Cystic Fibrosis and Whole Body Vibration
Cystic Fibrosis (CF) is a genetic disorder that affects the secretory glands in the body which include mucus and sweat. CF significantly impacts the lungs, pancreas, liver, intestines, sinuses, and sex organs. Mucus is produced by the lining of certain body tissue. Normally, mucus is slippery and water-like keeping the walls of organs moist which helps to prevent infections. When an individual has CF, mucus becomes thick and sticky which may lead to a blocked airway. Mucus buildup leads to multiple infections due to the accumulation of bacteria, which may lead to permanent damage of the lungs. Many of the treatments for CF are focused on removing secretions from the lungs and preventing chest infections. In the pancreas and small intestine, mucus build-up blocks pancreatic ducts so that digestive enzymes cannot enter the small intestine. This leads to malnutrition as the body does not absorb all the needed nutrients. The undigested food also causes large bulky stool which leads to abdominal bloating and constipation. An individual with CF may also have mineral imbalances due to the excessive salt lost with sweating. These imbalances lead to several issues including dehydration. Individuals with CF are also at higher risk for developing osteoporosis and diabetes. Progression of CF and severity of the disease can vary between individuals. Lung function often begins to show a decline in childhood. Meanwhile, respiratory failure is the most common cause of death in individuals with CF. Nutritional and respiratory therapies, exercise and medications are all part of early therapeutic interventions that allow individuals with CF to live into their forties.
Exercise is an important aspect of managing CF. Aerobic exercise can help to loosen and dislodge mucus and assist with secretion clearance while improving overall physical health 1. Also, diet modifications may have to be made to account for an increase in salt loss due to excessive sweating during exercise 1. Meanwhile, habitual physical activity has also been shown to slow down the decline in lung function 2.
Secretion clearance is essential to help maintain lung function and decrease the risk of recurrent lung infections. Traditionally, manual chest physiotherapy (CPT) had been used on a daily basis to help with secretion clearance. It consists of percussion (clapping) over the chest wall, along with postural drainage to use gravity to assist with the removal of secretions. In the 1990s, a high frequency chest compression (HFCC) vest was found to be as effective at removing secretions as manual CPT techniques 3. The initial vest developed provides compressions during expiration while also causing a vibrating frequency to the chest between 5 and 25 Hz 4.
There have been two studies investigating the effects of Whole Body Vibration (WBV) on individuals with CF. In one study, adults with CF were trained for three months using WBV at a frequency between 20 to 25 Hz. Improvements in muscle function was shown; however, no changes were made to force expiratory volume in one second (FEV1) or forced vital capacity (FVC) from using WBV 5. The second study involved adults with CF being trained by WBV for six months. The findings suggest improvements in neuromuscular and intramuscular coordination which allow individuals to use less muscle force to achieve the same amount of muscle power (increased efficiency of movement)6. Lung functions remained unchanged 6. Both studies used small sample sizes and did not have a control group to compare changes and improvements to. Both studies looked at lung function through FEV1 but they did not investigate sputum production as a result of using WBV. Therefore it remains unclear if WBV would impact secretion removal. There has been no research looking into the benefits/risks of WBV on children with CF.
These preliminary studies show promising potential for the use and benefits of WBV with individuals with CF. In other populations WBV have found to improve or maintain bone density** which is a relevant concern for individuals with CF. There are several contraindications that may prevent some individuals with CF from using WBV. They include but are not limited to severe osteoporosis and an active infection. As with any chronic illness it is essential that an individual with CF discuss the addition of WBV to their exercise routine. It is important that the physician understand WBV so that they can help the individual decide if the benefits outweigh any potential risks.
Once a physician has cleared an individual to use WBV, they should begin at a lower intensity and duration. Also symptoms should be continuously monitored. WBV should be discontinued if any symptoms related to an individual’s CF become worse, and any changes should be discussed with a physician. WBV should not replace any treatments and recommendations made by an individual’s health care team. Once an individual has become comfortable with the machine, and no changes in symptoms occur, the intensity of exercises can be increased and exercises at the appropriate level may be added. In general, if an individual experiences shortness of breath, pain or dizziness when using WBV it should be discontinued immediately
References
1. www.nhlbi.nih.gov/health/dci/Diseases/cf/cf_treatments.html, retrieved May 25, 2010.
2. Wilkes DL, Schneiderman JE, Nguyen T, Heale L, Moola F, Ratjen F, Coates AL, Wells GD. 2009. Exercise and physical activity in children with cystic fibrosis, Paediatric Repiratory Reviews, 10(3), 105-9.
3. Arens R, Gozal D, Omlin KJ, Vega J, Boyd KP, Keens TG, Woo MS. 1994. Comparison of high frequency chest compression and conventional chest physiotherapy in hospitalized patients with cystic fibrosis, American Journal of Respiratory and Critical Care Medicine, 150(4), 1154-7.
4. Hansen LG, Warwick WJ. 1990. High-frequency chest compression system to aid in clearance of mucus from the lung, Biomedical Instrumentation and Technology, 24(4), 289-94.
5. Rietschel E, van Koningsbruggen S, Fricke O, Semler O, Schoenau E. 2008. Whole body vibration: a new therapeutic approach to improve muscle function in cystic fibrosis?, International Journal of Rehabilitation Research, 31(3), 253-6.
6. Roth J, Wust M, Rawer R, Schnabel D, Armbrecht G, Beller G, Rembitzki I, Wahn U, Felsenberg D, Staab D. 2008. Whole body vibration in cystic fibrosis--a pilot study, Journal of Musculoskeletal and Neuronal Interactions, 8(2), 179-87.
** For a list of studies see the T-zone Vibration Technology User’s Manual.
Various models and machines on the market have been used for the purpose of conducting research. Also, a variety of frequencies (speeds) and amplitudes (platform variation) which may or may not be known to us have been used. We do not guarantee or claim users will achieve similar results with our T-Zone Whole Body Vibration machine.
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