The more flexible you are as you age, the longer you’re likely to live. That’s the conclusion of a new study that associated increased flexibility in middle age with a lower odds of mortality over the next dozen or so years. The prospective cohort study, which evaluated the flexibility of more than 3,100 men and women in Brazil, found body flexibility was strongly and inversely associated with mortality risk over a 13-year follow-up period.
Claudio Gil Araújo, MD, PhD, the research director of the Exercise Medicine Clinic-CLINIMEX in Rio de Janeiro, who led the study, said his group was not surprised by the results. “We found what we expected. Reduced flexibility was related to poor survival,” he said.
The findings, published today in the Scandinavian Journal of Medicine & Science in Sports, used data from 2,087 men and 1,052 women who underwent a medical-functional evaluation at CLINIMEX. They received a body flexibility score, called the Flexindex, based on the range of motion in 20 movements in seven joints, with a minimum score of 0 and a maximum score of 80.
Among the 3,139 participants, there were 302 deaths (9.6%) during a mean follow-up of 12.9 years, with cardiovascular diseases and cancer the most common underlying causes in men and women, respectively. “The probability of death during nearly 13 years of follow-up was close to 1% when Flexindex scores exceeded 49 for men and 56 for women,” Araújo told Medscape Medical News. “On the other hand, for men and women placed in the lower 10th percent of Flexindex scores, death rates were, respectively, 26.9% and 18.2%.”
Barry Franklin, PhD, director of preventive cardiology and cardiac rehabilitation at Corewell Health William Beaumont University Hospital in Royal Oak, Michigan, and a co-author of the new study, said men with the poorest flexibility were nearly twice as likely to die over the follow-up period than men with high flexibility. Women with the poorest flexibility were almost five times more likely to die than those with high flexibility.
Flexibility Assessment and Training
Araújo opened CLINIMEX in 1994, and since then, its staff of five physicians has evaluated more than 10,000 individuals using the Flexitest. Araújo has published two previous studies on flexibility. The first showed that the ability to rise from a sitting position on the floor is a strong predictor of longevity, and the second demonstrated that the inability to stand on one leg for at least 10 seconds is linked to an increased risk for death over seven years.
Araújo and his colleagues believe the current study is the first to assess the association between levels of body flexibility and mortality. However, the observational analysis was unable to establish causality, and therefore, they could not show a definitive mechanism to explain the association between low levels of flexibility and premature mortality. The authors noted several limitations of their study. The participants were primarily affluent Whites, and the researchers did not control for the time of day flexibility was measured or for variables such as diet and physical activity. They also acknowledged that reduced flexibility may be a consequence of poor lifestyle habits rather than a causal risk factor for mortality.
Jonathan Bonnet, MD, MPH, an exercise expert at the Stanford Center on Longevity Lifestyle Medicine in California, said the researchers used a more robust evaluation of flexibility than a traditional sit-and-reach test. However, he expressed concern that the primary comparisons were of the upper and lower 10% of performers and that the average differences in Flexindex scores between people who died and those who survived were only a handful of points in an 80-point test. “People who are not flexible probably have other health-related issues that limit their mobility, and those who are very flexible are either genetically different from inflexible individuals or are doing something to maintain or increase their flexibility to a high level,” Bonnet said. “Not knowing how active or inactive people are at baseline when flexibility was assessed or over the duration of the study limits how confident we can be that flexibility is the cause of mortality.”
Bonnet, a member of the American College of Lifestyle Medicine, noted that the latest guidelines on physical activity from the US Department of Health and Human Services do not include recommendations on stretching, given the lack of data demonstrating its specific health benefits. While maintaining mobility and range of motion in joints is important for long-term health, he said the new study does not provide sufficient evidence to recommend stretching as a way to reduce mortality. “Until there are more data that can show a cause-and-effect relationship with stretching and health outcomes, time is better spent doing aerobic and muscle-strengthening activities,” Bonnet said.
Franklin said future studies could better account for missing potential confounders like physical activity and whether individuals were taking protective medications, such as aspirin, cholesterol-lowering drugs, or beta-blockers. Studies are also needed to assess whether training-induced gains in flexibility are specifically related to increases in survival and whether their findings apply to people over the age of 65, he said.
The current findings “give us some additional ammo to say, ‘Wow, being more flexible may, in fact, improve long-term survival or outcomes,’” Franklin said. Regardless, flexibility still “improves quality of life, it improves balance and reduces the potential for falls, and all those things make it worthy of better recognition or appreciation by the general public and clinicians,” he added.
Araújo said he would like his research to influence people’s health. “While to exercise regularly is advisable, what really matters is to be physically fit and not only in aerobic or strength fitness but also in flexibility,” he said. “The study is adding a new and, I believe, important ‘relevant for survival’ label on flexibility assessment and training.”
Recommended Stretches for Increased Mobility and Flexibility
Matthew Accetta, MS, exercise physiologist at Hospital for Special Surgery in New York City
1. Hip Hug Stretch
This stretch effectively targets the gluteal muscles, piriformis, and other deep hip rotators, which can become tight from prolonged sitting or lack of movement. Tight hips can contribute to lower back pain. By stretching the hip muscles, you can reduce tension and pressure on the lower back. Regularly performing this stretch helps to improve hip joint mobility, which is essential for maintaining functional movement and preventing stiffness as you age.
• Start by sitting and crossing one leg over the other.
• Hug your knee to your chest.
• Focus on keeping your chest up to feel the stretch in the glute.
• Hold for 20-30 seconds.
• Repeat on the opposite side.
2. Half Kneeling Hip Flexor Stretch
As people age, they often spend more time sitting, which can lead to tight hip flexors. This stretch specifically targets these muscles, helping to alleviate tightness and improve mobility. Tight hip flexors can contribute to poor posture by pulling the pelvis into an anterior tilt, which can lead to lower back pain and other postural issues. Stretching these muscles helps to counteract this effect and promote better posture.
• Kneel on a pad (the side you kneel on is the side being stretched); position the front leg far enough away so the front knee stays behind the toes.
• With a tall posture, engage your abdominals and tuck your tailbone by engaging your glutes until a stretch is felt in the front of the thigh on the kneeling leg.
• Hold for 20-30 seconds.
• Repeat on the opposite side.
3. Calf Stretch at a Wall
Tight calf muscles can lead to discomfort and limit the range of motion in the ankles. Stretching the calves helps to maintain and improve flexibility in these muscles. Flexible calf muscles contribute to better mobility in the ankles and feet, making daily activities like walking, climbing stairs, and running more comfortable. Tight calves can increase the risk for strains, Achilles tendonitis, and other injuries.
• Stand facing a wall with your hands on the wall at about eye level. Put the leg you want to stretch about a step behind your other leg.
• Stand in a staggered stance in front of a wall with your arms stretched out.
• Keeping your back heel on the floor, bend your front knee until you feel a stretch in the back leg.
• Hold the stretch for 15-30 seconds.
• Repeat on the opposite side.
4. Standing Quad Stretch
Regularly stretching the quadriceps helps maintain and improve flexibility in these muscles, which is crucial for overall lower body mobility. Flexible quadriceps are less prone to strains and injuries. Tight quadriceps can contribute to knee pain and discomfort by exerting excessive pressure on the knee joint. Stretching these muscles helps alleviate this pressure and reduce knee pain.
• While standing, hold onto a countertop or chair back to assist in balance.
• Bend your knee by grasping your ankle with one hand and moving your foot toward your buttocks.
• Gently pull on your ankle to bend your knee as far as possible.
• Maintain the position for 30 seconds.
• Repeat on the opposite side.
5. Seated Hamstring Stretch
Regularly stretching the hamstrings helps maintain and improve their flexibility, which is crucial for the overall mobility of the lower body. Tight hamstrings can contribute to lower back pain by pulling on the pelvis and causing an anterior pelvic tilt. Stretching these muscles can help alleviate tension and reduce back pain. Hamstring flexibility helps to contribute to a better range of motion in the hip and knee joints, making daily activities such as walking, bending, and reaching easier.
• Sit on the front half of a firm chair with your back straight.
• Extend one leg out in front of you with your heel on the floor and your toes pointed out.
• Bend the opposite knee so that your foot is flat on the floor.
• Center your chest over our straight leg.
• Slowly lean forward at the hips until you feel a stretch in the back of your thigh.
• Hold the stretch for 30 seconds.
• Slowly return to your original position and repeat on the opposite side.
https://onlinelibrary.wiley.com/doi/epdf/10.1111/sms.14708
(Scandanavian Journal for full details etc.)
