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    Flexibility and arterial stiffness

    My jaw dropped at this one: I've talked before about how being flexible helps with weight lifting performance due to enhancing elasticity during the stretch shortening cycle.... but this is just incredible.

    Yamamoto et al. Poor trunk flexibility is associated with arterial stiffening. AJP Heart and Circulatory Physiology, 2009; 297 (4):

    A Simple Way For Older Adults To Assess Arterial Stiffness: Reach For The Toes

    ScienceDaily (Oct. 7, 2009) — How far you can reach beyond your toes from a sitting position – normally used to define the flexibility of a person’s body – may be an indicator of how stiff your arteries are.

    A study in the American Journal of Physiology has found that, among people 40 years old and older, performance on the sit-and-reach test could be used to assess the flexibility of the arteries. Because arterial stiffness often precedes cardiovascular disease, the results suggest that this simple test could become a quick measure of an individual’s risk for early mortality from heart attack or stroke.

    “Our findings have potentially important clinical implications because trunk flexibility can be easily evaluated,” said one of the authors, Kenta Yamamoto. “This simple test might help to prevent age-related arterial stiffening.”

    It is not known why arterial flexibility would be related to the flexibility of the body in middle age and older people. But the authors say that one possibility is that stretching exercises may set into motion physiological reactions that slow down age-related arterial stiffening.

    Arteries should be elastic

    Healthy blood vessels are elastic, and elasticity helps to moderate blood pressure. Arterial stiffness increases with age and is a risk factor for cardiovascular disease and death. Previous studies have established that physical fitness can delay age-related arterial stiffness, although exactly how that happens is not understood. The authors noted that people who keep themselves in shape often have a more flexible body, and they hypothesized that a flexible body could be a quick way to determine arterial flexibility.

    The researchers studied 526 healthy, non-smoking adults, 20 to 83 years old, with a body mass index of less than 30. They wanted to see whether flexibility of the trunk, as measured with the sit and reach test, is associated with arterial stiffness. The researchers divided the participants into three age groups:

    * young (20-39 years old)
    * middle aged (40-59 years old)
    * older (60-83 years old)

    The researchers asked participants to perform a sit-and-reach test. The volunteers sat on the floor, back against the wall, legs straight. They slowly reached their arms forward by bending at the waist. Based on how far they could reach, the researchers classified the participants as either poor- or high-flexibility.

    The researchers also measured blood pressure and the speed of a pulse of blood as it flowed through the body. They measured how long the pulse takes to travel between the arm and the ankle and between the neck and the leg. They also measured aortic pressure in some participants and tested the participants for cardiorespiratory fitness, muscular strength and endurance.

    The study found that trunk flexibility was a good predictor of artery stiffness among middle age and older participants, but not among the younger group. In middle age and older participants, they also found that systolic blood pressure (the peak pressure that occurs as the heart contracts) was higher in poor-flexibility than in high-flexibility groups.

    What’s happening?

    Why would the flexibility of the body be a good indicator of arterial stiffness? In the study, the authors speculate on why this would be. One possibility is that there is a cause and effect: the stretching exercises that provide flexibility to the body may also slow the age-related stiffening of the arteries. The study found that arterial stiffness among middle age and older people was associated with trunk flexibility but was independent of muscle strength and cardiorespiratory fitness (as measured by performance on an exercycle). In addition, they cited another recent study that found that middle age and older adults who began a regular stretch exercise program significantly improved the flexibility of their carotids, a major artery found in the neck.

    “Together with our results, these findings suggest a possibility that improving flexibility induced by the stretching exercise may be capable of modifying age-related arterial stiffening in middle-aged and older adults,” Dr. Yamamoto said. “We believe that flexibility exercise, such as stretching, yoga and Pilates, should be integrated as a new recommendation into the known cardiovascular benefits of regular exercise.”

    However, there are other possibilities as to why bodily flexibility should be an indicator of arterial stiffness. One possibility is that it is related to the higher blood pressure that was seen in the poor flexibility group. Another possibility is that the amount of collagen and elastin, which makes the muscles flexible, also makes the arteries flexible. Further research is needed to understand whether there is a cause-effect relationship between flexibility and arterial stiffness, they said.

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    • Back To Top    #2
      Mecca V.I.P. Adam23's Avatar
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      Feb 2008
      that's some interesting stuff for sure !!!

      very good article Ironslave !!! repped


    • Back To Top    #3
      Mecca V.I.P. tim290280's Avatar
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      Jul 2006
      Western Australia
      I see your point IS. I was thinking it would be down to people who are maintaining flexibility as they get older would be more active, stronger and fitter. But to then have that ruled out They don't mention whether the more flexible people stretched regularly or had always been flexible.

      Maybe it isn't the stretching itself but the relaxation of the body while stretching?? I always feel better after a good stretch, so maybe a hormonal response to that of some sort.

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    • Back To Top    #4
      Definitely more of a chronic adaptation, not an acute response of stress relief or something. here's the discussion.

      The key new findings of the present study are as follows. First, in middle-aged and older subjects, arterial stiffness deteriorated in the poor-flexibility groups compared with the high-flexibility groups. Second, a negative relationship between flexibility and arterial stiffness was observed in middle-aged and older subjects, but there were no relationships in young subjects. These results support our hypothesis that a less flexible body indicates arterial stiffening, especially in middle-aged and older adults. Furthermore, age-related arterial stiffening was greater (~30% in baPWV) in the poor-flexibility than in the high-flexibility groups, which suggests that poor flexibility is associated with greater age-related arterial stiffening.

      In general, because habitual exercise includes flexibility exercise (e.g., stretching during warming up or cooling down), an active person may tend to be more flexible than an inactive one (11). In fact, a positive relationship between cardiorespiratory fitness and flexibility was observed in the present study. It is well known that cardiorespiratory fitness was inversely related to arterial stiffness (25). The present study also showed that both peak oxygen uptake and leg power are inversely related to baPWV. Stepwise multiple-regression analysis revealed that among the components of fitness and age, sit-and-reach was an independent correlate of baPWV. These findings statistically support the idea that flexibility is identified as a determinant or predictor of arterial stiffness, independent of other components of fitness. On the other hand, the peak oxygen uptake was also an independent correlate of baPWV. This result may indicate that subjects who have low cardiorespiratory fitness have higher arterial stiffness than high cardiorespiratory fitness subjects in high-flexibility groups. The same might apply for physical activity. The interaction among flexibility and other components of fitness or physical activity in determining the arterial stiffness awaits further studies.

      Recently, Cortez-Cooper et al. (7) examined the effects of strength training on central arterial compliance in middle-aged and older adults. In this previous study, a stretching exercise group was included as a control group. An unexpected finding of the study was that a stretching program significantly increased carotid arterial compliance. Together with our results, these findings suggest a possibility that improving flexibility induced by the stretching exercise may be capable of modifying age-related arterial stiffening in middle-aged and older adults.

      Ehlers-Danlos syndrome is a rare connective tissue disorder inherited as an autosomal-dominant trait. As a result, the patients are pathologically hyperflexible. A previous study showed abnormally low values of aortic PWV in the ecchymotic Ehlers-Danlos syndrome (10). Furthermore, Boutouyrie et al. (5) reported that carotid distensibility was 27% higher in the vascular type Ehlers-Danlos syndrome than in control subjects. Thus patients with Ehlers-Danlos syndrome are less likely to have stiff arteries. In contrast, people with spinal cord injury seem to be immobile subjects, indicating the loss of ligamentous laxity. A recent study showed that the aortic PWV among people with spinal cord injuries was higher than that in control subjects (18). These pathological observations are in line with the present results.

      We can only speculate on the mechanisms responsible for the greater age-related arterial stiffening in the poor-flexibility groups. First, both arterial stiffness and flexibility may be structurally determined by similar compositions such as the muscles or connective tissues (e.g., elastin-collagen composition) (19). Thus age-related alterations in arterial stiffness may correspond to age-related alterations in flexibility within the same individual. Second, arterial stiffness is functionally determined by the vascular tone of the artery (19). Vascular tone is partially regulated by sympathetic nerve activity. Stretching of skeletal muscle causes an increase in sympathetic nerve activity via the central nervous system (26). Repetitive stimulation of transient sympathoexcitation induced by habitual stretching exercises, which improve flexibility, may chronically reduce resting sympathetic nerve activity. This reduction in sympathetic nerve activity may result in a decrease in arterial stiffness. On the other hand, the higher sympathetic nerve activity elevates blood pressure. In middle-aged and older subjects, systolic blood pressure in the poor-flexibility group was higher than in the high-flexibility group (Table 1). Elevated blood pressure can increase arterial stiffness (19). In this regard, heart rate (HR) appears to be low for young and older subjects, suggesting a well-conditioned population. If sympathetic nerve activity in poor-flexibility groups is higher than that in high-flexibility groups, then HR might be higher in poor-flexibility groups. Although sympathetic nerve activity increases with age, HR appears unchanged because of age-related decrease in intrinsic HR (6, 15). Further experimental studies are needed to verify the proposed mechanisms related to the present findings.

      Our findings have potentially important clinical implications. Trunk flexibility can be easily evaluated over all ages and in any practical fields. Thus a measurement of flexibility as a physical fitness might contribute to assist in the prevention of age-related arterial stiffening. Stretching is widely recommended for injury prevention despite the limited evidence (9). In addition to the recommendation, we believe that flexibility exercise such as stretching, yoga, and pilates would be integrated as a new recommendation into the known cardiovascular benefit of regular exercise. However, although the present results are the first to provide evidence demonstrating that poor flexibility is associated with greater age-related arterial stiffening, the present cross-sectional study provided only associations among age, flexibility, and arterial stiffness. An intervention study is also needed to determine the cause-and-effect relationship between flexibility and arterial stiffness.

      We used baPWV for an estimation of arterial stiffness. A major advantage of baPWV is its simple way of measurement by only wrapping the four extremities with blood pressure cuffs. This technique does not need the refined technique of applanation tonometry that is required for the measurements of aortic PWV. Although the value of baPWV mainly reflects stiffness in the central arteries (21, 28), baPWV includes stiffness from the brachial part, the ascending and descending aorta, and the abdominal aorta and leg part. When compared with central elastic arteries, peripheral arteries are generally considered to be of less clinical significance (20). Aortic PWV has been directly linked with cardiovascular mortality and morbidity (2, 16, 17, 22). In the present study, the same results as the baPWV were obtained by the use of the aortic PWV. (Table 2, and Fig. 1). In contrast, faPWV did not differ between the poor-flexibility and high-flexibility groups (Table 2). Therefore, we believe that baPWV provides qualitatively similar information as that derived from aortic PWV in this cross-sectional study and that the faPWV may be less sensitive to physical fitness or daily activity compared with the baPWV and aortic PWV (13, 23).

      The present study has several limitations. First, we used the sit-and-reach test as an indicator of flexibility. The sit-and-reach test may be differentially influenced by arm and leg length or sex. In the present study, we set an individual zero point for each subject (see flexibility in METHODS for details). Thus the effects of arm and leg length were few. Furthermore, the differences between the two flexibility groups remained significant after normalizing baPWV and aortic PWV for sex when analyzed by ANCOVA. Although the sit-and-reach test has been commonly used to assess flexibility as health-related fitness, the test reflects trunk flexibility. We did not examine the flexibility of other regions such as neck, shoulder, and/or lower extremity. Further investigations are required to improve our understanding of the relationship between flexibility and arterial stiffness. Second, subjects in the present study included premenopausal women. The elastic properties of central arteries fluctuate with the phases of the menstrual cycle (12). However, we did not monitor the menstrual phase in the present study. Thus, if premenopausal women in this population are tested during the early follicular phase, the relationship between flexibility and arterial stiffness could be analyzed more accurately.

      In conclusion, the present results indicate that poor flexibility is associated with greater age-related arterial stiffening. The association was independent of cardiorespiratory fitness and muscular strength. These findings suggest the possibility that flexibility may be a predictor of arterial stiffening, independent of other components of fitness.

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