UNIVERSITY OF TRÁS-OS-MONTES AND ALTO DOURO
EFFECTS OF PILATES FOR HEALTHY ELDERLY:
PHYSICAL AND PSYCHOLOGICAL DIMENSIONS
DOCTORAL THESIS IN SPORT SCIENCES
Vanessa Sanders Curi
HELDER MIGUEL FERNANDES
JOSÉ MANUEL VILAÇA MAIO ALVES
ALINE NOGUEIRA HAAS
UNIVERSITY OF TRÁS-OS-MONTES AND ALTO DOURO
EFFECTS OF PILATES FOR HEALTHY ELDERLY:
PHYSICAL AND PSYCHOLOGICAL DIMENSIONS
VANESSA SANDERS CURI
This academic t h e s i s was submitted for the purpose of obtaining a doctoral degree in Sports Sciences according to the provisions of Portuguese Decree-Law 107/2008 of June 25th.
This work is the sum of personal efforts, of committed professionals that I had the good fortune to find in this trajectory. Taking inspiration from my father's entrepreneurship and enthusiasm that inspired me to love the human movement. I tried to keep motivation on this journey. The difficulties have arisen, always in the form of self-improvement, to learn to have patience with what I cannot change and to have wisdom in difficult moments.
Initially, I thank the University of Trás-os-Montes and Alto Douro, for welcoming and receiving me. In particular, all my appreciation to my advisor, Prof. Dr. Helder Miguel, who inspires me incredibly, due to his maturity, despite his youth, in his conduct as a mentor. Always flawless, extremely competent and bright.
Thanks to my supervisor, Prof. Dr. José Vilaça who is a motivator, and is, in his joy and passion for what he does, an example. He has my respect and admiration, then, put into practice with everything he teaches.
In particular, I thank this brave woman, researcher, my guidance and example, Prof. Dr. Aline Nogueira Haas. A research fellow for more than ten years, since I have been mentioning her since my undergraduate work. Academic and professional life brought us closer. It is an honor to share and build knowledge together.
I thank my colleagues, always patient with my concerns, especially Lycia, Rosângela and Wellington, you have made all the difference.
To the UCS Senior Project, which again welcomed me as a researcher, because we already had this academic partnership during my Masters.
To the Federal University of Rio Grande do Sul, represented by its Committee of Ethics and Research of the School of Physical Education, Physiotherapy and Dance (ESEFID), that contributed substantially for the project of this thesis.
Without forgetting the reception and collaboration of the Catholic Community Nossa Senhora Medianeira and its members. All the research participants were dedicated.
I thank my friends Maria Estela Lunardi and Helionize Serpa; without your help, none of this would be possible. Finally, I thank the most important ones, my family, who understood my absence even when present. God bless.
Tables of Contents
Acknowledgments ... IV List of publications ... VII Figure Index ... VIII Tables Index ... IX List of Abbreviations ... X Abstract ... XII Resumo ... XIII
INTRODUCTION ... 1
Chapter 1: General Introduction ... 1
Introduction ... 2
1.1 Aspects related to the physical dimensions: functional autonomy ... 4
1.2 Aspects related to psychological dimensions: subjective well-being / satisfaction with life, health perception and sleep quality. ... 4
1.3 Justification ... 6
1.4 Research Problem ... 8
1.5 General Objectives ... 9
1.5.1 Specific Objectives, study 1. ... 9
1.5.2 Specific Objectives, study 2. ... 10
1.5.3 Specific Objectives, study 3. ... 10
1.6 Hypotheses ... 10
1.7 Structure of the thesis ... 11
References ... 12
Chapter 2: Systematic Review ... 15
Study 1. Effects of the Pilates method on healthy elderly: a systematic review ... 16
Introduction ... 16 Methods ... 18 Results ... 19 Discussion ... 23 Conclusions ... 26 References ... 26 EXPERIMENTAL ... 30
Chapter 3: Experimental Studies ... 30
Study 2. Effects of 16-weeks of Pilates on functional autonomy and life satisfaction among elderly women ... 31
VI Introduction ... 31 Methods ... 32 Results ... 36 Discussion ... 37 Conclusions ... 42 References ... 42 __________________________________________________________________________ ... 47
Study 3. Effects of 16-weeks of Pilates on health perception and sleep quality among elderly women: a randomized control trial. ... 47
Introduction ... 47 Methods ... 49 Results ... 53 Discussion ... 54 Conclusions ... 57 References ... 57
GENERAL DISCUSSION AND CONCLUSIONS ... 60
Chapter 4. General Discussion and Conclusions ... 60
General Discussion and Conclusions ... 61
REFERENCES ... 64
Chapter 5. References ... 64
References ... 65
ATTACHMENTS6 ... 72
Chapter 6. Attachments ... 72
Attachment 1. Consubstantiated Opinion - Ethics Committee ... 73
Termo de Consentimento Livre e Esclarecido ... 74
List of publications
Work accepted for publication:
Curi, V.S., Fernandes, H.M, Vilaça-Alves. Effects of 16-weeks of Pilates on functional autonomy and life satisfaction among elderly women. Journal of Bodyworks and Movement Therapies.
Works submitted for publication:
Curi, V.S., Fernandes, H.M, Vilaça-Alves. Effects of Pilates Method in healthy elderly: A systematic review.
Curi, V.S, Fernandes, H.M, Vilaça-Alves. Effects of 16-weeks of Pilates on health perception and sleep quality among elderly women.
Figure 1 Flowchart to selection of studies. ... 19
Effects of 16-weeks of Pilates on functional autonomy and life satisfaction among elderly women.
Figure 1 Flowchart of participants during the trial……….…….33
Effects of 16-weeks of Pilates on health perception and sleep quality among elderly women.
Table 1 Score of the studies………...…….…….…….………21 Table 2 Characteristics of the selected studies……….…….………...….22 .
Effects of 16-weeks of Pilates on functional autonomy and life satisfaction among elderly women.
Table 1 Class planning in the first two weeks..………...…………..34 Table 2 Planning the next ten weeks of intervention……….………...35 Table 3 Results of the variables studied between the time before and after 16-week of PM training………...………...……….37
Effects of 16-weeks of Pilates on health perception and sleep quality among elderly women.
Table 1 Class planning in the first two weeks..………51 Table 2 Planning the next ten weeks of intervention…...………...………….52 Table 3: Results from baseline to the end of the intervention (after 16 weeks) for the control and exercise groups………...…54 Table 4: Correlations between the change scores in the outcome measures, separately by groups……….………...55
List of Abbreviations
AP Abdominal Perimeter
ANCOVA Covariance Analysis
ANOVA Analysis of Variance
BMI Body Mass Index
CG Control Group Cm Centimeter CF Cutaneous Folds CG Control Group CI Confidence Interval D Depression EG Experimental Groups F% Fat Percentage FA Functional Autonomy FM Fat Mass G% Fat Percentage
G / mm2 Grams per square millimeter
HG Hydrogymnastics Group
HP Health Perception
HR Heart Rate
HRmax Maximum Heart Rate
IBGE Brazilian Institute of Geography and Statistics
IMC Body Mass Index
Kg / m2 Kilograms per square meter
LM Lean Mass
MANOVA Multivariate Analysis of Variance MP Método Pilates
PM Pilates Method
SD Standard deviations
WHO World Health Organization
The main objective of this study study was to analyze the effects of regular Pilates practice in the physical (functional autonomy) and psychological (perception of general health, sleep quality and subjective well-being) dimensions of older women after 16 weeks of training. Three studies were developed from 2013 to 2016. However, firstly a systematic review was conducted, in order to understand the state of the art and the gaps for the investigation of Pilates as an intervention for the elderly. Searches were carried out in the following databases: MEDLINE, EBSCOhost and Cochrane Central Register for the following terms and combinations in titles and abstracts: "Pilates","Pilates and Aging", "Pilates and elderly" and "Pilates for seniors". The research included studies published in scientific journals and magazines, indexed, written in English, randomized clinical trials, experimental and quasi-experimental, with healthy elderly and with a control group, and one that used the Pilates Method as an intervention. Of the studies included in this review, ten were included with values ranging between three and six according to the PEDro scale; 4.2 average, and the PM for the elderly did not influence some metabolic parameters, such as glucose, cholesterol and triglyceride levels or maximum oxygen consumption; decreased systolic blood pressure. However, there was improvement in body composition: a reduction in the percentage of body fat and fat mass, increased lean body mass, functional autonomy: improvements in balance, agility and functional mobility, decrease in the levels of fear and preventing falls; increase in muscle function and flexibility. In addition, according to the studies included psychological benefits in perception of quality of life and decreased depression. In the second and third studies the sample consisted of 61 healthy elderly divided into experimental group, (EG: 31 women, 64.25±0.14 years old) and control group (CG: 30 women, 63.75±0, 08 years old). Intervention in the second and third studies were conducted for 16 weeks at a frequency of two weekly sessions of 60 minutes repeated measurements were performed at baseline and after 16 weeks. All assessment procedures were standardized. The univariate and multivariate statistical procedures were performed using SPSS 20. No significant differences were found (p> 0.05) between groups at baseline. In the second study, the effects of Pilates for elderly in the physical dimensions were analyzed: functional autonomy; and psychological dimension: life satisfaction. In the experimental group, after 16 weeks of training period, were found significant results in all tests: strength and flexibility of lower and upper limbs; aerobic capacity; dynamic balance; and life satisfaction. In a third study, the effects of Pilates the psychological dimensions were analyzed: sleep quality and general health perception. All significant effects were classified as moderate to large. Significant positive correlations were found in both groups and the total score GHQ-12 and its subscales and total score between the PSQI-BR and its subscales. In the control group, a positive correlation between the total score GHQ-12 and usual subscale of sleep efficiency was observed, as well as a negative correlation between social dysfunction and subjective subscales sleep quality. In EG, changes in the sub-range of sleep disorders were positively correlated with changes in GHQ-12 total score, depression, sleep latency and duration of sleep dimensions. Moreover, positive association was also found only in the exercise group, the latency between sleep quality and sleep, and between sleep duration and habitual sleep efficiency. According to the results of this study, the effects of PM influences on sleep quality and perceived health of older women that confirmed the benefits of this practice.
O presente estudo tem como objetivo central, analisar os efeitos da prática regular do Método Pilates (MP) nas dimensões físicas (autonomia funcional), dimensões psicológicas (percepção de saúde geral, qualidade do sono e bem-estar subjetivo) de idosas após 16 semanas de treinamento. Foram desenvolvidos três estudos desde 2013 – 2016. O primeiro estudo é uma revisão sistemática, com o intuito de compreender o estado da arte, entender as lacunas existentes para a investigação do MP como uma intervenção para os idosos. As buscas foram realizadas nas seguintes bases de dados: MEDLINE, EBSCOhost e Cochrane Central Register, nos seguintes termos e combinações colocados nos títulos e resumos: "Pilates", "método Pilates", "Pilates e Envelhecimento"," Pilates e pessoas idosas "e" Pilates em Idosos". Foram incluídos os estudos publicados em revistas e jornais, indexados, escrito em Inglês, ensaios clínicos randomizados, experimentais e quasi-experimental, com idosos saudáveis e com um grupo controle, e que utilizaram o MP como intervenção. Foram incluídos nesta revisão dez estudos com classificação entre três e seis de acordo com a escala PEDro. Foi observado que o MP para idosos não influenciou alguns parâmetros metabólicos, como glicose, colesterol e os níveis de triglicéridos, o consumo máximo de oxigênio e a diminuição da pressão sistólica arterial. No entanto, houve melhora da composição corporal (redução na percentagem de gordura corporal e massa gorda, aumento da massa corporal magra), na autonomia funcional (equilíbrio, agilidade e mobilidade funcional, diminuição nos níveis de medo e de prevenção de quedas, aumento da função muscular e flexibilidade) e benefícios psicológicos (percepção da qualidade de vida e diminuição da depressão). No segundo e terceiro estudos a amostra foi composta por 61 idosas saudáveis e divididas em grupo experimental, (EG: 31 mulheres, 64,25±0,14 anos de idade) e grupo controle, (CG: 30 mulheres 63,75± 0,08). O programa de intervenção foi realizado durante 16 semanas, com uma frequência de duas sessões semanais de 60 minutos. Foram avaliados no início e após 16 semanas. Todos os procedimentos de avaliação foram estandardizados. Os procedimentos estatísticos univariados e multivariados foram realizados no programa SPSS 20. Não foram encontradas diferenças significativas (p> 0,05), entre os grupos, no início do estudo. No segundo estudo, foram analisados os efeitos do MP para idosas nas dimensões físicas (autonomia funcional) e nas dimensões psicológicas (bem-estar subjetivo). No grupo experimental após o período de treinamento de 16 semanas foram encontrados resultados significativos em todos os testes: Força e flexibilidade nos membros inferiores e superiores, capacidade aeróbica, equilíbrio dinâmico e escala de satisfação de vida. No segundo estudo, verificaram-se melhora na autonomia satisfação funcional e bem-estar subjetivo, medidos através da escala de satisfação de vida, nos idosos expostos ao treinamento de 16 semanas com o MP. No terceiro estudo, foram analisados os efeitos do MP nas dimensões psicológicas (qualidade do sono e percepção de saúde geral). Todos os efeitos significativos foram classificados como moderados a grandes. Correlações positivas significativas foram encontradas, em ambos os grupos, entre a pontuação total GHQ-12 e suas subescalas, e entre a pontuação total PSQI-BR e suas subescalas. No grupo controle, foi observada uma correlação positiva entre a pontuação total GHQ-12 e sub-escala habitual de eficiência do sono, bem como, uma correlação negativa entre a disfunção social e as sub-escalas subjetivas qualidade do sono. Por outro lado, no grupo de exercícios, mudanças na sub- escala de distúrbios do sono foram positivamente correlacionadas com mudanças nas GHQ- 12 pontuação total, depressão, a latência do sono e duração do sono dimensões. Além disso, associações positivas também foram encontradas, apenas no grupo exercício, entre a latência a qualidade do sono e dormir, e entre a duração do sono e eficiência do sono habitual. Concluímos que o MP interfere positivamente na qualidade do sono e percepção de saúde das mulheres idosas, de acordo com os resultados deste estudo que confirmam os benefícios desta prática.
The search for physical activities that promote greater safety for its practitioners is constant. This concern is more frequent in the adult and elderly public. Among the different physical activity currently found at gyms, social centers, clubs, free schools, community centers and sports associations (spaces where there is a proposal of physical exercise, regardless of the modality performed), the Pilates Method has been becoming more popular in these environments of leisure, sport and education
According to Carvalho et al. (2010), the Pilates Method is a form of physical and mental conditioning that dates from the beginning of the 20th century and is being spread today as a provider of body-mind balance, physical fitness, postural control and quality of life.
For Camarão (2004, p.15), the Pilates Method is an exercise system that allows greater integration of the individual in his daily life. It works with the whole body, corrects posture and realigns the muscles. It helps to develop bodily stability, which is necessary for a healthier and longer life.
The Pilates Method was created to achieve a healthy body, a healthy mind and a healthy life. Aparício & Pérez (2005) define the Pilates Method with a single word: movement, or with two words: movement with control, or with three: strength, elasticity and control.
Aparício & Pérez (2006) remember another important feature of the Pilates Method is the strengthening of the "center of strength". An expression that refers to the lower circumference of the torso, the structure that supports and reinforces the rest of the body. The second pillar of the method is the application of the six fundamental basic principles: concentration, control, centralization, fluidity of movement, breathing and precision. Each exercise is designed to integrate these principles. It is necessary to incorporate the principles in a correct manner and work the fundamental concepts until they flow naturally and become habits.
Concerning the principle of concentration, Pilates & Miller (1998) suggest that for the execution of the method it is necessary for the practitioner to concentrate on the correct movements each time the exercises are performed. Moreover, they should never be performed improperly so as not to lose all their benefits.
Hall (2003) talks about the principle of centralization and exposure, stating that basic training with Pilates Method requires torso support and control in conjunction with
dynamic limb movements. Therefore, centralization and balance are always involved.
On the principle of fluidity, Winsor & Laska (1999) compare the Pilates Method with Dance. These authors claim that the Pilates Method is like a perfect piece of choreographed dance, and performing it gracefully means performing the movements accurately. Each movement or exercise has a specific point where it starts and where it ends. According to Camarão (2004, p.15), in relation to the principle that involves breathing, Pilates stated that before any benefit cab be obtained by using the method, the person needs to learn to breathe correctly, and that this is very difficult. Breathing correctly involves the inhalation and complete exhalation of air - that is to say, then, metaphorically, to tighten every atom of air in your lungs until they are as empty as the vacuum.
Regarding the principle of precision, Panelli & De Marco (2006) point out that maintaining the correct placement of body parts is a determining factor for our health and well-being, and is closely related to our posture. For this to happen, the mind must be alert at every movement. We recommend using few repetitions of each exercise, with quality of execution.
Ungaro (2002) describes the control principle, clearly stating that each movement performed must be meticulously calculated and planned. In this way, the Pilates Method can reduce the risk of injury during physical activity. Preparing the body for daily activities in the same way that an athlete prepares for a sporting event.
According to Haas (2006), if the Pilates Method is oriented by a qualified professional, the possibility of injuries or muscular pains is practically nonexistent, since there is no impact.
A study by Cedrón and Haas (2006) had the general objective of analyzing the motivational aspects that lead to the practice of the Pilates Method and to identify if these aspects are related to health, social and/or aesthetic factors. The authors had a sample of 16 adult individuals, of both sexes, who practiced the Pilates Method. A questionnaire with 15 items adapted from Scalon (2006) was applied for data collection. The results indicated that the main motivational aspect for most of the sample was the "search for an improvement in quality of life". Improvement in physical abilities and "relieving tension and relaxing" were also motivating factors that stood out in the search for this practice in that sample. The factors that were more often selected as very important relate to aesthetic and health aspects. However, the perception of these gains or benefits to justify regular practice should be tied to the possible results or effects intended by the practice of the Pilates Method and which may be obtained. These effects are directly related to aspects of functional autonomy, levels
of satisfaction with life, general health perception and sleep quality. Therefore, we seek to investigate the effects of its practice for the elderly, a population that constantly seeks alternatives for healthy aging through physical practices.
1.1 Aspects related to the physical dimensions: functional autonomy
Regarding the effects of Pilates on the agility and functional mobility of the elderly, Gildenhuys et al. (2013) found a significant improvement in agility and functional mobility.
Rodrigues et al. (2010) evaluated 52 elderly women who underwent an evaluation of functional autonomy: protocol (GLAM) and static balance (Tinetti). The intervention group (Pilates Group = 27) participated in a Pilates exercise program twice a week for eight weeks. A post t-student test showed significant in PG and GLAM balance.
A study by Fraga et al. (2010) analyzed the impact of a physical activity program on the aerobic resistance, functional autonomy and quality of life of older women. The results showed a significant improvement for aerobic resistance (Δ% = 29.06%, P = 0.0001), functional autonomy (Δ% = -27.15%, p = 0.0001) and Q (Δ% = 15.47%, P = 0.0001). These authors concluded that systematic physical exercise positively influences the range, endurance and quality of life of the elderly.
The objective of the study by Kovach et al. (2013) was to compare and measure the effects of Pilates and hydrogymnastics training on functional fitness. The Fullerton functional fitness test (FFFT) was used to measure functional fitness, pre- and post- training. The overall physical performance of the healthy elderly improved, regardless of the type of exercise.
1.2 Aspects related to psychological dimensions: subjective well-being / satisfaction with life, health perception and sleep quality.
Disease and health are situated in a dynamic context formed by several structural elements between body and society, which are essential to study the perception of health status and are the subject of several research initiatives to understand the causes of health asymmetries (Ministry Of Health-Brazil, 2004).Among the many aspects related to these variations are demographic and socioeconomic factors, such as gender, age, marital status,
level of education, occupation and household (Ferreira & Santana, 2003; Scliar, 2007).
Throughout history, health has been defined as the absence of disease; however, it represents much more, that is, it must be understood as a state of physical, mental and social well-being, extrapolating the disease-free condition. General health perception is still an unexplored psychological dimension, and it is understood as a process by which the individual organizes sensory / perceptual stimuli into meaningful information (Ross, 2010), learning from an early age to perceive and know their body and the concept of health and disease (Azevêdo, 2010; Santos, Barbosa, Faro & Júnior, 2005), which is not centered on objective medical interpretations, but on subjective evaluations of our physical and mental health (Vintém, 2008).
In this context, health perception tends to be reported as a reliable and valid measure of the individual's health status at a given time (Ferraro & Yu, 1995), which characterizes it as an important predictor of morbidity, mortality. It is known that the perception of a negative state of health can be reflected in biopsychosocial states that cause illnesses in functional disability and life expectancy, (Abellán, 2003), and could go unnoticed by objective instruments (Appels, Bosma, Grabauskas, Gostautas & Sturmans, 1996),
Although the relationship between exercise and subjective/psychological well- being is not fully understood, evidence suggests that exercise increases levels of neurotransmitters such as endorphins in the brain and improves the general mood, promoting an increase in well-being and other benefits such as reduction of stress, anxiety and depressive states (Seedat, Scott, Angermeyer, Berglund, Bromet, Brugha et al., 2009).
Zubia Veqar and Hussain (2012) concluded that exercise is a positive behavioral modification tool for all age groups to bring about an improvement in sleep quality. Exercise can be very effective in older populations not only to improve sleep. Acute exercises do not seem to be very effective in bringing about an improvement in sleep quality. The effects of long-term aerobic training and endurance training can improve sleep quality. Exercising right before going to sleep seems to have a negative effect on sleep quality. When thinking about the importance of sleep to achieve the desired effects in regular Pilates practice, sleep quality is relevant in the healthcare process. For example, the results found in a meta-analysis by Yan et al. (2012) indicate that participation in physical training has a moderately beneficial effect on sleep quality and decreases both sleep latency and use of sleeping medication. These results suggest that an exercise therapy may be an alternative or complementary approach to existing therapies for sleep problems, especially
since exercise is low-cost, widely available and generally safe.
This work falls within the scope of physical activity and health in special populations, specifically the elderly. When researching the existing literature, only one study was found on cardiometabolic aspects linked to the practice of the Pilates method for the elderly.
The study by Marinda et al. (2013) shows that the Pilates Method influences the reduction of systolic pressure levels. The authors also question whether this effect has an extended duration in order to have cardiac benefits. The authors consider that metabolic alterations are influenced by gender and age, which were controlled factors, since the study was done with elderly women. Moreover, they suggest that systolic blood pressure could have decreased due to proper breathing performance during the Pilates method, which promotes relaxation.
The study found a decrease in abdominal circumference (pre 83.50 ± 12.79 mm to 81.44 ± 9.90 mm), percentage of fat mass (pre 25.03 ± 9.53), percentage of body fat observed (from 33.85 ± 6.67% to 32.23 ± 5.82%) and weight (23.69 ± 8.06 kilograms), and an increase in lean mass (from 46.67 ± 6.33 kilograms to 48.04 ± 7.52 kilograms). Despite these beneficial changes, the indices measured in the blood tests did not demonstrate significant cardio metabolic alterations.
Regarding the effects of the Pilates Method on body composition, Ruiz-Montero et al. (2014), conducted a study along with an education program for the elderly. They concluded that a combined aerobic and Pilates program under the supervision of an instructor at a frequency of at least twice a week produces health benefits in functional, independent women over 60 years of age. In addition, initial muscle mass values remained stable, while the percentage of body fat decreased.
However, in a study by Aladro-Gonzalvo et al. (2012), the authors state that there is poor empirical evidence indicating a conclusive effect of Pilates Method exercises on body composition. In addition, they suggest that the main reason for explaining this finding is the lack of methodological quality of the published studies.
Justifying the need for this study, we must consider other factors such as the diversity in the application of the Pilates Method and its frequency, intensity and duration of sessions.
However, we found only two studies on the effects of regular Pilates practice on the posture of the elderly.
First, the study by Pata et al. (2013), with 35 individuals, 31 women and 4 men, aged 61-87 years, with an average age of 74.4 years. These individuals completed a 16- session exercise program and maintained a frequency of 84.3% in the sessions. Turn-180 was applied pre- and post-training. The results showed improvement with statistical significance in postural stability.
The second study regarding improvement in posture was by Kuo et al. (2009). It found a small improvement in the thoracic kyphosis, in the orthostatic position, only in the period after the exercises. The researchers justify that the short duration of the exercise program and the relatively upright posture of the participants before the intervention may explain the lack of substantial changes in the posture of the sagittal spine.
Among the effects studied, we observed that most studies on using the Pilates Method with the elderly verified static or dynamic balance.
First, in a study by Bird et al. (2012), although there were no significant differences between groups, participation in the Pilates component of the study led to a better static and dynamic balance. The authors justify that the lack of differences between the groups could be due to the small size of the sample or the design of the crossover study, because the Pilates Method could produce neuromuscular resilience adaptations that are still unknown.
According to a study by Appel et al. (2012), the Pilates Method offers exercises designed to stabilize the postural muscles and improves body balance. These effects of the Pilates Method contribute to an efficient use of the postural muscles, resulting in an integration of the information provided by various receptor systems to control the activities of these muscles.
Mokhtari et al. (2013) investigated the effectiveness of Pilates exercises over a 12- week period on depression and lack of balance associated with falling in the elderly. Prior to the intervention, the sample, comprised of 30 elderly women, received a geriatric depression scale to assess their depression level, and a timed functional test and timed up- and-go to assess balance. The experimental group had a decrease in depression (19.80%), and in the time for the functional test (16.70%) and the timed up-and-go test (7.26%). The authors suggest that the practice of Pilates exercises decreases depression and improves the balance, preventing falls.
strength, pre- and post-training, to reduce the number of falls in elderly women who underwent a 12-week Pilates Method training, one hour per week. Sixty female participants over 65 years old from a retirement home in Ankara participated in the study, also recording the number of falls they had before and during the 12-week period. Dynamic balance, flexibility, reaction time and muscle strength improved (p <0.05) in the exercise group when compared to the control group. The authors concluded that Pilates exercises are effective in improving dynamic balance, flexibility, reaction time and muscle strength, as well as decreasing the propensity to fall in older women.
In a study by Granacher et al. (2013), the authors emphasize the low methodological quality of Core and Pilates studies, and point out that, especially in Pilates interventions, a minimum of 12 weeks of intervention should be prioritized to achieve the desired effects.
In order to evaluate the effects of the Pilates method on personal autonomy, static balance and quality of life in healthy elderly women, Rodriguez et al. (2010) developed a study with a sample of fifty-two elderly women who were selected and submitted to evaluation protocols to evaluate functional autonomy (GLAM), static balance (Tinetti) and quality of life (WHOQOL-OLD). The intervention group (PG = 27) participated in a Pilates Method exercise program twice a week for eight weeks. According to these authors, the Pilates Method significantly improves personal autonomy, static balance and quality of life of the elderly.
These studies reaffirm the importance of the Pilates Method in the prevention of falls and reinforce the low cost of these exercises. Besides focusing on the high governmental costs with the number of falls in the elderly and how much this affects their independence.
Regarding the performance of daily life activities, after twelve weeks of training the Pilates Method with women aged 65 to 75 years, a study by C u r i - Pérez et al. (2014) concluded that the time to perform daily life activities reduced with statistical significance in all tests applied compared to the results of the previous training period.
As was said before, some benefits of the Pilates Method have already been proven. However, new studies are needed, especially with the elderly, so these evidences can be corroborated.
1.4 Research Problem
considering the growth of this kind of exercise, which is also performed as rehabilitation. It is becoming increasingly popular, with different approaches and lines of action.
The professionals who work with this have different academic backgrounds. It cannot be forgotten that Pilates Method instructor training courses in workshops and for free have different hours, as well as content, as well as sequence, nomenclature and number of different exercises studied.
This fact reflects directly on the performance of the professionals and influences how they affect the bodies of their practitioners. Therefore, we currently observe different types of Pilates Method, for example: lessons with the use of equipment; Group classes with exercises performed on the mat; Use of balls and other market trends that use the name "Pilates" and, unfortunately, mix it other techniques.
This study on the practice of the Pilates Method intends to investigate the effects of this form of physical exercise on the elderly. We believe that, for the practitioner, what really justifies the initiative to practice the Pilates Method and to keep practicing it relates to the desired and achieved effects on their daily life. Then, the question arise: "What are the effects of the Pilates Method for the elderly? Can these possible effects influence aspects of functional autonomy, subjective well-being, general health perception and sleep quality?"
1.5 General Objectives
The general objective of this investigation was to verify the effects of the Pilates Method on the elderly.
1.5.1 Specific Objectives, study 1.
Systematic Review on the Effects of the Pilates Method for the Elderly.
This study had the following specific objectives:
Investigating the effects of the Pilates Method on the elderly through a systematic review and checking the existing theoretical framework to evaluate the scientific evidence of the effects of Pilates exercises on healthy elderly.
scientific websites: Science Direct, MEDLINE, PubMed, SPORTDiscus, PEDro, Cochrane Central Register of Controlled Trials, CINAHL and WebScience. Two reviewers will independently apply the inclusion criteria to potentially selected studies. The research includes those studies that have been published in a peer-reviewed journal, indexed, written in English, with randomized controlled trials, quasi-experimental, performed in healthy elderly, with control group, and which used the Pilates Method as the intervention.
Data collection occurred with the assistance of two independent reviewers (study design, subjects, intervention, keywords, and results) and applied the Physioterapy Evidence Database (PEDro) Scale to assess the methodological quality of the studies and to determine the strength of the evidence using the best systematic and synthetic graduation of scientific evidence.
1.5.2 Specific Objectives, study 2.
Effects of the Pilates Method on the functional autonomy and life satisfaction of the elderly.
Analyzing the effects on functional autonomy
Verifying the effects on life satisfaction in elderly women exposed to 16 weeks of Pilates practice.
1.5.3 Specific Objectives, study 3.
Effects of the Pilates Method on sleep quality and general health perception of the elderly.
Verifying the effects of the Pilates Method on the elderly regarding the levels of general health perception.
Investigating the sleep quality of elderly women exposed to the practice of the Pilates Method.
Regular practice of the Pilates Method can positively influence functional autonomy. After the 16-week period, significant effects are expected on life satisfaction in elderly
Pilates Method can contribute to the quality of sleep of the elderly.
After the 16-week period, significant effects are expected on general health perception of elderly Pilates practitioners.
Regular practice of the Pilates Method does not interfere with the studied variables, a null hypothesis.
1.7 Structure of the thesis
The structure of the thesis is based on the so-called Scandinavian model. It is divided into three chapters that correspond in sequence: general introduction; Articles accepted or submitted for publication in periodicals of relevance in the area, formatted according to the respective publication standards; Final considerations, limitations and new research perspectives; and, finally, the implications for practice.
Chapter 1 presents an introduction of the work, leading to a brief review of aspects pertinent to physical and psychological dimensions, with a focus on studies on the effects of the PM for older women, highlighting the most relevant aspects of research and effects already studied. It presents the justification of the study by developing the issue of analyzing the effects of PM on the physical and psychological dimensions; Addresses the issue of the plurality of forms of teaching and practicing the PM, as well as their effects on other populations; and, finally, the study design, duration of practice and relation with previous studies. The objectives are presented in detail to the production of each study, and finally there is a synthesis of the general structure of the thesis.
Chapter 2 includes the three scientific articles produced throughout the research in pursuit of the objectives outlined in the introduction. It consists of a systematic review study and two exploratory/quasi-experimental studies, with comparative analyses of the effect of physical exercise and the PM on the physical and psychological dimensions of the elderly. Chapter 3 is devoted to the final considerations of the scientific articles referred to in Chapter 2, the limitations of the thesis and new research perspectives after the contributions of the studies and influences in consideration to the previous literature, and, lastly, the implications of this study for the practice of Pilates. The bibliography for each study is presented at the end of each chapter, in accordance with the norms of the journals to which they were submitted.
Abellán, A. (2003). Percepción del estado de salud. Revista Multidisciplinar de
Gerontología,13 (5), 340-342.
Albuquerque, C. & Alves, R. (2006). A evasão dos alunos das academias: um estudo de caso no centro integrado de estética e a atividade física. Caicó: CIEAF.
Albuquerque, A.S., Tróccoli, B.T. (2004). Desenvolvimento de uma escala de bem-estar subjetivo. Psicologia: Teoria e Pesquisa, Brasília, 20 (2), 153-164.
Aladro-Gonzalvo, A.R; Machado-Díaz, M., Moncada-Jímenez, J., Hernándes-Elizondo, J., Araya-Vargas, G. (2012).The effect of pilates exercises on body composition: a systematic review. Journal of Bodywork & Movement Therapies, 16,109-114.
Aparício E., Pérez, J. (2005). O autêntico método Pilates, a arte do controle. São Paulo: Planeta do Brasil.
Appel, I.P., Coriolano, P., Vicente R., Nascimento, M.M., Coriolano, Appel H.(2012).The pilates method to improve body balance in the elderly.Arch Exerc Health Dis, 3 (3), 188-193.
Berg, K.O., Wood-Dauphinee S.L., Williams J.I., Gayton D. (1989). Measuring balance in the elderly: preliminary development of an instrument. Berg Balance Scale.
Physiother Can, 41, 304-311.
Bird, M.L., Hill, K.D., Feel, J.W. (2012). A randomized controlled study investigating static and dynamic balance order adults after training with Pilates. Arch Phys Med
Rehabil, 10, 43-49.
Buyisse, D.J., Reynolds C.F., Monnk, T.H., Berman SR, Kupper, D.J. (1989).The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.
Psychiatry Res, 28 (2), 193-213.
Camarão, T. (2004). Pilates no Brasil: corpo e movimento. Rio de Janeiro: Elsevier.
Carvalho, C.M., Ferreira, S.C.B., Cunha, M.A.T., Silva, V.F. (2010). Fundamentação Teórica do Método Pilates: uma revisão sistematizada. Fedération Internationale
d´Education Physique-FIEP, 80, 1-6.
Cedron, J., & Haas, A. N. (2006). Aspectos motivacionais que levam à prática do Método Pilates em uma academia de Porto Alegre [monografia]. Porto Alegre (RS): Pontifícia Universidade Católica do Rio Grande do Sul.
Curi-Pérez, V. S., Haas, A. N, Wolff. Analysis of activities in the daily lives of older adults exposed to the Pilates Method. Journal of Bodywork and Movement Therapies, 18 (3), 326 – 331.
Pilates, J., & Miller, J. (1998). Return to life trough Contrology. New York: presentations Dynamics.Goon, D.T, Marinda, F., Gildenhys M., Ina, S., Brandon, S., Abel. T. (2013). Effects of a mat pilates program on cardiometabolic parameters in elderly
women. Pak J Med Science, 29 (2), 500-504.
Gil, A. (2002). Como Elaborar Projetos de Pesquisa. São Paulo: Atlas.
Goldberg, D. (1978). http://www.proqolid.org/instruments/general_health_questionnaire Granacher, U.G., Hortobagyi, A., Kressig, T.B, Muehlbauer, R.T.(2013) .The Importance of Trunk Muscle Strength for Balance, Functional Performance, and Fall Prevention in seniors: A Systematic Review. Sports Med, 43, 627–641. Haas, A. (2006). Sustentável Leveza. Revista Nextime, 32-35.
Hall, C., & Brody, L. (2003). Deficiência do equilíbrio. In: Exercício Terapêutico– Na busca da função.Rio de Janeiro: Guanabara Koogan.
Irez, G.B., Ozdemir, A.E., Irez, R., Salih, G., Korkusuz, F. (2011).Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls. Journal of Sports
Science and Medicine, 10, 105-11.
Kuo, Y.L, Tully, E.A., Galea, M.P. (2009). Sagital posture after pilates-based exercise in healthy older adults. SPINE, 1 (34), 1046-1051.
Marinda, F., Magda, G., Ina, S., Brandon, S., Abel, T., & Ter Goon, D. (2013). Effects of a mat pilates program on cardiometabolic parameters in elderly women. Pakistan Journal of Medical Sciences, 29(2), 500–504.
McCrum-Gardner, E. Sample size and power calculations made simple. (2010). International
Journal of Therapy and Rehabilitation, 17(1): 10-14.
McNeill, W. Decision making in Pilates. (2011). Journal of Bodywork & Movement
Therapies, 15, 103-107.
Melzack, R.The McGill pain questionnaire: major properties and scoring methods. (1975).
Pain, 1, 277-299.
Miyamoto, S.T., Lombardi J.I., Berg, K.O., Ramos, L.R.N. (2004). Brazilian version of the Berg balance scale. Brazilian Journal of Medical and Biological Research, 37, 1411-1421.
Mokhtari, M., Nezakatalhosani, M., Esfarjani, F. (2013). The effect of 12-week pilates exercises on depression and balance associated with falling in the elderly.
Procedia-Social and Behavioral Sciences, 70, 1714-1723.
Morton, N.A. (2009). The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother, 55, 129-133.
Panelli, C., & De Marco, A. (2006). Método Pilates de condicionamento do corpo, um programa para toda a vida. São Paulo: Phorte.
Pasquali, L., Gouveia, V.V., Andriola, W.B., Miranda, F.J. & Ramos, A.L.M. (1994). Questionário de Saúde Geral de Goldberg (QSG): adaptação brasileira.
Pata, R. W., Lord, K., Lamb, J.The effect of Pilates based exercise on mobility, postural stability, and balance in to decrease fall risk in older adults. Journal of Bodywork
& Movement Therapies, 18 (3), 361-367.
Ribamar, S. (2005). Apostila de Curso de Formação no Método Pilates Original. Studio Zen. Rikli, R.E., Jones, CJ. (2002). Measuring functional. The Journal on Active Aging, 24-30.
Rodrigues, B.G., Cader, S.A, Torres, N.V.O.B, Oliveira, E.M., Dantas, E.H.M. (2010). Pilates method in personal autonomy, static balance and quality of life of elderly females. Journal Bodywork & Movement Therapies, 14, 195–202.
Oliveira, E.M., Dantas, E.H.M. (2010). Pilates method in personal autonomy, static balance and quality of life of elderly females. Journal Bodywork & Movement Therapies, 14, 195-202.
Ruiz-Montero, P.J., Castillo-Rodriguez, A., Mikalack, M., Nebosjsa, C., Korovljev, D. (2014). Pilates method in personal autonomy, static balance and quality of life of elderly females. Clinical Interventions in Aging, 9, 243-248.
Thomas, J., & Nelson, J. (2002). Métodos de pesquisa em atividade física. Porto Alegre: Artmed.
Ungaro, A. (2002). Pilates body in motion. New York: Dorling Kinderley.
Verhagen, A.P., Vet H.C., Bie, R.A. (1998).The Delphi List: a criteria list of quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphy consensus. J Clin Epidemiol, 51, 1235-41.
Wells, C., Kolt, S.G., Bialocerkoski, A. (2012). Defining Pilates Exercise: A Systematic Review. Complementary Therapies in Medicine, 20, 253-262.
Chapter 2: Systematic Review
Study 1. Effects of the Pilates method on healthy elderly: a systematic review Abstract
Pilates has become popular as an exercise program for the elderly. The aim of this review was
to investigate the effects of Pilates as an intervention for the elderly. Method: A search was
performed in February 2016, in the databases Science Direct, MEDLINE, EBSCOhost and Cochrane Central Register of Controlled Trials using the following terms and combinations placed in the titles and abstracts: “Pilates”, “Method Pilates”, “Pilates and Aging”, “Pilates
and Older People” and “Pilates in Elderly”. The following studies were included: published
in peer-reviewed journals, indexed, written in English, with randomized controlled trials, experimental and quasi- experimental, in healthy elderly with a control group, and which used a Pilates as an intervention method. Results: ten studies were included with values ranging between three and six according to the PEDro scale; average 4.2. Conclusions: the use of Pilates in the elderly did not influence some metabolic parameters, such as glucose, cholesterol and triglyceride levels, maximal oxygen consumption, or decrease in blood systolic pressure. However, there was improvement in body composition, decreases in body fat percentage and fat mass and increase in lean body mass. Also, there was an increase in functional autonomy, with improvement of balance, agility and functional mobility, a decrease in fear levels and increase in prevention of falls and muscle function and flexibility. In addition, there were psychological benefits in perception of quality of life and decreased depression.
Keywords: Pilates, aging, elderly, older people.
According to the World Health Organization (2015), in almost every country, the proportion of people aged over 60 years is growing faster than in any other age group, a result of both longer life expectancy and declining fertility rates. Population aging can be seen as a success story for public health policies and for socio-economic development, but it also challenges society to adapt, in order to maximize the health and the functional capacity of older people as well as their social participation and sense of security.
Among the different physical activity and exercise programs made available for the elderly at gyms, cohabitation centers, clubs, free schools, community centers and sports associations, the Pilates Method has been gaining popularity.
According to Di Lorenzo (2011, p. 352), Joseph Pilates was self-educated in anatomy, bodybuilding, boxing, wrestling, yoga, gymnastics and martial arts. At the outbreak of World War I, he was interned as an enemy alien in England and became a nurse and physiotherapist to his fellow internees who were sick or injured. Joseph Pilates published two books, the first in 1934 and the second in1945, in which he passionately described his
overall philosophy on holistic health and balanced well-being, but not his method of exercise. Pilates believed that his method, called “Contrology”, would activate brain cells to stimulate the mind and affect the body.
As McNeill (2011, p. 103) states, “there are many differences in the way that Pilates is taught. It is often divided into two types of Pilates: Pilates on the mat and Pilates equipment in which the work is based on the use of Pilates machines”. He invented his apparatus as an aid to learn movement patterns; mastering the mat program was the method’s goal, with the outcome of transference to more functional and integrative movement.
According to Di Lorenzo (2011, p. 355), there are 12 original pieces of Pilates equipment: the reformer, cadillac, wunda chair, electric or high chair, magic circle, ladder barrel, small barrel, baby chair, mat, spine corrector, toe corrector and breath-a-cizer.
Another important feature of Pilates was highlighted by Aparício and Pérez (2005), regarding the emphasis of this method on the strengthening of the powerhouse, which includes the circumference of the lower torso, which is responsible for supporting and strengthening of the rest of the body.
Working with the whole body, with correct alignment and appropriate posture, it helps to develop the body stability necessary for a healthy and long life. However, according to Di Lorenzo (2011, p. 354), the consensus regarding the anatomical boundaries of the “core” is that it begins inferiorly at the pelvic floor and goes to the ribcage, superiorly. This is consistent with most of the current operative definitions.
However, Pilates differed in his description of “centring”, representing it as a “box” delineated by two horizontal lines: one line running from shoulder to shoulder and the second line running from hip joint to hip joint. “Centre”, “core” and “powerhouse” are conventional terms used interchangeably, not only in Pilates parlance, but also in the medical and fitness communities. However, when defining the core by the limits of the box, Pilates included the shoulder and hip girdles in total core strengthening. He then took exercise a step further by enlisting the simultaneous participation of the extremities – total arm strengthening and total leg strengthening – all with control and precision. In other words, Pilates = total core strengthening (TCS) + total arm strengthening (TAS) + total leg strengthening (TLS).
Therefore, this systematic review is justified by the orientation of regular physical
activity for older people based on scientific evidence. In this sense, the aim of this systematic
A systematic review of the literature was conducted in the month of February of 2016 using the databases Science Direct, MEDLINE, EBSCOhost and Cochrane Central Register of Controlled Trials. In the search, the following terms and combinations were placed in the titles and abstracts: “Pilates”, “Method Pilates”, “Pilates and Aging”, “Pilates and
Older People” and “Pilates in Elderly”.
Studies were included if they were published in indexed journals, written in English, conducted as randomized, experimental or quasi-experimental trials, with a control group, and conducted with samples of healthy elderly, aged over 60 years, including studies using measures to evaluate the effects of Pilates as an intervention. Two independent reviewers read all abstracts and then excluded studies that did not fit the selection criteria. A third reviewer was consulted to verify any disagreement between the two reviewers. The reviewers applied the inclusion criteria and then read the studies that could potentially be included.
Two reviewers analyzed the studies that met the inclusion criteria independently and the following information was extracted: authors, year of publication, sample, intervention used and main results. A third reviewer was consulted to resolve differences.
Methodology for Quality Assessment
Two reviewers independently assessed the quality of the method for each study using the criteria of the Physiotherapy Evidence Scale (PEDro scale), and a third reviewer was consulted to resolve disagreements. All studies were then scored and recorded.
The PEDro scale is based on a Delphi list developed by Verhagen (1998), which includes these items: specified eligibility criteria; random allocation; concealed allocation; homogeneity in the sample; blind subjects; blind therapists; blind assessors; appropriate follow-up; analysis of intention to treat; comparisons between groups; point estimates; variability. The eligibility criteria are related to the external validity used to calculate the PEDro score, which can range from 1 to 10.
In order to stratify the ratings of the methodological quality, the following categories were used: a PEDro score lower than 5 indicates poor quality, a score of 5 indicates regular
quality, and a PEDro score of 5 or higher indicates high quality. This systematic review was registered with the process number 30217 in PROSPERO, Centre for Reviews and Dissemination of the University of York.
The search on the databases Science Direct, Medline, EBSCOhost, Cochrane found 2907studies with the terms "Pilates" and "Method Pilates". The terms "Pilates and Aging",
"Pilates and Older People", "Pilates in Elderly". Were used to refine the search, and 22
studies were selected as possibilities. However, the following were excluded: five studies that had no control group; one study that was in another language. Four studies in which the sample was composed of institutionalized elderly; one study where the sample was made up of hospitalized elderly; and a study in which the age of participants started at 45 years old. Based on the reviewers’ decisions, only ten studies met all the criteria for inclusion.
Figure 1 Flowchart of the selection of studies
Table 1 shows the characteristics of the selected study, including type of study, variables studied, sample, type of intervention used and the relevant findings. The scores found
IDENTIFICATIONN The search on the databases Science Direct, Medline, EBSCOhost, Cochrane found 2907 studies with the terms Pilates and Method Pilates in their titles. Total: 2907 studies.
SCREENING Refining the search for Pilates and Aging,
Pilates and Older People, Pilates in Elderly, 265 studies were found, and 22
were selected as possibilities.
ELIGIBILITY 5 studies that had no control group were excluded; 1 study that was in another language; 4 studies in which the sample was composed of institutionalized elderly; 1 study where the sample was made up of hospitalized elderly: and 1 study where the initial age of participants was 45 years.
in this systematic review ranged between 3 and 6 on the PEDro scale (average of 4.2, indicating low methodological quality). The scores of each study are shown in Table 2.
Table 1 Characteristics of the selected studies
Mesquita et al., Pre- and Functional N*:58 Duration and frequency: Women in the PNFG showed significantly better static and dynamic balance than 2015 Post-test. mobility, static PG**:20 1 month 3 times a week, 1 hour per session. did women in
and dynamic PNFG***:20 PG: floor exercises, Swiss ball, theraband and magic circle. the CG. Women in the PG also showed better dynamic balance than did women in postural balance. CG****:18 PNFG: basic facilitation procedures: the CG.
resistance, manual pressure, traction, stretch and No significant differences were observed in any of the balance variables assessed Approximation between the PNFG and PG.
reflexes, and visual and verbal stimulation. CG: no diferences CG: without exercise. Oliveira et al., 2015 Pre- and Post-test. Lower leg strength, postural balance, functional mobility and the health-related quality of life.
N:32 PG:16 CG:16
PG: 60-minute sessions of Pilates held twice a week for 12 weeks (total of 24 sessions) with Pilates apparatus: a) Combo chair; b) Cadillac trapeze table; c) Universal reformer; d) Ladder barrel.
CG: without exercise.
Improvements in lower limb muscle strength, static and dynamic postural balance, functional mobility and quality of life.
Guimarães Pre- and Flexibility of hip N:60 PG: 60-minute sessions of Pilates held twice a week for 12 PG: increase in flexibility of hip and shoulder. et al., 2014 Post-test. and shoulder in
weeks, Pilates apparatus: reformer, cadillac, wunda chair, barrel, wall, and on the mat, accessories: over ball, theraband, step barrel, magic circle, Swiss ball, rollers, half-moon barrel and sitting box.
CG: no diferences
Marinda Pre- and post- Cardiometabolic N:50 Duration and frequency: PG: only decrease in systolic pressure and increase in blood glucose. et al, 2013 test. parameters:
resting heart rate, resting blood pressure and fasting blood glucose, cholesterol and triglycerides. PG:25 CG:25
8 weeks, 3 times a week, 60 minutes. PG: floor exercises, mat Pilates, level basic. CG: without exercise.
CG: no diferences
Fourie Pre- and post- Lean body mass, N:50 8 weeks, 3 times a week, 1 hour per session. Decrease in body fat percentage, increase in lean body mass, no changes in body et al., 2013 test. body mass, fat
mass, body fat percentage.
PG: floor exercises, mat Pilates, level basic. CG: without exercise.
mass and body mass index. CG: no differences.
Kovách Pre- and post- Functional fitness N:54 6 months, 3 times a week, 1 hour per session. Improved overall physical performance of healthy, et al., 2013 test. and quality of
PG:22 AFG:17 CG:15.
PG: basic Pilates mat exercises were used.
AFG: shallow-water training, where the feet touch the bottom of the pool and water does not exceed shoulder level. CG: without exercise.
regardless of the type of exercise. Improved only some aspects of quality of life. For PG in aspects of perception, autonomy and sociability. And for AFG, only improved aspect of sociability.
Rodrigues et Pre- and post- Functional N:52, 8 weeks, twice weekly, 60 minutes PG: improved static balance, personal autonomy and quality of life. al., 2010 test. autonomy, static
balance and quality of life. PG:27 CG:25 PG: Pilates apparatus CG: without exercise. CG: no differences. Study Design Studied variables Sample Intervention Relevant findings
Gildenhuys Pre- and post- Agility, N:50 8 weeks, 3 times a week, 1 hour per session. PG: improved agility and functional mobility. In aspect cardiorespiratory fitness, et al., 2013 test. functional P:25 PG: floor exercises, mat Pilates, level basic. no differences.
mobility, CG:25 CG: without exercise. CG: no differences. cardiorespiratory
fitness (VO2 máx).
For the two groups subjected to the training programs all the other variables Plachy Pre- and post- Functional fitness N:54 6 months, 3 times a week, 1 hour per session. showed significant differences. The most remarkable results for the Pilates group et al., 2012 test. and quality of PG:22 PG: basic Pilates mat exercises were used. were with the 6-minute walk and sit-to-stand test, while for the aqua-fitness and
life. PAFG*****:1 PAFG: aqua-fitness class twice a week with one Pilates Pilates group it was shoulder and hip flexion. 7 session. CG: no differences.
Mokhtari et al., Pre- and post- Depression, N:30 PG:15 12 weeks, three times a week, 60 minutes PG: decrease in the depression level and improving the balance. 2013 test. balance, falls. CG:15 per session. PG: first 6 weeks with floor exercises and the next CG: no differences.
6 weeks with exercises with elastic bands.
*N (sample); **PG (Pilates group); ***PNFG (Pilates neuro-proprioceptive facilitation group); ****CG (control group), *****PAFG (hydrogymnastics and Pilates group).
The scores found in this systematic review ranged between 3 and 6 on the PEDro scale (average of 4.2, indicating low methodological quality). The scores of each study are shown in Table 2.
Table 2 The scores of studies according PEDro Escale
Mesquita et al.,2015 6
Oliveira et al., 2015 5
Guimarães et. al., 2014 5
Marinda et al., 2013 5 Fourie et al., 2013 4 Gildenhuys et al., 2013 3 Plachy et al., 2012 3 Mokhtari, 2012 3 Average 4.2 Median 4.0 Standard Deviation 0.979
This systematic review was conducted to investigate the available scientific evidence on the effects of regular Pilates practice on healthy elderly. Studies assessing institutionalized elderly were excluded, because these seniors have other life conditions regarding physical, cognitive and social aspects. The durations of the interventions found in the studies were diverse, ranging from one month to six months. The weekly frequency ranged from two to three weekly sessions. The training sessions in all studies were one hour long.
Types of Intervention
With respect to the different interventions or forms of Pilates: the studies that used
Pilates apparatus employed springs, or other types of resistance, with the use of elastic bands or stable surfaces (on the floor), or unstable elements (swiss balls). However, the most commonly used form was the mat Pilates. This is explained by the low cost and higher availability, meaning a larger number of subjects can use it simultaneously.
In this systematic review of ten selected studies, seven used the mat: Mesquita et al. (2015), Marinda et al. (2013), Fourie et al. (2013), Kovách et al. (2013), Gildenhuys et al. (2013), Plachy et al. (2012) and Mokhtari et al. (2013).
The study by Guimarães et al. (2014) used accessories such as therabands and swiss balls, which a r e adaptations o f the ori gi n al m e t h o d . This use of accessories also occurred in the study by Mesquita et al. (2015), but an accessory created by Joseph Pilates was added: the Magic Circle.
There are several forms of exercise that are presented to the public as Pilates, and there is a lack of standardization of the spring loads used in their apparatus. These changes to the original project apparatus are reflected in the ergonomics and in the deepening and execution of the original exercise.
Rodrigues et al. (2010) tested this equipment as to their effects on improved static balance, functional autonomy and quality of life. Meanwhile, Guimarães et al. (2014) assessed the shoulder and hip flexibility of elderly people who trained with the Pilates method. The last selected study that used Pilates equipment with the elderly was that of Oliveira et al. (2015), who examined lower limb muscle strength, static and dynamic postural balance, functional mobility and quality of life.
Tunar et al. (2012) performed a study with sedentary adolescent patients with type 1 diabetes aged 12-17 years. They tested the rates of glycated hemoglobin, daily dose of subcutaneous insulin, triglycerides, total cholesterol, low density lipoproteins and high density lipoproteins. Statistically, no significant differences were observed in glycated hemoglobin levels and daily doses of subcutaneous insulin between groups.
However, in the study by Martins-Menezes et al. (2015), after the training period, statistically significant differences were found in diastolic and systolic blood pressure, waist circumference and waist-hip ratio (p <0.05).
In relation to the physiological variables and blood markers associated with Metabolic Syndrome, a study by Amirsasan and Dolgarisharaf (2015) found statistically significant improvements at the 0.05 level of confidence for weight, body fat %, waist-hip ratio, systolic blood pressure, and diastolic, fasting glycemia, total cholesterol and LDL-C after 8 weeks of training. However, no significant difference was found in the levels of triglycerides and HDL-C between the CG and the EG.
Considering that physiological markers are directly related to body composition, a study by Ramezankhany et al. (P <0.001) and body mass index (P <0.05) were found positive effects in all experimental groups (Pilates Group and Aerobic Exercise Group).
These results were also found in a study by Cakmakçi (2011), which only found changes in the intervention group, with a statistically significant difference in waist-hip ratio (p <0.001), body fat percentage (p <0.001) and mass (P <0.01).
Niehues et al. (2015) conducted a review of the literature that aimed to investigate the hypothesis that the Pilates method, as a supplementary training method, may be beneficial for lung function and functional capacity in obese adults.
The results support the observations of these authors that Pilates strengthens the abdominal muscles and improved the diaphragmatic function, optimizing respiratory function, thus improving the functional capacity. However, the authors did not find specific studies with obese people, which justifies the need for future studies.
Pilates and Muscle Function
Regarding the effects on the powerhouse, or core strength, a study by Markovic et al. (2015) compared a vibratory platform, called the Huber, and traditional Pilates. The