Reis dos et al.

BMC Sports Science, Medicine and Rehabilitation (2024) 16:11 BMC Sports Science, Medicine
https://doi.org/10.1186/s13102-024-00808-6
and Rehabilitation

RESEARCH Open Access

Effects of stretching in a pilates program

on musculoskeletal fitness: a randomized
clinical trial
Alex Lopes dos Reis1 , Laís Campos de Oliveira1 and Raphael Gonçalves de Oliveira1,2*

Abstract
Background The scientific literature questions the impact of stretching exercises performed immediately before
muscle strengthening exercises on different components of musculoskeletal physical fitness. Pilates is a physical
exercise modality that typically uses stretching exercises preceding muscle-strengthening exercises. However, no
studies have investigated the effects of stretching in a Pilates program on components of musculoskeletal fitness.
The aim of the present study was to verify the effects of stretching in a Pilates exercise program on flexibility, strength,
vertical jump height and muscular endurance.
Methods Thirty-two sedentary young women were randomized into two groups: traditional Pilates (TP), who
performed flexibility and muscle strengthening exercises (n = 16), and nontraditional Pilates (NTP), who only
performed muscle-strengthening exercises (n = 16). Sessions took place 3 times a week for 8 weeks. The following
tests were performed pre- and postintervention: 10-RM knee extensors, vertical jump, handgrip, 1-min sit-ups,
Sorensen and sit-and-reach. The occurrence of adverse events was recorded throughout the intervention and
compared between groups using odds ratio (OR). To compare the results of motor tests between groups, ANCOVA
or Mann‒Whitney U test was used for parametric and nonparametric data, respectively. The data were analyzed by
intention-to-treat.
Results After intervention, the TP was superior to NTP for the sit-and-reach test, with a large effect size (d = 0.87;
p = 0.035), with no differences between groups for the other tests. Intragroup comparisons showed significant
differences (p < 0.05) for TP and NTP for improvement in 10-RM knee extensors and vertical jump measurements,
while only TP showed significant intragroup improvement (p < 0.05) for the sit-and-reach test. A greater chance of
experiencing pain or other discomfort as a result of exercise was shown by NTP (OR = 4.20, CI95% 0.69 to 25.26).
Conclusion Our findings demonstrated that stretching exercises performed at the beginning of sessions in a Pilates
program did not impair or enhance the development of strength, vertical jump height and muscular endurance in
young women. However, only the Pilates program with stretching improved flexibility and reduced the chances of
adverse events such as musculoskeletal pain and other discomfort resulting from the exercise protocol.
ClinicalTrials.gov NCT05538520, prospectively registered on September 16, 2022.

*Correspondence:
Raphael Gonçalves de Oliveira
[email protected]
Full list of author information is available at the end of the article

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Reis dos et al. BMC Sports Science, Medicine and Rehabilitation (2024) 16:11 Page 2 of 11

Keywords Young adult, Warm-Up exercise, Physical fitness, Exercise movement techniques

Background technique has been explored for different applications,

Stretching exercises are widely used in training routines, such as observing its effectiveness in the musculoskel-
typically preceding or following main exercise practice, etal fitness of volleyball [23] and basketball [24] players.
whether the objective is related to rehabilitation [1] or Understanding the impact of stretching exercises used
physical conditioning [2], also aiming at improving per- in Pilates on components of musculoskeletal fitness can
formance in subsequent exercises involving musculoskel- help physical exercise professionals define intervention
etal fitness [3]. In addition, stretching is considered the protocols, whether aimed at rehabilitation or physi-
main exercise to gain flexibility [4], although resistance cal conditioning. With this issue in mind, the aim of the
training alone can promote increased flexibility [5]. How- present study was to verify the effects of stretching in a
ever, the performance of stretching exercises, preceding Pilates program on flexibility, muscle strength, vertical
muscle strengthening exercises, has been questioned in jump height and endurance.
the literature over the last few years [6–8], which evi-
dently can generate doubts in the definition of interven- Methods
tion protocols for the most diverse objectives. Study design
For example, even considering that static stretching This is a randomized clinical trial (prospectively regis-
or techniques such as proprioceptive neuromuscular tered in ClinicalTrials.gov ID NCT05538520) that fol-
facilitation are effective for improving flexibility, studies lowed the recommendations of CONSORT [25]. The
show that performing these forms of stretching, preced- randomization process was performed by a blinded
ing muscle strengthening training, can generate a sig- researcher who was not part of the study team. Random
nificantly lower gain in strength, power and muscular numbers were generated by online software (randomiza-
resistance when compared to its nonperformance [9–11]. tion.com), which distributed participants into two groups
On the other hand, the literature has noted that dynamic of equal size (1:1). The same researcher who performed
stretching does not seem to impair the subsequent devel- the randomization process sealed the opaque envelopes
opment of these components of musculoskeletal fitness containing the group that each participant would be allo-
and may, in some cases, enhance its gain [12, 13]. How- cated and handed it to the main researcher. Subsequently,
ever, most studies within this theme involve acute inter- blind participants individually received the envelope
ventions, which may not reflect long-term effects [14]. numbered according to their entry into the study and
Furthermore, some forms of stretching have not been broke the seal to verify which would be their allocation
investigated, such as the stretching exercises used in the group. In this study, because it is an intervention with
practice of Pilates, which despite having a dynamic char- exercise, it was not possible to blind the participants and
acteristic, are performed at a slow pace, following princi- the therapist responsible for the intervention.
ples such as concentration, breathing, control, precision,
centralization and fluidity [15]. Sample size
It is common in Pilates protocols for stretching exer- The sample calculation was performed using the Bioes-
cises to be performed at the beginning of the session, tat 5.3 program (Instituto Mamirauá, Amazonas, Bra-
preceding muscle strengthening exercises [16–18]. How- zil), taking into account the muscle strength values of
ever, how this impacts a possible harm or benefit in the the lower limbs available in a previous study [26]. In this
development of variables such as strength, power and case, the postintervention mean and standard devia-
muscular endurance is unknown. Pilates is a technique tion for muscle strength of the lower limb evaluated by
used both in cases of rehabilitation and for physical the 10-RM test (kg) in the Leg Press between the group
conditioning, involving stretching exercises and muscle “dynamic stretching combined with resistance training”
strengthening [15, 19]. The popularity of the technique (337.1 ± 37.29) vs. the group “resistance training alone”
has increased; however, scientific research is still in its (374.3 ± 32.07) was used, with test power at 80% and
infancy. In the USA, for example, between 2010 and alpha value at 0.05, which generated the need for at least
2021, an average of 10 million Pilates practitioners were 16 participants in each group, already considering an
registered per year [20]. In Brazil, when grouped along- additional 15%, to avoid a decrease in statistical power in
side yoga, gymnastics and stretching, it is characterized case of sample loss.
as the sixth most practiced physical activity [21].
Although Pilates exercises are often associated with the Participants
treatment of low back pain and have been demonstrated The sample consisted of 32 female participants who
to be effective for this purpose [22], in recent years, the were insufficiently active and apparently healthy; the
Reis dos et al. BMC Sports Science, Medicine and Rehabilitation (2024) 16:11 Page 3 of 11

Table 1 Baseline characteristics of participants Table 2 Resistance of elastic bands for assessments of the
TP (n = 16) NTP (n = 16) 10-RM knee extensors
Age (years) 27.44 (5.70) 29.00 (7.59) Thera-Band Number Initial Knee Extensors
Body mass (kg) 56.06 (5.99) 55.47 (4.45) color of layers length Terminal Re-
(cm) length sis-
Height (cm) 160.69 (5.95) 161.69 (4.79)
(%) tance
BMI (kg/m2) 21.64 (1.49) 21.19 (1.76)
(kg)
Data are expressed as the mean and standard deviation
Black 4 70 160 22.9
TP: Traditional Pilates; NTP: Non-Traditional Pilates; BMI: body mass index
65 180 25.0
60 203 27.5
participants were subdivided into two groups of equal Silver 4 75 143 29.5
size (Table 1). Recruitment was carried out in the city of 70 160 32.2
Ibaiti, state of Paraná, Brazil, through poster advertise- 65 180 35.3
ments posted in public places and advertisements on 60 203 38.9
social media. The ethical norms established in the Dec- 55 231 43.2
laration of Helsinki (1975, revised in 1983) were followed, Gold 4 75 143 47.4
and the study was approved by the Human Research Eth- 70 160 51.7
ics Committee of the Universidade Estadual do Norte do 65 180 56.5
Paraná, Brazil, before its beginning under the opinion 60 203 62.3
number 5.548.126. All participants signed an informed 55 231 69.0
consent form. 50 264 77.1
Inclusion criteria were as follows: a) being aged 45 304 87.0
Adapted from Guex, Daucourt and Borloz [29]
between 18 and 45 years old; (b) having a body mass
index (BMI) between 18.5 and 24.9 kg/m2 (normoweight
individuals); (c) not participating in physical exercise pro- five-minute interval between each test, and the tests were
grams for at least six months; (d) being healthy, according performed in the same order of execution for all partici-
to the Physical Activity Readiness Questionnaire (PAR- pants pre- and postintervention.
Q) [27]; (e) not reporting any known medical restric-
tions on physical exercise; (f ) having no history of injury, 10-RM knee extensors
trauma or illness in the last six months; (g) not having The muscle strength of the knee extensors was assessed
undergone previous surgery in the last six months; (h) using elastic bands (Thera Band GmbH, Hadamar, Ger-
not having cardiorespiratory and neurological musculo- many) as previously described [29]. Three elastic bands
skeletal disorders; (i) not being under the action of drugs (black, silver and gold) were used, which, depending on
that cause muscle relaxation or that may inhibit muscle the number of layers and initial length, allowed fifteen
tonic action; (j) not using dietary supplements or ana- different resistances, represented in kg, known from the
bolic steroids; (k) not being on a calorie-restricted diet; percentage of displacement (Table 2) [29, 30]. The par-
and (l) being insufficiently physically active according to ticipants were positioned on the seat of a standardized
the IPAC short version [28]. chair and were tested on their dominant side. For the
Exclusion criteria were: (a) starting the practice of any evaluation, the elastic band was attached immediately
type of physical exercise during the study period; (b) proximal to the lateral malleolus of the participants and
refusal to participate in assessment or intervention pro- on a backrest positioned behind the chair (~ 40 cm below
cedures; (c) emergence of injuries or other intercurrence the knee and ~ 160 cm behind this articulation). Partici-
during the intervention period; (d) withdrawal from par- pants were asked to perform the maximum number of
ticipating in the study. repetitions with an elastic band of intermediate resis-
tance (black). If they were able to perform 11 repetitions,
Assessment procedures an elastic band of greater resistance was selected for the
Motor tests chosen as indicators of strength, vertical next attempt. This procedure was repeated (maximum
jump height, muscular endurance and flexibility were of 5 attempts with 5 min of rest between attempts) until
administered. These tests were administered at two the participant was able to perform 10 or fewer repeti-
times: (1) in the week before the interventions (preinter- tions. The following prediction equation was then used:
vention assessment) and (2) in the week following the end 1-RM = resistance in kg/(1.0278 – [0.0278 × reps]) [31].
of the interventions (postintervention assessment). Prior Therefore, a 10-RM test was performed dynamically and
to the motor tests, all participants underwent a 10-min- with consecutive repetitions, but the values were subse-
ute warm-up on a cycle ergometer (60 rpm, 80 W). The quently adjusted to represent the 1-RM according to the
same evaluator performed all motor tests, respecting a procedure indicated in the validation study of this test
Reis dos et al. BMC Sports Science, Medicine and Rehabilitation (2024) 16:11 Page 4 of 11

[29]. This test demonstrated high validity against peak one minute. The result was recorded as the number of
concentric exchange measured by an isokinetic dyna- correct repetitions performed in one minute. This test
mometer (r = 0.93) and test-retest reliability (ICC ≥ 0.98, demonstrated high test-retest reliability (ICC = 0.91) [34].
CV [%] ≤ 3.44) [29].
Sorensen
Vertical jump To evaluate the muscular endurance of the trunk exten-
The countermovement jump test (sargent jump) was sors, the Sorensen test was used. The participant had to
used to measure vertical jump height in cm. The objec- be in ventral decubitus with the lower extremity of the
tive of the test was to verify the highest height at the peak body affixed to a stretcher, with the region of the anterior
of the vertical jump, measuring two points marked on the superior iliac crest demarcating the final point of sup-
wall by the participant himself, with the fingers of one of port. Before starting the test, the participant was allowed
the hands dirty with chalk: (1) the initial measurement to rest the upper extremity of the body, located outside
was obtained with the participant standing and erect, the stretcher, on a chair. The test started when the par-
keeping the dominant arm extended parallel and above ticipant raised her torso and remained without leaning
the head, marking the wall with chalk as high as possi- on the chair, with her arms crossed in front of her chest,
ble, keeping the soles of the feet fully in contact with the and kept her torso parallel to the ground for as long as
floor; (2) the second measurement was obtained with the possible. The test was interrupted when the participant
participant touching the wall with the fingers of the hand could no longer sustain the position or was warned more
as high as possible during the peak of the vertical jump. than 2 times to align the trunk and maintain the neutral
Three attempts were allowed with intervals of two min- position. The test results were recorded within seconds.
utes between them, and the highest value in centimeters This test demonstrated moderate to high test-retest reli-
among the three attempts was recorded. This test dem- ability in healthy adults (ICC ≥ 0.76 ≤ 0.97) [35].
onstrated high validity (r = 0.99) and test-retest reliability
(r = 0.99) [32]. Sit-and-reach
To assess the flexibility of the posterior region of the
Handgrip body, the sit-and-reach test with the Wells bench was
To determine handgrip strength, a digital hydraulic dyna- used. The participant had to sit facing the bench, with
mometer (Saehan SH1001) was used. The participant had bare feet, knees extended and the soles of the feet in con-
to be in a sitting position, with an erect spine and knees tact with the bench. The participant extended her arms
flexed at 90°. The dominant upper limb tested was posi- over the surface of the bench, with her hands positioned
tioned with the shoulder in adduction and neutral rota- one over the other, coinciding with the tip of her middle
tion, wrist in neutral position and elbow at a 90° angle. fingers. Trunk forward flexion was requested, keeping
Participants were instructed to perform three repetitions the arms extended and the hand touching the measure-
of maximum contraction maintained for five seconds, ment scale, trying to reach the greatest possible distance
with a 60-second interval between each repetition. The in a slow movement and without jerks. For the purpose
maximum voluntary contraction was determined by the of the final result of the test, the greatest distance in
highest value obtained in kg from the three attempts. centimeters achieved in the series of three attempts was
This instrument demonstrated excellent validity (r ≥ 0.97) computed. This test demonstrated high test-retest reli-
and test-retest reliability (r ≥ 0.98) [33]. ability (r = 0.98) [36].

1-min sit-ups Pilates protocol

To evaluate abdominal muscle endurance, the 1-min sit- The intervention consisted of 24 sessions of Pilates exer-
ups test was performed. In dorsal decubitus, the partici- cises performed three times a week for 8 weeks. Each ses-
pant had to flex her knees, keeping the soles of her feet sion lasted 50 min in the Traditional Pilates (TP) group
in contact with the ground, with her feet separated at a and 40 min in the Non-Traditional Pilates (NTP) group.
distance identical to the width of her hips. Her arms were The sessions took place on Mondays, Wednesdays and
crossed over her chest. The evaluator rested his hands on Fridays in the afternoon. The equipment used to perform
the participant’s feet to keep them in permanent contact the exercises was as follows: Step Chair, Cadillac Trape-
with the ground. At the signal emitted by the evaluator, zio, Reformer Universal and Ladder Barrel (ISP, Brazil).
the participant raised the trunk until the anterior face of The TP and NTP protocols were identical, except for
the forearms came into contact with the thighs, returning the fact that TP performed stretching exercises at the
shortly afterwards to the initial position, with the contact beginning of the sessions and NTP did not (Table 3). TP
of at least the anterior half of the scapulae on the ground. performed a total of 20 exercises, while NTP performed
These movements had to be repeated over the course of 15 exercises. Participants were instructed to follow the
Reis dos et al. BMC Sports Science, Medicine and Rehabilitation (2024) 16:11 Page 5 of 11

Table 3 Sequence of Pilates exercises adverse events resulting from the interventions. Any
Type of exercise Exercise name Equip- reported adverse events were noted on the individual
ment/
form used to record the training.
accessory
Stretching* Stretching the Chain Reformer
Posterior Data analysis
Front Splits Modified Reformer Data normality was verified using the Shapiro‒Wilk test.
Stomach Massage: Reformer To verify whether the groups presented differences at the
Round beginning of the study, Student’s t test for independent
Stretches Front Ladder samples was used. Intragroup alterations pre and postint-
Barrel ervention were analyzed using Student’s t test for depen-
Stretches Back: Quadri- Ladder dent samples for parametric data and the Wilcoxon test
ceps Stretch Barrel
for nonparametric data. To verify differences between
Core Strengthening Bridge Magic
groups, analysis of covariance (ANCOVA) was per-
Circle/Ball
formed, with postintervention data used as the depen-
The Hundred Ball
Teaser Mini Barrel
dent variable and preintervention data as the covariate.
Swan Mini Barrel
The homogeneity of variances was determined by Lev-
Swimming Mini Barrel
ene’s test. For nonparametric data, differences between
Lower limbs strengthening Footwork Double Leg Step Chair groups at postintervention were calculated using the
Pumps Mann‒Whitney U test.
Pump One Leg Front Step Chair Within-group and between-group effect sizes were
Forward Lunge Step Chair calculated using Cohen’s d, which was considered triv-
Wall Side Ball ial (0-0.19), small (0.20–0.49), medium (0.50–0.79) or
Tower Cadillac large (≥ 0.80) [38]. Data were analyzed per protocol and
Upper limbs strengthening Arms Pulling I Cadillac by intention-to-treat analysis (ITT). As the results did
Rowing Front: Hug a Cadillac not change, we present only the ITT data, including
Tree all randomized individuals (for missing postinterven-
Arms Pulling II Cadillac tion data, preintervention data were imputed). To com-
Arm Pulling III Cadillac pare each adverse event reported between groups, the
Extension Arm Up Cadillac chi-square test was used. To determine the difference
*Stretching exercises are only performed at the beginning of the sessions by
the Traditional Pilates group. The remaining exercises were performed by both
between groups in terms of the likelihood of develop-
groups (Traditional Pilates and Non-Traditional Pilates), always maintaining the ing any adverse events, odds ratio (OR) was calculated.
same sequence For all tests, the significance level adopted was P < 0.05.
Analyses were processed in SPSS 22.0 (Chicago, Illinois),
principles of Pilates (center, control, concentration, flu- except for effect size calculations (Cohen’s d), which were
idity, precision and breathing). The Pilates protocol processed in GPower 3.1 (Franz Faul, Universität Kiel,
containing the images of the exercises is available as a Germany).
supplementary file.
The exercises were performed in a series of ten rep- Results
etitions, with a one-minute rest interval between exer- Initially, 55 participants were checked for eligibility
cises. For load progression, the resistance of the springs (Fig. 1). Recruitment started on September 05, 2022,
in each piece of equipment was replaced (changing the and the study was completed on November 25, 2022. Of
position of the springs in the equipment or replacing the the 32 participants who met the inclusion criteria and
springs with others of greater resistance) every 15 days, were randomized, there was a total loss of 8 participants
as the evolution of the strength of the participants was throughout the study due to factors that made it unfea-
observed. The number of sets, repetitions and rest inter- sible to continue the interventions, considering personal
vals were always maintained. reasons and the emergence of commitments at the time
To determine the level of effort and consequently the of the interventions.
evolution of loads, verbal descriptions were used accord- No significant (p > 0.05) difference between groups
ing to the OMNI scale [37]: extremely easy (OMNI was observed at baseline for age, anthropometric vari-
0–1), easy (OMNI 2–3), reasonably easy (OMNI 4–5), ables of weight, height and BMI, and musculoskeletal
fairly difficult (OMNI 6–7), difficult (OMNI 8–9) and fitness outcomes. Table 4 present the results of the intra-
extremely difficult (OMNI 10). The effort level main- group and intergroup comparisons for the musculo-
tained during the sessions was between 8 and 9 (difficult). skeletal fitness variables. In the intergroup comparison,
In all sessions, the participants were asked about possible the results showed a significant increase only for the
Reis dos et al. BMC Sports Science, Medicine and Rehabilitation (2024) 16:11 Page 6 of 11

Fig. 1 Flow diagram (CONSORT)

sit-and-reach test, in favor of the PT (p = 0.03), with a complaint was delayed onset muscle soreness, reported
large effect size (d = 0.87). In the intragroup comparison, by PT (56.25%) and NTP (81.25%), mainly in the first
significant results were observed in the following tests: weeks of intervention. Other adverse events, such as
10-RM knee extensors in PT (p = 0.006, d = 0.79) and muscle pain in specific regions of the body (lumbar and
NTP (p = 0.01, d = 0.68); vertical jump in TP (p = 0.007, cervical spine), dizziness, cramps, eagerness and nausea,
d = 0.78) and NTP (p = 0.001, d = 0.98); and sit-and-reach, occurred less frequently and were usually reported after
only in PT (p = 0.003, d = 0.88). For handgrip, 1-min sit- exercise sessions (Table 5).
ups and Sorensen tests, no significant results were found
(p > 0.05). Discussion
This study aimed to verify whether the practice of
Adverse events stretching in a Pilates program preceding strengthening
In total, 55 adverse events were reported—21 in the TP exercises could affect the development of musculoskel-
and 34 in the NTP—with the incidences being reported etal fitness in sedentary young adult women. In brief, our
by 10 participants in the TP and 14 in the NTP. The findings demonstrated that only flexibility was affected.
chances of participants who did not stretch (NTP In this case, only the traditional Pilates program, which
group) having an adverse event were four times greater included stretching exercises at the beginning of the ses-
(OR = 4.20, CI95% 0.69 to 25.26). The participants’ main sions, allowed an increase in the sit-and-reach test. For
Reis dos et al. BMC Sports Science, Medicine and Rehabilitation (2024) 16:11 Page 7 of 11

Table 4 Intra- and intergroup comparisons for musculoskeletal Table 5 Frequency of adverse events
fitness between TP vs. NTP TP NTP P
TP NTP Co- P‡ (n = 16) (n = 16)
(n = 16) (n = 16) hen’s Pain, n (%)
d Muscle soreness 9 (56.2) 13 (81.2) 0.127
(intergroup) Muscle pain in lower limbs 3 (18.7) 4 (25.0) 0.669
10-RM knee extensors (kg)* Muscle pain in the lumbar spine 0 (0.0) 1 (6.2) 0.310
Baseline 45.53 51.14 0.03 0.576 Muscle pain in the cervical spine 1 (6.2) 0 (0.0) 0.310
(14.66) (10.77)
Abdominal muscle pain 3 (18.7) 2 (12.5) 0.626
Post-intervention 52.94 58.18 (8.80)
Muscle pain in upper limbs 2 (12.5) 4 (25.0) 0.365
(13.92)
Shoulder joint pain 2 (12.5) 3 (18.7) 0.626
Change after 8 weeks 7.40 (9.35) 7.03 (10.31)
Others, n (%)
Cohen’s d (intragroup) 0.79 0.68
Dizziness 0 (0.0) 1 (6.2) 0.310
P (intragroup) 0.006 0.01
Cramp 1 (6.2) 1 (6.2) 1.000
Vertical jump (cm)
Retching 0 (0.0) 3 (18.7) 0.069
Baseline 29.22 (3.40) 32.13 (5.51) 0.07 0.810
Seasickness 0 (0.0) 2 (12.5) 0.144
Post-intervention 31.34 (4.13) 34.44 (6.04)
Data expressed as absolute numbers (percentage values). The Chi-square test
Change after 8 weeks 2.12 (2.72) 2.31 (2.35) was used to compare groups. TP: Traditional Pilates; NTP: Non-Traditional Pilates
Cohen’s d (intragroup) 0.78 0.98
P (intragroup) 0.007 0.001
In this sense, the current study presents important
Handgrip (kg)
practical applications, demonstrating that profession-
Baseline 28.15 (4.58) 30.03 (5.24) 0.32 0.238
als who work with Pilates exercises can include stretch-
Post-intervention 27.46 (5.12) 30.33 (5.01)
ing exercises at the beginning of sessions without
Change after 8 weeks -0.69 (2.58) 0.30 (3.47)
compromising subsequent strengthening training, aim-
Cohen’s d (intragroup) 0.27 0.09
ing to develop strength, vertical jump height and mus-
P (intragroup) 0.301 0.729
cular endurance. Furthermore, if the objective is also to
1-min sit-ups (reps)
develop flexibility, professionals should include stretching
Baseline 18.13 (7.35) 20.13 (7.14) 0.39 0.224
exercises in the Pilates intervention protocol since per-
Post-intervention 19.56 (7.87) 20.56 (7.03)
Change after 8 weeks 1.44 (3.28) 0.44 (1.50)
forming strengthening exercises alone was not enough to
Cohen’s d (intragroup) 0.42 0.20
improve flexibility. Our results also indicate that the five
P (intragrupo)† 0.092 0.237 stretching exercises used in the protocol were exclusively
Sorensen (sec) responsible for improving flexibility in the TP group
Baseline 61.38 63.75 0.22 0.390 since only these exercises differed between the interven-
(30.88) (20.08) tion groups.
Post-intervention 59.75 66.56 This is the first long-term study that aimed to verify the
(29.74) (14.22) effects of Pilates stretching exercises on musculoskeletal
Change after 8 weeks −1.63 2.81 (17.94) fitness components. Previous studies tested more tradi-
(21.64) tional stretching, such as static, dynamic, ballistic and
Cohen’s d (intragroup) 0.07 0.16 PNF, mainly in an acute condition, with few long-term
P (intragroup) 0.768 0.540 studies [26, 39–42]. Notably, most long-term studies have
Sit-and-reach (cm)
focused only on intervening with stretching, aiming to
Baseline 23.13 (6.43) 26.69 (8.95) 0.87 0.035
verify its effects on various parameters, such as flexibil-
Post-intervention 27.31 (6.98) 27.50 (9.40)
ity [40, 41], strength [40–42], vertical jump [39, 40] and
Change after 8 weeks 4.19 (4.76) 0.81 (2.78)
muscular endurance [40]. Given that this is not the reality
Cohen’s d (intragroup) 0.88 0.29
of most rehabilitation or physical conditioning programs,
P (intragroup) 0.003 0.262
the present study used a protocol that reflects a common
10-RM (10 repetition maximum). *Values were converted to represent 1-RM
(one repetition maximum) [29]. Data are expressed as the mean and standard session in clinical practice in which stretching exercises
deviation. TP: Traditional Pilates; NTP: Non-Traditional Pilates. Dependent and strengthening exercises are performed in the same
Student’s t test for intragroup comparisons, except for 1-min sit-ups (†Wilcoxon
test); ‡ANCOVA with preintervention data as a covariate, except for 1-min sit- session.
ups (Mann‒Whitney U Test). Significant differences are highlighted in bold Previous studies that involved only stretching exercises
have generally demonstrated the effectiveness of chronic
the indicators of strength, vertical jump height and mus- stretching in increasing flexibility, muscular strength and
cular endurance, there was no difference between per- vertical jump performance [39–42]. However, for mus-
forming or not performing stretching exercises at the cular strength and vertical jump the effects are trivial
beginning of the sessions. to small, mainly benefiting sedentary people and older
Reis dos et al. BMC Sports Science, Medicine and Rehabilitation (2024) 16:11 Page 8 of 11

persons, while for flexibility, the effects are of moderate exercises are directed toward this specific purpose. With
to large magnitude for any population [3]. In line with this, an improvement in flexibility in the group that per-
this perspective, in the present study, we observed that formed stretching was already expected, considering that
the five stretching exercises performed by the TP group this technique has already proven to be effective for this
had large effects (d > 0.80) on intra- and intergroup flex- outcome in chronic interventions, if performed at least
ibility. However, we did not observe any effect of stretch- twice a week, regardless of the form of stretching [43].
ing on indicators of strength, muscular endurance and Likewise, according to the principle of specificity, it
performance in the vertical jump. was expected that after eight weeks of intervention, there
A long-term study, which, like ours, sought to repro- would be a significant intragroup improvement, for both
duce what is commonly done in clinical practice, that groups, in the results of the motor tests selected to evalu-
is, stretching and muscle strengthening exercises in the ate muscular strength and endurance and performance in
same session, found that after 12 weeks of intervention, the vertical jump. This is because our protocol included
there was no difference in flexibility and muscle strength 15 strengthening exercises for the main muscle groups.
of the upper limbs among the groups that performed (a) However, a significant improvement within groups
stretching before strength training; (b) stretching after occurred only for the 10-RM knee extensors and vertical
strength training; (c) isolated strength training; and (d) jump tests, but not for the handgrip, 1-min sit-ups and
isolated stretching. The only difference observed between Sorensen. To improve the muscle strength of the knee
groups was for lower limb muscle strength, in which extensors and vertical jump performance, other clinical
the isolated strength training group was superior to the trials have also demonstrated the effectiveness of Pilates
isolated stretching group [26]. That is, as in the present exercises [17, 44, 45].
study, performing stretching and strengthening exer- In relation to the handgrip test, as it involves the iso-
cises in the same session did not affect muscle strength. metric strength of a very specific region, such as the fore-
However, as a divergence, in the current study, we found arm and mainly palmar flexors, perhaps Pilates exercises,
that only the group that performed Pilates stretching as they prioritize larger muscle groups, are not as effec-
increased flexibility. tive at improving muscle strength in this region. This has
Unlike traditional dynamic stretching, in Pilates also been observed in other clinical trials that did not find
stretching exercises, the performer holds the final posi- results for this outcome after the Pilates program [46,
tion of maximum joint amplitude for a few seconds, time 47]. With regard to the muscular endurance of the trunk
necessary to inhale again, before returning to the initial flexors and extensors, evaluated by the 1-min sit-ups and
position, performing exhalation. That is, the performer Sorensen tests, respectively, a probable justification for
inhales whenever he is in the extremities (initial position not observing significant results within the groups, be
and position of maximum amplitude) and exhales when- it the way the test is performed, compared with what is
ever he is in motion. This specific technique adopted by required in the practice of Pilates. In other words, while
Pilates, in comparison with other forms of stretching, the Pilates exercise protocol requires muscular strength,
needs to be better explored in the literature. A study that the tests require muscular endurance.
compared Pilates exercises vs. static stretching identi- Other studies that used these same tests also did not
fied after 12 weeks that the interventions did not differ observe significant effects after a period of intervention
for the following ranges of motion: trunk flexion, hip with Pilates exercises [48, 49]. Unlike when measure-
flexion, plantar flexion and dorsiflexion. However, Pilates ment occurs through the muscular strength of the trunk
exercises were superior for trunk range of motion in flexor and extensor muscles through isokinetic dyna-
extension and for muscle strength of knee extensors and mometry, for which Pilates has already proven effective
flexors [17, 18]. The present study advances the discus- [50]. Including enabling adequate balance of the muscles
sion by adding other indicators of musculoskeletal fit- involved in flexion and extension of the trunk [51].
ness in addition to flexibility, in addition to verifying Finally, in relation to adverse events, although there was
the absence of stretching exercises in a Pilates program no significant difference between groups for each event
regarding these components. individually, it was possible to observe that, in total, NTP
Our findings help to fill an important gap in the scien- presented 62% more adverse events when compared to
tific literature since little is known about the impact of TP. This represented a four times greater chance of devel-
performing Pilates stretching exercises preceding muscle oping an adverse event among participants who did not
strengthening exercises on flexibility and strength, ver- stretch. In this sense, the stretching exercises performed
tical jump height and muscular endurance. The effects by the TP seem to have provided a protective effect on
we found on flexibility in the group that performed the sensation of pain and other discomfort resulting from
Pilates stretching at the beginning of the sessions can the exercises. The lack of a significant difference between
be explained by the principle of specificity; that is, the the groups for individual adverse events is probably
Reis dos et al. BMC Sports Science, Medicine and Rehabilitation (2024) 16:11 Page 9 of 11

Funding
related to the sample size, which was not scaled to meet This study was financed in part by the Coordenação de Aperfeiçoamento de
this outcome. Although conflicting findings exist in the Pessoal de Nível Superior– Brazil (CAPES)– Finance Code 001.
literature, a stretching routine immediately preceding
Data availability
physical exercise seems to contribute to the reduction of The datasets used and/or analysed during the current study are available from
pain and discomfort [52]. the corresponding author on reasonable request.
The present study has some limitations that need to
be highlighted: (a) we investigated only young women, Declarations
as necessary studies also including male participants, as
Ethics approval and consent to participate
well as people of other age groups; (b) Pilates exercises This study was carried out in accordance with the principles stated in the
were performed mainly on equipment, which may dif- Declaration of Helsinki and approval was granted for the study by the Ethics
fer from a protocol exclusively designed with Mat Pilates Committee of the Universidade Estadual do Norte do Paraná (nº 5,548,126).
All participants were aware of the research and volunteered to participate and
exercises, in which the exercises are performed only with confidentiality was guaranteed. We obtained written informed consent from
a gym mat, which may be investigated in future studies; all participants.
(c) the vertical jump test and the 10-RM knee extensor
Consent for publication
and handgrip tests, from a biomechanical point of view, Written informed consent was obtained for the use of the images of the
do not directly measure muscle power and strength, person appearing in the supplemental file for the presentation of the Pilates
respectively; and (d) we did not explore the mechanisms exercise protocol.

that could explain the improvement in flexibility that Competing interests

occurred only in the TP group or the lack of difference The authors declare no competing interests.
between the groups for the other outcomes. Future stud-
Author details
ies should seek to replicate our study, if possible, while 1
Postgraduate Program in Human Movement Sciences, Health Sciences
remedying the limitations presented. Center, Universidade Estadual do Norte do Paraná (UENP), Alameda Padre
Magno, 841, Nova Alcântara, Jacarezinho, PR CEP: 86400-000, Brazil
2
Postgraduate Program in Physical Exercise in Health Promotion, Health
Conclusion Sciences Research Center, Universidade Norte do Paraná (UNOPAR),
Our findings demonstrated that stretching exercises pre- Londrina, PR, Brazil
ceding strengthening exercises in a Pilates program did
Received: 28 July 2023 / Accepted: 4 January 2024
not impair, after 8 weeks of intervention, performance in
tests indicative of strength, muscular endurance and ver-
tical jump performance. Furthermore, the program that
included stretching exercises was superior in improving
References
flexibility and provided a lower chance of adverse events 1. Luan L, El-Ansary D, Adams R, Wu S, Han J. Knee osteoarthritis pain and
such as feelings of pain and other discomforts. In this stretching exercises: a systematic review and meta-analysis. Physiotherapy.
sense, it is recommended that Pilates programs include 2022;114:16–29. https://doi.org/10.1016/j.physio.2021.10.001.
2. Babault N, Rodot G, Champelovier M, Cometti C. A Survey on stretching prac-
stretching exercises prior to the muscle strengthening tices in women and men from various sports or Physical Activity Programs.
exercise routine, aiming to develop flexibility and reduce Int J Environ Res Public Health. 2021;18(8):3928. https://doi.org/10.3390/
the sensation of pain and discomfort caused by the ijerph18083928.
3. Arntz F, Markov A, Behm DG, Behrens M, Negra Y, Nakamura M, Moran J,
exercises. Chaabene H. Chronic effects of Static stretching exercises on muscle strength
and power in Healthy Individuals across the Lifespan: a systematic review
Supplementary Information with multi-level Meta-analysis. Sports Med. 2023;53(3):723–45. https://doi.
The online version contains supplementary material available at https://doi. org/10.1007/s40279-022-01806-9.
org/10.1186/s13102-024-00808-6. 4. Bouguezzi R, Sammoud S, Markov A, Negra Y, Chaabene H. Why Flexibility
deserves to be further considered as a standard component of physical fit-
ness: a narrative review of existing insights from Static stretching study inter-
Supplementary Material 1: Pilates Exercise Protocol ventions. Youth. 2023;3(1):146–56. https://doi.org/10.3390/youth3010010.
Supplementary Material 2: Study Protocol 5. Leite TB, Costa PB, Leite RD, Novaes JS, Fleck SJ, Simão R. Effects of dif-
ferent number of sets of Resistance Training on Flexibility. Int J Exerc Sci.
2017;10(3):354–64.
Acknowledgements 6. Peck E, Chomko G, Gaz DV, Farrell AM. The effects of stretching on perfor-
The authors would like to thank the Coordenação de Aperfeiçoamento de mance. Curr Sports Med Rep. 2014;13(3):179–85. https://doi.org/10.1249/
Pessoal de Nível Superior (CAPES), Brazil, for the master’s scholarship received JSR.0000000000000052.
by the author ALR. 7. Simic L, Sarabon N, Markovic G. Does pre-exercise static stretching inhibit
maximal muscular performance? A meta-analytical review. Scand J Med Sci
Author contributions Sports. 2013;23(2):131–48. https://doi.org/10.1111/j.1600-0838.2012.01444.x.
R.G.O. and L.C.O. contributed to the conception and design of the study; 8. Gil MH, Neiva HP, Sousa AC, Marques MC, Marinho DA. Current approaches
A.L.R. contributed to the acquisition, analysis, interpretation of results and on warming up for sports performance: a critical review. Strength Cond J.
preparation of the work; R.G.O. and L.C.O. reviewed the work critically; A.L.R., 2019;41(4):70–9. https://doi.org/10.1519/SSC.0000000000000454.
R.G.O. and L.C.O. approved the final version and agree to be responsible for all 9. Gomes TM, Simão R, Marques MC, Costa PB, da Silva Novaes J. Acute
aspects of the work. effects of two different stretching methods on local muscular endurance
Reis dos et al. BMC Sports Science, Medicine and Rehabilitation (2024) 16:11 Page 10 of 11

performance. J Strength Cond Res. 2011;25(3):745–52. https://doi. 31. Brzycki M. Strength testing: predicting a one-rep max from repetitions to
org/10.1519/JSC.0b013e3181cc236a. fatigue. J Phys Educ Recr Dance. 1993;64:88–90. https://doi.org/10.1080/0730
10. Carvalho FLP, Prati JELR, Carvalho MCGA, Dantas EHM. Acute effects of static 3084.1993.10606684.
stretching and proprioceptive neuromuscular facilitation on the performance 32. de Salles PG, Vasconcellos FV, de Salles GF, Fonseca RT, Dantas EH. Validity
of vertical jump in adolescent tennis players. Fit Perform J. 2009;8(4):264–8. and reproducibility of the sargent jump test in the assessment of explosive
https://doi.org/10.3900/fpj.8.4.264.e. strength in soccer players. J Hum Kinet. 2012;33:115–21. https://doi.
11. Silva GVLC, Silveira ALBezerra, Masi FD, Bentes CM, Sousa MSC, Novaes JS. org/10.2478/v10078-012-0050-4.
Acute effect of different stretching methods on isometric muscle strength. 33. Reis MM, Arantes PMM. Assessment of hand grip strength: validity and
Acta Sci Health Sci. 2014;36(1):51–7. https://doi.org/10.4025/actascihealthsci. reliability of the saehan dynamometer. Fisioter Pesqui. 2011;18(2):176–81.
v36i1.15581. https://doi.org/10.1590/S1809-29502011000200013.
12. Behm DG, Blazevich AJ, Kay AD, McHugh M. Acute effects of muscle 34. DiNucci J, McCune D, Shows D. Reliability of a modification of the health-
stretching on physical performance, range of motion, and injury incidence related physical fitness test for use with physical education majors. Res Q
in healthy active individuals: a systematic review. Appl Physiol Nutr Metab. Exerc Sport. 1990;61(1):20–5. https://doi.org/10.1080/02701367.1990.106074
2016;41(1):1–11. https://doi.org/10.1139/apnm-2015-0235. 74.
13. Opplert J, Babault N. Acute effects of Dynamic stretching on muscle flex- 35. Keller A, Hellesnes J, Brox JI. Reliability of the isokinetic trunk extensor test,
ibility and performance: an analysis of the current literature. Sports Med. Biering-Sørensen test, and Astrand bicycle test: assessment of intraclass
2018;48(2):299–325. https://doi.org/10.1007/s40279-017-0797-9. correlation coefficient and critical difference in patients with chronic low
14. Stone M, Ramsey MW, Kinser AM, O’Bryant HS, Ayers C, Sands WA. Stretch- back pain and healthy individuals. Spine. 2001;26(7):771–7. https://doi.
ing: acute and chronic? The potential consequences. Strength Cond J. org/10.1097/00007632-200104010-00017.
2006;28(6):66–74. 36. Wells KF, Dillon EK. The Sit and Reach—A test of back and Leg Flexibility. Res
15. Wells C, Kolt GS, Bialocerkowski A. Defining pilates exercise: a systematic Q Am Assoc Health Phys Educ. 1952;23(1):115–8. https://doi.org/10.1080/106
review. Complement Ther Med. 2012;20(4):253–62. https://doi.org/10.1016/j. 71188.1952.10761965.
ctim.2012.02.005. 37. Robertson RJ, Goss FL, Rutkowski J, Lenz B, Dixon C, Timmer J, Frazee K, Dube
16. de Oliveira RG, Anami GEU, Coelho EA, de Oliveira LC. Effects of Pilates J, Andreacci J. Concurrent validation of the OMNI perceived exertion scale
exercise on bone mineral density in postmenopausal women: a systematic for resistance exercise. Med Sci Sports Exerc. 2003;35(2):333–41. https://doi.
review and meta-analysis. J Geriatr Phys Ther. 2022;45(2):107–14. https://doi. org/10.1249/01.MSS.0000048831.15016.2A.
org/10.1519/JPT.0000000000000309. 38. Cohen J. Statistical power analysis for the behavioral sciences. 2rd ed. Hills-
17. Oliveira LC, Oliveira RG, Pires-Oliveira DAA. Pilates increases the iso- dale, NJ: Lawrence Erlbaum Associates; 1988.
kinetic muscular strength of the knee extensors and flexors in elderly 39. Gunaydin G, Citaker S, Cobanoglu G. Effects of different stretching exer-
women. J Bodyw Mov Ther. 2017;21(4):815–22. https://doi.org/10.1016/j. cises on hamstring flexibility and performance in long term. Sci Sports.
jbmt.2017.01.006. 2020;35(6):386–92. https://doi.org/10.1016/j.scispo.2020.04.009.
18. Oliveira LC, Oliveira RG, Pires-Oliveira DA. Comparison between static stretch- 40. Ikeda N, Ryushi T. Effects of 6-Week Static stretching of knee extensors
ing and the pilates method on the flexibility of older women. J Bodyw Mov on flexibility, muscle strength, Jump Performance, and muscle endur-
Ther. 2016;20(4):800–6. https://doi.org/10.1016/j.jbmt.2016.01.008. ance. J Strength Cond Res. 2021;35(3):715–23. https://doi.org/10.1519/
19. Di Lorenzo CE. Pilates: what is it? Should it be used in rehabilitation? Sports JSC.0000000000002819.
Health. 2011;3(4):352–61. https://doi.org/10.1177/1941738111410285. 41. Warneke K, Brinkmann A, Hillebrecht M, Schiemann S. Influence of long-
20. Statista. Accessed May 20,. Number of pilates participants in the United lasting Static stretching on maximal strength, muscle thickness and flexibility.
States from 2010 to 2021. Available online: https://www.statista.com/statis- Front Physiol. 2022;13:878955. https://doi.org/10.3389/fphys.2022.878955.
tics/191616/participants-in-pilates-training-in-the-us-since-2006. (2023). 42. Warneke K, Keiner M, Wohlann T, Lohmann LH, Schmitt T, Hillebrecht M,
21. Guimarães Lima M, Malta DC, Monteiro CN, da Silva Sousa NF, Stopa SR, Brinkmann A, Hein A, Wirth K, Schiemann S. Influence of long-lasting Static
Medina LPB, de Azevedo Barros MB. Leisure-time physical activity and stretching intervention on functional and morphological parameters in the
sports in the Brazilian population: a social disparity analysis. PLoS ONE. Plantar flexors: a Randomized Controlled Trial. J Strength Cond Res. 2023.
2019;14(12):e0225940. https://doi.org/10.1371/journal.pone.0225940. https://doi.org/10.1519/JSC.0000000000004513. [Online ahead of print].
22. Patti A, Thornton JS, Giustino V, Drid P, Paoli A, Schulz JM, Palma A, Bianco A. 43. Konrad A, Alizadeh S, Daneshjoo A, Anvar SH, Graham A, Zahiri A, Goudini
Effectiveness of Pilates exercise on low back pain: a systematic review with R, Edwards C, Scharf C, Behm DG. Chronic effects of stretching on range of
meta-analysis. Disabil Rehabil. 2023. https://doi.org/10.1080/09638288.2023.2 motion with consideration of potential moderating variables: A systematic
251404. review with meta-analysis. J Sport Health Sci. 2023:S2095-2546(23)00057– 1.
23. Greco G, Messina G, Angiulli A, Patti A, Iovane A, Fischetti F. A preliminary https://doi.org/10.1016/j.jshs.2023.06.002.
comparative study on the effects of pilates training on physical fitness 44. Campos de Oliveira L, de Gonçalves R, Pires-Oliveira DA. Effects of Pilates
of young female volleyball players. Acta Med Mediterr. 2019;35(2):783–9. on muscle strength, postural balance and quality of life of older adults: a
https://doi.org/10.19193/0393-6384_2019_2_118. randomized, controlled, clinical trial. J Phys Ther Sci. 2015;27(3):871–6. https://
24. Cruz TMF, Germano MD, Crisp AH, Sindorf MAG, Verlengia R, Mota GR, Lopes doi.org/10.1589/jpts.27.871.
CR. Does Pilates training change physical fitness in young basketball ath- 45. Preeti SK, Yadav J, Pawaria S. Effect of Pilates on lower limb strength, dynamic
letes? J Exerc Physiol Online. 2014;17(1):1–9. balance, agility and coordination skills in aspiring state level badminton
25. Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 statement: players. J Clin Diagnostic Res. 2019;13(7):1–6. https://doi.org/10.7860/
updated guidelines for reporting parallel group randomised trials. BMJ. JCDR/2019/41713.12978.
2010;340:c332. https://doi.org/10.1136/bmj.c332. 46. Evangelou C, Sakkas GK, Hadjicharalambous M, Aphamis G, Petrou P, Giannaki
26. Leite T, de Souza Teixeira A, Saavedra F, Leite RD, Rhea MR, Simão R. Influ- CD. The effect of a three month, low-load- high-repetitions group-based
ence of strength and flexibility training, combined or isolated, on strength exercise program versus pilates on physical fitness and body composition in
and flexibility gains. J Strength Cond Res. 2015;29(4):1083–8. https://doi. inactive women. J Bodyw Mov Ther. 2021;26:18–23. https://doi.org/10.1016/j.
org/10.1519/JSC.0000000000000719. jbmt.2020.08.017.
27. Thomas S, Reading J, Shephard RJ. Revision of the physical activity readiness 47. Zaras N, Kavvoura A, Gerolemou S, Hadjicharalambous M. Pilates-mat training
questionnaire (PAR-Q). Can J Sport Sci. 1992;17(4):338–45. and detraining: effects on body composition and physical fitness in pilates-
28. Matsudo S, Araújo T, Marsudo V, Andrade D, Andrade E, Oliveira LC, Brag- trained women. J Bodyw Mov Ther. 2023;36:38–44. https://doi.org/10.1016/j.
gion G. International physical activity questionnaire (IPAQ): study of validity jbmt.2023.05.002.
and reability in Brazil. Rev Bras Ativ Fís Saúde. 2001;6(2):5–18. https://doi. 48. Coelho VS, Kozu AH, Santos CF, Vitor LGV, Gil AW, Oliveira MR, Parreira RB, Silva
org/10.12820/rbafs.v.6n2p5-18. RA. Evaluation of the effects of pilates method on the function of trunk. Ter
29. Guex K, Daucourt C, Borloz S. Validity and reliability of maximal-strength Man. 2010;8(40):508–16.
assessment of knee flexors and extensors using elastic bands. J Sport Rehabil. 49. Santos JCL, Vancini RL, Sarro KJ. Impact of 12 weeks of mat pilates practice
2015;24(2):151–5. https://doi.org/10.1123/jsr.2013-0131. on handgrip force, abdominal endurance and on the flexibility evaluated
30. Page PA, Labbe A, Topp RV. Clinical force production of Thera-Band elastic by photogrammetry in healthy women. Pensar Prática. 2017;20(2):246–56.
bands. J Orthop Sports Phys Ther. 2000;30(1):A47–8. https://doi.org/10.5216/rpp.v20i2.40616.
Reis dos et al. BMC Sports Science, Medicine and Rehabilitation (2024) 16:11 Page 11 of 11

50. Sekendiz B, Altun O, Korkusuz F, Akın S. Effects of Pilates exercise on trunk

strength, endurance and flexibility in sedentary adult females. J Bodyw Mov Publisher’s Note
Ther. 2007;11(4):318–26. https://doi.org/10.1016/j.jbmt.2006.12.002. Springer Nature remains neutral with regard to jurisdictional claims in
51. Kolyniak IEG, Cavalcanti SMB, Aoki MS. Isokinetic evaluation of the published maps and institutional affiliations.
musculature involved in trunk flexion and extension: Pilates© method
effect. Rev Bras Med Esporte. 2004;10(6):491–3. https://doi.org/10.1590/
S1517-86922004000600005.
52. Behm DG, Kay AD, Trajano GS, Alizadeh S, Blazevich AJ. Effects of Acute and
Chronic stretching on Pain Control. J Clin Exerc Physiol. 2021;10(4):150–9.
https://doi.org/10.31189/2165-6193-10.4.150.