374

Journal of Strength and Conditioning Research, 2003, 17(2), 374378

2003 National Strength & Conditioning Association
Adding Weights to Stretching Exercise Increases
Passive Range of Motion for Healthy Elderly
ANN MARIE SWANK,
1
DANIEL C. FUNK,
2
MICHAEL P. DURHAM,
1
AND
SHERRI ROBERTS
3
1
Exercise Physiology Lab, University of Louisville, Louisville, Kentucky 40292;
2
Sport Management Program,
University of Texas at Austin, Austin, Texas 78712;
3
Baptist East Hospital, Cardiac Rehabilitation Department,
Louisville, Kentucky 40292.
ABSTRACT
Stretching exercise is effective for increasing joint range of
motion (ROM). However, the Surgeon Generals Report and
the American College of Sports Medicine cite a lack of stud-
ies identifying strategies capable of increasing the effective-
ness of stretching exercise. This investigation evaluated add-
ing modest weight (0.451.35 kg) to a stretching exercise rou-
tine (Body Recall [BR]) on joint ROM. Forty-three subjects
ages 5583 years participated in 1 of 2 training groups, BR,
BR with weights (BRW), or a control group (C). ROM was
evaluated at the neck, shoulder, hip, knee, and ankle before
and after 10 weeks of exercise. Using ANCOVA, signicant
differences (p 0.01) were observed for right and left cer-
vical rotation, hip extension, ankle dorsiexion, ankle plantar
exion, and shoulder exion. Post hoc analysis revealed that
cervical rotation (left and right), hip extension, and ankle
dorsiexion for BRW subjects differed signicantly from
BR and C (p 0.01). Signicant differences with shoulder
exion and ankle plantar exion were found for both BR and
BRW in comparison to C (p 0.01). Results indicate that
addition of weights enhanced the effectiveness of stretching
exercise for increasing joint ROM with 4 of the 6 selected
measurements. Thus, a modest intensity exercise program
that is within the reach of most elderly may signicantly
affect joint ROM and exibility.
Key Words: aging, exibility, independence, activities
of daily living
Reference Data: Swank, A.M., D.C. Funk, M.P. Dur-
ham, and S. Roberts. Adding weights to stretching ex-
ercise increases passive range of motion for healthy
elderly. J. Strength Cond. Res. 17(2):374378. 2003.
Introduction
R
ange of motion (ROM) decreases with increasing
age, a decline related to the aging process itself,
trauma from mechanical stress, disuse, and diseases
such as arthritis (7, 12, 18). Stretching exercise is an
effective means of increasing ROM for older adults (4,
6, 10, 13, 16). However, both the Surgeon Generals
Report and the American College of Sports Medicine
acknowledge a lack of studies evaluating exercise and
ROM (11, 19). Specically, there is a need to identify
strategies capable of enhancing the effectiveness of
stretching exercise on ROM, especially for the elderly,
for whom adequate ROM is important for performance
of activities of daily living and maintenance of an in-
dependent lifestyle (11, 19).
Raab et al. (16) postulated that adding modest
hand and ankle resistance may increase the effective-
ness of stretching exercise on joint ROM. The authors
compared ROM responses for a weighted group to
both a nonexercising control group and an exercise
group without weights. Both exercise groups increased
joint ROM relative to the control group; however, ad-
dition of weights provided no additional benet. To
decrease potential for injury, weighted stretching ex-
ercises used by Raab et al. (16) were not performed
through a full ROM. The authors concluded that this
exercise modication was a plausible reason for lack
of a positive effect with weights on ROM (16).
The current investigation evaluated adding modest
hand and ankle weights to stretching exercise on
ROM, with an emphasis that exercises were performed
through full ROM. The exercise program used in this
investigation was Body Recall (BR), (5) a program de-
veloped at Berea College, Owensboro, KY, by Dorothy
Chrisman, Ph.D. This low-intensity program empha-
sizes pain-free, smooth, rhythmic movement for the
purpose of maintaining, enhancing, and restoring
strength and exibility. In addition, BR classes provide
knowledge and motivation for lifetime tness in a
manner that is within the reach of most elderly indi-
viduals. The sequence of class activities begins with
maneuvers such as slow ankle circles and progresses
to more complex activities involving larger muscle
groups and more physical effort. Exercises are per-
formed in sitting, standing, and lying positions (5).
Weighted Exercise for Healthy Elderly 375
Statistics from 1993 indicate that the BR network had
spread into 43 states, trained and certied over 700
teachers, and involved over 30,000 participants. Our
purpose was to evaluate a simple strategy, adding
modest weights to routine body movements, that may
enhance compliance with an exercise program for the
elderly. This enhanced compliance would likely be due
to the simplicity of the program, a byproduct of the
design of BR, and the ability for the individual to per-
form the movements without supervision, in contrast
to most traditional and more aggressive resistance
training regimens. We hypothesized that adding
weights would enhance the effectiveness of stretching
exercise on joint ROM beyond that of the stretching
exercise alone.
Methods
Subjects
Subjects were recruited from ongoing classes of BR,
and 43 healthy elderly individuals ages 5583 years
completed the requirements. A total of 11 subjects
from the original subject pool of 54 dropped out of the
study because of personal illness (n 2), subject re-
quest (n 1), or were excluded from analysis because
of lack of compliance, dened as attendance less than
50% (n 8). BR group comprised 18 subjects (8 men,
10 women, average age 67.9 5.6 years and weight
74.1 14.2 kg). BR weights (BRW) group com-
prised 14 subjects (4 males, 10 females, average age
68.4 3.1 years and weight 67.3 13.2 kg). Control
(C) group comprised 11 subjects (1 man, 10 women,
average age 68.6 6.5 years and weight 68.4
15.4 kg).
Health status of subjects was determined with a
medical history questionnaire and a risk factor prole
for cardiovascular disease to ensure safe participation.
Participants were excluded if they were shown to have
overt disease or any severely limiting orthopedic prob-
lems that may have prohibited performance of BR ex-
ercise. Medical history questionnaires revealed that
several subjects were currently on medication for hy-
pertension, tachycardia, depression, and arthritis. Sub-
jects reported numerous minor orthopedic problems,
but none that prohibited them from participating fully
in the BR exercise with or without weights. After an
explanation of the study and potential risks of partic-
ipation, all subjects signed an informed consent, which
had been approved by the legal counsel of Baptist East
Hospital, Louisville, KY, and the University of Louis-
ville Human Studies Committee. All testing and ex-
ercise training was conducted at Baptist East Hospital,
Louisville, KY.
Experimental Design
Forty-three subjects, ages 5583 years, participated in
1 of 2 training groups, BR and BRW or C. ROM was
evaluated at the neck, shoulder, hip, knee, and ankle
before and after 10 weeks of exercise. BR classes con-
sisted of 60 minutes of group instruction 3 times week-
ly for a period of 10 weeks. A Body Recall, Inc. certi-
ed instructor led participants in performing an ana-
tomically balanced selection of movements. The se-
quence of activity began with maneuvers that used
isolated muscle groups such as slow, thorough ankle
circles on 1 side at a time, and progressed to activities
that were more complex involving more muscles and
effort. Good posture and appropriate breathing were
emphasized to reduce potential for a Valsalva maneu-
ver. Table 1 lists sample arm and leg movements per-
formed either sitting or standing during the BR class
for both BR and BRW groups.
HeavyHands, Inc. (Pittsburgh, PA) hand weights
were used with various arm movements of BR pro-
gram for BRW group. HeavyHands are cushioned
weights ranging from 0.43 to 1.36 kg with a handle
that ts snugly over the knuckles. Ankle wrap weights
(0.91 kg) were utilized for nonweight-bearing (chair)
and weight-bearing (standing) exercises. Ankle
weights were padded to provide comfort and a Velcro
strap facilitated ease in attaching and removing
weights. The rst 5 weeks of training for BRW group
consisted of a gradual progression of number of
weighted exercises. At week 1, 1015 exercises utilized
weights. A weekly increase of 5 exercises allowed a
goal number of 35 exercises to be attained by week 6.
Weeks 6 through 10 served as maintenance phase of
training, with total number of exercises remaining
constant at 35. All subjects began training with 0.43-
kg HeavyHands and 0.91-kg ankle weights. Weekly
surveys were given to all participants to determine if
training was causing injuries and determine subject
compliance. Injury reports were limited to general
muscle soreness after weighted exercise during initial
5 weeks of training. No training sessions were missed
because of soreness or injury.
ROM Evaluation
ROM was evaluated at the neck, shoulder, hip, knee,
and ankle. All measurements were taken on the right
side, except for the neck, where both left and right
cervical rotation were measured. The same investiga-
tor obtained before and after exercise training mea-
surements (3). Measurement procedures followed the
recommendations of Russe and Gerhardt (17). A full-
circle and half-circle goniometer were used in deter-
mining joint ROM.
Cervical rotation was measured to the left and
right with subject seated. With both shoulders in con-
tact with a chair and head upright, subject passively
rotated head as far as possible to the appropriate side.
Degree of rotation was measured as 90 minus angle
between shoulders and sagittal plane of head, as
viewed from above subject.
Shoulder exion was measured in the supine po-
376 Swank, Funk, Durham, and Roberts
Table 1. Selected body recall exercises utilized for both BRW and BR.*
Arm exercises (chair)
Open/close hands
Elbow ex and extend
Wrist circling
Small arm circling
Large arm circling
Shoulder shrugs
Arm lift from knees
Single arm ings
Leg exercises (chair)
Ankle circling
Heel toe rock
Toe rising/pedaling
Bent leg lift
Alternate leg lift/extend
Lower leg extensions
Straight leg lifts
Leg sweeps to side
Single knee lift to chest
Single leg lift/extend/lower
Double knee lift
Single leg sweep
Leg circling
Heel lift with bent knee
Arm exercises (standing)
Bent arms backward pull
Jogger
Double arm ings
Swing forward/side/forward/side
Arm coordination
Leg exercises (standing)
Single straight leg lift
Toe rising
Forward stride
Leg lift backward
Leg lift sideward
Leg lift forward
Knee lifts
Knee swing
* BR body recall; BRW body recall with weights.
sition with thumb pointing up and arm passively lift-
ed over the head to full ROM. A goniometer was
placed on lateral side of shoulder joint with right axis
parallel to the trunk and left axis pointed toward the
medial epicondyle. Shoulder abduction was measured
in the supine position with arm passively moved from
side of the body to beside the head, with points of
reference identical to shoulder exion.
Hip exion was measured in the supine position,
left leg extended, right leg bent with foot on the table.
Subject was assisted to pull knee as close to chest as
possible with hips stabilized. The goniometer was
placed with center axis at greater trochanter with left
axis parallel to side of the body and right axis pointing
toward head of the bula. Hip extension was mea-
sured with subject lying on stomach, hips stabilized,
and leg passively lifted to full ROM. The goniometer
was placed at greater trochanter with left axis parallel
to trunk and right axis pointed toward lateral malle-
olus.
Knee extension was measured in the supine posi-
tion, legs extended, and ankle supported by a towel
roll to check for hyperextension. The goniometer cen-
ter axis was placed at lateral aspect of knee with left
axis toward greater trochanter and right axis toward
lateral malleolus. Knee exion was measured in the
supine position, left leg extended, right leg bent with
foot on the table. Subject was assisted by investigator
to pull foot as near buttocks as possible. The goni-
ometer was placed with center axis at lateral aspect of
knee with left axis pointing toward greater trochanter
and right axis pointing toward lateral malleolus.
Ankle measurements were performed with subject
supine on a table with knees extended and feet un-
supported. During measurement of plantar exion,
right ankle was passively extended with leg stabilized.
During dorsiexion measurement, subject was assisted
by investigator to attain maximum ROM. The goni-
ometer was placed on medial side of foot with center
axis on lateral malleolus. Left axis pointed toward
head of the bula and right axis was parallel with fth
metatarsal.
Statistical Analyses
ANCOVA was used with the pretest scores serving as
covariates in each analysis to statistically control for
preexercise training group differences (8, 9). Homo-
geneity of regression assumption was tested and re-
sults of a Levenes test of equality indicated that the
assumption of homogeneity of variance was support-
ed. A series of ANCOVAs were conducted on 11 ROM
outcomes using pretest scores as a covariate. Tests of
simple effects were followed by a Tukey Honestly Sig-
nicant Difference post hoc test to follow up the effect
and test observed differences on the adjusted means.
A p value of 0.01 was chosen as the level of signi-
cance.
Weighted Exercise for Healthy Elderly 377
Table 2. Posttest joint ROM (degrees) mean scores for 3 groups and baseline covariate (BCov).
Flexibility measures
Conditioning method
BCov BRW BR Control p
Cervical rotation right
Cervical rotation left
Hip extension
Ankle dorsiexion
Shoulder exion
56.6 12.0
59.9 14.7
21.3 7.7
6.0 7.6
167.4 8.7
73.4 8.2
67.1 2.0
14.9 2.4
8.2 0.9
171.5 1.2
52.2 9.1
56.2 1.6
32.9 1.5
4.4 0.8
171.3 1.0
55.6 4.8
58.6 1.9
31.8 2.0
5.1 1.0
166.6 1.3
0.01*
0.01*
0.01*
0.01*
0.01**
Ankle plantar exion
Knee extension
Hip exion
Knee exion
Shoulder abduction
42.9 13.7
2.5 2.6
118.5 11.5
138.9 16.1
166.9 14.9
51.8 1.4
0.69 0.40
125.0 2.2
146.0 1.7
164.2 2.1
49.4 1.2
1.5 0.40
121.8 1.8
143.1 1.4
168.5 1.8
46.7 1.5
1.4 0.5
126.1 2.2
142.7 1.7
170.6 2.3
0.01**
0.30
0.26
0.04
0.12
ROM range of motion; BR body recall; BRW body recall with weights.
* BRW signicantly increased compared to both BR and C.
** BRW and BR signicantly increased compared to C.
Results
ANCOVA-adjusted means for before exercise, 2 exper-
imental groups, and control, as well as standard de-
viations, and p-values of ROM for subjects are listed
in Table 2. Signicant differences across experimental
conditions for 6 ROM measures were observed: left
and right cervical rotation, hip extension, ankle dor-
siexion, shoulder exion, and ankle plantar exion.
No signicant differences were observed (p 0.01) for
the other 5 ROM measures. Post hoc analysis revealed
that ROM of cervical rotation (left and right), hip ex-
tension, and ankle dorsiexion for BRW subjects was
signicantly greater than BR and C (p 0.01). BR and
C for these measurements were not signicantly dif-
ferent (p 0.01). Signicant differences with shoulder
exion and ankle plantar exion were found for both
BR and BRW in comparison to C (p 0.01). The
main effect of BRW had moderate power with eta-
square values ranging from 0.21 to 0.43. In general,
these results suggest that participants increased ROM
when assigned to a BRW program, and the addition
of weights provided more benet than BR.
Discussion
This investigation compared joint ROM between 2
groups (BR and BRW) and a control group for
healthy elderly subjects. Results indicate that addition
of weights enhanced effectiveness of stretching exer-
cise by increasing ROM on 4 measurements above that
achieved with traditional stretching exercise associated
with BR program.
Prior investigations (4, 6, 10, 13, 16) have demon-
strated increases in ROM for elderly using a combi-
nation of stretching and rhythmic movements through
full ROM. Although it is difcult to compare results
of various studies given different joints measured and
different techniques, a consistent nding is that
stretching exercise is effective for enhancing ROM.
Only 1 study added weights with a purpose of in-
creasing effectiveness of stretching exercises on ROM.
Raab et al. (16) reported increases in ROM for shoulder
exion, shoulder abduction, left cervical rotation, and
ankle plantar exion in elderly women after a 25-week
exercise program for both weighted and nonweighted
groups. Addition of wrist and ankle weights provided
no additional benet and in the case of shoulder ab-
duction the nonweighted groups joint ROM was great-
er than that of the weighted group. To enhance safety
of exercises performed with weights, investigators
modied several of the leg and arm movements by
methods such as exing knees or elbows, modica-
tions that shortened the lever arm (16). However, it is
likely that for weights to be effective in increasing joint
ROM, the limb must move beyond a vertical plane to
maximize effect of gravity (16). Our current study
found that addition of weights enhanced effectiveness
of stretching exercise. It is likely a positive effect was
noted for 2 reasons: increased resistance during exer-
cise movement and exercises were performed through
full ROM. Safety of exercise routine was enhanced by
carefully selected exercises, modest additional weight,
and healthy and active subjects.
Limitations of the current investigation are twofold.
The interpretation of benecial effects of adding
weights to stretching exercise on ROM is limited by
nonrandom assignment of subjects; however, ANCO-
VA may correct for initial group differences. In addi-
tion, the ability to generalize responses is limited to
healthy, active, older adults who may not represent the
normal aging population. An indication of relative
joint tness of subjects is that pre-ROM values for the
BRW, BR, and C groups represent respectively 97%,
94%, and 95% of American Academy of Orthopedic
378 Swank, Funk, Durham, and Roberts
Surgeons standards (1). It seems plausible to hypoth-
esize that greater effects would be shown by addition
of weights to stretching routines for nursing home cli-
ents or free-living, otherwise sedentary elderly.
Practical Applications
The signicant improvements in joint ROM observed
with addition of weights may affect performance of
activities of daily living, a factor critical in mainte-
nance of an independent lifestyle (14, 18). For example,
increased ROM at shoulder complex may be related to
activities such as reaching overhead to a shelf (2). Im-
proved knee exion and extension would be associated
with increased ability to climb stairs or rise from a
chair. Improvements in hip extension, ankle plantar
exion, and ankle dorsiexion may serve a crucial role
in the maintenance of normal gait patterns in the el-
derly (14, 18), whereas increased cervical rotation has
been shown to improve driving skills for an older
driver (15).
This study demonstrated that adding weights to
stretching exercise represents an effective strategy for
increasing joint ROM. Future research should evaluate
this modication on other aspects of muscular tness
including endurance and strength. In addition, the ef-
fectiveness of this exercise modication should be eval-
uated with different populations such as the nursing
home individual and less t albeit free-living elderly.
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Address correspondence to Dr. Ann Marie Swank,
swank@louisville.edu.