Vibrotherapy in COVID-19 rehabilitation.

There is consistent evidence of the beneficial effects of whole-body vibration (WBV) in the rehabilitation of weaker patients, such as pain and fatigue relief in fibromyalgia or improvement in muscle mass, physical fitness, and quality of life in elderly sarcopenia patients. Therefore, it was decided to analyze the potential of WBV as a safe and useful method of COVID-19 patients treatment/ rehabilitation in order to reduce the time patients spend in intensive care units and to improve the recovery process after the disease. A deep analysis of a number of publications presenting the influence of WBV on the symptoms of various ailments was performed, including: fibromyalgia, Parkinson’s disease, condition after bone marrow transplantation, rheumatoid arthritis, chronic obstructive pulmonary disease (COPD), or in elderly patients, or those undergoing intensive therapy. The focus was on the symptoms similar to those seen in COVID-19, which may closely correspond to the treatment of COVID-19. Based on the analyzed articles, the following benefits of WBV treatments relevant to the context of COVID-19 were noticed:

• reduction of fatigue and the risk of dyspnea (common COVID-19 symptoms);
• improvement of the immune and redox status favoring the maintenance of cell homeostasis and normal inflammatory response in the lungs (which seems to be crucial in many severe cases of COVID-19);
• general improvement in the quality of life, enabling better prognosis for bedridden patients, also hospitalized in intensive care units (faster recovery of the patient means faster return of hospitals to “pre-pandemic standards”).

Prepared on the basis of:

The original review article was written as a joint effort by members of the World Association of Vibration Exercise Experts (WAVEX), mainly university scientists from many countries, such as: Spain, France, Portugal, Germany, Netherlands, Italy, USA, New Zealand, Brazil and Australia.

Potential Application of Whole Body Vibration Exercise For Improving The Clinical Conditions of COVID-19 Infected Individuals: A Narrative Review From the World Association of Vibration Exercise Experts (WAVex) Panel. Sañudo B, Seixas A, Gloeckl R, et al. Int J Environ Res Public Health. 2020;17(10):3650.

Therapeutic vibration parameters

Vibrations with a frequency of 20-30 Hz and an amplitude of 2-4 mm helped to reduce fatigue associated with fibromyalgia, Parkinson’s disease, or after bone marrow transplantation.

Vibrations (25 Hz, 2 mm, 2.5 g, where g – gravitational acceleration) helped to reduce dyspnea in Parkinson’s disease, and in patients after bone marrow transplantation.

Performing squats on a vibrating platform (4 mm, 35 Hz) caused the level of anti-inflammatory cytokine interleukin 10 (IL-10) to be significantly increased and pro-inflammatory IL-6 – decreased, which may suggest anti-inflammatory effects of WBV. In patients with fibromyalgia, a single WBV session (4 mm, 40 Hz) also improved the status of the inflammatory response.

Recent pilot studies on inflammatory markers in patients with COPD have demonstrated the effectiveness of WBV (35 Hz, 2 mm, 6 × 30 s) in increasing anti-inflammatory IL-10 levels.

Comment

COVID-19, disease caused by the SARS-CoV-2 virus, is responsible for serious problems of many countries’ healthcare capacity in 2020. Most patients present mild symptoms, such as fever, fatigue and cough, but in rare cases the disease can quickly lead to a serious condition – very dangerous acute respiratory distress syndrome, septic shock, metabolic acidosis or blood clotting disorders. Severe cases mainly affect the elderly, especially those with coexisting diseases. Out of over 72 thousand cases of patients analyzed as COVID-19 [i] a significant proportion (80%) presented mild symptoms, 15% – severe, and the remaining 5% – critical where patients required cardiopulmonary resuscitation; 2-5% of all patients died. Mortality was influenced by age, comorbidities, and the saturation of health systems. The mortality of patients with a critical course of COVID-19 reached 61% (80% of patients over 60 years of age).

A special obstacle of COVID-19 is formed by the ease of SARS-CoV-2 to spread thus block health workers and hospitals in quarantines. Both suspected and confirmed cases of SARS-CoV-2 infection should be treated in designated hospitals with adequate isolating conditions for both normal and intensive care. COVID-19 therapy employs {as for the time when the original article is written – editorial note} mainly bed rest with basic vital/ cardiovascular functions being monitored (such as pulse, oxygen saturation, respiratory rate, blood pressure) and the constant replenishment of essential vitamins, electrolytes, water, nutrients, etc.

The SARS-CoV-2 virus, because negatively affects the immune system, may in some cases lead to an increase in the expression of pro-inflammatory cytokines in skeletal muscles. Moreover, in the course of COVID-19, muscle pain, fatigue, and symptoms of respiratory distress syndrome are often observed. Therefore, when considering the COVID-19 clinic and the need for constant bed rest of patients, it should be noted that patients in fact are significantly deprived of physical activity. Recent studies indicate the need for covid patients to maintain regular (mild to moderate) physical training that positively affects the immune system and the inflammatory response it controls. Since covid patients cannot actively benefit from physical training, other strategies of musculoskeletal metabolism stimulation should be considered. It could be the use of WBV which can be safely administered even to bedridden patients and, as recent studies show directly, also in the practice of intensive care units. {The effects of WBV in mechanically ventilated patients were already preliminarily assessed and the vibrations turned out to be both safe and potentially beneficial: increasing metabolism with no changes in basic vital signs [Wollersheim et al., 2017] – editorial note.}

Many reports show that the weakening of the musculoskeletal system in intensive care units patients is a serious side effect of a severe disease negatively affecting the therapy itself and the subsequent rehabilitation. An attempt to introduce medical vibrations with adequate parameters into COVID-19 therapy, replacing temporarily unavailable physical activity, but improving immunology and metabolism, seems to be an interesting strategy. The passive nature of WBV exercise can be especially important in extremely debilitated patients unable to exercise. In addition, the cardiovascular system requirements of vibration training as its demands for oxygen supply are moderate. This has been shown not only in healthy women and men of different age but also in patients with stabilized COPD and even in intensive care patients. Many authors note that patients report improved subjective quality of life after the use of WBV, including patients with a severe respiratory disease such as COPD, which symptoms can be compared to those of the severe course of COVID-19.

{It seems therefore, that research on the use of appropriate therapeutic vibrations to combat COVID-19 and the long term consequences of this disease should be started immediately; editorial note.}

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[i] There were approximately 45,000 (62%) patients with a positive genetic diagnosis, the remaining patients were associated with COVID-19 causally and symptomatically: based on the characteristic symptoms and contact with COVID-19 patients.