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Journal of Bodywork & Movement Therapies (2016) xx, 1e8

Available online at www.sciencedirect.com

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RANDOMIZED STUDY

The effects of 12 weeks Pilates-inspired

exercise training on functional performance
in older women: A randomized clinical trial
Natália Donzeli Vieira, BSc a, Daniela Testa, BSc a,
Paula Cristine Ruas, BSc a, Tânia de Fátima Salvini, PhD b,
Aparecida Maria Catai, PhD b, Ruth Caldeira Melo, PhD a,*

a
School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil
b
Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil

Received 11 March 2016; received in revised form 6 June 2016; accepted 10 June 2016

KEYWORDS Summary Background: Recent scientific evidence supports the benefits of Pilates exercises on
Pilates; postural balance and muscle strength of older persons. However, their effects on other aspects of
Elderly; physical fitness, which are also important for independent living in older age, are still unknown.
Physical fitness; Objective: To investigate the effects of a 12-week Pilates-inspired exercise program on the func-
Postural balance; tional performance of community-dwelling older women.
Muscle strength; Methods: Forty community-dwelling older women were randomly enrolled in a Pilates-inspired ex-
Aerobic resistance ercise training (2 times/week, 60 min/session) (PG, n Z 21, 66.0
1.4yrs) or kept in the control
group (CG; n Z 19, 63.3
0.9yrs). The Pilates exercises were conducted in small groups and per-
formed on mats (using accessories such as exercise rubber bands, swiss and exercise balls). The
functional performance on one-leg stance (OLS), timed up and go (TUG), five-times-sit-to-stand
(STS) and 6-min walk (6 MW) tests was evaluated before and after the 12-week Pilates training
or control follow-up period.
Results: After 12 weeks, time effects were observed for STS (p Z 0.03) and 6 MW tests (p < 0.01).
Only among PG subjects did the time spent to rise from a chair and return to a seated position
decrease significantly (2.0 s faster, p Z 0.02) and the distance walked in 6 min increase
(w30 m, p < 0.01). OLS and TUG performance remained unaltered in both groups.
Conclusion: Pilates-inspired exercises improved dynamic balance, lower-extremity strength and
aerobic resistance in community-dwelling older women. Therefore, it may be a potentially effec-
tive exercise regimen to maintain physical fitness in old age.
ª 2016 Elsevier Ltd. All rights reserved.

* Corresponding author. Av. Arlindo Béttio, 1000, Ermelino Matarazzo, São Paulo, SP, 03828-000, Brazil. Tel.: þ55 11 30918136;
fax: þ55 11 65450243.
E-mail address: ruth.melo@usp.br (R.C. Melo).

http://dx.doi.org/10.1016/j.jbmt.2016.06.010
1360-8592/ª 2016 Elsevier Ltd. All rights reserved.

Please cite this article in press as: Vieira, N.D., et al., The effects of 12 weeks Pilates-inspired exercise training on functional perfor-
mance in older women: A randomized clinical trial, Journal of Bodywork & Movement Therapies (2016), http://dx.doi.org/10.1016/
j.jbmt.2016.06.010
 + MODEL
2 N.D. Vieira et al.
Introduction
The number of older people worldwide is expected to
nearly triplicate by 2050 (Kulik et al., 2014). Population
aging will lead to an increased number of people with dis-
abilities and, consequently, to overburdened social security
systems, public health, and society (Gu et al., 2014). One of
several important components related to independence in
older age is the ability to safely and effectively carry out
daily tasks, which in turn is influenced by various physical
abilities such as postural balance, mobility, muscular
strength and endurance (den Ouden et al., 2011;
Vermeulen et al., 2011).
In order to support older persons in remaining indepen-
dent and enjoying good health for as long as possible, many
studies have sought to find determinants of disability in
community-dwelling elderly individuals (Idland et al., 2013;
den Ouden et al., 2011, 2013a; 2013c; Paterson et al.,
2004). Besides age (Idland et al., 2013; den Ouden et al.,
2013c; Paterson et al., 2004), gender (i.e., women) (den
Ouden et al., 2013c, 2013b) and number of chronic dis-
eases (den Ouden et al., 2013c, 2013b), measurements of
balance (functional reach test) (Idland et al., 2013),
mobility (gait speed and timed up and go test) (Donoghue
et al., 2014; Idland et al., 2013), muscular strength (hand
grip and lower limb) (den Ouden et al., 2013c) and aerobic
resistance (Paterson et al., 2004) have been considered
predictive of disability in activities of daily living (ADL).
Moreover, most of these physical capabilities have been
associated with the risk of falls (Ganz et al., 2007; Muir
et al., 2010) and frailty in older age (Clegg et al., 2013).
The relationship between poor physical functioning and
undesired outcomes (i.e., dependence, falls and frailty)
confirms the importance of targeted interventions to
maintain and improve physical performance and, conse-
quently, to postpone the onset of disability (Idland et al.,
2013). A recent meta-analysis study (Tak et al., 2013), for
example, showed that physical activity can prevent and
slow down age-related functional decline that leads to
disability. In addition, a preventive effect was found in both
older (75 years) and younger (<74 years) older adults, in
individuals with or without diseases, and in older adults
who already had functional limitations or disability.
Considering that above-average physical performance
probably acts as a physical reserve, allowing older adults to
respond adequately to present and future stressors (Blain
et al., 2010), physical activity should be encouraged in all
older adult age groups regardless of their functional status.
Current guidelines recommend 150 min of physical ac-
tivity per week to achieve health benefits, and multicom-
ponent training programs (i.e., a combination of two or
more of the following exercises: endurance, flexibility,
balance and strength) are the most suitable activity for
older individuals (Chodzko-Zajko et al., 2009). In the same
way, multicomponent training programs seem to be more
effective in improving functional performance (Daniels
et al., 2008; Karinkanta et al., 2007), reducing fall rates
and the risk of falling (Gillespie et al., 2009) and managing
frailty (Theou et al., 2011) among the elderly. In spite of
the benefits of physical activity, older adults are less likely
to become and stay physically active (Brawley et al., 2003).
Please cite this article in press as: Vieira, N.D., et al., The effects of 12 weeks Pilates-inspired exercise training on functional perfor-
mance in older women: A randomized clinical trial, Journal of Bodywork & Movement Therapies (2016), http://dx.doi.org/10.1016/
j.jbmt.2016.06.010
Considering that there is no “one-size-fits-all” exercise
program and that motivation is key to maintain exercise
adherence, especially for the elderly (Chao et al., 2000), it
is important to offer different alternatives of physical
training to this age group.
In the last two decades the Pilates method, an exercise
system developed over 80 years ago, has been receiving
attention due to its beneficial effects on postural balance,
endurance, coordination, strength and flexibility (Lange
et al., 2000). Two recent meta-analyses evaluated the
benefits of Pilates on balance (Barker et al., 2015) and on
physical fitness (Bullo et al., 2015) in older adults. In
summary, Pilates training seems to be effective for
improving dynamic balance (Barker et al., 2015; Bullo
et al., 2015) and muscle strength (Bullo et al., 2015), and
it is a promising exercise regimen to improve physical
fitness and to prevent falls. However, the poor quality of
randomized controlled trials involving the Pilates method
and the variety of methodologies that have been used in
the studies, mainly regarding the intervention period (5, 8,
12 and 24 weeks), frequency (2 and 3 sessions/week) and
types of exercises (mat, mat with accessories, apparatus
and others combinations) (Barker et al., 2015; Bullo et al.,
2015), make it difficult to draw meaningful comparisons.
Furthermore, other important physical capabilities needed
to maintain an independent life in older age, such as
cardiorespiratory fitness (Gildenhuys et al., 2013; Kovách
et al., 2013), were assessed in only a few studies. In this
sense, the purpose of the present study was to investigate
the effects of a 12-week Pilates-inspired exercise program
on functional performance among community-dwelling
older women.
Methods
Subjects
The study was designed as a randomized clinical trial
(ClinicalTrials.gov Identifier: HI017/2010). One hundred
and one community-dwelling older women (aged between
60 and 80 years) attending an Open University for the
Third Age at the University of São Paulo in Brazil vol-
unteered to participate in this study. After screening out
the subjects that were currently smokers, obese
(BMI > 30 kg/cm2), regularly engaged in other physical
conditioning programs (>2/week and/or >150 min/
week), who had musculoskeletal limitations, neurologic
diseases, cardiovascular diseases and/or any other con-
dition in which exercising is contraindicated, the remain-
ing subjects were randomly divided in two groups: Control
Group (CG, n Z 26) and Pilates Group (PG, n Z 26). An
independent researcher, who was not involved in the
recruitment of participants, executed a randomization on
http://www.random.com to assign each individual to a
specific group. The final sample in the present analysis
consisted of 19 women in the CG (7 did not return for
reassessment) and 21 in the PG (3 dropped out for per-
sonal reasons and 2 had low attendance rates, i.e., <70%).
The progress flowchart is presented in Fig. 1. All included
subjects were in good health based on clinical and
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Pilates training and functional performance 3

Figure 1 Flowchart showing participants throughout the study.

physical examination. Subjects were informed about the
experimental procedures and signed an informed consent
form approved by the Ethics Committee of the Institution
to participate in the study (protocol number: 017/2010).
Each subject had been instructed to avoid caffeinated and
alcoholic beverages and to not perform moderate or heavy
exercise the day before and the day of the application of
the protocols. Before beginning the test, subjects were
interviewed and examined to confirm their good health
and whether they had a normal night’s sleep.
Functional tests
One-leg stance test (OLS)
The OLS test has been used as a clinical tool to assess
postural balance in a static position. Previously to this test,
subjects were allowed to practice and were free to choose
which leg they preferred to lift. They were instructed to
remain in a position with a comfortable base of support
with their eyes open, arms by the side of the trunk and
weight evenly distributed between both feet. After that,
subjects were asked to stand freely on one leg for as long as
possible. The OLS test was interrupted after 30 s or if the
subjects touched the floor with the swing leg. If the sub-
jects were not able to maintain the unipodal support for
30 s at the first trial, three trials were performed (Jonsson
et al., 2004).
Timed up and go test (TUG)
The TUG test is a reliable and valid test for quantifying
functional mobility and is recommended by the American
Geriatrics Society and British Geriatrics Society for
screening the risk of falling (Panel on Prevention of Falls in
Older Persons, American Geriatrics Society and British
Geriatrics Society, 2011). In the present study, the TUG
test was performed using an ordinary arm-chair and a
stopwatch. Subjects started the test with their back against
the back of the chair. They were instructed to stand up,
walk a distance of 3 m, turn around, walk back to the chair
and sit down as quickly as they feel safe and comfortable
doing. One practice trial was conducted with each partici-
pant. The stopwatch was started at the word “go” and
stopped when the subject’s back touched the backrest of
the chair. TUG time was measured in seconds (s). The final
score was the average of the results of three trials (Bennell
et al., 2011).
Five-times sit-to-stand test (STS)
This test is a widely used measure of lower extremity
strength and dynamic balance among older adults. All
subjects were instructed to cross their arms over their
chest and sit with their back against the backrest of the
chair. They were also asked to come to a full stand between
repetitions (i.e., upright trunk with fully extended hips and
knee). After that, the time it took for subjects to rise from
an ordinary chair and return to their seated position five

Please cite this article in press as: Vieira, N.D., et al., The effects of 12 weeks Pilates-inspired exercise training on functional perfor-
mance in older women: A randomized clinical trial, Journal of Bodywork & Movement Therapies (2016), http://dx.doi.org/10.1016/
j.jbmt.2016.06.010
 + MODEL
4 N.D. Vieira et al.
times, as quickly as possible, was recorded with a stop-
watch (Bennell et al., 2011).
Six-minute walk test (6 MW)
This test measures the maximum distance walked in a
period of 6 min. The 6 MW is commonly used to measure
functional exercise capacity in patients with chronic
obstructive pulmonary disease and heart failure. Consid-
ering that it assesses the submaximal level of aerobic ca-
pacity, 6 MW may better reflect the functional exercise
level necessary to perform ADL than do maximal exercise
capacity tests, particularly among older persons (Crapo
et al., 2002). The 6 MW was performed as preconized by
The American Thoracic Society (Crapo et al., 2002). Briefly,
subjects were instructed to walk back and forth a 30-
m hallway during a period of 6 min. They were also ori-
ented to walk as fast as possible, but to not jog or run.
During the test, all subjects were encouraged using stan-
dard phrases (“You are doing well” and/or “Keep up the
good work”) and the completed laps were registered in a
worksheet. After 6 min, the subject was instructed to stop
and the distance walked in the last lap was measured.
Pilates program
The Pilates program was conducted twice weekly, in 60-
min sessions, for twelve consecutive weeks by a certified
Pilates Instructor. The session was divided into warm-up
(10 min), Pilates inspired-exercises (40 min) and cool-down
period (10 min), and was delivered to small groups of par-
ticipants (8e10). The exercises were performed on mats,
using accessories such as exercise rubber bands, swiss and
exercise balls. The Pilates program was designed to work
the full range of motion and to incorporate strength, bal-
ance and coordination into different body positions (i.e.,
lying, sitting, kneeling and standing postures) (Lange et al.,
2000). Subjects were instructed to perform the movements
with control and precision, with attention to their breath-
ing pattern (exhaling during flexion and inhaling during
extension, for example) and to powerhouse activation
during execution (Lange et al., 2000). The control group did
not take part in the Pilates training program and were
instructed to maintain their current activities during the
twelve-week follow-up period.
Statistical analysis
The calculation of sample size was based on previous studies
(Bohannon, 2006; Pata et al., 2014). A total sample size of
thirty-two subjects was needed to detect differences of
Table 1 Subject characteristics.
Control group
Before
Age (years) 63.3
0.91
Height (cm) 1.55
0.02
Weight (kg) 67.4
1.72
BMI (kg/m2) 28.1
0.84
Data are reported as mean
EPM. BMI Z body mass index.
Please cite this article in press as: Vieira, N.D., et al., The effects of 12 weeks Pilates-inspired exercise training on functional perfor-
mance in older women: A randomized clinical trial, Journal of Bodywork & Movement Therapies (2016), http://dx.doi.org/10.1016/
j.jbmt.2016.06.010
1.4 s in one outcome (TUG time), assuming a standard de-
viation of 1.8 s, a power of 80% and a significance level of 5%.
All statistical analyses were carried out using the statis-
tical software package SPSS (v.20; Chicago IL, USA) for
Macintosh. The parametricity of the data was determined
using the KolmogoroveSmirnov test. Baseline characteris-
tics of subjects in the two groups were compared using the
independent t-test. Group and time effects on weight, body
mass index (BMI) and functional performance were assessed
by repeated measures ANOVA. When significant main effects
were detected, comparisons using unpaired (intergroup) or
paired (intra-group) t-tests with Bonferroni correction were
carried out. The ManneWhitney and Wilcoxon signed ranks
tests were used to assess group and time effects, respec-
tively, for the parameters that did not follow a Gaussian
distribution (only OLS data). All data are presented as mean
(SEM) and the level of significance was set at p  0.05.
Results
Baseline characteristics of older women in our sample are
displayed in Table 1. There were no differences between
groups in any of the variables measured at baseline condi-
tion. Weight and BMI remained unchanged for both groups
during the training or control follow-up period.
The effects of 12 weeks of Pilates-inspired exercise
training or control follow-up (untrained) are shown in
Fig. 2. No group and time effects were observed for OLS
(CG Z 24.4
2.1 [95% CI Z 20.1 to 28.7] vs. 22.5
2.3 s
[95% CI Z 17.9 to 27.1] and PG Z 21.6
2.0 [95% CI Z 17.5
to 25.7] vs. 24.0
2.1 s [95% CI Z 19.6 to 28.3]; Fig. 2A)
and TUG (CG Z 7.3
0.28 [95% CI Z 6.7 to 7.9] vs.
7.5
0.18 s [95% CI Z 7.1 to 7.9] and PG Z 7.3
0.27
[95% CI Z 6.8 to 7.9] vs. 6.9
0.17 s [95% CI Z 6.6 to 7.3];
Fig. 2C) tests. Even though no difference was found in OLS
performance, the percentage of older women in PG that
achieved the highest OLS score increased from 53% to 71%
after the training period. In the CG, 63% and 58% of par-
ticipants could stand on one leg for 30 s before and after
the control follow-up period, respectively.
Time effects were observed for sit-to-stand test
(p Z 0.03, Fig. 2B) and 6-min walk test (p < 0.01, Fig. 2D).
It is important to note that all subjects completed the 6-
min walk test without interruptions. Intragroup compari-
sons showed that PG decreased the time they spent to rise
from a chair and return to a seated position five times
(14.6
0.6 s [95% CI Z 13.4 to 15.8] vs. 12.6
0.5 s [95%
CI Z 11.6 to 13.5], p Z 0.02) and increased the distance
they walked in 6 min (510
9 m [95% CI Z 490 to 529] vs.
542
11 m [95% CI Z 518 to 565], p < 0.01). Conversely,
Pilates group
After Before After
e 66.0
1.35 e
e 1.53
0.01 e
67.5
1.82 61.5
2.60 61.4
2.57
28.1
0.88 26.3
0.95 26.3
0.97
 + MODEL
Pilates training and functional performance 5

Figure 2 Functional performance before and after 12 weeks of Pilates-inspired exercise training or control period. Time effects
were observed for sit-to-stand test (p Z 0.03, panel B) and 6-min walk test (p < 0.01, panel D) (p < 0.05). The Pilates group
significantly decreased the time spent to rise from a chair and return to a seated position five times (*p Z 0.02) and increased the
distance walked in 6 min (*p < 0.01). No effects were observed for timed up and go (A) one-leg stance (C) and tests.

the control group showed no significant improvement in
these variables (STS Z 14.7
0.6 s [95% CI Z 13.2 to 15.7]
vs. 14.1
0.5 s [95% CI Z 13.2 to 15.1] and
6 MW Z 506
10 m [95% CI Z 486 to 527] vs. 519
12 m
[95% CI Z 493 to 543]). No additional effects were observed
for all variables studied.
Discussion
The present study investigated the effects of a 12-week
Pilates-inspired exercise training on functional perfor-
mance in community-dwelling older women. Results
showed that only PG significantly decreased the time spent
to complete the five-times STS test (2 s faster) and
increased the distance walked in the 6 MW test (w30 m),
while no changes were observed for the CG. Despite the
lack of changes in static balance and mobility tests after
the training period, we believe that Pilates-inspired exer-
cises might be a potentially effective workout regimen to
maintain functional performance and, possibly, to prevent
falls in old age.
The ability to maintain postural balance depends on the
complex interaction between sensory and musculoskeletal
systems. It is well established that the aging process affects
these systems, compromising balance and causing insta-
bility (Chodzko-Zajko et al., 2009). So, elderly persons with
impaired balance have a higher risk of developing ADL
disability (Vermeulen et al., 2011) and are in risk of falling
(Ganz et al., 2007). The effects of Pilates exercises on
static balance are controversial. As far as we know, only
two studies (Mesquita et al., 2015; Siqueira Rodrigues
et al., 2010) showed positive effects of Pilates exercises
(performed with equipment and on mat) on static balance
(POMA and stabilometric parameters) in older women. The
absence of Pilates training effects on OLS performance
observed here is in agreement with findings by Kloubec
(2010), who recorded no difference in static balance after
a mat Pilates training-program (12 weeks, 2 sessions/week,
60 min/session) in healthy middle-aged adults. Even though
in the present study no differences were noted in the time
spent to perform OLS between groups, which can be partly
explained by the ceiling effect of this test (i.e., many
subjects in both groups achieved the maximal score at
baseline), the percentage of volunteers in the Pilates group
(PG) that achieved the highest OLS score (i.e., 30 s)
increased by 18% after the follow-up period. An earlier
study showed that the inability to maintain unipodal bal-
ance for 30 s was commonly associated with a history of
falls (Hurvitz et al., 2000), so the increase in the number of
older women that completed the OLS after a Pilates
training period should be taken into consideration.
Previous studies have shown that Pilates-inspired exer-
cises lead to consistent improvements in dynamic balance
(Gildenhuys et al., 2013; Kovách et al., 2013; Mokhtari
et al., 2013; Siqueira Rodrigues et al., 2010) among older
adults, and the TUG test and/or the 8-foot up-and-go are
the most widely used tools to evaluate it (Gildenhuys et al.,
2013; Kovách et al., 2013; Mokhtari et al., 2013). Mokhtari
et al. (2013), for example, observed a decrease in time

Please cite this article in press as: Vieira, N.D., et al., The effects of 12 weeks Pilates-inspired exercise training on functional perfor-
mance in older women: A randomized clinical trial, Journal of Bodywork & Movement Therapies (2016), http://dx.doi.org/10.1016/
j.jbmt.2016.06.010
 + MODEL
6 N.D. Vieira et al.
(0.94 s) spent to perform the TUG test in the experimental
group after the training period (12-week Pilates exercises, 3
sessions/week, 60 min/session). Likewise, Kóvach et al.
(2013) and Gildenhuys et al. (2013) also showed improve-
ments in dynamic balance (evaluated by the 8-foot
upeand-go test) of community-dwelling older adults after
a Pilates training program. Contrary to these findings, the
present investigation failed to find differences between
subjects who practiced Pilates-inspired exercises and sub-
jects in a control group regarding the TUG test. At least two
factors contributed to this result: first, our mean data for
TUG scores at baseline (7.3 s for both groups) are lower
(faster) than the reference value (8.1 s) for this age group
(60e69 years old) (Bennell et al., 2011), suggesting that our
sample has a good mobility performance; second, our
Pilates protocol was not long enough to produce changes in
mobility or the TUG test was not sensitive enough to detect
these changes.
In addition to changes in balance due to aging, muscle
strength is also an important predictor of disability, frailty,
risk of falls and dependence among the elderly (Clegg
et al., 2013; Moreland et al., 2004). Age-related changes
in skeletal muscles include reduction in mass, strength and
muscular quality (Lang et al., 2010). Furthermore, a
decrease in muscle mass, prevailingly in the lower body, is
observed in elderly individuals (Janssen et al., 2000), and
such decrease is inversely related to functional capacity
and independence (Reid et al., 2008). Considering that
Pilates exercises involve employing different types of
resistance (springs, resistance rings, rubber bands and the
individual’s own body weight against gravity) (Lange et al.,
2000), it is likely that this type of exercise should also
produce benefits related to maintaining and increasing
muscle strength. In this sense, some studies demonstrated
increases in both upper (Kovách et al., 2013) and lower limb
muscle strength (Gildenhuys et al., 2013; Irez et al., 2011;
Kovách et al., 2013) among older adults after a Pilates
training program. It is important to note that improvements
in lower-limb strength were observed after different Pilates
training periods (i.e., 8e24 weeks). Gildenhuys et al.
(2013), for example, observed reductions in the time
spent by older adults to perform STS test (one and five
repetitions) after eight weeks of mat Pilates training. Our
results are in accordance with these previous studies, since
the Pilates group reduced the time needed to complete the
STS test (w2 s faster), while no changes were observed in
the control group.
Regarding the effects of Pilates exercises on the car-
diovascular system, it has still to be determined whether it
can improve cardiovascular fitness and/or aerobic endur-
ance. Spilde et al. (2013) measured the oxygen uptake in
healthy young adults during two sessions of Pilates exer-
cises, which were classified according to their intensity as
beginner and intermediate level. During the higher in-
tensity session (i.e., intermediate level), the observed ox-
ygen uptake and the heart rate levels were equivalent to
44% and 62% of their maximal values, respectively. Since
benefits of aerobic exercise are achieved when it is per-
formed between 50 and 70% of maximal heart rate or
40e60% of the maximal/peak oxygen uptake (Chodzko-
Zajko et al., 2009), it is possible that moderate-high in-
tensity Pilates exercises could also improve cardiovascular
Please cite this article in press as: Vieira, N.D., et al., The effects of 12 weeks Pilates-inspired exercise training on functional perfor-
mance in older women: A randomized clinical trial, Journal of Bodywork & Movement Therapies (2016), http://dx.doi.org/10.1016/
j.jbmt.2016.06.010
fitness. As far as we know, only two recent studies evaluate
the effects of Pilates on cardiovascular fitness of older
adults (Gildenhuys et al., 2013; Kovách et al., 2013). While
Gildenhuys et al. (2013) found no changes on maximal/peak
oxygen uptake after 8 weeks of Pilates training, Kovách
et al., 2013 observed an increase in the distance walked
during the 6 MW test after six months of Pilates training.
Our results are in agreement with Kovách et al. (2013),
since only the PG increased the distance walked in the
6 MW test after the follow-up period. Although the 6 MW
test does not determine the maximal/peak oxygen uptake,
it is widely used to evaluate functional capacity of the
elderly due to its practicality and low cost (Araújo et al.,
2006). Considering that the 6 MW test assesses the sub-
maximal level of aerobic capacity, it may better reflect the
functional exercise level necessary to perform ADL than
does subjects’ maximal exercise capacity, especially in old
age (Enright et al., 2003). So, the effects of Pilates exer-
cises on cardiovascular fitness observed here should be
interpreted with caution, since other physical characteris-
tics (i.e., lower-limb strength) can also influence perfor-
mance in the 6 MW test.
Finally, there are some limitations that should be
acknowledged and addressed regarding the present study.
As subjects were recruited inside an Open University for the
Third Age, it is possible that they were slightly more active
than average, resulting in higher scores/performance at
baseline. Because of this, the present results cannot be
generalized to all community-dwelling older adults.
Although we used only classical tests tailored for older
adults, it is possible that some of them (i.e., OLS and TUG
tests) were not sensitive enough to detect additional
changes after a Pilates training period.
Conclusion
Pilates-inspired exercises improved dynamic balance,
lower-extremity strength and cardiovascular fitness in
community-dwelling older women. Therefore, it might be a
potentially effective exercise regimen to maintain physical
fitness and, possibly, to prevent disability and falls in old
age. Yet, further investigation is needed to evaluate the
effectiveness of the Pilates method on functional and
physical fitness of older adults with characteristics that
differ from those of our sample.
Conflict of interest statement
The authors declare that there is no conflict of interest.
Funding
We are grateful for the financial support provided by CNPq
(process number: 557752/2009-4).
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