Musculoskeletal Stretching and Arterial Stiffness: Systematic Review and Meta-analysis of Acute and Longitudinal Interventions

Background Musculoskeletal stretching, a low-skill and accessible exercise, may help lower cardiovascular disease (CVD) risk by reducing arterial stiffness (AS). The most well-established measure of AS is pulse wave velocity (PWV). Objectives To determine (1) the effects of acute and longitudinal musculoskeletal stretching interventions on PWV in adults; and (2) whether the pooled effect is moderated by stretching prescription (i.e., frequency, intensity, time, and type [FITT]), study design (e.g., supervision), study quality and risk of bias, and study outcome (e.g., specific PWV segment). Data Sources Electronic databases (PubMed, Scopus, Embase, and Web of Science) were searched from 1974 to 2025, using the search terms: stretching AND (arterial stiffness OR pulse wave velocity OR PWV OR vascular stiffness). The reference lists of relevant studies and previous reviews were also screened. Study Selection The eligibility criteria included (1) adults aged 18 years or older; (2) randomized controlled, nonrandomized controlled, or crossover; (3) PWV outcome(s) measured; (4) published in English; (5) published since 1974; and (6) published in peer-reviewed journals. Appraisal and Synthesis Methods Initially, 242 studies were identified. After screening, six studies on acute stretching and six studies on longitudinal stretching were included. Effect sizes were calculated as standardized mean differences (SMD). Data were pooled using a 3-level model with restricted maximum likelihood estimation, and the magnitude of the effect was adjudicated as trivial (< 0.2), small (0.2), moderate (0.5), or large (0.8). Results Acute stretching led to a small, nonsignificant reduction (beneficial) in PWV (SMD = − 0.22, p = 0.258), whereas longitudinal stretching resulted in a large and statistically significant reduction in PWV (SMD = − 1.02, p = 0.012). The pooled effect size was significantly greater (more beneficial) when each stretch was repeated three or more times (versus less than three times, SMD contrast = − 1.46, p < 0.001). Larger (beneficial) pooled effect sizes were also observed when stretching was prescribed for 5–7 days/week (versus 3–4 days/week, SMD contrast = − 1.05, p = 0.149), when stretching sessions lasted at least 30 min (versus less than 30 min, SMD contrast = − 0.79, p = 0.169), and when sessions were supervised (versus unsupervised, SMD contrast = − 1.11, p = 0.130); however, these differences did not reach statistical significance. Conclusions A single bout of stretching resulted in a small acute decrease in PWV (SMD = − 0.22, 95% CI − 0.62 to 0.17). There was a large decrease in PWV (SMD = − 1.02, 95% CI − 1.79 to − 0.25) following a 4- to 12-week intervention. We recommend stretching each major muscle–tendon group three or more times. These findings may be used to help design a future intervention to test the efficacy and biological plausibility of stretching exercises to reduce arterial stiffness and possibly CVD risk.