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Effects of 18-month low-magnitude high-frequency vibration on fall rate and fracture risks in 710 community elderly—a cluster-randomized controlled trial

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This study is a prospective cluster-randomized controlled clinical trial involving 710 elderly subjects to investigate the long-term effects of low-magnitude high-frequency vibration (LMHFV) on fall and fracture rates, muscle performance, and bone quality. The results confirmed that LMHFV is effective in reducing fall incidence and enhancing muscle performance in the elderly.


Falls are direct causes of fragility fracture in the elderly. LMHFV has been shown to improve muscle function and bone quality. This study is to investigate the efficacy of LMHFV in preventing fall and fractures among the elderly in the community.


A cluster-randomized controlled trial was conducted with 710 postmenopausal females over 60 years. A total of 364 participants received daily 20 min LMHFV (35 Hz, 0.3 g), 5 days/week for 18 months; 346 participants served as control. Fall or fracture rate was taken as the primary outcome. Also, quadriceps muscle strength, balancing abilities, bone mineral density (BMD), and quality of life (QoL) assessments were done at 0, 9, and 18 months.


With an average of 66.0 % compliance in the vibration group, 18.6 % of 334 vibration group subjects reported fall or fracture incidences compared with 28.7 % of 327 in the control (adjusted HR = 0.56, p = 0.001). The fracture rate of vibration and control groups were 1.1 and 2.3 % respectively (p = 0.171). Significant improvements were found in reaction time, movement velocity, and maximum excursion of balancing ability assessment, and also the quadriceps muscle strength (p < 0.001). No significant differences were found in the overall change of BMD. Minimal adverse effects were documented.


LMHFV is effective in fall prevention with improved muscle strength and balancing ability in the elderly. We recommend its use in the community as an effective fall prevention program and to decrease related injuries.

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  1. Kryger AI, Andersen JL (2007) Resistance training in the oldest old: consequences for muscle strength, fiber types, fiber size, and MHC isoforms. Scand J Med Sci Sports 17(4):422–430. doi:10.1111/j.1600-0838.2006.00575.x

    Article  CAS  PubMed  Google Scholar 

  2. Sze PC, Lam PS, Chan J, Leung KS (2005) A primary falls prevention programme for older people in Hong Kong. Br J Community Nurs 10(4):166–171

    PubMed  Google Scholar 

  3. Roelants M, Delecluse C, Verschueren SM (2004) Whole-body-vibration training increases knee-extension strength and speed of movement in older women. J Am Geriatr Soc 52(6):901–908. doi:10.1111/j.1532-5415.2004.52256.x

    Article  PubMed  Google Scholar 

  4. Rogan S, Hilfiker R, Herren K, Radlinger L, de Bruin ED (2011) Effects of whole-body vibration on postural control in elderly: a systematic review and meta-analysis. BMC Geriatr 11:72. doi:10.1186/1471-2318-11-72

    Article  PubMed Central  PubMed  Google Scholar 

  5. Verschueren SM, Roelants M, Delecluse C, Swinnen S, Vanderschueren D, Boonen S (2004) 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 19(3):352–359. doi:10.1359/jbmr.0301245

    Article  Google Scholar 

  6. Cheung WH, Mok HW, Qin L, Sze PC, Lee KM, Leung KS (2007) High-frequency whole-body vibration improves balancing ability in elderly women. Arch Phys Med Rehabil 88(7):852–857. doi:10.1016/j.apmr.2007.03.028

    Article  PubMed  Google Scholar 

  7. Torvinen S, Kannus P, Sievanen H, Jarvinen TA, Pasanen M, Kontulainen S, Nenonen A, Jarvinen TL, Paakkala T, Jarvinen M, Vuori I (2003) Effect of 8-month vertical whole body vibration on bone, muscle performance, and body balance: a randomized controlled study. J Bone Miner Res Off J Am Soc Bone Miner Res 18(5):876–884. doi:10.1359/jbmr.2003.18.5.876

    Article  Google Scholar 

  8. Rubin C, Recker R, Cullen D, Ryaby J, McCabe J, McLeod K (2004) 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 19(3):343–351. doi:10.1359/jbmr.0301251

    Article  Google Scholar 

  9. von Stengel S, Kemmler W, Engelke K, Kalender WA (2011) Effects of whole body vibration on bone mineral density and falls: results of the randomized controlled ELVIS study with postmenopausal women. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 22(1):317–325. doi:10.1007/s00198-010-1215-4

    Article  Google Scholar 

  10. Stewart JM, Karman C, Montgomery LD, McLeod KJ (2005) Plantar vibration improves leg fluid flow in perimenopausal women. Am J Physiol Regul Integr Comp Physiol 288(3):R623–R629. doi:10.1152/ajpregu.00513.2004

    Article  CAS  PubMed  Google Scholar 

  11. Leung KS, Shi HF, Cheung WH, Qin L, Ng WK, Tam KF, Tang N (2009) Low-magnitude high-frequency vibration accelerates callus formation, mineralization, and fracture healing in rats. J Orthop Res Off Publ Orthop Res Soc 27(4):458–465. doi:10.1002/jor.20753

    Article  Google Scholar 

  12. Shi HF, Cheung WH, Qin L, Leung AH, Leung KS (2010) Low-magnitude high-frequency vibration treatment augments fracture healing in ovariectomy-induced osteoporotic bone. Bone 46(5):1299–1305. doi:10.1016/j.bone.2009.11.028

    Article  PubMed  Google Scholar 

  13. Chow DH, Leung KS, Qin L, Leung AH, Cheung WH (2011) Low-magnitude high-frequency vibration (LMHFV) enhances bone remodeling in osteoporotic rat femoral fracture healing. J Orthop Res Off Publ Orthop Res Soc 29(5):746–752. doi:10.1002/jor.21303

    Article  Google Scholar 

  14. Wang H, Wan Y, Tam KF, Ling S, Bai Y, Deng Y, Liu Y, Zhang H, Cheung WH, Qin L, Cheng JC, Leung KS, Li Y (2011) Resistive vibration exercise retards bone loss in weight-bearing skeletons during 60 days bed rest. Osteoporos Int: J established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. doi:10.1007/s00198-011-1839-z

    Google Scholar 

  15. Slatkovska L, Alibhai SM, Beyene J, Hu H, Demaras A, Cheung AM (2011) Effect of 12 months of whole-body vibration therapy on bone density and structure in postmenopausal women: a randomized trial. Ann Intern Med 155(10):668–679, W205

    Article  PubMed  Google Scholar 

  16. Slatkovska L, Alibhai SM, Beyene J, Cheung AM (2010) Effect of whole-body vibration on BMD: a systematic review and meta-analysis. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 21(12):1969–1980. doi:10.1007/s00198-010-1228-z

    Article  CAS  Google Scholar 

  17. Hannan MT, Gagnon MM, Aneja J, Jones RN, Cupples LA, Lipsitz LA, Samelson EJ, Leveille SG, Kiel DP (2010) Optimizing the tracking of falls in studies of older participants: comparison of quarterly telephone recall with monthly falls calendars in the MOBILIZE Boston Study. Am J Epidemiol 171(9):1031–1036. doi:10.1093/aje/kwq024

    Article  PubMed Central  PubMed  Google Scholar 

  18. Mackenzie L, Byles J, D’Este C (2006) Validation of self-reported fall events in intervention studies. Clin Rehabil 20(4):331–339

    Article  PubMed  Google Scholar 

  19. Zecevic AA, Salmoni AW, Speechley M, Vandervoort AA (2006) Defining a fall and reasons for falling: comparisons among the views of seniors, health care providers, and the research literature. The Gerontologist 46(3):367–376

    Article  PubMed  Google Scholar 

  20. Fung V, Cheung NT, Ho E, Cheung C, Chan H, Tsang K, Cheung J, Ho W, Lau M, Hung V, Wong A, Tong A, Wong WN, Sek A (2007) Building a womb-to-tomb health record in Hong Kong—an application of information architecture. Studies in health technology and informatics 129(Pt 1):474–477

    PubMed  Google Scholar 

  21. Qin L, Choy W, Leung K, Leung PC, Au S, Hung W, Dambacher M, Chan K (2005) Beneficial effects of regular Tai Chi exercise on musculoskeletal system. J Bone Miner Metab 23(2):186–190

    Article  PubMed  Google Scholar 

  22. Lynn HS, Lau EM, Au B, Leung PC (2005) Bone mineral density reference norms for Hong Kong Chinese. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 16(12):1663–1668

    Article  CAS  Google Scholar 

  23. Lam CL, Gandek B, Ren XS, Chan MS (1998) Tests of scaling assumptions and construct validity of the Chinese (HK) version of the SF-36 Health Survey. J Clin Epidemiol 51(11):1139–1147

    Article  CAS  PubMed  Google Scholar 

  24. Murray D (1998) Design and analysis of group randomized trials. Oxford University Press, New York

    Google Scholar 

  25. Chan J, Lam PS, Sze PC, Leung KS (2004) A study of the epidemiology of falls in Hong Kong. Paper presented at the International Society for Fracture Repair Symposium on Preventing Falls and Fractures in Older Persons, Yokohama, Japan, Jun 29–Jul 1

  26. Ho KS, Chan WM (2003) Falls in elderly—a “clinical syndrome” and a public health issue. Public Health Epidemio Bulln 12(2):13–17

    Google Scholar 

  27. Cumming RG, Sherrington C, Lord SR, Simpson JM, Vogler C, Cameron ID, Naganathan V (2008) Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital. BMJ 336(7647):758–760

    Article  PubMed Central  PubMed  Google Scholar 

  28. Lin DY, Wei DJ (1989) The robust inference for the Cox proportional hazards model. J Am Stat Assoc 84:1074–1078

    Article  Google Scholar 

  29. Brady T. West, Kathleen B. Welch, Galecki AT (2006) Linear Mixed Models: a practical guide using statistical software. 1st edn. Chapman & Hall/CRC

  30. Donner A, Klar N (2000) Design and analysis of cluster randomization trials in health research. Arnold, London

    Google Scholar 

  31. Bogaerts A, Delecluse C, Boonen S, Claessens AL, Milisen K, Verschueren SM (2011) Changes in balance, functional performance and fall risk following whole body vibration training and vitamin D supplementation in institutionalized elderly women. A 6 month randomized controlled trial. Gait & posture 33(3):466–472

    Article  Google Scholar 

  32. Ho CSS, Woo J (1998) Circumstances and risk factors for falls in the Chinese elderly cohort: a prospective study, 1st edn. The Chinese University of Hong Kong, Hong Kong, Department of Community and Family Medicine

    Google Scholar 

  33. Kennis E, Verschueren SM, Bogaerts A, Coudyzer W, Boonen S, Delecluse C (2013) Effects of fitness and vibration training on muscle quality: a 1-year postintervention follow-up in older men. Arch Phys Med Rehabil 94(5):910–918

    Article  PubMed  Google Scholar 

  34. Zaidell LN, Mileva KN, Sumners DP, Bowtell JL (2013) Experimental evidence of the tonic vibration reflex during whole-body vibration of the loaded and unloaded leg. PLoS ONE 8(12):e85247. doi:10.1371/journal.pone.0085247

    Article  PubMed Central  PubMed  Google Scholar 

  35. Pollock RD, Woledge RC, Martin FC, Newham DJ (2012) Effects of whole body vibration on motor unit recruitment and threshold. J Appl Physiol (1985) 112(3):388–395. doi:10.1152/japplphysiol.01223.2010

    Article  Google Scholar 

  36. Alonso AC, Brech GC, Bourquin AM, Greve JM (2011) The influence of lower-limb dominance on postural balance. Sao Paulo medical journal = Revista paulista de medicina 129(6):410–413

    PubMed  Google Scholar 

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The authors would like to thank the 24 community centers for their help in the recruitment of elderly women and with monitoring the subjects in the LMHFV cohorts. This study was supported by General Research Fund (Ref: 469508) of University Grants Committee (, Hong Kong SAR government. This study was supported by the General Research Fund (Ref. No. 469508) from the University Grants Committee, Hong Kong SAR government. ( number: NCT00973167)

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Correspondence to W. H. Cheung.

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K.S. Leung and C.Y. Li are the co-first authors.

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Supplementary Table 1

Predicted difference in secondary outcomes between baseline and 18-month follow-up (linear mixed models)*. (DOC 48 kb)

Supplementary Table 2

Difference of bone mineral density change between high compliance vibration group and control group (cluster-adjusted 2 sample t test analysis). (DOC 51 kb)

Supplementary Table 3

Adverse events. (DOC 35 kb)

Supplementary Table 4

Fracture sites. (DOC 32 kb)

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Leung, K.S., Li, C.Y., Tse, Y.K. et al. Effects of 18-month low-magnitude high-frequency vibration on fall rate and fracture risks in 710 community elderly—a cluster-randomized controlled trial. Osteoporos Int 25, 1785–1795 (2014).

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