Journal of

Functional Morphology
and Kinesiology

Review
Whole Body Vibration: A Valid Alternative Strategy to Exercise?
Roberto Bonanni 1,† , Ida Cariati 1, *,† , Cristian Romagnoli 2 , Giovanna D’Arcangelo 3,4 ,
Giuseppe Annino 3,4 and Virginia Tancredi 3,4

1 Department of Clinical Sciences and Translational Medicine, “Tor Vergata” University of Rome,
Via Montpellier 1, 00133 Rome, Italy
2 Sport Engineering Lab, Department of Industrial Engineering, “Tor Vergata” University of Rome,
Via Politecnico 1, 00133 Rome, Italy
3 Department of Systems Medicine, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy
4 Centre of Space Bio-Medicine, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy
* Correspondence: ida.cariati@uniroma2.it
† These authors contributed equally to this work.

Abstract: Several studies agree that mechanical vibration can induce physiological changes at dif-
ferent levels, improving neuromuscular function through postural control strategies, muscle tuning
mechanisms and tonic vibration reflexes. Whole-body vibration has also been reported to increase
bone mineral density and muscle mass and strength, as well as to relieve pain and modulate proprio-
ceptive function in patients with osteoarthritis or lower back pain. Furthermore, vibratory training
was found to be an effective strategy for improving the physical performance of healthy athletes
in terms of muscle strength, agility, flexibility, and vertical jump height. Notably, several benefits
have also been observed at the brain level, proving to be an important factor in protecting and/or
preventing the development of age-related cognitive disorders. Although research in this field is still
Citation: Bonanni, R.; Cariati, I.; debated, certain molecular mechanisms responsible for the response to whole-body vibration also
Romagnoli, C.; D’Arcangelo, G.; appear to be involved in physiological adaptations to exercise, suggesting the possibility of using
Annino, G.; Tancredi, V. Whole Body
it as an alternative or reinforcing strategy to canonical training. Understanding these mechanisms
Vibration: A Valid Alternative
is crucial for the development of whole body vibration protocols appropriately designed based
Strategy to Exercise? J. Funct.
on individual needs to optimize these effects. Therefore, we performed a narrative review of the
Morphol. Kinesiol. 2022, 7, 99.
literature, consulting the bibliographic databases MEDLINE and Google Scholar, to i) summarize the
https://doi.org/10.3390/
jfmk7040099
most recent scientific evidence on the effects of whole-body vibration and the molecular mechanisms
proposed so far to provide a useful state of the art and ii) assess the potential of whole-body vibration
Academic Editors:
as a form of passive training in place of or in association with exercise.
Giuseppe Musumeci and
Cristina Cortis
Keywords: whole-body vibration; physiological adaptations; cognitive function; neurodegeneration;
Received: 1 October 2022 musculoskeletal disorders; pain; exercise; prevention; alternative strategy
Accepted: 28 October 2022
Published: 3 November 2022

Publisher’s Note: MDPI stays neutral

with regard to jurisdictional claims in
1. Introduction
published maps and institutional affil- Scientific research on the effects of mechanical vibrations has clearly highlighted the
iations. danger that this stimulus can pose to the state of health, emphasizing how the risk from
vibrations is generated when using specific tools, working instruments and machinery
that induce continuous stresses in the body of the worker using them, compromising
apparatuses, joints, or even internal organs [1,2]. Furthermore, the study of vibrations’
Copyright: © 2022 by the authors. effect on the human body has led, in recent years, to a greater understanding of degenerative
Licensee MDPI, Basel, Switzerland.
phenomena leading to a broad spectrum of occupational diseases. However, there are
This article is an open access article
still poorly documented aspects of both foot-transmitted vibration (FTV) and hand–arm
distributed under the terms and
vibration (HAV) [3,4].
conditions of the Creative Commons
A further condition is the whole-body vibration (WBV) to which many workers are
Attribution (CC BY) license (https://
exposed while driving trucks and agricultural machinery, or through the use of tools
creativecommons.org/licenses/by/
that produce high-amplitude vibrations that are transferred to the entire body, damaging
4.0/).

J. Funct. Morphol. Kinesiol. 2022, 7, 99. https://doi.org/10.3390/jfmk7040099 https://www.mdpi.com/journal/jfmk

J. Funct. Morphol. Kinesiol. 2022, 7, 99 2 of 19

various organs and apparatuses [5,6]. In this context, prolonged exposure to vibration in
the construction work environment has been reported to be significantly associated with
musculoskeletal disorders, predominantly in the neck, shoulder, and arm [7,8]. Notably,
such disorders induced by WBV exposure are manifested by musculoskeletal pain, the
chronicity of which, due to the persistence of the stimulus, leads to reduced hours of work
activity, impaired emotional well-being and, in general, a worsening of the individual’s
quality of life [9,10].
Although a negative impact of vibrations has also been documented in the peripheral
nervous system, the digestive system, the female reproductive system, and the vestibular
system [11–14], an increasing part of the literature reports scientific evidence in favor of
the use of WBV as a form of alternative training in patients unable to exercise [15]. In this
context, the beneficial effects of WBV appear to be numerous, including the prevention
of chronic and degenerative diseases. Vibratory stimulation has also been suggested
as an effective tool to prevent and/or counteract age-related cognitive decline and to
mitigate the physiological changes that characterize aging [16]. Importantly, the utility of
WBV does not appear to be limited to the prevention of disease and aging, but is also often
applied for rehabilitation purposes in athletes with various conditions, including to improve
balance in individuals with ankle instability [17], to increase muscle strength in individuals
with anterior cruciate ligament reconstruction [18], and to reduce patellofemoral pain by
optimizing sports performance [19].
Although WBV represents a powerful stimulus for the entire organism, the underlying
biological mechanisms have not yet been fully elucidated, due in part to the extreme
variability of its effects, which are strongly dependent upon the parameters that characterize
mechanical vibration, such as the frequency and amplitude of the vibration as well as
the duration of vibration exposure [20]. Nevertheless, a complete understanding of the
physiological adaptations to WBV and the consequent application of protocols customized
to individual needs should be the primary goal of research in this field, providing a valid
strategy to counteract the progression of various degenerative diseases, as well as age-
related physiological decline in individuals unable to exercise. Furthermore, depending on
the needs of individual athletes, specific WBV protocols, sometimes administered at the
same time as exercise, could prove extremely useful in the rehabilitation of musculoskeletal
disorders as well as for improving sports performance.
Therefore, the aim of our review was to (i) summarize the scientific information and
experimental data on physiological adaptations to WBV with a focus on the effects on
cognitive function, musculoskeletal health, and pain perception, and (ii) gather evidence on
the clinical efficacy of WBV in order to consider its use as an alternative strategy to exercise.

2. Literature Search Strategy

A non-systematic search strategy was adopted for the writing of this narrative review,
selecting 100 scientific articles concerning the effects of vibratory training on the entire or-
ganism, with a focus on nervous and musculoskeletal tissues. The bibliographic databases
MEDLINE and Google Scholar were used to select peer-reviewed articles of interest pub-
lished between 1945 (start date) and 2022. The search strategy was based on the use of the
following combinations of medical subject headings (MeHS) and keywords: (whole body
vibration) AND (benefits); (whole body vibration) AND (nervous system); (whole body
vibration) AND (cognitive function); (whole body vibration) AND (neurodegeneration);
(whole body vibration) AND (brain); (whole body vibration) AND (musculoskeletal sys-
tem); (whole body vibration) AND (bone); (whole body vibration) AND (muscle); (whole
body vibration) AND (osteoporosis); (whole body vibration) AND (osteoarthritis); (whole
body vibration) AND (sarcopenia); (whole body vibration) AND (pain); (whole body vi-
bration) AND (low back pain); (whole body vibration) AND (fibromyalgia); (whole body
vibration) OR (prevention); (whole body vibration) AND (exercise); (whole body vibration)
OR (alternative strategy). For each combination listed, the keyword “whole body vibration”
was replaced with the terms “vibratory training”, “mechanical vibration” and “WBV”.
J. Funct. Morphol. Kinesiol. 2022, 7, 99 3 of 19

The results included in vitro and in vivo experimental studies, systematic reviews and
meta-analyses, narrative reviews, randomized controlled trials and clinical trials to provide
a comprehensive overview.
All search results were analyzed by two researchers who defined their relevance to
the topic. Any disagreements during the article selection process were resolved through
discussion with a third researcher. Finally, a further check of the reference lists was
conducted by two other authors who confirmed the validity of the search performed and
clarified any doubts. The search process was performed on a worldwide basis, without
excluding specific geographical areas or different ethnic groups. Language and species
filters were applied to the list of results to eliminate non-English language articles.

3. Physiological Adaptations to WBV

Most of the knowledge regarding the molecular mechanisms underlying physiological
adaptations to WBV is provided by studies conducted on rodents, which have shown that
the positive effects of vibratory training depend on specific parameters, such as vibration
frequency, and vibration exposure time. In particular, most studies agree that the main
J. Funct. Morphol. Kinesiol. 2022, 7, xbenefits are associated with low-intensity WBV protocols, with variable
FOR PEER REVIEW 4 of 20 effects mainly
affecting nervous and musculoskeletal tissue [21–23] (Figure 1).

Figure 1. A schematic representation of the WBV effects on the nervous and musculoskeletal sys-
Figure 1. A schematic representation of the WBV effects on the nervous and musculoskeletal systems.
tems. WBV improves brain health by increasing neuronal activity, cognitive function, and synaptic
WBV
plasticity. At the brain
improves health
nervous systemby increasing
level, WBV alsoneuronal
promotes activity, cognitive
proprioceptive function,
function, reducingand
the synaptic plasticity.
intensity and perception of pain. At the level of the musculoskeletal system, WBV increases muscle
mass and strength, as well as motor performance, while reducing muscle atrophy. In addition, vi-
bratory training increases bone mineral density and promotes fracture healing and joint stability.
Taken together, these effects make WBV a valuable preventive strategy for neurodegenerative dis-
eases, musculoskeletal disorders such as sarcopenia and osteoporosis, and pain-associated diseases.
J. Funct. Morphol. Kinesiol. 2022, 7, 99 4 of 19

At the nervous system level, WBV also promotes proprioceptive function, reducing the intensity
and perception of pain. At the level of the musculoskeletal system, WBV increases muscle mass
and strength, as well as motor performance, while reducing muscle atrophy. In addition, vibratory
training increases bone mineral density and promotes fracture healing and joint stability. Taken
together, these effects make WBV a valuable preventive strategy for neurodegenerative diseases,
musculoskeletal disorders such as sarcopenia and osteoporosis, and pain-associated diseases.

3.1. WBV Improves Cognitive Function and Counteracts Neurodegeneration

The transmission of vibrations and oscillations to the body is known to stimulate skin
receptors, muscle spindles and the vestibular system, inducing numerous changes in brain
activity, such as those in the somatosensory cortex, thalamus, hippocampus, and amygdala,
and altering the concentrations of important neurotransmitters, such as dopamine and
serotonin, which act as messengers for nervous cells [24–26]. The positive effects of WBV on
brain function were mainly observed through studies in animal models, which showed that
5-week WBV training increased the activity of the cholinergic system in the somatosensory
cortex and amygdala of C57Bl/6J mice [27], and preliminary studies found a WBV-induced
enhancement of immediate and early c-fos gene expression, indicative of increased neuronal
activity [28]. In agreement with this, a significant improvement in neurological and motor
abilities was found in female rats exposed to a low-frequency WBV protocol for 30 days,
in association with a reduction in post-stroke inflammation and frailty that prevented
post-ischemic cognitive decline. [29]. More recently, Peng and colleagues studied the
effects of 8 weeks of vibration training on neuronal loss, synaptic protein expression and
neurotrophic factor levels in a rat model with chronic restraint stress-induced depression
(CRS). Interestingly, a significant improvement in cognitive function was observed, in
addition to neuroprotection and reduction of neuronal damage and death, suggesting
WBV as a powerful therapeutic strategy for major depressive disorder [30]. Similarly,
Cariati et al. investigated changes in synaptic plasticity by means of electrophysiological
recordings of the hippocampus in 4-month-old and 24-month-old young mice exposed
to different WBV protocols, identifying the protocol characterized by a lower vibration
frequency and longer recovery time as the only one capable of positively modulating
hippocampal synaptic plasticity and influencing the higher cognitive processes of learning
and memory. In contrast, the other vibration training protocols, which differed in vibration
frequency, vibration exposure time and recovery time, were found to be too stressful,
inducing the appearance of an epileptic tendency and possibly damaging the hippocampus
and other brain structures related to memory functions [31]. These results were later
confirmed by the same authors through histological and morphometric analyses, showing
that reduced synaptic function was associated with the presence of structural alterations,
including a reduction in the number of Purkinje cells in the cerebellum, as well as reduced
or even absent pyramidal neurons in the hippocampus, indicating WBV-induced sensory
stimulation as an essential part of the mechanism underlying the improved cognitive
performance in mice [32].
Brain adaptations to WBV could also involve multiple brain regions in humans, given
the close communication between the sensory systems of vibration perception and the areas
that oversee cognitive functions [33]. In this regard, Regterschot et al. investigated the acute
effects of passive WBV on executive functions in 133 healthy young adults subjected to six
training sessions (frequency 30 Hz, amplitude approximately 0.5 mm) alternating with six rest
sessions of two minutes each. The use of the Color–Word Interference Test (CWIT) and Stroop
Difference Score (SDS) showed a significant improvement in executive functions, specifically
attention and inhibition, in the trained group compared to the control group, suggesting
passive WBV as a therapeutic strategy for the elderly and other populations with reduced
attention and inhibition, including persons with attention deficit hyperactivity disorder [34].
J. Funct. Morphol. Kinesiol. 2022, 7, 99 5 of 19

Importantly, increased neuronal activity would appear to be directly associated with the
acute increase in glucose metabolism, as reduced basal glucose levels have been suggested as
indicative of brain pathology, as well as being considered an early biomarker for Alzheimer’s
disease [35,36]. However, no significant data are available on possible changes in glucose
metabolism in the brain after WBV stimulation. In this context, Boerema et al. investigated
the impact of a 5-week WBV intervention on brain activity by assessing glucose metabolism
in the murine brain and testing executive functioning and memory in elderly subjects without
cognitive deficits. Positron emission tomography (PET) scans performed in the mice revealed
that glucose uptake was not altered by WBV exposure, although WBV improved cognition
and motor performance and reduced arousal-induced home cage activity. Interestingly,
cognitive tests in humans showed a selective improvement in the Stroop Color–Word
test, known to be positively correlated with cholinergic activity, disconfirming WBV as
a safe intervention to improve brain functioning, albeit with variable effects depending
on the protocol used [37]. In agreement with this, Alashram and colleagues highlighted
in a systematic review that included twenty randomized controlled trials and pseudo-
randomized controlled trials how short-term WBV training represents a valid strategy to
reduce lower limb spasticity and improve mobility and balance in patients with neurological
disorders, although the optimal parameters of an appropriate WBV protocol remain unclear
and current evidence is limited by heterogeneity and a scarcity of research [38].

3.2. WBV Promotes Musculoskeletal Health

The effects of WBV on the musculoskeletal system have been extensively documented
in both animal and human models, suggesting, among the main benefits, an increase in
muscle mass and strength and bone mineral density, as well as improved motor perfor-
mance and general health [39,40]. Not surprisingly, vibratory training is currently used
as a valid strategy to prevent various diseases, including sarcopenia, osteoporosis, and
arthrosis, as well as to improve musculoskeletal function and joint stability [41,42]. In this
context, Matsumoto and Goto investigated the effects of low-intensity WBV in 13-week-old
mice undergoing tibial perforation, finding an improvement in bone healing induced by
an increase in vascular growth [43]. In agreement with this, Keijser and colleagues ob-
served that exposure to a 5-week WBV protocol (30 Hz, 5 or 30 min per day for 5 weeks)
in CD1 mice improved motor performance and object recognition in a dose-dependent
manner, confirming the duration of the training session as another key parameter to con-
sider when designing appropriate protocols [44]. Similarly, Cariati et al. observed how a
WBV protocol characterized by low frequency, short vibration exposure time and longer
recovery period between two consecutive sessions improved musculoskeletal health in a
middle-aged mouse model. In contrast, light and electron microscopy analyses showed
altered sarcomeric structures, abundant inter-fiber fibrosis and a higher percentage of
atrophic fibers when animals were exposed to a more stressful WBV protocol [45]. These
results were recently confirmed by the same authors in a study on 4-month-old young
mice, showing that animals exposed to the less-stressful WBV protocol had the largest
mean muscle fiber diameter and the least amount of inter-fiber connective tissue compared
to the other experimental groups. Interestingly, histological and morphometric analysis
also showed an improvement in the qualitative characteristics of bone tissue, such as
higher bone volume and trabecular thickness and less trabecular separation compared to
sedentary animals [32]. Indeed, increased bone mass and improved structural parameters
in healthy young rodents are well documented. Specifically, a WBV protocol of 5 days per
week for 3 weeks increased femoral cortical thickness, cross-sectional area and femoral
trabecular bone cell activity in 7-week-old male mice [46]. In addition, a WBV protocol of
15 min/day increased the rate of bone formation in the endocortical surface of the tibial
metaphysis and reduced osteoclastic activity in the tibial trabecular bone in 8-week-old
female mice [47]; additionally, an increase in tibial trabecular bone fraction was found in
1-week-old mice with osteogenesis imperfecta [48]. Finally, an increase in bone mass and
improvement in structural parameters after WBV exposure were also found in young ro-
J. Funct. Morphol. Kinesiol. 2022, 7, 99 6 of 19

dents with spinal cord injury, unloading or oophorectomy, confirming it as a valid strategy
in the management of bone disorders [49–51].
WBV has been shown to produce osteogenic effects, counteracting age-related changes
in bone mass. However, contradictory results have been provided regarding the effects
of WBV on bone mass in postmenopausal and elderly women. Ruan et al. found a
4.3% increase in the BMD of the lumbar spine and a 3.2% improvement in BMD of the
femoral neck in postmenopausal women with osteoporosis exposed to 6 months of WBV
(duration 10 min, 5 times per week, frequency of 30 Hz and amplitude of 5 mm) [52].
In agreement with this, ElDeeb and colleagues recently showed how exposure to WBV
twice a week for 24 weeks improved leg muscle work and lumbar and femoral BMD in
43 postmenopausal women with low BMD [53]. In contrast, Slatkovska et al. found no
increase in calcaneal BMD in postmenopausal women exposed to vibration training for
12 months (frequency of 90 or 30 Hz, with a peak acceleration of 0.3 g) and treated with
calcium and vitamin D supplements [54]. Similarly, Rubin et al. found no changes in the
bone mineral content (BMC) of the spine, hip, and distal radius in postmenopausal women
after WBV (frequency of 30 Hz and size of 0.2 g) [55]. More recently, Marín-Cascales and col-
leagues conducted a systematic review and meta-analysis evaluating previously published
randomized controlled trials investigating the effects of WBV on total, femoral neck, and
lumbar spine BMD in postmenopausal women, in order to identify potential moderating
factors explaining the adaptations to this type of exercise. Interestingly, vibratory training
has been observed to improve the BMD of the lumbar spine in postmenopausal women,
especially in those under the age of 65, confirming it as a potential non-pharmacological
intervention to improve bone mass in postmenopausal and elderly women, particularly on
the lumbar spine, which has been shown to be the most sensitive area [56].
Finally, the improved performance of the balance bundle, object recognition and
increased activity of the cholinergic system in the somatosensory cortex and amygdala
of experimental mouse models has directed the use of WBV in the management of pa-
tients with neurodegenerative diseases such as Parkinson’s disease (PD), especially in the
treatment of motor symptoms such as bradykinesia, tremor, muscle rigidity and postural
instability. Indeed, the association between PD and significant sensorimotor deficits sug-
gested WBV as a potential strategy to improve sensorimotor function [57]. In this context, Li
et al. recently demonstrated how vibratory training represented a passive and safe clinical
intervention for patients with moderate PD, especially in cases of motor impairment or
poor balance function, with effects comparable to those of conventional therapy [58].

3.3. WBV Favours Pain Relief

WBV, known to reduce pain intensity and improve function and quality of life, is
currently used to treat patients with low back pain, which is a major cause of disability
and remains a major public health concern in many developed countries [59,60]. Several
sources have explained the WBV effects on lower back pain treatment, reporting positive
correlations between core muscle inactivity, pain intensity and function in patients with
lower back pain. In this regard, vibratory training has been suggested to activate muscle
fibres and strengthen core stability muscles, improving back function in lower back pain
patients [61,62]. Interestingly, the improvement in muscle activity and strength has been
attributed to the enhancement of neural factors, such as recruitment and synchronization,
as well as inter- and intramuscular coordination and proprioceptor responses [63]. In this
regard, Rittweger et al., in a 6-month follow-up randomized controlled trial, suggested
that both lumbar extension and WBV could alleviate pain and improve the associated
limitation in everyday life [64], as well as direct evidence of significant effects in patients
with chronic lower back pain after a 12-week WBV therapy compared to no treatment was
provided [65]. WBV has also been proposed to increase muscle spindle activity and cause a
stretch-reflex response of the trunk muscles, thus activating and strengthening the muscles
in patients with lower back pain [66]. In fact, a tonic vibration reflex (TVR) has previously
been shown to be provoked by direct mechanical vibrations applied to the muscle belly,
J. Funct. Morphol. Kinesiol. 2022, 7, 99 7 of 19

just as vibration-induced neuromuscular activation leading to TVR would appear to be

primarily determined by muscle spindle reflexes [67]. Finally, proprioception deficits in
the lumbosacral region often cause dysfunction and spinal instability in lower back pain
patients, suggesting WBV as an alternative method to improve proprioceptive function by
activating the proprioceptors of lower back pain patients [68,69]. Due to the presence of
pain, many pathologies prevent affected individuals from performing exercises on their
own, thus hindering rehabilitation. Fortunately, the use of external mechanical vibratory
stimuli, which reduces the deficit in voluntary muscle activation by the neuromuscular
stretch reflex, has proven to be an effective method for people with severe disabilities [70].
Furthermore, an alteration and attenuation of pain perception has been reported as a
consequence of mechanical vibration in large-diameter fiber systems [71]. As reported
by Gate in the pain control theory, the interpretation of pain occurs in the higher centers
that receive afferent neural signals from the dorsal horn of the spinal cord. Therefore, the
synchronous activation of more Aα/Aβ fibers stimulating the dorsal horn of the spinal
cord could be responsible for the reduction of pain caused by vibrations [72]. In this
context, Sonza et al. recently observed a significant reduction in sensitivity to Aβ fibers
mediated by mechanical allodynia and C fibers already mediated by thermal stimulation
after the third WBV session in a mouse model of chronic pain. Notably, a strong influence of
vibratory training was found on tactile pressure mechanoreceptors, confirming its efficacy
in rehabilitation programs based on sensitivity and pain reduction [73].
In summary, the main evidence reported on the effects of WBV on the brain and
musculoskeletal system is presented in Table 1.
J. Funct. Morphol. Kinesiol. 2022, 7, 99 8 of 19

Table 1. A schematic representation of the main scientific evidence on the WBV effects.

References Experimental Groups Objectives WBV Parameters WBV Effects

15 female Sprague-Dawley rats • Significant reduction in inflammatory

(9–12 months) exposed to transient middle Testing the efficacy of WBV in counteracting • Frequency: 40 Hz markers and
cerebral artery occlusion: post-ischemic stroke fragility and brain • Acceleration: 0.3× g infarct volume
[29] • Duration: 15-min series, twice a day for 5 • Significant increase in
• CTRL group: n = 8 damage in reproductively senescent female
• WBV group: n = 7 rats days/week for 30 days BDNF expression
• Improvement in functional activity

• Attenuation of depressive behavior, with

reduced immobility and improved mood
18 male rats (3 months): • Frequency: 30 Hz • Improvement of spatial memory deficits
Examining the WBV effects on neuronal loss,
• CTRL group: n = 5 synaptic protein and neurotrophin • Amplitude: 4.5 mm and reduction of hippocampal neuronal
[30] • CTRL group with CRS: n = 6 • Duration: 30 min a day, 6 days a week for neurodegeneration
expression in a rat model of chronic restraint
• WBV group with CRS: n = 7 stress-induced depression 8 weeks • Preservation of brain morphology
• Maintenance of BDNF and IGF-1 protein
levels

• Frequency: 90 Hz (A protocol) and 45 Hz

32 male BALB/c mice (B and C protocol)
20 mice of 4 months: • Amplitude: 1.1 mm at 90 Hz and
• In the group of young mice, only the C
1.5 mm at 45 Hz
• CTRL group: n = 4 protocol promoted a preservation of
• Acceleration: 2× g at 90 Hz and 2.8× g at
• CTRL WBV group: n = 4 normal synaptic activity
45 Hz
• WBV groups: n = 12 Assessing the WBV ability to modulate • In the old mice group, the C protocol
[31] • Duration: 5 series of 3 min with
12 mice of 24 months: hippocampal synaptic plasticity induced a significant increase in synaptic
1 min recovery between series,
plasticity and the disappearance of the
• CTRL group: n = 4 3 times a week for 12 weeks (A and B
epileptic tendency found in the CTRL
• CTRL WBV group: n = 4 protocols); 3 series of 2 min 30 s with 2
groups
• WBV group: n = 4 min 30 s recovery between series, 3 times
a week for 12 weeks
(C protocol)
J. Funct. Morphol. Kinesiol. 2022, 7, 99 9 of 19

Table 1. Cont.

References Experimental Groups Objectives WBV Parameters WBV Effects

• Preservation of cerebellar and

hippocampal architecture, increased
mean diameter of muscle fibres, less
• Frequency: 45 Hz interfibral connective tissue, and
• Amplitude: 1.5 mm improved bone morphometric
20 male BALB/c mice: • Acceleration: 2.8× g parameters after WBV exposure,
• CTRL group: n = 5 • Duration: 5 series of 3 min with especially for the C-trained group
Investigate WBV-induced brain and 1 min recovery between series, 3 times a • Significant increase in BDNF and FNDC5
[32] • CTRL WBV group: n = 5 musculoskeletal adaptations week for 12 weeks expression in the cerebellum and
• WBV groups: n = 10
(B protocols); 3 series of 2 min 30 s with 2 hippocampus of the
min 30 s recovery between series, 3 times C-trained group
a week for 12 weeks (C protocol) • Increased expression of FNDC5 in muscle
and bone of trained mice, in association
with reduced myostatin expression in
muscle and increased COL-1 in bone

• Frequency: 30 Hz
• Short-term positive effect on executive
Studying the acute effects of passive WBV • Amplitude: 0.5 mm
[34] 133 healthy young adults (20.5 ± 2.2.) functions of attention and inhibition,
vibration on executive functions • Duration: 6 sessions of 2 min alternated
with a high level of cognitive functioning
with 6 recovery sessions

For the animal model:

• Frequency: 30 Hz
• Amplitude: 0.05 mm • Significant increase in performance in the
20 C57Bl/6J mice (15 weeks): • Acceleration: 0.098× g equilibrium beam crossing test and
• CTRL group: n = 10 • Duration: 10 min per day, 5 days per reduction of excitation-induced activity
• WBV group: n = 10 Assessing the WBV impact on brain activity, week, for a period of 5 weeks in animals exposed to WBV
[37] 34 adults over 40: arousal-induced activity, and executive For humans: • Improvement of executive functions of
functioning attention and inhibition assessed by
• CTRL group: n = 16 • Frequency: 30 Hz
• WBV group: n = 18 • Amplitude: 0.5–1 mm Stroop Color-Word test in men exposed
• Acceleration: 0.9–1.8× g to WBV
• Duration: 4 min per day, 4 days per week,
for a period of 5 weeks
J. Funct. Morphol. Kinesiol. 2022, 7, 99 10 of 19

Table 1. Cont.

References Experimental Groups Objectives WBV Parameters WBV Effects

48 male C57BL/6 mice (13 weeks) with
cortical perforation on the tibial bone: Investigating the WBV effects on • Frequency: 30 Hz • Modulation of vascularization and
[43] • CTRL group: n = 24 vascularization during the early stages of • Acceleration: 0.1× g acceleration of regeneration in terms of
• WBV group: n = 24 fracture healing • Duration: 20 min daily for 12 days volume and bone mineral density

44 male CD1 mice (3 months): • Frequency: 30 Hz

• Significant improvement in balance beam
• CTRL groups: n = 22 Assessing the WBV effects on attention and • Acceleration: 1.9× g
[44] performance and object recognition only
• WBV groups: n = 22 motor performance • Duration: 5 or 30 min a day, 5 days a
after exposure to a 5-min WBV protocol
week for 5 weeks

• Frequency: 90 Hz (A protocol) and 45 Hz

(B and C protocol)
• Amplitude: 1.1 mm at 90 Hz and
1.5 mm at 45 Hz • Improved muscle structure, with
20 male BALB/c mice (12 months): • Acceleration: 2× g at 90 Hz and 2.8× g at well-preserved mitochondria, correct
• CTRL group: n = 4 Studying muscle adaptations to WBV in a 45 Hz sarcomeric organization and increased
[45] • CTRL WBV group: n = 4 • Duration: 5 series of 3 min with fibre diameter only in groups trained
middle-aged mouse model
• WBV groups: n = 12 1 min recovery between series, with
3 times a week for 12 weeks (A and B B and C protocols
protocols); 3 series of 2 min 30 s with 2
min 30 s recovery between series, 3 times
a week for 12 weeks (C protocol)

• Increased thickness of the femoral

58 male mice (7 weeks): • Frequency: 90 Hz
Identifying a WBV protocol that promotes cortical area, together with reduced
• CTRL groups: n = 34 • Acceleration: 0.5–2× g
[46] bone growth in healthy expression of sclerostin and DMP1 in
• WBV groups: n = 24 • Duration: 15 min a day for 5 days a week
young mice cortical osteocytes, only after WBV
for 3 to 9 weeks
exposure for 3 weeks

• Frequency: 45 Hz • Reduction of osteoclastic activity in the

38 female BALB/cBxJ mice (8 weeks): • Acceleration: 0.3× g trabecular metaphysis and tibial
Investigating the influence of WBV on • Duration: 15 min a day for 5 days a week epiphysis, by 33% and 31% respectively,
• CTRL groups: n = 18 trabecular and cortical formation and
[47] • WBV group: n = 10 for 3 weeks. In the WBV-R group, each after WBV exposure
resorption processes in the training session was interspersed with a • No significant changes at the cellular
• WBV-R group: n = 10 growing skeleton 10-s level were observed in the
recovery period WBV-R group
J. Funct. Morphol. Kinesiol. 2022, 7, 99 11 of 19

Table 1. Cont.

References Experimental Groups Objectives WBV Parameters WBV Effects

• 24 homozygous wild type • Improvement of bone mechanical

• Frequency: 45 Hz
(B6C3Fe-a/a-+/+) female mice Studying the WBV effects on cortical and properties and morphology of trabecular
• Acceleration: ±0.3× g
[48] • 24 homozygous oim trabecular bone formation in young mice and cortical bone in hind limbs in the
• Duration: 15 min a day for 5 days a week
(B6C3Fe-a/a-oim/oim) with osteogenesis imperfecta osteogenesis
for 3 to 9 weeks
female mice imperfecta group

94 postmenopausal women with • Frequency: 30 Hz

osteoporosis: Investigating the WBV effects on • Increased lumbar and femoral neck BMD
• Amplitude: 5 mm
[52] • CTRL group: n = 44 (63.73 ± 5.45) menopause-induced BMD decline and and significantly reduced back pain
• Duration: 10 min a day, 5 days a week for
• WBV group: n = 51 (61.23 ± 8.20) chronic back pain intensity
6 months

43 postmenopausal women: • Frequency: 20–35 Hz • Significant improvement in leg muscle

• CTRL group: n = 21 (57.29 ± 4.44) Studying the WBV impact on muscle work • Amplitude: 2.5–5 mm contraction
[53] • Duration: 5 to 10 min, twice a week for • Significant increase in BMD of the
• WBV group: n = 22 (55.08 ± 4.19) and BMD of the lumbar vertebrae and femur
24 weeks lumbar vertebrae and femur

202 postmenopausal women: • Frequency: 30 or 90 Hz

• CTRL group: n = 67 (60.8 ± 5.5) • No significant improvement on calcaneal
Examining the WBV effects on calcaneal • Acceleration: 0.3× g
[54] • WBV groups: n = 135 QUS measurements after exposure to
QUS measurements • Duration: 20 consecutive min per day for
(59.6 ± 6.0–60.5 ± 7.0) WBV
12 months

64 postmenopausal women: • Frequency: 30 Hz

• Placebo group: n = 32 Investigating the ability of WBV to inhibit • Acceleration: 0.2× g • Reduced bone loss and increased BMD of
[55] (47–64 years) • Duration: 2 sessions of 10 min a day, 7 the femoral neck and lumbar spine
bone loss
• WBV group: n = 32 (52–64 years) days a week for 1 year

• Frequency: 6 Hz
29 patients with moderate PD: • Amplitude: 3 mm
Studying the short-term effect of WBV on • Significant improvement in
[58] • CTRL group: n = 16 (60.06 ± 3.38) motor proprioceptive functions in patients • Duration: 2 treatment sessions consisting
• WBV group: n = 13 (61.15 ± 3.72) motor function
with moderate PD of 5 series of 1 min with
1 min of recovery
J. Funct. Morphol. Kinesiol. 2022, 7, 99 12 of 19

Table 1. Cont.

References Experimental Groups Objectives WBV Parameters WBV Effects

• Frequency: 18 Hz
50 patients with chronic low back pain: • Amplitude: 6 mm • Significant reduction in pain sensation
• LEX group: n = 25 (49.8 ± 6.6) Comparing the WBV effects on chronic back • Duration: 4–7 min, 2 series per week and related disability in both trained
[64]
• WBV group: n = 25 (54.1 ± 3.4) pain versus LEX during the first 6 weeks and 1 series per groups
week for the next 6 weeks

• Frequency: 20 Hz
49 patients with non-specific low • Duration: twice a week for 12 weeks,
back pain: Testing the effectiveness of WBV in with a recovery day between sessions. • Reduction in functional disability and
[65] • CTRL group: n = 24 (59.53 ± 5.47) counteracting chronic non-specific low back The WBV exposure time was 60 s for the back pain, with significant improvement
• WBV group: n = 25 (58.71 ± 4.59) pain first 2 weeks and increased by a further in quality of life
60 s every
2 weeks

60 male Wistar rats (3 months)

• CTRL group: n = 12 • Frequency: 42 Hz
• CTRL group with pain: n = 12 • Amplitude: 2 mm • Reduced mechanical and thermal
• Low-intensity training group: Studying the WBV effects in a chronic pain • Acceleration: 7.1× g sensitivity and hyperalgesia after WBV
[73]
n = 12 model • Duration: 5 min on the first 5 days and 10 exposure
• WBV group: n = 12 min on the remaining 5 days
• Combined training group: n = 12

WBV: whole body vibration; CTRL: control; BDNF: brain-derived neurotrophic factor; CRS: chronic restraint stress; IGF-1: insulin-like growth factor 1; FNDC5: fibronectin type III
domain-containing protein 5; COL-1: collagen I; DMP1: dentin matrix acidic phosphoprotein 1; BMD: bone mineral density; QUS: quantitative ultrasound; PD: Parkinson’s disease;
LEX: lumbar extension exercise.
J. Funct. Morphol. Kinesiol. 2022, 7, 99 13 of 19

4. Molecular Mediators Involved in WBV Effects

Although the effects of WBV are widely known, the underlying biological mechanisms
have yet to be elucidated, as has the identification of a protocol tailored to the individual’s
characteristics for a specific personalized intervention [74,75]. However, in recent years,
several studies have been conducted in this field, and some key molecules have been
proposed to be responsible for the effects of WBV on the whole organism.
In particular, improved cognitive function has been suggested to depend upon in-
creased production of neurotrophins, known mediators of neuronal development, survival,
and function [76]. In this context, brain-derived neurotrophic factor (BDNF) appears to be
the most susceptible to exercise-induced regulation and may be among the main contribu-
tors to the cascade of molecular and cellular events that support brain plasticity. Indeed,
BDNF is considered the main neurotrophin linked to neuronal plasticity, playing a key
role in neuronal differentiation and survival [77]. Numerous studies have shown a close
correlation between increased BDNF levels and aerobic exercise, while it is unclear how
mechanical vibrations may influence the expression of this neurotrophin. In this regard,
Simão et al. proposed that the combination of vibratory training with squat exercises
improves lower limb muscle performance in elderly women with knee osteoarthritis, prob-
ably through an increase in plasma BDNF levels, suggesting a role in the modulation of
neuromuscular plasticity [78]. Similarly, Ribeiro and colleagues demonstrated that expo-
sure to WBV for 6 weeks promotes an increase in plasma BDNF levels in association with
an improvement in lower limb muscle strength, aerobic capacity, clinical symptoms and
quality of life in patients with fibromyalgia syndrome [79]. Interestingly, under pathological
conditions in rodent models of cerebral ischemia or stroke, WBV has been observed to
stimulate the expression of several mediators involved in neurogenesis, including BDNF,
insulin-like growth factor (IGF-1) and doublecortin (DCX) [80]. In this regard, Oberste
et al. conducted a double-blind randomized controlled trial to study the effects of a 6-week
WBV protocol in adolescent patients hospitalized for major depressive disorder. Notably,
antidepressant effects of vibratory training were found in association with increased serum
levels of BDNF, IGF-1 and inflammatory markers [81].
Irisin, a polypeptide generated by the cleavage of fibronectin type III domain-containing
protein 5 (FNDC5), is also undoubtedly involved in physiological adaptations to exercise,
as its expression is known to increase abundantly during exercise in musculoskeletal tissue
and nerve tissue. Importantly, BDNF-mediated effects in brain tissue could be enhanced
by FNDC5, as its exercise-induced up-regulation is known to result in the up-regulation of
BDNF [82]. Furthermore, the increased production of irisin through exercise could influence
the bone–muscle crosstalk, promoting an increase in the proliferative and mineralizing
capacity of osteoblasts [83], as well as promoting muscle growth through a signaling pathway
that reduces the expression of myostatin, the main negative regulator of muscle growth [84].
In this regard, Yang and colleagues observed an up-regulation of osteogenic markers, such
as osterix, RUNX2 and osteopontin, in MC3T3-E1 murine osteoblasts in response to irisin,
suggesting its involvement in bone formation and mineralization processes [85]. Similarly,
Shan and colleagues showed that knockout of the myostatin gene produces an increase in
the muscle mass and browning of adipose tissue, effects known to be attributed to irisin [86].
In agreement with this, Cariati et al. recently studied the potential effects of WBV on the
expression of FNDC5 and tissue-specific markers such as BDNF in brain, myostatin in
muscle, and collagen I (COL-1) in the bone of 4-month-old young mice [32]. Interestingly,
increased expression of FNDC5, improved tissue structural organization and increased BDNF
expression were detected after exposure to a WBV protocol with shorter vibration exposure
times and longer recovery times. Furthermore, increased FNDC5 expression was found in the
muscles and bones of trained mice, as well as reduced myostatin expression and increased
COL-1, confirming WBV as a valid strategy to preserve musculoskeletal health [32].
J. Funct. Morphol. Kinesiol. 2022, 7, 99 14 of 19

5. WBV vs. Exercise: Do We Have a Chance?

The effectiveness of adding WBV to conventional training generally remains an open
question. On the one hand, several sources have reported the combination of WBV and
physical therapy as a valid strategy to significantly increase muscle strength and power,
flexibility and BMD, as well as to reduce abdominal fat [87–90]. Specifically, a significant in-
crease in isometric and dynamic knee extensor strength and countermovement jump height
was observed in healthy women undergoing 12 weeks of WBV and resistance training [91].
Similarly, Osawa and colleagues observed significant improvements in knee extensor
strength and countermovement jump height in young and older adults undergoing WBV
combined with routine exercises [92]. Furthermore, Berschin et al. investigated whether
WBV could be considered a practical alternative to a standard exercise programme in
40 patients undergoing anterior cruciate ligament (ACL) reconstruction. Notably, expo-
sure to WBV resulted in better neuromuscular performance, in terms of strength and
co-ordination, as well as improved postural control in a short period of time, making it a
good alternative to a standard exercise programme in ACL rehabilitation [93]. In contrast,
Cochrane et al. found no improvement in countermovement jump height, sprint speed
and agility performance in non-elite athletes subjected to 9 sessions of WBV training [94].
Similarly, Rogan et al. concluded that adding WBV to physical therapy did not improve
muscle strength in healthy elderly people [95], and Anwer and colleagues found no benefi-
cial effects of WBV on quadriceps muscle strength in patients with knee osteoarthritis [96].
More recently, Rasti and colleagues conducted a randomized clinical trial to compare the ef-
fects of physical training with and without WBV on flexibility, vertical jump height, agility,
and pain in 24 athletes with patellofemoral pain (PFP), a well-known musculoskeletal
condition prevalent among active young adults [97]. Interestingly, physical therapy with
and without WBV was observed to significantly reduce pain and increase agility, vertical
jump height and flexibility in athletes with PFP. However, WBV implementation to routine
physical therapy increased the latter’s effects on flexibility, confirming vibratory training as
a valuable additional strategy to increase the effectiveness of conventional physical therapy
and optimize athletic performance [97]. In agreement with this, Gloeckl et al. demonstrated
that balance training performed on a WBV platform induced greater benefits in terms of
balance performance and muscle power than conventional training in patients with severe
chronic obstructive pulmonary disease (COPD) and functional impairment [98]. Finally,
Guadarrama-Molina and colleagues found a significant improvement in functional balance
status in 45 PD patients after exposure to conventional therapy and WBV, suggesting their
combination as a viable therapeutic alternative to improve quality of life in PD patients
compared to conventional therapy alone [99].

6. Conclusions
WBV is undoubtedly an expanding area of research with clear potential for medical
applications. However, this field could benefit from more standardized and customized
protocols. In this regard, the identification of a WBV protocol suitable for a specific age
group could pave the way for intervention studies targeting subjects forced to a sedentary
lifestyle. Indeed, the future goal of research in this field should be to tailor appropriate
training protocols to the individual’s characteristics, as each subject possesses unique and
nuanced characteristics at the molecular, physiological, environmental exposure and be-
havioral levels, thus requiring specific interventions. The use of translational research can
facilitate this by considering vibration amplitude, vibration frequency, method of applica-
tion, session duration/frequency and total duration of intervention as key parameters of
WBV. In this regard, studies performed with significantly different protocols in terms of
frequency, amplitude, acceleration, and duration were compared in our manuscript, posing
difficulties in comparing the evidence analyzed. Notably, such information was not always
found to be complete, and this represents a major limitation for both the studies exam-
ined and our narrative review. Importantly, van Heuvelen et al. have recently published
guidelines for the correct and complete drafting of in vitro and in vivo studies, in animal
J. Funct. Morphol. Kinesiol. 2022, 7, 99 15 of 19

and human models, relating to vibratory training, indicating all the variables that must
necessarily be specified in scientific papers [100].
Nevertheless, the study of physiological adaptations induced by specific WBV pro-
tocols is crucial for the development of preventive and/or therapeutic strategies. In this
context, WBV training represents a real potential application for improving dose–response
effects and counteracting multi-organ decay related to age and/or degenerative diseases,
foreseeing an improvement in quality of life and a potential reduction in public health
costs. Therefore, substantial investigations into the underlying molecular mechanisms are
needed in order to identify the role of potential key mediators involved in physiological
adaptations to WBV that could be used as markers of efficacy of the protocol used.

Author Contributions: Conceptualization, R.B. and I.C.; investigation, R.B., I.C. and C.R.; data
curation, R.B., I.C. and C.R.; writing—original draft preparation, R.B. and I.C.; writing—review and
editing, G.D., G.A. and V.T.; supervision, V.T. All authors have read and agreed to the published
version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: No new data were created or analyzed in this study. Data sharing is
not applicable to this article.
Acknowledgments: The authors acknowledge the Centre of Space Bio-medicine, “Tor Vergata”
University of Rome for their support.
Conflicts of Interest: The authors declare no conflict of interest.

References
1. Fethke, N.B.; Schall, M.C.; Merlino, L.A.; Chen, H.; Branch, C.A.; Ramaswamy, M. Whole-Body Vibration and Trunk Posture
During Operation of Agricultural Machinery. Ann. Work Expo. Health 2018, 62, 1123–1133. [CrossRef] [PubMed]
2. Chadefaux, D.; Moorhead, A.P.; Marzaroli, P.; Marelli, S.; Marchetti, E.; Tarabini, M. Vibration transmissibility and apparent mass
changes from vertical whole-body vibration exposure during stationary and propelled walking. Appl. Ergon. 2021, 90, 103283.
[CrossRef] [PubMed]
3. Krajnak, K. Health effects associated with occupational exposure to hand-arm or whole body vibration. J. Toxicol. Environ. Health
B Crit. Rev. 2018, 21, 320–334. [CrossRef]
4. Eger, T.; Thompson, A.; Leduc, M.; Krajnak, K.; Goggins, K.; Godwin, A.; House, R. Vibration induced white-feet: Overview and
field study of vibration exposure and reported symptoms in workers. Work 2014, 47, 101–110. [CrossRef]
5. Bovenzi, M. A prospective cohort study of neck and shoulder pain in professional drivers. Ergonomics 2015, 58, 1103–1116.
[CrossRef] [PubMed]
6. Griffin, M.J. Predicting and controlling risks from human exposures to vibration and mechanical shock: Flag waving and flag
weaving. Ergonomics 2015, 58, 1063–1070. [CrossRef]
7. Charles, L.E.; Ma, C.C.; Burchfiel, C.M.; Dong, R.G. Vibration and Ergonomic Exposures Associated with Musculoskeletal
Disorders of the Shoulder and Neck. Saf. Health Work 2018, 9, 125–132. [CrossRef] [PubMed]
8. Hagberg, M.; Burström, L.; Ekman, A.; Vilhelmsson, R. The association between whole body vibration exposure and muscu-
loskeletal disorders in the Swedish work force is confounded by lifting and posture. J. Sound Vib. 2006, 298, 492–498. [CrossRef]
9. Patterson, F.; Miralami, R.; Tansey, K.E.; Prabhu, R.K.; Priddy, L.B. Deleterious effects of whole-body vibration on the spine: A
review of in vivo, ex vivo, and in vitro models. Anim. Model. Exp. Med. 2021, 4, 77–86. [CrossRef]
10. Bonanni, R.; Cariati, I.; Tancredi, V.; Iundusi, R.; Gasbarra, E.; Tarantino, U. Chronic Pain in Musculoskeletal Diseases: Do You
Know Your Enemy? J. Clin. Med. 2022, 11, 2609. [CrossRef]
11. Jalilian, H.; Zamanian, Z.; Gorjizadeh, O.; Riaei, S.; Monazzam, M.R.; Abdoli-Eramaki, M. Autonomic Nervous System Responses to
Whole-Body Vibration and Mental Workload: A Pilot Study. Int. J. Occup. Environ. Med. 2019, 10, 174–184. [CrossRef] [PubMed]
12. Miyazaki, Y. Adverse effects of whole-body vibration on gastric motility. Kurume Med. J. 2000, 47, 79–86. [CrossRef] [PubMed]
13. Zarei, S.; Dehghan, S.F.; Vaziri, M.H.; Gilani, M.A.S.; Ardakani, S.K. Assessment of semen quality of taxi drivers exposed to whole
body vibration. J. Occup. Med. Toxicol. 2022, 17, 16. [CrossRef]
14. Yilmaz, N.; Ila, K. Effect of vibration on the vestibular system in noisy and noise-free environments in heavy industry. Acta
Otolaryngol. 2019, 139, 1014–1018. [CrossRef] [PubMed]
15. Musumeci, G. The use of vibration as physical exercise and therapy. J. Funct. Morphol. Kinesiol. 2017, 2, 17. [CrossRef]
J. Funct. Morphol. Kinesiol. 2022, 7, 99 16 of 19

16. Odano, I.; Maeyatsu, F.; Asari, M.; Yamaguchi, S.; Miura, T.; Taki, Y. Whole-body vibration exercise and training increase regional
CBF in mild cognitive impairment with enhanced cognitive function. Ann. Nucl. Med. 2022, 36, 82–94. [CrossRef]
17. Sierra-Guzmán, R.; Jiménez-Diaz, F.; Ramírez, C.; Esteban, P.; Abián-Vicén, J. Whole-Body-Vibration Training and Balance in
Recreational Athletes with Chronic Ankle Instability. J. Athl. Train. 2018, 53, 355–363. [CrossRef]
18. Costantino, C.; Bertuletti, S.; Romiti, D. Efficacy of Whole-Body Vibration Board Training on Strength in Athletes After Anterior
Cruciate Ligament Reconstruction: A Randomized Controlled Study. Clin. J. Sport Med. Off. J. Can. Acad. Sport Med. 2018, 28,
339–349. [CrossRef]
19. Shadloo, N.; Kamali, F.; Salehi Dehno, N. A comparison between whole-body vibration and conventional training on pain and
performance in athletes with patellofemoral pain. J. Bodyw. Mov. Ther. 2021, 27, 661–666. [CrossRef]
20. Costantino, C.; Gimigliano, R.; Olvirri, S.; Gimigliano, F. Whole body vibration in sport: A critical review. J. Sports Med. Phys.
Fitness 2014, 54, 757–764.
21. Roberts, R.E.; Bilgen, O.; Kineman, R.D.; Koh, T.J. Parameter-Dependency of Low-Intensity Vibration for Wound Healing in
Diabetic Mice. Front. Bioeng. Biotechnol. 2021, 9, 654920. [CrossRef] [PubMed]
22. Corbiere, T.F.; Weinheimer-Haus, E.M.; Judex, S.; Koh, T.J. Low-Intensity Vibration Improves Muscle Healing in a Mouse Model
of Laceration Injury. J. Funct. Morphol. Kinesiol. 2018, 3, 1. [CrossRef] [PubMed]
23. Oroszi, T.; Geerts, E.; de Boer, S.F.; Schoemaker, R.G.; van der Zee, E.A.; Nyakas, C. Whole Body Vibration Improves Spatial
Memory, Anxiety-Like Behavior, and Motor Performance in Aged Male and Female Rats. Front. Aging Neurosci. 2021, 13, 801828.
[CrossRef] [PubMed]
24. Wei, Q.-S.; Huang, L.; Chen, X.-H.; Wang, H.-B.; Sun, W.-S.; Huo, S.-C.; Li, Z.-Q.; Deng, W.-M. Effect of whole body vibration therapy
on circulating serotonin levels in an ovariectomized rat model of osteoporosis. Iran. J. Basic Med. Sci. 2014, 17, 62–68. [PubMed]
25. Nakamura, H.; Moroji, T.; Nohara, S.; Nakamura, H.; Okada, A. Activation of cerebral dopaminergic systems by noise and
whole-body vibration. Environ. Res. 1992, 57, 10–18. [CrossRef]
26. Vizzi, L.; Padua, E.; D’Amico, A.G.; Tancredi, V.; D’Arcangelo, G.; Cariati, I.; Scimeca, M.; Maugeri, G.; D’Agata, V.; Montorsi, M.
Beneficial Effects of Physical Activity on Subjects with Neurodegenerative Disease. J. Funct. Morphol. Kinesiol. 2020, 5, 94. [CrossRef]
27. Heesterbeek, M.; Jentsch, M.; Roemers, P.; Keijser, J.N.; Toth, K.; Nyakas, C.; Schoemaker, R.G.; van Heuvelen, M.J.G.; Van der
Zee, E.A. Whole body vibration enhances choline acetyltransferase-immunoreactivity in cortex and amygdale. J. Neurol. Transl.
Neurosci. 2017, 5, 1079.
28. Van der Zee, E.A.; Riedel, G.; Rutgers, E.H.; De Vries, C.; Postema, F.; Venema, B.J. Enhanced neuronal activity in selective brain
regions of mice induced by whole body stimulation. Fed. Eur. Neurosci. Soc. Abstr. 2010, 5, R2.
29. Raval, A.P.; Schatz, M.; Bhattacharya, P.; d’Adesky, N.; Rundek, T.; Dietrich, W.D.; Bramlett, H.M. Whole Body Vibration Therapy
after Ischemia Reduces Brain Damage in Reproductively Senescent Female Rats. Int. J. Mol. Sci. 2018, 19, 2749. [CrossRef]
30. Peng, G.; Yang, L.; Wu, C.Y.; Zhang, L.L.; Wu, C.Y.; Li, F.; Shi, H.W.; Hou, J.; Zhang, L.M.; Ma, X.; et al. Whole body vibration
training improves depression-like behaviors in a rat chronic restraint stress model. Neurochem. Int. 2021, 142, 104926. [CrossRef]
31. Cariati, I.; Bonanni, R.; Pallone, G.; Annino, G.; Tancredi, V.; D’Arcangelo, G. Modulation of Synaptic Plasticity by Vibratory
Training in Young and Old Mice. Brain Sci. 2021, 11, 82. [CrossRef] [PubMed]
32. Cariati, I.; Bonanni, R.; Pallone, G.; Romagnoli, C.; Rinaldi, A.M.; Annino, G.; D’Arcangelo, G.; Tancredi, V. Whole Body Vibration
Improves Brain and Musculoskeletal Health by Modulating the Expression of Tissue-Specific Markers: FNDC5 as a Key Regulator
of Vibration Adaptations. Int. J. Mol. Sci. 2022, 23, 388. [CrossRef] [PubMed]
33. Diociaiuti, M.; Bonanni, R.; Cariati, I.; Frank, C.; D’Arcangelo, G. Amyloid Prefibrillar Oligomers: The Surprising Commonalities
in Their Structure and Activity. Int. J. Mol. Sci. 2021, 22, 6435. [CrossRef] [PubMed]
34. Regterschot, G.R.H.; Van Heuvelen, M.J.G.; Zeinstra, E.B.; Fuermaier, A.B.M.; Tucha, L.; Koerts, J.; Tucha, O.; Van Der Zee, E.A.
Whole body vibration improves cognition in healthy young adults. PLoS ONE 2014, 9, e100506. [CrossRef]
35. Butterfield, D.A.; Halliwell, B. Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease. Nat. Rev. Neurosci.
2019, 20, 148–160. [CrossRef]
36. Cariati, I.; Masuelli, L.; Bei, R.; Tancredi, V.; Frank, C.; D’Arcangelo, G. Neurodegeneration in Niemann-Pick Type C Disease: An
Updated Review on Pharmacological and Non-Pharmacological Approaches to Counteract Brain and Cognitive Impairment. Int.
J. Mol. Sci. 2021, 22, 6600. [CrossRef]
37. Boerema, A.S.; Heesterbeek, M.; Boersma, S.A.; Schoemaker, R.; de Vries, E.F.J.; van Heuvelen, M.J.G.; Van der Zee, E.A. Beneficial
Effects of Whole Body Vibration on Brain Functions in Mice and Humans. Dose-Response 2018, 16, 1559325818811756. [CrossRef]
38. Alashram, A.R.; Padua, E.; Annino, G. Effects of Whole-Body Vibration on Motor Impairments in Patients with Neurological
Disorders: A Systematic Review. Am. J. Phys. Med. Rehabil. 2019, 98, 1084–1098. [CrossRef]
39. Annino, G.; Iellamo, F.; Palazzo, F.; Fusco, A.; Lombardo, M.; Campoli, F.; Padua, E. Acute changes in neuromuscular activity in
vertical jump and flexibility after exposure to whole body vibration. Medicine 2017, 96, e7629. [CrossRef]
40. Zhang, J.; Wang, R.; Zheng, Y.; Xu, J.; Wu, Y.; Wang, X. Effect of Whole-Body Vibration Training on Muscle Activation for
Individuals with Knee Osteoarthritis. BioMed Res. Int. 2021, 2021, 6671390. [CrossRef]
41. Annino, G.; Alashram, A.R.; Alghwiri, A.A.; Romagnoli, C.; Messina, G.; Tancredi, V.; Padua, E.; Mercuri, N.B. Effect of segmental
muscle vibration on upper extremity functional ability poststroke: A randomized controlled trial. Medicine 2019, 98, e14444.
[CrossRef] [PubMed]
J. Funct. Morphol. Kinesiol. 2022, 7, 99 17 of 19

42. Cao, S.; Wang, Z.; Li, C.; Wang, Q. The effect of whole-body vibration exercise on postmenopausal women with osteoporosis: A
protocol for systematic review and meta-analysis. Medicine 2021, 100, e25606. [CrossRef] [PubMed]
43. Matsumoto, T.; Goto, D. Effect of low-intensity whole-body vibration on bone defect repair and associated vascularization in
mice. Med. Biol. Eng. Comput. 2017, 55, 2257–2266. [CrossRef] [PubMed]
44. Keijser, J.N.; van Heuvelen, M.J.G.; Nyakas, C.; Tóth, K.; Schoemaker, R.G.; Zeinstra, E.; van der Zee, E.A. Whole body vibration
improves attention and motor performance in mice depending on the duration of the whole-body vibration session. Afr. J. Tradit.
Complement. Altern. Med. AJTCAM 2017, 14, 128–134. [CrossRef] [PubMed]
45. Cariati, I.; Bonanni, R.; Annino, G.; Scimeca, M.; Bonanno, E.; D’Arcangelo, G.; Tancredi, V. Dose-Response Effect of Vibratory
Stimulus on Synaptic and Muscle Plasticity in a Middle-Aged Murine Model. Front. Physiol. 2021, 12, 678449. [CrossRef]
46. Gnyubkin, V.; Guignandon, A.; Laroche, N.; Vanden-Bossche, A.; Malaval, L.; Vico, L. High-acceleration whole body vibration
stimulates cortical bone accrual and increases bone mineral content in growing mice. J. Biomech. 2016, 49, 1899–1908. [CrossRef]
47. Xie, L.; Jacobson, J.M.; Choi, E.S.; Busa, B.; Donahue, L.R.; Miller, L.M.; Rubin, C.T.; Judex, S. Low-level mechanical vibrations can
influence bone resorption and bone formation in the growing skeleton. Bone 2006, 39, 1059–1066. [CrossRef]
48. Vanleene, M.; Shefelbine, S.J. Therapeutic impact of low amplitude high frequency whole body vibrations on the osteogenesis
imperfecta mouse bone. Bone 2013, 53, 507–514. [CrossRef]
49. Minematsu, A.; Nishii, Y.; Imagita, H.; Takeshita, D.; Sakata, S. Whole-body vibration can attenuate the deterioration of bone
mass and trabecular bone microstructure in rats with spinal cord injury. Spinal Cord 2016, 54, 597–603. [CrossRef]
50. Li, Z.; Tan, C.; Wu, Y.; Ding, Y.; Wang, H.; Chen, W.; Zhu, Y.; Ma, H.; Yang, H.; Liang, W.; et al. Whole-body vibration and
resistance exercise prevent long-term hindlimb unloading-induced bone loss: Independent and interactive effects. Eur. J. Appl.
Physiol. 2012, 112, 3743–3753. [CrossRef]
51. Chen, G.-X.; Zheng, S.; Qin, S.; Zhong, Z.-M.; Wu, X.-H.; Huang, Z.-P.; Li, W.; Ding, R.-T.; Yu, H.; Chen, J.-T. Effect of
low-magnitude whole-body vibration combined with alendronate in ovariectomized rats: A random controlled osteoporosis
prevention study. PLoS ONE 2014, 9, e96181. [CrossRef]
52. Ruan, X.-Y.; Jin, F.-Y.; Liu, Y.-L.; Peng, Z.-L.; Sun, Y.-G. Effects of vibration therapy on bone mineral density in postmenopausal
women with osteoporosis. Chin. Med. J. 2008, 121, 1155–1158. [CrossRef] [PubMed]
53. ElDeeb, A.M.; Abdel-Aziem, A.A. Effect of Whole-Body Vibration Exercise on Power Profile and Bone Mineral Density in Postmenopausal
Women with Osteoporosis: A Randomized Controlled Trial. J. Manip. Physiol. Ther. 2020, 43, 384–393. [CrossRef] [PubMed]
54. Slatkovska, L.; Beyene, J.; Alibhai, S.M.H.; Wong, Q.; Sohail, Q.Z.; Cheung, A.M. Effect of whole-body vibration on calcaneal
quantitative ultrasound measurements in postmenopausal women: A randomized controlled trial. Calcif. Tissue Int. 2014, 95,
547–556. [CrossRef] [PubMed]
55. Rubin, C.; Recker, R.; Cullen, D.; Ryaby, J.; McCabe, J.; McLeod, K. Prevention of postmenopausal bone loss by a low-magnitude,
high-frequency mechanical stimuli: A clinical trial assessing compliance, efficacy, and safety. J. Bone Miner. Res. Off. J. Am. Soc.
Bone Miner. Res. 2004, 19, 343–351. [CrossRef] [PubMed]
56. Marín-Cascales, E.; Alcaraz, P.E.; Ramos-Campo, D.J.; Martinez-Rodriguez, A.; Chung, L.H.; Rubio-Arias, J.Á. Whole-body vibration
training and bone health in postmenopausal women: A systematic review and meta-analysis. Medicine 2018, 97, e11918. [CrossRef]
57. Marazzi, S.; Kiper, P.; Palmer, K.; Agostini, M.; Turolla, A. Effects of vibratory stimulation on balance and gait in Parkinson’s
disease: A systematic review and meta-analysis. Eur. J. Phys. Rehabil. Med. 2021, 57, 254–264. [CrossRef]
58. Li, K.-Y.; Cho, Y.-J.; Chen, R.-S. The Effect of Whole-Body Vibration on Proprioception and Motor Function for Individuals with
Moderate Parkinson Disease: A Single-Blind Randomized Controlled Trial. Occup. Ther. Int. 2021, 2021, 9441366. [CrossRef]
59. Maher, C.; Underwood, M.; Buchbinder, R. Non-specific low back pain. Lancet 2017, 389, 736–747. [CrossRef]
60. Linek, P.; Noormohammadpour, P.; Mansournia, M.A.; Wolny, T.; Sikora, D. Morphological changes of the lateral abdominal muscles
in adolescent soccer players with low back pain: A prospective cohort study. J. Sport Health Sci. 2020, 9, 614–619. [CrossRef]
61. Ye, J.; Ng, G.; Yuen, K. Acute effects of whole-body vibration on trunk muscle functioning in young healthy adults. J. strength
Cond. Res. 2014, 28, 2872–2879. [CrossRef] [PubMed]
62. Yue, Y.-S.; Wang, X.-D.; Xie, B.; Li, Z.-H.; Chen, B.-L.; Wang, X.-Q.; Zhu, Y. Sling exercise for chronic low back pain: A systematic
review and meta-analysis. PLoS ONE 2014, 9, e99307. [CrossRef] [PubMed]
63. Boucher, J.-A.; Abboud, J.; Dubois, J.-D.; Legault, E.; Descarreaux, M.; Henchoz, Y. Trunk neuromuscular responses to a single
whole-body vibration session in patients with chronic low back pain: A cross-sectional study. J. Manip. Physiol. Ther. 2013, 36,
564–571. [CrossRef]
64. Rittweger, J.; Just, K.; Kautzsch, K.; Reeg, P.; Felsenberg, D. Treatment of chronic lower back pain with lumbar extension and
whole-body vibration exercise: A randomized controlled trial. Spine (Phila Pa 1976). 2002, 27, 1829–1834. [CrossRef]
65. del Pozo-Cruz, B.; Hernández Mocholí, M.A.; Adsuar, J.C.; Parraca, J.A.; Muro, I.; Gusi, N. Effects of whole body vibration
therapy on main outcome measures for chronic non-specific low back pain: A single-blind randomized controlled trial. J. Rehabil.
Med. 2011, 43, 689–694. [CrossRef] [PubMed]
66. Cardinale, M.; Bosco, C. The use of vibration as an exercise intervention. Exerc. Sport Sci. Rev. 2003, 31, 3–7. [CrossRef]
67. Burke, D.; Gandevia, S.C. The human muscle spindle and its fusimotor control. In Neural Control Of Movement; Springer: Boston,
MA, USA, 1995; pp. 19–25.
J. Funct. Morphol. Kinesiol. 2022, 7, 99 18 of 19

68. Belavý, D.L.; Armbrecht, G.; Gast, U.; Richardson, C.A.; Hides, J.A.; Felsenberg, D. Countermeasures against lumbar spine
deconditioning in prolonged bed rest: Resistive exercise with and without whole body vibration. J. Appl. Physiol. 2010, 109,
1801–1811. [CrossRef]
69. Stewart, V.H.; Saunders, D.H.; Greig, C.A. Responsiveness of muscle size and strength to physical training in very elderly people:
A systematic review. Scand. J. Med. Sci. Sports 2014, 24, e1–e10. [CrossRef]
70. Sonza, A. Human cutaneous mechanoreceptive afferents response after Whole Body Vibration: A literature review. Rev. Hosp.
Univ. Pedro Ernesto 2018, 17, 35–38.
71. Prager, J.P. What does the mechanism of spinal cord stimulation tell us about complex regional pain syndrome? Pain Med. 2010,
11, 1278–1283. [CrossRef]
72. Melzack, R.; Wall, P.D. Pain mechanisms: A new theory. Science 1965, 150, 971–979. [CrossRef]
73. Sonza, A.; Sanada, L.S.; de Oliveira, L.R.; Bernardo-Filho, M.; Sá-Caputo, D.D.C.D.; Zaro, M.A.; Achaval, M. Whole-body
vibration mediates mechanical hypersensitivity through Aβ-fiber and C-fiber thermal sensation in a chronic pain model. Exp.
Biol. Med. 2021, 246, 1210–1218. [CrossRef] [PubMed]
74. Pallone, G.; Palmieri, M.; Cariati, I.; Bei, R.; Masuelli, L.; D’Arcangelo, G.; Tancredi, V. Different continuous training modalities
result in distinctive effects on muscle structure, plasticity and function. Biomed. Rep. 2020, 12, 267–275. [CrossRef] [PubMed]
75. Palmieri, M.; Cariati, I.; Scimeca, M.; Pallone, G.; Bonanno, E.; Tancredi, V.; D’Arcangelo, G.; Frank, C. Effects of short-term
aerobic exercise in a mouse model of Niemann-Pick type C disease on synaptic and muscle plasticity. Ann. Dell’istituto Super.
Sanità 2019, 55, 330–337. [CrossRef]
76. Bonanni, R.; Cariati, I.; Tarantino, U.; D’Arcangelo, G.; Tancredi, V. Physical Exercise and Health: A Focus on Its Protective Role in
Neurodegenerative Diseases. J. Funct. Morphol. Kinesiol. 2022, 7, 38. [CrossRef]
77. von Bohlen Und Halbach, O.; von Bohlen Und Halbach, V. BDNF effects on dendritic spine morphology and hippocampal
function. Cell Tissue Res. 2018, 373, 729–741. [CrossRef]
78. Simão, A.P.; Mendonça, V.A.; Avelar, N.C.P.; da Fonseca, S.F.; Santos, J.M.; de Oliveira, A.C.C.; Tossige-Gomes, R.; Ribeiro, V.G.C.;
Neves, C.D.C.; Balthazar, C.H.; et al. Whole Body Vibration Training on Muscle Strength and Brain-Derived Neurotrophic Factor
Levels in Elderly Woman with Knee Osteoarthritis: A Randomized Clinical Trial Study. Front. Physiol. 2019, 10, 756. [CrossRef]
79. Ribeiro, V.G.C.; Lacerda, A.C.R.; Santos, J.M.; Coelho-Oliveira, A.C.; Fonseca, S.F.; Prates, A.C.N.; Flor, J.; Garcia, B.C.C.; Tossige-
Gomes, R.; Leite, H.R.; et al. Efficacy of Whole-Body Vibration Training on Brain-Derived Neurotrophic Factor, Clinical and
Functional Outcomes, and Quality of Life in Women with Fibromyalgia Syndrome: A Randomized Controlled Trial. J. Healthc.
Eng. 2021, 2021, 7593802. [CrossRef]
80. Huang, D.; Yang, Z.; Wang, Z.; Wang, P.; Qu, Y. The macroscopic and microscopic effect of low-frequency whole-body vibration
after cerebral ischemia in rats. Metab. Brain Dis. 2018, 33, 15–25. [CrossRef]
81. Oberste, M.; Großheinrich, N.; Wunram, H.-L.; Graf, J.L.; Ziemendorff, A.; Meinhardt, A.; Fricke, O.; Mahabir, E.; Bender, S.
Effects of a 6-week, whole-body vibration strength-training on depression symptoms, endocrinological and neurobiological
parameters in adolescent inpatients experiencing a major depressive episode (the “Balancing Vibrations Study”): Study protocol
for a randomized placebo-controlled trial. Trials 2018, 19, 347. [CrossRef]
82. Zsuga, J.; Tajti, G.; Papp, C.; Juhasz, B.; Gesztelyi, R. FNDC5/irisin, a molecular target for boosting reward-related learning and
motivation. Med. Hypotheses 2016, 90, 23–28. [CrossRef]
83. Cariati, I.; Bonanni, R.; Scimeca, M.; Rinaldi, A.M.; Marini, M.; Tarantino, U.; Tancredi, V. Exposure to Random Positioning
Machine Alters the Mineralization Process and PTX3 Expression in the SAOS-2 Cell Line. Life 2022, 12, 610. [CrossRef] [PubMed]
84. LeBrasseur, N.K.; Schelhorn, T.M.; Bernardo, B.L.; Cosgrove, P.G.; Loria, P.M.; Brown, T.A. Myostatin inhibition enhances the
effects of exercise on performance and metabolic outcomes in aged mice. J. Gerontol. A Biol. Sci. Med. Sci. 2009, 64, 940–948.
[CrossRef] [PubMed]
85. Yang, J.; Yu, K.; Liu, D.; Yang, J.; Tan, L.; Zhang, D. Irisin enhances osteogenic differentiation of mouse MC3T3-E1 cells via
upregulating osteogenic genes. Exp. Ther. Med. 2021, 21, 580. [CrossRef]
86. Shan, T.; Liang, X.; Bi, P.; Kuang, S. Myostatin knockout drives browning of white adipose tissue through activating the
AMPK-PGC1α-Fndc5 pathway in muscle. FASEB J. Off. Publ. Fed. Am. Soc. Exp. Biol. 2013, 27, 1981–1989. [CrossRef] [PubMed]
87. Fagnani, F.; Giombini, A.; Di Cesare, A.; Pigozzi, F.; Di Salvo, V. The effects of a whole-body vibration program on muscle
performance and flexibility in female athletes. Am. J. Phys. Med. Rehabil. 2006, 85, 956–962. [CrossRef]
88. Machado, A.; García-López, D.; González-Gallego, J.; Garatachea, N. Whole-body vibration training increases muscle strength
and mass in older women: A randomized-controlled trial. Scand. J. Med. Sci. Sports 2010, 20, 200–207. [CrossRef]
89. Verschueren, S.M.P.; 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. Off. J. Am. Soc. Bone Miner. Res. 2004, 19, 352–359. [CrossRef]
90. Vissers, D.; Verrijken, A.; Mertens, I.; Van Gils, C.; Van de Sompel, A.; Truijen, S.; Van Gaal, L. Effect of long-term whole body
vibration training on visceral adipose tissue: A preliminary report. Obes. Facts 2010, 3, 93–100. [CrossRef]
91. Delecluse, C.; Roelants, M.; Verschueren, S. Strength increase after whole-body vibration compared with resistance training. Med.
Sci. Sports Exerc. 2003, 35, 1033–1041. [CrossRef]
92. Osawa, Y.; Oguma, Y.; Ishii, N. The effects of whole-body vibration on muscle strength and power: A meta-analysis. J.
Musculoskelet. Neuronal Interact. 2013, 13, 380–390.
J. Funct. Morphol. Kinesiol. 2022, 7, 99 19 of 19

93. Berschin, G.; Sommer, B.; Behrens, A.; Sommer, H.-M. Whole Body Vibration Exercise Protocol versus a Standard Exercise
Protocol after ACL Reconstruction: A Clinical Randomized Controlled Trial with Short Term Follow-Up. J. Sports Sci. Med. 2014,
13, 580–589. [PubMed]
94. Cochrane, D.J.; Legg, S.J.; Hooker, M.J. The short-term effect of whole-body vibration training on vertical jump, sprint, and agility
performance. J. Strength Cond. Res. 2004, 18, 828–832. [CrossRef] [PubMed]
95. Rogan, S.; de Bruin, E.D.; Radlinger, L.; Joehr, C.; Wyss, C.; Stuck, N.-J.; Bruelhart, Y.; de Bie, R.A.; Hilfiker, R. Effects of whole-body
vibration on proxies of muscle strength in old adults: A systematic review and meta-analysis on the role of physical capacity
level. Eur. Rev. Aging Phys. Act. 2015, 12, 12. [CrossRef] [PubMed]
96. Anwer, S.; Alghadir, A.; Zafar, H.; Al-Eisa, E. Effect of whole body vibration training on quadriceps muscle strength in individuals
with knee osteoarthritis: A systematic review and meta-analysis. Physiotherapy 2016, 102, 145–151. [CrossRef]
97. Rasti, E.; Rojhani-Shirazi, Z.; Ebrahimi, N.; Sobhan, M.R. Effects of whole body vibration with exercise therapy versus exercise
therapy alone on flexibility, vertical jump height, agility and pain in athletes with patellofemoral pain: A randomized clinical trial.
BMC Musculoskelet. Disord. 2020, 21, 705. [CrossRef]
98. Gloeckl, R.; Schneeberger, T.; Leitl, D.; Reinold, T.; Nell, C.; Jarosch, I.; Kenn, K.; Koczulla, A.R. Whole-body vibration training versus
conventional balance training in patients with severe COPD-a randomized, controlled trial. Respir. Res. 2021, 22, 138. [CrossRef]
99. Guadarrama-Molina, E.; Barrón-Gámez, C.E.; Estrada-Bellmann, I.; Meléndez-Flores, J.D.; Ramírez-Castañeda, P.; Hernández-
Suárez, R.M.G.; Menchaca-Pérez, M.; Salas-Fraire, O. Comparison of the effect of whole-body vibration therapy versus conven-
tional therapy on functional balance of patients with Parkinson’s disease: Adding a mixed group. Acta Neurol. Belg. 2021, 121,
721–728. [CrossRef]
100. van Heuvelen, M.J.G.; Rittweger, J.; Judex, S.; Sañudo, B.; Seixas, A.; Fuermaier, A.B.M.; Tucha, O.; Nyakas, C.; Marín, P.J.; Taiar,
R.; et al. Reporting Guidelines for Whole-Body Vibration Studies in Humans, Animals and Cell Cultures: A Consensus Statement
from an International Group of Experts. Biology 2021, 10, 965. [CrossRef]