Exercise as it relates to Disease/Whole body vibration exercise for patients with type 2 diabetes

Whole body vibration (WBV) is a novel exercise form utilized for rehabilitation of a range of diseases, including Rheumatoid Arthritis and Muscular Atrophy. It is well known now that exercise treatment is able to enhance glycaemic control in type 2 diabetic patients. Due to the benefits of conventional exercise shown with diabetic patients, considering the possible similar effects, recent years a few studies investigated whether WBV may also be beneficial to patients with type 2 diabetes mellitus (T2DM).

Influences of WBV on Glycaemia control
HbA1c is a key parameter that indicates the circumstance of glucose metabolism of patients with T2DM, and it is considered the optimal parameter reflecting the long–term outcome of glycaemic control.A recent experiment conducted on mice trained daily for twenty minutes for eight weeks, founded that WBV could make a reduction in HbA1c level of mice. Latest Study with T2DM patients showed there was a significant reduction in both HbA1c and fasting blood glucose through 12 weeks WBV intervention compared with the control group.

Effects of WBV on complications
Diabetic peripheral neuropathy is one of the most prevalent complications encountered by diabetic patients. A pilot study with WBV therapy on 8 participants who experienced diabetic peripheral neuropathy showed a significant relief in both acute and chronic neuropathic pain following four weeks WBV training. In addition, Diabetic patients with peripheral neuropathy tend to loss of balance because of the impaired sensation. Several studies have displayed that WBV training is beneficial to improve balance and gait in older adults.

Possible Therapeutic Mechanism of WBV
Studies have reported that the potential mechanisms of exercise training, including aerobic and resistance training, to promote glucose control are the improvement of insulin sensitivity and the enhancement of glucose carriers, such as glucose transporter protein GLUT4. GLUT4, locating at muscle cell surface, assists blood glucose uptake by skeletal muscle fibres. Given that WBV training could activate a larger proportion of motor units compared with conventional exercise modalities, similar to resistance training, it is considered that the improvement of glycaemia control following WBV training is likely attributed to the increase of glucose transporter protein GLUT4 too.

WBV Compared With Conventional Exercise
It is well known now that exercise treatment is able to enhance glycaemic control in type 2 diabetic patients. Whole body vibration exercise has shown several advantages in comparison with traditional training forms. It seems that using WBV training has time-efficiency. A study compared the effects between strength training and WBV training on blood glucose control in T2DM and found two training modes showed similar influence on reduction of peak glucose concentrations during OGTT. The duration of strength training sessions, however, were as twice as those of WBV training. Furthermore, different individuals, such as obesity patients, could utilize WBV exercise more broadly as it is a low-impact exercise modality.

Conclusions
It appears that whole body vibration training could be an effective and efficient intervention to assist type 2 diabetic patients not only in promoting their blood glucose metabolism, but also in relieving the diabetic peripheral neuropathy pain. In addition, it has been shown that WBV therapy is beneficial to the improvement of gait and balance with type 2 diabetic patients.Further studies should also be considered to validate effects and evaluate safety risks of WBV intervention on type 2 diabetics using different intensity, frequency and subsequently design optimized protocols.

Recommendations
Due to long-term exposure to WBV may increase the risk to lumbar spine, neck and shoulder, reducing exposure can reduce the risk of musculoskeletal disorders. It is important to balance the risks of detrimental side-effects on the neurovascular systems with potential benefits when designing a WBV exercise protocol. WBV exercise may need to control in 10 minute workout per day.