The Effect of An Acute Bout of Static and Dynamic Stretching on Balance Performance in Older Adults

Jessica Tischendorf, Allison Smith, Cassie Peeters, Emily Haese, Lance Dalleck, PhDUniversity of Wisconsin - Eau Claire

AbstractAs humans age, the ability to maintain stability and avoid injurious falls is of great importance in preserving independence. This study examined the effects of an acute bout of static and dynamic stretching on balance performance in older adults. Participants in this study included 9 males and 6 females, aged 66.1±8.1 (mean±SD) all age 50 or older, who were participating in a regular physical activity program at the time of testing and had varying amounts of exposure to balance training. Balance was assessed using the Fullerton Advanced Balance Scale (FABS) after completing a rest, static and dynamic stretching intervention, on three separate occasions. We found no differences in FABS performance between any experimental treatments. These results suggest the ordering of flexibility and balance training does not pose an increased risk of falls in older adults within an exercise program. IntroductionOne of the primary causes of falls is poor balance. Accordingly, recently published physical activity guidelines from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA), aimed at reducing the risk of falls for older adults, includes the specific recommendation for balance training exercises (1). However, the optimal details of an exercise program for maintaining and improving balance are presently unclear. Additionally, there are no well-controlled research studies available to provide evidence for the most appropriate sequencing of balance exercises within the exercise program (2). Good balance is multi-factorial, and research has demonstrated that one of the factors that impacts balance is strength (3, 4) Although research findings are equivocal (5, 6). it has been reported that pre-exercise static stretching may temporarily decrease the ability of a muscle to generate force, which subsequently could lead to balance perturbations. In fact, Behm and colleagues (7) found that an acute bout of pre-exercise static stretching decreased balance performance in young, healthy adults. Conversely, it has been suggested that acute, pre-exercise dynamic stretching may actually augment muscle strength performance; potentially enhancing balance performance. Although to our knowledge the effect of pre-exercise dynamic stretching on balance has not previously been investigated. The paucity of data on the effect of pre-exercise stretching on balance performance and the overall lack of research on the ideal sequencing of balance exercises within the overall exercise routine prompted the present investigation.

PurposeThe purpose of our study was to examine the effects of acute bouts of static stretching and dynamic stretching on balance performance in older adults. We predicted static stretching would decrease balance performance when compared to no stretching in older adults. We also predicted that dynamic stretching would improve balance performance when compared to no stretching in the older adults.

Participants were scored on ten different balance challenges from the FABS. The ten balance challenges in the scale assess both static and dynamic balance; the challenges and detailed scoring criteria are outlined in table 2. All analyses were performed using Statistical Package for the Social Sciences, Version 15.0 (SPSS, Inc, Chicago, IL). Measures of centrality and spread are presented as mean SD. Mean differences in the cumulative Advanced Fullerton balance score and each individual test score between pre-exercise static stretch, dynamic stretch, and no-stretch groups were assessed with one-way analysis of variance (ANOVA). Tukey’s post hoc tests were performed to determine differences between treatment groups. The probability of making a Type I error was set at p ≤ 0.05 for all statistical analyses.

ResultsMean ± standard deviation for each individual balance challenge and total score are presented in Table 3. Analysis of variance showed no significant (p>0.05) differences in cumulative FABS scores between pre-exercise static stretch, dynamic stretch, and no-stretch groups. Additionally, Friedman Tests completed for each individual balance challenge revealed no significant differences in the individual scores.

Table 2. Fullerton Advance Balance Scale description and scoring1. Stand with feet together and

eyes closed0 Unable to obtain the correct standing position independently1 Able to obtain the correct standing position independently but unable to maintain the position or keep the eyes closed for more than 10 seconds2 Able to maintain the correct standing position with eyes closed for more than 10 seconds but less than 30 seconds3 Able to maintain the correct standing position with eyes closed for 30 seconds but requires close supervision4 Able to maintain the correct standing position safely with eyes closed for 30 seconds

2. Reach forward to retrieve an object (pencil) held at shoulder height with outstretched arm

0 Unable to reach the pencil without taking more than two steps1 Able to reach the pencil but needs to take two steps2 Able to reach the pencil but needs to take one step3 Can reach the pencil without moving the feet but requires supervision4 Can reach the pencil safely and independently without moving the feet

3. Turn 360° in right and left directions

0 Needs manual assistance while turning1 Needs close supervision or verbal cueing while turning2 Able to turn 360° but takes more than four steps in both directions3 Able to turn 360° but unable to complete in four or fewer in one direction4 Able to turn 360° safely taking four steps or fewer in both directions

4. Step up and over a 6-inch bench

0 Unable to step up onto the bench without loss of balance or manual assistance1 Able to step onto bench with leading leg, but trailing leg contacts bench or leg swings around bench during swing-through phase in both directions2 Able to step up onto the bench with leading leg, but trailing leg contacts the bench during the swing-through phase in one direction3 Able to correctly complete the step up and over in both directions but requires close supervision in one or both directions4 Able to correctly complete the step up and over in both directions safely and independently

5. Tandem walk (walking heel to toe on a straight line)

0 Unable to complete 10 steps independently1 Able to complete the 10 steps with more than five interruptions 2 Able to complete the 10 steps with five or fewer interruptions3 Able to complete the 10 steps with two or fewer interruptions4 Able to complete the 10 independently and with no interruptions

6. Stand on one leg (arms crossed eyes open)

0 Unable to try or needs assistance to prevent falling1 Able to lift leg independently but unable to maintain position for more than 5 seconds2 Able to lift leg independently but unable to maintain position for more than 5 but less than 12 seconds3 Able to lift leg independently and maintain position for 12 or more seconds but than less than 204 Able to lift leg independently and maintain position for the full 20 seconds

7. Stand on foam with eyes closed

0 Unable to step onto foam or maintain standing position independently with eyes open1 Able to step onto foam independently and maintain standing position but unable or unwilling to close eyes2 Able to step onto foam independently and maintain standing position with eyes closed for 10 seconds or less3 Able to step onto foam independently and maintain standing position with eyes closed for more than 10 seconds but less than 204 Able to step onto foam independently and maintain standing position with eyes closed for 20 seconds

8. Two-footed jump for distance 0 Unable to attempt or attempts to initiate two-footed jump, but one or both feet do not leave the floor1 Able to initiate two-footed jump, but one foot either leaves the floor or lands before the other2 Able to perform two-footed jump, but unable to jump farther than the length of their own feet3 Able to perform two-footed jump and achieve a distance greater than the length of their own feet4 Able to perform two-footed jump and achieve a distance greater than twice the length of their own feet

9. Walking in a straight line while turning head 30° to the beat of a 100bpm metronome

0 Unable to walk 10 steps independently while maintain 30° head turns at an established pace1 Able to walk 10 steps independently but unable to complete required number or 30° head turns at an established pace2 Able to walk 10 steps but veers from s straight line while performing 30° head turns at an established pace3 Able to walk 10 steps in straight line while performing 30° head turns at an established pace but head turns less than 30° in one or both directions4 Able to walk 10 steps in a straight line while performing 30° head turns at an established pace

10. Reactive postural control (falls back into testers hand)

0 Unable to maintain upright balance; no observes attempt to step; requires manual assistance to restore balance1 Unable to maintain upright balance; takes two or more; requires manual assistance to restore balance2 Unable to maintain upright balance; takes two or more steps and requires manual assistance to restore balance3 Unable to maintain upright balance; takes one to two steps but is able to restore balance independently4 Unable to maintain upright balance but able to restore balance independently with only one step

Males (n=9)

Range Females

(n=6) Range

Combined (n=15)

Range

Age (years) 66.3±8.0 57 – 85 65.7±9.0 52 – 76 66.1±8.1 52 – 85

Height (cm) 176.8±7.0 164-186.5 161.9±7.3 150 – 168.5 170.9±10.2 150 – 186.5

Weight (kg) 99.6±11.4 78.2 – 118.6 72.5±6.7 62.8 – 80 88.7±16.7 62.8 – 118.6

BMI (kg/m2) 32.1±5.2 26.6 – 44.1 27.8±4.7 24.3 – 35.6 30.4±5.3 24.3 – 44.1

Systolic BP (mmHg) 135.3±16.1 118 – 152 132.7±7.3 122 - 142 134.3±13.0 118 - 152

Diastolic BP (mmHg) 76.4±10.7 64 – 98 79.2±8.0 72 – 90 77.5±9.5 64 - 98

RHR (b/m) 63.7±11.2 43 - 84 63.2±17.9 40 - 84 63.5±13.7 40 - 84

Waist-to-hip ratio 0.94±0.05 0.88 – 1.02 0.77±0.1 0.62 – 0.88 0.87±0.1 0.62 – 1.02

VO2max (ml/kg/min) (n = 11)

30.1 ± 10.9 10 – 42.8 30.2 ± 5.7 24 - 39 30.2 ± 8.6 10 – 42.8

Table 1. Physical and physiological characteristics of participants.

Mean SD

Fig. 1A Fig. 1B

Fig. 1C Fig. 1D

Fig. 1E

Fig. 2A

Fig. 2EFig. 2D

Fig. 2CFig. 2B

*1A. Side lunge, 1B. High knees, 1C. Leg kicks, 1D. Walking calf raises, 1E. Butt kicks.**2A. Butterfly, 2B. pretzel stretch, 2C. seated leg extension, 2D. calf stretch, 2E. quad stretch.

Figure 1. Dynamic stretching exercises.* Figure 2. Static stretching exercises.**

MethodsParticipants in this study included 9 males and 6 females, all age 50 or older, who were participating in a regular physical activity program at the time of testing. Physical and physiological characteristics of participants are presented in Table 1. Participants were risk stratified prior to beginning the program and high risk participants obtained physician consent to participate. All participants completed an informed consent and the University Human Subjects Institutional Review Board approved all procedures.  The stretching interventions consisted of 15 minutes of dynamic stretching, 15 minutes of static stretching, or a control session of no stretching that required the participant to sit quietly for an equivalent 15 minutes. Five stretching exercises were used for both the dynamic (Figure 1) and static (Figure 2) interventions and were designed to include one stretch each for the hips, calves, and quadriceps, and two for the hamstrings.

Table 3. Individual and cumulative Fullerton Advanced Balance Scale scores.

Summary and Conclusions Our results demonstrate no significant difference in balance

performance based on stretching intervention in individual balance challenges or cumulative FABS scores.

Previous research has suggested static stretching impairs maximum strength and power performance—both are factors which have been identified as contributors to balance performance; so it was necessary to further investigate this relationship.

These findings suggest static stretching prior to a session of balance training will not increase the risk of falls in older adults.

In addition, our results indicate an older adult performing the flexibility portion of their exercise program at the end of a session does not put themselves at greater risk of falls when resuming activities of daily living following the exercise session.

In their recent physical activity recommendations, the AHA and ACSM specifically recommend the inclusion of balance training exercises to decrease the risk of falls.

Prior to this investigation, there were no well-controlled studies detailing the most appropriate sequencing of balance exercises within the exercise program.

The current study suggests the performance of balance training exercises immediately following an acute bout of static stretching consistent with ACSM flexibility recommendations does not increase the risk of injurious balance disturbances.

AcknowledgementsThis study was supported by the Department of Kinesiology

at the University of Wisconsin – Eau Claire.

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No Stretch Dynamic Stretch Static Stretch FAB Scale Item

X±SD Mean Rank

X±SD Mean Rank

X±SD Mean Rank

P value

1. Stand w/ feet together, eyes closed 4.0 ± 0.0 2.0 4.0 ± 0.0 2.0 4.0 ± 0.0 2.0 1.000

2. Forward reach 3.9 ± 0.4 1.9 4.0 ± 0.0 2.1 4.0 ± 0.0 2.1 0.135

3. 360° turn 2.0 ± 0.0 1.9 2.1 ± 0.5 2.0 2.1 ±0.3 2.0 0.607

4. Step up and over 3.1 ± 1.2 1.8 3.9 ± 0.5 2.3 3.3 ± 1.2 1.9 0.099

5. Tandem walk 3.8 ± 0.4 2.1 3.7 ± 0.6 1.9 3.7 ± 0.6 2.0 0.651

6. One-leg stand 3.0 ± 1.4 2.0 2.8 ± 1.3 1.8 3.2 ± 1.2 2.2 0.343

7. Stand on foam, eyes closed 3.9 ± 0.5 2.0 3.9 ± 0.3 2.1 3.8 ± 0.6 1.9 0.670

8. 2-foot jump 3.7 ± 0.8 2.0 3.7 ± 0.8 2.0 3.7 ± 0.8 2.0 1.000

9. Walk with head turns 3.8 ± 0.8 2.2 3.3 ± 1.0 1.7 3.8 ± 0.4 2.1 0.069

10. Reactive Postural Control 2.7 ± 0.6 2.0 2.7 ± 0.9 2.1 2.4 ± 0.6 1.9 0.674

Total score 33.7 ± 2.1 34.1 ± 2.6 34.0 ± 2.9 0.929