Assigment .Apa seven . All instructions attached.

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Synthesis of the Literature

Alex De Cardenas

Florida National University

MSN Capstone Project-DAX-DL01

Dr. Carmen Lazo

June 6, 2026

Synthesis of the Literature

The literature documents a consistent pattern: structured stretching and movement exercises are associated with changes in musculoskeletal stiffness and flexibility, as well as in physical discomfort, across various populations and settings. In many studies, regular, structured, and integrated stretching is correlated with better self-reported musculoskeletal benefits. A general pattern was emerging: using stretching as a repeated self-management behavior is a more effective method of self-management than stretching as a one-time, isolated activity. This is evident in research studies in clinical and community-based populations as well as experiments and is consistently highlighted as a crucial factor for outcomes.

Need for Change: Local and National Statistical Data

National and local data support the need for a structured stretching and movement intervention. In the United States, 24.3% of adults experienced chronic pain in 2023, and 8.5% experienced high-impact chronic pain that frequently limited life or work activities (Lucas & Sohi, 2024). Low back pain has the highest prevalence among musculoskeletal conditions and remains the single leading cause of disability worldwide, affecting an estimated 619 million people in 2020, with cases projected to increase to 843 million by 2050 (World Health Organization [WHO], 2023). Local data also support the need for prevention and self-management strategies. Miami-Dade Matters reported that adult arthritis estimates across Miami-Dade census places ranged from 13.2% to 33.1%, with a median value of 19.9%, based on CDC PLACES data (Miami-Dade Matters, 2024). In addition, 30.7% of Miami-Dade adults were classified as sedentary during the 2017–2019 BRFSS measurement period, which was higher than the Florida value of 26.5% and above the Healthy People 2030 target of 21.8% (Miami-Dade Matters, 2026). These statistics strengthen the rationale for a feasible nurse-led intervention focused on stretching, movement, flexibility, and early self-management of musculoskeletal stiffness.

Cost Associated With the Health Problem

The cost associated with musculoskeletal problems is substantial because pain and stiffness may contribute to health care utilization, reduced mobility, absenteeism, and decreased productivity. Musculoskeletal diseases impose an estimated annual economic cost of approximately $980 billion in the United States, representing about 5.8% of the national gross domestic product (Nguyen et al., 2024). The WHO (2023) also identifies low back pain as a condition linked to reduced quality of life, work limitations, and broad economic burden for individuals and society. Therefore, a low-cost stretching and movement intervention is clinically relevant because it may support prevention, improve self-management, and reduce avoidable functional limitations before symptoms become more disabling.

Structured stretching and movement based interventions reductions in musculoskeletal stiffness and improve flexibility. In Zhang et al. (2025), the authors did not find consistent evidence of the benefits of post-exercise stretching compared to a no-stretching control group on any measures of soreness, strength, or performance improvements in healthy and athletic populations. However, the authors state that there may still be an effect of stretching on muscle mechanical properties, which are closely linked to ‘felt stiffness ', for example, relaxation speed and tissue extensibility, and tendon compliance. On the other hand, stretching programmes that are structured and repeated have more consistent effects. The study by Nageswari et al (2026) found that after six weeks of self-stretching, lower back pain, flexibility, and functional mobility were decreased. Similarly, Warneke et al. (2022) found that daily stretching over several weeks helped maintain physical performance, while inactivity led to functional decline. These results collectively indicate that the effects of stretching are more noticeable when performed routinely over time as opposed to as a single intervention (Zhang et al., 2025; Nageswari et al., 2026; Warneke et al., 2022).

Nurses as Leaders in the Project

Nurses are essential leaders in this project because they are positioned to assess patient needs, teach prevention strategies, coordinate care, and evaluate patient progress. Registered nurses provide and coordinate patient care, educate patients and the public about health conditions, and teach patients and families how to manage illness or injury at home (Bureau of Labor Statistics, 2025). In this project, the nurse leader would guide implementation by educating participants on safe stretching techniques, screening for self-reported stiffness or discomfort, reinforcing adherence, monitoring self-reported outcomes, and communicating concerns to the appropriate provider when symptoms suggest a need for further evaluation. Current nursing leadership recommendations also emphasize that nurses should be prepared to promote health, reduce disparities, contain costs, and maintain patient- and family-centered care (Hassmiller & Wakefield, 2022). For this reason, the nurse-led structure of the intervention strengthens feasibility, patient engagement, safety, and sustainability.

A strong pattern across the literature is the influence of frequency and duration on outcomes. According to Warneke et al. (2025), the experts agree that a moderate amount of stretching most days of the week is linked to decreased muscle stiffness and enhanced musculoskeletal function. To support this, Martín-Baute et al. (2024) reveal that a 12-week movement-based program that included stretching activities increased flexibility, mobility, and functional capacity in older adults. Additionally, Roine et al. (2026) note that having a structured approach to guidance increases the likelihood of the individual engaging in consistent self-management practices. These results collectively demonstrate that continuing engagement and professional guidance play a pivotal role in improving musculoskeletal outcomes (Warneke et al., 2025; del Carmen Martín-Baute et al., 2024; Roine et al., 2026).

Stretching has been consistently represented as a simple, low-cost, and universal intervention, which can be carried out in various care settings. According to Zhang et al. (2025), stretching is low impact and doesn't need equipment and can be done alone. Other researchers, Warneke et al. (2025), also characterize stretching as very practical and appropriate for a wide range of people, such as those who do not have access to rehabilitation facilities. Mitić et al. (2024) also illustrate that even short, structured exercise programmes can successfully be implemented in daily life, and still achieve positive results in perceived physical well-being. The results confirm that stretching is a suitable nurse-led intervention for both primary care and community services that are time- and resource-intensive ( Zhang et al., 2025; Warneke et al., 2025; Mitić et al., 2024).

Increased range of motion, less stiffness felt, and better tolerance with stretching perception are often linked to changes in musculoskeletal outcome measures. The authors of Fonta et al. (2021) and Warneke et al. (2022) found acute effects of static stretching on trunk ROM and chronic effects of repeated daily static stretching on increased flexibility over time, respectively. In addition, Zhao et al. (2024) report that there is a strong association between musculoskeletal discomfort and restrictive postures and movement patterns that are potentially modifiable by stretching activities. These studies show the effects of stretching on mechanical properties and sensory perception of movement, including reducing stiffness and enhancing comfort perception (Fonta et al., 2021; Warneke et al., 2022; Zhao et al., 2024).

The mechanisms thought to bring the results are always reported throughout the literature under both physiological and perceptual. The benefits of stretching interventions for the properties of tissues, tendons, and range of motion are described by Zhang et al. (2025) and Fonta et al. (2021). Most of these changes come with a greater ability to stretch and a diminished perception of discomfort as one is moving. Some additional insights mentioned by Warneke et al. (2025) are that, due to repetitive stretching over time, the properties of the muscles are also changed, adding to the decrease in perception of stiffness. Such a mixture of mechanical adaptation and sensory adjustment can also be safely used to explain gains reported across populations and intervention designs.

Movement-based intervention studies in broader populations also support the role of structured activity in improving physical function and well-being. Mitić et al. (2024) show that short, structured exercise programs improve perceived physical health when consistently applied. del Carmen Martín-Baute et al. (2024) further report improvements in balance, mobility, and functional capacity following a combined yoga and dietary intervention that includes stretching components. The results suggest that structured movement can affect not only flexibility but also involve more complex aspects of physical functioning. The finding indicates that stretching might be beneficial for functional independence on a long-term basis when it is performed regularly over the course of time (Mitić et al., 2024; del Carmen Martín-Baute et al., 2024).

Self-management behavior is a frequent construct that affects outcomes of musculoskeletal conditions. According to Zhao et al. (2024), sitting a lot, repetitive strain, and a lack of preventive movement practices are the major factors causing stiffness and discomfort. Someone with structured guidance will be more likely to engage in active coping, with movement-based interventions, whereas someone who is not guided will be less inclined to move. Also, Kubik et al. (2025) prove that organized and deliberately designed physical activity increases functional engagement and decreases fear-related avoidance behaviors. Overall, the results indicate that education/guidance is important in helping individuals stick to stretching routines and participate more with self-care.

Effectiveness is always called for in terms of adherence and feasibility across studies. Warneke et al. (2022) demonstrate that short daily stretching exercises are readily followed for weeks and are observable as improvements in flexibility. Likewise, Nageswari et al. (2026) present that structured stretching programmes are realistic to implement in the real world and that they can enhance pain and mobility outcomes. Kubik et al. (2025) also report high levels of adherence with simple, well-defined, and directed structured movement training programs. The results of these studies suggest that such brief, more structured interventions tend to be adhered to over the long term, especially when they are a part of an ongoing routine of behaviors and have help from healthcare providers.

Across the literature, stretching-based interventions are consistently associated with improvements in musculoskeletal comfort, flexibility, and perceived stiffness when they are structured and regularly performed. Findings are generally consistent, although this may differ based on the population characteristics and intervention design. Stretching is amongst the most frequently cited low-risk, practical, and easily accessible strategies that can be used both in clinical and community settings. It fits in with the patient-centredness, early prevention, and self-management of early musculoskeletal symptoms approaches.

Conclusion

In conclusion, the literature supports structured stretching and movement as a practical, low-risk, and low-cost intervention for improving musculoskeletal comfort, flexibility, and perceived stiffness when performed consistently over time. National and local statistics demonstrate that chronic pain, low back pain, arthritis, and sedentary behavior remain important health concerns that affect function, quality of life, and productivity. The economic burden of musculoskeletal conditions further supports the need for preventive and self-management approaches that can be implemented without expensive equipment or complex resources. Nurses are appropriate leaders for this project because they can educate participants, promote adherence, monitor self-reported outcomes, and support sustainable behavior change. Overall, the evidence supports a nurse-led stretching and movement intervention as a realistic strategy to address musculoskeletal stiffness and improve patient-centered outcomes.

References

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Fonta, M., Tsepis, E., Fousekis, K., & Mandalidis, D. (2021). Acute effects of static self-stretching exercises and foam roller self-massaging on the trunk range of motions and strength of the trunk extensors. Sports, 9(12), 159. https://doi.org/10.3390/sports9120159

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