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The Case for Retiring Flexibility As a Major Component of Physical Fitness

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The Case for Retiring Flexibility As a Major Component of Physical Fitness Sports Medicine https://doi.org/10.1007/s40279-019-01248-w CURRENT OPINION The Case for Retiring Flexibility as a Major Component of Physical Fitness James L. Nuzzo1,2 © Springer Nature Switzerland AG 2019 Abstract Flexibility refers to the intrinsic properties of body tissues that determine maximal joint range of motion without causing injury. For many years, fexibility has been classifed by the American College of Sports Medicine as a major component of physical ftness. The notion fexibility is important for ftness has also led to the idea static stretching should be prescribed to improve fexibility. The current paper proposes fexibility be retired as a major component of physical ftness, and conse- quently, stretching be de-emphasized as a standard component of exercise prescriptions for most populations. First, I show fexibility has little predictive or concurrent validity with health and performance outcomes (e.g., mortality, falls, occupa- tional performance) in apparently healthy individuals, particularly when viewed in light of the other major components of ftness (i.e., body composition, cardiovascular endurance, muscle endurance, muscle strength). Second, I explain that if fexibility requires improvement, this does not necessitate a prescription of stretching in most populations. Flexibility can be maintained or improved by exercise modalities that cause more robust health benefts than stretching (e.g., resistance training). Retirement of fexibility as a major component of physical ftness will simplify ftness batteries; save time and resources dedicated to fexibility instruction, measurement, and evaluation; and prevent erroneous conclusions about ftness status when interpreting fexibility scores. De-emphasis of stretching in exercise prescriptions will ensure stretching does not negatively impact other exercise and does not take away from time that could be allocated to training activities that have more robust health and performance benefts. 1 Flexibility Defned objective [2, 3] and is assessed with force sensors, isokinetic dynamometers, and shear wave elastography. Flexibility refers to the intrinsic properties of body tissues The current paper is concerned with static fexibility and that determine maximal joint range of motion (ROM) with- the sit-and-reach test. The sit-and-reach requires participants out causing injury [1, 2]. Static fexibility refers to joint to sit on the foor or in a chair and reach toward their toes. ROM usually in relaxed muscle [2, 3]. Static fexibility is This test is used in school ftness batteries in the United subjective, as the limit ROM is determined by the tester or States [12, 13]. The American College of Sports Medi- the patient and their stretch tolerance [2, 3]. Tools used to cine (ACSM) states the sit-and-reach should be included in assess static fexibility include rulers, goniometers, electro- health-related physical testing due to the “relative importance goniometers, inclinometers, feximeters, photography, vis- of hamstring fexibility to activities of daily living and sports ual estimations, and three-dimensional kinematics [4–11]. performance…” [14]. Numerous studies have examined the Dynamic fexibility refers to stifness of the muscle-tendon validity and reliability of the sit-and-reach [4, 15–50]. The unit within normal ROM [2, 3]. Dynamic fexibility is more test is reliable and primarily measures hamstrings fexibility. 2 Brief History of Flexibility in the United * James L. Nuzzo States [email protected] Clinical tests have been used to measure static fexibil- 1 Neuroscience Research Australia, Barker Street, Randwick, NSW, Australia 2031 ity (hereafter termed “fexibility”) in intact humans since the early 1900s [11, 51]. In 1941, Cureton summarized 2 School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia research on fexibility [52]. He discussed ways fexibility Vol.:(0123456789) J. L. Nuzzo health benefts [51]. The same year, the American Alliance Key Points for Health, Physical Education, Recreation and Dance estab- lished the frst national health-related physical ftness battery Flexibility has been considered a major component of [12]. It included the sit-and-reach. physical ftness for many years, and signifcant time and Today, fexibility is conceptualized as part of physical resources are devoted to its instruction, measurement, ftness. The Department of Health and Human Services and evaluation. says fexibility is “an important component of physical This paper proposes fexibility be retired as a major ftness” [65]. The American College of Sports Medicine component of physical ftness because it has little predic- (ACSM) says flexibility is “important in athletic per- tive or concurrent validity with meaningful health and formance (e.g., ballet, gymnastics) and in the ability to performance outcomes in apparently healthy individu- carry out activities of daily living” and “maintaining fex- als, particularly when viewed in light of the other major ibility…may prevent injury” [14]. The ACSM considers components of physical ftness (i.e., body composition, fexibility along with body composition, cardiovascular cardiovascular endurance, muscle endurance, muscle endurance, muscle endurance, and muscle strength, the strength). fve components of health-related physical ftness [14] (hereafter termed “major components”). Because the fundamental purpose of stretching is to The notion fexibility is important for physical ftness improve fexibility, this paper also proposes stretching has led to the idea fexibility exercises (i.e., stretching) be does not need to be a standard component of exercise prescribed to improve ROM. The ACSM says: “it is rea- prescriptions for most populations. Other activities that sonable, based on the available evidence, to recommend cause more robust health benefts (e.g., resistance train- individuals engaging in a general ftness program perform ing) are sufcient for improving or maintaining fexibil- fexibility exercise following cardiorespiratory or resist- ity, if desired. ance exercise—or alternatively—as a stand-alone program [14].” The ACSM recommends 2–3 days of stretching per week (2–4 repetitions of multiple stretches per day) [14, was assessed, explained fndings from studies that compared 66]. In the United States, 80% of personal trainers say they fexibility in diferent groups, and described stretches to prescribe static stretching [67]. An international survey improve fexibility [52]. He did not state explicitly fexibil- revealed 53% of physically active adults normally stretch, ity should be a component of physical ftness, but his paper 60% stretch for 5–10 min per exercise session, and 23% gave credence to the idea. stretch for over 10 min per session [68]. Throughout the 1950s and 1960s, researchers contin- ued to study and discuss fexibility [53–62]. In 1952, Wells and Dillon created the sit-and-reach—a modifcation of the 3 Aim “Standing, Bobbing,” which required participants to stand on a bench and bob down to their toes [50]. In 1954, Kraus and The current paper proposes fexibility be retired as a major Hirschland reported American youth exhibited worse physi- component of physical ftness. In Sect. 4, I explain fexibil- cal ftness (including fexibility) than European youth [58]. ity has little predictive or concurrent validity with health Their results led to the creation of the President’s Council on and performance outcomes, particularly when assessed by Physical Youth Fitness and school ftness testing [12, 63]. In the sit-and-reach and when compared to other ftness com- 1958, Guilford wrote physical educators have “recognized ponents. In Sect. 5, I explain the case for retiring fexibility for a long time that fexibility of movement is important in is also the case for decreased emphasis on stretching as a athletic training” [64]. In 1960, Leighton wrote about the standard or necessary component of exercise prescriptions “signifcance of fexibility for physical educators” [59]. In for most populations. Static stretching does not clearly 1962, Nick and Fleishman classifed fexibility as one of and consistently improve health and function. Moreover, the fve components of “physical profciency” [60]. The fol- fexibility can be maintained or improved by exercise lowing year, Fleishman included tests of “extant fexibility” modalities that cause more robust health benefts than in a factor analysis that attempted to establish valid tests stretching (e.g., resistance training). In Sect. 6, I describe for each component of ftness [54]. In 1968, Holland com- potential implications of decreased emphasis on flex- municated skepticisms and uncertainties about fexibility, ibility and stretching. In Sect. 7, I counter potential mis- and concluded fexibility and human motor performance are interpretations of my position and provide fnal thoughts “probably not as highly correlated as traditionally believed” on the paradox between the lack of evidence supporting [56]. In 1980, Corbin and Noble called fexibility a “major fexibility and its continued status as a major component component of physical ftness” and made claims about its of ftness. Flexibility as a Component of Fitness 4 Case for Retiring Flexibility as a Major greater in individuals who report greater life satisfaction Component of Physical Fitness [109–111]. Other studies have not observed a relationship between fexibility and quality of life, but they have observed 4.1 Mortality relationships with other ftness measures and quality of life [112–114]. Flexibility,
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