Longguo Zhang

Background Whole-body vibration training (WBVT) stimulates muscles via mechanical oscillations to induce involuntary contractions, offering an alternative for those unable to engage in conventional voluntary resistance exercise. Since blood flow restriction (BFR) promotes adaptations through metabolic stress, combining it with WBVT may potentiate muscular adaptations. Objectives To determine whether muscle strength and hypertrophy adaptations from WBVT could be enhanced when performed under BFR conditions. Methods We searched nine databases (PubMed, Embase, Scopus, Web of Science, Cochrane Library, CNKI, Wanfang, VIP, and CBM) from inception through 25 May 2026. Randomized controlled trials (RCTs) comparing WBVT-BFR with WBVT alone in healthy participants were included. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Meta-analyses were conducted using standardized mean differences (SMD) with 95% confidence intervals (CIs), and overall certainty of evidence was evaluated using GRADE. Results Five RCTs (total n = 153; WBVT-BFR: n = 75; WBVT: n = 78) were included. Pooled analysis demonstrated a significant effect favoring WBVT-BFR for muscle strength (SMD=0.32; 95% CI, 0.03 to 0.61; p = 0.03) with low heterogeneity (I 2 =14%; p = 0.32). For muscle hypertrophy, the pooled effect reached marginal significance (SMD=0.41; 95% CI, −0.01 to 0.83; p = 0.05), with no significant heterogeneity (I 2 =0%; p = 0.60). However, leave-one-out sensitivity analyses revealed that findings for both outcomes were not robust and were heavily influenced by individual studies. Consequently, the overall certainty of evidence for both outcomes was rated as very low. Conclusions The current evidence regarding the superiority of WBVT-BFR over WBVT alone for enhancing both muscle strength and hypertrophy remains inconclusive. Although initial analyses showed a small advantage for strength and a marginal effect for hypertrophy, sensitivity testing revealed both findings were fragile. Consequently, these results must be interpreted with strict caution due to the high risk of bias and very low certainty of the available evidence.

Objective To evaluate the effectiveness of telerehabilitation on pain intensity and functional outcomes in patients with nonoperatively managed tendinopathy compared with home exercise or in-person physical therapy. Methods A systematic search of major databases was conducted to identify randomized controlled trials comparing telerehabilitation with home exercise or in-person physical therapy. The primary outcomes were pain intensity and functional recovery. Methodological quality was assessed using the Physiotherapy Evidence Database scale and the Cochrane Risk of Bias tool, whereas the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation framework. This review was prospectively registered with International Prospective Register for Systematic Reviews (Registration Number: CRD420251207558). Results A total of 10 studies comprising 412 participants were included. Compared with home exercise, telerehabilitation demonstrated a potential advantage in reducing pain (standardized mean difference = 0.99, p < 0.001) and improving functional outcomes (standardized mean difference = 0.52, p < 0.001). Conversely, compared with in-person physical therapy, telerehabilitation showed no statistically significant difference in either pain reduction (standardized mean difference = −0.34, p = 0.49) or functional improvement (standardized mean difference = 0.04, p = 0.76). Sensitivity analyses using the leave-one-out method identified specific outliers contributing to heterogeneity, and the pooled estimates shifted appreciably, indicating limited robustness. The overall certainty of evidence was rated as low to very low because of risk of bias and imprecision. Conclusions Telerehabilitation shows potential benefit for patients with tendinopathy, providing clinical outcomes that may be superior to home exercise and comparable to conventional in-person therapy. By facilitating consistent progressive loading through remote supervision, telerehabilitation may serve as a promising option for patients facing barriers to traditional care. However, confidence in these findings remains limited, and the results should be interpreted with caution because of the low certainty of evidence, high risk of bias across most studies, and limited robustness of the pooled estimates. These findings highlight the need for future high-quality, adequately powered trials.