Clinical Pilates Research Articles

Clinical Pilates Research 

The following Research Article Links confirm the usefulness of Clinical Pilates in a Rehabilitative Setting;
  • Abstract

    BACKGROUND: There are very few randomized controlled studies on exercise in cancer patients. Consequently, there are no guidelines available with regard to the exercises that can be recommended and difficulties are encountered in the clinical practice as to which exercise is more suitable to the patients.

    AIM: The purpose of this study was to investigate the impact of pilates exercises on physical performance, flexibility, fatigue, depression and quality of life in women who had been treated for breast cancer.

    DESIGN: Randomized controlled trial.

    SETTING: Out patient group, Department of Physical Medicine and Rehabilitation and Medical Oncology Department, University Hospital.

    POPULATION: Fifty-two patients with breast cancer were divided into either pilates exercise (group 1) and control group (group 2).

    METHODS: Patients in Group 1 performed pilates and home exercises and patients in group 2 performed only home exercises. Pilates exercise sessions were performed three times a week for a period of eight weeks in the rehabilitation unit.

    MAIN OUTCOME MEASURES: Subjects were assessed before and after rehabilitation program, with respect to, 6-min walk test (6MWT), modified sit and reach test, Brief Fatigue Inventory (BFI), Beck Depression Index (BDI) and the European Organisation for Research and Treatment of Cancer Quality of Life C30 (EORTC QLQ-C30) and EORTC QLQ BR23.

    RESULTS: After the exercise program, improvements were observed in Group 1 in 6-minute walk test, BDI, EORTC QLQ-C30 functional, and EORTC QLQ-C30 BR23 functional scores (P<0.05). In contrast, no significant improvement was observed in Group 2 after the exercise program in any of parameters in comparison to the pre-exercise period (P>0.05). When the two exercise groups were compared, there were significant differences in 6MWT in pilates-exercise group (P<0.05).

    CONCLUSION: Pilates exercises are effective and safe in female breast cancer patients. There is a need for further studies so that its effect can be confirmed. CLINICAL REHABILITATION IMPACT: This study addressed the effects of pilates exercise, as a new approach, on functional capacity, fatigue, depression and quality of life in breast cancer patients in whom there are doubts regarding the efficacy and usefulness of the exercise.

    J Orthop Sports Phys Ther. 2012 May;42(5):425-36. Epub  2012 Jan 25.

    Derivation of a preliminary clinical prediction rule for identifying a subgroup of patients with low back pain likely to benefit from Pilates-based exercise.

    Stolze LR, Allison SC, Childs JD.

    Source: Graduate Program in Orthopedics, Rocky Mountain University of Health Professions, Provo, UT, USA.


    STUDY DESIGN: Prospective cohort study.

    OBJECTIVE: To derive a preliminary clinical prediction rule for identifying a subgroup of patients with low back pain (LBP) likely to benefit from Pilates-based exercise.

    BACKGROUND: Pilates-based exercise has been shown to be effective for patients with LBP. However, no previous work has characterized patient attributes for those most likely to have a successful outcome from treatment.

    METHODS: Ninety-six individuals with nonspecific LBP participated in the study. Treatment response was categorized based on changes in the Oswestry Disability Questionnaire scores after 8 weeks. An improvement of 50% or greater was categorized as achieving a successful outcome. Thirty-seven variables measured at baseline were analyzed with univariate and multivariate methods to derive a clinical prediction rule for successful outcome with Pilates exercise. Accuracy statistics, receiver-operator curves, and regression analyses were used to determine the association between standardized examination variables and treatment response status.

    RESULTS: Ninety-five of 96 participants completed the study, with 51 (53.7%) achieving a successful outcome. A preliminary clinical prediction rule with 5 variables was identified: total trunk flexion range of motion of 70° or less, duration of current symptoms of 6 months or less, no leg symptoms in the last week, body mass index of 25 kg/m2 or greater, and left or right hip average rotation range of motion of 25° or greater. If 3 or more of the 5 attributes were present (positive likelihood ratio, 10.64), the probability of experiencing a successful outcome increased from 54% to 93%.

    CONCLUSION: These data provide preliminary evidence to suggest that the response to Pilates-based exercise in patients with LBP can be predicted from variables collected from the clinical examination. If subsequently validated in a randomized clinical trial, this prediction rule may be useful to improve clinical decision making in determining which patients are most likely to benefit from Pilates-based exercise.

    Rheumatol Int. 2012 Jul;32(7):2093-9. Epub  2011 Apr 17.

    Effect of Pilates training on people with ankylosing spondylitis.

    Altan L, Korkmaz N, Dizdar M, Yurtkuran M.


    Department of Physical Medicine and Rehabilitation, University of Uludag, Bursa, Turkey.


    The objective of this study was to investigate the effects of Pilates on pain, functional status, and quality of life in patients with ankylosing spondylitis. The study was performed as a randomized, prospective, controlled, and single-blind trial. Fifty-five participants (30 men, 25 women) who were under a regular follow-up protocol in our Rheumatology Clinic with the diagnosis of AS according to the modified New York criteria were included in the study. The participants were randomly assigned into two groups: in group I, Pilates exercise program of 1 h was given by a certified trainer to 30 participants 3 times a week for 12 weeks, and in group II, designed as the control group, 25 participants continued previous standard treatment programs. In groups, pre-(week 0) and post treatment (week 12 and week 24) evaluation was performed by one of the authors who was blind to the group allocation. Primary outcome measure was functional capacity. Evaluation was done using the Bath Ankylosing Spondylitis Functional Index (BASFI). Exploratory outcome measures were Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Chest expansion, and ankylosing spondylitis quality of life (ASQOL) questionnaire. In group I, BASFI showed significant improvement at week 12 (P = 0.031) and week 24 (P = 0.007). In group II, this parameter was not found to have significantly changed at week 12 and week 24. Comparison of the groups showed significantly superior results for group I at week 24 (P = 0.023). We suggest Pilates exercises as an effective and safe method to improve physical capacity in AS patients. Our study is the first clinical study designed to investigate the role of Pilates method in AS treatment. We believe that further research with more participants and longer follow-up periods could help assess the therapeutic value of this popular physical exercise method in AS.

    Arch Phys Med Rehabil. 2009 Dec;90(12):1983-8.

    Effect of pilates training on people with fibromyalgia syndrome: a pilot study.

    Altan L, Korkmaz N, Bingol U, Gunay B.


    Department of Physical Medicine and Rehabilitation, University of Uludag, Bursa, Turkey.


    Altan L, Korkmaz N, Bingol U, Gunay B. Effect of Pilates training on people with fibromyalgia syndrome: a pilot study.

    OBJECTIVE: To investigate the effects of Pilates on pain, functional status, and quality of life in fibromyalgia, which is known to be a chronic musculoskeletal disorder.

    DESIGN: Randomized, prospective, controlled, and single-blind trial.

    SETTING: Physical medicine and rehabilitation department.

    PARTICIPANTS: Women (N=50) who had a diagnosis of fibromyalgia syndrome (FMS) according to the American College of Rheumatology criteria.

    INTERVENTION: The participants were randomly assigned into 2 groups. In group 1, a Pilates exercise program of 1 hour was given by a certified trainer to 25 participants 3 times a week for 12 weeks. In group 2, which was designed as the control group, 25 participants were given a home exercise (relaxation/stretching) program. In both groups, pre- (week 0) and posttreatment (week 12 and week 24) evaluation was performed by one of the authors, who was blind to the group allocation.

    MAIN OUTCOME MEASURES: Primary outcome measures were pain (visual analog scale) and Fibromyalgia Impact Questionnaire (FIQ). Exploratory outcome measures were number of tender points, algometric score, chair test, and Nottingham Health Profile.

    RESULTS: Twenty-five Pilates exercise and 24 relaxation/stretching exercise participants completed the study. In group 1, significant improvement was observed in both pain and FIQ at week 12 but only in FIQ at 24 weeks. In group 2, no significant improvement was obtained in pain and FIQ at week 12 and week 24. Comparison of the 2 groups showed significantly superior improvement in pain and FIQ in group 1 at week 12 but no difference between the 2 groups at week 24.

    CONCLUSIONS: We suggest Pilates as an effective and safe method for people with FMS. Our study is the first clinical study designed to investigate the role of the Pilates method in FMS treatment. We believe that further research with more participants and longer follow-up periods could help assess the therapeutic value of this popular physical exercise method.

    J Vestib Res. 2008;18(2-3):139-46

    Aquatic physiotherapy for vestibular rehabilitation in patients with unilateral vestibular hypofunction: exploratory prospective study.

    Gabilan YP, Perracini MR, Munhoz MS, Gananç FF.

    Neurotology Division, Department of Otorhynolaryngology, Head and Neck, Federal University of São Paulo, São Paulo, Brazil.


    PURPOSE: To explore the effects of aquatic physiotherapy on individuals with unilateral vestibular hypofunction and examine the association of therapeutic effects with age, time since symptom onset and use of antivertigo medication.

    STUDY DESIGN: Exploratory study.

    SETTING: Tertiary referral center.

    PATIENTS: Twenty-one patients presenting chronic dizziness with uncompensated unilateral vestibular loss.

    INTERVENTION: All patients underwent a regimen of 10 sessions of aquatic physiotherapy for vestibular rehabilitation.

    MAIN OUTCOME MEASURES: Patient evaluation prior to and following rehabilitation involved the application of the Brazilian version of the Dizziness Handicap Inventory (DHI), dynamic computerized posturography and the self-perception scale of dizziness intensity. Statistical analysis compared average variables prior to and following rehabilitation using the Student t test.

    RESULTS: Brazilian DHI total scores were lower following rehabilitation (p = 0.001). Posturography revealed a reduction in the variation of body displacement following rehabilitation in the average stability and anterior/posterior stability indexes (p = 0.001) and in the average medial/lateral stability index (p = 0.003). Self-perception of dizziness intensity was lower following rehabilitation (p = 0.001). No association between age, time since symptom onset and use of antivertigo medication and rehabilitation therapeutic effects were found.

    CONCLUSION: Unilateral vestibular hypofunction patients undergoing aquatic physiotherapy for vestibular rehabilitation achieved an improvement in quality of life, body balance and self-perception of dizziness intensity, regardless of age, time since symptom onset, and use of antivertigo medication.

    J Strength Cond Res. 2013 Mar 28.

    Systematic review of core muscle activity during physical fitness exercises.

    Martuscello JM, Nuzzo JL, Ashley CD, Campbell BI, Orriola JJ, Mayer JM.

    1 School of Physical Education & Exercise Science, College of Education, University of South Florida, Tampa, FL, US 2 School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, US 3 Shimberg Health Sciences Library, Morsani College of Medicine, University of South Florida, Tampa, FL, US.

    A consensus has not been reached among strength and conditioning specialists regarding what physical fitness exercises are most effective to stimulate activity of the core muscles. Thus, the purpose of this paper was to systematically review the literature on the electromyographic (EMG) activity of three core muscles (lumbar multifidus, transverse abdominis, quadratus lumborum) during physical fitness exercises in healthy adults. CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, PubMed, SPORTdiscus, and Web of Science databases were searched for relevant articles using a search strategy designed by the investigators. Seventeen studies enrolling 252 participants met the review’s inclusion/exclusion criteria. Physical fitness exercises were partitioned into five major types: traditional core, core stability, ball/device, free weight, and non-core free weight. Strength of evidence was assessed and summarized for comparisons among exercise types. The major findings of this review with moderate levels of evidence indicate that lumbar multifidus EMG activity is greater during free weight exercises compared with ball/device exercises, and similar during core stability and ball/device exercises. Transverse abdominis EMG activity is similar during core stability and ball/device exercises. No studies were uncovered for quadratus lumborum EMG activity during physical fitness exercises. The available evidence suggests that strength and conditioning specialists should focus on implementing multi-joint free weight exercises, rather than core-specific exercises, in order to adequately train the core muscles in their athletes and clients.

    PMID: 23542879

    Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial.

    Rydeard R, Leger A, Smith D

    School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada.

    The Journal of Orthopaedic and Sports Physical Therapy [2006, 36(7):472-484]

    STUDY DESIGN: A randomized controlled trial, prestest-posttest design, with a 3-, 6-, and 12-month follow-up.

    OBJECTIVES: To investigate the efficacy of a therapeutic exercise approach in a population with chronic low back pain (LBP).

    BACKGROUND: Therapeutic approaches developed from the Pilates method are becoming increasingly popular; however, there have been no reports on their efficacy.

    METHODS AND MEASURES: Thirty-nine physically active subjects between 20 and 55 years old with chronic LBP were randomly assigned to 1 of 2 groups. The specific-exercise-training group participated in a 4-week program consisting of training on specialized (Pilates) exercise equipment, while the control group received the usual care, defined as consultation with a physician and other specialists and healthcare professionals, as necessary. Treatment sessions were designed to train the activation of specific muscles thought to stabilize the lumbar-pelvic region. Functional disability outcomes were measured with The Roland Morris Disability Questionnaire (RMQ/RMDQ-HK) and average pain intensity using a 101-point numerical rating scale.

    RESULTS: There was a significantly lower level of functional disability (P =.023) and average pain intensity (P =.002) in the specific-exercise-training group than in the control group following the treatment intervention period. The posttest adjusted mean in functional disability level in the specific-exercise-training group was 2.0 (95% CI, 1.3 to 2.7) RMQ/RMDQ-HK points compared to a posttest adjusted mean in the control group of 3.2 (95% CI, 2.5 to 4.0) RMQ/RMDQ-HK points. The posttest adjusted mean in pain intensity in the specific-exercise-training group was 18.3 (95% CI, 11.8 to 24.8), as compared to 33.9 (95% CI, 26.9 to 41.0) in the control group. Improved disability scores in the specific-exercise-training group were maintained for up to 12 months following treatment intervention.

    CONCLUSIONS: The individuals in the specific-exercise-training group reported a significant decrease in LBP and disability, which was maintained over a 12-month follow-up period. Treatment with a modified Pilates-based approach was more efficacious than usual care in a population with chronic, unresolved LBP.

    Phys Ther. 2008 Jan;88(1):12-21. Epub 2007 Nov 6.

    Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial.

    Source: Rheumatology Rehabilitation Section, Division of Rheumatology, Federal University of São Paulo, São Paulo, Brazil. Silva LE, Valim V, Pessanha AP, Oliveira LM, Myamoto S, Jones A, Natour J.


    This study was designed to evaluate the effectiveness of hydrotherapy in subjects with osteoarthritis (OA) of the knee compared with subjects with OA of the knee who performed land-based exercises.

    Sixty-four subjects with OA of the knee were randomly assigned to 1 of 2 groups that performed exercises for 18 weeks: a water-based exercise group and a land-based exercise group. The outcome measures included a visual analog scale (VAS) for pain in the previous week, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), pain during gait assessed by a VAS at rest and immediately following a 50-foot (15.24-m) walk test (50FWT), walking time measured at fast and comfortable paces during the 50FWT, and the Lequesne Index. Measurements were recorded by a blinded investigator at baseline and at 9 and 18 weeks after initiating the intervention.

    The 2 groups were homogenous regarding all parameters at baseline. Reductions in pain and improvements in WOMAC and Lequesne index scores were similar between groups. Pain before and after the 50FWT decreased significantly over time in both groups. However, the water-based exercise group experienced a significantly greater decrease in pain than the land-based exercise group before and after the 50FWT at the week-18 follow-up.

    Both water-based and land-based exercises reduced knee pain and increased knee function in participants with OA of the knee. Hydrotherapy was superior to land-based exercise in relieving pain before and after walking during the last follow-up. Water-based exercises are a suitable and effective alternative for the management of OA of the knee.

    PMID: 17986497 [PubMed – indexed for MEDLINE] Free full text

    The effectiveness of a 6-week Pilates programme on outcome measures in a population of chronic neck pain patients: A pilot study.

    Source: School of Public Health, Physiotherapy and population science, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland. Electronic address: G, Murphy S. J Bodyw Mov Ther. 2013 Jul;17(3):376-84. doi: 10.1016/j.jbmt.2013.03.003. Epub 2013 Apr 24.


    Neck pain is becoming increasingly more common and multiple interventions have been advocated in its management. The literature supports the use of a variety of exercises including specific low load endurance exercises, scapular muscle retraining and neck and upper limb strengthening. Pilates is one form of exercise that is developing in popularity. This pilot uncontrolled study investigates whether a 6-week matwork based Pilates programme can change outcome measures in a group of chronic neck pain patients. Thirteen subjects were assessed on self-report tests; neck disability index (NDI), patient specific functional scale (PSFS), numerical rating pain scale (NRPS) and one objective measure; the abdominal drawing in test (ADIT). A statistically significant improvement was obtained in the disability outcomes (NDI and PSFS) at both 6 and 12 weeks. The NRPS also demonstrated statistical improvement at 12 weeks but not at 6. The minimal clinically important difference (MCID) is the score that reflects a change that is meaningful for the patient and this was achieved at 12-weeks for the NDI (>5 points), PSFS (>3 points) and NRPS (>2 points). Only 2 subjects reached normal levels in the ADIT at 12-weeks.

    The results of this pilot study suggest that Pilates has a role to play in reducing pain and disability in neck pain patients.

    Effects of Pilates exercises on pain, functional status and quality of life in women with postmenopausal osteoporosis.

    Source: Uludağ University Medical Faculty, Physical Medicine and Rehabilitation, Turkey. Küçükçakır N, Altan L, Korkmaz N. J Bodyw Mov Ther. 2013 Apr;17(2):204-11. doi: 10.1016/j.jbmt.2012.07.003. Epub 2012 Aug 9.


    OBJECTIVE: The present study aimed to evaluate the effects of Pilates exercise program on pain, functional status and quality of life in women with postmenopausal osteoporosis.

    DESIGN: The study was performed as a randomized, prospective, controlled and single-blind trial. PARTICIPATIONS: Seventy women (age range, 45-65 years) with the diagnosis of postmenopausal osteoporosis were included.

    METHODS AND INTERVENTIONS: Patients were randomly allocated into two groups (home and Pilates exercise groups). Patients in the Pilates exercise group underwent a supervised Pilates exercise program twice a week for one year. Patients in the home exercise group were asked to perform a home exercise program consisting of thoracic extension exercises. Patients were evaluated at baseline and after one year of participation in the exercise programs.

    MAIN OUTCOME MEASUREMENTS: Visual Analog Scale for pain, six-minute walking and sit-to-stand tests for functional status, and the Qualeffo-41 Questionnaire and the Short Form-36 (SF-36) for quality of life. Patients were also asked to report the number of falls during the intervention.

    RESULTS: At the end of the study, the results of 60 patients were analyzed. A significant improvement was noted in all evaluation parameters at the end of the exercise program in the Pilates exercise group. Except for Qualeffo- Leisure Time Activities, SF-36 physical role limitation and emotional role limitation subscales, a significant improvement was noted in all other evaluation parameters at the end of the exercise program in the home exercise group. Improvement was significantly greater in the Pilates exercise group compared to the home exercise group in all parameters.

    CONCLUSION: Pilates exercises may be a safe and an effective treatment alternative for the quality of life in patients with postmenopausal osteoporosis.

    Functional Movement Scores and Longitudinal Performance Outcomes in Elite Track and Field Athletes.

    Source: Human Performance Laboratory, Dept of Kinesiology, Indiana University, Bloomington, IN., Chapman RF, Laymon AS, Arnold T., Int J Sports Physiol Perform.


    Subjects with scores on the Functional Movement Screen (FMS) assessment of <14 or with at least one bilateral asymmetry have been shown to have greater future injury incidence than subjects with FMS scores >14 or no movement asymmetries.

    PURPOSE: To determine if FMS injury risk factors extend to longitudinal competitive performance outcomes in elite track and field athletes.

    METHODS: 121 elite track and field athletes were examined, each completing an FMS prior to the 2011 competitive season. Best competition marks for the year were obtained from athletes’ actual performances for 2010 and 2011. Performance change between 2010 and 2011 was examined in cohorts of: a) FMS scores <14 (LoFMS) vs. >14 (HiFMS), b) athletes with bilateral asymmetry in at least one of the five FMS movements vs. athletes with no asymmetry, and c) athletes who scored 1 on the deep squat movement vs. athletes who scored 2 or 3.

    RESULTS: HiFMS had a significantly different change in performance from 2010 to 2011 (+0.41±2.50%, n=80) compared to LoFMS (-0.51±2.30%, p=0.03, n=41). Athletes with no asymmetries had a longitudinal improvement in performance (+0.60+2.86%, n=50) compared to athletes with at least one asymmetry (-0.26±2.10%, p=0.03, n=71). Athletes who scored 1 on the deep squat movement had a significantly different change in performance (-1.07±2.08%, n=22) vs. athletes who scored 2 (+0.13±2.28%, p=0.03, n=87) or 3 (+1.98±3.31%, p=0.001, n=12).

    CONCLUSION: Functional movement ability, known to be associated with the likelihood of future injury, is also related to the ability to improve longitudinal competitive performance outcomes.

    Benefits of Aquatic Therapy After Hip or Knee Replacement

    This is the first study reported to look at the benefit of aquatic therapy in the early days after joint replacement. Physical therapists in Australia randomly placed patients getting a hip or knee replacement into one of three different treatment groups. The goal was to find out what kind of treatment is best in the early days after orthopedic surgery. With the recent effort to reduce the length of hospital stays, physical therapists are exploring the most effective ways to treat orthopedic patients. The standard rehab program after hip or knee joint replacement includes a mix of exercises to improve circulation and to prevent blood clots and other complications. Other goals include improving motion, strength, and function (especially walking).

    In today’s evidence-based medicine, the question has been raised: what is best practice during the acute postoperative phase for hip and knee replacements? What is the role (if any) of aquatic therapy? Can the hydrostatic forces and warm and gravity-free environment make a difference? Are there additional benefits of aquatic therapy that cannot be obtained through the standard rehab protocol? The authors of this study asked and answered all of those questions.

    Aquatic (pool) therapy is defined as physical therapy that is performed in the water. There are good reasons to consider using aquatic therapy after joint replacement. Aquatic therapy uses the resistance of water instead of weights. With the reduced load provided by the buoyancy of the water, certain exercises (e.g., squats, step ups, walking without a cane or walker) can be started sooner in water than on land. Circulation is also improved leading to faster tissue healing and reduced swelling.

    Everyone in the study either had a hip or knee replacement. They each received the standard postoperative hospital care by a physical therapist for the first three days after the operation. After that, the patients were randomly assigned to one of three groups. Group one continued with the standard care. This included circulation and deep breathing exercises, transfer practice, gait (walking) training, and practice going up and down stairs. Stretching and strengthening exercises were also done daily. Group two received a nonspecific water therapy session each day they were in the hospital. Group three had one standard physical therapy treatment each day and attended aquatic therapy everyday while in the hospital. The aquatic physical therapy was performed at a slow (50 to 58 beats per minute) and fast pace (80 to 88 beats per minute) using a metronome to tick out the speed. The idea of using speed as a tool to enhance movement in water is part of the aquatic therapy. The program included exercises to improve range-of-motion, muscle strengthen, trunk stability, and reciprocal motion (arms and legs swinging rhythmically and repetitively while walking).

    Measures used to compare the results of different treatment approaches included strength of the hip abductor muscles, walking speed, and patient self-reported function (disability). Patients in all three groups were tested at the end of 14 days for short-term effects and again at the end of six months. Retesting at the six month time period allowed them to see if the short-term improvements held up over time. Three tests commonly used by physical therapists to measure results included a handheld dynamometer for muscle testing, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the timed 10-meter walking test. The WOMAC is a survey patients fill out answering questions about pain, function, and stiffness. Muscles tested using the dynamometer included the hamstrings, quadriceps, and gluteus medius.

    In order to be considered clinically significant, patients in one group had to have more than a 15 per cent change from before to after treatment. The only reported difference among groups in this study was hip abductor muscle strength. Patients in the specific aquatic therapy program had the greatest improvement in strength. Hip abductor strength is important for trunk and hip stability and normal a gait (walking) pattern. When all other variables were compared among the groups, the aquatic group had the best short-term improvements, but they didn’t reach the 15 per cent difference. This means they were important measures but not always considered statistically significant. At the end of six months, there was no difference in outcomes from one group to the next. There were overall trends that seemed to support the idea that aquatic therapy was slightly more beneficial than either land-based or nonspecific water-based exercises.

    The authors conclude that for physical therapists who have access to an appropriate pool at their hospital, an aquatic program for total hip and knee is safe and effective. Improved postoperative hip strength has been shown in other studies to be a key factor in functional recovery after hip or knee replacement. Improved early functional recovery is more likely with a specific aquatic program (even over just water exercises). There’s more to this success than just warm, buoyant water. Further studies are needed to find out why this is so and which exercises (type and amount) are best during the early recovery phase.

    Reference: Ann E. Rahmann, BPhty, et al. A Specific Inpatient Aquatic Physiotherapy Program Improves Strength After Total Hip or Knee Replacement Surgery: A Randomized Controlled Trial. In Archives of Physical Medicine and Rehabilitation. May 2009. Vol. 90. No. 5. Pp. 745-755.

    Effects of Pilates Training on Lumbo-Pelvic Stability and Flexibility

    Source: Asian J Sports Med. 2011 March; 2(1): 16–22. Author:Sureeporn Phrompaet, MSc, Aatit Paungmali, MPhty, PhD, Ubon Pirunsan, MPhty, PhD, and Patraporn Sitilertpisan, MSc, PhDAbstract

    Purpose: This study was performed to assess and compare the effects of Pilates exercise on flexibility and lumbo-pelvic movement control between the Pilates training and control groups.

    Methods: A randomized single-blinded controlled design was utilized in the study. Forty healthy male and female volunteers (mean age 31.65±6.21 years) were randomly divided into Pilates-based training (20 subjects) and the control groups (20 subjects). The Pilates group attended 45-minute training sessions, 2 times per week, for a period of 8 weeks. Flexibility and lumbo-pelvic stability tests were determined as outcome measures using a standard “sit and reach test” and “pressure biofeedback” respectively at 0, 4 and 8 weeks of the study.

    Results: The results showed that the Pilates training group improved flexibility significantly (P<0.001) during time intervals. This effect was also significantly greater than the control group for both 4 weeks and 8 weeks of the training period (P<0.001). There were 65% and 85% of the subjects from Pilates group passing the lumbo-pelvic stability test at 4 and 8 weeks of training periods respectively. No subjects from the control group passed the test at any stages.

    Conclusions: Pilates can be used as an adjunctive exercise program to improve flexibility, enhance control-mobility of trunk and pelvic segments. It may also prevent and attenuate the predisposition to axial musculoskeletal injury.

    Keywords: Pilates Training, Pilates-Based Exercises, Flexibility, Lumbo-pelvic stability, Exercise

    The effects of pilates on balance, mobility and strength in patients with multiple sclerosis.

    Authors: Guclu-Gunduz A, Citaker S, Irkec C, Nazliel B, Batur-Caglayan HZ. Source: NeuroRehabilitation. 2013 [Epub ahead of print]

    BACKGROUND: Although there are evidences as to Pilates developing dynamic balance, muscle strength and flexibility in healthy people, evidences related to its effects on Multiple Sclerosis patients are insufficient. Objectives: The aims of this study were to investigate the effects of Pilates on balance, mobility, and strength in ambulatory patients with Multiple Sclerosis.

    METHODS: Twenty six patients were divided into two groups as experimental (n = 18) and control (n = 8) groups for an 8-week treatment program. The experimental group underwent Pilates and the control group did abdominal breathing and active extremity exercises at home. Balance and mobility were measured with Berg Balance Scale and Timed up and go test, upper and lower muscle strength with hand-held dynamometer. Confidence in balance skills while performing daily activities was evaluated with Activities Specific Balance Confidence Scale.

    RESULTS: Improvements were observed in balance, mobility, and upper and lower extremity muscle strength in the Pilates group (p < 0.05). No significant differences in any outcome measures were observed in the control group (p > 0.05).

    DISCUSSION AND SUMMARY/CONCLUSION: Due to its structure which is made up of balance and strengthening exercises, Pilates training may develop balance, mobility and muscle strength of MS patients. For this reason, we think that, Pilates exercises which are appropriate for the disability level of the patient may be suggested.

    Pilates and the Pelvic Floor For pelvic floor rehab, Pilates puts the power back where it belongs – the patient

    By Bruce Crawford, MD

    Joseph Pilates, founder of the Pilates method, teaches us that every movement begins with the core. This fundamental idea needs to be repeated again and again through a broad network of community fitness professionals to achieve a change in our understanding of what causes incontinence, and how it should be treated.

    A Fitness Issue

    Bladder control is a fitness issue. This is rather happy news for patients with incontinence, because fitness problems generally have fitness solutions. While telling someone they have a medical problem usurps their power, telling them they have a fitness issue empowers them. If you have a medical problem, you rely on your healthcare provider to tell you if you will get better, how to get better, and how long it will take. But a fitness solution puts the power back where it belongs: in the hands of the patient. This idea represents a significant shift in the current culture of understanding about urinary incontinence, fecal incontinence, sexual dysfunction and pelvic organ prolapse. In most instances these pelvic floor disorders share a common cause of pelvic floor dysfunction. There is little debate anymore that therapeutic exercise is the best first-line treatment for stress, urge and mixed urinary incontinence. According to the Cochrane Review, Dumoulin and Hay-Smith’s 2010 review, “Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women, provides support for the widespread recommendation that PFMT [pelvic floor muscle training] be included in first-line conservative management programs for women with stress, urge, or mixed urinary incontinence.” Stress urinary incontinence and overactive bladder affect millions of Americans. Overactive bladder alone has an impact on quality of life second only to major depression. Most practitioners will recommend women experiencing urinary incontinence perform a program of home pelvic floor exercises often referred to as Kegel exercises. The data is clear that there is therapeutic benefit to these exercises and the recommendation is a good one; but perhaps our understanding of the pelvic floor and how to exercise it has been limited.

    The Pelvic Floor

    The pelvic floor is like any other somatic neuromuscular system, and to function properly it requires conditioning. If we accept that the skeletal muscle of the pelvic floor and the somatic nerves that supply that muscle respond to exercise in a way similar to other muscles in the body, we might rethink how we recommend our patients pursue pelvic floor fitness. We cannot overstate the value of Arnold Kegel’s contribution to women’s health. Kegel was an American gynecologist who in 1948 first published his idea that voluntary contraction of the pelvic floor muscles provided useful nonsurgical treatment for what he called “genital relaxation.” This idea remains the mainstay conservative recommendation for most PTs and MDs treating patients with pelvic floor disorders. The importance of Kegel’s contribution should not, however, keep us from re-examining the issue and asking the question: How can we do better? For the last 70 years we have encouraged patients to isolate the pelvic floor, and biofeedback has focused on teaching patients how to engage the pelvic floor independent of the abdominal, gluteal and inner thigh muscles. But does this really make sense? I would argue it does not. The pelvic floor can be seen as an element of a larger neuromuscular system that includes the abdominals, gluteals, lower extremity adductors and external hip rotators. The pelvic floor naturally responds, with these muscles, to movement in a way that allows us to maintain posture and stability. It is a basic principle of conditioning to engage a muscle in a way that challenges its natural purpose. It would be absurd to attempt to rehabilitate the quadriceps by having the patient sit in a chair and contract his quadriceps over and over again. Rather, we would recommend the patient perform a series of movements that engage the quadriceps naturally. If we accept that the pelvic floor is like any other neuromuscular system and that it naturally responds to certain types of movement, then it seems implicit that we might better condition the pelvic floor using movement rather than the traditional isometric Kegel exercise.

    Pilates Pelvic Floor Victoria BCPilates Movements

    This was my starting point in 2008 when, frustrated with the prevalence of pelvic floor dysfunction among my patients at The Center for Pelvic Floor Medicine in Reno, Nev., I began to study the effects of movement on the pelvic floor using video synchronized multichannel EMG. What we discovered has completely changed the way we approach pelvic floor rehabilitation. We studied 120 mat Pilates, personal training, and yoga movements, looking for movements that provide a degree of passive engagement of the pelvic floor. These movements were analyzed in 6 multiparous women without prior Pilates experience. We identified ten movements that provided significant passive pelvic floor engagement and that were suitable for the general public. While seven of the movements were inspired by the Pilates method, none are performed in the classic Pilates style. The movements selected include: lunges, squats, side-lying bent knee lifts, side-lying straight leg circles, butterfly, bridging, corkscrew, hovering, all fours bent knee lift, and “cat into cow.” Each movement is performed as a series of repetitions followed by a sustained hold at the point of peak passive pelvic floor engagement, followed by a pulse. During the pulse phase of each movement, a maximal voluntary pelvic floor contraction is added to the already partially engaged pelvic floor. Each movement uses two or more “co-recruiter” muscles to achieve greater pelvic floor engagement and greater sensor feedback from the pelvic floor.

    Lack of Research

    Surprisingly, there is very little in the literature about the use of Pilates movements for the conditioning of the pelvic floor. In 2010 Culligan et al. reported on a randomized trial of 12 weeks of pelvic floor muscle training in comparison to a Pilates exercise program. Published in the International Urogynecology Journal, the study found that both groups demonstrated greater pelvic floor strength with no significant difference between the groups. Given that no one really disputes the benefit of pelvic floor exercise, perhaps the most important questions we can ask address compliance. I believe it’s likely that our patients will be more compliant with a program of pelvic floor conditioning that involves movement and that can be incorporated into a regular fitness routine.

    Moving On

    Use of video-EMG synchronization has provided an additional opportunity that brings us back to the premise that Joseph Pilates taught us 50 years ago: Every movement begins with the powerhouse (core). Once our patients achieve improved pelvic floor performance over the course of a 4-6 week period, we reintroduce each of the 10 movements as a template for a functional movement. For instance, it’s possible to learn to use the squat to change the way one moves from a standing to a seated position. If this can be habituated, we have automatically introduced 50-70 reps of improved pelvic floor contractions daily. I believe that once patients learn to move differently – from the core – they may no longer require a separate program for pelvic floor fitness. Given the impact of pelvic floor dysfunction on the lives of the individual, as well as our society and economy as a whole, we need to rethink how we approach these problems. Perhaps most important is to reconsider how we approach prevention. Providing access to these ideas at the level of the community fitness professional is an excellent step in the right direction. Those with a keen interest in doing their part can help change the culture of understanding about the role of exercise in overcoming the burden of pelvic floor dysfunction in their communities.

    Bruce Crawford is director of the Center for Pelvic Floor Medicine in Reno, Nev. He is a board certified gynecologist, pelvic floor specialist, and the creator of the Pfilates Method of pelvic floor rehabilitation (, a plyometric pelvic floor fitness training program. Crawford is also creator of the VESy System of pelvic floor rehabilitation (

    Does regular exercise including pelvic floor muscle training prevent urinary and anal incontinence during pregnancy? A randomised controlled trial.

    BJOG. 2012 Sep;119(10):1270-80. doi: 10.1111/j.1471-0528.2012.03426.x. Epub 2012 Jul 17.Stafne SN, Salvesen KÅ, Romundstad PR, Torjusen IH, Mørkved S.


    OBJECTIVE: To assess whether pregnant women following a general exercise course, including pelvic floor muscle training (PFMT), were less likely to report urinary and anal incontinence in late pregnancy than a group of women receiving standard care.

    DESIGN: A two-armed, two-centred randomised controlled trial.

    SETTING: Trondheim University Hospital (St. Olavs Hospital) and Stavanger University Hospital, in Norway.

    POPULATION: A total of 855 women were included in this trial.

    METHODS: The intervention was a 12-week exercise programme, including PFMT, conducted between 20 and 36 weeks of gestation. One weekly group session was led by physiotherapists, and home exercises were encouraged at least twice a week. Controls received regular antenatal care.

    MAIN OUTCOME MEASURES: Self-reported urinary and anal incontinence after the intervention period (at 32-36 weeks of gestation)

    RESULTS: Fewer women in the intervention group reported any weekly urinary incontinence (11 versus 19%, P = 0.004). Fewer women in the intervention group reported faecal incontinence (3 versus 5%), but this difference was not statistically significant (P = 0.18).

    CONCLUSIONS: The present trial indicates that pregnant women should exercise, and in particular do PFMT, to prevent and treat urinary incontinence in late pregnancy. Thorough instruction is important, and specific pelvic floor muscle exercises should be included in exercise classes for pregnant women. The preventive effect of PFMT on anal incontinence should be explored in future trials.

    The effects of pilates mat exercise on the balance ability of elderly females.

    Author information: Hyun J1, Hwangbo K2, Lee CW1.   J Phys Ther Sci. 2014 Feb;26(2):291-3. doi: 10.1589/jpts.26.291. Epub 2014 Feb 28., Department of Rehabilitation Science, Graduate School, Daegu University, Republic of Korea., Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea.
    Purpose: The purpose of this study was to examine the effects of Pilates exercise on a mat and balance exercise on an unstable base of support for trunk stability on the balance ability of elderly females.
    Subjects and Methods: Forty elderly women aged 65 or older were equally assigned to a Pilates mat exercise (PME) group and an unstable support surface exercise (USSE) group. They conducted exercise three times per week for 12 weeks for 40 minutes each time. In order to examine balance, sway length and the speed of the center of foot pressure were measured for one minute, and in order to examine dynamic balance, the Timed Up and Go (TUG) test was conducted. [Results] After the intervention, sway length, sway speed, and TUG significantly decreased in both groups. A comparison of sway speed after the intervention between the two groups revealed that the PME group showed larger decreases than the USSE group.
    Conclusion: PME and USSE elicited significant effects on the static and dynamic balance of elderly female subjects, suggesting that those exercises are effective at enhancing the balance ability of this group of subjects. However, the Pilates mat exercise is regarded as being safer than exercise on an unstable base of support.
    KEYWORDS: Elderly females; Pilates mat exercise; Unstable support surface exercise. Free PMC Article