Abstract
Our objective was to verify the effectiveness of Pilates method compared against other exercise modalities for muscle strength increase, balance and flexibility.
Method
Databases used and its respective results were: CENTRAL (n = 456), CINAHL (n = 291), EMBASE (n = 313), PEDro (n = 176), PUBMED (n = 236), SCIELO (n = 98), SPORTDiscus (n = 197) e Web of Science (n = 150). It included randomized controlled studies using Pilates and others exercise modalities that measured muscle strength.
Results
Eleven studies were included for analysis. The mean methodological quality score of these studies, evaluated by the PEDro scale, was 6 ± 1. For the primary outcome, not being observed this difference for dynamic force (SMD = -0.29; 95%IC -0.69; 0.10), isometric (SMD = 0.20; 95%IC -0.06; 0.47) or resistance (SMD = -0.19; 95%IC -0.46; 0.07). For secondary outcomes, there was no difference for balance and flexibility.
Conclusion
In conclusion, there is very low to low evidence that there is no difference between Pilates and other exercise modalities for dynamic strength, isometric strength, resistance strength, balance and flexibility.
Keywords: Pilates, Strength, Exercise, Muscle
Pilates; Strength; Exercise; Muscle.
1. Introduction
Pilates was created by Joseph Pilates initially as “Contrology” for outdoor practice and aiming to increase muscle strength through body weight [1]. It is currently considered a method of physical conditioning to improve physical fitness through the balance between body, mind, and spirit [1, 2]. The execution of its exercises, both on the floor or with machines, must be carried out following its principles such as concentration, control, centralization, fluidity, precision, and breathing [1, 2, 3]. Despite the objective of initially working on strength, today Pilates is best known for improving flexibility, balance, motor coordination, posture, and mental health [4, 5, 6].
There are many reviews have researched to showing de benefits of Pilates practice on body composition like decrease weight, body fat percentage, circumference, increase muscle mass [7], or improving flexibility, dynamic balance and muscular endurance [5] for pain and quality of life seems great too [8]. Low back pain is one of the most studied outcomes and Pilates is more effective than minimal interventional, but when Pilates compared with other exercises there are not difference [9]. Despite many studies presenting the benefits of the Pilates method, the practice of the Pilates method to increase strength is still little known.
The increase in muscle strength through the practice of exercises is considered an important factor for the maintenance of the population's health [10, 11]. Muscle strength can be trained under Pilates Method using the practitioner’s own body weight or machines equipped with springs and elastic bands [1]. Although muscle strength is an important factor for a healthy body, little is known about Pilate’s effectiveness in increasing muscle strength. As Pilates is usually used towards flexibility or balance training, those have been the common outcomes studied by researchers [5, 12, 13].
Therefore, the objective of this systematic review was to verify the effectiveness of Pilates method compared to other exercise modalities in increasing muscle strength in healthy individuals.
2. Materials and methods
2.1. Protocol and registration
A protocol of this systematic review was registered in The International Prospective Register of Systematic Reviews – PROSPERO (CRD42020202940). The study followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). There was no patient or public involvement in the conceptualization or development of this study.
2.2. Eligibility criteria
Only randomized controlled trials published in peer-reviewed journals were included in this review. Studies described with quasi-randomized allocation were not considered. There was no restriction on language or year of publication.
2.2.1. Inclusion
It included participants without musculoskeletal limitations to perform the exercises and without age restrictions. We selected studies that directly named at least one group among the comparisons as Pilates or Contrology; and studies that compared the muscle strength outcome, pre- and post-intervention between Pilates and other physical exercise modalities.
2.2.2. Exclusion
It was excluded from this review studies that combined Pilates with any other type of exercise in the same study group, studies that included participants with some contraindication for performing physical exercise, pregnant women, more serious diseases such as cancer, fracture, inflammatory or degenerative diseases.
2.3. Data search and selection
The search was executed on August 2020 on the following databases: CENTRAL, CINAHL, EMBASE, PEDro, PUBMED, SCIELO, SPORTDiscus and Web of Science. The search keywords were combined in two blocks: Intervention and Study Type. The full search strategy is presented as Supplementary Material.
Two independent reviewers were responsible for data selection and extraction. The initial selection was through reading the title and abstract and then the full text. Any disagreement between the reviewers was resolved by consensus. Information about the studies and characteristics of the interventions was collected.
As the main outcome, we considered dynamic muscle strength, strength resistance and isometric strength. As secondary outcomes, flexibility and balance were considered. For the extraction of outcome data, the mean, pre- and post-intervention standard deviation and sample size were considered. When presented in graphical format, an approximate extraction was performed using the WebPlotDigitizer Software. When approximate extraction was not possible, we contacted the authors by electronic mail requesting study data.
2.4. Risk of bias
The methodological quality of all studies was evaluated using PEDro Scale [14]. The scale has 11 items generating a maximum grade of 10 points (the first item does not generate a point). The higher the grade, the less risk of bias. Studies with high (grade 6 or more) and low (grade 5 or less) methodological quality were considered in this review [15]. The complete information is presented as Supplementary Material.
2.5. Certainty of evidence
The certainty of evidence was reported according to the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) [16]. It was classified as High, Moderate, Low or Very Low according to the following lowering factors: (1) Risk of Bias – more than 25% of all selected studies have a high risk of bias; (2) Inconsistency – I2 higher than 50%; (3) Indirect Evidence – 50% or more of all participants are not included in the main group under analysis; (4) Imprecision – the final comparison has less than 400 participants; (5) publication bias. The complete information is presented as Supplementary Material.
2.6. Data synthesis and analysis
In this review, a comparison was made between pilates method and other modalities of physical exercise with a subgroup analysis by type of exercise. For the main outcome (muscle strength) a comparison was performed for each type of muscle strength manifestation (i) dynamic, (ii) isometric and (iii) resistance. For secondary outcomes, (iv) balance and (v) flexibility using the sit-and-reach test, and (vi) flexibility using the behind-back test were performed.
The combined data was presented in a meta-analysis through forest plot for each comparison of outcomes. For comparisons with a high heterogeneity (I2 > 80%), a sensitivity analysis was performed considering two aspects: methodological quality of the study (excluding studies with high risk of bias, PEDro scale score <6) or studies with high heterogeneity (excluding studies causing of high heterogeneity). All analyzes were performed using the Review Manager Software (RevMan 5.3).
To carry out the meta-analysis, the mean data and post-intervention standard deviation of each study were used. Studies that presented multiple data for the same outcome were combined to form a single data. The combination of these data was performed according to the guidance described in chapter 6; section 6.5.2.10 of the Cochrane handbook [16]. For studies that compared pilates method with more than one group, the sample size of the Pilates group was divided by the number of comparisons in the study [16].
The analysis method considered was the random effect model, difference between standardized means and 95% confidence interval (95% CI). Studies that did not present data, or that it was not possible to extract the approximate data or did not return our contact were excluded from the meta-analysis, however, they were included in the descriptive analysis.
The evaluation of heterogeneity was performed by visually inspecting the forest graph (confidence interval overlap) and by I2 test result. Heterogeneity was considered low if <50%, moderate between 50-80% and high if >80%.
3. Results
The search resulted in 1917 potential studies. After reviewing the title, abstract and full text 16 studies were part of this review. Eleven studies were included in the meta-analysis. The complete study selection flowchart is shown in Figure 1.
Figure 1.
Flow of study selection.
Of the studies included in this review, 3 studies were written in Persian [17, 18, 19]. Contact with the authors, requesting the data, was necessary for 7 studies [17, 18, 20, 21, 22, 23, 24]. Of these studies, only 1 returned data [23] and two other studies [20, 22] approximate data were used. The remaining studies [17, 18, 21, 22, 25] were included in the descriptive analysis, however, they were not used in the metanalysis. The reason for the exclusion of studies after reading the full text are presented s Supplementary Material.
The general characteristics of all selected studies can be consulted in Table 1. The total number of participants in the studies was 689 (Pilates = 354 and Other Exercises = 335). The mean number of participants for each group was 43 ± 23. The mean age of participants was 60 ± 19 years. The mean intervention period was 12 ± 7 weeks, with a minimum of 4 and a maximum of 24 weeks. The average frequency of sessions was 3 ± 1 sessions per week, with a minimum of 2 and a maximum of 3 sessions. Data on muscle strength, flexibility and balance outcomes can be consulted in Table 2.
Table 1.
Intervention characteristics.
| Data | Age (year) | Total Sample | Pilates Sample | Exercises Sample | Duration (weeks) | Freq. | % Δ Pilates | % Δ Exercises |
|---|---|---|---|---|---|---|---|---|
| Mean | 60 | 43 | 22 | 21 | 12 | 3 | 27 | 21 |
| ±SD | 19 | 23 | 18 | 14 | 7 | 1 | 16 | 24 |
| Min. | 56 | 30 | 14 | 16 | 4 | 2 | 0 | -15 |
| Max. | 78 | 101 | 81 | 69 | 24 | 3 | 60 | 69 |
Notes: Freq.: Frequency, number of sessions during the week; % Δ: Percentage of difference between pre- and post-intervention mean for muscle strength outcome; SD: Standard deviation; Min.: Minimum; Max.: Maximum.
Table 2.
Characteristics of studies and outcomes muscle strength, balance and flexibility, mean values and standard deviation.
| Estudy | Group (n) | Assessment/Outcome | Pre mean (±SD) | Post mean (±SD) | Difference (IC95%) | PEDro Scale |
|---|---|---|---|---|---|---|
| Carrasco-Poyatos et al. 2019 [26] | Pilates (16) Strength (19) |
Dynamic Force Comb. Isokinetic Dynamometer | 45.03 (19.51) 39.07 (18.91) |
51.48 (26.18) 50.19 (21.3) |
6.45 (-1.63; 14.53) 11.12 (4.67; 17.58) |
7 |
| Isometric Force Comb. Isokinetic Dynamometer | 105.22 (72.23) 118.06 (83.83) |
138.02 (92.5) 133 (88.82) |
32.81 (3.77; 61.84) 14.94 (-12.74; 42.62) |
|||
| Carvalho et al. 2017 [20] | Pilates (21) PNF (21) |
Isometric Force Comb. Load Cell | 90.48 (41.98) 82.39 (47.32) |
129.16 (65.54) 139.14 (60.59) |
38.68 (14.79; 62.57) 56.75 (33.15; 80.34) |
5 |
| Culligan et al. 2010 [21]∗ | Pilates (28) Physiotherapy (24) |
Dynamic Force MMII Peak Force Pelvis | N/R | 5 | ||
| Dashti et al. 2015 [17]∗ | Pilates (15) Elastic Band (15) |
Resistance Force MMII Stand Chair Test | N/R | 5 | ||
| Donath et al. 2016 [22] | Pilates (17) Balance (16) |
Isometric Force Comb. Trunk Flexion Test ACSM | 96.87 (74.46) 115.57 (94.24) |
123.46 (79.91) 144.53 (110.78) |
26.59 (-10.81; 63.99) 28.96 (-22.44; 80.36) |
4 |
| Resistance Force Dynamic Test Trunk Flexion | 25.08 (12.04) 24.15 (9.75) |
31.19 (17.96) 28.22 (12.8) |
6.11 (-4.57; 16.79) 4.07 (-4.15; 12.29) |
|||
| Balance Comb. Force Platform (COP) | 4256.45 (1361.75) 3598.36 (1021.4) |
5100.27 (1203.23) 5011.93 (1200.88) |
843.82 (221.6; 1466.03) 1413.57 (856.48; 1970.66) |
|||
| Balance Comb. Y Balance Test | 73.41 (13.38) 87.79 (8.4) |
73.11 (10.56) 81.54 (8.28) |
-0.29 (-6.13; 5.54) -6.25 (-10.42;-2.08) |
|||
| Filho et al. 2016 [27] | Pilates (21) Gymnastics (23) Water Aerobics (24) Strength (22) |
Dynamic Force Comb. 10RM. | 13 (7.22) 12 (6.29) 14.25 (7.19) 13.25 (7.25) |
17 (8.57) 16.75 (8.71) 16.5 (7.84) 20.75 (9.44) |
4 (-0.25; 8.25) 4.75 (2.54; 6.96) 2.25 (0.11; 4.39) 7.5 (5; 10) |
4 |
| Pilates (21) Gymnastics (23) Water Aerobics (24) Strength (22) |
Flexibility MMII Test Sit Reach | 1.64 (3.17) 1.55 (3.2) 1.48 (3.2) 1.56 (3.71) |
2.21 (3.39) 1.99 (3.91) 1.91 (3.33) 1.95 (3.91) |
0.57 (-3.25; 4.39) 0.44 (-1.68; 2.56) 0.43 (-1.47; 2.33) 0.39 (-1.93; 2.71) |
||
| Flexibility MMSS Back Reach Test | -5.39 (4.86) -5.43 (4.55) -5.33 (4.16) -5.56 (4.66) |
-4.02 (4.37) -4.01 (4.73) -4.32 (4.77) -4.12 (4.77) |
1.37 (-4.01; 6.75) 1.42 (-1.34; 4.18) 1.01 (-1.59; 3.61) 1.44 (-1.43; 4.31) |
|||
| González-Gálvez et al. 2019 [25]∗ | Pilates (81) Physical Education (20) |
Isometric Force Sörensen Test | 147.98 (70.7) 139.4 (50.4) |
182.75 (61) 114.5 (44.8) |
34.77 (14.28; 55.26) -24.9 (-55.42; 5.62) |
6 |
| Resistance Force Trunk Flexion | 57.96 (34.5) 57.15 (35.1) |
76.51 (37.9) 50.05 (26.3) |
18.55 (7.3; 29.8) -7.1 (-26.95; 12.75) |
|||
| Irandous & Taheri 2016 [18] | Pilates (20) Yoga (20) |
Resistance Force MMII Stand Chair Test | 6.2 (0.9) 6.4 (1.3) |
9.9 (1.7) 10.1 (1.3) |
3.7 (2.83; 4.57) 3.7 (2.87; 4.53) |
4 |
| Balance Stork Test | 14.9 (0.9) 14.8 (0.9) |
14.6 (0.5) 16.8 (0.7) |
-0.3 (-0.77; 0.17) 2 (1.48; 2.52) |
|||
| FlexibilityTest Sit Reach | 22 (1.8) 22.3 (2.1) |
24.9 (1.9) 25.1 (1.9) |
2.9 (1.72; 4.08) 2.8 (1.52; 4.08) |
|||
| Kovach et al. 2013 [28] | Pilates (22) Water Aerobics (17) |
Resistance Force Comb. Elbow Curl Test | 19.95 (5.21) 18.9 (5.14) |
27.85 (5.69) 25.55 (5.02) |
7.9 (5.59; 10.21) 6.65 (4.19; 9.11) |
4 |
| Pilates (22) Water Aerobics (17) |
Flexibility MMSS Back Reach Test | -0.86 (6.5) 1.3 (8.4) |
-3.4 (5.6) -2.7 (8) |
-2.54 (-6.23; 1.15) -4 (-9.73; 1.73) |
||
| Flexibility MMII Test Sit Reach | 4.9 (8.7) 5 (8.7) |
-8.3 (4.6) -8.3 (6.8) |
-13.2 (-17.43;-8.97) -13.3 (-18.76;-7.84) |
|||
| Markovic et al. 2015 [29] | Pilates (14) Vibration Platform (16) |
Dynamic Force MMSS 1RM |
22.9 (6.7) 23 (4) |
24.4 (6.8) 24.8 (4.4) |
1.5 (-3.74; 6.74) 1.8 (-1.24; 4.84) |
7 |
| Isometric Force Comb. Trunk Isometric (N) | 305.25 (104.01) 288.25 (69.57) |
314.5 (110.75) 369.75 (100.67) |
9.25 (-30.99; 49.49) 81.5 (51.23; 111.77) |
7 | ||
| Balance Force Platform (COP) | 37.5 (8) 37.7 (4.6) |
37.7 (8.4) 35.3 (5.4) |
0.2 (-6.17; 6.57) -2.4 (-6.02; 1.22) |
|||
| Oliveira et al. 2015a [30] | Pilates (16) Stretching (16) |
Dynamic Force Comb. Isokinetic Dynamometer | 38.6 (7.43) 38 (8.74) |
52.3 (8.53) 37.43 (9.3) |
13.7 (10.9; 16.5) -0.58 (-3.73; 2.58) |
5 |
| Oliveira et al. 2015b [24]∗ | Pilates (16) Stretching (16) |
Dynamic Force Comb. Isokinetic Dynamometer | N/R | 7 | ||
| Oliveira et al. 2017 [31] | Pilates (16) Stretching (16) |
Dynamic Force Comb. Isokinetic Dynamometer | 60.45 (25.36) 61 (25.74) |
77.6 (25.41) 61.35 (27.94) |
17.15 (8.27; 26.03) 0.35 (-9.05; 9.75) |
8 |
| Oliveira et al. 2018 [32] | Pilates (17) Vibration Platform (17) |
Dynamic Force Comb. Isokinetic Dynamometer | 63.08 (29.82) 54.53 (23.18) |
68.33 (29.32) 56.73 (23.01) |
5.25 (-4.78; 15.28) 2.2 (-5.63; 10.03) |
8 |
| Sahebozamani et al. 2016 [19]∗ | Pilates (16) Mackenzie (15) |
Lumbar Dynamic Force Test Bent Knee Down | 67.18 (11.37) 62.66 (12.92) |
58.37 (10.95) 59.86 (13.05) |
-8.81 (-16.87;-0.75) -2.8 (-12.51; 6.91) |
4 |
| Taskiran et al. 2014 [23] | Pilates (18) Yoga (18) |
Dynamic Force Hand Grip Strength |
0.34 (0.12) 0.29 (0.1) |
0.34 (0.12) 0.32 (0.12) |
0 (-0.08; 0.08) 0.03 (-0.04; 0.1) |
5 |
| Resistance Force Elbow Curl Test | 13.2 (4.41) 12.35 (3.53) |
13.85 (5.02) 13.2 (3.95) |
0.65 (-1.57; 2.87) 0.85 (-0.91; 2.61) |
|||
RM: Repetition Maximum; SD: Standard Deviation; n: Sample; IC: Interval Confidence; Pre = Pre Intervention; Post = Post Intervention; PNF: Proprioceptive Neuromuscular Facilitation; ACSM: American College of Sports Medicine; N: Newton; MMSS: Superior Member; MMII: Inferior Member; Comb.: Data from the combined studies. COP: Pressure Center. Physical Education: Physical Education Classes. N/R: Not returned the data request by electronic mail.
∗ Studies that did not enter the meta-analysis because of the direction of results or not returned data request.
The studies included in this review evaluated muscle strength in different ways, being divided into dynamic, isometric and resistance strength. The types of assessment used to measure muscle strength were repetition maximum (RM) being 1RM and 10RM, elbow flexion test, load cell, sit and stand test, isokinetic dynamometer, trunk flexion test dynamic or isometric (abdominal), handgrip strength test, trunk extension and flexion in isometry and modified Sorensen test, peak pelvis strength test and test of descending flexed knees.
The types of exercises compared to Pilates in the studies were varied. Being, strength exercises, stretching, physical education class, balance, proprioceptive neuromuscular facilitation (PNF), physiotherapy, gymnastics, pool exercises, vibrating platform, elastic bands, and yoga. These data are presented in Table 2, as Supplemental Material.
3.1. Risk of bias
The studies were considered to have moderate methodological quality, with a mean value of 6 ± 1 of a maximum score of 10. The maximum score achieved was 8 and the minimum score was 4. The main factors for reducing the maximum score were: blinding and analysis by intention to treat. The analysis was performed directly from PEDro website (https://pedro.org.au/). Six studies [17, 19, 21, 23, 24, 25] required a manual analysis. The evaluation of each study can be consulted as Supplementary Material.
3.2. Dynamic muscle strength
The comparison of dynamic muscle strength (Figure 2) was composed of a total sample of 958 participants (Pilates = 376 and Other Exercises = 582). Low certainty of evidence (two-level reduction, risk of bias and inconsistency). The result shows that there was no statistically significant difference (SMD = -0.29; 95%CI -0.69; 0.10; I2 = 87%; n = 958).
Figure 2.
Forest plot of comparison Pilates versus Exercises. Outcome: dynamic muscle strength.
A sensitivity analysis was performed due to the high heterogeneity presented I2 = 87%. With the exclusion of the two studies using stretching exercises [26, 27], with scores in the risk of bias analysis of 5 and 8 respectively, the heterogeneity was became low I2 = 36%. However, even with the reduction of heterogeneity (Figure 3) the result shows that there was no statistically significant difference (SMD = -0.06; 95%CI -0.27; 0.15; I2 = 36%; n = 702).
Figure 3.
Forest plot of comparison Pilates versus Exercises with sensitivity analysis. Outcome: dynamic muscle strength.
3.3. Isometric muscle strength
The comparison of isometric muscle strength (Figure 4) was composed of a total sample of 410 participants (Pilates = 196 and Other Exercises = 214). Low certainty of evidence (two-level reduction, risk of bias and inconsistency). The result shows that there was no statistically significant difference (SMD = 0.20; 95%CI -0.06; 0.47; I2 = 43%; n = 410).
Figure 4.
Forest plot of comparison Pilates versus Exercises. Outcome: isometric muscle strength.
3.4. Muscle strength endurance
The comparison of strength resistance (Figure 5) was composed of a total sample of 223 participants (Pilates = 117 and Other Exercises = 106). Low certainty of evidence (two-level reduction, risk of bias and imprecision). The result is that there was no statistically significant difference (SMD = -0.19; 95%CI -0.46; 0.07; I2 = 0%; n = 223).
Figure 5.
Forest plot of comparison Pilates versus Exercises. Outcome: muscle strength endurance.
3.5. Balance
The comparison of balance (Figure 6) was composed of a total sample of 202 participants (Pilates = 102 and Other Exercises = 100). Very low certainty of evidence (4-level reduction, risk of bias and inconsistency and imprecision). The result shows that there was no statistically significant difference (SMD = 0.94; 95%CI -0.31; 2.19; I2 = 94%; n = 202).
Figure 6.
Forest plot of comparison Pilates versus Exercises Outcome: balance.
A sensitivity analysis was performed due to the high heterogeneity presented I2 = 94%. With the exclusion of the evaluation type (Balance Test Y18 and Test of Stork14), with a score in the risk of bias analysis of 4 for both studies, the heterogeneity become low I2 = 0%. However, even with the reduction of heterogeneity (Figure 7) the result shows that there was no statistically significant difference (SMD = -0.15; 95%CI -0.56; 0.25; I2 = 0%; n = 96).
Figure 7.
Forest plot of comparison Pilates versus Exercises with sensitivity analysis. Outcome: balance.
3.6. Flexibility – sit and reach test
The comparison of flexibility evaluated through the sit and reach test (Figure 8) was composed of a total sample of 169 participants (Pilates = 63 and Other Exercises = 106). Very low certainty of evidence (three-level reduction, risk of bias and imprecision). The result shows that there was no statistically significant difference (SMD = -0.00; 95%CI -0.33; 0.33; I2 = 0%; n = 169).
Figure 8.
Forest plot of comparison Pilates versus Exercises through the sit and reach test. Outcome: flexibility.
3.7. Flexibility – back scratch test
The comparison of flexibility evaluated through the test of reaching behind the back (Figure 9) was composed of a total sample of 129 participants (Pilates = 43 and Other Exercises = 86). Low certainty of evidence (two-level reduction, risk of bias and imprecision). The result shows that there was no statistically significant difference (SMD = 0.02; 95%CI -0.37; 0.41; I2 = 0%; n = 129).
Figure 9.
Forest plot of comparison Pilates versus Exercises through back scratch test. Outcome: flexibility.
4. Discussion
Comparisons of the effectiveness of Pilates method against other exercise modalities for muscle strength, balance, and flexibility showed a low to very low quality of evidence. Mainly due to the low methodological quality of the studies and the small size of the studies, with an average of 43 ± 27 participants (minimum: 30 and maximum: 101). The studies presented different methods of intervention and evaluation of outcomes, resulting in a high heterogeneity, which we already expected due to the difference between the interventions. Among the comparisons of outcomes, only the comparison for the strength resistance outcome showed a statistically significant difference, favoring other exercise modalities. While other comparisons did not show any statistically significant difference.
4.1. Pilates vs other exercises
The first of our findings was that there was no statistically significant difference for muscle strength when compare Pilates method than exercises, however, the certainty of the evidence of this comparison was considered low, and further studies may change this result. However, the application of the Pilates method with an average frequency of 12 ± 7 weeks with a frequency of 3 ± 1 sessions per week, increased muscle strength by 27% ± 16, when comparing pre and post intervention. This shows us that although we did not observe any difference for the muscle strength, Pilates is an option for increasing muscle strength considering pre and post intervention data.
The second finding of this review was that the secondary outcomes balance and flexibility showed no difference between Pilates and other types of exercise. However, the number of studies for this analysis was too small for balance (n = 3 studies) and flexibility (n = 3 studies). These comparisons also presented a very low certainty of evidence, mainly because these studies present a high risk of bias and a low total number of participants for comparison.
An already published systematic review [33] with elderly participants evaluated the effects of Pilates compared to no activity (control group). In their results for the muscle strength outcome, they showed a large effect size for lower limb strength SMD = 1.13 (0.30–1.96, 95% CI). And a mean effect size for the upper limb SMD = 0.72 (0.02–1.43, CI95%). Indicating that Pilates increases lower limb strength after intervention. For the flexibility outcome, it presented a large effect size for the hip and lumbar region SMD = 1.22 (0.39–2.04, CI95%) and upper limb SMD = 1.16 (0.70–1.63, CI95%). For balance outcome, the effect size was also considered large SMD = 1.10 (0.29–1.90, 95%CI). .
In another systematic review [34] also comparing the effects of Pilates to no activity (control group). A large effect size of 1.23 (g of Hedges) (0.84–1.62 95% CI) was observed for muscle strength, favoring Pilates. However, this meta-analysis consisted of only three studies. When analyzing balance, they found a moderate effect size for static balance 0.34 (0.097–0.594, CI95%), and dynamic balance 0.77 (0.451–1.090, CI95%). When analyzing flexibility, there was no difference.
On another review [35] analyzing the benefits of Pilates in young people (aged ≤21 years), tha authors observed a large effect size >0.8 (g of Hedges) favoring Pilates for the outcomes muscle strength and flexibility.
The data from these studies shows that Pilates may be effective for increasing muscle strength and improving flexibility and balance when compared to no activity. However, we also observed in our study an increase in post-intervention muscle strength. Our results shows that this increase in muscle strength and improvement in flexibility and balance are not superior to those presented by other types of exercise, showing no differences when comparing Pilates to other types of exercises.
To the best of our knowledge, this is the first systematic review considering the effectiveness of the Pilates method compared to other types of exercises for the muscle strength outcome. We performed a comprehensive search in the literature without language limitations, as many reviews are limited to considering only studies in the English language and we found studies in languages such as Persian, Portuguese and Spanish. Therefore, the health professional, when considering the needs of his client/patient, through his experience, should evaluate which exercise modality have the best evidence from the literature to determine the best intervention, increasing adherence and enhancing results.
5. Study limitations
As a limitation, we can consider the lack of analysis by subgroup considering the age of the participants and the evaluation methods used for each outcome. We did not differentiate between Pilate’s mat and its apparatus method, due to the difference in the sequence of exercises and stimuli, the responses to each outcome may be altered. In our analysis, we did not separate the use of the intervention as a method of physical training or physical therapy.
6. Conclusions
The data from this review show that there is very low to low certainty of evidence that there is no difference between Pilates and other types of exercises for dynamic strength, isometric strength, resistance strength, balance and flexibility.
Declarations
Author contribution statement
All authors listed have significantly contributed to the development and the writing of this article.
Funding statement
This work was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior [001], Fundação para a Ciência e a Tecnologia [UIDB/04585/2020].
Data availability statement
Data will be made available on request.
Declaration of interest’s statement
The authors declare no conflict of interest.
Additional information
No additional information is available for this paper.
Appendix A. Supplementary data
The following is the supplementary data related to this article:
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Data Availability Statement
Data will be made available on request.