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The effects of the Pilates method in the elderly: a systematic review

ABSTRACT

Several studies show the benefits of including muscle strength and aerobic physical activity in the routine of elderly people. Among the various possibilities of physical activity, the Pilates method has become a popular modality in recent years, through a system of exercises enabling to work the whole body and that corrects posture and realigns the muscles, developing the body stability needed for a healthier life. The aim of this study was to review the current evidence on the effects of the practice of the Pilates method in the elderly. A systematic literature review was conducted in the following electronic databases: Pubmed, Scielo, Lilacs/Bireme, Scopus, Pedro and Isi of Knowledge, from descriptors pilates, elderly, old adults, aging. In the selection of studies the following inclusion criteria were used: original articles in English, Portuguese and Spanish languages. All selection and evaluation processes of the articles were performed by peers and the quality was verified by the Downs and Black scale. Twenty-one studies were included. The year of publication ranged from 2003 to 2014 and the size of the sample varied from 8 to 311 elderly subjects, aged at least 60 years old. The intervention period was from 4 weeks to 12 months of Pilates exercise practice. It was concluded that despite the studies pointing to physical and motor benefits of the Pilates method in the elderly, we cannot state whether or not the method is effective, in view of the poor methodological quality of the studies included in this review.

Keywords:
Elderly; Aging; Motor activity; Review

RESUMO

Diversos estudos apontam os benefícios da inclusão de atividades físicas de resistência muscular e aeróbicas na rotina dos idosos. Dentre as diversas possibilidades da atividade física, o método Pilates se tornou uma modalidade popular nos últimos anos, por meio de um sistema de exercícios que possibilita trabalhar o corpo todo, corrige a postura, realinha a musculatura e desenvolve a estabilidade corporal necessária para uma vida mais saudável. O objetivo do presente estudo foi revisar as evidências atuais sobre os efeitos da prática do método Pilates em idosos. A revisão sistemática da literatura foi feita nas bases de dados eletrônicas Pubmed, Scielo, Lilacs/Bireme, Scopus, Pedro e Isi of Knowledge a partir dos descritores pilates, elderly, old adults e aging. A seleção teve como critérios de inclusão artigos originais nas línguas inglês, português e espanhol. Todos os processos de seleção e avaliação de artigos foram feitos por pares e a qualidade foi verificada pela escala de Downs and Black. Foram incluídos 21 estudos. O ano de publicação variou de 2003 a 2014 e a amostra de oito a 311 idosos, com idade mínima de 60 anos. O período de intervenção apresentou variação de quatro semanas a 12 meses de exercícios do método Pilates. Concluiu-se que apesar de os estudos apontarem para benefícios físicos e motores do método Pilates em idosos, não podemos afirmar que o método é ou não efetivo, tendo em vista a baixa qualidade metodológica dos estudos que compõem a revisão.

Palavras-chave:
Idoso; Envelhecimento; Atividade motora; Revisão

Introduction

According to the census of 2010,11 IBGE. Censo 2010. Available from: http://www.ibge.gov.br. [Accessed 27.02.15].
http://www.ibge.gov.br...
Brazil moves toward an increasingly aged demographic profile, with an increase in the number of elderly subjects.22 WHO. Active ageing – a police framework. A Contribution of the World Health Organization to the second United Nations World Assembly on Aging. Genebra: WHO; 2002. Due to medical advances, among other things, the Brazilian life expectancy has become increasingly higher, and for 2050, the Brazilian Bureau of Statistics projected a life expectancy of 81 years.11 IBGE. Censo 2010. Available from: http://www.ibge.gov.br. [Accessed 27.02.15].
http://www.ibge.gov.br...

Aging is an involuntary and inevitable process that causes progressive structural and functional loss in the body, such as deterioration of functional capacity, muscle mass and strength loss (mainly due to sarcopenia), loss of bone mass and of hormone production, and delays in reaction time, which are risk factors that lead to a loss of autonomy and increased risk of falling.33 Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc. 2008;56:2234-43.

4 Hong W, Cheng Q, Zhu X, Zhu H, Li H, Zhang X, et al. Prevalence of sarcopenia and its relationship with sites of fragility fractures in elderly Chinese men and women. PLOS ONE. 2015;14(10):9.

5 Cederholm T, Cruz-Jentoft AJ, Maggi S. Sarcopenia and fragility fractures. Eur J Phys Rehabil Med. 2013;49:111-7.
-66 Narici M, Maffulli N. Sarcopenia: characteristics, mechanisms and functional significance. Br Med Bull. 2010;95:139-59.

Live an independent and autonomous life, with the ability to carry out their basic tasks of daily life, is a key aspect for maintaining quality of life for the elderly.77 Ferreira OGL, Maciel SC, Costa SMG, Silva AO, Moreira MASP. Envelhecimento ativo e sua relação com a independência funcional. Texto Contexto Enfermag. 2012;21:513-8. However, a condition for allowing autonomy of the elderly is to maintain their physical fitness. Physical activity seems to be a strategy for maintaining autonomy, improving functional capacity, decreasing the risk of falls and, consequently, improving quality of life.66 Narici M, Maffulli N. Sarcopenia: characteristics, mechanisms and functional significance. Br Med Bull. 2010;95:139-59.,88 Cerullo F, Gambassi G, Cesari M. Rationale for antioxidant supplementation in sarcopenia. J Aging Res. 2012:1–8.

According to the United States Centers for Disease Control and Prevention (CDC), elderly individuals should perform muscular strength (twice a week or more, with involvement of most muscle groups) and aerobic activities (at least 150 min of moderate intensity activity or 75 min of vigorous intensity activity, or a combination of these per week) in order to reduce the risk of mortality from all causes, coronary heart disease, stroke, hypertension, and type 2 diabetes.99 U.S. Department of Health and Human Services (United States). 2008 physical activity guidelines for Americans. Washington, DC: U.S. Department of Health and Human Services; 2008. Available from: www.health.gov/paguidelines/guidelines/chapter5.aspx [accessed 10.06.15].
www.health.gov/paguidelines/guidelines/c...
Among the various possibilities of physical activity, the Pilates method has become a popular modality in recent years. Such a method has emerged as a popular way of improving the strength and overall conditioning for people of all ages and currently has been used as an adjuvant method in rehabilitation of injuries.1010 Stivala A, Hartley G. The effects of a pilates-based exercise rehabilitation program on functional outcome and fall risk reduction in an aging adult status-post traumatic hip fracture due to fall. J Geriatr Phys Ther. 2013, http://dx.doi.org/10.1097/JPT.0000000000000005 [Epub ahead of print].
http://dx.doi.org/10.1097/JPT.0000000000...
According to several authors, this method entails benefits such as increased bone mineral density, positive changes in body composition, and improvement in muscular strength and endurance, coordination, balance and flexibility.1111 Jago R, Jonker ML, Missaghian M, Baranowski T. Effect of 4 weeks of pilates on the body composition of young girls. Prev Med. 2006;42:177-80.

12 Sekendiz B, Altun O, Korkusuz F, Akın S. Effects of pilates exercise on trunk strength, endurance and flexibility in sedentary adult females. J Bodywork Mov Ther. 2007;11:318-26.
-1313 Smith K, Smith E. Integrating pilates-based core strengthening into older adults fitness programs: implications for practice. Top Geriatr Rehabil. 2005;21:57-67.

In view of the benefits described above and considering that the practice of this method is individualized, thereby reducing the risk of possible injury, Pilates has been quite indicated for the elderly. However, there are few studies published on systematic reviews, and particularly studies assessing the methodological quality of research in order to check the evidence for the decision-making process about the use of the method in physical activity programs aimed to the health of the elderly. In this sense, the aim of this study is to assess the effects of the Pilates method in the parameters of physical fitness and physiological and cognitive function in the elderly.

Methods

A systematic literature review was conducted in electronic databases, using the following inclusion criteria: original articles, Portuguese, English or Spanish language, and no restriction as to the year of publication. Review articles, case studies, theses and dissertations were considered as exclusion criteria.

The electronic search was conducted in the following databases: Pubmed, Scielo, Lilacs/Bireme, Scopus, Pedro and Isi of Knowledge. The descriptors used (Pilates, elderly, old adults, aging) were inserted into the Descriptors in Health Sciences (DeCS), in English and their equivalents in Portuguese language. The descriptors were used with the following combinations: "Pilates and elderly", "Pilates and old adults" and "Pilates and aging."

All articles found in the different databases were imported into EndNote, a reference managing software. After exclusion of duplicated articles, an analysis in the titles of the studies was carried out; those articles that did not address Pilates were excluded. Later, the abstracts of the articles were analyzed, and those that were not related to the review goals, for example, did not include subjects with the age group of interest for the study (individuals aged 60 or older) were excluded. The articles that remained after the analysis of the abstracts were read in their entirety, and in the absence of reasons for their exclusion were included in this review. All article selection and evaluation processes were performed independently by two reviewers.

Included studies were assessed for quality according to Downs and Black Checklist.1414 Downs S, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions. J Epidemiol Community Health. 1998;52:377-84. This assessment was also carried out by two independent evaluators and, in case of disagreement on the score awarded to items, a third evaluation was requested to another independent appraiser.

The assessment tool proposed by Downs and Black is composed of 27 questions divided into five sub-scales: evaluation of appropriate information (10 items), external validity (3 items), the internal validity of the detailed measurements and bias outcomes (7 items), confounding factors (6 items) and power (one item). The maximum score that can be achieved by the instrument is 32 points. Each item that makes up the checklist assigns scores ranging from 0 to 1, with the exception of that item that evaluates the description of confounding factors, which one can assign up to two points, and the item that assesses the description of the study power, which one can assign up to five points. The item 27 has been modified, in line with its use in other studies1515 Ratcliffe E, Pickering S, Mclean S, Lewis J. Is there a relationship between subacromial impingement syndrome and scapular orientation? A systematic review. Br J Sports Med. 2014;48:1251-6.,1616 Benjamin DR, Van Der Water ATM, Peiris CI. Effects of exercise on diastasis of rectus abdominis muscle in antenatal and postnatal periods: a systematic review. Physiotherapy. 2014;100:1-8. ; for this item, the score that originally ascribed 0–5 points was modified to ascribe between 0 and 1 point; thus, the score of 1 was awarded if the article showed a power calculation and/or sample size calculation, and 0 if not showed any of these calculations. After this modification, total scores ranging from 0 to 28 points were obtained with the checklist.

Results

After the search in various databases, 170 articles were identified. Of these articles, 83 were excluded because they were duplicates, and 53 were discarded because the title did not relate the article to the objectives of the present review. In addition, 13 articles were excluded after reading the abstracts. At the end of the selection process, 21 articles met the inclusion criteria and were included in the systematic review, as shown in the flow chart (Fig. 1).

Fig. 1
Flowchart of database search.

The 21 studies included in this study received their scores by assessing their quality using the Downs and Black Checklist, ranging from 10 to 19 points out of 28 possible points to be achieved (average 14.76 ± 2.12). Studies with the highest score were performed by Bird et al.1717 Bird ML, Hill KD, Fell JW. A randomized controlled study investigating static and dynamic balance in older adults after training with Pilates. Arch Phys Med Rehabil. 2012;93:43-9. and Mallery et al.1818 Mallery LH, MacDonald EA, Hubley-Kozey CL, Earl ME, Rockwood K, MacKnight C. The feasibility of performing resistance exercise with acutely ill hospitalized older adults. BMC Geriatr. 2003;3:1-18. with 19 points; and studies with lower scores were the those by Kaesler et al.,1919 Kaesler DS, Mellifont RB, Swete Kelly P, Taaffe DR. A novel balance exercise program for postural stability in older adults: a pilot study. J Bodywork Mov Ther. 2007;11:37-43. Newell et al.,2020 Newell D, Shead V, Sloane L. Changes in gait and balance parameters in elderly subjects attending an 8-week supervised pilates programme. J Bodywork Mov Ther. 2012;16:549-54. and Ruiz-Montero et al.,2121 Ruiz Montero PJ, Castillo-Rodriguez A, Mikalački M, Nebojsa C, Korovljev D. 24-Weeks pilates-aerobic and educative training to improve body fat mass in elderly serbian women. Clin Interv Aging. 2014;9:243-8. with 12 points each. The quality criteria with lower scores were: lack of an accurate description of confounding factors; not reporting the most important adverse events; not displaying information on the environment and care received by the sample; not informing whether the subjects included in the samples were counterparts to those of the general population; not reporting adjustments for confounding factors; not reporting whether there were losses to follow-up, and if this fact was taken into account; lack of a control group for proper comparison; and lack of sample randomization. Furthermore, none of these studies conducted sample size or power calculations.

As for countries where the studies were carried out, four studies in Brazil,2222 Siqueira Rodrigues BG, Ali Cader S, Bento Torres NV, Martin Dantas Eh. Pilates method in personal autonomy, static balance and quality of life of elderly females. J Bodywork Mov Ther. 2010;14:195-202.

23 Guimarães ACA, Azevedo SF, Simas JPN, Machado Z, Jonck VTF. The effect of pilates method on elderly flexibility. Fisioter Mov. 2014;27:181-8.

24 Rodrigues BGS, Cader SA, Torres NVOB, Oliveira EM, Dantas EHM. Functional autonomy of elderly women practicing pilates. Rev Fisioter Pesq. 2010;17:300-5.
-2525 Curi Perez VS, Haas AN, Wolff SS. Analysis of activities in the daily lives of older adults exposed to the pilates method. J Bodywork Mov Ther. 2014;18:326-31. four in Australia,1717 Bird ML, Hill KD, Fell JW. A randomized controlled study investigating static and dynamic balance in older adults after training with Pilates. Arch Phys Med Rehabil. 2012;93:43-9.,1919 Kaesler DS, Mellifont RB, Swete Kelly P, Taaffe DR. A novel balance exercise program for postural stability in older adults: a pilot study. J Bodywork Mov Ther. 2007;11:37-43.,2626 Bird ML, Fell J. Positive long-term effects of pilates exercise on the aged-related decline in balance and strength in older, community-dwelling men and women. J Aging Phys Act. 2014;22:342-7.,2727 Kuo YL, Tully EA, Galea MP. Sagittal spinal posture after pilates-based exercise in healthy older adults. Spine. 2009;34:1046-51. and four in South Africa,2828 Fourie M, Gildenhuys GM, Shaw I, Shaw BS, Toriola AL, Goon DT. Effects of a mat pilates programme on body composition in elderly women. West Indian Med J. 2013;62:524-8.

29 Fourie M, Gildenhuys GM, Shaw I, Shaw BS, Toriola AL, Goon DT. Effects of a mat pilates program on flexibility in elderly women. Med Sport (Roma). 2013;66:545-53.

30 Marinda F, Magda G, Ina S, Brandon S, Abel T, Goon DT. Effects of a mat pilates program on cardiometabolic parameters in elderly women. Pak J Med Sci. 2013;29:500-4.
-3131 Gildenhuys GM, Fourie M, Shaw I, Shaw B, Toriola A, Witthuhn J. Evaluation of pilates training on agility, functional mobility and cardiorespiratory fitness in elderly women. Afr J Phys Health Educ Recreat Dance. 2013;19:505-12. two in Turkey,3232 Irez GB. The effects of different exercises on balance, fear and risk of falling among adults aged 65 and over. Anthropologist. 2014;18:129-34.,3333 Irez GB, Ozdemir RA, Evin R, Irez SG, Korkusuz F. Integrating pilates exercise into an exercise program for 65 or more year-old women to reduce falls. J Sports Sci Med. 2011;10:105-11. and two in Hungary,3434 Plachy J, Kovách M, Bognár J. Improving flexibility and endurance of elderly women through a six-month training programme. Hum Mov Sci. 2012;13:22-7.,3535 Kovach MV, Plachy JK, Bognar J, Balogh ZO, Barthalos I. Effects of pilates and aqua fitness training on older adults' physical functioning and quality of life. Biomed Hum Kinet. 2013;5:22-7. and one in Canada,1818 Mallery LH, MacDonald EA, Hubley-Kozey CL, Earl ME, Rockwood K, MacKnight C. The feasibility of performing resistance exercise with acutely ill hospitalized older adults. BMC Geriatr. 2003;3:1-18. United Kingdom,2020 Newell D, Shead V, Sloane L. Changes in gait and balance parameters in elderly subjects attending an 8-week supervised pilates programme. J Bodywork Mov Ther. 2012;16:549-54. Serbia,2121 Ruiz Montero PJ, Castillo-Rodriguez A, Mikalački M, Nebojsa C, Korovljev D. 24-Weeks pilates-aerobic and educative training to improve body fat mass in elderly serbian women. Clin Interv Aging. 2014;9:243-8. South Korea,3636 Hyun J, Hwangbo K, Lee CW. The effects of pilates mat exercise on the balance ability of elderly females. J Phys Ther Sci. 2014;26:291-3. and United States3737 Pata RW, Lord K, Lamb J. The effect of pilates based exercise on mobility, postural stability, and balance in order to decrease fall risk in older adults. J Bodywork Mov Ther. 2014;18:361-7. were found.

Table 1 summarizes the main characteristics of the articles that make up our review study, as well as the scope, methodological procedures and main results. Among these articles, 16 experimental studies,1717 Bird ML, Hill KD, Fell JW. A randomized controlled study investigating static and dynamic balance in older adults after training with Pilates. Arch Phys Med Rehabil. 2012;93:43-9.,1818 Mallery LH, MacDonald EA, Hubley-Kozey CL, Earl ME, Rockwood K, MacKnight C. The feasibility of performing resistance exercise with acutely ill hospitalized older adults. BMC Geriatr. 2003;3:1-18.,2121 Ruiz Montero PJ, Castillo-Rodriguez A, Mikalački M, Nebojsa C, Korovljev D. 24-Weeks pilates-aerobic and educative training to improve body fat mass in elderly serbian women. Clin Interv Aging. 2014;9:243-8.

22 Siqueira Rodrigues BG, Ali Cader S, Bento Torres NV, Martin Dantas Eh. Pilates method in personal autonomy, static balance and quality of life of elderly females. J Bodywork Mov Ther. 2010;14:195-202.

23 Guimarães ACA, Azevedo SF, Simas JPN, Machado Z, Jonck VTF. The effect of pilates method on elderly flexibility. Fisioter Mov. 2014;27:181-8.
-2424 Rodrigues BGS, Cader SA, Torres NVOB, Oliveira EM, Dantas EHM. Functional autonomy of elderly women practicing pilates. Rev Fisioter Pesq. 2010;17:300-5.,2727 Kuo YL, Tully EA, Galea MP. Sagittal spinal posture after pilates-based exercise in healthy older adults. Spine. 2009;34:1046-51.

28 Fourie M, Gildenhuys GM, Shaw I, Shaw BS, Toriola AL, Goon DT. Effects of a mat pilates programme on body composition in elderly women. West Indian Med J. 2013;62:524-8.

29 Fourie M, Gildenhuys GM, Shaw I, Shaw BS, Toriola AL, Goon DT. Effects of a mat pilates program on flexibility in elderly women. Med Sport (Roma). 2013;66:545-53.

30 Marinda F, Magda G, Ina S, Brandon S, Abel T, Goon DT. Effects of a mat pilates program on cardiometabolic parameters in elderly women. Pak J Med Sci. 2013;29:500-4.

31 Gildenhuys GM, Fourie M, Shaw I, Shaw B, Toriola A, Witthuhn J. Evaluation of pilates training on agility, functional mobility and cardiorespiratory fitness in elderly women. Afr J Phys Health Educ Recreat Dance. 2013;19:505-12.

32 Irez GB. The effects of different exercises on balance, fear and risk of falling among adults aged 65 and over. Anthropologist. 2014;18:129-34.

33 Irez GB, Ozdemir RA, Evin R, Irez SG, Korkusuz F. Integrating pilates exercise into an exercise program for 65 or more year-old women to reduce falls. J Sports Sci Med. 2011;10:105-11.

34 Plachy J, Kovách M, Bognár J. Improving flexibility and endurance of elderly women through a six-month training programme. Hum Mov Sci. 2012;13:22-7.

35 Kovach MV, Plachy JK, Bognar J, Balogh ZO, Barthalos I. Effects of pilates and aqua fitness training on older adults' physical functioning and quality of life. Biomed Hum Kinet. 2013;5:22-7.
-3636 Hyun J, Hwangbo K, Lee CW. The effects of pilates mat exercise on the balance ability of elderly females. J Phys Ther Sci. 2014;26:291-3. four quasi-experimental studies,1919 Kaesler DS, Mellifont RB, Swete Kelly P, Taaffe DR. A novel balance exercise program for postural stability in older adults: a pilot study. J Bodywork Mov Ther. 2007;11:37-43.,2525 Curi Perez VS, Haas AN, Wolff SS. Analysis of activities in the daily lives of older adults exposed to the pilates method. J Bodywork Mov Ther. 2014;18:326-31.,2626 Bird ML, Fell J. Positive long-term effects of pilates exercise on the aged-related decline in balance and strength in older, community-dwelling men and women. J Aging Phys Act. 2014;22:342-7.,3737 Pata RW, Lord K, Lamb J. The effect of pilates based exercise on mobility, postural stability, and balance in order to decrease fall risk in older adults. J Bodywork Mov Ther. 2014;18:361-7. and one observational study2020 Newell D, Shead V, Sloane L. Changes in gait and balance parameters in elderly subjects attending an 8-week supervised pilates programme. J Bodywork Mov Ther. 2012;16:549-54. were found, and the year of publication ranged between 2003 and 2014. The sample size of the studies ranged from eight1919 Kaesler DS, Mellifont RB, Swete Kelly P, Taaffe DR. A novel balance exercise program for postural stability in older adults: a pilot study. J Bodywork Mov Ther. 2007;11:37-43. to 3112121 Ruiz Montero PJ, Castillo-Rodriguez A, Mikalački M, Nebojsa C, Korovljev D. 24-Weeks pilates-aerobic and educative training to improve body fat mass in elderly serbian women. Clin Interv Aging. 2014;9:243-8. elderly subjects. The reported minimum age was 60 years; in 12 studies the samples were composed of both genders,1717 Bird ML, Hill KD, Fell JW. A randomized controlled study investigating static and dynamic balance in older adults after training with Pilates. Arch Phys Med Rehabil. 2012;93:43-9.

18 Mallery LH, MacDonald EA, Hubley-Kozey CL, Earl ME, Rockwood K, MacKnight C. The feasibility of performing resistance exercise with acutely ill hospitalized older adults. BMC Geriatr. 2003;3:1-18.

19 Kaesler DS, Mellifont RB, Swete Kelly P, Taaffe DR. A novel balance exercise program for postural stability in older adults: a pilot study. J Bodywork Mov Ther. 2007;11:37-43.

20 Newell D, Shead V, Sloane L. Changes in gait and balance parameters in elderly subjects attending an 8-week supervised pilates programme. J Bodywork Mov Ther. 2012;16:549-54.
-2121 Ruiz Montero PJ, Castillo-Rodriguez A, Mikalački M, Nebojsa C, Korovljev D. 24-Weeks pilates-aerobic and educative training to improve body fat mass in elderly serbian women. Clin Interv Aging. 2014;9:243-8.,2323 Guimarães ACA, Azevedo SF, Simas JPN, Machado Z, Jonck VTF. The effect of pilates method on elderly flexibility. Fisioter Mov. 2014;27:181-8.,2626 Bird ML, Fell J. Positive long-term effects of pilates exercise on the aged-related decline in balance and strength in older, community-dwelling men and women. J Aging Phys Act. 2014;22:342-7.,2727 Kuo YL, Tully EA, Galea MP. Sagittal spinal posture after pilates-based exercise in healthy older adults. Spine. 2009;34:1046-51.,3232 Irez GB. The effects of different exercises on balance, fear and risk of falling among adults aged 65 and over. Anthropologist. 2014;18:129-34.,3535 Kovach MV, Plachy JK, Bognar J, Balogh ZO, Barthalos I. Effects of pilates and aqua fitness training on older adults' physical functioning and quality of life. Biomed Hum Kinet. 2013;5:22-7.

36 Hyun J, Hwangbo K, Lee CW. The effects of pilates mat exercise on the balance ability of elderly females. J Phys Ther Sci. 2014;26:291-3.
-3737 Pata RW, Lord K, Lamb J. The effect of pilates based exercise on mobility, postural stability, and balance in order to decrease fall risk in older adults. J Bodywork Mov Ther. 2014;18:361-7. and in nine studies only women were evaluated.2222 Siqueira Rodrigues BG, Ali Cader S, Bento Torres NV, Martin Dantas Eh. Pilates method in personal autonomy, static balance and quality of life of elderly females. J Bodywork Mov Ther. 2010;14:195-202.,2424 Rodrigues BGS, Cader SA, Torres NVOB, Oliveira EM, Dantas EHM. Functional autonomy of elderly women practicing pilates. Rev Fisioter Pesq. 2010;17:300-5.,2525 Curi Perez VS, Haas AN, Wolff SS. Analysis of activities in the daily lives of older adults exposed to the pilates method. J Bodywork Mov Ther. 2014;18:326-31.,2828 Fourie M, Gildenhuys GM, Shaw I, Shaw BS, Toriola AL, Goon DT. Effects of a mat pilates programme on body composition in elderly women. West Indian Med J. 2013;62:524-8.

29 Fourie M, Gildenhuys GM, Shaw I, Shaw BS, Toriola AL, Goon DT. Effects of a mat pilates program on flexibility in elderly women. Med Sport (Roma). 2013;66:545-53.

30 Marinda F, Magda G, Ina S, Brandon S, Abel T, Goon DT. Effects of a mat pilates program on cardiometabolic parameters in elderly women. Pak J Med Sci. 2013;29:500-4.
-3131 Gildenhuys GM, Fourie M, Shaw I, Shaw B, Toriola A, Witthuhn J. Evaluation of pilates training on agility, functional mobility and cardiorespiratory fitness in elderly women. Afr J Phys Health Educ Recreat Dance. 2013;19:505-12.,3333 Irez GB, Ozdemir RA, Evin R, Irez SG, Korkusuz F. Integrating pilates exercise into an exercise program for 65 or more year-old women to reduce falls. J Sports Sci Med. 2011;10:105-11.,3434 Plachy J, Kovách M, Bognár J. Improving flexibility and endurance of elderly women through a six-month training programme. Hum Mov Sci. 2012;13:22-7. The intervention period ranged from four weeks1818 Mallery LH, MacDonald EA, Hubley-Kozey CL, Earl ME, Rockwood K, MacKnight C. The feasibility of performing resistance exercise with acutely ill hospitalized older adults. BMC Geriatr. 2003;3:1-18. to 12 months,3232 Irez GB. The effects of different exercises on balance, fear and risk of falling among adults aged 65 and over. Anthropologist. 2014;18:129-34. with a predominance of interventions of eight1919 Kaesler DS, Mellifont RB, Swete Kelly P, Taaffe DR. A novel balance exercise program for postural stability in older adults: a pilot study. J Bodywork Mov Ther. 2007;11:37-43.,2020 Newell D, Shead V, Sloane L. Changes in gait and balance parameters in elderly subjects attending an 8-week supervised pilates programme. J Bodywork Mov Ther. 2012;16:549-54.,2222 Siqueira Rodrigues BG, Ali Cader S, Bento Torres NV, Martin Dantas Eh. Pilates method in personal autonomy, static balance and quality of life of elderly females. J Bodywork Mov Ther. 2010;14:195-202.,2828 Fourie M, Gildenhuys GM, Shaw I, Shaw BS, Toriola AL, Goon DT. Effects of a mat pilates programme on body composition in elderly women. West Indian Med J. 2013;62:524-8.

29 Fourie M, Gildenhuys GM, Shaw I, Shaw BS, Toriola AL, Goon DT. Effects of a mat pilates program on flexibility in elderly women. Med Sport (Roma). 2013;66:545-53.

30 Marinda F, Magda G, Ina S, Brandon S, Abel T, Goon DT. Effects of a mat pilates program on cardiometabolic parameters in elderly women. Pak J Med Sci. 2013;29:500-4.
-3131 Gildenhuys GM, Fourie M, Shaw I, Shaw B, Toriola A, Witthuhn J. Evaluation of pilates training on agility, functional mobility and cardiorespiratory fitness in elderly women. Afr J Phys Health Educ Recreat Dance. 2013;19:505-12.,3737 Pata RW, Lord K, Lamb J. The effect of pilates based exercise on mobility, postural stability, and balance in order to decrease fall risk in older adults. J Bodywork Mov Ther. 2014;18:361-7. (38%) and 12 weeks2626 Bird ML, Fell J. Positive long-term effects of pilates exercise on the aged-related decline in balance and strength in older, community-dwelling men and women. J Aging Phys Act. 2014;22:342-7.,2727 Kuo YL, Tully EA, Galea MP. Sagittal spinal posture after pilates-based exercise in healthy older adults. Spine. 2009;34:1046-51. (9.5%). In more than half of the studies (n = 11), there was no report of a gradual increase in exercise intensity, according to the evolution of the his/her practitioner.1717 Bird ML, Hill KD, Fell JW. A randomized controlled study investigating static and dynamic balance in older adults after training with Pilates. Arch Phys Med Rehabil. 2012;93:43-9.,2222 Siqueira Rodrigues BG, Ali Cader S, Bento Torres NV, Martin Dantas Eh. Pilates method in personal autonomy, static balance and quality of life of elderly females. J Bodywork Mov Ther. 2010;14:195-202.,2323 Guimarães ACA, Azevedo SF, Simas JPN, Machado Z, Jonck VTF. The effect of pilates method on elderly flexibility. Fisioter Mov. 2014;27:181-8.,2525 Curi Perez VS, Haas AN, Wolff SS. Analysis of activities in the daily lives of older adults exposed to the pilates method. J Bodywork Mov Ther. 2014;18:326-31.,2626 Bird ML, Fell J. Positive long-term effects of pilates exercise on the aged-related decline in balance and strength in older, community-dwelling men and women. J Aging Phys Act. 2014;22:342-7.,2828 Fourie M, Gildenhuys GM, Shaw I, Shaw BS, Toriola AL, Goon DT. Effects of a mat pilates programme on body composition in elderly women. West Indian Med J. 2013;62:524-8.,2929 Fourie M, Gildenhuys GM, Shaw I, Shaw BS, Toriola AL, Goon DT. Effects of a mat pilates program on flexibility in elderly women. Med Sport (Roma). 2013;66:545-53.,3131 Gildenhuys GM, Fourie M, Shaw I, Shaw B, Toriola A, Witthuhn J. Evaluation of pilates training on agility, functional mobility and cardiorespiratory fitness in elderly women. Afr J Phys Health Educ Recreat Dance. 2013;19:505-12.,3232 Irez GB. The effects of different exercises on balance, fear and risk of falling among adults aged 65 and over. Anthropologist. 2014;18:129-34.,3535 Kovach MV, Plachy JK, Bognar J, Balogh ZO, Barthalos I. Effects of pilates and aqua fitness training on older adults' physical functioning and quality of life. Biomed Hum Kinet. 2013;5:22-7.,3636 Hyun J, Hwangbo K, Lee CW. The effects of pilates mat exercise on the balance ability of elderly females. J Phys Ther Sci. 2014;26:291-3.

Table 1
Description of the characteristics and results of studies involving the Pilates method.

The main effects of the Pilates method reported for the age group studied were: increased balance,1919 Kaesler DS, Mellifont RB, Swete Kelly P, Taaffe DR. A novel balance exercise program for postural stability in older adults: a pilot study. J Bodywork Mov Ther. 2007;11:37-43.,2222 Siqueira Rodrigues BG, Ali Cader S, Bento Torres NV, Martin Dantas Eh. Pilates method in personal autonomy, static balance and quality of life of elderly females. J Bodywork Mov Ther. 2010;14:195-202.,2626 Bird ML, Fell J. Positive long-term effects of pilates exercise on the aged-related decline in balance and strength in older, community-dwelling men and women. J Aging Phys Act. 2014;22:342-7.,3232 Irez GB. The effects of different exercises on balance, fear and risk of falling among adults aged 65 and over. Anthropologist. 2014;18:129-34.,3333 Irez GB, Ozdemir RA, Evin R, Irez SG, Korkusuz F. Integrating pilates exercise into an exercise program for 65 or more year-old women to reduce falls. J Sports Sci Med. 2011;10:105-11.,3636 Hyun J, Hwangbo K, Lee CW. The effects of pilates mat exercise on the balance ability of elderly females. J Phys Ther Sci. 2014;26:291-3.,3737 Pata RW, Lord K, Lamb J. The effect of pilates based exercise on mobility, postural stability, and balance in order to decrease fall risk in older adults. J Bodywork Mov Ther. 2014;18:361-7. flexibility,2323 Guimarães ACA, Azevedo SF, Simas JPN, Machado Z, Jonck VTF. The effect of pilates method on elderly flexibility. Fisioter Mov. 2014;27:181-8.,2929 Fourie M, Gildenhuys GM, Shaw I, Shaw BS, Toriola AL, Goon DT. Effects of a mat pilates program on flexibility in elderly women. Med Sport (Roma). 2013;66:545-53.,3232 Irez GB. The effects of different exercises on balance, fear and risk of falling among adults aged 65 and over. Anthropologist. 2014;18:129-34.,3434 Plachy J, Kovách M, Bognár J. Improving flexibility and endurance of elderly women through a six-month training programme. Hum Mov Sci. 2012;13:22-7. and strength,99 U.S. Department of Health and Human Services (United States). 2008 physical activity guidelines for Americans. Washington, DC: U.S. Department of Health and Human Services; 2008. Available from: www.health.gov/paguidelines/guidelines/chapter5.aspx [accessed 10.06.15].
www.health.gov/paguidelines/guidelines/c...
,3232 Irez GB. The effects of different exercises on balance, fear and risk of falling among adults aged 65 and over. Anthropologist. 2014;18:129-34. positive modifications in body composition,2121 Ruiz Montero PJ, Castillo-Rodriguez A, Mikalački M, Nebojsa C, Korovljev D. 24-Weeks pilates-aerobic and educative training to improve body fat mass in elderly serbian women. Clin Interv Aging. 2014;9:243-8.,2828 Fourie M, Gildenhuys GM, Shaw I, Shaw BS, Toriola AL, Goon DT. Effects of a mat pilates programme on body composition in elderly women. West Indian Med J. 2013;62:524-8.,3232 Irez GB. The effects of different exercises on balance, fear and risk of falling among adults aged 65 and over. Anthropologist. 2014;18:129-34. and also improved functional autonomy2222 Siqueira Rodrigues BG, Ali Cader S, Bento Torres NV, Martin Dantas Eh. Pilates method in personal autonomy, static balance and quality of life of elderly females. J Bodywork Mov Ther. 2010;14:195-202.,2424 Rodrigues BGS, Cader SA, Torres NVOB, Oliveira EM, Dantas EHM. Functional autonomy of elderly women practicing pilates. Rev Fisioter Pesq. 2010;17:300-5.,2525 Curi Perez VS, Haas AN, Wolff SS. Analysis of activities in the daily lives of older adults exposed to the pilates method. J Bodywork Mov Ther. 2014;18:326-31. and less risk of falls2020 Newell D, Shead V, Sloane L. Changes in gait and balance parameters in elderly subjects attending an 8-week supervised pilates programme. J Bodywork Mov Ther. 2012;16:549-54.,3232 Irez GB. The effects of different exercises on balance, fear and risk of falling among adults aged 65 and over. Anthropologist. 2014;18:129-34.,3737 Pata RW, Lord K, Lamb J. The effect of pilates based exercise on mobility, postural stability, and balance in order to decrease fall risk in older adults. J Bodywork Mov Ther. 2014;18:361-7. in the elderly.

Discussion

In terms of methodology, according to the Downs and Black checklist, the assessed articles showed low scores, and more than half of them awarded a score ≤14, from a total of 28 points. The important and primary criteria for scientific soundness of studies have been missed, or at least have not been presented, in most of these studies. Among the missing quality indicators, stand out the objective description of confounding factors; the reporting of adverse events important to the study; the description of information on the environment and care received by the study sample; the indication of the representativeness of the samples; the adjustment for confounding factors; the reporting of losses and if this fact was taken into account; a control group and randomization of the sample. All these factors challenge the findings of some studies, which should be treated with extreme caution.

It was found that the studies were composed predominantly of female subjects or of both genders, with no study with a sample composed only of men. The greatest demand and adherence by females to Pilates may help explain this finding. On the other hand, with respect to the place of origin of the study, Brazil2222 Siqueira Rodrigues BG, Ali Cader S, Bento Torres NV, Martin Dantas Eh. Pilates method in personal autonomy, static balance and quality of life of elderly females. J Bodywork Mov Ther. 2010;14:195-202.,2424 Rodrigues BGS, Cader SA, Torres NVOB, Oliveira EM, Dantas EHM. Functional autonomy of elderly women practicing pilates. Rev Fisioter Pesq. 2010;17:300-5. and Australia1717 Bird ML, Hill KD, Fell JW. A randomized controlled study investigating static and dynamic balance in older adults after training with Pilates. Arch Phys Med Rehabil. 2012;93:43-9.,2626 Bird ML, Fell J. Positive long-term effects of pilates exercise on the aged-related decline in balance and strength in older, community-dwelling men and women. J Aging Phys Act. 2014;22:342-7. stand out, probably due to the demand for this method in these countries.3838 Sacco ICN, Andrade MS, Souza OS, Nisiyama M, Cantuária AL, Maeda FYI, et al. Método pilates em revista: aspectos biomecânicos de movimentos específicos para reestruturação postural – estudos de caso. Rev Bras Ciênc Mov. 2005;13:65-78.

Several studies which made up this review suggest that the practice of Pilates had a positive effect on increasing and preventing the reduction of flexibility levels in the elderly.2323 Guimarães ACA, Azevedo SF, Simas JPN, Machado Z, Jonck VTF. The effect of pilates method on elderly flexibility. Fisioter Mov. 2014;27:181-8.,2929 Fourie M, Gildenhuys GM, Shaw I, Shaw BS, Toriola AL, Goon DT. Effects of a mat pilates program on flexibility in elderly women. Med Sport (Roma). 2013;66:545-53.,3333 Irez GB, Ozdemir RA, Evin R, Irez SG, Korkusuz F. Integrating pilates exercise into an exercise program for 65 or more year-old women to reduce falls. J Sports Sci Med. 2011;10:105-11.,3434 Plachy J, Kovách M, Bognár J. Improving flexibility and endurance of elderly women through a six-month training programme. Hum Mov Sci. 2012;13:22-7. Despite the positive results of reports, the studies reviewed did not report on the control of confounding factors, and on blinding of those who applied the intervention and its potential adverse effects, as well as sample size calculation.

Other studies have shown, as the effects of the Pilates method, improvement of static and dynamic balance.1919 Kaesler DS, Mellifont RB, Swete Kelly P, Taaffe DR. A novel balance exercise program for postural stability in older adults: a pilot study. J Bodywork Mov Ther. 2007;11:37-43.,2222 Siqueira Rodrigues BG, Ali Cader S, Bento Torres NV, Martin Dantas Eh. Pilates method in personal autonomy, static balance and quality of life of elderly females. J Bodywork Mov Ther. 2010;14:195-202.,3333 Irez GB, Ozdemir RA, Evin R, Irez SG, Korkusuz F. Integrating pilates exercise into an exercise program for 65 or more year-old women to reduce falls. J Sports Sci Med. 2011;10:105-11.,3636 Hyun J, Hwangbo K, Lee CW. The effects of pilates mat exercise on the balance ability of elderly females. J Phys Ther Sci. 2014;26:291-3.,3737 Pata RW, Lord K, Lamb J. The effect of pilates based exercise on mobility, postural stability, and balance in order to decrease fall risk in older adults. J Bodywork Mov Ther. 2014;18:361-7. The main methodological problems in these studies refer to the lack of control for confounding factors, identification of potential adverse effects of the intervention, blinding of those who applied and who received the intervention, representativeness of samples, and sample size calculation.

With regard to advances in personal autonomy, the studies reviewed have reported that Pilates exercise caused significant evolution in the functional performance of healthy elderly women in activities like wearing a shirt, getting up from sitting and lying position2222 Siqueira Rodrigues BG, Ali Cader S, Bento Torres NV, Martin Dantas Eh. Pilates method in personal autonomy, static balance and quality of life of elderly females. J Bodywork Mov Ther. 2010;14:195-202.,2424 Rodrigues BGS, Cader SA, Torres NVOB, Oliveira EM, Dantas EHM. Functional autonomy of elderly women practicing pilates. Rev Fisioter Pesq. 2010;17:300-5. and gait.2020 Newell D, Shead V, Sloane L. Changes in gait and balance parameters in elderly subjects attending an 8-week supervised pilates programme. J Bodywork Mov Ther. 2012;16:549-54. However, these studies have their findings weakened as a result of the lack of an objective description of confounding factors, characteristics of the subjects of the samples that have been lost, blinding to the intervention, and sample size calculation.

As for body composition, Fourie et al.2828 Fourie M, Gildenhuys GM, Shaw I, Shaw BS, Toriola AL, Goon DT. Effects of a mat pilates programme on body composition in elderly women. West Indian Med J. 2013;62:524-8. report that the method was effective in stabilizing and even reversal of bodily implications of the aging phenomenon, as in lean mass loss and, also, in normalization and reduction of body fat, controlling or reversing morbidities associated with obesity (p. ex., hypertension and glucose intolerance). In relation to this study, several important factors to be considered in the assessment of the quality of the article could not be determined, because the lack of description of such factors in our survey (sample representativeness, blinding process, adherence to the intervention, randomization, control for confounding factors, and report of losses to follow-up).

Perez et al.3232 Irez GB. The effects of different exercises on balance, fear and risk of falling among adults aged 65 and over. Anthropologist. 2014;18:129-34. obtained positive results with the practice for muscle strength gains that, along with the increase or stabilization of loss of balance and of flexibility, lead to a decrease in the number of falls among the elderly. However, important aspects of quality are not clear in their study, including the distribution of main confounders in each group of subjects that were compared, possible adverse effects of the intervention, and sample size calculation.

Also in relation to outcomes related to body composition, Ruiz-Montero et al.2121 Ruiz Montero PJ, Castillo-Rodriguez A, Mikalački M, Nebojsa C, Korovljev D. 24-Weeks pilates-aerobic and educative training to improve body fat mass in elderly serbian women. Clin Interv Aging. 2014;9:243-8. reported that the combination of Pilates with aerobic exercise resulted in positive changes, such as reducing skin folds and preventing lean body mass loss. Despite these apparently promising results, this study2121 Ruiz Montero PJ, Castillo-Rodriguez A, Mikalački M, Nebojsa C, Korovljev D. 24-Weeks pilates-aerobic and educative training to improve body fat mass in elderly serbian women. Clin Interv Aging. 2014;9:243-8. showed the lowest score on the scale of assessment of methodological quality (12 points) among all evaluated studies. This fact undermines the credibility of the conclusions of their research.

Regarding postural changes, the study by Kuo et al.2727 Kuo YL, Tully EA, Galea MP. Sagittal spinal posture after pilates-based exercise in healthy older adults. Spine. 2009;34:1046-51. informs, as a their main result, that the reduction of kyphosis in the standing position was detected in the sagittal plane, immediately after the Pilates program. This study did not describe the distributions of principal confounders in each group of subjects, nor blinded these subjects for the intervention, did not perform randomization, and showed no sample size calculation.

Only the study by Marinda et al.3030 Marinda F, Magda G, Ina S, Brandon S, Abel T, Goon DT. Effects of a mat pilates program on cardiometabolic parameters in elderly women. Pak J Med Sci. 2013;29:500-4. related the Pilates method with cardiac and metabolic variables; this study showed that eight weeks of Pilates produced no improvement in cardiometabolic variables tested, except for a decrease of systolic blood pressure. The authors did not describe the characteristics of the sample and the study dropouts, distributions of main confounders in each group, potential adverse effects of the intervention, the blinding of individuals, and whether the sample size calculation was made.

A study related positive changes in parameters such as functionality, stability, mobility, dynamic and static balance, muscle strength, and flexibility, among others, with improved self-confidence, and a decrease in fear of falling and in the number of falls in the elderly.3737 Pata RW, Lord K, Lamb J. The effect of pilates based exercise on mobility, postural stability, and balance in order to decrease fall risk in older adults. J Bodywork Mov Ther. 2014;18:361-7. Despite being one of the studies with the highest score in the methodological assessment carried out, there was no information on significant adverse effects of the intervention; and blinding of subjects to intervention, sample randomization and sample size calculation were not presented.

In conclusion, although the studies are pointing to physical and motor benefits with the use of Pilates in the elderly, we cannot state whether or not the method is effective, in view of the low methodological quality of the studies included in this review.

Therefore, it is suggested that new studies, especially randomized clinical trials, are conducted with larger samples, longer intervention periods, and involving individuals of both genders. It would also be critical a more detailed methodological control, considering that the scores obtained in evaluating the quality of the studies included in this systematic review were low, especially when it came to the inclusion of a control group, adjusting for confounder factors, information on important adverse events, sample size and power calculation, and reporting on loss of follow-up. We also point out the need of studies that compare the Pilates method with other types of exercise, as well as studies confronting the exercises of the method performed on the ground versus practices using accessories and/or devices.

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Publication Dates

  • Publication in this collection
    Jul-Aug 2016

History

  • Received
    21 June 2015
  • Accepted
    18 Nov 2015
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