Cardiovascular Responses to Muscle Stretching: A Systematic Review and Meta-analysis

Abstract

The aim of this study will be to review the current body of literature to understand the effects of stretching on the responses of the cardiovascular system. A literature search was performed using the following databases: Scopus, NLM Pubmed and ScienceDirect. Studies regarding the effects of stretching on responses of the cardiovascular system were investigated. Outcomes regarded heart rate(HR), blood pressure, pulse wave velocity (PWV of which baPWV for brachial-ankle and cfPWV for carotid-femoral waveforms), heart rate variability and endothelial vascular function. Subsequently, the effects of each outcome were quantitatively synthetized using meta-analytic synthesis with random-effect models. A total of 16 studies were considered eligible and included in the quantitative synthesis. Groups were also stratified according to cross-sectional or longitudinal stretching interventions. Quality assessment through the NHLBI tools observed a “fair-to-good” quality of the studies. The meta-analytic synthesis showed a significant effect of d=0.38 concerning HR, d=2.04 regarding baPWV and d=0.46 for cfPWV. Stretching significantly reduces arterial stiffness and HR. The qualitative description of the studies was also supported by the meta-analytic synthesis. No adverse effects were reported, after stretching, in patients affected by cardiovascular disease on blood pressure. There is a lack of studies regarding vascular adaptations to stretching.

Key words

stretching - vascular - heart rate - stiffness

• References

• 1 Weppler CH, Magnusson SP. Increasing muscle extensibility: a matter of increasing length or modifying sensation?. Phys Ther 2010; 90: 438-449 doi:10.2522/ptj.20090012
• 2 Thomas E, Bianco A, Paoli A. et al. The relation between stretching typology and stretching duration: the effects on range of motion. Int J Sports Med 2018; 39: 243-254
• 3 Blazevich AJ, Cannavan D, Waugh CM. et al. Range of motion, neuromechanical, and architectural adaptations to plantar flexor stretch training in humans. J Appl Physiol (1985) 2014; 117: 452-462
• 4 Kubo K, Kanehisa H, Fukunaga T. Effect of stretching training on the viscoelastic properties of human tendon structures in vivo. J Appl Physiol 1985; 92: 595-601
• 5 Guissard N, Duchateau J. Neural aspects of muscle stretching. Exerc Sport Sci Rev 2006; 34: 154-158 doi:10.1249/01.jes.0000240023.30373.eb
• 6 Lee JH, Gak HB. Effects of self stretching on pain and musculoskeletal symptom of bus drivers. J Phys Ther Sci 2014; 26: 1911-1914 doi:10.1589/jpts.26.1911
• 7 Apostolopoulos N, Metsios GS, Flouris AD. et al. The relevance of stretch intensity and position – a systematic review. Front Psychol 2015; 6: 1128
• 8 Page P. Current concepts in muscle stretching for exercise and rehabilitation. Int J Sports Phys Ther 2012; 7: 109-119
• 9 Milanovic Z, Pantelic S, Trajkovic N. et al. Age-related decrease in physical activity and functional fitness among elderly men and women. Clin Interv Aging 2013; 8: 549-556
• 10 Nuzzo JL. The case for retiring flexibility as a major component of physical fitness. Sports Med 2020; 50: 853-870
• 11 Kruse NT, Scheuermann BW. Cardiovascular responses to skeletal muscle stretching: "stretching" the truth or a new exercise paradigm for cardiovascular medicine?. Sports Med 2017;
• 12 Stebbins CL, Brown B, Levin D. et al. Reflex effect of skeletal muscle mechanoreceptor stimulation on the cardiovascular system. J Appl Physiol (1985) 1988; 65: 1539-1547
• 13 Cui J, Blaha C, Moradkhan R. et al. Muscle sympathetic nerve activity responses to dynamic passive muscle stretch in humans. J Physiol 2006; 576: 625-634
• 14 Yamato Y, Hasegawa N, Fujie S. et al. Acute effect of stretching one leg on regional arterial stiffness in young men. Eur J Appl Physiol 2017; 117: 1227-1232
• 15 Hotta K, Kamiya K, Shimizu R. et al. Stretching exercises enhance vascular endothelial function and improve peripheral circulation in patients with acute myocardial infarction. Int Heart J 2013; 54: 59-63
• 16 Venturelli M, Rampichini S, Coratella G. et al. Heart and musculoskeletal hemodynamic responses to repetitive bouts of quadriceps static stretching. J Appl Physiol (1985) 2019; 127: 376-384
• 17 Gifford JR. Stretching-based vascular rehabilitation? it's not a stretch. J Physiol 2020; 598: 3537-3538 doi:10.1113/jp280278
• 18 Wang YY, Chen YH, Guo DJ. et al. The benefit of stretching along the artery. Annu Int Conf Proc IEEE Eng Med Biol Soc 2008; 2008: 2451-2452
• 19 Russo TA, Stoll D, Nader HB. et al. Mechanical stretch implications for vascular endothelial cells: altered extracellular matrix synthesis and remodeling in pathological conditions. Life Sci 2018; 213: 214-225
• 20 Chappell JC, Wiley DM, Bautch VL. Regulation of blood vessel sprouting. Semin Cell Dev Biol 2011; 22: 1005-1011 doi:10.1016/j.semcdb.2011.10.006
• 21 Han HC, Ku DN, Vito RP. Arterial wall adaptation under elevated longitudinal stretch in organ culture. Ann Biomed Eng 2003; 31: 403-411 doi:10.1114/1.1561291
• 22 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. PLoS Med 2009; 6: e1000097
• 23 Harriss DJ, MacSween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817 doi:10.1055/a-1015-3123
• 24 Jackson D, Turner R. Power analysis for random-effects meta-analysis. Res Synth Methods 2017; 8: 290-302
• 25 Wasserman S. Reviewed Work: Statistical methods for meta-analysis by Larry V. Hedges, Ingram Olkin. J Educ Stat 1988; 13: 75-78
• 26 Glass GV. Primary, secondary, and meta-analysis of research. Educ Res 1976; 5: 3-8
• 27 Farinatti PT, Brandao C, Soares PP. et al. Acute effects of stretching exercise on the heart rate variability in subjects with low flexibility levels. J Strength Cond Res 2011; 25: 1579-1585
• 28 Fisher JP, Bell MP, White MJ. Cardiovascular responses to human calf muscle stretch during varying levels of muscle metaboreflex activation. Exp Physiol 2005; 90: 773-781
• 29 Inami T, Baba R, Nakagaki A. et al. Acute changes in peripheral vascular tonus and systemic circulation during static stretching. Res Sports Med 2015; 23: 167-178
• 30 Kato M, Masuda T, Ogano M. et al. Stretching exercises improve vascular endothelial dysfunction through attenuation of oxidative stress in chronic heart failure patients with an implantable cardioverter defibrillator. J Cardiopulm Rehabil Prev 2017; 37: 130-138
• 31 Kruse NT, Sillette CR, Scheuermann BW. Influence of passive stretch on muscle blood flow, oxygenation and central cardiovascular responses in young healthy males. Am J Physiol Heart Circ Physiol 2016;
• 32 Logan JG, Kim SS, Lee M. et al. Effects of static stretching exercise on lumbar flexibility and central arterial stiffness. J Cardiovasc Nurs 2018;
• 33 Mueck-Weymann M, Janshoff G, Mueck H. Stretching increases heart rate variability in healthy athletes complaining about limited muscular flexibility. Clin Auton Res 2004; 14: 15-18 doi:10.1007/s10286-004-0123-0
• 34 Nishiwaki M, Yonemura H, Kurobe K. et al. Four weeks of regular static stretching reduces arterial stiffness in middle-aged men. Springerplus 2015; 4: 555
• 35 Patil SG, Aithala MR, Das KK. Effect of yoga on arterial stiffness in elderly subjects with increased pulse pressure: a randomized controlled study. Complement Ther Med 2015; 23: 562-569 doi:10.1016/j.ctim.2015.06.002
• 36 Shinno H, Kurose S, Yamanaka Y. et al. Evaluation of a static stretching intervention on vascular endothelial function and arterial stiffness. Eur J Sport Sci 2017; 17: 586-592
• 37 Silveira A, Rocha A, Costa C. et al. Acute effects of an active static stretching class on arterial stiffness and blood pressure in young men. J Exerc Physiol 2016; 19: 1-11
• 38 Wong A, Figueroa A. Eight weeks of stretching training reduces aortic wave reflection magnitude and blood pressure in obese postmenopausal women. J Hum Hypertens 2014; 28: 246-250 doi:10.1038/jhh.2013.98
• 39 Yamato Y, Hasegawa N, Sato K. et al. Acute effect of static stretching exercise on arterial stiffness in healthy young adults. Am J Phys Med Rehabil 2016; 95: 764-770
• 40 Bisconti AV, Cè E, Longo S. et al. Evidence for improved systemic and local vascular function after long-term passive static stretching training of the musculoskeletal system. J Physiol 2020; 598: 3645-3666
• 41 Burns PB, Rohrich RJ, Chung KC. The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg 2011; 128: 305-310 doi:10.1097/PRS.0b013e318219c171
• 42 Shaffer F, Ginsberg JP. An overview of heart rate variability metrics and norms. Front Public Health 2017; 5: 258 doi:10.3389/fpubh.2017.00258
• 43 Malik M. Heart rate variability. Ann Noninvasive Electrocardiol 1996; 1: 151-181 doi:10.1111/j.1542-474X.1996.tb00275.x
• 44 Nakamoto T, Matsukawa K. Muscle receptors close to the myotendinous junction play a role in eliciting exercise pressor reflex during contraction. Auton Neurosci 2008; 138: 99-107 doi:10.1016/j.autneu.2007.11.005
• 45 Stiber JA, Seth M, Rosenberg PB. Mechanosensitive channels in striated muscle and the cardiovascular system: not quite a stretch anymore. J Cardiovasc Pharmacol 2009; 54: 116-122 doi:10.1097/FJC.0b013e3181aa233f
• 46 Amann M, Sidhu SK, Weavil JC. et al. Autonomic responses to exercise: group III/IV muscle afferents and fatigue. Auton Neurosci 2015; 188: 19-23
• 47 Matsumoto T, Sugita S, Yaguchi T. Biomechanics of Blood Vessels: Structure, Mechanics, and Adaptation. In: Niinomi M, Narushima T, Nakai M. Advances in metallic biomaterials: Tissues, materials and biological reactions. Berlin, Heidelberg: Springer; 2015: 71-98
• 48 Mathieu-Costello O, Hoppeler H, Weibel ER. Capillary tortuosity in skeletal muscles of mammals depends on muscle contraction. J Appl Physiol (1985) 1989; 66: 1436-1442
• 49 Poole DC, Copp SW, Ferguson SK. et al. Skeletal muscle capillary function: contemporary observations and novel hypotheses. Exp Physiol 2013; 98: 1645-1658
• 50 Gladwell VF, Fletcher J, Patel N. et al. The influence of small fibre muscle mechanoreceptors on the cardiac vagus in humans. J Physiol 2005; 567: 713-721
• 51 Shirwany NA, Zou MH. Arterial stiffness: A brief review. Acta Pharmacol Sin 2010; 31: 1267-1276 doi:10.1038/aps.2010.123
• 52 Palombo C, Kozakova M. Arterial stiffness, atherosclerosis and cardiovascular risk: Pathophysiologic mechanisms and emerging clinical indications. Vascul Pharmacol 2016; 77: 1-7 doi:10.1016/j.vph.2015.11.083
• 53 Safar ME, Asmar R, Benetos A. et al. Interaction between hypertension and arterial stiffness. Hypertension 2018; 72: 796-805
• 54 Antonov P, Antonova M, Nikolova N. et al. Age dependent changes of arterial wall viscoelasticity. Clin Hemorheol Microcirc 2008; 39: 63-68
• 55 Gates PE, Seals DR. Decline in large elastic artery compliance with age: a therapeutic target for habitual exercise. Br J Sports Med 2006 2006; 40: 897-899
• 56 Yamamoto K, Kawano H, Gando Y. et al. Poor trunk flexibility is associated with arterial stiffening. Am J Physiol Heart Circ Physiol 2009; 297: H1314-H1318
• 57 Yamamoto K. Human flexibility and arterial stiffness. J Sports Med Phys Fitness 2017; 6: 1-5
• 58 Segers P, Rietzschel ER, Chirinos JA. How to measure arterial stiffness in humans. Arterioscler Thromb Vasc Biol 2020;
• 59 Townsend RR, Wilkinson IB, Schiffrin EL. et al. Recommendations for improving and standardizing vascular research on arterial stiffness: A scientific statement from the American Heart Association. Hypertension 2015; 66: 698-722
• 60 Jackson ZS, Gotlieb AI, Langille BL. Wall tissue remodeling regulates longitudinal tension in arteries. Circ Res 2002; 90: 918-925 doi:10.1161/01.res.0000016481.87703.cc
• 61 Ozaki H, Yasuda T, Ogasawara R. et al. Effects of high-intensity and blood flow-restricted low-intensity resistance training on carotid arterial compliance: role of blood pressure during training sessions. Eur J Appl Physiol 2013; 113: 167-174
• 62 Randall OS. Effect of arterial compliance on systolic blood pressure and cardiac function. Clin Exp Hypertens A 1982; 4: 1045-1057 doi:10.3109/10641968209060773
• 63 Pagani M, Montano N, Porta A. et al. Relationship between spectral components of cardiovascular variabilities and direct measures of muscle sympathetic nerve activity in humans. Circulation 1997; 95: 1441-1448
• 64 Widlansky ME, Malik MA. Vascular endothelial function. In: Lanzer P. Panvascular Medicine. Berlin, Heidelberg: Springer; 2015: 89-120
• 65 Dharmashankar K, Widlansky ME. Vascular endothelial function and hypertension: Insights and directions. Curr Hypertens Rep 2010; 12: 448-455 doi:10.1007/s11906-010-0150-2
• 66 Nobre V, Ataíde TB, Brant LC. et al. Use of reactive hyperemia-peripheral arterial tonometry and circulating biological markers to predict outcomes in sepsis. Rev Bras Ter Intensiva 2016; 28: 387-396
• 67 Hotta K, Behnke BJ, Arjmandi B. et al. Daily muscle stretching enhances blood flow, endothelial function, capillarity, vascular volume and connectivity in aged skeletal muscle. J Physiol 2018; 596: 1903-1917
• 68 Hellsten Y, Rufener N, Nielsen JJ. et al. Passive leg movement enhances interstitial VEGF protein, endothelial cell proliferation, and eNOS mRNA content in human skeletal muscle. Am J Physiol Regul Integr Comp Physiol 2008; 294: R975-R982
• 69 Avadhanam B, Gangoda S, Gupta V. et al. Effect of cyclic stretch on endothelial nitric oxide synthase and associated cell survival pathways in vascular endothelial cells. In: Abstracts From the 36th Annual Scientific Meeting of the HBPRCA. Hypertension 2015;
• 70 Korsager Larsen M, Matchkov VV. Hypertension and physical exercise: The role of oxidative stress. Medicina (Kaunas) 2016; 52: 19-27 doi:10.1016/j.medici.2016.01.005
• 71 Maeda S, Otsuki T, Iemitsu M. et al. Effects of leg resistance training on arterial function in older men. Br J Sports Med 2006; 40: 867–869
• 72 Ferrari M, Binzoni T, Quaresima V. Oxidative metabolism in muscle. Philos Trans R Soc Lond B Biol Sci 1997; 352: 677-683 doi:10.1098/rstb.1997.0049
• 73 Buscemi S, Canino B, Batsis JA. et al. Relationships between maximal oxygen uptake and endothelial function in healthy male adults: a preliminary study. Acta Diabetol 2013; 50: 135-141
• 74 Tinken TM, Thijssen DH, Hopkins N. et al. Impact of shear rate modulation on vascular function in humans. Hypertension 2009; 54: 278-285
• 75 Venturelli M, Cè E, Limonta E. et al. Central and peripheral responses to static and dynamic stretch of skeletal muscle: Mechano- and metaboreflex implications. J Appl Physiol (1985) 2017; 122: 112-120
• 76 Wilmore JH. Aerobic exercise and endurance: improving fitness for health benefits. Phys Sportsmed 2003; 31: 45-51 doi:10.3810/psm.2003.05.367