Neurological Sciences

, Volume 39, Issue 12, pp 2159–2168 | Cite as

Whole body vibration and treadmill training in Parkinson’s disease rehabilitation: effects on energy cost and recovery phases

  • Silvia CorbiancoEmail author
  • Gabriella Cavallini
  • Giacomo Baldereschi
  • Maria Chiara Carboncini
  • Francesca Lidia Fiamingo
  • Paolo Bongioanni
  • Marco Dini
Original Article



Although physical treatment is recognized as being beneficial for patients with Parkinson’s disease (PD), there is scant literature on the type of rehabilitation program most useful for patients with PD. The aim of the present study was to investigate the effects of two different training protocols (aerobic treadmill training, AER and whole body vibration training, WBVT) on energy cost and adaptations after exercise and recovery phases, by means of the oxygen consumption measurement and the assay of metabolic biochemical substrates.


Twenty male patients with idiopathic Parkinson’s disease, aged 51–66 years, were enrolled. Patients were randomly assigned to the training groups. The total work time was 20 min per group for 4 weeks, four times a week. In both groups, training intensity was monitored by the ratings of perceived exertion (RPE). Workload was gradually increased until patients worked up to the exertion level of 13 to 15 on the 20-point Borg scale RPE. The outcome measures were oxygen consumption, free fatty acid (FFA), and amino acid (AA) levels.


The oxygen consumption during exercises does not show significant differences between the two training groups. Instead, only in the AER group, excess post-exercise oxygen consumption measurements increased significantly (p < 0.01) as well as FFA availability (p < 0.01).


The WBVT does not appear to require a long time of recovery and leads to less feeling of fatigue, whereas AER needs an appropriate recovery time after the training session.


Parkinson’s disease Rehabilitation Vibration Excess post-exercise oxygen consumption Amino acids Free fatty acids 


Compliance with ethical standards

The study was approved by the local Ethical Committee of the Azienda Ospedaliero-Universitaria Pisana in accordance with the code of Ethics of the World Medical Association (Declaration of Helsinki). Written informed consent was obtained prior to participation in the study and after explanation of the protocol.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Italian Society of Clinical Neurophysiology; Italian Neurological Society; Guidelines for the Treatment of Parkinson’s Disease 2002 (2003) Treatment of Parkinson’s disease. Neurol Sci 24 Suppl 3:S165–S213Google Scholar
  2. 2.
    Shen X, Wong-Yu IS, Mak MK (2016) Effects of exercise on falls, balance, and gait ability in Parkinson’s disease: a meta-analysis. Neurorehabil Neural Repair 30:512–527CrossRefPubMedGoogle Scholar
  3. 3.
    Xu Q, Park Y, Huang X, Hollenbeck A, Blair A, Schatzkin A, Chen H (2010) Physical activities and future risk of Parkinson disease. Neurology 75:341–348CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Gama GL, Celestino ML, Barela JA, Forrester L, Whitall J, Barela AM (2017) Effects of gait training with body weight support on a treadmill vs overground for individuals with stroke. Arch Phys Med Rehabil 98:738–745CrossRefPubMedGoogle Scholar
  5. 5.
    Drużbicki M, Guzik A, Przysada G, Kwolek A, Brzozowska-Magoń A, Sobolewski M (2016) Changes in gait symmetry after training on a treadmill with biofeedback in chronic stroke patients: a 6-month follow-up from a randomized controlled trial. Med Sci Monit 22:4859–4868CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Khan F, Amatya B, Galea MP, Gonzenbach R, Kesselring J (2017) Neurorehabilitation: applied neuroplasticity. J Neurol 264:603–615CrossRefPubMedGoogle Scholar
  7. 7.
    Rittweger J (2010) Vibration as an exercise modality: how it may work, and what its potential might be. Eur J Appl Physiol 108:877–904CrossRefPubMedGoogle Scholar
  8. 8.
    Chanou K, Gerodimos V, Karatrantou K, Jamurtas A (2012) Whole-body vibration and rehabilitation of chronic diseases: a review of the literature. J Sports Sci Med 11:187–200PubMedPubMedCentralGoogle Scholar
  9. 9.
    Hiroshige K, Mahbub MH, Harada N (2014) Effects of whole-body vibration on postural balance and proprioception in healthy young and elderly subjects: a randomized cross-over study. J Sports Med Phys Fitness 54:216–224PubMedGoogle Scholar
  10. 10.
    Ebersbach G, Edler D, Kaufhold O, Wissel J (2008) Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson’s disease. Arch Phys Med Rehabil 89:399–403CrossRefPubMedGoogle Scholar
  11. 11.
    Lauhoff P, Murphy N, Doherty C, Horgan NF (2013) A controlled clinical trial investigating the effects of cycle ergometry training on exercise tolerance, balance and quality of life in patients with Parkinson’s disease. Disabil Rehabil 35(5):382–387CrossRefPubMedGoogle Scholar
  12. 12.
    da Silva PG, Domingues DD, de Carvalho LA, Allodi S, Correa CL (2016) Neurotrophic factors in Parkinson’s disease are regulated by exercise: evidence-based practice. J Neurol Sci 363:5–15CrossRefPubMedGoogle Scholar
  13. 13.
    Gelb DJ, Oliver E, Gilman S (1999) Diagnostic criteria for Parkinson disease. Arch Neurol 56:33–39CrossRefPubMedGoogle Scholar
  14. 14.
    Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442CrossRefPubMedGoogle Scholar
  15. 15.
    Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, van Hilten JJ, LaPelle N, for the Movement Disorder Society UPDRS Revision Task Force (2008) Movement disorder society-sponsored revision of the unified Parkinson’s disease rating scale (MDSUPDRS): scale presentation and clinimetric testing results. Mov Disord 23:2129–2170CrossRefPubMedGoogle Scholar
  16. 16.
    Borg G (1970) Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med 2:92–98PubMedGoogle Scholar
  17. 17.
    Tanaka H, Monahan KD, Seals DR (2001) Age-predicted maximal heart rate revisited. J Am Coll Cardiol 37:153–156CrossRefPubMedGoogle Scholar
  18. 18.
    Cardinale M, Lim J (2003) Electromyography activity of vastus lateralis muscle during whole body vibrations of different frequencies. J Strength Cond Res 17:621–624PubMedGoogle Scholar
  19. 19.
    Leff ML, Hill JO, Yates AA, Cotsonis GA, Heymsfield SB (1987) Resting metabolic rate: measurement reliability. JPEN J Parenter Enteral Nutr 11:354–359CrossRefPubMedGoogle Scholar
  20. 20.
    Donati A, Cavallini G, Bergamini E (2009) Methods for inducing and monitoring liver autophagy relative to aging and antiaging caloric restriction in rats. Methods Enzymol 452:441–455CrossRefPubMedGoogle Scholar
  21. 21.
    Fisher BE, Wu AD, Salem GJ, Song J, Lin CH, Yip J, Cen S, Gordon J, Jakowec M, Petzinger G (2008) The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson’s disease. Arch Phys Med Rehabil 89:1221–1229CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Turbanski S, Haas CT, Friedrich A, Duisberg P, Schmidtbleicher D (2005) Effects of random whole-body vibration on postural control in Parkinson’s disease. Res Sports Med 13:243–256CrossRefPubMedGoogle Scholar
  23. 23.
    Petzinger GM, Fisher BE, McEwen S, Beeler JA, Walsh JP, Jakowec MW (2013) Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease. Lancet Neurol 12:716–726CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Bosco C, Komi PV, Ito A (1981) Prestretch potentiation of human skeletal muscle during ballistic movement. Acta Physiol Scand 111:135–140CrossRefPubMedGoogle Scholar
  25. 25.
    Romaiguére P, Vedel JP, Azulay JP, Pagni S (1991) Differential activation of motor units in the wrist extensor muscles during the tonic vibration reflex in man. J Physiol 444:645–667CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Kaufman MP, Rybicki KJ, Waldrop TG, Mitchell JH (1984) Effect on arterial pressure of rhythmically contracting the hind-limb muscles of cats. J Appl Physiol 56:1265–1271CrossRefPubMedGoogle Scholar
  27. 27.
    Blomqvist CG, Lewis SF, Taylor WF, Graham RM (1981) Similarity of the hemodynamic responses to static and dynamic exercise of small muscle groups. Circ Res 48:I87–I92PubMedGoogle Scholar
  28. 28.
    Bahr R (1992) Excess postexercise oxygen consumption-magnitude, mechanisms and practical implications. Acta Physiol Scand Suppl 605:1–70PubMedGoogle Scholar
  29. 29.
    Børsheim E, Bahr R (2003) Effect of exercise intensity, duration and mode on post-exercise oxygen consumption. Sports Med 33:1037–1060CrossRefPubMedGoogle Scholar
  30. 30.
    Scott CB (2011) Quantifying the immediate recovery energy expenditure of resistance training. J Strength Cond Res 25:1159–1163CrossRefPubMedGoogle Scholar
  31. 31.
    Van Loon LJ, Greenhaff PL, Constantin-Teodosiu D, Saris WH, Wagenmakers AJ (2001) The effects of increasing exercise intensity on muscle fuel utilisation in humans. J Physiol 536:295–304CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Smith J, Mc Naughton L (1993) The effects of intensity of exercise on excess postexercise oxygen consumption and energy expenditure in moderately trained men and women. Eur J Appl Physiol Occup Physiol 67:420–425CrossRefPubMedGoogle Scholar
  33. 33.
    Purdom T, Kravitz L, Dokladny K, Mermier C (2018) Understanding the factors that effect maximal fat oxidation. J Int Soc Sports Nutr 15:3CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Wolfe RR, Klein S, Carraro F, Weber JM (1990) Role of triglyceride-fatty acid cycle in controlling fat metabolism in humans during and after exercise. Am J Phys 258:E382–E389Google Scholar
  35. 35.
    Cordeiro LMS, Rabelo PCR, Moraes MM, Teixeira-Coelho F, Coimbra CC, Wanner SP, Soares DD (2017) Physical exercise-induced fatigue: the role of serotonergic and dopaminergic systems. Braz J Med Biol Res 50:e6432CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Bédard C, Wallman MJ, Pourcher E, Gould PV, Parent A, Parent M (2011) Serotonin and dopamine striatal innervation in Parkinson’s disease and Huntington’s chorea. Parkinsonism Relat Disord 17:593–598CrossRefPubMedGoogle Scholar
  37. 37.
    Newsholme EA, Blomstrand E (1995) Tryptophan, 5-hydroxytryptamine and a possible explanation for central fatigue. Adv Exp Med Biol 384:315–320CrossRefPubMedGoogle Scholar
  38. 38.
    Paul J, Kuruvilla KP, Mathew J, Kumar P, Paulose CS (2011) Dopamine D1 and D2 receptor subtypes functional regulation in cerebral cortex of unilateral rotenone lesioned Parkinson’s rat model: effect of serotonin dopamine and norepinephrine. Parkinsonism Relat Disord 17:255–259CrossRefPubMedGoogle Scholar
  39. 39.
    Cai G, Huang Y, Luo S, Lin Z, Dai H, Ye Q (2017) Continuous quantitative monitoring of physical activity in Parkinson’s disease patients by using wearable devices: a case-control study. Neurol Sci 38:1657–1663CrossRefPubMedGoogle Scholar
  40. 40.
    Gökçe Çokal B, Yurtdaş M, Keskin Güler S, Güneş HN, Ataç Uçar C, Aytaç B, Durak ZE, Yoldaş TK, Durak İ, Çubukçu HC (2017) Serum glutathione peroxidase, xanthine oxidase, and superoxide dismutase activities and malondialdehyde levels in patients with Parkinson’s disease. Neurol Sci 38:425–431CrossRefPubMedGoogle Scholar
  41. 41.
    Dogan VB, Koksal A, Dirican A, Baybas S, Dirican A, Dogan GB (2015) Independent effect of fatigue on health-related quality of life in patients with idiopathic Parkinson’s disease. Neurol Sci 36:2221–2226CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Interdepartmental Research Centre on Biology and Pathology of AgingUniversity of PisaPisaItaly
  2. 2.Human Movement and Rehabilitation Research LaboratoryPisaItaly
  3. 3.Neurorehabilitation UnitAzienda Ospedaliero-Universitaria PisanaPisaItaly
  4. 4.NeuroCare OnlusPisaItaly

Personalised recommendations