Effect of Pilates Intervention on Physical Function of Children and Youth: A Systematic Review

Effect of Pilates exercises on balance and gross motor coordination in children with Down syndrome

OBJECTIVE

To investigate the effect of Pilates exercises on balance and gross motor coordination in children with Down syndrome (DS).

METHODS

Forty children with DS, aged 8 up to 10 years, were randomly divided into two groups; experimental and control groups. A designed physical therapy program was applied for both groups, while the experimental group received an additional Pilates exercise program. Balance and gross motor coordination as primary outcomes and quality of life (QoL) as secondary outcome were assessed using Biodex balance system (BBS), Bruininks Oseretsky of Motor Proficiency (BOT-2), and Pediatric quality of life inventory (PedsQL™) sequentially.

RESULTS

Both experimental (Pilates) and control groups demonstrated significant improvements in dynamic balance, gross motor coordination, and QoL after interventions. However, comparison between groups showed significant improvement in favor of the Pilates group in all measured outcomes (P < 0.0001).

CONCLUSION

Adding Pilates exercises to the designed physical therapy program could provide more significant improvements in balance, gross motor coordination, and QoL in children with DS.

TRIAL REGISTRATION

Clinical Trial gov number Identifier: NCT05928949.

Unlocking the Potential: Increasing Muscle Strength in Lower Limbs of Youth Soccer Players over Five Weeks through Mat Pilates Training-A Pilot Study

The interest in soccer generally starts during childhood, with children and young people often looking for opportunities in sports. New exercise techniques can be effective in improving training. The aim of this study was to compare the effects on the strength and physical posture of a group practicing Pilates with another not practicing Pilates, both undergoing continuous football training. In this controlled randomized clinical trial, the participants were 15 soccer club members, who had a training frequency of least three times weekly. The sample was divided into a control group (n = 7) of players who did not undergo any therapeutic intervention (only the usual training) and a Pilates group (n = 8) of players who participated in the mat Pilates program. The intervention consisted of fifteen sessions. Postural evaluations were performed using biophotogrammetry and force analysis. Significant improvements were obtained in terms of increased muscle strength (p = 0.001) for the Pilates group, but there were no significant postural alterations when comparing the two groups. Five weeks of mat Pilates was sufficient to increase lower limb muscle strength in young football players. This pilot study indicates that Mat Pilates as a method that could be planned to be included in training.

Effect of concurrent resistance-aerobic training on inflammatory factors and growth hormones in children with type 1 diabetes: a randomized controlled clinical trial

BACKGROUND

Exercise training is a major factor in controlling type 1 diabetes mellitus (T1DM) in children. The present study aimed to assess the effect of concurrent resistance-aerobic training on selected inflammatory factors and hormones related to blood glucose homeostasis in children with T1DM.

METHODS

In this randomized controlled clinical trial, 40 children (with the mean age of 11.11 ± 2.29 years) were randomly assigned to an experimental (N = 20) or control group (N = 20). They underwent a 16-week training program, composed of concurrent resistance-aerobic training performed intermittently for 60 min three times a week. Before and after training, blood samples were analyzed for glucose homeostasis, selected inflammatory factors, and growth factors. Data were analyzed by paired t-test and analysis of covariance (ANCOVA) in IBM SPSS version 22.

RESULTS

The exercise training intervention reduced fasting blood sugar index (P = 0.002) and glycosylated hemoglobin significantly (P = 0.003). The growth hormone levels were increased significantly only in the experimental group (P = 0.037), whereas no significant difference was noted in the insulin-like growth factor-1 (P = 0.712). It was also found that interleukin-1β and high-sensitivity C-reactive protein did not change in the experimental or control group as compared to the pretest (P > 0.05).

CONCLUSION

As it was shown, it seems that concurrent resistance-aerobic training may improve blood glucose homeostasis and growth hormone. Therefore, these findings may suggest the benefit from exercise training of moderate intensity in children with T1DM. Besides, we recommend undertaking further clinical trials to determine if the exercise training was effective.

TRIAL REGISTRATION

This study was registered in the Iranian Registry of Clinical Trials under the code IRCT20150531022498N30: https://en.irct.ir/trial/41031 . Registered on July 26, 2019. All experiments on the participants were following the Declaration of Helsinki.

Physical activity and education about physical activity for chronic musculoskeletal pain in children and adolescents

BACKGROUND

Chronic pain is a major health and socioeconomic burden, which is prevalent in children and adolescents. Among the most widely used interventions in children and adolescents are physical activity (including exercises) and education about physical activity.

OBJECTIVES

To evaluate the effectiveness of physical activity, education about physical activity, or both, compared with usual care (including waiting-list, and minimal interventions, such as advice, relaxation classes, or social group meetings) or active medical care in children and adolescents with chronic musculoskeletal pain.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PEDro, and LILACS from the date of their inception to October 2022. We also searched the reference lists of eligible papers, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that compared physical activity or education about physical activity, or both, with usual care (including waiting-list and minimal interventions) or active medical care, in children and adolescents with chronic musculoskeletal pain.

DATA COLLECTION AND ANALYSIS

Two review authors independently determined the eligibility of the included studies. Our primary outcomes were pain intensity, disability, and adverse events. Our secondary outcomes were depression, anxiety, fear avoidance, quality of life, physical activity level, and caregiver distress. We extracted data at postintervention assessment, and long-term follow-up. Two review authors independently assessed risk of bias for each study, using the RoB 1. We assessed the overall certainty of the evidence using the GRADE approach. We reported continuous outcomes as mean differences, and determined clinically important differences from the literature, or 10% of the scale.

MAIN RESULTS

We included four studies (243 participants with juvenile idiopathic arthritis). We judged all included studies to be at unclear risk of selection bias, performance bias, and detection bias, and at high risk of attrition bias. We downgraded the certainty of the evidence for each outcome to very low due to serious or very serious study limitations, inconsistency, and imprecision. Physical activity compared with usual care Physical activity may slightly reduce pain intensity (0 to 100 scale; 0 = no pain) compared with usual care at postintervention (standardised mean difference (SMD) -0.45, 95% confidence interval (CI) -0.82 to -0.08; 2 studies, 118 participants; recalculated as a mean difference (MD) -12.19, 95% CI -21.99 to -2.38; I² = 0%; very low-certainty evidence). Physical activity may slightly improve disability (0 to 3 scale; 0 = no disability) compared with usual care at postintervention assessment (MD -0.37, 95% CI -0.56 to -0.19; I² = 0%; 3 studies, 170 participants; very low-certainty evidence). We found no clear evidence of a difference in quality of life (QoL; 0 to 100 scale; lower scores = better QoL) between physical activity and usual care at postintervention assessment (SMD -0.46, 95% CI -1.27 to 0.35; 4 studies, 201 participants; very low-certainty evidence; recalculated as MD -6.30, 95% CI -18.23 to 5.64; I² = 91%). None of the included studies measured adverse events, depression, or anxiety for this comparison. Physical activity compared with active medical care We found no studies that could be analysed in this comparison. Education about physical activity compared with usual care or active medical care We found no studies that could be analysed in this comparison. Physical activity and education about physical activity compared with usual care or active medical care We found no studies that could be analysed in this comparison.

AUTHORS' CONCLUSIONS

We are unable to confidently state whether interventions based on physical activity and education about physical activity are more effective than usual care for children and adolescents with chronic musculoskeletal pain. We found very low-certainty evidence that physical activity may reduce pain intensity and improve disability postintervention compared with usual care, for children and adolescents with juvenile idiopathic arthritis. We did not find any studies reporting educational interventions; it remains unknown how these interventions influence the outcomes in children and adolescents with chronic musculoskeletal pain. Treatment decisions should consider the current best evidence, the professional's experience, and the young person's preferences. Further randomised controlled trials in other common chronic musculoskeletal pain conditions, with high methodological quality, large sample size, and long-term follow-up are urgently needed.

Effects of Pilates in children and adolescents - A systematic review and meta-analysis

BACKGROUND

Pilates can be performed by children as a form of exercise to promote healthy growth and development. The increasing use of Pilates as a type of exercise for children or as an adjunct tool in pediatric rehabilitation should be supported by evidence of its benefits. The aim of this systematic review and meta-analysis was to assess the effects of Pilates as an exercise prescription for children and adolescents.

METHODS

Five electronic databases were searched to identify trials (randomized controlled clinical trials or quasi-experimental studies) with a population of children or adolescents in which Pilates (mat or equipment) was performed as a form of exercise. Studies that investigated outcomes related to health and physical performance was analyzed. Individual trial effects were extracted and pooled for meta-analysis whenever possible. To evaluate the external and internal validity of the studies, we assessed their risk of bias.

RESULTS

Fifteen studies (from 945 records), including 1235 participants, met the eligibility criteria, and were included. The reported outcomes were heterogeneous, so only the effect on flexibility could be included in the meta-analysis (n = 4 studies). A significant positive trend toward improved flexibility for the control group compared with the Pilates group was found (Std. mean difference, 0.54; 95%CI: 0,18, 0.91; p = 0.003).

CONCLUSION

Few studies have assessed the effect of Pilates on children and adolescents. The lack of appropriate methodological descriptions/controls made it impossible to determine if all of the included studies were of good quality.

Describing the nonsurgical, nonpharmacological interventions offered to adolescents with persistent back pain in randomized trials: A scoping review

BACKGROUND AND OBJECTIVES

Persistent nonspecific back pain is now established as a biopsychosocial phenomenon that can be meaningfully affected by individuals' cognitions, emotions, lifestyle factors and family and social relationships. Recent guidelines for the treatment of adolescents with persistent nonspecific back pain, as well as those for youth with mixed chronic pain, strongly recommend interdisciplinary care in which adolescents receive treatment for both mind and body. The objective of this scoping review was to examine the interventions evaluated in randomized trials for adolescents with persistent back pain to determine whether they correspond to these guidelines and to reveal future research priorities.

DATABASES AND DATA TREATMENT

The review protocol was registered in March 2022. We followed the PRISMA guidelines for scoping reviews. Twelve electronic databases were searched for relevant study reports. Data were charted on study characteristics, participant characteristics and intervention details using the Template for Intervention Description and Replication (TIDieR) checklist.

RESULTS

The search yielded 1952 records, of which eight reports representing seven randomized trials were eligible. The most common interventions were exercise therapy (n = 6) and back education (n = 4). Five studies employed multiple intervention components, but none was multidisciplinary. Studies primarily targeted posture or biomechanical factors. One study included an intervention addressing participants' fears and beliefs about pain.

CONCLUSIONS

Randomized trials for adolescents with persistent back pain have primarily relied upon an outdated, biomechanical explanation of persisting pain. Future randomized trials should align with current treatment recommendations and measure outcomes across multiple biopsychosocial domains.

SIGNIFICANCE

This scoping review describes in detail the interventions included in randomized trials for adolescents with persistent, nonspecific back pain. The review is important because it reveals discrepancies between those interventions and the interventions recommended for this population.

Pilates-based exercises for gait and balance in ambulant children with cerebral palsy: feasibility and clinical outcomes of a randomised controlled trial

PURPOSE

To determine if Pilates-based exercise classes could be feasible and effective in changing gait kinematics and balance in ambulant children with Cerebral Palsy (CP).

MATERIALS AND METHODS

A single-blind multi-centre randomised controlled trial compared a four-week, twice-weekly Pilates-based exercise class to a usual exercise control, for ambulant children with CP. Clinical outcome measures were three-dimensional trunk and lower limb kinematics during walking on level ground, uneven ground and crossing an obstacle; and clinical balance measures. Feasibility outcomes were adherence and enjoyment.

RESULTS

Forty-six children (29 male, mean age 10 years 8 months (range 7-17 years), 23 per group) participated. After the four-week intervention, there were no significant between-group differences in trunk or lower limb gait kinematics. Differences were detected in Berg Balance Scale (1.38 points, 95% CI 0.58-2.18) and Functional Walking Test (1.40 points, 95% CI 0.58-2.22), but they were less than the minimum clinically important difference and therefore clinically insignificant. Median class attendance was 5/8 classes.

CONCLUSION

Pilates-based exercises did not change lower limb or trunk kinematics during walking in children with CP and had a clinically insignificant impact on balance. Lower than anticipated adherence prompts consideration of more flexible delivery of future interventions. Implications for RehabilitationAmbulant children with CP can experience impairment of trunk control, negatively impacting balance and gait.In this study, Pilates-based exercise classes did not change kinematics of the trunk or lower limbs during walking and led to negligible improvement in functional balance.Children did not manage to do their Home Exercise Programme, indicating that Pilates-based exercise should be delivered within supervised practice.Children missed on average one in three classes due to unforeseen circumstances, so this should be anticipated when planning group classes.

The Effect of Equipment-Based Pilates (Reformer) Exercises on Body Composition, Some Physical Parameters, and Body Blood Parameters of Medical Interns

BACKGROUND

Pilates is a type of exercise that exerts positive effects on body composition and general health. This study set out to investigate the effects of equipment-based Pilates (reformer) exercise on body composition, some physical parameters, and blood parameters of medical interns showing a tendency toward sedentary life.

MATERIALS AND METHODS

The experimental group (EG) comprising 22 healthy internship students in the medical faculty performed Pilates reformer exercises for nine weeks. The control group (CG) consisted of 18 students who did not engage in any exercise program. The baseline and final parameters of all the participants were measured.

RESULTS

The mean age of the experimental group (EG) was 23.68±1.29 years, while that of the control group (CG) was 24.78±3.44 (p=0.089). A significant difference was evident between the performance pre-test and post-test scores of the EG (p<0.05). However, a significant positive difference was noted only between the waist pre-test and post-test results in the body composition measurements (p<0.05). A significant rise in HDL and fasting blood sugar levels and a decrease in insulin levels was observed in the post-exercise biochemical parameters measured in the EG (p=0.05). When the EG and CG were compared, a significant difference was found only in HDL cholesterol values in relation to the differences between the pre-test and the post-test groups (p=0.024).

CONCLUSION

The positive data from performance tests, especially with its HDL-increasing and insulin-lowering effects in the EG, implicate that Pilates reformer exercises can produce a favorable effect on the healthy living standards of medical interns.

Effects of modified pilates on trunk, postural control, gait and balance in children with cerebral palsy: a single-blinded randomized controlled study

OBJECTIVE

This study aimed to determine the effects of modified pilates exercises (MPE) and neurodevelopmental therapy (NDT) on trunk, postural control, gait, and balance in children with cerebral palsy (CP).

METHODS

18 children with CP between gross motor function classification system (GMFCS) I and III were randomized into two groups as study (Group A, MPE) and control (Group B, NDT). Physiotherapy (PT) took place 2 days a week for 8 weeks. Trunk control measurement scale (TCMS), seated postural control measurement (SPCM), pediatric reach test (PRT), pediatric berg balance measurement (PBBM), 6 minute walking test (6MWT), observational gait scale (OGS), core stability performance measurements, and muscle strength tests were performed.

RESULTS

Mean age of group A (n = 9) was 9 ± 1.58 years, and group B (n = 9) was 10 ± 2.73 years. Significant differences were found in the SPCM posture (p = 0.000), TCMS (p = 0.004), OGS right (p = 0.019) and left (p = 0.001) scores, abdominal fatigue test (AFT) (p = 0.014), modified side bridge (MSBT) test (right p = 0.04, left p = 0.031), pressure biofeedback unit test (PBU) (p = 0.024), and sit-ups test (SUT) (p = 0.011) in favor of group A. According to the initial measurements of the percentage changes of the tests, significantly difference was found in PBBMR (p = 0.001), PBBML (p = 0.000), SPCM posture (0.001), TCMS (0.000), MBSTET (0.000), MSBT left (p = 0.034), AFT (p = 0.002), PBU (p = 0.015), SUT (p = 0.000), MPUT (p = 0.018), and OGS right (p = 0.029) in favor of group A.

CONCLUSION

The results revealed that MPEs in children with CP positively affects trunk, postural control, gait, and balance compared to NDT. It is concluded that MPE can be used as an alternative treatment approach in children with CP. TRIAL REGISTRATION NUMBER/DATE OF REGISTRATION/STUDY START DATE/URL OF THE RECORD: NCT04035954/ 24/07/2019/ August 1, 2019/ https://clinicaltrials.gov/ct2/show/NCT04035954 .

How does the Execution of the Pilates Method and Therapeutic Exercise Influence Back Pain and Postural Alignment in Children Who Play String Instruments? A Randomized Controlled Pilot Study

BACKGROUND

Inappropriate posture in children while playing some string instruments can cause back pain and alterations of the spine. To date, there is no research on the effect of exercise on children who play a musical instrument, although it is known that transversus abdominis muscle control through the Pilates method has shown pain reduction and posture improvement in this population.

OBJECTIVE

To assess the effectiveness of the Pilates method combined with therapeutic exercise with respect to therapeutic exercise exclusively in reducing pain and improving postural alignment in children playing string instruments applying a protocol of low dose to increase children's adherence to training.

METHODS

A randomized controlled pilot study was designed with two parallel intervention groups. Twenty-five children (10-14 years old) were randomized in two intervention groups: Pilates method with therapeutic exercise (experimental) and therapeutic exercise (control) for 4 weeks (50 min per day, one day per week). Two assessments were performed (before and after treatment) to assess back pain and shoulders and hips alignment using a visual analog scale and the Kinovea program.

RESULTS

Statistically significant differences were obtained for pain reduction before (p = 0.04) and after (p = 0.01) playing the instrument in the experimental group. There were no significant changes in alignment improvement in any of the two groups.

CONCLUSION

The application of a low dose of the Pilates method combined with therapeutic exercise could be a beneficial intervention for pain reduction before and after musical practice in children who play string instruments.

The effect of concurrent resistance-aerobic training on serum cortisol level, anxiety, and quality of life in pediatric type 1 diabetes

Background Given the importance of anxiety and quality of life for the mental health of children with type 1 diabetes (T1D), exercise prescription can be of crucial significance. The present study aims to explore the effect of concurrent resistance-aerobic training on serum cortisol level, anxiety, and quality of life among pediatric T1D. Methods Forty children (aged 8-14 years) were randomly assigned to experimental (n = 20) and control groups (n = 20) for 16 weeks. The exercise training program was composed of 16 weeks of interval concurrent resistance-aerobic training with a duration of 60 min performed three times a week. The subjects first performed the resistance training (20 min of Pilates exercises and 20 min of body weight-bearing exercises). Then, the aerobic exercises were performed with an intensity of 50-75% of maximum heart rate. Before and after the training, blood tests including cortisol were carried out on the subjects by RIA kit. Anxiety and quality of life were measured by the Revised Children's Manifest Anxiety Scale (RCMAS) and Pediatric Quality of Life (PedsQL), respectively. Body composition was measured by InBody. Data were analyzed by paired and independent t-test at p < 0.05 significance level. Results Sixteen weeks of concurrent resistance-aerobic exercise significantly reduced the anxiety index (p = 0.001) and increased the quality of life (p = 0.003). Although the cortisol index was increased, it did not reveal any significant differences between the experimental and control groups (p = 0.781). No significant differences were observed in the indices of quality of life, anxiety, and cortisol in the control group. Conclusions A 16-week program of concurrent resistance-aerobic training can improve the quality of life and anxiety among children suffering from T1D, but it may not influence the cortisol level (p > 0.05).

Effect of Pilates on Sleep Quality: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective: Pilates exercise is increasingly used to improve sleep quality, but relevant evidence remains unclear. We aimed to estimate the effect of Pilates on sleep quality.

Methods: Five databases were searched for articles published until 10 December 2019. Two investigators screened the articles and extracted data from each included study. A meta-analysis was performed to evaluate the effect of Pilates on sleep quality, assessed using the Pittsburgh Sleep Quality Index (PSQI).

Results: Six randomized controlled trials (RCTs) comprising 477 participants were included according to the inclusion and exclusion criteria in the study. All included studies reported the positive effects Pilates had on sleep quality. The Pilates group (PG) significantly lowered the PSQI total score (MD = −3.60, 95%CI: [−5.41, −1.78), P = 0.0001, I² = 97%) compared to the non-exercising control group (CG), whereas no significant improvement in use of sleep medication was observed (MD = −0.33, 95%CI: [−0.73, −0.06), P = 0.10, I² = 68%). However, in a subgroup analysis, we found that there was no significant reduction in the PSQI total score for healthy participants over 40 years old (MD = −3.73, 95%CI: [−7.89, 0.42], P = 0.08, I² = 98%) and for postmenopausal women (MD = −5.55, 95%CI: [−13.98, −2.89], P = 0.20, I² = 98%).

Conclusions: Overall, Pilates improved sleep quality but had no significant effect on the use of sleep medication. However, Pilates showed no significant impact on sleep quality for healthy individuals over 40 years old and for postmenopausal women. Well-designed and large-scale RCTs are needed in the future.