Comparison of different physical exercise modalities in health-related and quality of life outcomes: cross-sectional study of alternative physical training modalities and health (MALTS-Study)ABSTRACT
This study aimed to compare sociodemographic, anthropometric, hemodynamic, physical, and psychosocial characteristics of practitioners of non-conventional exercise modalities (NCMs) and a conventional modality (CM). A cross-sectional, descriptive design was used to compare individuals practicing functional training, Tango, Pilates, “Mova-se,” and gym-based strength and aerobic training regarding health-related outcomes. A total of 100 adults participated, the majority of whom were women. Tango practitioners demonstrated the most favorable indicators in quality of life and depressive symptoms, while Mova-se and CM practitioners showed better cardiorespiratory fitness and flexibility, and Mova-se practitioners exhibited better anthropometric measures. These findings indicate that different exercise modalities produce positive health outcomes, suggesting that diverse forms of movement can offer similar benefits to practitioners.
Keywords:
Quality of life; Physical fitness; Mental health; Physical exercise
RESUMO
Este estudo teve como propósito comparar características sociodemográficas, antropométricas, hemodinâmicas, físicas e psicossociais de praticantes de modalidades de exercício físico não convencionais (MNCs) e de uma modalidade convencional (MC). Foi utilizado um delineamento transversal e descritivo para comparar indivíduos praticantes de treinamento funcional, Tango, Pilates, “Mova-se” e musculação/aeróbio em academia quanto a desfechos relacionados à saúde. Participaram 100 adultos, sendo a maioria mulheres. Praticantes de Tango apresentaram os melhores indicadores de qualidade de vida e sintomas depressivos, enquanto praticantes de Mova-se e da modalidade convencional demonstraram melhores níveis de aptidão cardiorrespiratória e flexibilidade, e praticantes de Mova-se exibiram melhores medidas antropométricas. Esses achados indicam que diferentes modalidades de exercício produzem resultados positivos em desfechos de saúde, sugerindo que diversas formas de movimento podem oferecer benefícios semelhantes aos praticantes.
Palavras-chave:
Qualidade de vida; Aptidão física; Saúde mental; Exercício físico
RESUMEN
Este estudio tuvo como propósito comparar las características sociodemográficas, antropométricas, hemodinámicas, físicas y psicosociales de practicantes de modalidades de ejercicio físico no convencionales (MNC) y de una modalidad convencional (MC). Se empleó un diseño transversal y descriptivo para comparar practicantes de entrenamiento funcional, Tango, Pilates, “Mova-se” y entrenamiento de musculación/aeróbico en gimnasio en relación con desenlaces de salud. Participaron 100 adultos, en su mayoría mujeres. Los practicantes de Tango presentaron los mejores indicadores de calidad de vida y síntomas depresivos, mientras que los grupos Mova-se y MC mostraron mejores niveles de aptitud cardiorrespiratoria y flexibilidad, y el grupo Mova-se presentó mejores medidas antropométricas. Estos hallazgos indican que diferentes modalidades de ejercicio físico producen resultados positivos en desenlaces de salud, lo que sugiere que diversas formas de movimiento pueden ofrecer beneficios similares a sus practicantes.
Palabras-clave:
Calidad de vida; Aptitud física; Salud mental; Ejercicio físico
INTRODUCTION
The continuous practice of physical exercise offers numerous benefits, including improvements in quality of life, mental health, and physical fitness (Schuch and Vancampfort, 2021; Fiuza-Luces et al., 2013; Warburton and Bredin, 2017). Despite these benefits, 81% of adolescents and 27.5% of adults worldwide do not meet the minimum physical activity recommendations set by the World Health Organization (WHO), highlighting physical inactivity and sedentary behavior as critical and emerging public health issues (Guthold et al., 2020).
Moreover, approximately 50% of individuals who initiate an exercise program discontinue it within the first six months of practice (Weinberg and Gould, 2016). Several factors contribute to this dropout, including unengaging exercise prescriptions, overly rigid initial guidelines on intensity, duration, and frequency, and traditional approaches that fail to foster self-responsibility or adaptation over time (Weinberg and Gould, 2016).
In this context, alternative forms of physical exercise, that differs from traditional aerobic or weightlifting training in gyms, have been gaining increasing recognition and popularity. For instance, Functional Training, characterized by its multicomponent approach, incorporates movements in various planes and simulates the physical demands of daily activities during training sessions (Monteiro et al., 2023). Pilates, a mind–body exercise, focuses on strength, core stability, flexibility, muscular control, posture, and breathing (Afsha et al., 2023). Likewise, Tango dancing, a partner dance, has been shown to reduce stress, prevent certain physical and mental illnesses, and promote social, mental, and physical well being in both healthy individuals and those with specific disabilities (Israili and Israili, 2018).
Modalities such as Pilates and Tango, for instance, have gained increasing recognition in rehabilitation settings (Pucci et al., 2019; McKinley et al., 2008). However, there remains limited information on the effects of non-conventional modalities on overall health outcomes, including physical and mental health. This lack of knowledge may drive both demand and supply for these modalities without a clear understanding of their actual benefits, particularly in comparison to traditional methods such as strenght training and aerobic exercise.
In this context, it is important to highlight that although intervention studies are essential to evaluate the effects of different modalities (especially those less commonly investigated), it is first necessary to adopt an observational and descriptive approach. Assessing and describing the health profiles of practitioners of these modalities in real-world settings provides valuable insights into their characteristics and outcomes. This foundational understanding can guide future interventions and comparative analyses. Therefore, the present study aims to compare the sociodemographic, anthropometric, hemodynamic, physical, and psychosocial characteristics of practitioners of four alternative modalities (activities that do not include walking, running, cycling, or strenght training) and conventional modalities (strenght training and aerobic exercise in gyms).
METHODS
Study design
This study adopts a descriptive, applied research approach with a cross-sectional design, conducted under the project “Alternative Training Modalities and Health (MALTS).” The study received prior approval from the Ethics Committee of the Federal University of Santa Catarina (UFSC) under protocol number 5.410.178.
Participants
The sample was selected using a non-probabilistic, convenience sampling method and included individuals of both sexes, aged 18 years or older, who had been practicing physical exercise for at least three months. Participation in the study was voluntary, with all participants required to provide written informed consent. The following inclusion criteria were considered: being 18 years of age or older and practicing one of the following non-conventional modalities: Pilates, Tango, “Mova-se,” and Functional Training, or conventional modalities such as strength training and aerobic exercises performed on treadmills and cycle ergometers in Florianópolis, SC. The exclusion criteria were not signing the Informed Consent Form and participating in more than one of the modalities selected for the study.
Modalities
Pilates sessions were conducted in a studio, incorporating both floor-based exercises and equipment. Each session accommodated two participants, with exercise prescriptions individualized to each practitioner’s goals and needs. Sessions were held twice a week, lasting 50 min, and divided into three phases: initial preparation with stretching and joint mobility exercises, a main phase focusing on strength, flexibility, and balance, and a final phase of light exercises and relaxation.
Tango classes, held in small groups due to COVID-19 restrictions, occurred once a week and lasted 90 min. The warm-up included walking and dance movements specifically designed to prepare participants for Tango. The main phase involved reciprocal teaching and creative Tango movements, including turns, counterturns, enrosques, sweeps, and combinations. The session concluded with free and creative dances.
The Mova-se modality was inspired by the instructors' expertise in circus arts, breaking, capoeira, and yoga. Classes were offered five times a week, each lasting 90 min. Sessions followed a thematic approach, changing every three months, while also allowing students autonomy to pursue personal goals, such as strength, conditioning, mobility, flexibility, and acrobatic movements. Each session began with a warm-up tailored to the class's main technique, followed by the main workout, and concluded with relaxation, incorporating guided postures and breathing exercises.
Functional Training sessions were 60 min long and conducted three times per week. These sessions used various equipment, including ankle weights, dumbbells, resistance bands, cones, trampolines, mats, broomsticks, and body weight. The sessions began with general joint mobility exercises, followed by warm-ups specific to the session’s goal. The main phase included combined circuits (aerobic and strength exercises), performed individually or in pairs, and concluded with stretching exercises targeting the muscle groups emphasized during the workout.
Conventional modality sessions varied in weekly frequency and duration, depending on practitioners' availability. Gyms offered daily services, but the most common frequency among participants was three times per week. Workouts included weight training and aerobic exercises on treadmills and cycle ergometers, prescribed by gym instructors.
Recruitment
Initially, the managers of practice locations for each modality were contacted to present the research objectives and procedures. Practitioners from locations that agreed to participate were recruited via email invitations and in-person approaches. Recruitment occurred during two phases, in April and August of 2022. All interested and eligible participants provided informed consent by signing the Informed Consent Form.
Outcome assessments were conducted at pre-scheduled times and locations, including the practice sites of each modality or the Sports Center (CDS) of UFSC. Participants were instructed to abstain from physical exercise, alcoholic beverages, and caffeinated drinks for 24 h prior to the assessments.
Experimental procedures
Data collection was performed by a team of healthcare professionals coordinated by physical education specialists. A training session was held to align the team on the evaluation protocol, ensuring consistency in its application and reliability of the collected data.
Data on sample characterization, health history, and physical activity history were obtained through participant anamneses completed during the evaluations. Outcomes related to quality of life, sleep quality, and depressive symptoms were assessed using the WHOQOL-BREF, Pittsburgh Sleep Quality Index (PSQI), and the PHQ-9, respectively. The WHOQOL-BREF, a shortened version of the WHOQOL-100, was developed by the World Health Organization (WHO) and its Brazilian Portuguese version was validated by Fleck et al. (2000). This scale measures quality of life, with scores ranging from 0 to 100, where higher scores indicate better quality of life. The PSQI, developed by Buysse et al. (1989), assesses sleep quality, with a total score ranging from 0 to 21, where higher scores indicate worse sleep quality. Its Brazilian version was validated by Bertolazi et al. (2009). The PHQ-9, a brief depression severity measure developed by Kroenke et al. (2001), was validated for use in the Brazilian population by Santos et al. (2013). This scale assesses depressive symptoms on a scale of 0 to 27, with higher scores indicating more severe depressive symptoms.
Heart rate (HR) and blood pressure (BP) were measured in accordance with the Brazilian Hypertension Guidelines using an OMRON device (model HEM 7122). After a 5-min rest period, three BP measurements were taken at 1-min intervals, with the average of the three values recorded. HR was determined based on the first measurement (Barroso et al., 2020).
Anthropometric data were collected by measuring body mass (electronic scale, model PP 180, Marte®, 100 g precision), height (stadiometer, Alturaexata®, 1 mm precision), and waist circumference at the narrowest part of the abdomen following maximum expiration (flexible, non-elastic tape measure, Cescorf®, 1 mm precision). These measurements were used to calculate Body Mass Index (BMI) and Waist-to-Height Ratio (WHtR), with WHtR values >0.5 indicating increased cardiovascular or metabolic disease risk (Ashwell et al., 2012).
Participants also completed four physical tests: Flexibility, Handgrip Strength, Abdominal Endurance, and Aerobic Fitness. Flexibility was evaluated using the Sit-and-Reach test (Wells and Dillon, 1952) on a Wells bench. Handgrip strength was measured using a hand dynamometer (JAMAR) according to the American Society of Hand Therapists protocol (ASHT, 2015). The test involves the participant gripping the dynamometer with both the dominant and non-dominant hands, with the arm positioned at a 90° angle to the body and the elbow fully extended. Participants were instructed to squeeze the dynamometer with maximum effort for 5 s, with rest periods of 30 s between attempts to prevent muscle fatigue. The procedure was repeated three times for each hand, and the highest value obtained was recorded as the participant’s maximum handgrip strength for each hand. Abdominal endurance was assessed using a modified version of the protocol proposed by Pollock et al. (1993). Finally, aerobic fitness was evaluated through the six-minute step test, performed on a 20-cm step for women and men (ATS, 2002; Dal Corso et al., 2007).
Statistical analysis
Data analysis was conducted using R Commander software (version 4.3.0). Continuous variables were tested for normality and homogeneity using the Shapiro-Wilk and Breusch-Pagan tests, respectively. One-way ANOVA with Tukey’s post-hoc test or Kruskal-Wallis test was applied depending on data normality. Normally distributed variables were expressed as mean and standard deviation, whereas non-normally distributed variables were presented as median and interquartile range. Categorical variables were analyzed using chi-square tests or Fisher's exact test, with the latter applied when expected frequencies were low. Relative frequencies (%) were used to describe categorical variables. A significance level of 0.05 was adopted.
RESULTS
A total of 100 physical exercise practitioners were evaluated, including 76 participants in non-conventional modalities—Functional Training (12), “Mova-se” (24), Pilates (16), Tango (24)—and 24 in conventional modalities, such as strength training and aerobic exercises on treadmills and cycle ergometers.
Significant differences were observed in the sample characteristics (Table 1). Functional Training and “Mova-se” modalities had a higher proportion of female participants than other modalities. Tango practitioners were the oldest, followed by those in Functional Training and Pilates. In terms of age, significant differences were observed among modalities, except between “Mova-se” and Conventional modalities, which included the youngest participants.
Sample characteristics regarding sociodemographic and health data, divided into conventional and non-conventional modality groups (n = 100).
Most participants in Functional Training were married, showing significant differences compared to other modalities. The Functional Training group also had the lowest educational attainment, with 75% having only completed or incomplete basic education. Conversely, over half of Tango and Pilates practitioners held postgraduate degrees.
No significant differences were observed regarding participation in additional modalities outside the scope of this study, although less than 50% of Pilates practitioners engaged in another modality. Similarly, no significant differences were noted for coronary artery disease, hypertension, COVID-19, diabetes, or dyslipidemia.
Table 2 presents the results for quality of life, sleep quality, and depressive symptoms. In the WHOQOL-BREF, no significant differences were observed in the physical, psychological, or social relationships domains. However, Tango practitioners recorded the highest scores in the environmental domain, comparable to those in Pilates and conventional modalities. In overall quality of life, Tango practitioners scored significantly higher than Pilates practitioners. No significant differences were noted between groups for health perception, while Tango practitioners exhibited fewer depressive symptoms. Sleep quality did not differ significantly across groups.
Results for Psychosocial Outcomes: Quality of Life, Sleep Quality, and Depressive Symptoms (n = 100).
Regarding the use of medications for anxiety and depression, 2 participants from Functional Training, 2 from 'Mova-se,' 2 from Tango, and 5 from the conventional modalities reported using these medications, while no participants in the Pilates group reported such use.
Table 3 summarizes the results for physical fitness parameters. 'Mova-se' practitioners outperformed other non-conventional modalities in abdominal endurance and flexibility tests but showed no significant differences from the conventional modality. In the cardiorespiratory fitness test, both 'Mova-se' and conventional modalities demonstrated superior results compared to other groups.
Results of Physical Tests: Abdominal Endurance, Cardiorespiratory fitness, Flexibility and Handgrip Strength (n = 100).
In handgrip strength, conventional modality practitioners achieved the best results for the dominant hand, differing significantly from all other groups except Pilates. For the non-dominant hand, Pilates practitioners performed significantly better than other non-conventional modalities, except Tango.
Table 4 presents the hemodynamic parameters and body composition data. No significant group differences were observed for hemodynamic parameters. However, significant differences emerged in all anthropometric measures. 'Mova-se' practitioners showed the best results in Body Mass Index (BMI) and Waist-to-Height Ratio (WHtR), comparable to those in the conventional modality. Regarding the use of β-blockers, which directly influence heart rate—a key outcome in the present study—only 11 out of the 100 participants were using antihypertensive medication. Of these, 4 were in the Tango group, 4 in the Functional Training group, 3 in the Mova-se group, and none in the Pilates or Conventional Training groups.
DISCUSSION
The present study investigated and compared the sociodemographic profile, anthropometric, hemodynamic, physical, and psychosocial characteristics of practitioners across five physical training modalities: Functional Training, “Mova-se,” Pilates, Tango, and conventional modalities like strength training and aerobic exercise in gyms. The “Mova-se” and Functional Training modalities, offered exclusively to women at this unit, had a higher number of female participants, while Pilates and Tango practitioners tended to have higher educational levels, possibly due to the proximity of practice locations to a Federal University. Additionally, the youngest participants were predominantly in the “Mova-se” and conventional modalities.
No significant differences in chronic diseases or COVID-19 history were observed between groups, which is encouraging, particularly for Tango participants, the oldest group, and those in Functional Training, which exhibited a broader age range. Tango, despite its older demographic (average age 63 years), showed exceptional results in depressive symptoms and quality of life, especially in the environmental domain, as measured by WHOQOL-bref. This aligns with existing evidence that depression and low quality of life are prevalent among the elderly. Contributing factors may include the active lifestyle of these participants—75% engaged in additional physical activities—and their higher educational attainment, with 54.2% holding postgraduate degrees. Higher physical activity and education levels are strongly associated with better quality of life, while education may also influence financial stability, enhancing the environmental domain of life quality. The beneficial effects of Tango on mental health, particularly depressive symptoms, may also stem from the positive influence of dance on well being, as documented in prior research.
Dance interventions, such as Tango, stand out in the field of mental health due to their social and collective nature, as well as cognitive aspects like memorizing movements, rhythm, and spatial-temporal awareness (Lima and Freitas Camilo, 2019). A recent meta-analysis (Yan et al., 2024) compared dance interventions with other forms of exercise in terms of psychological and cognitive outcomes in older adults. The results indicate that dance interventions are as effective as other forms of exercise in reducing anxiety and improving depressive symptoms. Furthermore, they have shown superiority in enhancing motivation, memory aspects, social cognition, and in reducing distress.
Health perception and sleep quality did not differ significantly among modalities, with all groups reporting good sleep quality. This aligns with the WHO 2020 guidelines on physical activity, which highlight its benefits for mental health, anxiety reduction, and sleep improvement. In terms of physical fitness, “Mova-se” and conventional modalities outperformed others, likely due to the younger age of participants (27 ± 8 and 25.5 ± 8.5 years, respectively). The “Mova-se” modality showed superior outcomes in abdominal endurance, flexibility, cardiorespiratory fitness, BMI, waist-to-height ratio, and cardiometabolic risk, likely attributable to its comprehensive approach, incorporating elements from diverse disciplines such as circus arts, capoeira, and breaking. These results may also reflect higher session frequency and duration, emphasizing the volume-dependent nature of such outcomes.
Conventional modalities showed the best performance in dominant hand grip strength, reflecting their focus on strength training, while Pilates practitioners excelled in non-dominant hand grip strength, matching the performance of Tango in this regard. Literature supports Pilates as a modality that improves strength, endurance, and rehabilitation, making it a viable alternative for individuals seeking strength gains without conventional training (Cruz et al., 2016). Corroborating this finding, a study analyzing 12 weeks of Pilates training in elderly people living in a care home observed a significant improvement in handgrip strength post-intervention compared to the control group (Kayaoglu and Özsu, 2019). Hemodynamic parameters were consistently normal across all modalities, further underscoring the cardiovascular benefits of regular physical activity.
The study’s limitations include unequal sample sizes across modalities, the location of participants within specific sites, and the lack of analysis regarding participants' income. However, the findings highlight the importance of exploring diverse exercise modalities as tools to combat physical inactivity and promote health. All modalities showed positive impacts in at least one assessed domain, particularly unconventional modalities, which offer viable alternatives for individuals who may not thrive in traditional gym environments. These results emphasize the potential of diverse physical activities to foster inclusivity, support health promotion, and reduce sedentary behavior across populations.
CONCLUSION
Different unconventional modalities, alongside the conventional form of physical exercise, demonstrated favorable outcomes in relation to quality of life, sleep quality, depressive symptoms, and hemodynamic parameters. While some differences were noted among the groups regarding physical fitness and anthropometric measures, it is important to highlight that these values do not differ significantly, regardless of statistical significance.
This supports the notion that diverse forms of physical activity provide comparable benefits to their participants. A comprehensive understanding of the practitioners' profiles, as well as the advantages of regular engagement in these modalities, can inform strategic investments aimed at enhancing physical activity levels and mitigating sedentary behavior within the population. Such efforts could promote a more inclusive and accessible environment for diverse societal groups, where all individuals are encouraged to engage in physical activities that resonate with them.
FUNDING
DATA AVAILABILITY |
The data used in this study are available from the corresponding author upon request.
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Corresponding author: Angelica Danielevicz E-mail: angelica_danielevicz@hotmail.comEditors:
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