Rev. Bras. Reumatol. vol.56 número4

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rev bras reumatol.2016;56(4):352–365

ww w . r e u m a t o l o g i a . c o m . b r

REVISTA

BRASILEIRA

DE

REUMATOLOGIA

Review

article

The

effects

of

the

Pilates

method

in

the

elderly:

a

systematic

review

Patrícia

Becker

Engers,

Airton

José

Rombaldi,

Elisa

Gouvêa

Portella,

Marcelo

Cozzensa

da

Silva

∗

PostgraduatePrograminPhysicalEducation,UniversidadeFederaldePelotas,Pelotas,RS,Brazil

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Articlehistory:

Received21June2015 Accepted18November2015 Availableonline1June2016

Keywords:

Elderly Aging Motoractivity Review

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Severalstudiesshowthebenefitsofincludingmusclestrengthandaerobicphysical activ-ityintheroutineofelderlypeople.Amongthevariouspossibilitiesofphysicalactivity,the Pilatesmethodhasbecomeapopularmodalityinrecentyears,throughasystemof exer-cisesenablingtoworkthewholebodyandthatcorrectspostureandrealignsthemuscles, developingthebodystabilityneededforahealthierlife.Theaimofthisstudywastoreview thecurrentevidenceontheeffectsofthepracticeofthePilatesmethodintheelderly.A systematicliteraturereviewwasconductedinthefollowingelectronicdatabases:Pubmed, Scielo,Lilacs/Bireme,Scopus,PedroandIsiofKnowledge,fromdescriptorspilates,elderly,old adults,aging.Intheselectionofstudiesthefollowinginclusioncriteriawereused:original articlesinEnglish,PortugueseandSpanishlanguages.Allselectionandevaluationprocesses ofthearticleswereperformedbypeersandthequalitywasverifiedbytheDownsandBlack scale.Twenty-onestudieswereincluded.Theyearofpublicationrangedfrom2003to2014 andthesizeofthesamplevariedfrom8to311elderlysubjects,agedatleast60yearsold. Theinterventionperiodwasfrom4weeksto12monthsofPilatesexercisepractice.Itwas concludedthatdespitethestudiespointingtophysicalandmotorbenefitsofthePilates methodintheelderly,wecannotstatewhetherornotthemethodiseffective,inviewof thepoormethodologicalqualityofthestudiesincludedinthisreview.

Efeitos

da

prática

do

método

Pilates

em

idosos:

uma

revisão

sistemática

Palavras-chave:

Idoso

Envelhecimento Atividademotora Revisão

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e

s

u

m

o

Diversosestudosapontamos benefíciosdainclusão deatividadesfísicasde resistência musculareaeróbicasnarotinadosidosos.Dentreasdiversaspossibilidadesdaatividade física,ométodoPilatessetornouumamodalidadepopularnosúltimosanos,pormeiode umsistemadeexercíciosquepossibilitatrabalharocorpotodo,corrigeapostura,realinhaa musculaturaedesenvolveaestabilidadecorporalnecessáriaparaumavidamaissaudável.

∗ _{Corresponding}_author_.

E-mail:cozzensa@terra.com.br(M.C.Silva).

http://dx.doi.org/10.1016/j.rbre.2016.05.005

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Oobjetivodopresenteestudofoirevisarasevidênciasatuaissobreosefeitosdapráticado métodoPilatesemidosos.Arevisãosistemáticadaliteraturafoifeitanasbasesdedados eletrônicasPubmed,Scielo,Lilacs/Bireme,Scopus,PedroeIsiofKnowledgeapartirdos descritorespilates,elderly,oldadultseaging.Aseleçãotevecomocritériosdeinclusãoartigos originaisnaslínguasinglês,portuguêseespanhol.Todososprocessosdeseleçãoeavaliação deartigosforamfeitosporpareseaqualidadefoiverificadapelaescaladeDownsandBlack. Foramincluídos21estudos.Oanodepublicaçãovarioude2003a2014eaamostradeoito a311idosos,comidademínimade60anos.Operíododeintervençãoapresentouvariação dequatrosemanasa12mesesdeexercíciosdométodoPilates.Concluiu-sequeapesar deosestudosapontaremparabenefíciosfísicosemotoresdométodoPilatesemidosos, nãopodemosafirmarqueométodoéounãoefetivo,tendoemvistaabaixaqualidade metodológicadosestudosquecompõemarevisão.

Introduction

According to the censusof 2010,1 _Brazil _moves _toward _an

increasinglyageddemographicprofile,withanincreaseinthe numberofelderlysubjects.2_Due_to_medical_advances,_among

otherthings,theBrazilianlifeexpectancyhasbecome increas-inglyhigher,andfor2050,theBrazilianBureau ofStatistics projectedalifeexpectancyof81years.1

Agingisaninvoluntaryandinevitableprocessthatcauses progressivestructuralandfunctionallossinthebody,suchas deteriorationoffunctionalcapacity,musclemassandstrength loss(mainlyduetosarcopenia),lossofbonemassandof hor-moneproduction,anddelaysinreactiontime,whicharerisk factorsthatleadtoalossofautonomyandincreasedriskof falling.3–6

Liveanindependentandautonomouslife,withtheability tocarryouttheirbasictasksofdailylife,isakeyaspectfor maintainingqualityoflifeforthe elderly.7 _However,_a

con-ditionforallowing autonomy ofthe elderly isto maintain theirphysicalfitness.Physicalactivity seemstobea strat-egyformaintainingautonomy,improvingfunctionalcapacity, decreasingtheriskoffallsand,consequently,improving qual-ityoflife.6,8

AccordingtotheUnitedStatesCenters forDisease Con-trolandPrevention(CDC),elderlyindividualsshouldperform muscularstrength(twiceaweekormore,withinvolvement ofmostmusclegroups)andaerobicactivities(atleast150min ofmoderateintensityactivityor75minofvigorousintensity activity,oracombinationoftheseperweek)inordertoreduce theriskofmortalityfromallcauses,coronaryheartdisease, stroke,hypertension, andtype2diabetes.9 _Among_the

var-iouspossibilitiesofphysicalactivity,thePilatesmethodhas becomeapopularmodalityinrecentyears.Suchamethodhas emergedasapopularwayofimprovingthestrengthand over-allconditioningforpeopleofallagesandcurrentlyhasbeen usedasan adjuvantmethodin rehabilitationofinjuries.10

According to several authors, this method entails benefits suchasincreasedbonemineraldensity,positivechangesin body composition, and improvementin muscular strength andendurance,coordination,balanceandflexibility.11–13

Inview ofthe benefitsdescribed aboveand considering that the practice ofthis method is individualized, thereby

reducingtheriskofpossibleinjury,Pilateshasbeenquite indi-catedfortheelderly.However,therearefewstudiespublished onsystematicreviews,andparticularlystudiesassessingthe methodologicalqualityofresearchinordertocheckthe evi-denceforthedecision-makingprocessabouttheuseofthe methodinphysicalactivityprogramsaimedtothehealthof theelderly. Inthissense,theaimofthis studyistoassess theeffectsofthePilatesmethodintheparametersofphysical fitnessandphysiologicalandcognitivefunctionintheelderly.

Methods

A systematicliteraturereviewwas conductedinelectronic databases, using the following inclusion criteria: original articles, Portuguese, English or Spanish language, and no restrictionastotheyearofpublication.Reviewarticles,case studies,thesesanddissertationswereconsideredasexclusion criteria.

The electronic search was conducted in the following databases:Pubmed,Scielo,Lilacs/Bireme,Scopus,Pedroand IsiofKnowledge. Thedescriptorsused(Pilates,elderly, old adults,aging)wereinsertedintotheDescriptorsinHealth Sci-ences(DeCS),inEnglishandtheirequivalentsinPortuguese language.Thedescriptorswereusedwiththefollowing com-binations:“Pilatesandelderly”,“Pilatesandoldadults”and “Pilatesandaging.”

Allarticlesfoundinthedifferentdatabaseswereimported intoEndNote,areferencemanagingsoftware.Afterexclusion ofduplicatedarticles,ananalysisinthetitlesofthestudies was carried out;those articlesthat didnotaddress Pilates wereexcluded.Later,theabstractsofthearticleswere ana-lyzed,andthosethatwerenotrelatedtothereviewgoals,for example,didnotincludesubjectswiththeagegroupof inter-estforthestudy(individualsaged60orolder)wereexcluded. Thearticlesthatremainedaftertheanalysisoftheabstracts werereadintheirentirety,andintheabsenceofreasonsfor theirexclusionwereincludedinthisreview.Allarticle selec-tionandevaluationprocesseswereperformedindependently bytworeviewers.

Included studies were assessedforquality according to DownsandBlackChecklist.14_This_assessment_was_also

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disagreementonthescoreawardedtoitems,athird evalu-ationwasrequestedtoanotherindependentappraiser.

TheassessmenttoolproposedbyDownsandBlackis com-posedof27questionsdividedintofivesub-scales:evaluation of appropriate information (10 items), external validity (3 items),theinternalvalidityofthedetailedmeasurementsand biasoutcomes (7items), confounding factors(6 items)and power(oneitem).Themaximumscorethatcanbeachieved bytheinstrumentis32points.Eachitemthatmakesupthe checklistassignsscoresrangingfrom0to1,withtheexception ofthatitemthatevaluatesthedescriptionofconfounding fac-tors,whichonecanassignuptotwopoints,andtheitemthat assessesthedescriptionofthestudy power,whichonecan assignuptofivepoints.Theitem27hasbeenmodified,inline withitsuseinotherstudies15,16_;_for_this_item,_the_score_that

originallyascribed0–5pointswasmodifiedtoascribebetween 0and1point;thus,thescoreof1wasawardedifthearticle showedapowercalculationand/orsamplesizecalculation, and0ifnotshowedanyofthesecalculations.Afterthis modi-fication,totalscoresrangingfrom0to28pointswereobtained withthechecklist.

Results

Afterthesearchinvariousdatabases,170articleswere iden-tified.Ofthesearticles,83wereexcludedbecausetheywere duplicates,and53 werediscardedbecausethetitle didnot relatethe articletotheobjectives ofthepresent review.In addition,13articleswereexcludedafterreadingtheabstracts. Attheendoftheselectionprocess,21articlesmetthe inclu-sioncriteriaandwereincludedinthesystematicreview,as shownintheflowchart(Fig.1).

The21studiesincludedinthisstudyreceivedtheirscores byassessingtheirqualityusingtheDownsandBlack Check-list, rangingfrom 10 to19points out of28possiblepoints tobeachieved(average14.76±2.12).Studies withthe high-estscorewereperformedbyBirdetal.17_and_Mallery_et_al.18

with19points;andstudieswithlowerscoreswerethethose byKaesleretal.,19_Newell_et_al.,20_and_Ruiz-Montero_et_al.,21

with12 pointseach.Thequality criteriawith lower scores were:lackofanaccuratedescriptionofconfoundingfactors; notreportingthemostimportantadverseevents;not display-inginformationontheenvironmentandcarereceivedbythe sample;notinformingwhetherthesubjectsincludedinthe sampleswerecounterpartstothoseofthegeneralpopulation; notreportingadjustmentsforconfoundingfactors;not repor-tingwhethertherewerelossestofollow-up,andifthisfactwas takenintoaccount;lackofacontrolgroupforproper compar-ison;andlackofsamplerandomization.Furthermore,noneof thesestudiesconductedsamplesizeorpowercalculations.

Asforcountrieswherethestudieswerecarriedout,four studies inBrazil,22–25 _four _in_Australia,17,19,26,27 _and _four _in

SouthAfrica,28–31_two_in_Turkey,32,33_and_two_in_Hungary,34,35

and one in Canada,18 _United _Kingdom,20 _Serbia,21 _South

Korea,36_and_United_States37_were_found.

Table 1 summarizes the main characteristics of the articles that make up our review study, as well as the scope,methodologicalproceduresandmainresults.Among these articles, 16 experimental studies,17,18,21–24,27–36 _four

quasi-experimental studies,19,25,26,37 _and _one _{observational}

study20 _were _found, _and _the _year _of _publication _ranged

between2003and2014.Thesamplesizeofthestudiesranged fromeight19_to₃₁₁21_elderly_subjects._The_reported_minimum

age was 60 years; in 12 studies the samples were com-posedofbothgenders,17–21,23,26,27,32,35–37_and_in_nine_studies

only women were evaluated.22,24,25,28–31,33,34 _The

interven-tion periodrangedfrom fourweeks18_to₁₂ _months,32 _with

apredominanceofinterventionsofeight19,20,22,28–31,37 _(38%)

and 12 weeks26,27 _(9.5%). _In _more _than _half _of _the

stud-ies (n=11), there was no report of a gradual increase in exerciseintensity, accordingtotheevolutionofthehis/her practitioner.17,22,23,25,26,28,29,31,32,35,36

Themaineffectsofthe Pilatesmethod reportedforthe age group studied were: increased balance,19,22,26,32,33,36,37

flexibility,23,29,32,34 _and _strength,9,32 _positive _{modifications}

in body composition,21,28,32 _and _also _improved _functional

autonomy22,24,25_and_less_risk_of_falls20,32,37_in_the_elderly.

Discussion

Intermsofmethodology,accordingtotheDownsandBlack checklist,theassessedarticlesshowedlowscores,andmore than half of them awarded a score ≤14, from a total of 28 points.Theimportantand primarycriteriaforscientific soundnessofstudieshavebeenmissed,oratleasthavenot beenpresented,inmostofthesestudies.Amongthemissing qualityindicators,standouttheobjectivedescriptionof con-foundingfactors;thereportingofadverseeventsimportant tothestudy;thedescriptionofinformationonthe environ-mentandcarereceivedbythestudysample;theindication oftherepresentativenessofthesamples;theadjustmentfor confounding factors;the reportingoflosses andifthis fact wastakenintoaccount;acontrolgroupandrandomizationof thesample.Allthesefactorschallengethefindingsofsome studies,whichshouldbetreatedwithextremecaution.

It wasfound that the studies were composed predomi-nantlyoffemalesubjectsorofbothgenders,withnostudy withasamplecomposedonlyofmen.Thegreatestdemand and adherence byfemalestoPilatesmay helpexplainthis finding.Ontheotherhand,withrespecttotheplaceoforigin ofthestudy,Brazil22,24_and_Australia17,26_stand_out,_probably

duetothedemandforthismethodinthesecountries.38

Severalstudieswhichmadeupthisreviewsuggestthatthe practiceofPilateshadapositiveeffectonincreasingand pre-ventingthereductionofflexibilitylevelsintheelderly.23,29,33,34

Despitethepositiveresultsofreports,thestudiesrevieweddid notreportonthecontrolofconfoundingfactors,andon blind-ing ofthose whoappliedtheinterventionand itspotential adverseeffects,aswellassamplesizecalculation.

Other studies have shown, as the effects of the Pilates method, improvement of static and dynamic balance.19,22,33,36,37 _The _main _{methodological} _problems

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Table1–DescriptionofthecharacteristicsandresultsofstudiesinvolvingthePilatesmethod.

Author–year/

countryoforigin

ofthestudy

Studydesign Objective Sample Age Intervention Frequency/intensity/

duration

Primary endpoint/results

Downs

andblack

checklist

Guimarãesetal.,

201423_/Brazil

Experimental Toverifythe effectofthe Pilatesmethodin thehipand shouldergirdle flexibilitylevels intheelderly

60elderly subjects:30 CG/30PG(85% women;15% men)

Mean68(SD ± 5.1) years

Pilatesexercises withandwithout theuseof machines

60min,2× per week/averageto moderate intensity,10–12 repetitionseries foreach exercise/12-week duration

Hipflexibility:CG normalandlowerin pre-testandretest.PG pretest:60%normaland 10%higher;andon retest66.7%normaland 33%higher(p=0.180). Shoulderflexibility:PG pre-test:63%normal and17%higher,andon retest47%normaland 33%higher(p=0.001)

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BirdandFell, 201426_/Australia

Quasi-experimental

Toinvestigate theeffectof Pilatesexercise ontheriskof physicalfallrisk factors

30elderly subjectsofboth genders

Mean69(SD ± 7) years

Pilatesclasses 5weeksof intervention (T1)/post intervention (T2)/12months later(T3)

Thereweresignificant differencesindynamic balanceandstrength amongparticipantswho continuedwithPilates

versusthosewho discontinued.Oneyear later,improvementsin balancewere maintainedinall participants

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Birdetal., 201217_/Australia

Experimental Toevaluatethe effectsofa Pilates interventionin balanceand functioninthe elderlylivingin thecommunity

32elderly subjects,men andwomen(16 CGand16PG)

Over60years:mean 67.3(SD± 6.5)years

Pilatesexercises 260-mingroup sessionsper week/5-week duration

Therewereno significantdifferences betweenPGandCGfor allmeasuredvariables. Staticanddynamic balanceimproved significantlyfrompreto post-Pilates(p<0.05)

19

Rodriguesetal., 201024_/Brazil

Experimental Evaluatethe effectofthe Pilatesmethodin thefunctional autonomyof elderlywomen

52elderly women(27PG, 25CG)

60–78years:PG (66.9± 5.3years); CG(65.2 ± 3.9years)

Pilatespractice, usingaBobath ballandspecific devicesofthe method

2sessionstwice perweek.Each sessionlasting 1h/8-week duration

PGshowedsignificant improvementinthe functionalperformance ofoldersubjects (p<0.05)

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Table1–(Continued₎

Author–year/

countryoforigin

ofthestudy

duration

Downs

andblack

checklist

CuriPérezetal.,

201425_/Brazil

Quasi-experimental

Toanalyzethe PilatesMethod (PM)toassess whetheritcan helptoimprove theperformance ofactivitiesthat olderpeople performintheir dailylives

22elderly women

65–74years Pilatesclassical method

50-minsessions twiceper week/12-week duration

After12weeksof training,theelderly womenbegantotake lesstimetoperformthe activitiesofdailyliving

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Fourieetal., 201328_/South

Africa

Experimental Todeterminethe effectsofa Pilatesprogram inbodyfatin olderwomen

50elderly women(25CG, 25PG)

60yearsandover Pilatesexercise program

3weekly sessionslasting 60min/8-week duration

PGshowedasignificant reductionintotalbody fat

14

Fourieetal., 201329_/South

Africa

Experimental Todescribethe rangeofmotion ofsingleor multiplejointsin frailelderly people

Significant improvementin shoulderflexion(from 152.84± 21.32degreesto 179.60± 10.53degrees;

p=0.000)andhipflexion (from74.36±

13.07degreesto82.60 ±

16.40degrees;.p=0.002)

14

Hyunetal., 201436_/South

Korea

Experimental Tocomparethe effectsofPilates practicein balanceand stabilityof elderlyfemale

40elderly subjectsofboth genders(divided intoPGandCG)

65yearsandover Pilatesexercises 3timesperweek, eachsession lasting 40min/12-week duration

Aftertheintervention period,oscillation durationandbalance oscillationspeed loweredsignificantly(p <0.05)inbothgroups

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Author–year/

countryoforigin

ofthestudy

duration

Downs

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checklist

SiqueiraRodrigues

etal.,

201022_/Brazil

Experimental Toevaluatethe effectsofthe Pilatesmethodin personal autonomy,static balanceand qualityoflifein healthyolder women

52elderly women(27PG, 25CG)

60yearsandover Pilatesexercises 2sessionsof1h perweek/8-week duration

Therewasasignificant differenceinthe post-testinthePGfor balance(Delta%=4.35%,

p=0.0001);for functionalautonomy index(%Delta=

−13.35%,p=0.0001)and forqualityoflife (Delta%=1.26%,

p=0.0411)

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Irezetal., 201432_/Turkey

Experimental Tocomparethe effectsofPilates andawalking exerciseprogram ondynamic balance, flexibilityand musclestrength inanelderly population. Determinethe effectsofPilates inrestingheart rate,resting bloodpressure, fastingglucose, cholesteroland triglyceridesin olderwomen

45elderly subjectsofboth genders(15PG, 15CGand15 walkinggroup) with10female and5malein eachgroup

Over65years MatPilates exercises

3timesperweek, eachsession lasting 60min/14-week duration

Statisticallysignificant differenceswerefound inpre-and

post-interventionscores forweight(z=−2.94;

p=0.03),flexibility (z= −2.87,p=0.04), musclestrengthofhip flexion(z= −2.37,

p=0.02),balance (z= −2.67,p=0.03), balanceconfidence (z= −2.24;p=0.04),and Downtonfallriskindex (z= −2.12,p=0.03)in Pilatesgroup

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Marindaetal., 201330_/South

Africa

Experimental Todeterminethe effectsofPilates inrestingheart rate,resting bloodpressure, fastingglucose, cholesteroland triglyceridesin olderwomen

50elderly women(25CG and25PG)

60yearsand over;mean65.32 (SD ± 5.01)forCG and66.12 (SD ± 4.77)forPG

Pilatesexercise program

60min,3× per week/Progressive intensity/8-week duration

Statisticallysignificant reductioninsystolic bloodpressure,increase ofbloodglucose

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Author–year/

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ofthestudy

duration

Downs

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Newelletal.,

201220_/United

Kingdom

Observational Toinvestigate whetherelderly subjects participatingina supervised Pilates community program improvedin termsofgaitand balancepattern

9elderlysubjects ofbothgenders

60–76years; mean67.8 (SD ± 5.0)

MatPilates exercisesand accessories

60min/1× per week/intensity wasnot reported/8-week duration

Significant

improvementinwalking speedandstepcycle. Significantincreasein stridelength.Decrease inbothanteriorand posterioroscillation withimprovedriskof fallingindex

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Irezetal., 201133_/Turkey

Experimental Todetermine whetheran exerciseprogram basedonPilates methodwas effectivein improving dynamicbalance, mobility, posturalstability, inorderto reducethe numberoffalls intheelderly

60elderly women:30CG and30PG

Over65 years:mean, 72.8 ± 6.7years forPGand 78± 5.7yearsfor CG

MatPilates exercisesand accessories, elasticandball

60min/3× per week/intensity wasnot reported/12-week duration

PGshowedasignificant improvementin dynamicbalance comparedtothecontrol group.Regarding flexibility,PGshowed significant

improvementintheSit andReachtestfrom pre-toposttest,while CGshowedno significantdifference. PGalsoshowed improvementinmuscle strengthandreaction time,bothinsimpleand choice,after12weeksof Pilates.

Asmallernumberof fallswasreportedbyPG

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Author–year/

countryoforigin

ofthestudy

duration

Downs

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checklist

Kuoetal.,

200927_/Australia

Experimental Todetermine changesin sagittalspinal postureinolder adultsduring standingand sittingaftera Pilates-based exerciseprogram

34elderly subjects(10men, 24women)

Over60years: mean,64 ± 6years

Pilatesexercises performedon theground,in equipmentand withaccessories

75min,2× per week/intensity wasnotreported, butthelevelof exercisewasin accordancewith theparticipant’s progress/12-month duration

Standingandsitting postureremained unchanged,exceptthe angleofthelumbar spineinsittingposture. Immediatelyafterthe Pilatesexercise program,theelderly subjectspresenteda smallreductioninchest flexioninstanding posture,andsitting withincreasedlumbar extension

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Pataetal., 201437_/United

States

Quasi-experimental

Todetermine changesin sagittalspinal postureinolder adultsduring standingand sittingaftera Pilates-based exerciseprogram

35elderly subjects (31women and4men)

61–87years Exercisesusing thekey principlesof Pilatesdesigned forseniors

60min/2× per week/progressive exercises/8-week duration

Significant

improvementinTimed UpandGoTest, Turn-180ForwardReach tests.

Improvedconfidence, withrespecttofearof falling.Resultssuggest thataprogrambasedon Pilatesmethodcanbe effectiveinimproving balance,mobility, posturalstabilityandin reducingthenumberof falls

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ofthestudy

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Downs

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Kaesleretal.,

200719_/Australia

Quasi-experimental

Toexaminean intervention through exercises designedto improvebalance inanupright position,based onPilates techniques

8elderly subjects,men andwomen

66–71years Theselected exercisesand techniqueswere basedand inspiredbythe Pilates principles: dissociation, stabilization, mobilizationand dynamic stabilization

60min/2× per week/progression oftheexercises asneeded,the subjectshould perform15 repetitions/8-week duration

Significant

improvementinsome staticanddynamic componentsofpostural sway,aswellas improvementin functioning

demonstratedthrougha betterresponsetothe TimedUpandGoTest. Theresultssuggestthat ashorttrainingperiod basedonPilatescan improvepostural stability,andalso functioninginthe elderly

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Plachyetal., 201234_/Hungary

Experimental Toassess whethera regulartraining programlasting oneyearcan haveapositive effecton flexibility,range ofmotion,and aerobic enduranceina sampleofelderly women

42elderly womendivided intothree groups:PG:n=15 PG+water:n=15 CG:n=12

Mean,67.1±

4.5years

Pilatesexercises andwater exercises

60min/3× per week(PG-3×

Pilates,PG+A– 2× water exercise,and1×

Pilates)/intensity wasnot reported/6-month duration

Forthosesubjectsin bothgroupswho performedexercise,all variablesshowed significantdifferences. Theresultswithamore significantdifferencefor PGwerethe6-minwalk andthesit-to-stand tests;withregardto bothintervention groups,improved shoulderandhip flexibilitystoodout.The resultssuggestthata trainingprogram impactsonphysical performance improvementandon requirementsofdaily lifeinelderly

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Author–year/

countryoforigin

ofthestudy

duration

Downs

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Ruiz-Montero

etal.,

201421_/Serbia

Experimental Toevaluatethe differencesin body

compositionand anthropometric measurements inasampleof Serbianwomen over60yearsina 24-weekclinical intervention study,througha guidedprogram thatcombined aerobicexercises andPilates

311elderly subjects: 303women and8men

60–70years Trainingprogram consistedof aerobicexercise withmusic,and exercisesofbasic andintermediate levelsofPilates

55–60min/2× per week/intensity wasgradually increasedbased onthe

perceptionofthe firstsession effortontheBorg scale

(0–10)/24-week duration

Increaseinpost-test systolicanddiastolic bloodpressure. Significantreductionof bodyfat.Bonediameter boneandmuscle circumferencewerenot significantlydifferent. Ahighcorrelationwas foundbetweenbodyfat andwaist-hipratio. Basedontheresults, thepracticeofamixed programofPilatesand aerobicexercise generateaneffectof improvingmusclemass andreducingbodyfat, withoutcausing deteriorationduring practiceandinthe post-exerciseperiod

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Malleryetal., 200318_/Canada

Experimental Tomeasure adherenceand compliancetoa resistance programwhen performed duringacute treatmentina hospital

39elderly subjectsofboth genders:PG–

n=19(5menand 14women),CG

-n=20(11men and9women)

Over70years: meanage:PG– 82.7(SD± 8.5), CG–81.4 (SD ± 6.1)

Exercisesbased ontheprinciples ofresistance trainingand Pilates.The controlgroup received conventional physicaltherapy throughpassive motion

Meansessionof 10min/3× per week/intensity: 60–80%1RM,up to10 repeti-tions/duration reliedonlength ofhospitalstay; however,a maximum of4weeks

PGparticipationwas 71%(p=0.004),with63% adherence(p=0.020);CG participationwas96% with95%adherence

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Author–year/

countryoforigin

ofthestudy

duration

Downs

andblack

checklist

Gildenhuysetal.,

201331_/South

Africa

Experimental Tocheckthe effectsofPilates trainingin agility,functional mobilityandVO2

max.inolder women

Prescriptionofresistive exerciseforhospitalized patientsresultsin acceptabilityand adherence.Thetraining improvedsignificantly agility(from6.18/1.22s to4.70/0.90s;p=0.000) andfunctionalmobility (inalltests,p=0.000). Significant

improvementin VO2maxwasnot

observed

14

Kovachetal., 201335_/Hungary

Experimental Tomeasuringthe effectsofPilates andwater trainingon functionalfitness andqualityof lifeinolder individuals

54elderly subjectsofboth gendersdivided intothree groups:PG:n=22 Aquaticfitness group:n=17 CG:n=15

Mean66.4 (SD ± 6.2)years

Pilatesexercises andwater exercises

60min/3× a week(PGand water exer-cises)/intensity wasnot reported/6-month duration

Significant

improvementinlower andupperextremity strength,flexibility, physicalmobility (especiallydynamic balance),andaerobic endurancewasfoundin Pilatesgroup.Shoulder flexibilitysignificantly improvedintheaquatic fitnessgroup.BMIdid notchangesignificantly inanyofthegroups. WHOQOL(qualityoflife) showedimprovementin theperceptionand autonomyinPG,aidin sociabilityinthe aquaticgroup

14

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Total articles found in the database: 170

Excluded because they were duplicates:

83

Chosen articles for reading their abstracts:

34

Excluded after reading the abstracts:

13

Total articles included in the review study: 21

Excluded because the title did not relate to the objectives of the bibliographic search: 53

Fig.1–Flowchartofdatabasesearch.

Withregardtoadvancesinpersonalautonomy,thestudies reviewedhavereportedthatPilatesexercisecausedsignificant evolution inthe functional performance ofhealthy elderly womeninactivitieslikewearingashirt,gettingupfrom sit-tingandlyingposition22,24_and_gait.20_However,_these_studies

havetheirfindingsweakenedasaresultofthelackofan objec-tivedescriptionofconfoundingfactors,characteristicsofthe subjectsofthesamplesthathavebeenlost,blindingtothe intervention,andsamplesizecalculation.

Asfor body composition, Fourie et al.28 _report _that _the

methodwaseffectiveinstabilizingandevenreversalofbodily implicationsoftheagingphenomenon,asinleanmassloss and,also,innormalizationand reductionofbody fat, con-trollingorreversing morbiditiesassociatedwith obesity(p. ex.,hypertensionandglucoseintolerance).Inrelationtothis study,severalimportantfactorstobeconsideredinthe assess-mentofthequalityofthearticlecouldnotbedetermined, because thelack ofdescription ofsuchfactors in our sur-vey(samplerepresentativeness,blindingprocess,adherence totheintervention,randomization,controlforconfounding factors,andreportoflossestofollow-up).

Perezetal.32_obtained_positive_results_with_the_practice_for

musclestrengthgainsthat,alongwiththeincreaseor stabi-lizationoflossofbalanceandofflexibility,leadtoadecrease inthenumberoffallsamongtheelderly.However,important aspectsofqualityarenotclearintheirstudy,includingthe dis-tributionofmainconfoundersineachgroupofsubjectsthat werecompared,possibleadverseeffectsoftheintervention, andsamplesizecalculation.

Also in relation to outcomes related to body composi-tion,Ruiz-Monteroetal.21 _reported_that_the_combination_of

Pilates with aerobic exercise resulted in positive changes, suchasreducingskinfoldsand preventingleanbody mass loss.Despitetheseapparentlypromisingresults,thisstudy21

showed the lowest score on the scale of assessment of methodologicalquality(12points)amongallevaluated stud-ies.Thisfactunderminesthecredibilityoftheconclusionsof theirresearch.

Regarding postural changes, the study by Kuo et al.27

informs,asatheirmainresult,thatthereductionofkyphosis inthe standingpositionwasdetectedinthesagittalplane,

immediately afterthe Pilatesprogram. This study did not describe thedistributions ofprincipal confoundersineach groupofsubjects,norblindedthesesubjectsforthe interven-tion,didnotperformrandomization,andshowednosample sizecalculation.

Only the study by Marinda et al.30 _related _the _Pilates

method with cardiac and metabolic variables; this study showedthateightweeksofPilatesproducednoimprovement incardiometabolicvariablestested,exceptforadecreaseof systolicbloodpressure.Theauthorsdidnotdescribethe char-acteristicsofthesampleandthestudydropouts,distributions ofmainconfoundersineachgroup,potentialadverseeffects oftheintervention,theblindingofindividuals,andwhether thesamplesizecalculationwasmade.

A study relatedpositive changes inparameters suchas functionality,stability,mobility,dynamicandstaticbalance, musclestrength,andflexibility,amongothers,withimproved self-confidence,andadecreaseinfearoffallingandinthe numberoffallsintheelderly.37_Despite_being_one_of_the

stud-ieswiththehighestscoreinthemethodologicalassessment carriedout,therewasnoinformationonsignificantadverse effectsoftheintervention;andblindingofsubjectsto inter-vention,samplerandomizationandsamplesizecalculation werenotpresented.

Inconclusion,althoughthestudiesarepointingtophysical andmotorbenefitswiththeuseofPilatesintheelderly,we cannotstatewhetherornotthemethodiseffective,inview ofthelowmethodologicalqualityofthestudiesincludedin thisreview.

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themethodperformedonthegroundversuspracticesusing accessoriesand/ordevices.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

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