficient to provoke improvement in skeletal muscle mass and function. The capability of eccentric training to increase muscle strength and function, with minimal metabolic demand is well suited to this population.

Eccentric exercise demands oxygen consumption that is 1/6-1/7 of that used in conventional exercise (42). Eccentric exercise also results in a rapid adaptation that both stimulates muscle growth (hypertrophy) and protects the muscle from subsequent bouts of injury (43).

Besides the lack of equipment to perform eccentric exercise, there has been a long standing belief that the “overloading” allowed by eccentric training led to significant muscle injury. If one follows a gradual ramping-up of the load, muscle injury can be completely avoided. This is why there is such a strong emphasis on individual coaching in the BStrong4Life® clinical environment (44).

Muscle Strength and Size

The strength of a muscle is related to its size. As I’ve described, in aging there is a loss of size and, therefore, strength. There is also a decrease in the nerve-muscle connections (45).

When eccentric and concentric contractions are performed consistently in isolation as part of a structured strength-training program, a significant body of evidence suggests that eccentric contractions promote greater gains in muscle mass and strength (46, 47).

However, widespread implementation of resistance training programs in the elderly (particularly in frail elderly) may be hampered by the complexity and inherent danger of traditional resistance training programs. Conversely, eccentric-only training programs can be accomplished with less perceived effort and low metabolic cost. Research showed that, compared to a traditional weight training program, 11 weeks of low-effort eccentric training resulted in significantly greater strength gains, balance, stair descent abilities, and decreased fall risk in frail elderly subjects (34).

In further studies, the eccentric-only group experienced increased isometric and eccentric torque production, but no increase in concentric torque production. Studies have also shown strength increases of 46% in just 6 weeks.

Collectively, the available evidence suggests that eccentric training protocols are well tolerated in elderly individuals and can lead to improved muscle strength and functional characteristics (48).

Summary

The BStrong4Life® Training System combines three of the best forms of exercise for improving function in Activities of Daily Living. These are high intensity, short duration training, involving all key parameters of neuro-muscular function, in an efficient, supervised, and low risk environment. The system is accessible to a wide variety of individuals in various levels of physical fitness, and is adaptable to address many of the complications of aging and de-conditioning affecting the adult population. There is no doubt that this unique application of supervised training can profoundly impact the epidemic of muscular atrophy, imbalance, declining bone density and strength and add a valuable component to preventing falls in the adult population.  BStrong4Life®, Inc. has provided a natural, safe, and extremely effective solution to positively impact the function and overall health of humanity.

Selected References

Reference List

         1.          Lord SR and Sherrington C, Menz H Close J. Falls in Older People.  2007. New York, Cambridge University Press.
Ref Type: Generic

2.          Commodore DI. Falls in the elderly population: a look at incidence, risks, healthcare costs, and preventive strategies. Rehabil Nurs 1995;20:84-9.

3.          Findorff MJ, Wyman JF, Nyman JA, Croghan CF. Measuring the direct healthcare costs of a fall injury event. Nurs Res 2007;56:283-7.

4.          Carroll NV, Slattum PW, Cox FM. The cost of falls among the community-dwelling elderly. J Manag Care Pharm 2005;11:307-16.

5.          Das CP, Joseph S. Falls in elderly. J Indian Med Assoc 2005;103:136, 138, 140.

6.          Askari M, Eslami S, Scheffer AC et al. Different risk-increasing drugs in recurrent versus single fallers: are recurrent fallers a distinct population? Drugs Aging 2013;30:845-51.

7.          Freeland KN, Thompson AN, Zhao Y, Leal JE, Mauldin PD, Moran WP. Medication use and associated risk of falling in a geriatric outpatient population. Ann Pharmacother 2012;46:1188-92.

8.          Guthrie DM, Fletcher PC, Berg K, Williams E, Boumans N, Hirdes JP. The role of medications in predicting activity restriction due to a fear of falling. J Aging Health 2012;24:269-86.

9.          Hardigan PC, Schwartz DC, Hardigan WD. Using latent class analysis to model prescription medications in the measurement of falling among a community elderly population. BMC Med Inform Decis Mak 2013;13:60.

10.          Kamel MH, Abdulmajeed AA, Ismail S. Risk factors of falls among elderly living in urban Suez–Egypt. Pan Afr Med J 2013;14:26.

11.          Muir SW, Berg K, Chesworth BM, Klar N, Speechley M. Modifiable Risk Factors Identify People Who Transition from Non-fallers to Fallers in Community-Dwelling Older Adults: A Prospective Study. Physiother Can 2010;62:358-67.

12.          Olsson MU, Midlov P, Kristensson J, Ekdahl C, Berglund J, Jakobsson U. Prevalence and predictors of falls and dizziness in people younger and older than 80 years of age–a longitudinal cohort study. Arch Gerontol Geriatr 2013;56:160-8.

13.          Stanmore EK, Oldham J, Skelton DA et al. Risk factors for falls in adults with rheumatoid arthritis: a prospective study. Arthritis Care Res (Hoboken ) 2013;65:1251-8.

14.          Swartzell KL, Fulton JS, Friesth BM. Relationship between occurrence of falls and fall-risk scores in an acute care setting using the Hendrich II fall risk model. Medsurg Nurs 2013;22:180-7.

15.          Whitney J, Close JC, Lord SR, Jackson SH. Identification of high risk fallers among older people living in residential care facilities: a simple screen based on easily collectable measures. Arch Gerontol Geriatr 2012;55:690-5.

16.          Chamari K, Laffaye G, Ardigo LP, Padulo J. Concentric and eccentric exercise. J Pain 2013;14:1531-2.

17.          Ye X, Beck TW, Defreitas JM, Wages NP. An Examination of the Strength and Electromyographic Responses Following Concentric Versus Eccentric Exercise of the Forearm Flexors. J Strength Cond Res 2013.

18.          Munoz Saez CJ, Moras FG, Rodriguez-Jimenez S. [Effect of an 8-week vibration training program in the elderly]. Rev Esp Geriatr Gerontol 2013;48:15-21.

19.          Mischi M, Rabotti C, Cardinale M. Analysis of muscle fatigue induced by isometric vibration exercise at varying frequencies. Conf Proc IEEE Eng Med Biol Soc 2012;2012:6463-6.

20.          Verschueren SM, Roelants M, Delecluse C, Swinnen S, Vanderschueren D, Boonen S. Effect of 6-month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study. J Bone Miner Res 2004;19:352-9.

21.          Gusi N, Raimundo A, Leal A. Low-frequency vibratory exercise reduces the risk of bone fracture more than walking: a randomized controlled trial. BMC Musculoskelet Disord 2006;7:92.

22.          Iwamoto J, Takeda T, Sato Y, Uzawa M. Effect of whole-body vibration exercise on lumbar bone mineral density, bone turnover, and chronic back pain in post-menopausal osteoporotic women treated with alendronate. Aging Clin Exp Res 2005;17:157-63.

23.          Rubin C, Judex S, Qin YX. Low-level mechanical signals and their potential as a non-pharmacological intervention for osteoporosis. Age Ageing 2006;35 Suppl 2:ii32-ii36.

24.          Gilsanz V, Wren TA, Sanchez M, Dorey F, Judex S, Rubin C. Low-level, high-frequency mechanical signals enhance musculoskeletal development of young women with low BMD. J Bone Miner Res 2006;21:1464-74.

25.          Lai CL, Tseng SY, Chen CN et al. Effect of 6 months of whole body vibration on lumbar spine bone density in postmenopausal women: a randomized controlled trial. Clin Interv Aging 2013;8:1603-9.

26.          Jordan MJ, Norris SR, Smith DJ, Herzog W. Vibration training: an overview of the area, training consequences, and future considerations. J Strength Cond Res 2005;19:459-66.

27.          Bosco C, Iacovelli M, Tsarpela O et al. Hormonal responses to whole-body vibration in men. Eur J Appl Physiol 2000;81:449-54.

28.          Bosco C, Iacovelli M, Tsarpela O et al. Hormonal responses to whole-body vibration in men. Eur J Appl Physiol 2000;81:449-54.

29.          Russo CR, Lauretani F, Bandinelli S et al. High-frequency vibration training increases muscle power in postmenopausal women. Arch Phys Med Rehabil 2003;84:1854-7.

30.          Torvinen S, Kannu P, Sievanen H et al. Effect of a vibration exposure on muscular performance and body balance. Randomized cross-over study. Clin Physiol Funct Imaging 2002;22:145-52.

31.          Torvinen S, Kannus P, Sievanen H et al. Effect of four-month vertical whole body vibration on performance and balance. Med Sci Sports Exerc 2002;34:1523-8.

32.          Torvinen S, Kannus P, Sievanen H et al. Effect of 8-month vertical whole body vibration on bone, muscle performance, and body balance: a randomized controlled study. J Bone Miner Res 2003;18:876-84.

33.          Torvinen S, Sievanen H, Jarvinen TA, Pasanen M, Kontulainen S, Kannus P. Effect of 4-min vertical whole body vibration on muscle performance and body balance: a randomized cross-over study. Int J Sports Med 2002;23:374-9.

34.          Verschueren SM, Roelants M, Delecluse C, Swinnen S, Vanderschueren D, Boonen S. Effect of 6-month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study. J Bone Miner Res 2004;19:352-9.

35.          Bautmans I, Van HE, Lemper JC, Mets T. The feasibility of Whole Body Vibration in institutionalised elderly persons and its influence on muscle performance, balance and mobility: a randomised controlled trial [ISRCTN62535013]. BMC Geriatr 2005;5:17.

36.          Cheung WH, Mok HW, Qin L, Sze PC, Lee KM, Leung KS. High-frequency whole-body vibration improves balancing ability in elderly women. Arch Phys Med Rehabil 2007;88:852-7.

37.          Dolny DG, Reyes GF. Whole body vibration exercise: training and benefits. Curr Sports Med Rep 2008;7:152-7.

38.          Kawanabe K, Kawashima A, Sashimoto I, Takeda T, Sato Y, Iwamoto J. Effect of whole-body vibration exercise and muscle strengthening, balance, and walking exercises on walking ability in the elderly. Keio J Med 2007;56:28-33.

39.          Rees SS, Murphy AJ, Watsford ML. Effects of whole body vibration on postural steadiness in an older population. J Sci Med Sport 2009;12:440-4.

40.          Atha J. Strengthening muscle. Exerc Sport Sci Rev 1981;9:1-73.

41.          Hettinger T, MULLER EA. [Muscle capacity and muscle training]. Arbeitsphysiologie 1953;15:111-26.

42.          Bigland-Ritchie B, Woods JJ. Integrated electromyogram and oxygen uptake during positive and negative work. J Physiol 1976;260:267-77.

43.          Lastayo P, Marcus RL, Dibble L, Frajacomo F, Lindstedt SL. Eccentric Exercise in Rehabilitation: Safety, Feasibility and Application. J Appl Physiol (1985 ) 2013.

44.          Lastayo PC, Ewy GA, Pierotti DD, Johns RK, Lindstedt S. The positive effects of negative work: increased muscle strength and decreased fall risk in a frail elderly population. J Gerontol A Biol Sci Med Sci 2003;58:M419-M424.

45.          Thompson LV. Age-related muscle dysfunction. Exp Gerontol 2009;44:106-11.

46.          Clarkson PM, Tremblay I. Exercise-induced muscle damage, repair, and adaptation in humans. J Appl Physiol (1985 ) 1988;65:1-6.

47.          Nosaka K, Clarkson PM. Muscle damage following repeated bouts of high force eccentric exercise. Med Sci Sports Exerc 1995;27:1263-9.

48.          Hyldahl RD, Hubal MJ. Lengthening our perspective: Morphological, cellular and molecular responses to eccentric exercise. Muscle Nerve 2013.