Group Pilates Superior to At-home Exercise for Patients in Study

Patients in Pilates group showed significant gains in BASDAI, BASMI, quality of life

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by Lindsey Shapiro |

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An eight-week Pilates group training program for people with ankylosing spondylitis (AS) lowered disease activity, improved spine flexibility, and led to gains in endurance, balance, and quality of life, a recent study showed.

Several of these benefits were not seen among those who did an individual at-home exercise program, instead.

The study, “The effects of clinical pilates training on disease-specific indices, core stability, and balance in patients with ankylosing spondylitis,” was published in the Journal of Bodywork and Movement Therapies.

Regular exercise is recommended as part of a comprehensive treatment program for AS, but there is little evidence to support which type of exercise program might be most beneficial.

Pilates is a mind-body exercise method that focuses on six core principles: concentration, control, centering, flowing movement, precision, and breathing. It largely focuses on the body’s “core,” those muscles in the center of the body.

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Few studies have examined Pilates as an exercise strategy for AS patients. The studies that did found the program could ease pain, improve mobility, and reduce disease activity, but none have examined factors like balance or endurance.

The eight-week clinical study (NCT04292028) was conducted by researchers at the Dokuz Eylül University, Turkey with the goal of evaluating if clinical Pilates training might improve stability, balance, and other disease-specific measures in AS patients.

A total of 60 AS patients, ages 20 to 60, were recruited between June 2017 and June 2018. Participants had no regular exercise habits in the six months before the study.

The patients were randomly assigned to Pilates or to an at-home exercise program (control group) performed three times a week for eight weeks. All continued using their prescribed medications, but were asked to abstain from other types of physical exercise during the trial.

For the 30 people assigned to Pilates, the exercise training was conducted by a certified physiotherapist in groups of 10. Before training, a single session was conducted to teach patients about key training elements. The hour-long training session included a range of exercises with an emphasis on core activation, breath control, and spine alignment. Exercise difficulty was gradually increased over the eight weeks.

The home-based exercise group were asked to follow a program that included spinal range of motion, strengthening, stretching, and posture exercises for at least 30 minutes a session. Nine people from each group withdrew, with 21 from each intervention completing the entire study.

The primary goal was to assess the effects of the training program on disease activity, functional status, spinal mobility, and quality of life, which were assessed using disease-specific questionnaires administered by the physical therapist.

Results showed patients in the Pilates group demonstrated statistically significant improvements on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), a measure of disease activity, and the Bath Ankylosing Spondylitis Metrology Index (BASMI), a measure of spinal mobility, after the training program compared with before it.

These gains were superior to those in the control group, which did not see meaningful improvements on either scale.

Reductions in disease activity, “may be associated with reduced pain and stiffness resulting from increased activation of muscles supporting the spine,” the researchers wrote.

The Pilates group also saw significant improvements in measures of functional status and quality of life after training, whereas the control group did not.

Secondary goals included measures of core endurance and balance. Pilates patients again saw significant gains, with improvements in all measures of core endurance being superior to the control group.

At the study’s start, five people in the Pilates group were unable to perform the situp test, which measures dynamic core endurance. All five completed it after training, which the researchers attributed to “increased flexibility and core strength.” For six people in the control group who couldn’t perform the test, two were able to after at-home training.

Both groups saw gains in aspects of balance, with no significant differences seen between the two groups in final analyses.

The findings suggest “Pilates should be recommended in addition to medical treatment for the management of AS,” the researchers wrote. “Expanding the options of evidence-based exercise programs will help AS patients choose an exercise program based on their needs and increase their compliance.”