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A Systematic Review of the Effects of Pilates Method of Exercise in Healthy People

Published:October 26, 2011DOI:https://doi.org/10.1016/j.apmr.2011.06.018

      Abstract

      Cruz-Ferreira A, Fernandes J, Laranjo L, Bernardo LM, Silva A. A systematic review of the effects of Pilates method of exercise in healthy people.

      Objective

      To evaluate evidence for the effectiveness of the Pilates method of exercise (PME) in healthy people.

      Data Sources

      Published research was identified by searching Science Direct, MEDLINE, PubMed, SPORTDiscus, PEDro, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science.

      Study Selection

      Research studies published from inception to May 7, 2011 were selected for evaluation. Two reviewers independently applied the inclusion criteria to selected potential studies. Studies were included if they were published in a peer-reviewed journal, written in the English language, conducted as a randomized controlled trial (RCT) or quasi-RCT in healthy people, had an inactive and/or exercise control group(s), included key study outcomes, and used the PME as the study intervention in at least 1 study arm.

      Data Extraction

      Two reviewers independently extracted data (study, design, subjects, intervention, key outcomes results), applied the Physiotherapy Evidence Database (PEDro) scale to assess the method quality of selected studies, and determined the strength of the evidence using the best evidence synthesis grading system.

      Data Synthesis

      Sixteen studies met the inclusion criteria. PEDro scale values ranged from 3 to 7 (mean, 4.1), indicating a low level of scientific rigor. The outcomes studied most often were flexibility, muscular endurance, strength, and postural alignment. The PME appears to be effective in improving flexibility (strong evidence), dynamic balance (strong evidence), and muscular endurance (moderate evidence) in healthy people.

      Conclusions

      There was strong evidence to support the use of the PME at least to the end of training to improve flexibility and dynamic balance and moderate evidence to enhance muscular endurance. Future RCTs should focus on the components of blinding, concealed allocation, subject adherence, intention-to-treat analysis, and follow-up designs.

      Key Words

      List of Abbreviations:

      BES (best evidence synthesis), PEDro (Physiotherapy Evidence Database), PME (Pilates method of exercise), RCT (randomized controlled trial)
      THE PILATES METHOD was created by Joseph Pilates, who combined exercise/movement, philosophy, gymnastics, martial arts, yoga, and dance into an approach for healthy living. This program of mind-body exercise is based on 6 key principles: centering, concentration, control, precision, flow, and breath.
      • Latey P.
      The Pilates method: history and philosophy.
      According to Pilates, his method is total coordination of body, mind, and spirit, promoting the uniform development of the body; restoration of good posture and physical activity; and revitalization of the mind and spirit.
      • Pilates J.
      • Miller W.
      Return to life through contrology.
      The Pilates method of exercise (PME) is practiced on a mat or Pilates apparatus (body conditioning equipment) in private lessons or small groups. Instructors are certified in the PME through any number of recognized Pilates certification programs.
      Initially, the PME found great acceptance among professional dancers.
      • Lange C.
      • Unnithan V.
      • Larkam E.
      • Latta P.
      Maximizing the benefits of Pilates-inspired exercise for learning functional motor skills.
      Today, the PME is popular in the general population
      • Latey P.
      The Pilates method: history and philosophy.
      • Bernardo L.
      The effectiveness of Pilates training in healthy adults: an appraisal of the research literature.
      • Segal N.A.
      • Hein J.
      • Basford J.R.
      The effects of Pilates training on flexibility and body composition: an observational study.
      and the clinical and fitness areas.
      • Lange C.
      • Unnithan V.
      • Larkam E.
      • Latta P.
      Maximizing the benefits of Pilates-inspired exercise for learning functional motor skills.
      • Segal N.A.
      • Hein J.
      • Basford J.R.
      The effects of Pilates training on flexibility and body composition: an observational study.
      • La Touche R.
      • Escalante K.
      • Linares M.
      Treating non-specific chronic low back pain through the Pilates method.
      This proliferation has led health and fitness professionals to question the scientific validity of the benefits espoused by Pilates himself. Bernardo
      • Bernardo L.
      The effectiveness of Pilates training in healthy adults: an appraisal of the research literature.
      and Bernardo and Nagle
      • Bernardo L.
      • Nagle E.
      Does Pilates training benefit dancers? An appraisal of Pilates research literature.
      conducted critical appraisals of the published research in which the PME was tested in healthy adults and dancers, respectively. Their appraisals found weak support for the effectiveness of the PME on outcomes such as strength, flexibility, and alignment because of the quality of research methods and small sample sizes. A similar appraisal of the PME in healthy adults and dancers was conducted by Shedden and Kravitz,
      • Shedden M.
      • Kravitz L.
      Pilates exercise: a research-based review.
      who reinforced the necessity of well-controlled and well-designed studies to scientifically validate the effects of the PME in these populations.
      Three systematic reviews
      • La Touche R.
      • Escalante K.
      • Linares M.
      Treating non-specific chronic low back pain through the Pilates method.
      • Lim E.C.
      • Poh R.L.
      • Low A.Y.
      • Wong W.P.
      Effects of Pilates-based exercises on pain and disability in persistent nonspecific low back pain: a systematic review with meta-analysis.
      • Posadzki P.
      • Lizis P.
      • Hanger-Derengowska M.
      Pilates for low back pain: a systematic review.
      have been published on the effectiveness of the PME in relieving pain and improving function in adults with low back pain. La Touche et al
      • La Touche R.
      • Escalante K.
      • Linares M.
      Treating non-specific chronic low back pain through the Pilates method.
      concluded that when adapted for subjects' situations, the PME improved general functioning and decreased pain. Conversely, Lim et al
      • Lim E.C.
      • Poh R.L.
      • Low A.Y.
      • Wong W.P.
      Effects of Pilates-based exercises on pain and disability in persistent nonspecific low back pain: a systematic review with meta-analysis.
      found that although the PME is superior to minimal intervention, it is no more effective than other forms of exercise to reduce pain and disability. Posadzki et al
      • Posadzki P.
      • Lizis P.
      • Hanger-Derengowska M.
      Pilates for low back pain: a systematic review.
      reported inconclusive evidence to support the clinical effectiveness of the PME in reducing pain and functional disability.
      We conducted a systematic review to update the state of the science on effects of the PME in healthy people. The purpose of this systematic review was to answer the question: What is the evidence for the effectiveness of the PME in healthy people?

      Methods

      Search Strategy

      Studies were selected for review on May 7, 2011, by searching the following databases: Science Direct, MEDLINE Cambridge (1997 to present), PubMed (1950 to present), MEDLINE EBSCOhost (1965 to present), MEDLINE (1950 to present), MEDLINE ISI Web of Knowledge (1950 to present), PEDro (1929 to present), Cochrane Central Register of Controlled Trials, SPORTDiscus (1800 to present), CINAHL (1937 to present), and Web of Science (1900 to present). The search term was Pilates, as found in the title or abstract.

      Selection Criteria

      Studies were included if they were published in a peer-reviewed journal, written in the English language, conducted as a randomized controlled trial (RCT) or quasi-RCT in healthy people, had an inactive control group and/or exercise control group(s), included key study outcomes (primary measures of the effectiveness or lack of effectiveness of the PME), and used the PME as the study intervention in at least 1 study arm.

      Study Selection

      Two reviewers (A.C.-F., L.L.) independently read all abstracts and classified them as excluded or potentially included. A third reviewer (J.F.) was consulted if there was disagreement between the 2 reviewers. Reviewers applied the inclusion criteria after reading the potentially included studies.

      Data Extraction

      Studies meeting the inclusion criteria were analyzed independently by the 2 reviewers to extract the following data: authors, year of publication, study design, subjects, intervention used, and key outcomes results. The third reviewer was consulted to resolve disagreements between the 2 reviewers.

      Method Quality Assessment

      The 2 reviewers independently assessed the method quality of each RCT by using the Physiotherapy Evidence Database (PEDro) scale,
      • de Morton N.A.
      The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study.
      with the third reviewer consulted to resolve disagreements. All RCTs were scored and entered into a spreadsheet (table 1).
      Table 1PEDro Scale Ratings
      StudyEligibility CriteriaRandom AllocationConcealed AllocationGroups Similar At BaselineBlind SubjectBlind TherapistBlind AssessorFollow-UpIntention-to-Treat AnalysisBetween-Group ComparisonsPoint Measures and VariabilityPEDro Score
      Fitt et al, 1993
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      110000011003
      Parrott, 1993
      • Parrott A.
      The effects of Pilates technique and aerobic conditioning on dancers' technique and aesthetic.
      000000011013
      McMillan et al,1998
      • McMillan A.
      • Proteau L.
      • Lèbe R.
      The effect of Pilates-based training on dancers' dynamic posture.
      000100000113
      Jago et al, 2006
      • Jago R.
      • Jonker M.
      • Missaghian M.
      • Baranowski T.
      Effect of 4 weeks of Pilates on the body composition of young girls.
      000100011115
      Donahoe-Fillmore et al, 2007
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      010100010003
      Johnson et al, 2007
      • Johnson E.
      • Larsen A.
      • Ozawa H.
      • Wilson C.
      • Kennedy K.
      The effects of Pilates-based exercise on dynamic balance in healthy adults.
      010100100115
      Sekendiz et al, 2007
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      110100000114
      Caldwell et al, 2009
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Travis Triplett N.
      Effect of Pilates and Taiji quan training on self-efficacy, sleep quality, mood, and physical performance of college students.
      000100000113
      Rogers and Gibson, 2009
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      000101000114
      Caldwell et al, 2010
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Quin R.H.
      • Greeson J.
      Developing mindfulness in college students through movement-based courses: effects on self-regulatory self-efficacy, mood, stress, and sleep quality.
      000100000113
      Emery et al, 2009
      • Emery K.
      • De Serres S.
      • McMillan A.
      • Côté J.
      The effects of a Pilates training program on arm-trunk posture and movement.
      000100000113
      Kloubec, 2010
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      010100010115
      Rodrigues et al, 2010
      • Rodrigues B.
      • Cader S.
      • Torres N.
      • Oliveira E.
      • Dantas E.
      Pilates method in personal autonomy, static balance and quality of life.
      010100000114
      Critchley et al, 2011
      • Critchley D.J.
      • Pierson Z.
      • Battersby G.
      Effect of Pilates mat exercises and conventional exercise programmes on transversus abdominis and obliquus internus abdominis activity: pilot randomised trial.
      111100100116
      Cruz-Ferreira et al, 2011
      • Cruz-Ferreira A.
      • Fernandes J.
      • Gomes D.
      • et al.
      Effects of Pilates-based exercise on life satisfaction, physical self-concept and health status in adult women.
      111100101117
      Irez et al, 2011
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      110100100115
      Total59213014541313
      The PEDro scale is based on a Delphi list developed by Verhagen et al
      • Verhagen A.P.
      • de Vet H.C.
      • de Bie R.A.
      • et al.
      The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus.
      that includes 11 items: specified eligibility criteria, random allocation, concealed allocation, baseline comparability, blinded subjects, blinded therapists, blinded assessors, adequate follow-up, intention-to-treat analysis, between-group comparisons, and point estimates and variability. The eligibility criterion is related to external validity and is not used to calculate the PEDro score. PEDro scale scores range from 1 to 10; higher PEDro scores correspond to higher method quality. Because we do not know of the published validated cutoff scores for the PEDro scale, the following criteria were used to rate method quality: PEDro score of less than 5 indicates low quality and PEDro score of 5 or higher indicates high quality. The reliability of the PEDro scale has been evaluated previously and found sufficient for use in a systematic review of physical therapy RCTs
      • Maher C.
      • Sherrington C.
      • Herbert R.
      • Moseley A.
      • Elkins M.
      Reliability of the PEDro scale for rating quality of randomized controlled trials.
      and appears to be a useful scale to assess the method quality of physical therapy trials.
      • Olivo S.
      • Macedo L.
      • Gadotti I.
      • Fuentes J.
      • Stanton T.
      • Magee D.
      Scales to assess the quality of randomized controlled trials: a systematic review.

      Data Synthesis

      RCTs were divided into 2 groups, in which the PME group was compared with an inactive/usual exercise group or another exercise method. Outcomes were categorized as physiologic functioning, psychological functioning, and motor learning.
      • Lange C.
      • Unnithan V.
      • Larkam E.
      • Latta P.
      Maximizing the benefits of Pilates-inspired exercise for learning functional motor skills.
      The strength of the scientific evidence was measured by using the best evidence synthesis (BES). BES is an alternative to meta-analysis when the number of eligible studies is too small to establish adequate power. BES has been used successfully by other reviewers,
      • Maher C.G.
      A systematic review of workplace interventions to prevent low back pain.
      • Lievense A.M.
      • Bierma-Zeinstra S.M.
      • Verhagen A.P.
      • van Baar M.E.
      • Verhaar J.A.
      • Koes B.W.
      Influence of obesity on the development of osteoarthritis of the hip: a systematic review.
      • Bronfort G.
      • Hass M.
      • Evans R.L.
      • Bouter L.M.
      Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis.
      • Huisstede B.M.
      • Hoogvliet P.
      • Randsdorp M.S.
      • Glerum S.
      • van Middelkoop M.
      • Koes B.W.
      Carpal tunnel syndrome Part I: efectiveness of nonsurgical treatments–a systematic review.
      including the Cochrane Back Review Group.
      • Trinh K.
      Summaries and recommendations of the global impression method.
      The strength is determined by the number and quality of studies and consistency of results. In this method, quality is more important than quantity.
      • Trinh K.
      Summaries and recommendations of the global impression method.
      The following criteria are used to grade the strength of the evidence: strong evidence, provided in multiple high-quality RCTs; moderate evidence, provided in 1 high-quality RCT and 1 or more low-quality RCT; limited evidence, provided in 1 high-quality or multiple low-quality RCTs; and no evidence, provided in 1 low-quality RCT or contradictory outcomes.
      • Van Tulder M.W.
      • Koes B.W.
      • Bouter L.M.
      Conservative treatment of acute and chronic nonspecific low back pain: a systematic review of randomized controlled trials of the most common interventions.

      Results

      Study Selection

      Figure 1 shows the flowchart of the article selection process. Thirty-one published reports were selected as potentially included for this review. Based on the reviewers' decisions, 16 RCTs matched the inclusion criteria. Seven articles were identified from the Science Direct database, with the remaining articles from MEDLINE (n=1), PubMed (n=3), Sportdiscus (n=3), CINAHL (n=1), and Web of Science (n=1).
      Figure thumbnail gr1
      Fig 1Flowchart of article selection process. *Segal et al,
      • Segal N.A.
      • Hein J.
      • Basford J.R.
      The effects of Pilates training on flexibility and body composition: an observational study.
      Kaesler et al.
      • Kaesler D.
      • Mellifont R.
      • Kelly P.
      • Taaffe D.
      A novel balance exercise program for postural stability in older adults: a pilot study.
      †Culligan et al.
      • Culligan P.J.
      • Scherer J.
      • Dyer K.
      • et al.
      A randomized clinical trial comparing pelvic floor muscle training to a Pilates exercise program for improving pelvic muscle strength.
      ‡Kuo et al.
      • Kuo Y.
      • Tully E.
      • Galea M.
      Sagittal spinal posture after Pilates-based exercise in healthy older adults.
      §Menacho et al,
      • Menacho M.O.
      • Obara K.
      • Conceição J.S.
      • et al.
      Electromyographic effect of mat Pilates exercise on the back muscle activity of healthy adult females.
      Moreno,
      • Moreno J.
      • González-Cutre D.
      • Sicilia A.
      • Spray C.
      Motivation in the exercise setting: Integrating constructs from the approach-avoidance achievement goal framework and self-determination theory.
      Endleman and Critchley,
      • Endleman I.
      • Critchley D.J.
      Transversus abdominis and obliquus internus activity during Pilates exercises: measurement with ultrasound scanning.
      Herrington and Davies,
      • Herrington L.
      • Davies R.
      The influence of Pilates training on the ability to contract the Transversus Abdominis muscle in asymptomatic individuals.
      Petrofsky et al,
      • Petrofsky J.S.
      • Morris A.
      • Bonacci J.
      • Hanson A.
      • et al.
      Muscle use during exercise: a comparison of conventional weight equipment to Pilates with and without a resistive exercise device.
      Queiroz et al.
      • Queiroz B.C.
      • Cagliari M.F.
      • Amorim C.F.
      • Sacco I.C.
      Muscle activation during four Pilates core stability exercises in quadruped position.
      ‖Sewright et al,
      • Sewright K.
      • Martens D.N.
      • Axtell R.S.
      • et al.
      Effects of six weeks of Pilates mat training on tennis serve velocity, muscular endurance, and their relationship in collegiate tennis players [abstract].
      Otto et al,
      • Otto R.
      • Yoke M.
      • McLaughlin K.
      • et al.
      The effect of twelve weeks of Pilates vs resistance training on trained females [abstract].
      Wu and Chiang.
      • Wu H.Y.
      • Chiang I.T.
      The effects of a chair-based Pilates intervention on postural balance in young-old adults [abstract].
      ¶Hall,
      • Hall D.W.
      The effects of Pilates-based training on balance and gait in an elderly population [dissertation].
      Kish.
      • Kish R.L.
      The functional effects of Pilates training college dancers [dissertation].

      Method Quality

      PEDro scale scores ranged from 3 to 7 (mean, 4.1; median, 4; mode, 3). Most studies (n=10) scored less than 5,
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      • Parrott A.
      The effects of Pilates technique and aerobic conditioning on dancers' technique and aesthetic.
      • McMillan A.
      • Proteau L.
      • Lèbe R.
      The effect of Pilates-based training on dancers' dynamic posture.
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Travis Triplett N.
      Effect of Pilates and Taiji quan training on self-efficacy, sleep quality, mood, and physical performance of college students.
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Quin R.H.
      • Greeson J.
      Developing mindfulness in college students through movement-based courses: effects on self-regulatory self-efficacy, mood, stress, and sleep quality.
      • Emery K.
      • De Serres S.
      • McMillan A.
      • Côté J.
      The effects of a Pilates training program on arm-trunk posture and movement.
      • Rodrigues B.
      • Cader S.
      • Torres N.
      • Oliveira E.
      • Dantas E.
      Pilates method in personal autonomy, static balance and quality of life.
      and the rest (n=6) scored 5 or higher,
      • Jago R.
      • Jonker M.
      • Missaghian M.
      • Baranowski T.
      Effect of 4 weeks of Pilates on the body composition of young girls.
      • Johnson E.
      • Larsen A.
      • Ozawa H.
      • Wilson C.
      • Kennedy K.
      The effects of Pilates-based exercise on dynamic balance in healthy adults.
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      • Critchley D.J.
      • Pierson Z.
      • Battersby G.
      Effect of Pilates mat exercises and conventional exercise programmes on transversus abdominis and obliquus internus abdominis activity: pilot randomised trial.
      • Cruz-Ferreira A.
      • Fernandes J.
      • Gomes D.
      • et al.
      Effects of Pilates-based exercise on life satisfaction, physical self-concept and health status in adult women.
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      indicating a low and high quality of rigor, respectively. These 6 studies were published within the past 5 years (see table 1). The criteria satisfied most often related to statistical issues, such as the “similarity of the groups at baseline are reported for at least 1 key outcome,” “results of between-group statistical comparisons are reported for at least 1 key outcome,” and the “study provides both point measures and measures of variability for at least 1 key outcome.” The criterion “blinded subject” was not satisfied in any RCT, with only 1 and 2 studies satisfying the criteria “blinded therapists” and “allocation was concealed,” respectively (see table 1).

      Study Characteristics

      The most frequent study design was pre-post test (n=13), with 3 studies using an additional measurement during the study intervention.
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Travis Triplett N.
      Effect of Pilates and Taiji quan training on self-efficacy, sleep quality, mood, and physical performance of college students.
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Quin R.H.
      • Greeson J.
      Developing mindfulness in college students through movement-based courses: effects on self-regulatory self-efficacy, mood, stress, and sleep quality.
      • Cruz-Ferreira A.
      • Fernandes J.
      • Gomes D.
      • et al.
      Effects of Pilates-based exercise on life satisfaction, physical self-concept and health status in adult women.
      None of the studies included follow-up. Sample sizes were small, ranging from 10 to 62, except in the studies by Caldwell et al,
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Travis Triplett N.
      Effect of Pilates and Taiji quan training on self-efficacy, sleep quality, mood, and physical performance of college students.
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Quin R.H.
      • Greeson J.
      Developing mindfulness in college students through movement-based courses: effects on self-regulatory self-efficacy, mood, stress, and sleep quality.
      in which 98 and 166 subjects were enrolled, respectively. Half (n=8) of the studies were conducted in adults
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      • Johnson E.
      • Larsen A.
      • Ozawa H.
      • Wilson C.
      • Kennedy K.
      The effects of Pilates-based exercise on dynamic balance in healthy adults.
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      • Emery K.
      • De Serres S.
      • McMillan A.
      • Côté J.
      The effects of a Pilates training program on arm-trunk posture and movement.
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      • Critchley D.J.
      • Pierson Z.
      • Battersby G.
      Effect of Pilates mat exercises and conventional exercise programmes on transversus abdominis and obliquus internus abdominis activity: pilot randomised trial.
      • Cruz-Ferreira A.
      • Fernandes J.
      • Gomes D.
      • et al.
      Effects of Pilates-based exercise on life satisfaction, physical self-concept and health status in adult women.
      ; 3 in dancers
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      • Parrott A.
      The effects of Pilates technique and aerobic conditioning on dancers' technique and aesthetic.
      • McMillan A.
      • Proteau L.
      • Lèbe R.
      The effect of Pilates-based training on dancers' dynamic posture.
      ; 3 in students
      • Jago R.
      • Jonker M.
      • Missaghian M.
      • Baranowski T.
      Effect of 4 weeks of Pilates on the body composition of young girls.
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Travis Triplett N.
      Effect of Pilates and Taiji quan training on self-efficacy, sleep quality, mood, and physical performance of college students.
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Quin R.H.
      • Greeson J.
      Developing mindfulness in college students through movement-based courses: effects on self-regulatory self-efficacy, mood, stress, and sleep quality.
      ; and 2 in older adults.
      • Rodrigues B.
      • Cader S.
      • Torres N.
      • Oliveira E.
      • Dantas E.
      Pilates method in personal autonomy, static balance and quality of life.
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      Most RCTs enrolled both women and men (n=8),
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      • Johnson E.
      • Larsen A.
      • Ozawa H.
      • Wilson C.
      • Kennedy K.
      The effects of Pilates-based exercise on dynamic balance in healthy adults.
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Travis Triplett N.
      Effect of Pilates and Taiji quan training on self-efficacy, sleep quality, mood, and physical performance of college students.
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Quin R.H.
      • Greeson J.
      Developing mindfulness in college students through movement-based courses: effects on self-regulatory self-efficacy, mood, stress, and sleep quality.
      • Emery K.
      • De Serres S.
      • McMillan A.
      • Côté J.
      The effects of a Pilates training program on arm-trunk posture and movement.
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      • Critchley D.J.
      • Pierson Z.
      • Battersby G.
      Effect of Pilates mat exercises and conventional exercise programmes on transversus abdominis and obliquus internus abdominis activity: pilot randomised trial.
      with 7 studies limited to women
      • Parrott A.
      The effects of Pilates technique and aerobic conditioning on dancers' technique and aesthetic.
      • Jago R.
      • Jonker M.
      • Missaghian M.
      • Baranowski T.
      Effect of 4 weeks of Pilates on the body composition of young girls.
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      • Rodrigues B.
      • Cader S.
      • Torres N.
      • Oliveira E.
      • Dantas E.
      Pilates method in personal autonomy, static balance and quality of life.
      • Cruz-Ferreira A.
      • Fernandes J.
      • Gomes D.
      • et al.
      Effects of Pilates-based exercise on life satisfaction, physical self-concept and health status in adult women.
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      and 1 study that did not specify subject sex.
      • McMillan A.
      • Proteau L.
      • Lèbe R.
      The effect of Pilates-based training on dancers' dynamic posture.
      All studies used the PME as the study intervention. Control groups were inactive in 11 studies.
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      • McMillan A.
      • Proteau L.
      • Lèbe R.
      The effect of Pilates-based training on dancers' dynamic posture.
      • Jago R.
      • Jonker M.
      • Missaghian M.
      • Baranowski T.
      Effect of 4 weeks of Pilates on the body composition of young girls.
      • Johnson E.
      • Larsen A.
      • Ozawa H.
      • Wilson C.
      • Kennedy K.
      The effects of Pilates-based exercise on dynamic balance in healthy adults.
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      • Emery K.
      • De Serres S.
      • McMillan A.
      • Côté J.
      The effects of a Pilates training program on arm-trunk posture and movement.
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      • Rodrigues B.
      • Cader S.
      • Torres N.
      • Oliveira E.
      • Dantas E.
      Pilates method in personal autonomy, static balance and quality of life.
      • Cruz-Ferreira A.
      • Fernandes J.
      • Gomes D.
      • et al.
      Effects of Pilates-based exercise on life satisfaction, physical self-concept and health status in adult women.
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      In the remaining 5 studies, the PME was compared with Taiji quan,
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Travis Triplett N.
      Effect of Pilates and Taiji quan training on self-efficacy, sleep quality, mood, and physical performance of college students.
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Quin R.H.
      • Greeson J.
      Developing mindfulness in college students through movement-based courses: effects on self-regulatory self-efficacy, mood, stress, and sleep quality.
      GYROKINESIS,
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Quin R.H.
      • Greeson J.
      Developing mindfulness in college students through movement-based courses: effects on self-regulatory self-efficacy, mood, stress, and sleep quality.
      aerobic conditioning,
      • Parrott A.
      The effects of Pilates technique and aerobic conditioning on dancers' technique and aesthetic.
      recreation,
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Travis Triplett N.
      Effect of Pilates and Taiji quan training on self-efficacy, sleep quality, mood, and physical performance of college students.
      general postural education,
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      and strength training.
      • Critchley D.J.
      • Pierson Z.
      • Battersby G.
      Effect of Pilates mat exercises and conventional exercise programmes on transversus abdominis and obliquus internus abdominis activity: pilot randomised trial.
      The duration and frequency of PME interventions ranged from 5 to 15 weeks and 1 to 5 times per week, except for the study by Cruz-Ferreira,
      • Cruz-Ferreira A.
      • Fernandes J.
      • Gomes D.
      • et al.
      Effects of Pilates-based exercise on life satisfaction, physical self-concept and health status in adult women.
      which was conducted twice weekly for 6 months. Nine of the Pilates method interventions were performed on the mat,
      • Jago R.
      • Jonker M.
      • Missaghian M.
      • Baranowski T.
      Effect of 4 weeks of Pilates on the body composition of young girls.
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Travis Triplett N.
      Effect of Pilates and Taiji quan training on self-efficacy, sleep quality, mood, and physical performance of college students.
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      • Critchley D.J.
      • Pierson Z.
      • Battersby G.
      Effect of Pilates mat exercises and conventional exercise programmes on transversus abdominis and obliquus internus abdominis activity: pilot randomised trial.
      • Cruz-Ferreira A.
      • Fernandes J.
      • Gomes D.
      • et al.
      Effects of Pilates-based exercise on life satisfaction, physical self-concept and health status in adult women.
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      with the rest performed on the apparatus (reformer, trapeze table, cadillac, wall unit, combo chair; n=2),
      • Johnson E.
      • Larsen A.
      • Ozawa H.
      • Wilson C.
      • Kennedy K.
      The effects of Pilates-based exercise on dynamic balance in healthy adults.
      • Rodrigues B.
      • Cader S.
      • Torres N.
      • Oliveira E.
      • Dantas E.
      Pilates method in personal autonomy, static balance and quality of life.
      the mat and apparatus (n=3),
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      • McMillan A.
      • Proteau L.
      • Lèbe R.
      The effect of Pilates-based training on dancers' dynamic posture.
      • Emery K.
      • De Serres S.
      • McMillan A.
      • Côté J.
      The effects of a Pilates training program on arm-trunk posture and movement.
      or not specified (n=2)
      • Parrott A.
      The effects of Pilates technique and aerobic conditioning on dancers' technique and aesthetic.
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Quin R.H.
      • Greeson J.
      Developing mindfulness in college students through movement-based courses: effects on self-regulatory self-efficacy, mood, stress, and sleep quality.
      (table 2).
      Table 2Description of Studies Included in RCT
      StudyDesignSubjectsInterventionKey Outcomes Results
      Fitt et al, 1993
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      • Pre-post test
      • Intervention period (phase I and phase II)
      • University dance students
      • Phase I
      • N=29; mean age, 21.21
      • Pilates group: n=14
      • Control group 1: n=15
      • Phase II
      • Control group 2: n=8 (from Phase I control group 1)
      • Phase I
      • Duration: 7wk
      • Pilates group and control group 1 = habitual dance training (technique classes, rehearsals, and normal conditioning).
      • Pilates group = habitual dance training and supervised Pilates session on mat (1 × 90' per week) and individual work out on apparatus (2 × 30' per week) and daily individual work out
      • Pilates on mat.
      • Phase II
      • Duration: 5wk
      • Control Ggoup 2 = unsupervised Pilates on mat and supervised Pilates on apparatus.
      • Phase I
      • Pilates group = improved upper- and lower-limb strength, range of motion, and pelvic alignment; no differences on vertical jump.
      • Control group 1 = no differences on most of the variables, improved on 2 strength variables, 1 range of motion variable and decreased on pelvic alignment.
      • Phase II
      • Control group 2 = improved strength, pelvic alignment, and 2 range of motion variables; no differences on vertical jump and 2 range of motion variables.
      Parrott, 1993
      • Parrott A.
      The effects of Pilates technique and aerobic conditioning on dancers' technique and aesthetic.
      Pre-post test
      • Female university dance students
      • N=18; age range, 9–30
      • Pilates group: n=6
      • Aerobic conditioning group: n=6
      • Control group: n=6
      • Duration: 14wk
      • Pilates group, aerobic conditioning group, and control group = dance training (2–4h × 4 per week of rehearsal and 3–4h × 5 times per week of technique class - ballet, modern, and possibly jazz).
      • Pilates group = dance training and Pilates class (3 × 80′ per week).
      • Aerobic conditioning group = dance training and aerobic dance class (3 × 80' per week).
      • Pilates group = improved standing and in-motion alignment, intention of movement and expressivity of the body.
      • Aerobic conditioning group = improved the expressivity of the body.
      • Control group = no differences.
      McMillan et al,1998
      • McMillan A.
      • Proteau L.
      • Lèbe R.
      The effect of Pilates-based training on dancers' dynamic posture.
      Pre-post test
      • Ballet dancers
      • N=10; age range, 15–19
      • Pilates group: n=5
      • Control group: n=5
      • Duration: 14wk
      • Pilates group = ballet training (20–25h/wk) and 23 private Pilates sessions (1h each).
      • Pilates sessions on mat and apparatus.
      • Control group = ballet training (20–25h/wk).
      • Pilates group = improved the dynamic alignment of the upper body region.
      • Control group = no differences.
      Jago et al, 2006
      • Jago R.
      • Jonker M.
      • Missaghian M.
      • Baranowski T.
      Effect of 4 weeks of Pilates on the body composition of young girls.
      Pre-post test
      • Female students
      • N=30; mean age, 11.2
      • Pilates group: n=16
      • Control group: n=14
      • Duration and frequency: 4wk, 5 × 60' per week.
      • Pilates group = Pilates on mat.
      • Control group = habitual exercise.
      • Pilates group = decreased body mass index percentile; no differences on body mass index, waist circumference, and blood pressure.
      • Control group = no differences.
      Donahoe-Fillmore et al, 2007
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      Pre-post test
      • Healthy females
      • N=11; age range, 25–35
      • Pilates group: n=6
      • Control group: n=5
      • Duration and frequency: 10wk
      • Pilates group = general postural education (2 per week) and unsupervised Pilates on mat (3 per week).
      • Control group = general postural education (2 per week).
      • Pilates group = improved flexor and extensor trunk endurance; no differences on abdominal strength and pelvic alignment.
      • Control group = no differences.
      Johnson et al, 2007
      • Johnson E.
      • Larsen A.
      • Ozawa H.
      • Wilson C.
      • Kennedy K.
      The effects of Pilates-based exercise on dynamic balance in healthy adults.
      Pre-post test
      • Healthy adults
      • N=34
      • Pilates group: n=17; mean age, 27.5
      • Control group: n=17; mean age, 27.3
      • Duration: 10 sessions within 5wk.
      • Pilates group = Pilates on apparatus.
      • Control group = no exercise.
      • Pilates group = improved dynamic standing balance.
      • Control group = no differences.
      Sekendiz et al, 2007
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      Pre-post test
      • Sedentary adult females
      • N=38
      • Pilates group: n=21; mean age, 30
      • Control group: n=17; mean age, 30
      • Duration and frequency: 5wk, 3 × 60' per week.
      • Pilates group = Pilates on mat
      • Control group = no exercise.
      • Pilates group = increased abdominal and lower back strength, abdominal muscular endurance, and posterior trunk flexibility.
      • Control group = no differences.
      Caldwell et al, 2009
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Travis Triplett N.
      Effect of Pilates and Taiji quan training on self-efficacy, sleep quality, mood, and physical performance of college students.
      Pre, mid, and post test
      • College-age individuals
      • N=98
      • Pilates group: n=41
      • Taiji quan group: n=29
      • Recreation group: n=28
      • Mean age, 21.27
      • Duration: 15wk.
      • Pilates group = 2 × 75' per week or 3 × 50' per week.
      • Supervised Pilates sessions on mat.
      • Taiji quan group = 2 × 50' per week Taiji quan sessions.
      • Recreation group = habitual exercise.
      • Pilates group = improved self-efficacy, positive mood, and sleep quality.
      • Taiji quan = no differences.
      • Recreation group = no differences.
      Rogers and Gibson, 2009
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      Pre-post test.
      • Healthy adults
      • N=22
      • Pilates group: n=9; mean age, 25.5
      • Control group: n=13; mean age, 24.5
      • Duration and frequency: 8wk, 3 × 60' per week.
      • Pilates group = supervised Pilates sessions program on mat.
      • Control group = habitual unsupervised, self-prescribed cardiovascular and strength training regimens.
      • Exercise group = improved body composition (body density, relative body fat, chest, waist, and arm circumference), flexibility (low back, hamstrings, and upper body), and muscular endurance (abdominal and lower back); no differences on hips and thigh circumference. Control group = no differences.
      Caldwell et al, 2010
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Quin R.H.
      • Greeson J.
      Developing mindfulness in college students through movement-based courses: effects on self-regulatory self-efficacy, mood, stress, and sleep quality.
      Pre, mid, and post test
      • College students
      • N=166
      • Pilates group: n=80
      • GYROKINESIS group: n=48
      • Taiji quan group: n=38
      • Duration: 15wk
      • Pilates group and GYROKINESIS group=2 × 75' or 3 × 50' per week.
      • Taiji quan group = 2 × 50' per week.
      Pilates, GYROKINESIS, and Taiji quan group = improved overall mindfulness. These increases were related with improved sleep quality, self-regulatory, self-efficacy, mood, and perception of stress.
      Emery et al, 2009
      • Emery K.
      • De Serres S.
      • McMillan A.
      • Côté J.
      The effects of a Pilates training program on arm-trunk posture and movement.
      Pre-post test
      • Healthy adults
      • N=19
      • Pilates group: n=10; mean age, 31.1
      • Control group: n=9; mean age, 28.6
      • Duration and frequency: 12wk, 2 × 60' per week.
      • Pilates group = private Pilates sessions on mat and apparatus.
      • Control group = no exercise.
      • Pilates group = improved abdominal strength, thoracic kyphosis, and stabilization of core posture during shoulder flexion task movements.
      • Control group = no differences.
      Koulbec 2010
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      Pre-post test
      • Healthy active middle age
      • N=50; age range, 25–65
      • Pilates group: n=25
      • Control group: n=25
      • Duration: 12wk.
      • Pilates group = 2 × 60' per week.
      • Supervised Pilates classes on mat.
      • Control group = no exercise.
      • Pilates group = improved abdominal and upper body endurance and hamstring flexibility; no differences on static balance and posture.
      • Control group = no differences.
      Rodrigues et al, 2010
      • Rodrigues B.
      • Cader S.
      • Torres N.
      • Oliveira E.
      • Dantas E.
      Pilates method in personal autonomy, static balance and quality of life.
      Pre-post test
      • Elderly females
      • N=52; mean age, 66
      • Pilates group: n=27
      • Control group: n=25
      • Duration and frequency: 8wk, 2 × 60' per week.
      • Pilates group = supervised Pilates on apparatus.
      • Control group = no exercise.
      • Pilates group = improved the static balance, personal autonomy and quality of life index.
      • Control group = no differences.
      Critchley et al, 2011
      • Critchley D.J.
      • Pierson Z.
      • Battersby G.
      Effect of Pilates mat exercises and conventional exercise programmes on transversus abdominis and obliquus internus abdominis activity: pilot randomised trial.
      Pre-post test
      • Healthy adults
      • N=28; mean age, 30
      • Pilates group: n=17
      • Control group: n=11
      • Duration and frequency: 8wk, 2 × 45' per week.
      • Pilates group = unsupervised Pilates on mat.
      • Strength group = unsupervised strength program.
      • Pilates group = improved transversus abdominis and decreased obliquos internus thickness when performing Pilates exercises; no differences in transversus abdominis and obliquos internus thickness at rest and during functional postures.
      • Strength group = no differences.
      Cruz-Ferreira et al, 2011
      • Cruz-Ferreira A.
      • Fernandes J.
      • Gomes D.
      • et al.
      Effects of Pilates-based exercise on life satisfaction, physical self-concept and health status in adult women.
      Pre, mid, and post test
      • Adult females
      • N=62; mean age, 41.08
      • Pilates group: n=38
      • Control group: n=24
      • Duration and frequency: 6mo, 2 × 60' per week.
      • Pilates group = supervised Pilates on mat.
      • Control group = no exercise.
      • Pilates group = improved life satisfaction, physical self-concept, and perception of health status.
      • Control group = no differences.
      Irez et al, 2011
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      Pre-post test
      • Elderly females
      • N=60; aged ≤60y
      • Pilates group: n=30
      • Control group: n=22
      • Duration and frequency: 12wk, 3 × 60' per week.
      • Pilates group = supervised Pilates on mat.
      • Control group = no exercise.
      • Pilates group = improved strength, flexibility (hamstrings and lower back), dynamic balance, reaction time, and number of falls.
      • Control group = no differences.

      Effects of the PME on Health Outcomes

      In physiologic functioning, improvements were reported in flexibility,
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      muscular endurance,
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      transversus abdominis thickness,
      • Critchley D.J.
      • Pierson Z.
      • Battersby G.
      Effect of Pilates mat exercises and conventional exercise programmes on transversus abdominis and obliquus internus abdominis activity: pilot randomised trial.
      range of motion,
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      strength,
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      • Emery K.
      • De Serres S.
      • McMillan A.
      • Côté J.
      The effects of a Pilates training program on arm-trunk posture and movement.
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      reaction time, number of falls,
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      and body composition.
      • Jago R.
      • Jonker M.
      • Missaghian M.
      • Baranowski T.
      Effect of 4 weeks of Pilates on the body composition of young girls.
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      No improvements were reported in transversus abdominis and obliquus internus thickness at rest or during functional postures,
      • Critchley D.J.
      • Pierson Z.
      • Battersby G.
      Effect of Pilates mat exercises and conventional exercise programmes on transversus abdominis and obliquus internus abdominis activity: pilot randomised trial.
      blood pressure,
      • Jago R.
      • Jonker M.
      • Missaghian M.
      • Baranowski T.
      Effect of 4 weeks of Pilates on the body composition of young girls.
      abdominal strength,
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      body composition,
      • Jago R.
      • Jonker M.
      • Missaghian M.
      • Baranowski T.
      Effect of 4 weeks of Pilates on the body composition of young girls.
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      and vertical jump.
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      In psychological functioning, improvements were found in intention of movement, expressivity of the body,
      • Parrott A.
      The effects of Pilates technique and aerobic conditioning on dancers' technique and aesthetic.
      self-efficacy, positive mood and sleep quality,
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Travis Triplett N.
      Effect of Pilates and Taiji quan training on self-efficacy, sleep quality, mood, and physical performance of college students.
      mindfulness,
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Quin R.H.
      • Greeson J.
      Developing mindfulness in college students through movement-based courses: effects on self-regulatory self-efficacy, mood, stress, and sleep quality.
      personal autonomy, quality-of-life index,
      • Rodrigues B.
      • Cader S.
      • Torres N.
      • Oliveira E.
      • Dantas E.
      Pilates method in personal autonomy, static balance and quality of life.
      life satisfaction, physical self-concept, and perception of health status.
      • Cruz-Ferreira A.
      • Fernandes J.
      • Gomes D.
      • et al.
      Effects of Pilates-based exercise on life satisfaction, physical self-concept and health status in adult women.
      In motor learning, enhancements were observed in dynamic balance,
      • Johnson E.
      • Larsen A.
      • Ozawa H.
      • Wilson C.
      • Kennedy K.
      The effects of Pilates-based exercise on dynamic balance in healthy adults.
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      static balance,
      • Rodrigues B.
      • Cader S.
      • Torres N.
      • Oliveira E.
      • Dantas E.
      Pilates method in personal autonomy, static balance and quality of life.
      stabilization of core posture,
      • Emery K.
      • De Serres S.
      • McMillan A.
      • Côté J.
      The effects of a Pilates training program on arm-trunk posture and movement.
      and postural alignment.
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      • Parrott A.
      The effects of Pilates technique and aerobic conditioning on dancers' technique and aesthetic.
      • McMillan A.
      • Proteau L.
      • Lèbe R.
      The effect of Pilates-based training on dancers' dynamic posture.
      • Emery K.
      • De Serres S.
      • McMillan A.
      • Côté J.
      The effects of a Pilates training program on arm-trunk posture and movement.
      No enhancements were found in postural alignment
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      or static balance.
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      Overall, the outcomes studied most often were flexibility,
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      muscular endurance,
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      strength,
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      • Emery K.
      • De Serres S.
      • McMillan A.
      • Côté J.
      The effects of a Pilates training program on arm-trunk posture and movement.
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      and postural alignment
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      • Parrott A.
      The effects of Pilates technique and aerobic conditioning on dancers' technique and aesthetic.
      • McMillan A.
      • Proteau L.
      • Lèbe R.
      The effect of Pilates-based training on dancers' dynamic posture.
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      • Emery K.
      • De Serres S.
      • McMillan A.
      • Côté J.
      The effects of a Pilates training program on arm-trunk posture and movement.
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      (see table 2).

      Strength of the Evidence Using the BES Grading System

      Applying the BES to measure the strength of the evidence, strong evidence was found for improving flexibility (physiologic functioning category)
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      and dynamic balance (motor learning category).
      • Johnson E.
      • Larsen A.
      • Ozawa H.
      • Wilson C.
      • Kennedy K.
      The effects of Pilates-based exercise on dynamic balance in healthy adults.
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      Moderate evidence was found for improving muscular endurance (physiologic functioning category).
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      Limited and no evidence was found for the rest of the outcomes. Table 3 lists the strength of the evidence of each outcome and the direction of the effect against a comparison group. Figure 2 shows the number of outcomes in each level of the strength of evidence. Contradictory results were found in a number of studies and are listed in table 4.
      Table 3Levels of Evidence of Outcomes in Physiologic, Psychological, and Motor Learning Categories
      Level of EvidenceOutcomeStudy Arms
      Physiologic Functioning CategoryStrong evidenceFlexibility +Compared with inactive control or habitual exercise groups.
      Moderate evidenceMuscular endurance +
      Limited evidenceTransversus abdominis thickness when performing Pilates exercises +Compared with strength group.
      Transversus abdominis and obliquos internus thickness at rest and during functional postures −
      Reaction time +Compared with inactive control group.
      Number of falls +
      No evidenceRange of motion +Compared with habitual exercise group.
      Strength + −Compared with inactive control or habitual exercise group or general postural education group.
      Body composition + −Compared with habitual exercise group.
      Vertical jump −
      Psychological Functioning CategoryLimited evidenceLife satisfaction +
      Physical self-concept +Compared with inactive control group.
      Perception of health status +
      No evidenceIntention of movement +Compared with aerobic conditioning and inactive control groups.
      Expressivity the body +
      Self efficacy +Compared with Taiji quan and habitual exercise groups.
      Positive mood +
      Sleep quality +
      Mindfulness +Compared with Taiji quan and Gyrokinesis groups.
      Personal autonomy +Compared with inactive control group.
      Quality of life index +
      Motor Learning CategoryStrong evidenceDynamic balance +Compared with inactive control group.
      Stabilization of core posture +
      No evidencePostural alignment + −Compared with inactive control or habitual exercise groups or general postural education or inactive control group and aerobic conditioning groups or
      Static balance + −Compared with inactive control groups.
      Abbreviations: +, positive results; −, no changes; + −, contradictory results.
      Figure thumbnail gr2
      Fig 2Number of outcomes in each level of strength evidence.
      Table 4Outcomes With Contradictory Results in Healthy People
      OutcomeStudyResults
      StrengthUpper and lower limbsFitt et al, 1993
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      Pilates group improved upper- and lower-limb strength when compared with habitual dance training group.
      Lower backSekendiz et al, 2007
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      Pilates group improved lower back strength when compared with no exercise control group.
      HipIrez, et al, 2011
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      Pilates group improved hip strength, when compared with no exercise control group
      AbdominalSekendiz et al, 2007
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      Pilates group improved abdominal strength when compared with no exercise control group.
      Emery et al, 2010
      • Emery K.
      • De Serres S.
      • McMillan A.
      • Côté J.
      The effects of a Pilates training program on arm-trunk posture and movement.
      Donahoe-Fillmore et al, 2007
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      Pilates group did not improve abdominal strength when compared with general postural education group.
      Body CompositionBody mass index percentileJago et al, 2006
      • Jago R.
      • Jonker M.
      • Missaghian M.
      • Baranowski T.
      Effect of 4 weeks of Pilates on the body composition of young girls.
      Pilates group improved body mass index percentile when compared with habitual exercise control group.
      Body mass indexJago et al, 2006
      • Jago R.
      • Jonker M.
      • Missaghian M.
      • Baranowski T.
      Effect of 4 weeks of Pilates on the body composition of young girls.
      Pilates group did not improve body mass index when compared with habitual exercise control group.
      Waist circumferenceJago et al, 2006
      • Jago R.
      • Jonker M.
      • Missaghian M.
      • Baranowski T.
      Effect of 4 weeks of Pilates on the body composition of young girls.
      Pilates group did not improve waist circumference when compared with habitual exercise control group.
      Body densityRogers and Gibson, 2009
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      Pilates group improved body density when compared with habitual self-prescribed cardiovascular and strength training group.
      Relative body fatRogers and Gibson, 2009
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      Pilates group improved relative body fat when compared with habitual self-prescribed cardiovascular and strength training group.
      Chest, waist, and arm circumferenceRogers and Gibson, 2009
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      Pilates group improved chest, waist, and arm circumference when compared with habitual self-prescribed cardiovascular and strength training group.
      Hips and thigh circumferenceRogers and Gibson, 2009
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      Pilates group did not improve hips and thigh circumference when compared with habitual self-prescribed cardiovascular and strength training group.
      BalanceStatic balanceKloubec, 2010
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      • Pilates did not improve static balance when compared with no exercise control group.
      • Pilates improve static balance when compared with no exercise control group
      Rodrigues et al, 2010
      • Rodrigues B.
      • Cader S.
      • Torres N.
      • Oliveira E.
      • Dantas E.
      Pilates method in personal autonomy, static balance and quality of life.
      Postural AlignmentPelvicFitt et al, 1993
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      Pilates group improved pelvic alignment when compared with habitual dance training group.
      PelvicDonahoe-Fillmore et al, 2007
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      Pilates group did not improve pelvic alignment when compared with no general postural education group.
      Standing and in-motion alignmentParrott, 1993
      • Parrott A.
      The effects of Pilates technique and aerobic conditioning on dancers' technique and aesthetic.
      Pilates group improved standing and in-motion alignment when compared with no exercise group and aerobic conditioning group.
      DynamicMcMillan et al, 1998
      • McMillan A.
      • Proteau L.
      • Lèbe R.
      The effect of Pilates-based training on dancers' dynamic posture.
      Pilates group improved dynamic alignment of upper body region when compared with habitual dance training group.
      ThoracicEmery et al, 2009
      • Emery K.
      • De Serres S.
      • McMillan A.
      • Côté J.
      The effects of a Pilates training program on arm-trunk posture and movement.
      Pilates improved thoracic kyphosis when compared with no exercise control group.
      UnspecifiedKloubec, 2010
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      Pilates did not improve posture when compared with no exercise control group.

      Discussion

      This systematic review was conducted to answer the question: What is the evidence for the effectiveness of the PME on outcomes in healthy people? This investigation adds to previous reviews by applying a method quality scale, evaluating the strength of evidence by using an established grading system, and including a larger number of published RCTs. We found strong evidence to support the use of the PME to improve flexibility and dynamic balance, moderate evidence to improve muscular endurance, and limited evidence to improve transversus abdominis and to decrease obliquus internus thickness during performance of the PME, and to improve reaction of time, number of falls, life satisfaction, physical self-concept, and perception of health status. Limited evidence was found, with no change in transversus abdominis and obliquus internus thickness while at rest or during functional postures. No evidence was found for the rest of the outcomes.
      Until the mid-1980s, the PME was known and practiced almost exclusively by dancers. By the 1990s, this method had increased in popularity outside the world of dance.
      • Latey P.
      The Pilates method: history and philosophy.
      This historical timeline helps explain why the first 3 RCTs, published in the 1990s, were conducted with dancers. Since 2000, with the proliferation of the PME into mainstream fitness and exercise, an increasing number of published RCTs using the PME in healthy people have been published. More than half (n=9) the published studies were performed on the mat compared with the apparatus and mat plus apparatus. This is not surprising because mat exercises are not as demanding in terms of supervision, are more affordable and readily available, and can be taught in larger groups compared with apparatus exercises. There were no published studies comparing the type of Pilates training (mat or apparatus) and the type of Pilates certification method and its impact on outcomes.
      The method quality of studies generally was low (mean score, 4.1). PEDro scale items satisfied most often in the 16 RCTs are related to the similarity of subject characteristics at baseline, between-group comparisons, and point measures and variability. These items indicate strengths in the subject enrollment process and in analyzing subjects' data by using meaningful measures and statistical analyses. Although all studies were reported as RCTs, 9 did not satisfy the randomization criteria because they did not explicitly state that allocation was random. Items less satisfied were criteria related to blinding (blinding of therapist and subjects) and random allocation. Blinding of subjects
      • Maher C.G.
      A systematic review of workplace interventions to prevent low back pain.
      • Moseley A.
      • Herbert R.
      • Sherrington C.
      • Maher C.
      Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database.
      and therapists
      • Maher C.G.
      A systematic review of workplace interventions to prevent low back pain.
      is difficult to achieve in exercise studies. The intention-to-treat criterion was satisfied in only 4 studies. This criterion is important when determining a study's power to detect differences between groups and can be a threat to external validity. Intention to treat also encompasses subject dropouts, and less than one-third of the studies had a dropout rate less than 15%. Exercise studies with control groups can be plagued with high dropout rates because of subject disinterest, and methods to retain randomly assigned subjects should be used.
      Strong evidence was found for the PME improving flexibility compared with inactive
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      or habitual exercise groups
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      and dynamic balance compared with inactive groups.
      • Johnson E.
      • Larsen A.
      • Ozawa H.
      • Wilson C.
      • Kennedy K.
      The effects of Pilates-based exercise on dynamic balance in healthy adults.
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      This evidence was provided by 2 high-quality RCTs for each outcome.
      Moderate evidence was observed for improving muscular endurance compared with inactive
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      or habitual exercise
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      or general postural education groups,
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      provided by 1 high-quality and 3 low-quality RCTs. Additionally, changes in muscular endurance were not observed in general postural education groups, which determines the superiority of PME enhancing this outcome.
      Limited evidence was found in improving transversus abdominis and decreasing obliquos internus thickness of adults during performance of the PME by comparing the PME and strength training.
      • Critchley D.J.
      • Pierson Z.
      • Battersby G.
      Effect of Pilates mat exercises and conventional exercise programmes on transversus abdominis and obliquus internus abdominis activity: pilot randomised trial.
      Neither group improved this outcome while at rest or during functional postures. Therefore, although the PME increased muscle mass, it did not improve function compared with strength training alone. Furthermore, limited evidence was found for improving reaction time, number of falls,
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      life satisfaction, physical self-concept, and perception of health status
      • Cruz-Ferreira A.
      • Fernandes J.
      • Gomes D.
      • et al.
      Effects of Pilates-based exercise on life satisfaction, physical self-concept and health status in adult women.
      when the PME was compared with an inactive control group.
      • Cruz-Ferreira A.
      • Fernandes J.
      • Gomes D.
      • et al.
      Effects of Pilates-based exercise on life satisfaction, physical self-concept and health status in adult women.
      • Irez G.B.
      • Ozdemir R.A.
      • Evin R.
      • Irez S.G.
      • Korkusuz F.
      Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls.
      These conclusions were drawn from 1 RCT with a high methodological quality.
      There was no evidence for range of motion and vertical jump compared with a habitual exercise group.
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      No evidence was found for most outcomes of the psychological category. Women dance students who enrolled in Pilates method classes enhanced their intention of movement and expressivity of the body.
      • Parrott A.
      The effects of Pilates technique and aerobic conditioning on dancers' technique and aesthetic.
      Although the control group had no differences, the aerobic conditioning group improved only expressivity of the body, which does not establish the superiority of the PME in this outcome. Similar conclusions were presented by Caldwell et al,
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Quin R.H.
      • Greeson J.
      Developing mindfulness in college students through movement-based courses: effects on self-regulatory self-efficacy, mood, stress, and sleep quality.
      in which mindfulness was reported in college students after practicing the PME, GYROKINESIS, and Taiji quan programs. All these interventions are mind-body fitness methods; therefore, variability among groups was expected to be minimal. In contrast, Caldwell et al
      • Caldwell K.
      • Harrison M.
      • Adams M.
      • Travis Triplett N.
      Effect of Pilates and Taiji quan training on self-efficacy, sleep quality, mood, and physical performance of college students.
      showed that the PME promoted self-efficacy, positive mood, and sleep quality, making this method a better choice than Taiji quan and recreation. These health outcomes are psychological in nature, and the physicality of the PME may contribute to the improved outcomes in this study.
      No evidence was found for outcomes with contradictory results, which calls into question the effectiveness of the PME in outcomes in the physiologic (body composition and strength) and motor learning (postural alignment, static balance) categories (see table 4). Contradictory results were found for abdominal strength, for which improvements were observed by Sekendiz,
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      Emery,
      • Emery K.
      • De Serres S.
      • McMillan A.
      • Côté J.
      The effects of a Pilates training program on arm-trunk posture and movement.
      and colleagues and no improvements were found by Donahoe-Fillmore et al.
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      Differences between Sekendiz,
      • Sekendiz B.
      • Altun O.
      • Korkusuz F.
      • Akın S.
      Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females.
      Donahoe-Fillmore,
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      and colleagues may be related to the process for measuring abdominal strength (maximum curl-ups vs isometric contraction, respectively). Contradictions with conclusions drawn by Emery,
      • Emery K.
      • De Serres S.
      • McMillan A.
      • Côté J.
      The effects of a Pilates training program on arm-trunk posture and movement.
      Donahoe-Fillmore,
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      and colleagues may be due to the instructional and Pilates equipment methods (private Pilates method on the mat and apparatus vs unsupervised Pilates method on the mat, respectively) and duration of the Pilates method intervention (12 vs 10wk, respectively). In the study by Jago et al,
      • Jago R.
      • Jonker M.
      • Missaghian M.
      • Baranowski T.
      Effect of 4 weeks of Pilates on the body composition of young girls.
      no differences were found in women students' waist circumferences after 4 weeks of practicing the PME on the mat. Alternatively, Rogers and Gibson
      • Rogers K.
      • Gibson A.L.
      Eight-week traditional mat Pilates training-program effects on adult fitness characteristics.
      found improvements in waist circumference after 8 weeks of practicing the PME. Knowing that the procedure for waist measurement was the same for both studies, the difference in waist measurements may be because of the duration of the intervention, for which 4 weeks was not sufficient to produce decreases in waist circumference. Donahoe-Fillmore,
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      Fitt,
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      and colleagues assessed pelvic postural alignment by using the same procedures. In the first study, 10 weeks of general postural education and unsupervised Pilates on the mat did not produce effects on pelvic alignment in healthy adult women
      • Donahoe-Fillmore B.
      • Hanahan N.
      • Mescher M.
      • Clapp D.
      • Addison N.
      • Weston C.
      The effects of a home Pilates program on muscle performance and posture in healthy females: a pilot study.
      compared with the general postural education group. In comparison, dance students, after 7 weeks of habitual dance training, supervised Pilates method on the mat, individual work on the apparatus, and daily individual work with Pilates on the mat, improved pelvic postural alignment.
      • Fitt S.
      • Sturman J.
      • McClain-Smith S.
      Effects of Pilates-based conditioning on strength, alignment, and range of motion in university ballet and modern dance majors.
      The dancers' workload and supervised training could explain the differences in findings. Furthermore, dance students have an inherent capacity to internalize and apply the PME in their body work. Benefits were found in static balance in Rodrigues et al's investigation,
      • Rodrigues B.
      • Cader S.
      • Torres N.
      • Oliveira E.
      • Dantas E.
      Pilates method in personal autonomy, static balance and quality of life.
      whereas Kloubec
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      did not observe differences. Such differences may be because of the measures devices and type of intervention. Rodrigues
      • Rodrigues B.
      • Cader S.
      • Torres N.
      • Oliveira E.
      • Dantas E.
      Pilates method in personal autonomy, static balance and quality of life.
      used the Tinetti test,
      • Tinetti M.E.
      Performance-oriented assessment of mobility in elderly.
      and the intervention was based on supervised Pilates on the apparatus. Kloubec
      • Kloubec J.A.
      Pilates for improvement of muscle endurance, flexibility, balance, and posture.
      used a balance board, and the intervention consisted of supervised Pilates on the mat. Thus, the contradictory findings may be because of differences in surface (stable vs unstable) and equipment (Pilates equipment vs the mat).
      The low PEDro scale scores indicated weaknesses in research methods (lack of blinding, intention to treat, concealed allocation), and the lack of strength of evidence calls into question the effectiveness of the PME in healthy people and implies caution when applying the findings into practice. Other factors that affect the scientific validity of the effects include the type of certified PME, veracity of the PME instructor, and variability in measurement, study length, frequency of PME sessions, and age ranges of subjects.

      Study Limitations

      There are a number of limitations with our systematic review. We excluded all studies that were not RCTs or were quasi-RCTs. We did not determine the validity and reliability of the instruments, integrity of the type of PME taught, qualifications of Pilates method instructors, or appropriateness of statistical analyses. Outcomes were broadly grouped, and studies used various criteria for measuring outcomes. No study conducted follow-up assessments to determine lasting effects of the PME on outcomes. A meta-analysis of all RCTs was not feasible because of the clinical heterogeneity of study measures, small sample sizes, and lack of randomization. PEDro scale scoring comes with it own biases because items were scored only when the study clearly reported that criteria were met. The BES is relatively new in its application; thus, the strength of the evidence may have been over- or underestimated.

      Recommendations for Future Research

      The method quality of RCTs involving the PME should be improved to minimize bias, namely, concealing group allocation, using blinding criteria, using power analysis to determine sample size, applying an intention-to-treat analysis, and using interventions to decrease dropout rates. Furthermore, reporting the type of PME, order of exercises, and number of repetitions for each exercise would allow for reproducibility and consistency among researchers. Maintaining consistency in study duration and number and length of PME sessions would enhance the translation research findings into practice.

      Conclusions

      Findings from this systematic review indicate that the PME in healthy people has a low quality of scientific rigor. There was strong evidence to support use of the PME, at least at the end of training, to improve flexibility and dynamic balance and moderate evidence to enhance muscular endurance. Given the paucity of published RCTs, lack of follow-up designs, low method quality of most RCTs, and limited strength of the evidence, more rigorous and robust methods should be used in future investigations.

      Acknowledgments

      We thank Nelson Cortes, PhD, for help in the database and the colleagues of the Department of Sport and Health, University of Évora, for encouragement and support.

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