Accepted Manuscript

Effects of 16-weeks of Pilates on functional autonomy and life satisfaction among

elderly women

Vanessa Sanders Curi, Helder Miguel Fernandes, José Vilaça, Aline Nogueira Haas

PII: S1360-8592(17)30138-9
DOI: 10.1016/j.jbmt.2017.06.014
Reference: YJBMT 1561

To appear in: Journal of Bodywork & Movement Therapies

Received Date: 24 December 2016

Revised Date: 4 June 2017
Accepted Date: 15 June 2017

Please cite this article as: Curi, V.S., Fernandes, H.M., Vilaça, J., Haas, A.N., Effects of 16-weeks
of Pilates on functional autonomy and life satisfaction among elderly women, Journal of Bodywork &
Movement Therapies (2017), doi: 10.1016/j.jbmt.2017.06.014.

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 ACCEPTED MANUSCRIPT
Effects of 16-weeks of Pilates on functional autonomy and life satisfaction among
elderly women

RANDOMIZED CLINICAL TRIAL

______________________________________________________________________
*1
Vanessa Sanders Curi MSc PhD(Candidate)
Master in Biomedical Gerontology, PUCRS, Brasil.
PhD student at the University of Trás-os-Montes and Alto Douro,Vila Real, Portugal.

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2
Helder Miguel Fernandes PhD
Center for Research in Sport, Health and Human Development; University of Trás-os-
Montes and Alto Douro, Vila Real, Portugal.

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3
José Vilaça PhD

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Center for Research in Sport, Health and Human Development; University of Trás-os-
Montes and Alto Douro, Vila Real, Portugal.
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Aline Nogueira Haas PhD,

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Federal University of Rio Grande do Sul, Brazil.
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Address for correspondence:
Vanessa Sanders Curi, Rua Professor Antonio Manoel Martins, 57/103, Centro,
Palhoça, CEP: 88131-280, Brazil.
studiomovimentors@gmail.com
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ABSTRACT
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The aim of this study was to determine the effects of Pilates-based mat exercises on functional
autonomy and life satisfaction among elderly women. A randomized controlled trial was
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conducted in Caxias do Sul, Brazil in 2015, in which 61 healthy older women were
randomized into two groups (experimental group, EG = 31 participants with 64.25 mean years
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of age, SD = 0.14, and a control group, CG = 30 participants, 63.75 mean years of age; SD =
0.08). The EG participants performed the mat Pilates twice per week, 60-minutes per session.
The same measurements were performed at baseline and after 16 weeks. No significant
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differences were found between groups at baseline (p > 0.05). In the EG, the following factors
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were increased after the 16-weeks training period: flexibility of lower limbs, flexibility of
upper limbs, strength in lower and upper limbs, aerobic endurance and dynamic balance. This
study revealed significant improvements on the life satisfaction scale's score for the EG when
compared to the CG, after 16 weeks of intervention. No differences were found between
baseline and after 16 weeks on the functional autonomy and life satisfaction scores for the CG.
According to the results of this study, it was found that functional autonomy and life
satisfaction for elderly women was improved after exposure to 16 weeks of the PM, suggesting
this practice helps with healthy aging.
Keywords: Pilates method, functional autonomy, life satisfaction, elderly.

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Introduction

Life satisfaction is generally assumed and expected to decline in older age, most notably as
health conditions deteriorate. In reality the general finding of the large body of gerontological
literature on the relationship between age and life satisfaction is that there is no age-related

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decline in life satisfaction (Larson, 1978; Herzog and Rodgers, 1981; Horley and Lavery, 1995;
Diener and Suh, 1997; Smith et al., 1999). Schilling (2005) finds that, in general, there is an

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overlay of age- and cohort-related decline of life satisfaction for individuals in young-old age
and that once cohort effects are controlled for a decline in life satisfaction is observable across

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old age.
According to Hébert (1997), functional decline is defined as deterioration in self-care skills,
where functional autonomy is diminished and disability is increased.

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In this sense, among the different physical activity and exercise programs made available for
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the elderly at gyms, cohabitation centers, clubs, free schools, community centers and sports
associations, the Pilates Method has been gaining popularity.
Joseph Hubertus Pilates believed that his method, called “Contrology”, would activate brain
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cells to stimulate the mind and affect the body. As McNeill (2011, p. 103) states, “there are
many differences in the way that Pilates is taught. It is often divided into two types of Pilates:
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Pilates on the mat and Pilates equipment in which the work is based on the use of Pilates
machines”. Joseph Hubertus Pilates invented his apparatus as an aid to learning movement
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patterns; mastering the mat program was the method’s goal, with the outcome being
transference to a more functional and integrative movement.
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According to Di Lorenzo (2011, p. 355), there are 12 original pieces of Pilates equipment: the
reformer, cadillac, wunda chair, electric or high chair, magic circle, ladder barrel, small barrel,
baby chair, mat, spine corrector, toe corrector and breath-a-cizer. Aparício and Pérez (2005)
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highlighted another important feature of Pilates regarding the emphasis of this method on the
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strengthening of the powerhouse, which includes the circumference of the lower torso and is
responsible for supporting and strengthening the rest of the body. Working with the whole
body, with correct alignment and appropriate posture, it helps to develop the body stability
necessary for a long, healthy life.
With this increase in the elderly population, especially women, there is a need to investigate
interventions designed to promote their health (World Health Organization, 2016). In this
sense, research on the PM has developed over the last five years, and one of the areas where
there is considerable interest is in the area of this study (Costa et. al, 2016). However, research
with similar objectives and outcomes is still scarce. Mainly, the study of the variable life

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satisfaction in relation to the Brazilian older population is unprecedented.
Because of this, the aim of this study was to investigate the effects of the regular practice of
Pilates for elderly women and its influence on their functional autonomy and life satisfaction.
Our hypothesis is that the regular practice of the PM improves functional autonomy and life
satisfaction in elderly women.

Methods

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Design and Setting

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This randomized controlled study (Lakatos and Marconi, 2001) was submitted to the Research
Ethics Committee of the Federal University of Rio Grande do Sul, Brazil. After clarifying the

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objectives of this study and reading the Term of Free and Informed Consent, sixty-one female
volunteers registered with UCS, in the city of Caxias do Sul, Brazil, accepted to participate in
this study.

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Participants
The participants were randomized, with a draw, into an experimental group, EG = 31 women;
average age 64.25; and a control group, CG = 30 women, average age 63.75 (Fig 1).
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The inclusion criteria were that the subject had not exercised for at least six months, agreed to
participate in this controlled clinical trial, was female and at least 60 years old. The CG did not
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perform any physical activity in the same 16-weeks period and attended monthly meetings at a
groups of ladies in the Catholic community that lent the space for the activities of this research.
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We estimated a possible loss of up to 20 percent of the sample. The intention was to start with
80 elderly women, but only 74 were initially willing to volunteer.
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PLACE OF FIGURE 1
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Eligible
Did not meet the
Participants
criteria n= 9
N = 73

n = 64

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EG = 33 CG = 31

Drop out = 1,

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Drop out = 2,
personal issues personal
issues

Tests of Tests of

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Autonomy 16 weeks of Autonomy
Functional and Pilates Functional and
Satisfaction intervention Satisfaction
with Life with Life

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Scale, n= 31 AN Scale, n= 30

Repeated Repeated
measures measures
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Figure 1: Flowchart of participants during the trial.

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Procedures
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During the 16 weeks, the EG maintained a weekly frequency of two mat Pilates classes lasting
one hour each, supervised by the same qualified Pilates instructor. The exercises that were
given during the first two weeks of the intervention were designed and standardized according
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to the Classical Pilates Method (Table 1).

For the next 14-weeks of the intervention, the exercise protocol was amended by adding new
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intermediate-level exercises (Table 2). PLACE OF TABLE 1

Table 1: Class planning in the first two weeks. Source: Aparício and Pérez (2005).
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Series Exercises

Pre-pilates a) Exploring the Power House; b) Pushing the navel toward the spine; c) Pushing
exercises the spine toward the mat; d) Stretch the neck; e) Leading toward the chest; f) 5-10-
(Lying Down) 15; g) Rolling Down

Pre-pilates a) Towering above the rips; b) Lifting the knee; c) Raising and lowering the
exercises shoulders; d) Shoulders Circles; e) Looking around and over the shoulders; f)
(Sitting Down) Looking toward the navel; g) Bringing in the ear to the shoulder; h) Half Circle

a) The hundred; b) Rolling Up; c) Leg Circles; d) Rolling like a ball; e) Single Leg
Begginer Mat Stretch; f) Double Leg Stretch; g) Spine Stretch Foward

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a) Arm Circles; b) Rolling Down; c) Sitting on the Chair; d) “2x4” facing the wall
Wall Series
Series with a) Arms Forward; b) Arms to the side; c) Flexions of the forearm standing
weights (1kg)

PLACE OF TABLE 2
Table 2 Class planning in the first two weeks. Source: Aparício and Pérez (2005).
Exercises/Repetitions
Intermediate Mat

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Series The hundred (10 sets of 10 repetitions);
Roll up (3);
Leg circles (5 each way);
Rolling like a Ball (6);

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Single leg stretch (6);
Double leg stretch (6);
Single straight leg stretch/scissors (5 sets);
Double straight leg stretch/lower lift (5);

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Criss-crossing (5sets);
Spine stretching forward (3);
Open leg rocker (6);
Corkscrew (3 sets); Saw (3 sets);

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Neck circles (1 each way);
Single leg kicking (5);
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Double leg kicking (2 sets);
Stretch (3);
Side kicking Series – front/behind (5);
Side kicking Series – up/down (3);
Small circles (5);
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Teaser I (3) and

Seal (6).
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This was possible because the participants in the study demonstrated quick learning and
assimilation of the PM during the first two weeks of the intervention. Throughout the entire
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period of Pilates Method training, the participants reported no discomfort.

We used the following activities on the intervention: a series of pre-Pilates and Pilates for
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beginners, with the goal of completing the series of Pilates at the intermediate level.

Outcome variables
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Outcome variables were measured for both the EG and CG before and after training with the
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PM using the following tests:

(1) FUNCTIONAL AUTONOMY: the Rikli and Jones Protocol (2002) was used to measure
the functional autonomy of the participants. It comprises assessments of lower limb strength
(LLS) and upper limb strength (ULS), measured in repetitions per second; Lower limb
flexibility (LLF) and upper limb flexibility (ULF), measured in centimeters; Dynamic balance
(DB) and aerobic endurance (AE), measured in seconds and minutes. Battery tests include
getting up and down, forearm flexion, sitting and reaching, reaching behind the back, walking
2.44m and sitting back down, and walking six minutes.

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(2) LIFE SATISFACTION. The study of Subjective Life Satisfaction seeks to understand how
people evaluate their lives. Several items were drawn up for the development of an instrument
to measure the three major components of subjective well-being: life satisfaction, positive
affect and negative affect. Participants in this study completed the Brazilian version (Gouveia
et al., 2009) of the Satisfaction with Life Scale (Diener et al., 1985). This scale is composed of
five items rated on a 7-point Likert scale, with scores ranging from 1 = strongly disagree to 7 =

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strongly agree. In our study, the Cronbach alpha coefficients ranged from 0.75 at baseline to
0.79 after 16 weeks.

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Statistical analysis

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Data normality was confirmed with the Shapiro-Wilk test (p < 0.05), the ANOVA was used for
the repeated measures of the two groups (EG and CG); the x2 times (pre- and post-intervention)
model was used. The homogeneity of variance and covariance was also secured and tested using

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the Levene test, and sphericity was tested using the Mauchly test. The adopted significance level
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was 0.5. The descriptive statistical analysis, the averages and respective standard deviations of
each variable under study and all planned analysis of contexts were calculated using the IBM
SPSS 20 software.
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Results
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Table 3 presents the results of the variables studied, before and after 16-weeks of PM training.
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PLACE OF TABLE 3

Table 3: results of the variables studied, before and after 16-week of PM training
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Experimental Group Control Group

Variables
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Pre Post Pre Post

Lower Limb 13.23±2.45 14.87±2.53* 13.40±2.57 13.13±2.37$

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Strength
Upper limb 17.58±3.84 21.55±3.08* 16.03±3.15 15.87±2.92$
strength
Lower Limb 20.79±6.69 0.03±9.56* 18.62±8.08 18.48±7.75$
Flexibiliy
Upper Limb 5.50±6.95 0.40±7.74* 8.63±6.99 9.97±6.81$
Flexibility
Dynamic 7.44±1.21 6.34±0.99* 7.60±1.16 7.86±1.12$
balance
Aerobic 21.07±3.37 18.84±2.99* 20.14±3.06 20.34±3.25
endurance

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Life
Satisfaction 25.71±5.45 27.87±4.57* 26.03±4.05 26.13±3.50

*p < 0.005 before and after 16-week of PM training p < 0.005 between the EG and CG.

Discussion

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This study aimed to evaluate functional autonomy, through the application of the protocol used
by Rikli and Jones (2002), composed of lower limb strength, upper limb strength, lower limb

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flexibility, upper limb flexibility, dynamic balance and aerobic endurance tests. The findings
revealed significant improvements of those variables in relation to the CG, after 16 weeks of

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intervention. In addition, regarding life satisfaction, the findings revealed significant
improvements of this variable in relation to the CG, after 16 weeks of intervention.

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FUNCTIONAL AUTONOMY
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Strength
Following a study by Oliveira et al. (2015), which evaluated the improvement of isokinetic
torque with the PM, our study evaluated the strength of the lower limbs of elderly exposed to
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the PM. The results showed that PM exercises led to a significant improvement in the isokinetic
torque of knee extensors and flexors of older adults.
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It is important to keep in mind that maintaining strength levels in the aging process, as well as
training the limbs, is of paramount importance for functional autonomy, if we consider that
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sarcopenia occurs during the process of human aging. According Gomes et al. (2017),
sarcopenia is characterized by progressive and generalized loss of muscle and skeletal mass
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associated with age, and it occurs without the presence of underlying diseases.
In this study, the lower and upper limbs were tested for strength after the training period, and
statistically significant results were found.
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In addition, Mello et al. (2015) concluded that the PM can be considered an exercise
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intervention that increases muscle mass, strength, improves static and dynamic balance,
functional capacity to perform activities of daily life, and the quality of life of the elderly.
In this study, the lower limb strength (LLS) and upper limb strength (ULS) tests: the time effect
in LLS (F (1.59) = 11.956; p = 0.001 = 0.169 µp2) and the group x time interaction (F (1.59) =
22.997; p = < 0.0001; = µp2 0.280). Significant differences between groups were observed after
the intervention (p = 0.008). When we analyzed each individual group, a significant increase in
performance was observed in the EG according to the LLS test (p = < 0.0001).
In the ULS test, a time effect was observed (F (1.59) = 41.504; p < 0.0001; µp2 = 0.413), a
group x time interaction (F (1.59) = 49.102; p = < 0.0001; µp2 = 0.454), and group effect (F

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(1.59) = 21.307; p = < 0.0001; µp2 = 0.265). This test showed significant differences between
groups after the intervention (p = < 0.0001). When we analyzed each individual group, a
significant increase in performance on the ULS test was observed in the EG (p = < 0.0001),
significant differences in performance were observed in the CG.

Flexibility
According to Varejão et al. (2007), flexibility is one of the most important physical valences in

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the functional capacity of the elderly for the performance of daily activities, considering the
minimum necessary to enable the functional autonomy of the elderly.

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Considering the findings of the study by Guimarães et al. (2014) on the effects of the PM on the
levels of flexibility of the elderly, we also suggest a regular practice of the PM as a preventive

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way of maintaining satisfactory levels of flexibility.
However, in a systematic review by Cancela et al. (2014), the authors consider that there is
strong evidence for the effects of the PM on improving static and dynamic balance for the

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elderly when there is moderate evidence of the effects on lower limb flexibility.
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Moreover, to evaluate whether two different training programs in the first semester would have
a positive effect on flexibility, range of motion and endurance in a sample of the elderly
population, Plachy et al. (2012) performed analyses to find out which program was most
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effective. The significant results for the Pilates group were on aerobic capacity and dynamic
balance, while for the group of hydrogymnastics and Pilates, the flexibility of shoulder and hip
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were significant.
In this study, on the lower limb flexibility test (LLF), a time effect was observed (F = 201.649;
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p = < 0.0001; µp2 = 0.774), a time x group interaction (F (1.59) = 196.534; p = <0.0001; µp2
= 0.769) and group effect (F (1.59) = 17.657; p = <0.0001; µp2 = 0.230). This test showed a
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significant difference between groups after the intervention (p = < 0.0001).

When analyzing each individual group, it was observed that the EG showed a significant
increase in performance on the LLF test (p = 0.001). No significant difference was observed in
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the CG on the same test.

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In relation to the upper limb flexibility test (ULF), a time effect was observed (F (1.59) =
25.0111, p = <0.0001; µp2 = 0.298) a group x time interaction (F (1, 59) = 73.013; p = <0,
0001; µp2 = 0.553) and group effect of (F (1, 59) = 12.606, p = 0.001; µp2 = 0.176). This test
observed significant differences between groups after the intervention (p = <0.0001).
When each individual group was analyzed, a significant increase in performance in the ULF test
was observed in the EG (p = < 0.0001). In CG, there was a significant decrease in performance
(p = 0.001) in the same test.

Dynamic Balance

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However, Oliveira et al. (2015) investigated the effects of the PM on a systematic review and
demonstrated a strong level of evidence of static and dynamic balance improvements in older
women and limited evidence on improvements in balance in older men. These studies also
showed limited evidence of an improvement in muscle strength, flexibility, autonomy and
quality of life, and a decrease in risk of falls, in men and women. In addition, there is limited
evidence on adherence to a Pilates program and there were inconclusive results on the effects on
cardio-metabolic parameters.

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In this sense, a study by Rodrigues et al. (2010) evaluated 52 elderly women who underwent
functional autonomy assessment: protocol (GLAM) and static balance (Tinetti). After training

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with the Pilates Method, only the experimental group showed significant differences in the PG
and GLAM balance.

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Moreover, a study by Mello et al. (2015) concluded that the PM can be considered an exercise
intervention able to increase muscle mass, strength, improve static and dynamic balance,
functional capacity to perform activities of daily living and quality of life of the elderly.

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Balance associated with risk of falling was studied by Mokhtari et al. (2012), who investigated
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the effects of 12 weeks of PM exercise. Results of covariance showed that the EG showed a
decrease in time for the functional range test (16.703%) and the up-and-go timed test (7.263%).
Our study showed a time effect in the dynamic balance test (DB) (F (1.59) = 26.326;
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p<0.0001; µp2 = 0.298), a group x time interaction (F (1.59) = 70.107; p <0.0001; µp2 = 0.543)
and a group effect (F (1.59) = 9.388, p = 0.003; µp2 = 0.137). This test showed
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significant differences between groups after the intervention (p = <0.0001). Analyses of each
group showed an increase in performance in the EG (p <0.0001) and in CG (p = 0.004) for this
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test.
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Aerobic Endurance
A study by Fraga et al. (2010) analyzed the impact of a program of physical activity (leisure
and short) on aerobic endurance, functional autonomy and quality of life for older women. The
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results showed a significant improvement in aerobic resistance (∆% = 29.06%, p = 0.0001),

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functional autonomy (∆% = -27.15%, p = 0.0001) and QoL (∆% = 15.47%, p = 0.0001). These
authors concluded that systematic physical exercise positively influences the range, endurance
and QoL of the elderly.
The aim of a study by Kovách et al. (2013) was to compare and measure the effects of Pilates
and hydrogymnastics training on functional fitness. The Fullerton Functional Fitness Test
(FFFT) was used to measure functional fitness pre- and post-program, and improved overall
physical performance of the healthy elderly was found, regardless of the type of exercise.
When investigating the effects of the PM on the agility and functional mobility of the elderly,
the relevant results of the study by Gildenhuys et al. (2013) demonstrated a significant

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improvement in these variables.
But, in this study, a time effect was observed in the aerobic test (F (1.59) = 38.129; p = <0.0001;
µp2 = 0.393), a group x time interaction (F (1.59) = 55.250; p = <0.0001; µp2 = 0.484) and a
group effect was not observed. In this test, no differences were observed between groups before
and after the intervention. When each group was analyzed, a significant improvement in aerobic
test performance was observed in the EG (p = <0.0001). In the CG, no significant difference in
the performance on this test was observed.

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LIFE SATISFACTION

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The study of the psychological benefits of Pilates practice for the elderly is an important
research area if we consider that the PM is a method of physical and mental conditioning.

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According to the study by Bullo et al. (2015), PM effects are a relevant intervention to improve
quality of life, prevention of falls, physical fitness and states of humor in the elderly.
To identify the factors motivating women to practice physical activity, a multidimensional

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approach needs to be applied. According Terbová et. al (2009), regular physical activity in
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women during middle and late adulthood can increase overall life satisfaction and improve body
self-perception and well-being. Physical activity brings women positive emotions that influence
and improve their perception of their own bodies.
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The Satisfaction with Life Scale was developed in the United States as a multi-item scale for the
overall assessment of life satisfaction as a cognitive-judgmental process, rather than as a
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measurement satisfaction with specific areas (Andrews & Withey, 1976).

According to a study by Cruz-Ferreira et al. (2008) with adults, significant improvements were
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observed in the following variables after six months of intervention with the PM: satisfaction
with life, perception of appreciation by other people, perception of physical appearance,
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perceived functionality, perceived health status.

With respect to the satisfaction with life scale, our study found no significant group effect in the
scale's score across the two groups. However, significant time X group interaction effect (F
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(1.59) = 5.61, p = 0.021, η²= 0.09) and a main effect for time (F (1.59) = 6.76, p = 0.012, η² =
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0.10) were found. Univariate analyses revealed significant improvements in this variable for
the EG when compared to the CG after 16 weeks of intervention.
Therefore, regular practice of the Pilates method positively influences the functional autonomy
of elderly women, with the objective of maintaining the independence of this population. In the
present study, we corroborate the updated academic literature when we consider that there were
significant changes in the experimental group after the 16-week training period in all tests:
lower limb flexibility upper limb flexibility, lower limb strength, and upper limb strength,
aerobic capacity and dynamic balance.
We consider that one of the limiting factors of this study is that we could have a larger sample.

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We had few losses of participants, a fact that contributes to the conclusion of this study.
Another limiting factor is the paucity of studies comparing life satisfaction and the PM; only
one study was found with adult population. New studies are needed to reaffirm these findings,
especially regarding the aerobic capacity during the application of functional autonomy tests.
As to the implications for the practice of Pilates, we understand that promoting active and
healthy aging is associated with maintaining functional autonomy, and this is fundamental to
promote the independence of the elderly, as well as to improve the levels of life satisfaction

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present in this study. This fact motivated us to carry out this research, and it positively
influences the prescription of physical exercises, the psychological aspects involved, and

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especially in the regular practice of the Pilates Method.

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Conclusions
According to the results of this study, functional autonomy and life satisfaction for elderly
women was improved with exposure to 16 weeks of training in the Pilates method, suggesting

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this practice helps with healthy aging. On the other hand, no differences were found between
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baseline and after 16 weeks on the functional autonomy and life satisfaction scores for the CG.

Conflict of Interest:
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The authors declare no conflicts of interest.

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