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      Reduced Body Flexibility Is Associated With Poor Survival in Middle‐Aged Men and Women: A Prospective Cohort Study

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          Summary

          Flexibility is defined as the maximal physiological passive range of motion (ROM) in a given joint movement and it is specific for joints and movements which justify why several movements and joints should be included in the evaluation of body flexibility. Developed by Dr. Claudio Gil Araújo in late 70's, the Flexitest, an assessment tool for evaluating the maximal passive ROM in 20 body movements (7 joints), was utilized in this study. Flexitest is safe, simple to apply and no equipment is required for its application but only the availability of the evaluation maps. Each movement is scored from 0 to 4 by a visual comparison between the maximal passive ROM obtained by the evaluator and the evaluation maps (scores increase for higher mobility) (see an example in the figure 1 of the study - thumbnail). When the amplitude reaches position 2 on the map, score 2 is given until the maximum ROM reaches the level of score 3. 

          A Youtube 1-min Flexitest's demo video is freely available at https://www.youtube.com/watch?v=nDt8xm3jBqc

          FLEXITEST: STUDY’S MAIN IMPLICATIONS

          Flexibility is finally confirmed as a health-related physical fitness variable, since it is related to the most objective and relevant health outcome – natural mortality; 

          More attention and emphasis should be given to flexibility exercises;

          There is a need to evaluate the passive ROM in several joint movements (Flexitest is likely the best available option) to generate an individualized prescription of flexibility or stretching exercises.

          ABSTRACT

          Objectives

          Flexibility is recognized as one of the components of physical fitness and commonly included as part of exercise prescriptions for all ages. However, limited data exist regarding the relationship between flexibility and survival. We evaluated the sex‐specific nature and magnitude of the associations between body flexibility and natural and non‐COVID‐19 mortality in a middle‐aged cohort of men and women.

          Design

          Prospective cohort study.

          Methods

          Anthropometric, health and vital data from 3139 (66% men) individuals aged 46–65 years spanning from March 1994 to October 2022 were available. A body flexibility score, termed Flexindex, was derived from a combination of 20 movements (scored 0–4) involving seven different joints, resulting in a score range of 0–80. Kaplan–Meier survival curves were obtained, and unadjusted and adjusted hazard ratios (HRs) for mortality estimated.

          Results

          During a mean follow‐up of 12.9 years, 302 individuals (9.6%) comprising 224 men/78 women died. Flexindex was 35% higher in women compared to men (mean ± SD: 41.1 ± 9.4 vs. 30.5 ± 8.7; p < 0.001) and exhibited an inverse relationship with mortality risk in both sexes ( p < 0.001). Following adjustment for age, body mass index, and health status, the HR (95% CI) for mortality comparing upper and bottom of distributions of Flexindex were 1.87 (1.50–2.33; p < 0.001) for men and 4.78 (1.23–31.71; p = 0.047) for women.

          Conclusions

          A component of physical fitness—body flexibility—as assessed by the Flexindex is strongly and inversely associated with natural and non‐COVID‐19 mortality risk in middle‐aged men and women. Future studies should assess whether training‐induced flexibility gains are related to longer survival.

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          Exercise capacity and mortality among men referred for exercise testing.

          Jonathan Myers, Manish Prakash, Victor Froelicher … (2002)
          Exercise capacity is known to be an important prognostic factor in patients with cardiovascular disease, but it is uncertain whether it predicts mortality equally well among healthy persons. There is also uncertainty regarding the predictive power of exercise capacity relative to other clinical and exercise-test variables. We studied a total of 6213 consecutive men referred for treadmill exercise testing for clinical reasons during a mean (+/-SD) of 6.2+/-3.7 years of follow-up. Subjects were classified into two groups: 3679 had an abnormal exercise-test result or a history of cardiovascular disease, or both, and 2534 had a normal exercise-test result and no history of cardiovascular disease. Overall mortality was the end point. There were a total of 1256 deaths during the follow-up period, resulting in an average annual mortality of 2.6 percent. Men who died were older than those who survived and had a lower maximal heart rate, lower maximal systolic and diastolic blood pressure, and lower exercise capacity. After adjustment for age, the peak exercise capacity measured in metabolic equivalents (MET) was the strongest predictor of the risk of death among both normal subjects and those with cardiovascular disease. Absolute peak exercise capacity was a stronger predictor of the risk of death than the percentage of the age-predicted value achieved, and there was no interaction between the use or nonuse of beta-blockade and the predictive power of exercise capacity. Each 1-MET increase in exercise capacity conferred a 12 percent improvement in survival. Exercise capacity is a more powerful predictor of mortality among men than other established risk factors for cardiovascular disease.
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            International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines

            Mikel Izquierdo, R. Merchant, J E Morley … (2021)
            The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.
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              Population Research: Convenience Sampling Strategies.

              Samuel J Stratton (2021)
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                Author and article information

                Contributors
                Claudio Gil S. Araújo: (View ORCID Profile)
                Setor K. Kunutsor: (View ORCID Profile)
                Jari A. Laukkanen: (View ORCID Profile)
                Journal
                Title: Scandinavian Journal of Medicine & Science in Sports
                Abbreviated Title: Scandinavian Med Sci Sports
                Publisher: Wiley
                ISSN (Print): 0905-7188
                ISSN (Electronic): 1600-0838
                Publication date Created: August 2024
                Publication date (Electronic): August 21 2024
                Publication date (Print): August 2024
                Volume: 34
                Issue: 8
                Affiliations
                [1 ] Exercise Medicine Clinic – CLINIMEX Rio de Janeiro Brazil
                [2 ] Diabetes Research Centre, Leicester General Hospital University of Leicester Leicester UK
                [3 ] Section of Cardiology, Department of Internal Medicine Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba Winnipeg Manitoba Canada
                [4 ] William Beaumont University Hospital Corewell Health East Royal Oak Michigan USA
                [5 ] Department of Medicine, Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
                [6 ] Department of Medicine Wellbeing Services County of Central Finland Jyväskylä Finland
                [7 ] Division of Cardiology VA Palo Alto Health Care System and Stanford University Palo Alto California USA
                [8 ] Exercise and Sport Science, Faculty of Medicine and Health, School of Health Sciences and Sydney Medical School University of Sydney Sydney Australia
                Article
                DOI: 10.1111/sms.14708
                SO-VID: a53a3ef3-6c85-48fe-aff7-0ea3d3eda096
                Copyright © © 2024
                License:

                http://onlinelibrary.wiley.com/termsAndConditions#vor

                History

                Data availability: The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
                ScienceOpen disciplines: Medicine
                Keywords: physical fitness,CLINIMEX,cohort study,joint motion,exercise,physical activity
                Data availability: The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
                ScienceOpen disciplines: Medicine
                Keywords: physical fitness, CLINIMEX, cohort study, joint motion, exercise, physical activity

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