International Journal of

Environmental Research
and Public Health

Article
Gender-Specific Effects of 8-Week Multi-Modal Strength and
Flexibility Training on Hamstring Flexibility and Strength
Shangxiao Li 1 , Liduan Wang 2 , Jinfeng Xiong 3 and Dandan Xiao 1, *

1 Research Center for Sports Psychology and Biomechanics, China Institute of Sport Science,
Beijing 100061, China
2 School of Rehabilitation Medicine, Weifang Medical University, Weifang 261053, China
3 Institute of Sports Science, Sichuan University, Chengdu 610065, China
* Correspondence: [email protected]

Abstract: The purpose of this study was to investigate the effects of multi-modal strength training
or flexibility training on hamstring flexibility and strength in young males and females. A total
of 20 male and 20 female college students (aged 18–24 years) participated in this study and were
randomly assigned to either a multi-modal flexibility intervention group or strength intervention
group. Passive straight leg raise and isokinetic strength test were performed before and after the
intervention to determine flexibility and strength of the participants. Multivariate repeated-measure
ANOVA was used to determine the effect of training group and gender on hamstring strength and
flexibility. Both male and female participants in the strength intervention group significantly increased
peak torque, relative peak torque, and flexibility (all p ≤ 0.029). Both male and female participants
in the flexibility intervention group significantly increased flexibility (both p ≤ 0.001). Female
Citation: Li, S.; Wang, L.; Xiong, J.; participants in the flexibility intervention group significantly increased peak torque and relative
Xiao, D. Gender-Specific Effects of peak torque (both p ≤ 0.023). However, no change was seen in peak torque and relative peak torque
8-Week Multi-Modal Strength and of male participants in the flexibility intervention group (p ≥ 0.676). An 8-week strength training
Flexibility Training on Hamstring program involving various training components can increase flexibility in both males and females,
Flexibility and Strength. Int. J.
although the flexibility of male participants only increased slightly. While hamstring flexibility
Environ. Res. Public Health 2022, 19,
training protocol consisted of different types of stretching improved both flexibility and strength
15256. https://doi.org/10.3390/
in female participants, male participants increased only flexibility but not strength, indicating such
ijerph192215256
effects were gender-specific. For subjects with relatively low strength (e.g., older adults, sedentary
Academic Editors: Paul B. women, postoperative rehabilitation population, etc.), strength training alone or flexibility training
Tchounwou, Victor M. Reis, Filipe
alone may increase both strength and flexibility.
Manuel Clemente and Felipe J.
Aidar
Keywords: strength; flexibility; multi-modal training; injury prevention
Received: 15 August 2022
Accepted: 14 November 2022
Published: 18 November 2022
1. Introduction
Publisher’s Note: MDPI stays neutral
with regard to jurisdictional claims in Strength and flexibility are among the most important physical fitness features [1].
published maps and institutional affil- Strength and flexibility help people attain a healthy physical fitness level and functional
iations. autonomy, and play key roles in reducing sports injuries and improving sports skills and
ability [1,2].
Strength training alone may lead to an increase in flexibility. A study completed by
Santos et al. showed that an 8-week moderately intense strength training can improve
Copyright: © 2022 by the authors. shoulder and trunk joint flexibility in young sedentary women [3]. Barbosa et al. demon-
Licensee MDPI, Basel, Switzerland. strated that a 10-week weight training without performing stretching exercises significantly
This article is an open access article
increased sit-and-reach test score of elderly women [4]. Further, several studies have shown
distributed under the terms and
that strength training alone over a period of time promotes flexibility in older adults [5,6].
conditions of the Creative Commons
In addition, several studies concluded that eccentric training programs increased joint
Attribution (CC BY) license (https://
flexibility [7,8], supporting that eccentric exercise is an effective method of increasing lower
creativecommons.org/licenses/by/
limb flexibility [9].
4.0/).

Int. J. Environ. Res. Public Health 2022, 19, 15256. https://doi.org/10.3390/ijerph192215256 https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2022, 19, 15256 2 of 11

While most studies have shown acute decreases in strength after stretching [10,11], the
literature on the chronic effects of flexibility training on muscle strength showed strength
may increase [12,13] or not change [14,15]. A study by Behm et al. recruited twelve
male college students to participate in a stretching training program on quadriceps and
hamstring muscle, and the results showed a significant decrease (−6.1% to −10.7%) in
muscle strength after an acute bout of static stretching while no significant decrement on
strength was observed after 4 weeks of flexibility training [14]. In addition, it was shown
that 8 weeks of proprioceptive neuromuscular facilitation (PNF) stretching increased muscle
strength of knee flexors (15.5%) and knee extensors (6.1%) [13], and static stretching increase
muscle strength of knee flexors in untrained young men (8.7%) [13]. Several existing studies
supported that flexibility training alone over a period of time promotes strength [12,16].
Although the strength or flexibility training protocols used in actual practice usually
incorporate multiple training modalities, researches on the relevant topic generally focused
on the effects of a single type of technique [8,12] whose results may not be conveyed to
daily training. Multi-modal training may show superiority over one single training method.
Further examination of the influence of multi-modal strength and flexibility training on
flexibility or strength is an important part towards a comprehensive understanding of
the synergistic (or counteractive) effects of different training modalities, which could be
important when prescribing physical exercise programs with the purpose to increase the
effectiveness of training. Such information is also crucial for training programs aimed at
either preventing sports-related injuries or optimizing recovery after injuries occur.
Gender may play an important role in the physical fitness improvement in response to
different types of training. Beneka et al. found that resistance training effects were related
to gender [17]. Thomas et al. also found that the effects of high-velocity strength training
on isometric strength were gender specific [18]. While training produced improvements in
counter movement jump height in both genders, significant increases in maximal isometric
force and rate of force development were found only in females [18]. However, most
studies focused on single gender participants and did not consider gender as a potential
confounding factor [6,12,14], while some studies analyzed the results of both genders as
one group [16].
Therefore, the purpose of this study is to investigate how strength training or flexibility
training protocol that incorporates multiple training modalities can influence flexibility and
strength for males and females. Hamstring muscle was studied as hamstring strain injury
is one of the most common injuries with serious consequences in sports [19], and flexibility
and strength were the most investigated modifiable risk factors for hamstring injury [20].
We hypothesized that (1) 8 weeks of multi-modal strength training can significantly improve
hamstring strength in young healthy male and female adults without reducing hamstring
flexibility, and (2) 8 weeks of multi-modal flexibility training can significantly improve
hamstring flexibility in young healthy male and female adults without reducing strength.

2. Materials and Methods

2.1. Participants
Forty healthy college students (aged 18–24 years, 20 males and 20 females) regularly
participating in running or basketball, 2–3 times a week, volunteered for this study and
were randomly assigned to either a strength intervention group or a flexibility intervention
group. Using a block randomization procedure with a block size of 4, participants were
randomly assigned to either a flexibility intervention group or a strength intervention
group. A block was randomly picked by the 2th author (LDW) for every 4 incoming
participants. The assignment of each participant was revealed after the participant signed
the consent form. All participants had no history of lower extremity injuries 2 years prior
to the study. This study was approved by the Institutional Review Board. Prior to any data
collection, all participants signed a consent form. Detailed information for all participants
was shown in Table 1.
Int. J. Environ. Res. Public Health 2022, 19, 15256 3 of 11

Table 1. Participant demographic characteristics (mean ± standard deviation).

Gender Group Number of Age (Years) Weight (kg) Height (m)

Participants (N)
Male Flexibility 10 20.6 ± 1.6 70.5 ± 5.2 1.79 ± 0.04
Strength 10 20.8 ± 2.0 64.0 ± 3.2 1.74 ± 0.03
Female Flexibility 10 21.6 ± 1.4 55.6 ± 5.1 1.65 ± 0.05
Strength 10 20.8 ± 1.5 57.1 ± 6.4 1.63 ± 0.05
Flexibility, flexibility training group. Strength, strength training group.

2.2. Overview of Procedures

All participants completed a baseline testing, an 8-week multi-modal strength training
intervention or flexibility training intervention, and a post-intervention testing session.
All participants were trained and tested bilaterally. The pre- and post-intervention testing
sessions started with a passive straight leg raise (PSLR) test for flexibility evaluation, and
an isokinetic strength test for maximum muscle strength evaluation. Participants were
instructed not to perform any vigorous physical activity at least 48 h prior to either testing
session. All tests were carried out in the same laboratory, with room temperature and
humidity set at the same.

2.3. Training Session Protocol

All participants were trained three times per week for 30 min per session. A minimum
of 36 h between two consecutive sessions were given to provide enough recovery time
for the participants. Each training program consisted of 6 min of standardized warm-up
including jogging and reverse lunge and heel to butt exercises, followed by a series of
hamstring flexibility or strength training intervention for about 25 min, and was supervised
by certified personal trainers. The strength intervention included a series of knee flexion
exercises with resistance and Nordic hamstring curl exercises, with details shown in Table 2.
The flexibility intervention included a series of dynamic, static, and PNF stretches, with
details shown in Table 2. The type of PNF employed in the current study was based on the
contract-relax technique [21], which begins with a passive pre-stretch of the hamstrings
that is held at the point of mild discomfort for 10 s, then the participant extends the hip
against resistance from the trainer for 6 s. The participant then relaxes, and a passive
hip flexion stretch is applied and held for 10 s [21]. One set of PNF stretch includes
repeating the abovementioned procedure twice. Before the training program training
starts, all trainers and participants received written descriptions and illustrations of the
required interventions. All trainers were trained and examined to ensure that required
exercises were performed appropriately. The participants were instructed to maintain their
current physical activity level and dietary routine, and avoid any structured exercises while
participating in the study.

Table 2. Detailed flexibility and strength training content.

Flexibility Intervention Strength Intervention

Week Content Loading and Sets Content Loading and Sets
Repetitions Repetitions
1 Walking knee lift 15 times 2 NHC with bend 8 reps 3
Sitting toe touch 40 s/leg 2 Prone hamstrings curl 12 reps 4
PNF stretch 50 s/leg 3 Physio-ball curl (two-leg) 8 reps 3
Foam roll 40 s/leg 3 Glute bridge 50 s/leg 2
2–4 Forward lunge 15 times 2 NHC with bend 12 reps 3
Sitting toe touch 50 s/leg 3 Prone hamstrings curl 14 reps 3
PNF stretch 50 s/leg 3 Physio-ball curl (two-leg) 10 reps 3
Foam roll 50 s/leg 3 Glute bridge 50 s/leg 2
5–8 Forward lunge 15 times 2 NHC 12 reps 3
Semi-straddle 60 s/leg 2 Prone hamstrings curl 15 reps 3
PNF stretch 50 s/leg 3 Physio-ball curl (two-leg) 10 reps/leg 2
Foam roll 50 s/leg 4 Glute bridge 60 s/leg 2
PNF = Proprioceptive neuromuscular facilitation; NHC = Nordic hamstring curl. 30 s rest between sets, and 1 min
rest between exercises.
Int. J. Environ. Res. Public Health 2022, 19, 15256 4 of 11

2.4. PSLR Test for Flexibility

The flexibility of all participants was assessed three times using the PSLR test com-
bined with a high-definition digital camera (GC-PX100, JVC, Yokohama, Japan) placed
perpendicularly to the participant’s sagittal plane to record body position. All tests were
administered by the same experienced tester to avoid intra-operator variability. The test
started with the participant laid supine on a cushion, and the tester placed one hand on the
superior iliac crest of the non-testing side of the participant to prevent the pelvis from rotat-
ing, while lifting the testing leg slowly using the other hand. The participant’s knee was
kept extended throughout the test. The PSLR test was terminated when the participant’s
pelvis started to rotate, or when he/she started to feel discomfort or large resistance that
caused the testing leg no longer able to be lifted. Each participant was tested three times
for each leg, with 60 s rest time given between two consecutive tests.

2.5. Isokinetic Strength Test for Strength

Hamstring strength was assessed by measuring knee flexion torque using an IsoMed
2000 strength testing dynamometer (D&R Ferstl GmbH, Hemau, Germany). The participant
sat on the dynamometer with hip fixed at 90◦ , and the torso and pelvis secured on the
testing chair. The knee joint of the testing leg was aligned with the rotator arm of the
dynamometer, and the range of motion (ROM) for the rotator arm was between 0–110◦ ,
with 0◦ being when the knee was fully extended. The angular speed of isokinetic testing
was set at 10◦ /s. The participant was instructed to perform the isokinetic test with their
maximal effort, and each participant was tested three times for each leg, with 90 s rest time
given between two consecutive tests.
Data of this study was previously presented to determine the effects of altering ham-
string flexibility or strength on hamstring optimal lengths [22]. However, in this manuscript,
we sought to discuss whether multi-modal hamstring flexibility and strength training were
gender-specific.

2.6. Data Analysis

Maximal hip flexion angle was determined as the maximal hip flexion angle from the
digitized photo taken during the PSLR test. The range of hip joint flexion in each PSLR trial
was calculated as the angle between the vector from the hip joint center to knee joint center,
and the vector from the acromion process to hip joint center. The average of the maximal
hip flexion angles from three PSLR trials was used as the hamstring flexibility score for
each leg.
Isokinetic strength data were processed on the dynamometer to get peak torque of
the hamstring during the isokinetic test. Relative peak torque was calculated as the peak
torque divided by body mass, with a unit of Nm/kg. The strength testing trial that had the
maximal peak torque and relative peak torque was selected to represent hamstring strength.

2.7. Statistical Analyses

Multivariate repeated-measure ANOVA was used to determine the effect of train-
ing group and gender on hamstring strength and flexibility, with time as a factor in the
repeated-measure. If the three-way interaction was significant, then additional analysis
was carried out as needed and is detailed in the Section 3. If the three-way interaction was
not significant, then simple effects (LSD) test was used.
All statistical analyses were performed using Version 18.0 of SPSS computer program
package (SPSS, Chicago, IL, USA). Statistical significance was defined as the type I error
rate lower than or equal to 0.05. To measure the magnitude of training effects, Cohen’s d
(d) was calculated when applicable, with 0.2, 0.5 and 0.8 considered as small, medium and
larger effects, respectively.
Int. J. Environ. Res. Public Health 2022, 19, 15256 5 of 11

3. Results
All participants completed all training sessions. The three-way interaction from the
multivariate repeated-measure ANOVA was not significant for peak torque or relative
peak torque, so simple effect was used for subsequent tests. The three-way interaction
for flexibility was significant, and further analyses revealed that the two-way interaction
between time and gender, as well as between time and group, was significant. Paired t-test
(two-tail) was used for post-hoc analysis accordingly.
Peak torque of male participants and female participants in the strength intervention
group were both significantly increased in the post-intervention test in comparison to
the pre-intervention test (p = 0.010 and 0.004, respectively; Figure 1) with large effect size
(d = 0.80 and 0.99, increased by 9.0% and 16.3%, respectively). Relative peak torque of both
male and female participants also increased (p = 0.009 and 0.001, respectively; Figure 1) with
large effect size (d = 0.80 and 1.00, increased by 9.0% and 16.6%, respectively). Flexibility of
male participants as well as female participants in the strength intervention group were
Int. J. Environ. Res. Public Health 2022, 19,significantly increased in the post-intervention test in comparison
x FOR PEER REVIEW to the pre-intervention
6 of 12

test (p = 0.029 and <0.001, respectively; Figure 1) with small and large effect size (d = 0.43
and 1.52, increased by 4.5% and 10.5%, respectively).

Figure 1. Effects of an 8-week strength training program on hamstring strength and flexibility.
Figure 1. Effects of an 8-week strength training program on hamstring strength and flexibility. (A)
(A) Training
Training effect
effect on peak on (B)
torque. peak torque.
Training (B)
effect on Training effect
relative peak on(C)relative
torque. Trainingpeak torque.
(C) Training effect on
effect on hip
flexion
hipangle. * Significant
flexion angle. *training effects. training effects.
Significant
Peak torque of female participants in the flexibility intervention group was signifi-
cantly increased in the post-intervention test in comparison to the pre-intervention test (p
= 0.023; Figure 2) with medium effect size (d = 0.67, increased by 11.4%), while peak torque
of male participants was not significantly changed in the post-intervention test (p = 0.676,
d = −0.06; Figure 2). Relative peak torque of female participants in the flexibility inter-
vention group was significantly increased in the post-intervention test in comparison to
Int. J. Environ. Res. Public Health 2022, 19, 15256 6 of 11

Peak torque of female participants in the flexibility intervention group was signifi-
cantly increased in the post-intervention test in comparison to the pre-intervention test
(p = 0.023; Figure 2) with medium effect size (d = 0.67, increased by 11.4%), while peak
torque of male participants was not significantly changed in the post-intervention test
(p = 0.676, d = −0.06; Figure 2). Relative peak torque of female participants in the flexibility
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 7 of 12
intervention group was significantly increased in the post-intervention test in comparison
to the pre-intervention test (p = 0.009; Figure 2) with medium effect size (d = 0.66, increased
by 11.0%),
11.0%), while peakwhile
torque peak torque
of male of male
participants wasparticipants was
not significantly not significantly
changed in the changed in the
post-intervention test (p = test
post-intervention 0.803,(p
d ==−0.04;
0.803,Figure −0.04;
d = 2). Flexibility
Figureof male
2). participants
Flexibilityasofwell
male participants as well
as female participants in the strength intervention group were significantly increased in
as female participants in the strength intervention group were significantly increased in the
the post-intervention test in comparison to the pre-intervention test (both p < 0.001; Figure
2) with large effect size (d =test
post-intervention 2.06in
and comparison
3.10, increasedtobythe pre-intervention
18.1% test (both p < 0.001; Figure 2)
and 19.0%, respectively).
with large effect size (d = 2.06 and 3.10, increased by 18.1% and 19.0%, respectively).

Figure 2. Effects of an 8-week flexibility training program on hamstring strength and flexibility.
Figure 2. Effects of an 8-week flexibility training program on hamstring strength and flexibility. (A)
(A) Training
Training effect
effect on peak on (B)
torque. peak torque.
Training effect(B) Training
on relative peakeffect
torque.on
(C)relative
Training peak torque.
(C) Training effect on
effect on hip
flexion
hipangle. * Significant
flexion angle. training effects. training effects.
* Significant

4. Discussion
Results from the current study suggest that a multi-modal strength training interven-
tion program consisting of concentric, eccentric, and isometric training can significantly
increase hamstring peak torque and relative peak torque in both males and females (d ≥ 0.80
for both groups), which is consistent with our hypothesis. Therefore, we demonstrated
Int. J. Environ. Res. Public Health 2022, 19, 15256 7 of 11

that an 8-week integrated strength training protocol employed in this study can be used to
increase hamstring strength. In addition, significant increase in the PSLR test score was also
observed for both male and female participants (p ≤ 0.029, d ≥ 0.43), although flexibility of
males only increased by 4.5%. This is consistent with our first hypothesis that 8 weeks of
multi-modal strength training does not reduce hamstring flexibility.
The results of our study support the notion that multi-modal strength training without
stretching increases flexibility on healthy young adults. Several studies have found that
strength training alone contributes to the development and maintenance of flexibility
even without additional stretching [3,4,6,8,14]. However, these studies generally focused
on the effects of strength training on aging population or sedentary participants [3,4,6].
Moreover, studies have shown that the flexibility improvement with strength training may
be intensity-dependent and volume-dependent [6,23], with intensities 60% or 80% of 1RM
are more effective in producing flexibility gains compared to intensities 40% of 1RM [6].
This implies that for active individuals who possess relatively high level of strength, higher
training loads of strength training may be needed to increase flexibility. In addition, the
strength training method of our study included a series eccentric training. It has been
consistently shown that eccentric strength training could increase angular ROM and fascicle
length for several muscles, including the quadriceps, hamstring and triceps surae [9]. It
is worth mentioning that the effect size of flexibility gains by strength training was larger
for females (d = 1.52) while being small for males (d = 0.43). The difference may come
from training loads and gender differences. Male participants had greater strength before
training intervention. While our training protocol mainly focused on self-weight training,
the level of loading for males may be relatively lower compared to females.
The mechanism underlying the improved flexibility in response to strength training is
not fully understood, but several possibilities have been proposed. The first is related to
the physical property of the muscle. It has been shown that strength training could induce
a decrease in stiffness of the active part of the series elastic component [24], reduce passive
torque [7], and increase tensile strength of tendons and ligaments [25]. Second, eccentric
exercise is more likely to generate passive stretch to elongate the muscle fibers [26]. An
animal study showed that eccentric training induced longitudinal adaptation of the sarcom-
eres [27], which may increase muscle fascicle length and subsequently lead to improved
flexibility. In the current study, we employed a strength protocol which encompasses
concentric, eccentric as well as isometric training components. The enhanced flexibility
seen in both male and female participants following the 8 weeks training is likely due to
both the physical property changes in the hamstring in response to strength training, as
well as the effects of stretch of the muscle fibers that is caused by eccentric exercise.
The results from the current study also suggest that a multi-modal flexibility training
protocol that is consisted of static, dynamic, and PNF stretching can significantly improve
hip ROM in both male and female participants (p < 0.001, d ≥ 2.00 for both groups), which
is consistent with our second hypothesis and suggest that the flexibility training protocol
employed in this study can be used to increase flexibility. No change for strength was
observed in males (p ≥ 0.627, |d| ≤ 0.06), while significant increase in strength was seen
for female participants with medium effect size (p ≤ 0.039, d ≥ 0.62). Therefore, the effects
of flexibility training on strength seem to be gender specific.
Although there were some heterogeneity, most longitudinal studies found either
increase or no change in muscle strength following flexibility training, mainly for the lower
limb muscles [14,28,29]. Recently, a review of 25 studies indicated that flexibility training
may increase strength as measured during isotonic contractions, but no improvement
on strength was seen as measured using isometric contractions test [30]. That implied
that different methods used to evaluate strength may also contribute to the inconsistent
findings. Interestingly, study by Nelson et al. found that a 10-week unilateral static
stretching intervention in college students with no training experience not only increased
strength in triceps surae on the side being trained, but also showed a crossed training
effect on the contralateral side, as its strength was also improved [16]. Another 8-week
Int. J. Environ. Res. Public Health 2022, 19, 15256 8 of 11

PNF training study also found a cross-training effects, which increased by 9.9% on knee
extension torque on the non-training side [31]. This could be important information for
rehabilitation programs aiming at improving muscle function of an immobilized leg. The
results from the current study showed no strength change for males but significant increase
for female participants by an 8-week multi-modal flexibility training. Our study indicates
that long-term flexibility training may be an effective way to not only improve flexibility,
but also simultaneously improve strength, although in a gender-specific manner. Clearly
more research is needed to confirm this notion.
There are several possible mechanisms that may lead to the strength gain after longitu-
dinal flexibility training. The first is the structural adaptations in skeletal muscle. Stretching
has been shown to increase muscle mass, muscle length, muscle fiber size, serial sarcomere
number, and cross-sectional area in quails or rats [32,33]. Further analysis also suggested
increased muscle protein synthesis. These changes laid the structural foundation for the
potential muscle strength increase [34]. The second possible mechanism is the alteration
of physical properties of the muscle. It is possible that flexibility training induced skeletal
muscle physical property changes. It was reported that flexibility training can increase the
compliance of the series elastic component, reduce the viscoelastic properties of the tendon,
and store more elastic energy [35]. These changes could build the physical foundation for
strength gain in muscle. The third potential mechanism is the enhanced neuromuscular
adaptation. A study by Yamashita et al. indicated that stretching can increase the Ca2+
conductance at nerve terminal, facilitate the release of neurotransmitters, and therefore
improve neuromuscular transmission [36]. Coupled with other studies which indicated
that flexibility training leads to enhanced neuromodulation and reflex sensitivity [16,37], it
seems that a better neuromechanical adaptation is induced by this training modality that
prepares for the possible strength gain in skeletal muscle. Last but not least, PNF stretching
does include a strength training component. Several studies have reported that those with
low level of strength at baseline could increase strength following PNF stretching, as this
type of stretching includes both concentric and isometric contractions against external
loading [29,31].
The results of our study suggest that the effect of the multi-modal flexibility training
protocol employed in the current study on hamstring strength appears to be gender specific.
One previous study also investigated the gender-related effects in strength training and
concluded that females have higher adaptability following strength training, which is
likely attributed to their lower absolute as well as relative strength than males [18]. Male
participants in our study may have better neural recruitment pattern and the effect of
training on nervous system was relatively low, therefore no strength gain was observed
in male participants. As previously mentioned, strength gain by flexibility training was
mostly studied in old or sedentary adults, and those are individuals considered to have low
strength to begin with [16,28]. This study has shown that the increase in strength is mainly
due to muscle hypertrophy and increased recruitment of neurons, and improvement in
neuron recruitment generally happens at the early stage of training [38]. The hamstring
strength gain seen in female participants in this study is primary due to the results of the
enhanced neuromuscular conductance, as our training only lasted eight weeks. Taken
together, the influence of flexibility training on strength appears to be gender specific,
which is likely due to the different baseline strength between males and females. Therefore,
those with low baseline strength may have better strength gain following flexibility training,
although more specific research on this topic is required.
Studies on how strength training and flexibility training may influence strength and
flexibility have yielded conflicting results. Two studies from the same research team
included both flexibility training and strength training produced conflicting results [15,39].
One study drew the conclusion that flexibility training did not change strength while
strength training increased flexibility [15]. However, findings from the other study showed
that flexibility training increased strength slightly while strength training did not change
flexibility [39]. A similar study concluded that increases in muscle strength and flexibility
Int. J. Environ. Res. Public Health 2022, 19, 15256 9 of 11

are only developed by specific training programs [40]. Yet, gender differences were not
considered, although the study enrolled 35% female participants [40]. Different strength
levels between males and females before training may partly explain the results in our
study which showed that the effect of flexibility training on strength were gender-specific.
To sum up, the inconsistent findings in the literature may be attributed to various factors,
including but not limited to subject characteristics (such as gender, age and physical activity
level), specific training contents (type of training, intensity and duration of training), as
well as variety methods employed to evaluate flexibility and strength.
The limitations of this study must be addressed. First, muscle strength was tested
as the peak torque during isokinetic strength test, which only represents one aspect of
strength. In addition, the training protocols were designed for individuals who do not
have professional training experience, which may not be suitable for athletes who already
possess high level of strength and flexibility. Therefore, our findings may not be generalized
into this population. Third, this study only evaluated strength and flexibility in response
to training. How strength and flexibility training may influence other abilities crucial to
movement, such as balance and agility may need to be further explored.

5. Conclusions
An 8-week strength training program involving various training components can
increase flexibility in both males and females, although the flexibility of male participants
only increased slightly. While hamstring flexibility training protocol consisted of different
types of stretching improved both flexibility and strength in female participants, male
participants increased only flexibility but not strength, indicating such effects were gender
specific. When prescribing physical exercise programs, it is necessary to take gender or
baseline muscle strength level into consideration. For subjects with relatively low strength
(e.g., older adults, sedentary women, postoperative rehabilitation population etc.), strength
training alone or flexibility training alone may increase both strength and flexibility.

Author Contributions: Conceptualization, S.L. and D.X.; methodology, L.W.; analysis, J.X.; data
curation, S.L. and J.X.; writing—original draft preparation, S.L. and L.W.; writing—review and
editing, S.L. and D.X.; supervision, D.X. All authors have read and agreed to the published version of
the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: The study was conducted in accordance with the Declaration
of Helsinki, and approved by the Institutional Review Board of Beijing Sport University (IRB approval
ID #2018014H and June 2018).
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: Not applicable.
Acknowledgments: We would like to thank all the participants for their committed participation.
Conflicts of Interest: The authors declare no conflict of interest.

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