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NIHR Signal Mat Pilates probably improves balance and strength in older adults

Published on 7 March 2018

doi: 10.3310/signal-000564

Mat Pilates appears to improve muscle strength, flexibility, balance and cardiovascular fitness in older people compared to no exercise. There are limitations to the reliability of the evidence, but the consistent effect across all the aspects of fitness suggests this is probably a useful option for the increasing number of older people who wish to maintain their fitness.

This review pooled the results of nine trials of 415 older adults from around the world, though not the UK. Pilates sessions were attended at least twice weekly for four to 24 weeks.

Guidelines recommend 150 minutes of moderate activity per week for older adults and two sessions of strength training. If at risk of falls, balance exercises such as yoga are recommended. This review indicates that Pilates would be a viable alternative that would improve both balance and strength.

When taught by a qualified instructor and tailored to individual ability, Pilates is safe in this age group.

Share your views on the research.

Why was this study needed?

In the UK, 11.8 million people are aged 65 or older, with numbers increasing each year. Maintaining physical fitness in this age group is of paramount importance for the prevention of falls and cardiovascular disease but also to ensure mental wellbeing.

Mat Pilates is a form of exercise which only requires a mat or minimal equipment, such as rubber bands and Swiss balls. It aims to strengthen the core muscles. It also focuses on increased flexibility and balance. Pilates has been gaining popularity, and the 2005 UK national standard for Pilates ensures teachers are sufficiently skilled. Pilates teachers must have at least Level 3 to be on the UK Register of Exercise Professionals.

Though in theory, Pilates should be beneficial for older adults, there has been limited objective evidence.

What did this study do?

This systematic review included nine randomised controlled trials comparing mat Pilates with no exercise. Studies included 415 adults aged over 60 years with no recorded health concerns. Pilates sessions ranged from 50 to 60 minutes, two to four times per week, for four to 24 weeks. Studies were from Brazil, Israel, Turkey and South Africa.

Studies used different scales to measure each element of fitness. Therefore, results were converted into a standardised mean difference (SMD). They defined a difference of 0.2 as a small effect, 0.2 to 0.8 a moderate effect, and over 0.8 a large effect.

Five studies were assessed as high quality and four low quality. However, most study personnel were aware which group participants were in, either at time of allocation or assessment, which could have biased results in favour of Pilates.

What did it find?

Mat Pilates gave a large improvement in all the following elements compared to no exercise:

  • Dynamic balance (SMD 1.10, 95% confidence interval [CI] 0.29 to 1.90; three trials, 156 participants).
  • Lower limb muscle strength (SMD 1.13, 95% CI 0.30 to 1.96; five trials, 217 participants).
  • Lower body flexibility (SMD 1.22, 95% CI 0.39 to 2.04; three trials, 147 participants).
  • Cardiorespiratory fitness (SMD 1.48, 95% CI 0.42 to 2.54; three trials, 127 participants).

What does current guidance say on this issue?

Department of Health 2011 guidelines recommends adults aged 65 or more to be active daily, adding up to at least 150 minutes of moderate activity per week. They also recommend strength training on at least two days a week. If at risk of falls, balance training should be incorporated such as tai chi or yoga. There is no guidance on Pilates for older people.

NICE 2008 guidelines on mental wellbeing in the over 65s recommends tailored physical activity programmes, delivered by physiotherapists, fitness instructors and the voluntary sector. This includes strength, resistance, toning and stretching exercises, dancing, walking and swimming.

What are the implications?

It does not seem so surprising that Pilates should be better than no exercise for strength, balance and flexibility. The evidence has quality limitations but this is a difficult area to research without bias, and the apparent beneficial effect is substantial and consistent across outcomes. 

Exercise referral schemes are only funded for inactive people who have existing health conditions or are at increased risk of ill health. However, mat Pilates is often available outside this service from trained instructors at gyms, for example.

Pilates can be tailored to individual capabilities, making it an acceptable option for older adults. Once techniques have been learnt, it may be possible to practice at home.

Citation and Funding

de Souza ROB, de Faria Marcon, de Arruda ASF, et al. Effects of Mat Pilates on Physical Functional Performance of Older Adults: a Meta-analysis of Randomized Controlled Trials. Am J Phys Med Rehabil. 2017. [Epub ahead of print].

No funding information was provided for this study.

Bibliography

DoH. Physical activity guidelines for older adults (65+ years): Factsheet 5. London: Department of Health; 2011.

NICE. Mental wellbeing in over 65s: occupational therapy and physical activity interventions. PH16. London: National Institute for Health and Care Excellence; 2013.

NICE. Physical activity: exercise referral schemes. PH54. London: National Institute for Health and Care Excellence; 2014.

NICE. Physical activity: brief advice for adults in primary care. PH44. London: National Institute for Health and Care Excellence; 2013.

ONS. Overview of the UK population: July 2017. London: Office for National Statistics; 2017.

Why was this study needed?

In the UK, 11.8 million people are aged 65 or older, with numbers increasing each year. Maintaining physical fitness in this age group is of paramount importance for the prevention of falls and cardiovascular disease but also to ensure mental wellbeing.

Mat Pilates is a form of exercise which only requires a mat or minimal equipment, such as rubber bands and Swiss balls. It aims to strengthen the core muscles. It also focuses on increased flexibility and balance. Pilates has been gaining popularity, and the 2005 UK national standard for Pilates ensures teachers are sufficiently skilled. Pilates teachers must have at least Level 3 to be on the UK Register of Exercise Professionals.

Though in theory, Pilates should be beneficial for older adults, there has been limited objective evidence.

What did this study do?

This systematic review included nine randomised controlled trials comparing mat Pilates with no exercise. Studies included 415 adults aged over 60 years with no recorded health concerns. Pilates sessions ranged from 50 to 60 minutes, two to four times per week, for four to 24 weeks. Studies were from Brazil, Israel, Turkey and South Africa.

Studies used different scales to measure each element of fitness. Therefore, results were converted into a standardised mean difference (SMD). They defined a difference of 0.2 as a small effect, 0.2 to 0.8 a moderate effect, and over 0.8 a large effect.

Five studies were assessed as high quality and four low quality. However, most study personnel were aware which group participants were in, either at time of allocation or assessment, which could have biased results in favour of Pilates.

What did it find?

Mat Pilates gave a large improvement in all the following elements compared to no exercise:

  • Dynamic balance (SMD 1.10, 95% confidence interval [CI] 0.29 to 1.90; three trials, 156 participants).
  • Lower limb muscle strength (SMD 1.13, 95% CI 0.30 to 1.96; five trials, 217 participants).
  • Lower body flexibility (SMD 1.22, 95% CI 0.39 to 2.04; three trials, 147 participants).
  • Cardiorespiratory fitness (SMD 1.48, 95% CI 0.42 to 2.54; three trials, 127 participants).

What does current guidance say on this issue?

Department of Health 2011 guidelines recommends adults aged 65 or more to be active daily, adding up to at least 150 minutes of moderate activity per week. They also recommend strength training on at least two days a week. If at risk of falls, balance training should be incorporated such as tai chi or yoga. There is no guidance on Pilates for older people.

NICE 2008 guidelines on mental wellbeing in the over 65s recommends tailored physical activity programmes, delivered by physiotherapists, fitness instructors and the voluntary sector. This includes strength, resistance, toning and stretching exercises, dancing, walking and swimming.

What are the implications?

It does not seem so surprising that Pilates should be better than no exercise for strength, balance and flexibility. The evidence has quality limitations but this is a difficult area to research without bias, and the apparent beneficial effect is substantial and consistent across outcomes. 

Exercise referral schemes are only funded for inactive people who have existing health conditions or are at increased risk of ill health. However, mat Pilates is often available outside this service from trained instructors at gyms, for example.

Pilates can be tailored to individual capabilities, making it an acceptable option for older adults. Once techniques have been learnt, it may be possible to practice at home.

Citation and Funding

de Souza ROB, de Faria Marcon, de Arruda ASF, et al. Effects of Mat Pilates on Physical Functional Performance of Older Adults: a Meta-analysis of Randomized Controlled Trials. Am J Phys Med Rehabil. 2017. [Epub ahead of print].

No funding information was provided for this study.

Bibliography

DoH. Physical activity guidelines for older adults (65+ years): Factsheet 5. London: Department of Health; 2011.

NICE. Mental wellbeing in over 65s: occupational therapy and physical activity interventions. PH16. London: National Institute for Health and Care Excellence; 2013.

NICE. Physical activity: exercise referral schemes. PH54. London: National Institute for Health and Care Excellence; 2014.

NICE. Physical activity: brief advice for adults in primary care. PH44. London: National Institute for Health and Care Excellence; 2013.

ONS. Overview of the UK population: July 2017. London: Office for National Statistics; 2017.

"Effects of Mat Pilates on Physical Functional Performance of Older Adults: a Meta-analysis of Randomized Controlled Trials."

Published on 29 December 2017

de Souza, R. O. B.,de Faria Marcon, L.,de Arruda, A. S. F.,Pontes Junior, F. L.,de Melo, R. C.

Am J Phys Med Rehabil , 2017

OBJECTIVE: The present meta-analysis aimed to examine evidence from randomized controlled trials in order to determine the effects of mat Pilates on measures of physical functional performance in the elderly. DESIGN: A search was conducted in the MEDLINE/PubMed, Scopus, Scielo and PEDro databases between February and March 2017. Only RCTs that were written in English; included subjects 60 years-old; utilized mat Pilates exercises; included a comparison (control) group; and reported performance-based measures of physical function (balance, flexibility, muscle strength and cardiorespiratory fitness) were included. The methodological quality of the studies was analyzed according to the PEDro scale and the best-evidence synthesis. The meta-analysis was conducted with the Review Manager 5.3 software. RESULTS: The search retrieved 518 articles, nine of which fulfilled the inclusion criteria. High methodological quality was found in five of these studies. Meta-analysis indicated a large effect of mat Pilates on dynamic balance (SMD=1.10, 95%CI=0.29-1.90), muscle strength (SMD=1.13, 95%CI=0.30-1.96), flexibility (SMD=1.22, 95%CI=0.39-2.04) and cardiorespiratory fitness (SMD=1.48, 95%CI=0.42-2.54) of elderly subjects. CONCLUSION: There is evidence that mat Pilates improves dynamic balance, lower limb strength, hip and lower back flexibility and cardiovascular endurance in elderly individuals. Further high-quality studies are necessary to clarify the effects of mat Pilates on other physical functional measurements among older adults.

Expert commentary

As we get older exercise is important to help keep us active and independent. But some people worry that taking up a new exercise could cause an injury. Pilates is a type of exercise that can be done with an instructor as part of a class or can be done in the comfort of your own home. It can help us stay supple and steadier on our feet so we can get on with ageing well.

Dr Vicki Goodwin, Senior Research Fellow, NIHR CLAHRC South West Peninsula, University of Exeter