Box 1.

Pilates Modifications Used in This Study

Minimizes the number of position changes, as these can be stressful to hypermobile joints. Avoids breathing patterns that trigger excess tension in the core, but instead cues patients in how to integrate proper breathing with alignment and movement. Movements are slower to minimize fear of movement, improve body awareness, and to maintain joint stability during the exercises. Exercises are selected to minimize joint instability and stress on joints, starting in positions that provide more external stabilization. Cuing to avoid common errors that people with hypermobility often demonstrates when doing Pilates. Instructions provide increased cuing and information about sensory awareness and organization.