REJUVENATION RESEARCH

Volume 21, Number 5, 2018

ª Mary Ann Liebert, Inc.
DOI: 10.1089/rej.2017.2007

Effect of a Mat Pilates Program with TheraBand

on Dynamic Balance in Patients with Parkinson’s Disease:
Feasibility Study and Randomized Controlled Trial

Irimia Mollinedo-Cardalda,* José Marı́a Cancela-Carral, and Marı́a Helena Vila-Suárez

Abstract
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The aim of this study was to assess the effect of a physical exercise program based on Mat Pilates (MP) with
TheraBand on the dynamic balance of a sample population diagnosed with Parkinson’s disease (PD). After random
selection, 26 participants were allocated to a MP group or a control group where they performed calisthenics
exercises. Both interventions lasted 12 weeks and involved 2 weekly sessions of 60 minutes. Assessments took place
at baseline, 12 weeks after the intervention started and 4 weeks after the intervention was completed using the body
mass index (BMI), the Timed Up and Go (TUG) test with Wiva sensors, the 30 Second Chair Stand test, and the
Five Times Sit to Stand test. The group that completed the MP program presented significant improvements in BMI
(F1,21 = 3.986; p = 0.038), the 30 Second Chair Stand test (F1,21 = 6.716; p = 0.014), the Five Times Sit to Stand test
(F1,21 = 5.213; p = 0.032), and the time required to complete the TUG dynamic balance test (F1,21 = 5.035; p = 0.035).
The MP program performed by a sample population with PD led to improvements in dynamic balance, and
participants in the MP group showed increased strength in the lower limbs, but such improvements were not
permanent after the activity ceased.

Keywords: Parkinson’s disease, Pilates, dynamic balance, physical therapy, neurodegenerative disorders

Introduction in the 1940s after researching the thalamus and the internal
globus pallidus. Improved knowledge of the basal ganglia led

P arkinson’s disease (PD) is a neurodegenerative dis-

order that affects the central nervous system. Its prog-
ress is slow and asymmetric and, even though effective
treatments are available today (drugs, multidisciplinary re-
habilitation and sometimes surgery), there is still no cure.
PD results in a premature, progressive, and irreversible de-
generation in the pars compacta substantia nigra of dopa-
minergic neurons, which leads to a dopamine imbalance in
the striatum following a rostrocaudal pattern.1 This neurologi-
cal disease causes numerous motor and nonmotor symptoms2,3
and inclines patients toward a sedentary lifestyle, which has
many deleterious consequences. The cardinal symptoms of PD
are bradykinesia, rigidity, tremor and postural instability, which
explain the patient’s gradual loss of functional independence.4,5
At present, the basic pillars of PD treatment include drug
therapy and surgical techniques. Drug therapy is aimed at
reestablishing the content of striatal dopamine in the patient’s
striatum administering levodopa, a precursor of dopamine, or
dopaminergic agonists. Surgical techniques were introduced
to the exploration of new surgical targets, which, coupled
with advanced neuroimaging and intraoperative neuromoni-
toring techniques, have triggered a surgical turn in PD.6
These treatments, however, do not make PD symptoms dis-
appear. For this reason, over the past decade, physical therapy
has been put forward as an alternative treatment that is low in
cost and has no side effects, with the objective of maximizing
the functional capacities of PD patients.
Systematic and controlled physical activity performance has
positive effects on the development of conditional capacities,
gait, balance, coordination, and the patient’s emotional state,
thus improving the quality of life of PD populations.7–10 New
intervention proposals based on physical activity are currently
being tested11; however, these may not be applicable to the
whole population. For this reason, feasibility studies and pro-
tocol validations are required to determine which strategy
could be most appropriate for each specific pathology.
The Pilates Method of Exercise is a nonimpact activity
adaptable to different physical conditions and health status,

Department of Special Didactics, University of Vigo, Pontevedra, Spain.

*Galician Government predoctoral fellow.

423
 424
which is recommended for several different populations.12
The floorwork exercises can be performed with specific ap-
paratus (Equipment-based Pilates) or without them (Mat Pi-
lates [MP]). MP is a form of physical exercise designed to
improve strength, core balance, flexibility, muscular control,
posture, and breathing,13 which contributes to the achieve-
ment of an optimal lumbopelvic stabilization necessary for
daily life activities and functions.14 For the last few years, this
exercise modality has experienced an upsurge among older
adults, who have managed to enhance their physical condition,
emotional state, and balance, as well as to reduce the risk of
falling and improve their quality of life.15–18
Currently, the number of interventions featuring MP in
populations with PD is very limited, although the results re-
ported so far are generally positive, with an increase in flexibility
levels and improvements in quality of life.19–22 The present
study aims to measure the effect on dynamic balance of a MP
program with TheraBand in a population diagnosed with PD.
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Materials and Methods
Study design
This is a single-blind randomized controlled trial of an
MP intervention with TheraBand. Assessments were carried
out at baseline (week 0), at the end of the intervention (week
12), and as a follow-up, 4 weeks after the end of the inter-
vention (week 17). All three assessment stages focused on
the same variables.
Site and participant selection
The trial was designed and implemented by four experts in
physical activity and neurodegenerative diseases from the
University of Vigo in Spain. A sample of patients of both sexes
diagnosed with idiopathic PD was recruited at ‘‘Asociación de
Parkinson Provincial de Pontevedra,’’ according to the fol-
lowing inclusion criteria: (1) Hoehn & Yahr stage [H&Y] 1–3;
(2) no clinical history of dementia, neurological deficits (e.g.,
the after-effects of a stroke or spinal injuries), or any other
preexisting condition that could limit limb movement (as pa-
tients with a history of major surgical operations or wheelchair
users), and; (3) no medical or surgical interventions that could
interfere with the motor function. Before study, the trial was
approved by the Research Ethics Committee of the Department
of Health of the regional government and then assigned code
number 2015/484. The trial followed both the ethics guidelines
of the committee and the Declaration of Helsinki.
Recruitment
The recruitment phase spanned a period between De-
cember 2015 and January 2016, during which a meeting was
held with the people in charge of ‘‘Asociación de Parkinson
Provincial de Pontevedra’’ to share detailed information
about the experimental study. The patients were evaluated
by the lead researcher, who compiled a list of possible
candidates after applying the inclusion criteria. All partici-
pants gave written informed consent.
Randomization
The lead researcher performed trial randomization once
the initial evaluation had concluded. Taking sample size into
MOLLINEDO-CARDALDA ET AL.
account, a total of 26 PD patients met the inclusion criteria:
17 women and 9 men, who were randomly allocated with a
1:1 ratio to the MP intervention program group (MG) or to
the control group (CG) (Fig. 1). Randomization was per-
formed using IBM SPSS Statistics Software following
the sequence: Data > Select Cases > Random sample of
cases > Exactly 13 cases from the first 26 cases. The var-
iables taken under consideration were age, gender, disease
duration, H&Y scale ratings, and Unified Parkinson’s
Disease Rating Scale (UPDRS) motor score (Table 1).
Intervention
Participants in both groups (MG and CG) completed 24
sessions at a rate of two nonconsecutive 60-minute sessions
per week for 12 weeks (Table 2).
Participants in MG followed a program based on Pilates
floorwork exercises adapted for PD populations using
Medium-Resistant TheraBand as well as 0.5 kg ankle and/or
wristbands. The MG program consisted of seven exercises
distributed in three sets of eight repetitions (Table 2). Workout
intensity was measured using the Modified Borg Rating of
Perceived Exertion23 and then kept constant throughout the
program at a rating of 7, adapting the specific tasks to each
participant and adding extra resistance with the Thera-
Band, ankle, and/or wristbands. After finishing each ex-
ercise, participants were asked to rate their effort in the
Modified Borg scale, so that the supervisors could adjust
the workload appropriately.
Table 2 summarizes program structure. The first 10
minutes of every session (warm-up) focused on the stimu-
lation of body awareness, emphasizing thoracic breathing,
cervical spine alignment, neutral position of the pelvis, and
activation of the transversus abdominis and pelvic floor
musculature. The final 5 minutes of cool-down were devoted
to deep breathing and stretching of diverse muscle groups.
Participants in CG followed a physical activity program
based on calisthenics that combined aerobic exercises, such
as different varieties of marching, with strength, flexibility,
articular mobility, and coordination tasks. The sessions were
organized according to the same schedule as MG, leaving 10
minutes for warm-up focused on articular mobility exercises
and 5 minutes for cool-down and muscle group stretching.
It should be noted that MG performed all the exercises on
the floor from a sitting position, while most CG exercises,
which were performed from a standing position, required
more intense movements.
Assessment
Participants were assessed at baseline (week 0), at the end
of the intervention (week 12) and 4 weeks after the end of
the intervention (week 17) to analyze possible residual ef-
fects. The variables under analysis were as follows.
Anthropometric measurements. The height (cm) and
weight (kg) of the participants were registered while
dressed in light clothing and without shoes. Their body
mass index (BMI) was calculated with the formula, weight/
height2 (kg/m2). A Tanita TBF300 scale with a precision of
0.1 kg and a Handac stadiometer with a precision of
1.0 mm were used in the process.
 PILATES WITH THERABAND AND PARKINSON’S DISEASE 425
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FIG. 1. Sample distribution flowchart.

Strength. Both the 30 Second Chair Stand and the Five

Sit Up tests were used. The 30 Second Chair Stand is part of
the Senior Fitness Test battery designed to evaluate the test
Table 1. Baseline Characteristics and Medication takers’ physical condition.24 This test assesses the strength
Use for All Participants and resilience of their lower limbs considering the number
of times they can sit down and stand up from a chair in 30
MG CG
seconds. The Five Sit Up test, however, is part of the Short
n = 13 n = 13
Mean – SD/% Mean – SD/% Physical Performance Battery,25 measures the strength and
speed of the lower body and requires the test-takers to sit
Age (years) 62.85 – 9.75 66.00 – 13.14 and stand five times in the shortest possible span.
Gender (% female) 61.50 69.20
Disease duration (years) 5.77 – 3.39 5.69 – 4.40 Dynamic balance. This variable was assessed using the
H&Y stage 2.08 – 0.49 2.00 – 0.82 Timed Up and Go (TUG) test with Wiva sensors,26 a set of
Height (cm) 162.18 – 6.43 162.46 – 6.98
Weight (kg) 71.27 – 10.13 76.46 – 7.67 wireless inertial detection devices placed in the L4–L5 spinal
BMI (kg/m2) 27.05 – 3.30 29.13 – 4.01 segment. Wiva sensors include an accelerometer, a magne-
UPDRS motor score 29.55 – 11.26 31.54 – 11.84 tometer and a gyroscope that allows professionals and practi-
Parkinson’s medication tioners to gather information about the angular velocities
Levodopa and carbidopa 92.30% 84.61% reached during TUG. In addition, Wiva records split time data
Ropinirole 60.85% 53.16% in the early stages of TUG (Sit to Stand, Gait to Go, Turning,
Rasagiline mesylate 30.09% 30.09% Gait Return, and Stand to Sit) and the total time required to
Pramipexole 23.07% 13.38% complete the task. All this information was saved and sent to a
Rotigotine 23.07% 13.38% PC via Bluetooth with Biomech Study 2011 v.1.1.
Amantadine 7.69% 7.69%
BMI, body mass index; CG, control group; H&Y, Hoehn & Motor scale. The ‘‘Unified Parkinson’s Disease Rating
Yahr; MG, Mat Pilates group; UPDRS, unified Parkinson’s disease Scale III’’ (UPDRS-Motor Scale) was used to evaluate bra-
rating scale. dykinesia, tremor, or rigidity.27
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Table 2. Mat Pilates Program

Week
1–3 4–6 7–9 10–12
Warm-up exercises Abdominal breathing Abdominal breathing Abdominal breathing Abdominal breathing Abdominal breathing
(10 minutes) Thoracic breathing Thoracic breathing Thoracic breathing Thoracic breathing Thoracic breathing
Pelvic clock Pelvic clock Pelvic clock Pelvic clock Pelvic clock
Main part (45 minutes) Arm arcs Arm arcs Arm arcs with adduction strap
Arm arcs with 0.5 kg Arm arcs with straps and
wristbands 0.5 kg wristbands
Bridge Bridge with straps, alternating legs Bridge with 0.5 kg ankle bands, Isometric bridge with Isometric bridge with knee
(in bridge position, elevate one alternating legs (in bridge straps, alternating legs straps, alternating legs,
leg, then the other, then release) position elevate one leg, then and 0.5 kg ankle bands
the other, then release)
Curl ups Curl ups with LL in triple flexion Curl ups with LL in Curl ups with LL in Curl ups with LL in

426
and 0.5 kg ankle bands diagonal pattern diagonal pattern and diagonal pattern and
knee straps 0.5 kg ankle bands
Leg circles Leg circles with knee straps Leg circles with knee straps Leg circles with 0.5 kg Leg circles with 0.5 kg
ankle bands ankle bands
Side leg Side leg with 0.5 kg ankle bands Side leg with ankle straps Side leg with LL Side leg with 90 hip flexion
homolateral adduction and 0.5 kg ankle bands
and ankle straps
Superman Superman with UL straps Superman with UL straps Superman with ankle Superman with ankle
and ankle bands and wristbands and wristbands
Squats In sitting position, alternating hip Squats with straps Single leg stretch Single leg stretch with straps
flexion with ankle straps with straps
Cooling-off exercises Thoracic breathing Thoracic breathing Thoracic breathing Thoracic breathing Thoracic breathing
(5 minutes) Abdominal breathing Abdominal breathing Abdominal breathing Abdominal breathing Abdominal breathing
LL, lower limbs; UL, upper limbs.
 PILATES WITH THERABAND AND PARKINSON’S DISEASE
Feasibility. The following data were gathered to evaluate
feasibility in MG: recruitment rate (number of participants
recruited vs. number of participants who met the inclusion
criteria), participation rate (total completed hours of exercise
vs. total possible hours of exercise), adherence (rate of patients
with 80% participation or higher), dropout (number of partic-
ipants who could not complete the program), and safety and
tolerability (number of patients who suffered adverse effects
derived from the intervention, such as pain, dizziness, vertigo,
and falls).
All participants were assessed during their ‘‘activation’’
phase (1 to 1.5 hours after taking their PD medication). All
pharmacological treatments and dosage were kept stable for
the duration of the study (Table 1).
Safety for exercise
In the MP intervention program, participant safety was
considered at the time of performing the battery of tasks pro-
posed, particularly when sudden changes in position were in-
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volved, with the essential objective of preventing falls and/or
dizziness. Special attention was also paid during the muscle
awareness and breathing control stages in each session to
prevent instances of hyperventilation.
Sample size
Sample size was calculated in accordance with the results
obtained by Hirsch et al.28 for the balance parameters (20%
difference between the groups under analysis) considering
the comparison between two mean values, a level of con-
fidence of 85% (1-a), a statistical power of 60%, and ex-
pected losses of 20%. The application of these criteria
resulted in a sample size of 26 subjects.
Statistical analysis
A descriptive analysis of the initial sample was carried
out using central tendency and dispersion (mean and stan-
dard deviation) measures for each of the groups (MG and
CG). Sample homogeneity was checked using Student’s
t test for unpaired samples, since the quantitative parameters
met the normality criteria (Shapiro–Wilk test; p > 0.05).
To analyze the effect of the MP program with respect to
the physical activity of CG, a two-way analysis of variance
was performed (Group: MG and CG; Moment: Pre and Post;
2 · 2). Another two-way analysis of variance was applied to
check the possible residual effects of the Pilates intervention
on the PD collective (Group: MG and CG; Moment: Post
and Follow-up; 2 · 2). IBM SPSS Statistics 20 statistical
software was used for this analysis. Significance level was
set at p < 0.05.
Results
A total of 36 people, older than the age of 60 years,
diagnosed with PD were initially selected to take part in the
experiment. The recruitment rate was 86.66%, as six pa-
tients did not meet the inclusion criteria, three declined, and
one suffered physical problems. Consequently, the final
sample was reduced to 26 participants (MG, n = 13; CG,
n = 13), both groups being homogeneous, in accordance with
the characteristics shown in Table 1. 11.53% of participants
did not complete the experiment (MG, n = 1; CG, n = 2).
427
The participation rate in MG was 80.21%, with 231 hours
of workout out of a possible 288 hours. Ten out of 12 par-
ticipants in MG completed at least 80% of the sessions,
which resulted in an adherence rate of 83.33%. The dropout
rate was 7.69%, as one participant could not finish the
program. The safety and tolerability rate was 100%, since no
adverse effects derived from the program were attested.
The group of participants who were allocated to the MP
program presented significant improvements in BMI (kg/
m2), 30 Second Chair Stand (n), Five Sit Up (seconds), and
TUG cinematic parameters such as PD range (m/s2),
Gait Go (seconds), average angular velocity (/s), peak an-
gular velocity (/s), Gait Return (seconds), turning peak
angular velocity (/s), peak flexion angle turning (), peak
angular velocity turning (/s), time turning (seconds), and
total time (Table 3). The group allocated to the calisthenics
exercise program presented significant effects in the fol-
lowing TUG cinematic parameters: PD range (m/s2) and
average angular velocity turning (/s).
Table 3 indicates that 4 weeks after the intervention
ended (follow-up), several TUG cinematic parameters ex-
perienced a significant worsening in MG: average angular
velocity (/s), peak angular velocity (/s), peak extension
angle (), anteroposterior range (m/s2), mediolateral range
(m/s2), Sit to Stand (seconds), Gait Return (seconds), and
time turning (seconds). In the case of CG, average angular
velocity (/s) and peak angular velocity (/s) declined.
The analysis of the changes experienced by MG and CG
is presented in Table 3. Considering these results, it could be
stated that the MP program led to significant differences
with respect to the program based on calisthenics in terms
of BMI (kg/m2), 30 Second Chair Stand (n), Five Sit Up
(seconds), as well as the following TUG cinematic param-
eters: peak extension angle (), Gait Go (seconds), average
angular velocity turning (/s), peak angular velocity turning
(/s), Gait Return (seconds), turning peak angular velocity
(/s), time turning (seconds), and total time (seconds).
Discussion
The alteration of dynamic balance in PD populations is
one of the most characteristic symptoms of the disease. In
this randomized controlled trial, the group allocated to the
MP program obtained significant improvements with respect
to CG in parameters such as lower body strength and dy-
namic balance. The results obtained in MG are in line with
the conclusions presented in previous trials,19–21 where both
programs based on Pilates in PD populations led to an im-
provement in the levels of lower body strength and dynamic
balance, as indicated by the reduction in TUG test com-
pletion time. These results complement previous experi-
ences with PD populations,7–10 where physical exercise
performance had positive effects on physical abilities.
The physical program based on calisthenics that CG
carried out did not lead to significant gains in strength,
which, in turn, might have positive repercussions in the core
balance, muscular control, and balance dynamic.13 The
analysis of the data provided by UPDRS III (Motor Score)
points to the existence of differences between the two
groups. These results are in line with those presented by Li
et al.29 However, different results, show inverse trends for
MG and CG, which should be verified and contrasted with
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Table 3. Inferential Analysis of Mat Pilates Program Effects in Patients with Parkinson’s Disease
CG MG
n = 10 n = 12
Factor moment Factor moment
Pre Post Follow-up Pre Post Follow-up (pre-post) · program (postfollow) · program
BMI (kg/m2) 29.03 – 4.54 29.22 – 4.61 29.10 – 4.54 27.61 – 3.36 27.27 – 3.36* 27.42 – 3.49 F1,21 = 3.986; p = 0.038 F1,21 = 0.056; p = 0.814
H&Y 2.30 – 0.67 2.50 – 0.53 2.50 – 0.53 1.92 – 0.51 1.92 – 0.51 1.92 – 0.51 F1,21 = 3.108; p = 0.087 F1,21 = 0.001; p = 0.981
Sitting time (hours/week)
0–19 0.0% 0.0% 0.0% 0.0% 25.0% 0.0% — —
20–39 10.0% 20.0% 20.0% 25.0% 16.7% 27.3% — —
40–59 60.0% 50.0% 40.0% 41.7% 25.0% 54.5% — —
60–79 20.0% 30.0% 40.0% 33.3% 33.3% 18.2% — —
>80 10.0% 0.0% 0.0% 0.0% 0.0% 0.0% — —
30 Second Chair Stand (n) 13.90 – 4.12 12.30 – 5.06 12.20 – 5.69 17.75 – 6.36 23.83 – 6.41** 23.00 – 6.91 F1,21 = 6.716; p = 0.014 F1,21 = 0.039; p = 0.845
Five Sit Ups (seconds) 10.71 – 2.96 9.13 – 4.07 9.35 – 4.62 9.04 – 4.01 5.78 – 1.51* 6.40 – 1.59 F1,21 = 5.213; p = 0.032 F1,21 = 0.042; p = 0.838
UPDRS 3 (total) 35.00 – 9.65 38.50 – 10.81 37.60 – 12.79 28.33 – 12.09 27.92 – 12.46 27.82 – 15.87 F1,21 = 0.453; p = 0.506 F1,21 = 0.010; p = 0.921
Dynamic balance
TUG: Sit to Stand
Average angular velocity (/s) 19.82 – 8.36 17.70 – 9.81 24.16 – 5.96# 23.99 – 10.67 29.09 – 19.06 16.19 – 4.96# F1,21 = 0.332; p = 0.569 F1,21 = 6.108; p = 0.019
Peak angular velocity (/s) 96.71 – 38.97 79.91 – 48.80 135.53 – 88.22# 121.63 – 81.66 168.38 – 174.38 64.56 – 23.69# F1,21 = 0.295; p = 0.591 F1,21 = 6.516; p = 0.016
Peak flexion angle () -12.41 – 6.06 -12.95 – 6.48 -10.86 – 4.65 -14.40 – 8.42 -10.90 – 6.99 -13.79 – 4.64 F1,21 = 0.925; p = 0.343 F1,21 = 0.490; p = 0.489
Peak extension angle () 3.26 – 6.21 1.15 – 2.63 3.26 – 4.58 1.89 – 3.76 4.54 – 4.81 0.28 – 0.70# F1,21 = 4.444; p = 0.043 F1,21 = 6.200; p = 0.018

428
AP range (m/s2) 7.55 – 2.25 6.69 – 1.13 7.53 – 1.48 8.51 – 2.47 8.42 – 2.13 6.01 – 1.47## F1,21 = 0.453; p = 0.506 F1,21 = 12.970; p = 0.001
PD range (m/s2) 5.98 – 2.82 6.81 – 2.62* 7.61 – 2.54 6.13 – 1.34 7.98 – 2.31* 8.01 – 1.80 F1,21 = 2.546; p = 0.120 F1,21 = 0.127; p = 0.724
ML range (m/s2) 2.63 – 0.89 2.35 – 0.81 2.75 – 0.34 2.57 – 0.82 2.80 – 1.04 1.89 – 0.58# F1,21 = 0.113; p = 0.739 F1,21 = 8.117; p = 0.007
Sit to Stand (seconds) 1.49 – 0.43 1.54 – 0.35 1.54 – 0.41 1.38 – 0.35 1.32 – 0.74 1.99 – 0.43# F1,21 = 0.062; p = 0.805 F1,21 = 4.931; p = 0.042
TUG: Go
Gait go (seconds) 2.27 – 0.73 2.35 – 0.78 2.64 – 0.41 2.51 – 2.31 1.78 – 4.70* 2.56 – 3.23 F1,21 = 6.001; p = 0.021 F1,21 = 0.001; p = 0.983
TUG: turning
Average angular velocity (/s) 91.60 – 20.08 94.15 – 21.29 93.05 – 21.78 96.02 – 29.24 110.76 – 34.24* 114.74 – 35.56 F1,21 = 3.153; p = 0.049 F1,21 = 0.114; p = 0.738
Peak angular velocity (/s) 178.02 – 65.95 183.83 – 37.20 192.40 – 63.97 221.87 – 103.14 328.40 – 144.55* 297.76 – 109.35 F1,21 = 3.921; p = 0.045 F1,21 = 0.348; p = 0.559
Turning (seconds) 1.29 – 0.45 1.21 – 0.35 1.19 – 0.29 1.18 – 0.68 1.07 – 0.36 0.93 – 0.99 F1,21 = 1.298; p = 0.263 F1,21 = 0.087; p = 0.770
TUG: return
Gait return (seconds) 2.12 – 0.58 2.17 – 0.64 2.19 – 0.59 2.59 – 5.87 2.16 – 4.66* 2.65 – 1.25# F1,21 = 4.221; p = 0.041 F1,21 = 4.197; p = 0.040
TUG: Stand to Sit
Turning peak angular velocity (/s) 173.61 – 49.49 188.83 – 40.30 196.75 – 70.29 297.24 – 125.33 368.32 – 137.58* 311.87 – 115.98 F1,21 = 6.876; p = 0.010 F1,21 = 0.657; p = 0.423
Peak flexion angle turning () -26.31 – 34.65 -11.73 – 17.48 -11.03 – 20.18 -25.93 – 34.52 -21.84 – 5.70* -21.66 – 34.80 F1,21 = 0.051; p = 0.822 F1,21 = 0.052; p = 0.820
Peak extension angle turning () 61.00 – 35.06 80.19 – 8.36 76.95 – 9.99 65.74 – 31.39 82.69 – 6.77 61.35 – 33.27 F1,21 = 0.401; p = 0.531 F1,21 = 0.238; p = 0.629
Peak angular velocity turning (/s) 173.61 – 49.49 188.83 – 40.30 196.75 – 70.29 244.43 – 83.64 368.32 – 137.58* 311.87 – 115.98 F1,21 = 8.876; p = 0.001 F1,21 = 0.657; p = 0.423
Average angular velocity 148.10 – 62.18 135.50 – 38.18* 132.98 – 31.42 184.53 – 111.53 199.49 – 74.35 191.73 – 73.54 F1,21 = 3.603; p = 0.043 F1,21 = 0.147; p = 0.704
turning (/s)
Time turning (seconds) 1.93 – 1.36 1.95 – 1.16 2.06 – 0.54# 1.69 – 1.12 1.45 – 0.75* 1.54 – 0.69# F1,21 = 4.331; p = 0.047 F1,21 = 5.007; p = 0.035
TUG: total
Total time (seconds) 9.10 – 2.71 9.22 – 2.49 9.62 – 1.42 9.35 – 2.43 7.78 – 2.81** 7.81 – 5.64 F1,21 = 5.035; p = 0.035 F1,21 = 0.494; p = 0.488
# ##
Pretest–Posttest significant difference: *p < 0.05; **p < 0.001; posttest-follow-up significant difference: p < 0.05; p < 0.001.
AP, anteroposterior; MG, Mat Pilates group; ML, mediolateral; PD, Parkinson’s disease; TUG, Timed Up and Go.
 PILATES WITH THERABAND AND PARKINSON’S DISEASE
future research, given the impossibility of such comparison
at present. Therefore, it could be hypothesized that the in-
tensity levels of the calisthenics program were not appropri-
ate to produce the changes that were initially expected.
The analysis of TUG dynamic balance revealed that
participants in MG attested improvements in the Go, Return,
and Stand to Sit phases, while CG did not register such
enhancements, apart from Stand to Sit. These results indi-
cate that the inclusion of strength work in MP might explain
such increases, which are connected to higher levels of
functional independence in PD patients.30
Pilates training could be considered a form of physical
exercise focused on the improvement of strength, core sta-
bility, flexibility, muscular control, posture, and breathing.13
Studies by Hageman and Thomas31 and Thomas and Ha-
geman,32 where the intervention program involved the use
of TheraBand, did not report lower TUG total times, which
is not consistent with the results presented here. However,
the age and level of dependence in this sample might have
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had an impact on these figures.
When both programs were completed, after the 4-week
follow-up, the improvements achieved were not maintained,
which suggests that continued and scheduled practice adjusting
the intensity of the workout is an essential factor to increase
functional independence and keep strength at an adequate
level.
The TUG cinematic analysis revealed that the mean value of
the angle of hip flexion was lower in MG than in CG at the end
of the intervention, but higher at follow-up, even though such
differences were not significant. Future studies should control
these variables more closely, as the increase in angular velocity
could have been due to an improvement in strength and, con-
sequently, balance. The TUG Sit to Stand, Turning, and Stand
to Sit figures in MG confirm the assumption that one of the
objectives of MP is to improve coordination and core muscle
control, leading to the optimal lumbopelvic stabilization nee-
ded for daily life activities and functions.16
In summary, the promising results obtained in safety and
feasibility suggest that the MP program with TheraBand is
appropriate for PD populations. The intervention led to im-
provements in dynamic balance and significant gains in lower
body strength, even though such benefits were not maintained
4 weeks after the experiment concluded.
Limitations and future directions
The first limitation that should be made explicit involves
the low statistical power (60%) of sample size estimation,
which may have affected the probability of identifying
program effects.
The unavailability of a CG which did not exercise rep-
resents the second limitation of the present study; had there
been a CG with no physical activity, the effect of the Pilates
intervention could have been clearer.
The third limitation is related to the heterogeneity of the
sample (age, sex, and H&Y stage) that makes it difficult
to draw adequate comparisons and extrapolate useful data.
Future research should aim to stratify the sample according
to age, sex, and H&Y stage with the objective of identifying
program effects in more homogeneous groups.
The fourth limitation derives from the design of the
experiment, which is not double-blind, as would have been
429
desirable. The researchers were aware of participant allo-
cation in MG and CG.
The fifth and last limitation to be reported is connected to
the cinematic analysis performed on dynamic balance: TUG
with Wiva sensors is rare, because there are still no articles
where they use it, which has been an obstacle at the time of
contrasting the results obtained. Further research studies
should be conducted with these analyses.
Acknowledgment
The authors thank the Parkinson Pontevedra Association
for its participation in the study.
Author Disclosure Statement
No competing financial interests exist.
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Address correspondence to:
Irimia Mollinedo-Cardalda
Campus da Xunqueira s/n
Faculty of Education Sciences and Sports
Pontevedra E-36005
Spain
E-mail: imollinedo@uvigo.es
Received: August 10, 2017
Accepted: December 5, 2017