Pilates improves physical performance and decreases risk of falls in older adults: a systematic review and meta-analysis

Abstract

Background Falls are the leading cause of injury-related deaths in older adults. Physical exercise is a suitable strategy to reduce the risk of falls, but there is little research on the effectiveness of specific exercise modalities. Objectives To estimate the effectiveness of Pilates compared to habitual or non-exercise on physical performance and the risk of falls in older adults. Data sources Five databases were searched through April 15, 2021. Study selection Randomized controlled trial in people aged ≥60 years. Outcomes: balance, strength, flexibility, functionality, and risk of falls. Data synthesis Pooled standardized mean differences were calculated using a random-effects model. Subgroup analyses based on Pilates' modality, the existence of a detailed exercise protocol, supervision by a certified instructor, and overall risk of bias were performed. Results Thirty-nine studies were included in the systematic review and meta-analyses. The meta-analyses indicated a moderate effect of Pilates on balance (ES = 0.36; 95% CI = 0.21 to 0.50), strength (ES = 0.63; 95% CI = 0.44 to 0.81), flexibility (ES = 0.41; 95% CI = 0.16 to 0.67), and functionality (ES = 0.51; 95% CI = 0.32 to 0.72) as well as a large effect on the risk of falls (ES = 0.90; 95% CI = 0.41 to 1.38) in older adults when compared with control groups. The level of certainty of the findings was low for balance, flexibility, and functionality and moderate for strength and falls. Conclusion and implications of key findingsPilates may promote the autonomy of older people in their daily living activities. Contribution of the Paper• Pilates is an alternative exercise for reducing the risk of falls.• Pilates improves balance, strength, flexibility, and functionality in older people.• Pilates may increase the autonomy of older adults in their daily living activities.

Effects of Pilates Training on Physiological and Psychological Health Parameters in Healthy Older Adults and in Older Adults With Clinical Conditions Over 55 Years: A Meta-Analytical Review

“…Compared to ICs, PIs led to moderately larger improvements on physiological health parameters in both groups (clinical and non-clinical). The influence of PIs on individuals' physical condition has already been studied in detail and confirm the presented effects ( 19 , 105 ). Nevertheless, a higher amount of unspecific physical activity has been found to be effective and contribute to overall health in the older population ( 20 , 103 , 104 , 106 ).…”

“…The included interventions had a average duration of 12–14 weeks for clinical and non clinical groups, respectively, mostly adopting two formal sessions per week of 60 min each. The consensus reached by most of the included studies is consistent with previous findings and can be described as follows: In terms of a positive change in physiological health parameters, two to three sessions per week for 1–6 months and 50–60 min of exercise per each session were considered sufficiently ( 20 , 23 , 103 , 105 ). Greater effects were achieved when interventions lasted 24–36 sessions ( 20 ).…”

Community-based group physical activity and/or nutrition interventions to promote mobility in older adults: an umbrella review

“…C: No treatment or other exercise 11 (8 RCTs) Inclusion: Average ≥ 60 Range: 50–81 328 9% F only, 36% M only 45% high 36% moderate 9% low 1 not assessed (PEDro) Fernandez-Arguelles 2015 [ 39 ] To know the effects of dancing as a physical exercise modality on balance, flexibility, gait and muscle strength in older adults. PubMed, Cochrane Library Plus, PEDro, ScienceDirect, Dialnet, Academic Search Complete, Jan 2000-Jan 2013 2002–2012 I: Dance-based AT, dance and foot tapping or squatting, Turkish folk dance, low impact aerobic dance, Greek traditional dance, ballroom dance, and salsa dancing C: other types of exercise 7 RCTs Inclusion: > 60 Range: 63.1–82.2 354 Range: 26–97 NR; 43% F only 29% good 71% fair (PEDro) Fernández-Rodríguez 2021 [ 40 ] To estimate the effectiveness of Pilates on physical performance and risk of falls in older adults. MEDLINE, Scopus, Web of Science, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials to April 2021 2010–2021 I: At least one exercise intervention described as “Pilates” (Mat, machine, or both) C: Habitual or non-exercise 39 RCTs Inclusion: ≥60 Range: 60–80 1650 62 64% high 36% unclear (Cochrane) Finger 2015 [ 41 ] To determine whether protein supplements can optimize the effects of RT on muscle mass and strength in an aged population.…”

“…Included reviews reported on several types of interventions, with some reporting separate results for more than one intervention type. Most reviews focused on exercise or PA only ( n = 53) [ 26 – 35 , 37 – 40 , 42 , 44 , 45 , 47 , 49 – 75 , 77 , 78 , 80 – 84 , 86 ], while others included exercise with nutritional supplements ( n = 9) [ 25 , 36 , 41 , 43 , 46 , 48 , 76 , 79 , 85 ]. No reviews included group-based nutrition interventions alone.…”

“…No reviews included group-based nutrition interventions alone. Exercise or PA interventions were categorized as resistance exercise ( n = 12) [ 26 , 35 , 47 , 49 , 52 , 60 , 65 , 69 , 72 , 78 , 80 , 81 ], aerobic exercise ( n = 5) [ 28 , 29 , 33 , 38 , 66 ], combined aerobic and resistance exercise ( n = 9) [ 27 , 34 , 47 , 50 , 57 , 60 , 64 , 65 , 81 ], general PA ( n = 12) [ 42 , 44 , 45 , 49 , 54 , 58 , 62 , 63 , 67 , 69 , 70 , 86 ], mind-body exercise (e.g., Tai Chi, yoga, Pilates) ( n = 11) [ 31 , 32 , 37 , 40 , 49 , 56 , 59 , 71 , 74 , 75 , 84 ], dance ( n = 5) [ 39 , 51 , 61 , 73 , 81 ], and other (e.g., aquatics, stretching) ( n = 10) [ 30 , 47 , 49 , 53 , 55 , 68 , 77 , 81 – 83 ]. Nutritional supplements included protein ( n = 5) [ 41 , 43 , 48 ...…”