insights
Flexibility for Improved Physiology and Health
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The ability to bend without breaking is a powerful skill applicable to many areas of life. At the most basic body level, flexibility may help people keep moving, avoid injury, and maintain their ability to perform the physical activities that they enjoy and that support health and wellness. Workout activities that promote both flexibility and balance such as Pilates, dance, and stretching can positively impact several areas of health, including musculoskeletal health. Research studies suggest that they may also help to improve cardiovascular, cognitive, and mental health.1-3 A range of movement and exercise programs may be appropriate for patients depending on their medical situation, personal preferences, and health goals. How might patients benefit from incorporating flexibility and balance training into their daily routine or treatment strategy?
Pilates and Stretching
Pilates is a mind-body training that addresses flexibility and balance; helps to improve postural alignment, core strength, and mobility function; and may benefit chronic pain conditions. A 2022 systematic review of seven studies (n=397 participants) found that compared to other relevant exercises, Pilates was significantly effective at reducing back pain, neck pain, and pain associated with knee osteoarthritis and osteoporosis.4 Specific to chronic low back pain, a 2022 network meta-analysis of randomized controlled trials (n=9,710 subjects) found that while most of the included exercise interventions showed pain management benefit, the most effective interventions for reducing pain were Pilates, mind-body, and core-based exercises.5 In fact, after quantitative ranking analysis, Pilates showed a 93% and 98% likelihood for reducing pain and disability associated with low back pain.5
Pilates training continues to be studied for a range of other health-related benefits. In addition to its potential for improving balance and helping to reduce fall risk in older adults,6 Pilates has most recently been highlighted for several positive health effects, including the improvement of:
- Sleep quality in older adults.7
- Depression symptoms in patients with multiple sclerosis8 and in older women.3
- Functional mobility and balance performance in patients with Parkinson’s disease.9
- Vascular function and blood pressure in populations at risk for hypertension.10-12
Exercise programs focused specifically on active and passive stretching have also been studied for their health benefits. A 2020 meta-analysis of clinical trials (n=213 participants) suggested that muscle stretching exercises may reduce arterial stiffness and improve vascular endothelial function.13 The stretching exercise interventions included in this analysis extended between four and 12 weeks, with session durations and frequencies ranging from 15 to 60 minutes per stretching session, three to seven times per week.13 Mechanisms by which stretching improves cardiac autonomic function continue to be clarified. Evidence indicates that increases in baroreflex sensitivity, relaxation, and nitric oxide bioavailability may all play important roles.14
A 2022 meta-analysis of 18 randomized controlled trials (n=1,184 subjects) investigated the effect of aerobic, resistance, and stretching exercises on pain, depression, and quality of life for patients with fibromyalgia.15 Among the positive effects of these treatment approaches, stretching exercises were found to reduce pain perception and improve patients’ health-related and overall quality of life.15 Another chronic pain–related meta-analysis evaluated the effectiveness of stretching exercises on reducing pain associated with knee osteoarthritis.16 Eighteen randomized controlled trials (n=1,250 participants) were included in the analysis, and overall, per visual analogue scale measurements, stretching exercises significantly reduced osteoarthritis pain in patients.16
Balance and Ballet
Research studies suggest that different forms of aerobic dance benefit heart and brain health.17,18 Both balance and flexibility may also improve when engaging in dance therapies. A 2020 meta-analysis of 29 randomized controlled trials found that for older healthy adults, dance-based mind-motor activities were significantly associated with improved balance, mobility, and lower body strength.19 Further, researchers found a statistically significant 37% reduction in fall risk and a statistically significant 31% reduced rate of falls with these interventions.19
Ballet is one form of dance that can be practiced at all ages that emphasizes posture, flexibility, and balance. A 2020 systematic review investigating classical ballet training interventions lasting four weeks or longer found that for novice dancers, balance showed the greatest positive change among reported physical outcomes, with 75% of the included studies reporting improvement.20 The benefit of dance therapies, primarily ballet and tango, for stroke patients was evaluated in a 2022 systematic review of eight studies.21 While the heterogeneity was high for the included studies, results indicated an overall positive effect of dance therapy on post-stroke body functions such as gait and balance.21
Beyond the scope of specific dance modalities, the health benefits of balance training and core conditioning continue to be studied as essential components of comprehensive exercise programs. As an important example, a recent retrospective study that included 453 Veterans (mean age of 67 years; 94% male; 43% white and 50% Black participants) examined the changes in prescription medication utilization after 12 months (three days weekly) of supervised exercise as part of the Veterans Affairs Gerofit Exercise Program.22 This program includes a personalized routine of aerobic, strength, balance, mind-body, and core support training. In the studied cohort, the supervised exercise was associated with reductions in medication usage. Compared to baseline levels, investigators noted the net changes of 33% decrease in both opioids and mental health medications, 38% decrease in cardiac medications, 14% decrease in diabetes medications, and 17% decrease in lipid-lowering medications.22
Conclusion
In the functional medicine model, modifiable lifestyle factors such as physical activity are essential chronic disease intervention components. Exercise routines and increased movement specifically contribute to improved physiological fitness, and research continues to emphasize the importance of musculoskeletal health and maintaining muscle flexibility for optimal physical function.
Exercise prescriptions that focus on flexibility and balance are among those functional medicine strategies that may be appropriate for a patient’s treatment or prevention plan. These activities can easily fit into therapeutic interventions, and they can be fun for the patient. Personalizing treatments by aligning exercise programs with a patient’s preferences and goals helps patients achieve sustainable health improvements and positive lifestyle change. The IFM Toolkit offers practitioners a wide range of tools and resources, including those specific to exercise, from setting exercise goals and tracking treatment progress to tips for increasing daily movement and sustaining an active lifestyle to resources for wearable fitness devices.
Many different types of physical activities, from stretching to Pilates to high intensity training,23 are all beneficial for heart health. At IFM’s upcoming Cardiometabolic Advanced Practice Module (APM), learn more about the latest research on cardiovascular and metabolic health and those exercise treatment strategies that effectively address chronic cardiovascular diseases and risk factors.
Related Articles
Exercise Routines: Movement for a Fit Heart
Slowing Neurodegeneration With Exercise
Postures and Pressure Points – Strategies for PD Improvement
References
- Thomas E, Bellafiore M, Gentile A, Paoli A, Palma A, Bianco A. Cardiovascular responses to muscle stretching: a systematic review and meta-analysis. Int J Sports Med. 2021;42(6):481-493. doi:1055/a-1312-7131
- Rodziewicz-Flis EA, Kawa M, Skrobot WR, et al. The positive impact of 12 weeks of dance and balance training on the circulating amyloid precursor protein and serotonin concentration as well as physical and cognitive abilities in elderly women. Exp Gerontol. 2022;162:111746. doi:1016/j.exger.2022.111746
- Soori S, Heirani A, Rafie F. Effects of the aerobic and Pilates exercises on mental health in inactive older women. J Women Aging. 2022;34(4):429-437. doi:1080/08952841.2021.1924576
- Denham-Jones L, Gaskell L, Spence N, Pigott T. A systematic review of the effectiveness of Pilates on pain, disability, physical function, and quality of life in older adults with chronic musculoskeletal conditions. Musculoskeletal Care. 2022;20(1):10-30. doi:1002/msc.1563
- Fernández-Rodríguez R, Álvarez-Bueno C, Cavero-Redondo I, et al. Best exercise options for reducing pain and disability in adults with chronic low back pain: Pilates, strength, core-based, and mind-body. A network meta-analysis. J Orthop Sports Phys Ther. 2022;52(8):505-521. doi:2519/jospt.2022.10671
- Donatoni da Silva L, Shiel A, McIntosh C. Effects of Pilates on the risk of falls, gait, balance and functional mobility in healthy older adults: a randomised controlled trial. J Bodyw Mov Ther. 2022;30:30-41. doi:1016/j.jbmt.2022.02.020
- Fank F, Pereira FDS, Dos Santos L, de Mello MT, Mazo GZ. Effects of exercise on sleep in older adults: an overview of systematic reviews and meta-analyses. J Aging Phys Act. 2022;30(6):1101-1117. doi:1123/japa.2021-0444
- Kyriakatis GM, Besios T, Lykou PM. The effect of therapeutic exercise on depressive symptoms in people with multiple sclerosis – a systematic review. Mult Scler Relat Disord. 2022;68:104407. doi:1016/j.msard.2022.104407
- Mustafaoglu R, Ahmed I, Pang MYC. Which type of mind-body exercise is most effective in improving functional performance and quality of life in patients with Parkinson’s disease? A systematic review with network meta-analysis. Acta Neurol Belg. 2022;122(6):1433-1446. doi:1007/s13760-022-02070-4
- Andrade IYTP, Melo KCB, Andrade KTP, Almeida LG, Moreira SR. Pilates training reduces blood pressure in older women with type 2 diabetes: a randomized controlled trial. J Bodyw Mov Ther. 2022;30:168-175. doi:1016/j.jbmt.2022.02.022
- Rocha J, Cunha FA, Cordeiro R, Monteiro W, Pescatello LS, Farinatti P. Acute effect of a single session of Pilates on blood pressure and cardiac autonomic control in middle-aged adults with hypertension.J Strength Cond Res. 2020;34(1):114-123. doi:1519/JSC.0000000000003060
- Wong A, Figueroa A, Fischer SM, Bagheri R, Park SY. The effects of mat Pilates training on vascular function and body fatness in obese young women with elevated blood pressure. Am J Hypertens. 2020;33(6):563-569. doi:1093/ajh/hpaa026
- Kato M, Nihei Green F, Hotta K, et al. The efficacy of stretching exercises on arterial stiffness in middle-aged and older adults: a meta-analysis of randomized and non-randomized controlled trials. Int J Environ Res Public Health. 2020;17(16):5643. doi:3390/ijerph17165643
- Wong A, Figueroa A. Effects of acute stretching exercise and training on heart rate variability: a review. J Strength Cond Res. 2021;35(5):1459-1466. doi:1519/jsc.0000000000003084
- Couto N, Monteiro D, Cid L, Bento T. Effect of different types of exercise in adult subjects with fibromyalgia: a systematic review and meta-analysis of randomised clinical trials. Sci Rep. 2022;12(1):10391. doi:1038/s41598-022-14213-x
- Luan L, El-Ansary D, Adams R, Wu S, Han J. Knee osteoarthritis pain and stretching exercises: a systematic review and meta-analysis. Physiotherapy. 2022;114:16-29. doi:1016/j.physio.2021.10.001
- Peng Y, Su Y, Wang YD, Yuan LR, Wang R, Dai JS. Effects of regular dance therapy intervention on blood pressure in hypertension individuals: a systematic review and meta-analysis. J Sports Med Phys Fitness. 2021;61(2):301-309. doi:23736/S0022-4707.20.11088-0
- Teixeira-Machado L, Arida RM, de Jesus Mari J. Dance for neuroplasticity: a descriptive systematic review. Neurosci Biobehav Rev. 2019;96:232-240. doi:1016/j.neubiorev.2018.12.010
- Mattle M, Chocano-Bedoya PO, Fischbacher M, et al. Association of dance-based mind-motor activities with falls and physical function among healthy older adults: a systematic review and meta-analysis [published correction appears in JAMA Netw Open. 2021;4(1):e2037105]. JAMA Netw Open. 2020;3(9):e2017688. doi:1001/jamanetworkopen.2020.17688
- Letton ME, Thom JM, Ward RE. The effectiveness of classical ballet training on health-related outcomes: a systematic review. J Phys Act Health. 2020;17(5):566-574. doi:1123/jpah.2019-0303
- Ares-Benitez I, Billot M, Rigoard P, Cano-Bravo F, David R, Luque-Moreno C. Feasibility, acceptability and effects of dance therapy in stroke patients: a systematic review. Complement Ther Clin Pract. 2022;49:101662. doi:1016/j.ctcp.2022.101662
- Pepin MJ, Valencia WM, Bettger JP, et al. Impact of supervised exercise on one-year medication use in older veterans with multiple morbidities. Gerontol Geriatr Med. 2020;6:2333721420956751. doi:1177/2333721420956751
- Leal JM, Galliano LM, Del Vecchio FB. Effectiveness of high-intensity interval training versus moderate-intensity continuous training in hypertensive patients: a systematic review and meta-analysis. Curr Hypertens Rep. 2020;22(3):26. doi:1007/s11906-020-1030-z