European Journal of Sport Science

ISSN: 1746-1391 (Print) 1536-7290 (Online) Journal homepage: http://www.tandfonline.com/loi/tejs20

Evaluation of a static stretching intervention on
vascular endothelial function and arterial stiffness
Hiromi Shinno, Satoshi Kurose, Yutaka Yamanaka, Kyoko Higurashi, Yaeko
Fukushima, Hiromi Tsutsumi & Yutaka Kimura
To cite this article: Hiromi Shinno, Satoshi Kurose, Yutaka Yamanaka, Kyoko Higurashi, Yaeko
Fukushima, Hiromi Tsutsumi & Yutaka Kimura (2017) Evaluation of a static stretching intervention
on vascular endothelial function and arterial stiffness, European Journal of Sport Science, 17:5,
586-592, DOI: 10.1080/17461391.2017.1284267
To link to this article: http://dx.doi.org/10.1080/17461391.2017.1284267

Published online: 13 Mar 2017.

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Date: 19 April 2017, At: 12:35

European Journal of Sport Science, 2017Vol. 17, No. 5, 586–592, http://dx.doi.org/10.1080/17461391.2017.1284267

ORIGINAL ARTICLE

Evaluation of a static stretching intervention on vascular endothelial
function and arterial stiffness

HIROMI SHINNO1, SATOSHI KUROSE1, YUTAKA YAMANAKA1,KYOKO HIGURASHI1, YAEKO FUKUSHIMA1, HIROMI TSUTSUMI2, &YUTAKA KIMURA2,3
1

Department of Health Science, Graduate School of Medicine, Kansai Medical University, Osaka, Japan; 2Department of
Health Science, Kansai Medical University, Osaka, Japan & 3Health Science Center, Kansai Medical University, Osaka,Japan

Abstract
Purpose: Maintenance and enhancement of vascular endothelial function contribute to the prevention of cardiovasculardisease and prolong a healthy life expectancy. Given the reversible nature of vascular endothelial function, interventions toimprove this function might prevent arteriosclerosis. Accordingly, we studied the effects of a 6-month static stretchingintervention on vascular endothelial function (reactive hyperaemia peripheral arterial tonometry index: RH-PAT index)
and arterial stiffness (brachial-ankle pulse wave velocity: baPWV) and investigated the reversibility of these effects after a
6-month detraining period following intervention completion. Methods: The study evaluated 22 healthy, non-smoking,premenopausal women aged ≥40 years. Subjects were randomly assigned to the full-intervention (n = 11; mean age: 48.6
± 2.8 years) or a half-intervention that included a control period (n = 11; mean age: 46.9 ± 3.6 years). Results: Body
flexibility and vascular endothelial function improved significantly after 3 months of static stretching. In addition to these
improvements, arterial stiffness improved significantly after a 6-month intervention. However, after a 6-month detraining
period, vascular endothelial function, flexibility, and arterial stiffness all returned to preintervention conditions,demonstrating the reversibility of the obtained effects. Conclusion: A 3-month static stretching intervention was found to
improve vascular endothelial function, and an additional 3-month intervention also improved arterial stiffness. However,these effects were reversed by detraining.
Keywords: Endothelial function, arterial stiffness, flexibility, static stretching1.

Introduction

Regular physical activity, including exercise, contributes to the prevention of metabolic syndrome and cardiovascular diseases (Mitchell, Peter, Otto, &Lawrence, 2006). Studies have reported that aerobic
exercise and resistance training affect vascular endothelial function and arterial stiffness (Sugawara
et al., 2009), and static stretching not only affects
the muscles and tendons but also the vasculature of
the target muscle (Poole, Musch, & Kindig, 1997).
Specifically, when a blood vessel is stretched, its diameter decreases and its vascular resistance changes,
modifying the inflow of blood and affecting the intramuscular vasculature (Kagaya & Muraoka, 2005).

Yamamoto et al. (2009) demonstrated a significant
relationship between arterial stiffness and flexibility inpeople aged ≥40 years. Another study indicated thatthe flexibility-arterial stiffness relationship was notaffected by blood pressure, which is a major confounding factor. Further, sex differences wereobserved in this relationship; poor trunk flexibility
increased arterial stiffness in young, middle-aged,
and older men, but this relationship was found onlyin elderly women (Nishiwaki, Kurobe, Kiuchi,
Nakamura, & Matsumoto, 2014). According toMoreau and Hildreth (2014), arterial stiffness isenhanced in women due to menopause and aging.
Eight weeks of stretching training reduces aortic

Correspondence: Hiromi Shinno, Department of Health Science, Graduate School of Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573–1010, Japan. E-mail: hi-kota@soleil.ocn.ne.jp© 2017 European College of Sport Science53.5 ± 8. 2
20.8 ± 4.0
25.2 ± 7.7
96.0 ± 23.1∗∗
94.5 ± 20.1∗∗
46.0 ± 11.8∗∗
177.3 ± 255.6
53.6 ± 8.5
20.8 ± 4.2
25.9 ± 8.2
89.2 ± 21.8∗
87.6 ± 17.5
39.9 ± 10.9
168.0 ± 247.1
54.1 ± 11.9
21.7 ± 4.4
25.5 ± 8.8
87.4 ± 17.7∗∗
87.8 ± 15.4∗∗
35.0 ± 13.7∗∗
139.2 ± 94.2

6 months
3 months
Pre
Detraining

46.9 ± 3.6
161.0 ± 4.6
53.6 ± 8.6
20.8 ± 4.2
26.0 ± 7.2
88.0 ± 21.5
90.2 ± 17.8
39.8 ± 11.0
168.8 ± 247.8
53.9 ± 11.5
21.6 ± 4.3
25.5 ± 9.4
102.8 ± 13.4∗∗
98.5 ± 13.3∗∗
44.9 ± 9.0∗∗
143.5 ± 96.0

6 months
3 months

54.1 ± 11.3
21.7 ± 4.2
26.6 ± 9.7
95.6 ± 14.9∗∗
92.6 ± 14.2∗∗
39.6 ± 8.8∗
144.2 ± 97.3
47.9 ± 2.2
157.8 ± 7.0
54.0 ± 11.6
21.6 ± 4.3
25.4 ± 9.8
85.7 ± 15.9
87.4 ± 15.5
34.7 ± 13.6
139.8 ± 100.2

Notes: Results are expressed as means ± SD.
Asterisks show statistically significant difference (∗ p < .05, ∗∗ p < .01).
IPAQ: International physical activity questionnaire.

2.2.1. Body composition. The body composition(height, weight, BMI, and body fat percentage) was

Age (years)
Height (cm)Weight (kg)BMI (kg/m2)
Body fat percentage (%)
Straight leg raising (SLR) (Right・Degrees)
SLR (Left・Degrees)
Trunk flexion (cm)
IPAQ (kcal/day)

Measurement variables

Pre

Twenty-two healthy, non-smoking, premenopausal
women aged ≥40 years were investigated. We
defined healthy women as women with a body massindex (BMI) <25 kg/m2 and without neurological diseases, physical diseases, or lifestyle-related diseases(e.g. hypertension, hyperlipidaemia). Women wererandomised to either the full (n = 11, 48.6 ± 2.8
years) or the half group (n = 11, 46.9 ± 3.6 years),
which included a control period (Table I). In the fullgroup, the intervention period was 6 months, withthe women performing 15 minutes of static stretchingat least once per day, every day. In the half group, thewomen did not perform the intervention during thefirst 3 months (control period) but started doing thesame thing as the full group did for the next 3
months. In both groups, variables were assessed fourtimes: before the intervention, at 3 months, at 6
months, and after 6 months of detraining.
This study was conducted in accordance with theKansai Medical University Code of Ethics. The
study objectives, description, and precautions were
thoroughly explained to all participants, and theygave their consent before the study.

2.2.

Half group (n = 11)

Subjects and intervention period

Full group (n = 11)

2.1.

Methods

Table I. Changes in body composition, flexibility and IPAQ during the study period

2.

Detraining

wave reflection magnitude and blood pressure inobese postmenopausal women (Wong & Figueroa,2014). Four weeks of regular static stretching
reduces arterial stiffness in middle-aged men (Nishiwaki, Yonemura, Kurobe, & Matsumoto, 2015).
Thirteen weeks of moderate stretching twice or
thrice a week increases central arterial compliancein middle-aged and older adults (Cortez-Cooper
et al., 2008). The precise mechanism underlying
these differences remains unclear. Although several
reports have described multipart exercise interventions that included static stretching, few studies
have verified the effects of an intervention comprisingstatic stretching alone on vascular endothelial function and arterial stiffness. Therefore, our hypothesis
was that static stretching alone improved vascularendothelial function and arterial stiffness.
To study this hypothesis, we investigated theeffects of a 6-month static stretching intervention
on vascular endothelial function and arterial stiffness
in healthy women as well as the effects of a 6-monthdetraining period.

53.7 ± 8.0
20.8 ± 3.9
25.5 ± 7.9
87.7 ± 21.3∗∗
88.7 ± 18.0∗∗
40.7 ± 11.6∗∗
166.9 ± 246.4

Evaluation of a static stretching intervention 587

588

H. Shinno et al.

measured. Weight and body fat percentage were
measured by InBody720 device (BIOSPACE
Company, Seoul, Korea).

the subject’s height. The RH-PAT index, autonomic
function, and baPWV were measured in all subjects
in that order on the same day.

2.2.2. Flexibility. Flexibility was measured with SLR
and the sit-and-reach test. SLR was measured using a
Todai-style joint goniometer (Tsutsumi Seisakusho,
Y.K., Chiba, Japan) once on each side. The sit-andreach test was performed thrice using the
T.K.K.5112 device (Takei Kiki Kogyo, Tokyo,
Japan); the mean of the three trials was used in theanalyses.

2.2.5. Autonomic function. Autonomic function was
evaluated by the heart rate variability of the R-R interval (Kiritsu Meijin; Crosswell, Kanagawa, Japan). Low
frequency (LF), high frequency (HF), the LF-to-HF
ratio (L/H) were measured. Heart rate variability wasmeasured over a 3-minute period in which the participant was sitting quietly and for 3 minutes after a 10minute resting period. Autonomic function was analysed at every beat 30 seconds after starting.
All measurements were carried out at Kansai
Medical University Health Science Centre. Roomtemperature was maintained at 26°C. All subjects
were assessed under the same conditions. Therefore
all measurements were quite stable. The coefficientof variation as day-to-day reproducibility ofbaPWV, RH-PAT, LF/HF, and Flexibility indexes
were 0.1, 0.1, 0.1, and 0.1, respectively.

2.2.3. Physical activity. Physical activity in a normal
week was determined using the IPAQ short version(August 2002 edition). The subjects were asked tocomplete questions 1a–4. Consumption energy(kcal) = Amount of physical activity (METs.mins) ×
3.5 (ml/kg/min) × 0.005 (kcal/ml) × weight (kg).
Exercise intensity on the summary of IPAQ Short
Version was evaluated following with by themethod. METs that collected by the questionnaire
multiple by time (min) shows the amount of physicalactivity for one week. Then, the number divided by 7shows the average for one day. The amount of energy
on 1 ml oxygen uptake was set as 0.005kcal, and
1METs was set as 3.5 ml/kg/min was used for
calculation.
2.2.4. Vascular endothelial function. Blood pressure
was measured after urination, after 10 minutes ofrest in the supine position and at two other times continuously. We already reported in our previous study
that endothelial function was evaluated by reactive
hyperaemia peripheral arterial tonometry (Kurose
et al., 2014). And, we used the same method in thisstudy.
Brachial-ankle pulse wave velocity (baPWV), an
index of arterial stiffness, was measured using the vascular screening device BP-203RPE III (Omron
Colin, Tokyo, Japan). The distance between
sampling points for baPWV was calculated automatically according to the subject’s height. Pulse wave
data were measured at the upper arm and ankle,
and the velocity was calculated by determining thetime difference and distance between these tworecording sites. baPWV was measured at two consecutive times in the supine position. Before
measurement, subjects abstained from caffeine andfasted for at least 4 h. The left and right limb
baPWVs were measured using the oscillometricmethod. Pulse volume records of both brachial andankle arteries were monitored by continuous cuff
deflation. The distance between sampling points for
baPWV was calculated automatically according to

2.3.

Static stretching

Static stretching of the following 15 sites were performed whilst standing, sitting, or lying down: trapezius, arm flexors, deltoids, triceps, upper backmuscles (trapezius and rhomboid), pectoralis major,
latissimus dorsi, gastrocnemius, soleus, hip abductors,
hip adductors, quadriceps, hamstrings, gluteus
maximus, and the lower erector spinae. The stretching
duration was 20–30 seconds per site. The stretching
was performed to a degree that the participant characterised as “somewhat heavy” to “heavy” on the Ratingof Perceived Exertion (called Borg Scale). A calendar
specifically designed to keep a record of the intervention was created, which the participants filled on
their own. The rate of exercise completion was calculated by the number of interventions performed for thenumber of days in the intervention. Six optional
stretching seminars for both groups were offered
once per month during the intervention period.
Additionally, emails were sent out once per week to
distribute health-related information, respond to participant questions, and provide materials that encouraged continuation, especially for both groups during
the intervention period.

2.4.

Statistics

All measurements are expressed as means ± standard
deviations. We used the Spearman test and Wilcoxon
signed rank sum test. SPSS19.0 J for Windows wasused for analysis, and p < .05 was consideredsignificant.

107.4 ± 11.5∗
64.9 ± 10.1
35.8 ± 3.8∗
56.7 ± 1.9∗
3.0 ± 7.1∗∗
111.2 ± 14.4
66.8 ± 9.937.1 ± 4.8
59.2 ± 6.1
8.1 ± 10.1∗
113.4 ± 13.0
68.0 ± 10.4
37.8 ± 4.3
60.5 ± 3.5
1.0 ± 0.7
Notes: Results are expressed as means ± SD.
Asterisks show statistically significant difference (∗ p < .05, ∗∗ p < .01).
L/H: the ratio of low frequency to high frequency component of heart rate variability.

105.3 ± 13.5
67.0 ± 8.4∗
35.1 ± 4.5
51.0 ± 6.8
4.1 ± 5.2∗
102.8 ± 10.6∗∗
63.0 ± 7.5∗
34.3 ± 3.5
53.0.8 ± 4.2
0.9 ± 0.6
108.8 ± 12.3∗
67.9 ± 9.5
36.3 ± 4.1
54.6 ± 5.1
2.2 ± 2.9
112.0 ± 13.7
70.5 ± 9.937.3 ± 4.6
55.4 ± 5.1
1.6 ± 2.0

Full group (n = 11)

In the full group, systolic blood pressure decreased
significantly after 3 months of intervention, andboth systolic and diastolic blood pressure decreased
significantly from 3 to 6 months. Systolic bloodpressure also decreased significantly after 6 months
of intervention, compared with the preintervention
value. After 3 months of intervention, systolic bloodpressure decreased significantly (Table II). Additionally, at the 6-month period, there was a significant
difference (p < .05) in the mean blood pressure andpulse pressure (Table II).
The blood pressure and RH-PAT index were significantly related to the amount of change observed
at 3 and 6 months into the intervention in the fullgroup (p < .05).
In the full group, the RH-PAT index increased significantly after 6 months of intervention, comparedwith the preintervention value. A significant decreasein this value was observed after 6 months of detraining. In the half group, a significant increase wasobserved after 3 months of intervention (Figure 1).
In the full group, the baPWV decreased significantly after 6 months of intervention, comparedwith the 3-month and preintervention values. A significant increase in this value was observed after 6
months of detraining (Figure 2).

Table II. Changes in blood pressure, autonomic function during the study period

3.3. Blood pressure, vascular endothelial function,
and arterial stiffness

6 months

Detraining

Pre

In the full group, significant increases in trunk flexion
and right and left SLR were observed after the first 3
months and from 3 to 6 months of intervention.
Significant decreases was seen after 6 months ofdetraining compared with the values after the 6month intervention period. However, no significant
differences in these variables were observed between
preintervention and after 6 months of detraining.
In the half group, none of the measured variables
changed significantly after the 3-month control
period. After the 3-month intervention period,
however, trunk flexion and right and left SLR
increased significantly. No significant differences inthe values measured during preintervention andafter 6 months of detraining (Table I).

Systolic blood pressure (mmHg)
Diastolic blood pressure (mmHg)
mean blood pressure (mmHg)
pulse pressure (mmHg)
L/H

Flexibility

3 months

3.2.

Half group (n = 11)

None of the measured variables changed significantly
over time in both the full group and the half group(Table I).

3 months

3.1. Participants’ characteristics and changes inbody composition

6 months

Detraining

ResultsPre3.

110.7 ± 14.9
66.6 ± 12.3
36.9 ± 5.0
58.8 ± 3.5
4.7 ± 5.9

Evaluation of a static stretching intervention 589

590

H. Shinno et al.

Figure 1. Change in the RH-PAT index of the full and half groups.
∗∗
p < .01, significant difference between the full and half groups.

3.4.

Autonomic function

In the full group, the L/H increased significantly after
6 months of detraining, compared with the value
measured after the 6-month intervention. However,a significant difference was not observed between
the values measured at the preintervention and after
6 months of detraining. In the half group, the L/H
increased significantly after the control period anddecreased significantly after 3 months of intervention(Table II).

4.
4.1.

Discussion
Improvements in flexibility

The static stretching completion rate was 80.9 ±
14.7% during the 6-month period for the full groupand 81.0 ± 17.4% during the 3-month period for

Figure 2. Change in baPWV of the full and half groups. ∗∗ p < .01,
significant difference in the full group.

the half group. This corresponds to having performedat least five interventions per week. No correlation
was observed between the amount of change instretching completion rates and rate of increases inflexibility. Once a week, an email was sent to participants to confirm the number of times the stretches
were performed and to provide continued support.
The stretching was performed voluntarily, without
supervised enforcement.
The stretching duration was 20–30 seconds per
site, which is the duration generally recommended
in the literature (Bandy & Irion, 1994). The resultsof the present study suggested that intervention frequency, stretching duration, intensity, and intervention duration contributed to the improvement inflexibility.

4.2.

Improvement in vascular endothelial function

In both groups, the preintervention RH-PAT index
was lower than the reference range for vascular endothelial function (1.67) (Maiorana, O’Driscoll,
Taylor, & Green, 2003). After the respective intervention periods, this index improved significantly inboth groups to levels that exceeded the reference
range (1.68–2.09). Because of the changes intension around the vascular wall, the stretching
stimuli are applied to the vascular smooth muscle.
Additionally, shear stress caused by increased bloodflow is applied to the endothelial cells that face thevascular lumen and the muscle fibres are stretchedalong the long axis. When the shape of the muscle
changes, the blood vessels that run parallel to themuscle also stretch (Katanosaka et al., 2008). Thesephenomena decrease blood vessel diameter andcause temporary blood flow restriction (Cui, Blaha,
Moradkhan, Gray, & Sinoway, 2006). The increasein muscle blood volume after static stretching wasthought to be due to the increase in blood flow after
the release of a temporary cut-off, which may haveinduced reactive hyperaemia. After the stretch isreleased, shear stress is applied to the vascular endothelial cells owing to the increased blood flow (Yamamoto et al., 2003). This response leads to thesecretion of vasodilatory factors such as nitric oxide(NO) (Maeda et al., 2001) and endotheliumderived hyperpolarising factor from the vascularendothelial cells. Based on these observations, static
stretching presumably induces mechanical stress on
the stretching site, which contributes to augmented
muscle blood flow, which thus affects the endothelial
cells. Furthermore, the participants were premenopausal women, and oestrogen was possibly involvedin the improvement of vascular endothelial function(Hayashi et al., 2006). Increases in NO production

Evaluation of a static stretching intervention 591
in vascular endothelial cells and suppression of vascular smooth muscle proliferation are some of the properties of oestrogen that inhibit arteriosclerosis(Hambrecht et al., 2003); a synergistic effect withshear and mechanical stress caused by static stretching was also considered.
Participants in this study were premenopausal
women, and no restrictions were placed on diet.
The impact of other exercises, as obtained from the
IPAQ, was small.

4.3.

Improvement in arterial stiffness

An improvement in baPWV has been reported
immediately after performing short-term static
stretching (Yamato et al., 2016). The 4-week studyof Nishiwaki et al. (2015) monitored the effects of astretching intervention in men. In a study by Wongand Figueroa (2014), no improvement in baPWV
after 8 weeks of intervention was noted in postmenopausal obese women. Our study may have produced
different results because our intervention and participants were different.
Preintervention baPWVs in the present study were1159.0 ± 116.0 and 1161.7 ± 135.4 cm/s in the fulland half groups, respectively, both of which were
within the reference range for age-matched individuals. With 3 months of stretching intervention
in both groups, the RH-PAT index increased
significantly, but not on baPWV did not change significantly. This results did not come as our assumption. However, a significantly lower baPWV wasobserved after 6 months of intervention in the fullgroup. We had postulated that vascular endothelial
function would improve, which would simultaneously change the property of the blood vessel
and consequently improve arterial stiffness(Wallace et al., 2007). No direct relationshipbetween blood pressure and baPWV was observed.
The blood pressure and RH-PAT index were significantly related to the amount of change observed
at 3 and 6 months into the intervention in the fullgroup.
Flexibility increased in both groups during thepostintervention period; the RH-PAT index showeda reduced or downward trend; and baPWV
improved. In the full group, no correlation between
flexibility and the RH-PAT index or baPWV wasobserved.
IPAQ results did not change significantly during
the intervention period; therefore, the changes in
the RH-PAT index and baPWV were also considered
to have been caused by static stretching.
The results of the present study did demonstratedifferences at 3 months of intervention, showingthat to improve vascular endothelial function.
However, In order to improve the arterial stiffness
for the at least 3 months more of intervention isrequired.

4.4.

Autonomic function

A parasympathetic-dominant state is thought tooccur as an acute effect after static stretching (Hottaet al., 2013); however, the measurements in thisstudy were not conducted at the time when participants were quietly resting immediately after stretching, and this may have contributed to the absenceof the parasympathetic-dominant state.

4.5.

Limitations and future directions

The limitations of this study include the small
sample size and infrequent evaluation periods (at 3and 6 months) during the intervention. Although
we confirmed the menstrual cycle stage of eachsubject, it was not considered when the threemeasurements were carried out. In future research,
the influence of the menstrual cycle must be considered when setting the measurement date. In
addition, future studies should also investigate theeffects of haematological properties and ascertain
when these effects appear and when reversibility
occurs, by increasing the number of evaluations
during the intervention.

5.

Conclusion

A 3-month static stretching intervention was found to
improve vascular endothelial function, and an
additional 3-month intervention also improved arterial stiffness. However, these effects were reversed bydetraining.

Acknowledgements
The authors thank all study participants for theirunderstanding and willingness to participate. The
authors also thank Professor Kimura, who provided encouragement and support during thisstudy, and the members of the Kansai Medical
University Health Science Centre, who offeredhelpful advice.

Disclosure statement
No potential conflict of interest was reported by the authors.

592

H. Shinno et al.

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