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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Pre‐exercise stretching, Outcome 1 Soreness on day 1 (assessed 18‐30 hours post‐exercise).
Figuras y tablas -
Analysis 1.1

Comparison 1 Pre‐exercise stretching, Outcome 1 Soreness on day 1 (assessed 18‐30 hours post‐exercise).

Comparison 1 Pre‐exercise stretching, Outcome 2 Soreness on day 2 (assessed 42‐54 hours post‐exercise).
Figuras y tablas -
Analysis 1.2

Comparison 1 Pre‐exercise stretching, Outcome 2 Soreness on day 2 (assessed 42‐54 hours post‐exercise).

Comparison 1 Pre‐exercise stretching, Outcome 3 Soreness on day 3 (assessed 66‐78 hours post‐exercise).
Figuras y tablas -
Analysis 1.3

Comparison 1 Pre‐exercise stretching, Outcome 3 Soreness on day 3 (assessed 66‐78 hours post‐exercise).

Comparison 2 Post‐exercise stretching, Outcome 1 Soreness on day 1 (assessed 18‐30 hours post‐exercise).
Figuras y tablas -
Analysis 2.1

Comparison 2 Post‐exercise stretching, Outcome 1 Soreness on day 1 (assessed 18‐30 hours post‐exercise).

Comparison 2 Post‐exercise stretching, Outcome 2 Soreness on day 2 (assessed 42‐54 hours post‐exercise).
Figuras y tablas -
Analysis 2.2

Comparison 2 Post‐exercise stretching, Outcome 2 Soreness on day 2 (assessed 42‐54 hours post‐exercise).

Comparison 2 Post‐exercise stretching, Outcome 3 Soreness on day 3 (assessed 66‐78 hours post‐exercise).
Figuras y tablas -
Analysis 2.3

Comparison 2 Post‐exercise stretching, Outcome 3 Soreness on day 3 (assessed 66‐78 hours post‐exercise).

Comparison 3 Either pre‐exercise or post‐exercise stretching, Outcome 1 Soreness on day 1 (assessed 18‐30 hours post‐exercise).
Figuras y tablas -
Analysis 3.1

Comparison 3 Either pre‐exercise or post‐exercise stretching, Outcome 1 Soreness on day 1 (assessed 18‐30 hours post‐exercise).

Comparison 3 Either pre‐exercise or post‐exercise stretching, Outcome 2 Soreness on day 2 (assessed 42‐54 hours post‐exercise).
Figuras y tablas -
Analysis 3.2

Comparison 3 Either pre‐exercise or post‐exercise stretching, Outcome 2 Soreness on day 2 (assessed 42‐54 hours post‐exercise).

Comparison 3 Either pre‐exercise or post‐exercise stretching, Outcome 3 Soreness on day 3 (assessed 66‐78 hours post‐exercise).
Figuras y tablas -
Analysis 3.3

Comparison 3 Either pre‐exercise or post‐exercise stretching, Outcome 3 Soreness on day 3 (assessed 66‐78 hours post‐exercise).

Comparison 4 Both pre‐exercise and post‐exercise stretching, Outcome 1 Soreness in preceding week.
Figuras y tablas -
Analysis 4.1

Comparison 4 Both pre‐exercise and post‐exercise stretching, Outcome 1 Soreness in preceding week.

Comparison 4 Both pre‐exercise and post‐exercise stretching, Outcome 2 Bothersome soreness.
Figuras y tablas -
Analysis 4.2

Comparison 4 Both pre‐exercise and post‐exercise stretching, Outcome 2 Bothersome soreness.

Summary of findings for the main comparison. Pre‐exercise stretching to prevent soreness

Pre‐exercise stretching to prevent soreness

Patient or population: people doing unaccustomed exercise
Settings: any
Intervention: pre‐exercise stretching

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

pre‐exercise stretching

Soreness on day 1
Scale from: 0 to 100.
Follow‐up: 1 day

The mean soreness on day 1 in the control groups was
49

The mean soreness on day 1 in the intervention groups was
0.52 points lower
(11.30 lower to 10.26 higher)

70
(3 studies)

⊕⊕⊝⊝
low1,2,3

Soreness on day 2
Scale from: 0 to 100.
Follow‐up: 2 days

The mean soreness on day 2 in the control groups was
51

The mean soreness on day 2 in the intervention groups was
0.72 points higher
(11.20 lower to 12.64 higher)

40
(2 studies)

⊕⊕⊝⊝
low1,2,3

*The assumed risk for the 'control' group is based on the mean value of the results for all control groups in the trials included in each analysis. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Studies were randomised but little or no information was provided about allocation concealment, loss to follow‐up or analysis by intention to treat.
2 Most or all of these studies involved inducing muscle soreness using a standardised protocol. Such studies provide an indirect evaluation of the effects of stretching on soreness caused by recreational exercise.
3 There were too few studies to reliably assess risk of publication bias or other sources of small study bias.

Figuras y tablas -
Summary of findings for the main comparison. Pre‐exercise stretching to prevent soreness
Summary of findings 2. Post‐exercise stretching for people doing unaccustomed exercise

Post‐exercise stretching for people doing unaccustomed exercise

Patient or population: people doing unaccustomed exercise
Settings: any
Intervention: post‐exercise stretching

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

post‐exercise stretching

Soreness on day 1
Scale from: 0 to 100.
Follow‐up: 1 day

The mean soreness on day 1 in the control groups was
29

The mean soreness on day 1 in the intervention groups was
1.04 point lower
(6.88 lower to 4.79 higher)

127
(4 studies)

⊕⊕⊝⊝
low1,2,3

Soreness on day 2
Scale from: 0 to 100.
Follow‐up: 2 days

The mean soreness on day 2 in the control groups was
35

The mean soreness on day 2 in the intervention groups was
1.12 points higher
(4.63 lower to 6.87 higher)

158
(5 studies)

⊕⊕⊝⊝
low1,2,3

*The assumed risk for the 'control' group is based on the mean value of the results for all control groups in the trials included in each analysis. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Studies were randomised but little or no information was provided about allocation concealment, loss to follow‐up or analysis by intention to treat.
2 Most or all of these studies involved inducing muscle soreness using a standardised exercise protocol. Such studies provide an indirect evaluation of the effects of stretching on soreness caused by recreational exercise.
3 There were too few studies to reliably assess risk of publication bias or other sources of small study bias.

Figuras y tablas -
Summary of findings 2. Post‐exercise stretching for people doing unaccustomed exercise
Summary of findings 3. Either pre‐ or post‐exercise stretching for people doing unaccustomed exercise

Either pre‐exercise or post‐exercise stretching for people doing unaccustomed exercise

Patient or population: people doing unaccustomed exercise
Settings: any
Intervention: either pre‐ or post‐exercise stretching

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

either pre‐ or post‐exercise stretching

Soreness on day 1
Scale from: 0 to 100.
Follow‐up: 1 day

The mean soreness on day 1 in the control groups was
36

The mean soreness on day 1 in the intervention groups was
0.93 points lower
(6.05 lower to 4.20 higher)

197
(7 studies)

⊕⊕⊝⊝
low1,2,3

Soreness on day 2
Scale from: 0 to 100.
Follow‐up: 2 days

The mean soreness on day 2 in the control groups was
38

The mean soreness on day 2 in the intervention groups was
1.04 higher
(4.14 lower to 6.22 higher)

198
(7 studies)

⊕⊕⊝⊝
low1,2,3

*The assumed risk for the 'control' group is based on the mean value of the results for all control groups in the trials included in each analysis. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Studies were randomised but little or no information was provided about allocation concealment, loss to follow‐up or analysis by intention to treat.
2 Most or all of these studies involved inducing muscle soreness using a standardised exercise protocol. Such studies provide an indirect evaluation of the effects of stretching on soreness caused by recreational exercise.
3 There were too few studies to reliably assess risk of publication bias or other sources of small study bias.

Figuras y tablas -
Summary of findings 3. Either pre‐ or post‐exercise stretching for people doing unaccustomed exercise
Summary of findings 4. Both pre‐exercise and post‐exercise stretching for people doing unaccustomed exercise

Both pre‐exercise and post‐exercise stretching for people doing unaccustomed exercise

Patient or population: patients with people doing unaccustomed exercise
Settings: any
Intervention: both pre‐ and post‐exercise stretching

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Both pre‐ and post‐exercise stretching

Soreness in preceding week
Scale from: 0 to 100.

The mean soreness in preceding week in the control groups was
25

The mean soreness in preceding week in the intervention groups was
3.80 points lower
(5.17 to 2.43 lower)1

2377
(1 study)

⊕⊕⊕⊝
moderate2,3

Risk of bothersome soreness in preceding week
Self‐report (yes/no)

Study population

OR 0.69
(0.59 to 0.82)1

0
(1 study)

⊕⊕⊕⊝
moderate2

See comment

See comment

Medium risk population

323 per 1000

248 per 1000
(220 to 281)

*The assumed risk for the 'control' group is based on the results for the control groups in the only trial included in this analysis. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 The trial was a longitudinal study with repeated (non‐independent) observations on individuals. The estimate provided in the trial report is used here.
2 Significant loss to follow‐up. However most subjects provided some follow‐up data and longitudinal method of analysis deals optimally with missing data.
3 Only one study.

Figuras y tablas -
Summary of findings 4. Both pre‐exercise and post‐exercise stretching for people doing unaccustomed exercise
Comparison 1. Pre‐exercise stretching

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Soreness on day 1 (assessed 18‐30 hours post‐exercise) Show forest plot

3

70

Mean Difference (IV, Fixed, 95% CI)

‐0.52 [‐11.30, 10.26]

2 Soreness on day 2 (assessed 42‐54 hours post‐exercise) Show forest plot

2

40

Mean Difference (IV, Fixed, 95% CI)

0.72 [‐11.20, 12.64]

3 Soreness on day 3 (assessed 66‐78 hours post‐exercise) Show forest plot

2

40

Mean Difference (IV, Fixed, 95% CI)

‐2.50 [‐15.82, 10.82]

Figuras y tablas -
Comparison 1. Pre‐exercise stretching
Comparison 2. Post‐exercise stretching

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Soreness on day 1 (assessed 18‐30 hours post‐exercise) Show forest plot

4

127

Mean Difference (IV, Fixed, 95% CI)

‐1.04 [‐6.88, 4.79]

2 Soreness on day 2 (assessed 42‐54 hours post‐exercise) Show forest plot

5

158

Mean Difference (IV, Fixed, 95% CI)

1.12 [‐4.63, 6.87]

3 Soreness on day 3 (assessed 66‐78 hours post‐exercise) Show forest plot

3

67

Mean Difference (IV, Fixed, 95% CI)

‐0.03 [‐7.49, 7.43]

Figuras y tablas -
Comparison 2. Post‐exercise stretching
Comparison 3. Either pre‐exercise or post‐exercise stretching

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Soreness on day 1 (assessed 18‐30 hours post‐exercise) Show forest plot

7

197

Mean Difference (IV, Fixed, 95% CI)

‐0.93 [‐6.05, 4.20]

2 Soreness on day 2 (assessed 42‐54 hours post‐exercise) Show forest plot

7

198

Mean Difference (IV, Fixed, 95% CI)

1.04 [‐4.14, 6.22]

3 Soreness on day 3 (assessed 66‐78 hours post‐exercise) Show forest plot

5

107

Mean Difference (IV, Fixed, 95% CI)

‐0.28 [‐6.79, 6.22]

Figuras y tablas -
Comparison 3. Either pre‐exercise or post‐exercise stretching
Comparison 4. Both pre‐exercise and post‐exercise stretching

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Soreness in preceding week Show forest plot

1

2323

Mean Difference (Fixed, 95% CI)

‐3.8 [‐5.17, ‐2.43]

2 Bothersome soreness Show forest plot

1

2323

Odds Ratio (Fixed, 95% CI)

0.69 [0.59, 0.82]

Figuras y tablas -
Comparison 4. Both pre‐exercise and post‐exercise stretching