Pilates for Overweight or Obesity: A Meta-Analysis

Effects of protein supplementation during pilates training on body composition, core muscle endurance, and joint flexibility in trained women: a randomized controlled trial

BACKGROUND

Pilates is a popular type of exercise, aimed at improving core muscle strength and endurance, core stability, and joint flexibility through a variety of whole-body exercises. Research has shown that Pilates improves body composition, muscle endurance, and joint flexibility. Adequate protein intake is a key factor in supporting the adaptive response of skeletal muscle to exercise training. However, whether protein supplementation augments the adaptations to Pilates training remains unknown. Thus, the aim of the present study was to investigate the effects of protein supplementation during Pilates training on body composition, core muscle endurance, and joint flexibility in trained women.

METHODS

Nineteen Pilates-trained women (31 ± 9 y) performed 10 weeks of Pilates training using the Reformer and Cadillac apparatuses, at least 2 times per week. Participants were randomly allocated to either a placebo (n = 10) or protein supplementation group (n = 9) in a quadruple-blind (participants, intervention providers, investigators, and outcome assessors) design. Participants received 0.6 g of maltodextrin or whey protein per kg body weight daily, respectively. Habitual dietary intake was monitored throughout the study. Before and after the intervention, anthropometric measures (body weight, body mass index, waist and hip circumferences), body composition [through full-scan dual-energy X-ray absorptiometry (DXA) and multifrequency bioelectrical impedance analysis (BIA)], core muscle endurance (through the McGill's torso muscular endurance test battery), and joint flexibility (through the sit-and-reach test) were assessed. Data were analyzed by 2-way ANOVA (supplement × time) with repeated measures on time. Common DXA and BIA variables (whole-body fat and lean mass) were compared through paired Student's t tests and subjected to Pearson's correlation analysis. The level of statistical significance was set at α = 0.05.

RESULTS

Participants received, on average, 1.3 g protein/kg body weight/day from their habitual diet. After 10 weeks of Pilates training and regardless of supplementation, body fat (assessed by BIA) and hip circumference decreased; lean mass, total water, and extracellular water (by BIA) increased; and arm lean mass, trunk bone mineral content, and trunk bone area (by DXA) increased (all p < 0.05). The common BIA and DXA variables were highly correlated (r > 0.78, p < 0.001) and did not differ pre-intervention (p > 0.1), although they differed post-intervention (p < 0.001), with BIA overestimating lean mass compared with DXA. Core muscle endurance and joint flexibility increased with training (p < 0.05), with no effect of supplementation.

CONCLUSION

Ten weeks of Pilates training improved core muscle endurance, joint flexibility, and aspects of body composition in healthy trained women, but these adaptations were not enhanced by daily supplementation with 0.6 g of protein per kilogram body weight.

Are Pilates Exercises Effective in Improving Postural Misalignment? Systematic Review and Metanalysis

INTRODUCTION

Pilates is commonly used to treat postural misalignments; however, there is a lack of systematic reviews on this topic.

OBJECTIVE

To verify the effects of Pilates on postural misalignment.

METHODS

A search (25 February 2024) was conducted in PubMed, EMBASE, CENTRAL, CINAHL, Web of Science, LILACS, SportDiscus, and PEDro. The methodological quality was assessed via the PEDro scale, and the certainty of evidence via the GRADE system. The meta-analysis was conducted using the standardised mean difference (SMD).

RESULTS

Eighteen studies were included in the systematic review. Eight studies had a low risk of bias. In children and adolescents, there was moderate certainty of evidence that Pilates improves postural alignment of the thoracic angle (SMD = -0.45 [0.67, -0.23]) and lumbar angle (SMD = -0.29 [-0.50, -0.07]) compared with inactive controls, whereas there was very low certainty of evidence that the Schroth technique is superior to Pilates for scoliosis (SMD = 0.98 [0.32, 1.65]). In adults, very low- to low-certainty evidence has indicated that Pilates improves postural alignment of the shoulder angle (SMD = -0.78 [-1.23, -0.33]), scoliosis (SMD = -0.52 [-1.01, -0.04]) and lumbar lordosis (SMD = -0.40 [0.72, -0.08]) compared with inactive controls and improve the craniovertebral angle (SMD = -1.24 [-2.85, -0.38]) compared with stretching and strengthening exercises.

CONCLUSION

Pilates has some potential for improving postural misalignment of the thoracic and lumbar angles in children and adolescents. However, for other body segments, due to the low certainty of the evidence, further studies are needed.

Effect of Pilates exercises on symptoms of irritable bowel syndrome in women: a randomized controlled trial

Objective

The treatment of irritable bowel syndrome (IBS) is challenging, calling for therapeutic strategies other than pharmacological treatment. Therefore, this study aimed to investigate the effects of Pilates exercises on IBS symptoms and severity, frequency of complete spontaneous bowel movements, fatigue, anxiety, depression, and body weight in women with IBS.

Methods

Sixty women with IBS, aged 20-45, completed this study. They were randomly assigned to two equal groups: a study group (n = 30) and a control group (n = 30). The study group received an 8-week Pilates exercise program (2 sessions per week) in addition to dietary advice, while the control group received dietary advice only. Inclusion criteria were women, IBS diagnosed based on Rome IV Diagnostic criteria, constipation-predominant IBS, and moderate to severe IBS. The outcome measures were the IBS severity scoring system (IBS-SSS), the frequency of complete spontaneous bowel movements, the modified fatigue impact scale (MFIS), hospital anxiety and depression (HADS) scale, and body weight (BW).

Results

The study group showed more significant improvements than the control group in total IBS-SSS score (Cohen d = 0.73, p < 0.001), frequency of complete spontaneous bowel movements (Cohen d = 0.50, p < 0.001), total MFIS score (Cohen d = 0.74, p < 0.001), anxiety (Cohen d = 0.56, p < 0.001), and depression (Cohen d = 0.64, p < 0.001). The study group also showed a significant reduction in body weight compared to baseline (p < 0.05). The control group showed significant improvements in all outcomes, except body weight, compared to baseline (p < 0.05).

Conclusion

Pilates exercises, used in addition to dietary advice, may significantly improve IBS symptoms and severity, frequency of complete spontaneous bowel movements, and alleviate fatigue, anxiety, and depression moderately more than dietary advice alone in women with constipation-predominant IBS. Nevertheless, dietary advice alone may also significantly improve these outcomes in this cohort.

Effects of Online Pilates and Face-to-Face Pilates Intervention on Body Composition, Muscle Mechanical Properties, Cardiometabolic Parameters, Mental Health, and Physical Fitness in Middle-Aged Women with Obesity

With the emergence of coronavirus disease 2019, individuals have been participating in online exercises to maintain their health while avoiding infection. Among these online exercises, Pilates intervention is a popular modality. This study aimed to examine the differences between online and face-to-face Pilates interventions in terms of various physiological parameters and included 30 middle-aged individuals (age 43.3 ± 5.5 years) with obesity. These individuals were randomly divided into a face-to-face Pilates group (FPG), an online Pilates group (OPG), and a control group (CG). The FPG and OPG performed a 60-min mat Pilates program with a Borg scale of 11-17, three times a week for 12 weeks. The participants in the CG maintained their daily routines. Body composition, mechanical muscle properties, cardiometabolic parameters, mental health, and physical fitness were assessed before and after 12 weeks of intervention. No significant differences in body composition or cardiometabolic parameters were observed between groups. However, the FPG and OPG showed greater improvements than the CG in terms of muscle mechanical properties, cardiometabolic parameters, mental health, and physical fitness. In addition, the FPG showed greater improvement than the OPG. In conclusion, face-to-face Pilates is a more effective modality than online Pilates, although both modalities improve health-related parameters.

Pilates and multiple health outcomes: An umbrella review

OBJECTIVES

To summarize the evidence of associations between Pilates and multiple health outcomes, and evaluate the strength and validity of these associations.

DESIGN

Unbrella review.

METHODS

PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to February, 2023. The methodological quality of included studies was assessed using A Measurement Tool to Assess Systematic Reviews, version 2 and the certainty of evidence was graded by the Grading of Recommendation, Assessment, Development and Evaluations. We recalculated each outcome using random-effects models with standardized mean difference.

RESULTS

We identified 27 systematic reviews with meta-analyses in this umbrella review. 1 was rated as high quality, 1 as moderate quality, 15 as low quality, and 10 as critically low quality. These studies focused on the populations with diseases of the circulatory system, endocrine, nutritional or metabolic diseases, genitourinary system diseases, mental, behavioral, or neurodevelopmental disorder, musculoskeletal system diseases, neoplasms, nervous system diseases, sleep-wake function disorder and others. Compared with inactive/active intervention, Pilates can reduce body mass index and body fat percentage, relieve pain and disability, and improve sleep quality and balance. The certainty of evidence was very low to moderate for these outcomes.

CONCLUSIONS

Pilates showed benefits on several health outcomes related with low back pain, neck pain and scoliosis. However, the certainty of the evidence was mostly low; further high quality randomized controlled trials are needed to elucidate and support these promising findings.

Role of Mind-Body Fitness in Obesity

Various mind-body fitness modalities such as Pilates, yoga, Tai Chi, and Qigong have become an accepted part of the physical activity, exercise, and leisure sector, serving several populations eligible for meditative movement activities. However, no robust evidence is present in the current literature supporting the efficacy of these meditative movement activities on health, fitness, and well-being markers among obese adults. Interestingly, the feasibility and safety of mind-body fitness programs in this cohort are still questionable. However, the limited available data show the beneficial role of such alternative exercise options in improving numerous physical fitness and cardiometabolic health-related indicators. The major role of mind-body fitness in obese individuals is to promote muscle control, body functionality, flexibility, and balance while reducing physical limitations, chronic pain, and stress through sessions integrating body postures, efficient breathing patterns, meditation, and relaxation. Such a bodily movement-based approach may be associated with increased physical performance and improved cardiometabolic as well as mental health. However, data on anthropometric characteristics, body composition and cardiovascular disease risk factors modification are somewhat equivocal. Future studies are needed to investigate a wider spectrum of physical fitness and cardiometabolic health parameters, since obese people are likely to demonstrate poor functional capacity, impaired glucose control, lipid disorder, and abnormal blood pressure levels.

Effects of a 12-Week Pilates Program on Functional Physical Fitness and Basal Metabolic Rate in Community-Dwelling Middle-Aged Women: A Quasi-Experimental Study

Background: The aging society worldwide carries public and inevitable issues. Aging is accompanied by multiple diseases, and the health impacts challenge healthcare and social systems. In addition to medical treatment, exercise has been recognized as an effective strategy not only for disease prevention and alleviation, but also for multiple health benefits on health promotion. The purpose of this study was to investigate the effects of a suitable Pilates exercise intervention program on health maintenance and benefits in community-dwelling middle-aged women with a quasi-experimental design. Methods: We recruited healthy middle-aged community-dwelling women who had not regularly exercised in the previous three months. The participants were assigned to the experimental (n = 22) and control (n = 23) groups based on a quasi-experimental design. The experimental group participated in a mat-based Pilates exercise class twice a week (1 h/session) throughout the 12-week intervention, whereas there was no intervention for the control group. Body composition, basal metabolic rate, and functional physical fitness—comprising cardiovascular capacity, flexibility, muscular strength of upper limbs, muscular strength of lower limbs, core strength, agility, static balance, and dynamic balance—were assessed as primary outcomes in both groups before and after the intervention. Results: There were no significant differences in any of the dependent variables between the two groups before the exercise intervention. After the 12-week intervention, body composition, including body mass index, body fat (−1.5 to 3%), and basal metabolic rate (+10.6%), and functional fitness, including flexibility (+3.5%), core strength (+31.5%), lower-limb strength (+13.5%), agility (+7.3%), and balance (+4.2%), improved significantly in the experimental group relative to the control group (p < 0.05). Moreover, the improvement in physical fitness in lower-limb strength, agility, and balance for fall prevention also demonstrated higher clinical significance than the control. Conclusions: This 12-week mat-based Pilates exercise program significantly improved body composition, basal metabolic rate, and functional physical fitness in community-dwelling middle-aged women. The beneficial effects of Pilates exercise programs may thus promote improved health in the middle-aged female population, with practical implications for communities.

Psychophysiological Adaptations to Pilates Training in Overweight and Obese Individuals: A Topical Review

The prevalence of overweightness and obesity has been documented as a major public health issue since it has increased at an alarming rate worldwide. Structured physical exercise programs have been reported as an essential strategy for preventing, managing, and treating obesity, inducing critical improvements in various physiological and psychological markers. However, it is unclear whether Pilates training can elicit positive changes in body composition, physical fitness, cardiometabolic health, and well-being among overweight and obese populations. The purpose of this topical review was to catalog studies investigating the physiological and psychological adaptations to Pilates training in order to identify what outcomes have been assessed, the research methods used, and the results. The inclusion/exclusion criteria were met by 14 published articles involving 582 participants (83% female) who were overweight or obese. The present topical review on Pilates training-induced adaptations shows that this widely used exercise type can significantly improve the majority of the selected indicators. These beneficial changes are frequently focused on anthropometric parameters, body composition, glucose, and lipid metabolism, as well as blood pressure in sedentary overweight or obese women. Specialized equipment-based Pilates interventions and trials investigating various mental health indices were limited. Further research is warranted in this area, emphasizing the Pilates training configuration and potential mechanisms behind positive alterations in several psychophysiological markers through large-scale randomized controlled trials with superior methodological quality, implementing long-term interventions in various populations that are overweight and obese.

Effectiveness of Pilates Training on Body Composition and Isokinetic Muscular Strength in Adolescent Baseball Players

Body composition and muscular strength are important for baseball skills and successful performance. Conditioning training programs have the potential to enhance athletic performance via physiological changes. In this single-group interventional study, we investigated the effect of 8 weeks of Pilates training (PT) on contralateral and regional body composition, and isokinetic muscular strength in knee and trunk flexion/extension in adolescent baseball players. In our results, PT increased both right- and left-sided lean mass in the trunk. Following PT, work per repetition and average power showed significant increases in the flexion and extension of the left knee only. PT significantly decreased the peak torque of the trunk flexor and increased the average power of the trunk extensor. In addition, the ratio of the trunk flexion/extension strength of peak torque showed a decreasing trend, whereas that of work and average power did not change significantly following PT. In conclusion, PT evenly improved lean mass on both the right and left sides of the body. Knee and trunk strength increased after PT. Our findings suggest that PT may be a useful strategy for enhancing athletic performance in regard to the muscular strength of adolescent baseball players.

Efficacy of Pilates in Functional Body Composition: A Systematic Review

The aim of this review was to collect and systematize results of studies from the last 5 years concerning the influence of the Pilates method (PM) on functional body composition (FBC). Methods: The criteria of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used in this review. We conducted research in three scientific databases: (i) Web of Science Core Collection, (ii) SCOPUS, and (iii) search directory of the library catalog of the Faculty of Sport and Physical Education of the University of Coimbra—EBSCO Discovery Services. We found 334 articles, covering the period between 1 January 2017 and 31 December 2021. After the selection process, we found 33 eligible articles. Results: The main results seem to point to a tendency to get a better body weight and body fat percentage (BFP), hip circumference (HC), waist, and skinfolds from the chest, abdomen, triceps, and supra-iliac in mostly female samples. Available evidence indicates that, in body composition (BC) and FBC, Pilates practice tends to be effective in reducing obesity as a multifactorial condition. Conclusions: It is concluded that there is a marked trend in the benefits of Pilates in FBC, which is in line with other systematic reviews at the BC level (which includes body weight (BW) and body mass index (BMI)) and in the reduction of the percentage of fat mass (FM). It is also concluded that there is a vast lack of studies on the male population, preventing further scientific development in this area. The limitations of this systematic review can be overcome with studies that bring together multidisciplinary aspects of FBC, better designed and methodologically more robust, which will allow more reliable analyses for the implementation of the Pilates method in terms of FBC. In addition, further studies with a male sample or mixed samples (men vs. women) could confirm the trend of no gender differences in the benefits of Pilates practice.

Effect of 6 weeks Pilates training along with dill supplementation on serum concentrations of nesfatin-1, lipocalin-2, and insulin resistance in females with overweight and obesity: A randomized controlled trial

Background:

This study aimed to investigate the effect of 6 weeks’ pilates training along with dill supplementation on serum concentrations of nesfatin-1, lipocaline-2, and insulin resistance in females with overweight and obesity.

Materials and Methods:

In this randomized controlled trial study, 45 overweight and obese females are randomly assigned to four groups: Pilates training + dill group (PDG) (n = 12), pilates training + placebo group (PPG) (n = 11), dill supplementation group (DG) (n = 11), and placebo group (PG) (n = 11). Participants of PDG and PPG performed pilates training for 6 weeks (60 min, 3 sessions per week). PDG and DG received dill tablet (three times a day, 6 weeks). Anthropometric measurements, glycemic markers, and blood samples were assessed before (pretest) and after (posttest) 6 weeks of intervention.

Results:

Results showed a significant increase in serum concentrations of nesfatin-1 in PDG compared to pretest (P = 0.001). Differences in the serum concentrations of nesfatin-1 in PDG were greater than PPG, DG, and PG (P = 0.01). Furthermore, results found in significant reduction in serum concentrations of lipocalin-2, body mass index (BMI), and waist-hip ratio (WHR) in PDG, PPG, and DG as compared to pretest (P > 0.05). Fasting glucose plasma (FGP) was significantly decreased in all three intervention groups PDG (P < 0.001), PPG (P < 0.001), and DG (P < 0.001) as compared to pretest. Differences in FGP were significantly higher in PDG than PPG, DG, and PG (P = 0.001). A significant reduction was found for insulin only in PDG after 6 weeks of intervention as compared to pretest (P = 0.03). Insulin resistance significantly decreased in PDG (P = 0.03) and PPG (P = 0.04) as compared to pretest. Body fat percent (BFP) was significantly decreased in PDG (P = 0.003), PPG (P = 0.006), and DG (P = 0.01). However, there were no significant inter-group differences in insulin resistance, insulin, serum concentrations of lipocalin-2, BMI, BFP, and WHR after 6 weeks of Pilates training along with dill supplementation (P > 0.05).

Conclusion:

We concluded that 6 weeks of Pilates training along with dill may be beneficial for improvements in serum concentrations of nesfatin-1 and FGP.

Electroacupuncture for Gastrointestinal Function Recovery after Gynecological Surgery: A Systematic Review and Meta-Analysis

BACKGROUND

Evidence for the efficacy and safety of electroacupuncture (EA) on gastrointestinal function recovery after gynecological surgery is unclear.

OBJECTIVE

This meta-analysis aimed to evaluate the effects of EA on recovery of postoperative gastrointestinal function for patients receiving gynecological surgery. Data sources: PubMed, Cochrane Central Register of Controlled Trials (CINAHL), Embase, China National Knowledge Infrastructure (CNKI), Weipu (CQVIP), and Wanfang databases were systematically searched from the inception dates to May 30, 2020, for relevant randomized controlled trials (RCTs). Study selection: RCTs that evaluated EA for postoperative gastrointestinal function directly related to gynecological surgery in adults aged 18 years or over. Data extraction and synthesis: paired reviewer independently extracted the data and assessed study quality. Standardized mean differences (SMD) were calculated as the effect measure from a random effects model. Main outcomes and measures: time to first flatus (TFF), time to bowel sounds recovery (TBS), and time to first defecation (TFD) were recorded as primary outcomes; postoperative nausea and vomiting (PONV), motilin (MTL), gastrin (GAS), pH value of gastric mucosa (pHi), gastric mucosal partial pressure of carbon dioxide (PgCO2), vasoactive intestinal peptide (VIP), and adverse event were reported as secondary outcomes.

RESULTS

We included eighteen RCTs (1117 participants). Our findings suggested that compared to the control group (CG), electroacupuncture group (EG) showed significant effects on TFF (SMD = -0.98, 95% CI: [-1.28, -0.68], P < 0.00001, I 2 = 69%), TBS (SMD = -0.98, 95% CI: [-1.84, -0.12], P=0.03, I 2 = 92%), and TFD (SMD = -1.23, 95% CI: [-1.59, -0.88], P < 0.0001, I 2 = 0%). Moreover, the incidence of PONV at postoperative 6 h (OR = 0.42, 95% CI: [0.27, 0.64], P < 0.0001, I 2 = 0%) and 24 h (OR = 0.46, 95% CI: [0.32, 0.68], P < 0.0001, I 2 = 0%) was lower in the EG than that in the CG, whereas no significant difference in ratio of PONV at postoperative 48 h (OR = 0.55, 95% CI: [0.20, 1.51], P=0.25, I 2 = 0%) was detected between the two groups. Meanwhile, there was a significant effect in favor of EA on the level of MTL at postoperative 6 h (SMD = -0.93, 95% CI: [-1.36, -0.61], P < 0.0001, I 2 = 21%), while no significant effect was observed at postoperative 24 h (SMD = -0.43, 95% CI: [-0.89, 0.02], P=0.06, I 2 = 69%) in the EG when compared to the CG. Additionally, a large significant effect on decreasing PgCO2 was found in the EG in comparison to the CG, but no significant effect in favor of EA on GAS, VIP, or pHi was observed. It was reported that there was one participant with pain at the needling sites and bruising, and three participants withdrew because they were not intolerant to EA.

CONCLUSIONS

EA could be a promising strategy for the prevention and treatment of gastrointestinal dysfunction after gynecological surgery, including shortening TFF and TFD, TBS, regulating MTL, and decreasing the ratio of PONV within postoperative 24h. The effects on MTL and PONV varied with different intervention points, and EA used at 30 min prior to surgery might be recommended. However, the evidence quality ranged from low to very low, and large-scale and high-quality RCTs were warranted.

Pilates and TRX training methods can improve insulin resistance in overweight women by increasing an exercise-hormone, Irisin

AIMS AND BACKGROUND

Physical inactivity is leading to obesity and consequently insulin resistance and diabetes. Feasible and cost efficient strategies like Pilates and total body resistance exercise (TRX) training can impede obesity and its compilation. The aim of this study was to investigate the effects of 8 weeks Pilates and TRX training programs on irisin concentration and insulin resistance in overweight women.

METHOD

Thirty overweight women (Body mass index (BMI): 25-29.9 kg/m2) were divided, based on their BMI, into 3 groups; control, Pilates and TRX. The participants in the training groups were subjected to moderate intensity of Pilates or TRX exercise training 3 times a week for 8 weeks. Blood samples were taken at pre-test and 48 h after the last training session and used for analyzing irisin, insulin and glucose. Data were analyzed by ANCOVA and paired-samples t-test.

RESULTS

The finding showed that the Pilates training decreased body weight and BMI compared to the pre-test (P < 0.05). Also, it has been revealed that irisin concentration in response to Pilates and TRX training programs were increased in comparison with the control group (P < 0.05). However, there was no significant difference in irisin concentrations between training groups (p > 0.05). Moreover, fasting insulin, glucose and insulin resistance were significantly reduced after exercise intervention compared to the pre-test which were significantly lowered compared to the control group as well.

CONCLUSION

The results suggest Pilates and TRX trainings are two efficient model of exercise that by eliciting an exercise-hormone, irisin, can improve insulin resistance in overweight women.