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ARTICLE IN PRESS

Journal of Bodywork and Movement Therapies (2007) 11, 318326

Journal of
Bodywork and
Movement Therapies
www.intl.elsevierhealth.com/journals/jbmt

EXERCISE PHYSIOLOGY

Effects of Pilates exercise on trunk strength,


endurance and flexibility in sedentary
adult females
zkan Altuna, Feza Korkusuza,b, Sabire Aknb
Betu
l Sekendiza,, O
a

Physical Education and Sports Department, Middle East Technical University (METU), Turkey
Health Centre, METU, Turkey

Received 31 August 2006; received in revised form 28 November 2006; accepted 1 December 2006

KEYWORDS
Pilates mat exercises;
Isokinetic muscle
strength;
Trunk strength;
Flexibility;
Endurance;
Females;
Sedentary

Summary The objective of this study was to examine the effects of Pilates
exercise on abdominal and lower back strength, abdominal muscular endurance and
posterior trunk flexibility of sedentary adult females. The body fat and body mass
index (BMI) pre- and post-data were also assessed as secondary outcomes. To assess
abdominal and lower back strength, posterior trunk flexion and extension data were
obtained concentrically on a Biodex isokinetic dynamometer at speeds of 601 and
1201 s1. Abdominal muscular endurance was assessed using the crunch test and
posterior trunk flexibility was measured using the sit and reach test. Results of
multivariate analysis revealed a significant difference (po.05) between pre- and
post-measures of 601 s1 flexion/extension and 1201 s1 flexion, and abdominal
muscular endurance and posterior trunk flexibility of the exercise group. It can be
concluded that there was a positive effect of Modern Pilates mat exercises on
abdominal and lower back muscular strength, abdominal muscular endurance and
posterior trunk flexibility in sedentary adult females regardless of the fact that the
body weight and fat percentages did not differ significantly.
& 2007 Elsevier Ltd. All rights reserved.

Introduction
Joseph Pilates had developed a unique system
of hooking springs and straps in hospital beds to
Corresponding author. Orta Dogu Teknik Universitesi, Beden
Egitimi ve Spor Bo
lu
mu
, Inonu Bul. PK: 06531, Ankara, Turkiye.
Tel.: +90 532 547 12 56.
E-mail address: betulsekendiz@hotmail.com (B. Sekendiz).

help disabled and immobilized patients regain


strength and movement in order to counteract
the deleterious effects of deconditioning after
World War I, which was later going to be called
Pilates (Friedman et al., 1980; Latey, 2001; Wilson,
2002). With his development of the universal
reformer (Latey, 2001) the importance of training
the core abdominal and lower back muscles to
stabilize the torso and allow the whole body to

1360-8592/$ - see front matter & 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jbmt.2006.12.002

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Effects of Pilates exercise in sedentary adult females
move freely was recognized. This method inspired
other exercises to reach the desired level of
muscular strength and flexibility on simple equipments such as mats (Latey, 2001, 2002; Runion,
2002).
Within the last two decades Pilates exercises
have infused new insights into the fitness industry
and lower back rehabilitation methods. Current
Pilates exercise styles can be divided into (a) the
repertory approach, and (b) the modern approach
(Latey, 2001). The repertory approach being the
traditional method, uses set exercise sequences
and set numbers of repetitions with little amount of
modification for an individuals different types of
problems. However, in the modern approach, the
initial emphasis is on understanding the body
and improving awareness by tailoring the exercises
to clients particular needs, weaknesses and
strengths. In this respect, Modern Pilates mat
exercise trainees should think of their bodies as
single integrated units, with the goal of establishing a stable central core around which all movements take place (Argo, 1999). Through this
approach the quality but not the quantity of the
movement is imposed (Friedman et al., 1980). In
this respect, Modern Pilates mat exercises resembles the theory of weight training to gain optimum
strength and endurance (Ives and Sosnoff, 2000).
Despite the increased popularity of Pilates mat
exercises within the last two decades, little research
has been conducted on the method and its benefits
in a sedentary population. Pilates mat exercises have
been reported to be effective for improving static or
postural balance among a group of dancers (Fitt
et al., 1993). In recent studies (Geweniger, 2002;
Handa et al., 2000; Springen, 2003), it was presented
that Pilates mat exercises, utilized as a therapy
technique for the rehabilitation of severe low back
pain, can be beneficial and effective with improved
results documented in patients. However, further
research is necessary to ascertain the methods
potential to improve the outcome of Modern Pilates
mat exercises in a sedentary population.
The purpose of this 5-week prospective longitudinal study was to investigate the effects of
Modern Pilates mat exercises on abdominal and
lower back muscular strength, abdominal muscular
endurance and posterior trunk flexibility in sedentary
adult females. The body fat and body mass index
(BMI) were also assessed as secondary outcomes.

Subjects and method


Independent variables were groups (Pilates and
control) and time (before and after exercise).

319
Dependent variables included: (a) BMI, (b) body fat,
(c) abdominal and lower back muscular strength, (d)
abdominal muscular endurance, and (e) posterior
trunk flexibility.

Subjects
Randomly selected 45 sedentary academicians in a
university volunteered to participate in this study,
who had not been attending regular exercise
sessions, more than 45 min a day, three times a
week for more than a year. Each woman completed
a demographic and health history questionnaire.
Eighty percent of the participants reported that
they experienced low back pain from time to time.
Informed consent forms regarding information on
the study and possible side effects, such as muscle
soreness in the abdominals and back muscles due to
fatigue, were signed by the participants prior to
the study. Subjects were randomly assigned to the
Pilates and control groups.
Four participants of the exercise group and three of
the control group dropped out of the study. The
reasons for the dropouts were reported to be either
illness or personal decision. Therefore, the final results
reproduced data of 21 women (mean age: 3076.6
range 2647) of the exercise and 17 women (mean
age: 3078.6 range 2647) of the control groups.

Pilates exercise
Exercises were implemented three times a week for
five consecutive weeks. This resulted in a total of 15
sessions completed, which is the recommended
necessary number of exercise sessions to measure
the expected outcomes of Modern Pilates mat
exercises (Stott, 2006). A physical education and
sports instructor who had 2 years of experience and
certification in Modern Pilates mat exercises initiated the exercises. Participants followed a standardized exercise protocol for beginners that lasted
for 60 min day1 (Friedman et al., 1980) (Appendix
A). Some of the exercises in the protocol are shown
in Figs. 1(a)(c), 2(a), (b), 3(a), (b), and 4(a), (b).

Instrumentation and procedures


Instruments for testing all variables were calibrated and used by the same researcher in order to
control possible inter-tester variation. Both the
exercise and the control groups were given pre- and
post-tests on all variables measured. Prior to the
testing, a standardized 5 min warm-up including
brisk walking and upper-lower body stretching
exercises were completed.

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320

B. Sekendiz et al.

Figure 2 (a) The shoulder bridge (starting position) and


(b) the shoulder bridge.

Figure 1 (a) The hundred (modified, starting position),


(b) and (c) the hundred (modified)arms are parallel to
the floor, hovering 2 inches above it and are pulsed up
and down for five inhalations and five exhalations. Pulses
are repeated 10 times to equal 100.

Abdominal and lower back muscular strength


Abdominal and lower back muscular strength was
assessed concentrically on a Biodex System II

Isokinetic Dynamometer (Biodex Inc., Shirley, NY,


USA) at speeds of 601 and 1201 s1. These speeds
met the velocity of the range of motion of
the Modern Pilates mat exercises (Handa et al.,
2000; Roetert et al., 1996). Participants were
positioned in the dynamometer seated with their
back and neck supported with the adjustable pads
for safety. The thighs, pelvis and chest were
constrained by seatbelts to prevent sagittal pelvic
rotation and facilitate isolation of the trunk for
flexion/extension testing only. The ankles were
placed on an adjustable feet pad in neutral
position. Participants were instructed to keep
their heads and arms in a fixed position throughout
the test.
Before measurements, each subject was asked to
perform a warm-up test of five repetitions. The
actual test of 10 repetitions at the two angular
velocities was then carried out after a 10 s rest
period. Peak torque/body weight ratios were
statistically analyzed as the measure of muscle
strength (Jackson and Pollock, 1985).

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Effects of Pilates exercise in sedentary adult females

Figure 3 (a) The saw (starting position), (b) the saw.

Abdominal muscular endurance


Abdominal muscular endurance was assessed as the
maximum curl-ups performed without rest in 1 min
(Ransdell et al., 2002). Abdominal curl-ups were
performed in the supine position with the knees flexed
at 451 with legs slightly apart and feet on the ground.
The arms were extended along the sides of the body
with hands in prone position and fingers outstretched.
Participants were instructed to curl-up to lift the
shoulder blades off the mat and slide their fingers from
one end of a 12 cm ruler. After each curl-up, the subject was instructed to return to the starting position.

Posterior trunk flexibility


Posterior trunk flexibility was measured by the sit
and reach test (Clark et al., 1989). The participants
warmed-up for 5 min and then sat on the floor with
their heels touching the side of a box. Their finger
tips were on the 0 cm edge of the box that was
vertically marked in centimeters towards the

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Figure 4 (a) Swimming (starting position) and (b) swimming.

opposite edge. To measure flexibility, the participant was instructed to push the yardstick placed at
the edge of the box while holding the legs straight
and the hands parallel to the floor as far as she
could. According to the YMCA standards (Golding
et al., 1989), the participant had to hold this reach
long enough for the distance to be recorded. The
farthest test score of three trials was recorded.

Body fat
Body fat was measured from skin-fold thicknesses using
a Lange skin-fold caliper (16). Skin-fold thicknesses
were measured at the triceps, suprailiac and thigh
regions. Body fat percentage was calculated using the
Jackson and Pollock equation (Golding et al., 1989).

Body mass index


BMI was calculated as weight (in kg) divided by height
(in m) squared (Sardinha and Teixeira, 2000). The
participants were weighed using a pre-calibrated

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B. Sekendiz et al.

digital scale to the nearest .1 kg. Height was measured by a stadiometer to the nearest .1 cm.

Statistical analysis
Statistical Package for Social Sciences (SPSS) version 9.0 (SPSS, Inc., Chicago, IL) was used for the
analysis of the data. A 2 (group)  2 (time) analysis
of variance was conducted to evaluate the effect of
exercise on abdominal and back strength, muscular
endurance, trunk flexibility, body fat percentage
and BMI. In addition to these analyses, one-way
analysis of covariance was conducted to identify
any effect of body fat on BMI scores.

or not there is a significant difference between


groups. Independent sample t-test results revealed
that there was no significant difference between
control and Pilates groups with respect to
BMI (t .914, p .367), abdominal 601 s1 (t
1.600, p .118), abdominal 1201 s1 (t .501,
p .619), back strength 601 s1 (t .804,
p .427), and back strength 1201 s1(t 1.072,
p .291), body fat (t 1.250, p .220), abdominal endurance (t 1.704, p .101), and trunk
flexibility (t 1.219, p .231). It can be said
that all baseline values of groups in the present
study did not differ from each other.

Abdominal and lower back strength

Results
Each pre-measure of groups was analyzed by
independent sample t-test to delineate whether

The result of the analysis on trunk flexion indicated


that the Pilates group produced significantly higher
peak torque/body weight values than the control

Table 1 Changes in abdominal and back strength, muscular endurance, trunk flexibility, body mass index and
body fat percentage.
F

Exercise group
(N 21)
(Mean7SD)

Control group
(N 17)
(Mean7SD)

Abs and back strength


601 Flexion
Pre
Post

133.0755.8
168.8757.4

102.3770.4
95.4761.4

8.564

.006

601 Extension
Pre
post

95.28729.4
142.1762.6

84.9741.2
82.0735.0

13.682

.001

1201 Flexion
Pre
post

75.3740.4
115.4753.1

83.3743.1
74.9734.0

10.372

.003

1201 Extension
Pre
Post

78.9727.1
147.7745.8

146.47277.3
76.1734.3

3.184

.083

Muscular endurance
Curl-ups
Pre
Post

14.079.8
29.279.8

21.9716.9
22.6715.8

37.369

.000

Trunk flexibility
Sit and reach test
Pre
Post

23.977.5
31.376.8

20.778.3
21.879.4

66.703

.000

Body mass index


Pre
Post

22.072.5
22.072.7

22.872.6
22.972.7

2.145

.152

% Body fat
Pre
Post

29.074.0
29.475.1

31.076.0
31.176.1

.173

.680

Variable

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Effects of Pilates exercise in sedentary adult females
group in the post-test at both 601, and 1201 s1
(Table 1). Peak torque values relative to total body
weight were used to compare subjects of different
body size. Results of the repeated MANOVA test
revealed a significant interaction effect for group
and measurements at 601 s1 flexion (GreenhouseGeisser F 8.564, po.05), 601 s1 extension
(Greenhouse-Geisser F 13.682, po.05), and
1201 s1 flexion (Greenhouse-Geisser F 10.372,
po.05). There was a significant difference between pre-and post-measures of strength at 601 s1
flexion/extension and 1201 s1 flexion in the exercise group (Fig. 5(a) and (b)). Pilates exercise

Flexion 60-Pre

323
group showed more improvement regarding Abdominal and Back Strength results than did the
control group.

Abdominal muscular endurance


Results of repeated MANOVA revealed a significant interaction effect for group and measurements (Greenhouse-Geisser F 37.3, po.05) indicating that there was a significant difference
between pre- and post-measurements of endurance
only for the exercise group (Table 1) (Fig. 6).
Pilates exercise group showed more improvement

Flexion 120-Post

Extension 60-Pre

30.0

30.0
p = 0.006

25.0

p = 0.001

25.0

20.0

20.0

15.0

15.0

10.0

10.0

5.0

5.0

0
N=

16

GROUP

Extension 120-Post

16
Control
Flexion 120-Pre

0
N=

20
20
Exercise

16

GROUP

Flexion 120-Post

16
Control
Extension 120-Pre

30.0

20
20
Exercise
Extension 120-Post

30.0

25.0

25.0
p = 0.003

20.0

20.0

15.0

15.0

10.0

10.0

5.0

5.0

N=

16

GROUP

16
Control

20
20
Exercise

p = 0.083

0
N=

16

16
Control

20
20
Exercise

GROUP
1

Figure 5 (a) Abdominal and back strength at 601 s


flexion and extension.

flexion and extension, (b) abdominal and back strength at 1201 s1

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B. Sekendiz et al.
ENDURANCE-Pre

FLEXIBILITY- Pre

ENDURANCE-Post

50

50

FLEXIBILITY- Post

p = 0.000

p = 0.000
40

40

30

30

20

20

10

10

0
N=

17

GROUP

17
Control

21
21
Exercise

Figure 6 Muscular endurance difference between exercise and control group.

regarding abdominal endurance than did the control group.

0
N=

17

GROUP

17
Control

Figure 7 Difference in trunk flexibility between exercise


and control group.

Table 2 Characteristics of the exercise and


control groups.
Variable

Exercise group
(N 21)
(Mean7SD)

Control group
(N 17)
(Mean7SD)

Age
Height (m)
Weight (kg)
BMI (kg/m2)

30.276.6
164.875.7
61.977.1
22.072.5

30.878.6
161.075.8
57.278.14
22.872.6

Posterior trunk flexibility


Results of multivariate test revealed a significant
interaction effect for group and measurements
(Greenhouse-Geisser F 66.7, po.001). There was
a significant difference between the pre- and postmeasures of flexibility only for the exercise group
(Table 1) (Fig. 7). Pilates exercise group showed
more improvement regarding posterior trunk flexibility than did the control group.

BMI and body fat


BMI measures and the body fat ratios of the exercise
and control groups were not statistically different.
In addition to covariance effect, correlations of preand post-measures were calculated. The result of
this analysis showed that there was a significant
covariance effect of both pre-body fat measures on
pre-BMI measures (F 43.918, po.001, Z2 .33)
and post-body fat measures on post-BMI measures
(F 16.718, po.001, Z2 .32). See Table 2.

Discussion
With regard to the results of this study, Modern
Pilates mat exercises were found to be an efficient

21
21
Exercise

training method with significant changes in abdominal and lower back strength, posterior trunk
flexibility and abdominal muscular endurance
in sedentary adult females. Difference in the
means of the pre- and post-tests of abdominal
and lower back strength of the exercise group
proved to be higher compared to the control
group. There was a significant difference between
pre- and post-measurements of abdominal and
lower back strength at 601 s1 flexion/extension
and 1201 s1 flexion in the Pilates group. These
findings were in line with the literature (Fitt
et al., 1993) confirming that Modern Pilates
mat exercises increase muscular strength of the
trunk. Abdominal muscular endurance and posterior trunk flexibility of the Pilates group were
significantly higher in the follow-up tests than
that of the control group, which supported
previous findings in the relevant literature (Fitt
et al., 1993).

ARTICLE IN PRESS
Effects of Pilates exercise in sedentary adult females
Despite the fact that the results of Modern
Pilates mat exercises were generally positive, some
limitations to the study are also worth mentioning.
The finding that there was relatively greater
improvement in the abdominal muscular strength
compared to lower back muscles in the exercise
group was probably due to the exercise protocol
that was used in the study. Put another way, the
reason for the insignificant results with the isokinetic test may be due to the early fatigue in the
lower back muscles. In a future study in order to
maintain similar results in the lower back and
abdominal strength, the number of exercises that
would emphasize lower back muscles could be
increased in the exercise protocol.
As mentioned earlier in the paper, the body fat
and BMI pre- and post-data were also assessed as
secondary outcomes of this study, however no
significant changes were noted. One of the leading
reasons for this outcome may be due to the fact
that the Modern Pilates mat exercises were
practiced by the subjects for a period of 5 weeks
that can be considered to be a short interval to
effect the body fat and BMI measures. Another
reason might be the fact that there was not
any restriction in the diets of the participants. As
Mayo et al. (2003) suggests work involving larger
weight losses are entirely diet based. From this
standpoint, in a future longitudinal study of at least
8 weeks, a diet associated with Pilates mat exercise
regimen could be applied to sedentary adult
females to monitor changes in body fat and BMI
in addition to the hypothesized variables in this
study. In a future study it would also be interesting
to investigate if the applied Modern Pilates
mat exercises affect psychological variables of
participants.
In conclusion, this study showed that Modern
Pilates mat exercises contributed to increased
quality of life in sedentary adult females through
improvements in abdominal and lower back
strength, posterior trunk flexibility and abdominal
muscular endurance.

Appendix A. Exercise protocol


Exercise
Warm-up
1. Breathing
2. Imprint and release
3. Spinal rotation
4. Cat stretch
5. Hip rolls
6. Scapula isolation

Repetitions

325
7. Arm circles
8. Scapula elevation
Exercises
1. Ab prep
2. Breast stroke
3. Spine stretch
4. The hundred
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.

Half roll back


The roll up
Leg circles
Spine twist
Rolling like ball
Single leg stretch
Double leg stretch
Criss cross
Scissors
Shoulder bridge

15.
16.
17.
18.
19.
20.

Roll over preparation


Hell squeeze prone
Single leg kick
Breast stroke
Spine stretch
The saw

21.
22.
23.
24.
25.

Neck pull preparation


Obliques roll back
Side kick series
Spine stretch forward
Swimming

26. Leg pull front


27. Leg pull back

5
5
1
10 see Figs.
1(a)(c)
8
8
8
8
8
8
8
8
8
8 see Figs. 2(a)
and (b)
8
8
8
8
1
8 see Figs. 3(a)
and (b)
8
8
8
5
8 see Figs. 4(a)
and (b)
5
5

References
Argo, C., 1999. The Pilates Method for a balanced body,
American Fitness, March April: pp. 5254.
Clark, B., Osness, W., Adrian, M., Hoeger, W.W.K., Raab, D.,
Wiswell, R., 1989. Tests for fitness in older adults: AHHPERD
fitness task force. Journal of Physical Education, Recreation
and Dance 60 (3), 6671.
Fitt, S., Sturman, J., McClain-Smith, S., 1993. Effects of Pilatesbased conditioning on strength, alignment, and range of
motion in university ballet and modern dance majors.
Kinesiology and Medicine for Dance 16 (1), 3661.
Friedman, P., Eisen, G., Miller, W.J., Jopseph, H., 1980. Pilates
Techniques of Physical Conditioning. Doubleday and Company, New York.
Geweniger, V., 2002. Prevention of back pain with Pilates
Training. Finding a Healthy Balance 55 (10), 747749.
Golding, L.A., Myers, C.R., Sinning, W.E., 1989. The Ys way to
Physical Fitness, third ed. Human Kinetics, Champaign, IL.
Handa, N., Yamamoto, H., Tani, T., 2000. The effect of
trunk muscle exercises in patients over 40 years of age with

ARTICLE IN PRESS
326
chronic low back pain. Journal of Orthopaedic Science 32,
551557.
Ives, J.C., Sosnoff, J., 2000. Beyond the mind-body exercise
hype. The Physician and Sports Medicine 28 (3), 6781.
Jackson, A.S., Pollock, M.L., 1985. Practical assessment of body
composition. Physiology of Sports Medicine 13 (5), 7690.
Latey, P., 2001. The Pilates Method: history and philosophy.
Journal of Bodywork and Movement Therapies 5 (4), 275282.
Latey, P., 2002. Updating the principles of the Pilates methodPart
2. Journal of Bodywork and Movement Therapies 6 (2), 94101.
Mayo, M., Grantham, J.R., Balasekaran, G., 2003. Exercise
induced weight loss preferentially reduces abdominal fat.
Medicine & Science in Sports & Exercise 207213.
Ransdell, L.B., Taylor, A., Oakland, D., Schmidt, J., MoyerMileur, L., Shultz, B., 2002. Daughters and mothers exercising
together: effects of home- and community-based programs.
Medicine & Science in Sports & Exercise September 286296.

B. Sekendiz et al.
Roetert, E.P., McCormick, T.J., Brown, S.W., Ellenbecker, T.S.,
1996. Relationship between isokinetic and functional trunk
strength in elite junior tennis players. Isokinetics and
Exercise Science 6, 1520.
Runion, B., 2002. Pilates: Adjunct/Alternative Medicine Assignment. Med Complex Conditions III, July 27.
Sardinha, L.B., Teixeira, P.J., 2000. Obesity screening in older
women with the body mass index: a receiver operating
characteristic (ROC) analysis. Science and Sports 15,
212219.
Springen, K., 2003. Concentrating on the Bodys Core. Newsweek
141 (3), 67.
Stott, P., 2006. The ultimate resource for mind-body fitness 2006
Retrieved on August 31, 2006 from /http://www.stottpilates.
comS
Wilson, K., 2002. The Pilates potential. American Fitness 20 (2),
2527.