# Exercise as it relates to Disease/Physical activity interventions to improve chronic disease

Pilates as an Intervention to Improve Chronic Lower Back Pain
$^{Background}$
Back pain will affect around 80% of the population in their lifetime, of these people affected by back pain, 90% have non-specific back pain. Back pain also causes large economic costs to society due to the limitations it causes. Back pain affects many age groups but has the highest incidences of musculoskeletal problems in people aged 45 years or under.
Back pain is diagnosed as pain that is located between the inferior most aspect of the scapular to the gluteal folds that lasts for more than 12 weeks with no defined cause. Pilates have six main principles that it targets; core stability, strength, flexibility, posture, breathing and muscle control. These six principles are often seen as a weakness within people with non-specific back pain.
Pilates has gained a greater popularity within the last ten years especially within people with non specific lower back pain. Multiple Studies have been performed and many studies have agreed that Pilates is beneficial for non specific lower back pain. Though many studies have agreed that Pilates is an effective method, there is no empirical scientific evidence to back up these claims.
$^{ResearchType}$
This Pilates intervention to improve chronic lower back pain is a randomised controlled research report that involved a true experiment in a longitudinal study.
$^{WhoandWherewastheResearchBased?}$
The experiment that was performed at the University of São Paulo in São Paulo, Brazil in the outpatient physical therapy department of the university. The report was first published online before being published in the Journal of the American Physical Therapy Association in March 2013 by the authors Gisela C. Miyamoto, Leonardo Oliveira Pena Costa, Thalissa Galvanin and Cristina Maria Nunes Cabral.
$^{Whatdidtheresearchinvolve?}$
The researches aim was to assess four factors the researchers deemed had not been studied before. The four factors were global perceived effect, kineiophobia, pain intensity and general and specific disability. Global perceived effect is a measure of muscle pain which is measured using the 'Patient Specific Functional Scale. Kineiophobia is the fear of exercising for people with back pain and it is assessed on the 'Tampa Scale for Kinesiophobia'. Pain intensity is a scale out of 10 with 1 being 'no pain' and 10 being 'pain the worst it could be', this is called the 'Pain Numerical Rating Scale'. The general and specific disabilities were rated using the 'Roland-Morris Disability Questionnaire' and assess how well individuals can perform everyday tasks for normal living.
The research involved two study groups. One was an educational based Pilate’s study group and the other was a practical based Pilates study group. Both groups assessed how the addition of assisted and practical learning could improve lower back pain compared to a brief verbal education. The educational based Pilates study group were given pamphlets of activities to complete throughout investigation and were called twice a week for the first six weeks to answer any queries they may have regarding the pamphlet they have been supplied. The practical based Pilates group were also given a booklet in their first Pilates session as well as being supplied a one-hour modified Pilates session twice a week for the first six weeks of the intervention. There was a six-month follow up appointment for both study groups where the results were obtained for the experiment.
$^{Results}$
The researched showed a greater improvement in general and specific disability and pain intensity for the Pilates group greater than the improvements in the booklet study group, though there are no long term benefits. The experiment also showed no improvements in kineiophobia and global perceived effect for either study group.
$^{Conclusion}$
The conclusions that can be taken away from this study can only refer to the short and the medium term effects. Pain intensity can be improved in the short term but not the medium term. The fear participants had whilst exercising has no improvement throughout the whole experiment. General and specific disabilities were improved in 6 weeks but did not see effects after 6 months. Global perceived effects were also improved in the short term but did not see improvements in 6 months. The overall conclusion of the study was that there can be short term benefits for the chronic lower back pain population when doing Pilates, but there is no medium and long term if the exercises are maintained.
$^{Implicationsofthisresearch}$
An implication for the experiment is that it is not possible to have blind participants or assessor in this experiment. By not having blind assessors or participants it can create a subconscious bias against the research. Another limitation of the study is that the experiment did not have a control group. Whilst they have compared different methods of teaching people Pilates, they have not assessed whether Pilates is actually beneficial to alleviate non specific lower back pain by not having a control group.
The experiment lacked the controlled use of pharmaceuticals to control pain. The Pilates exercise participants reported using anti inflammatory and analgesics where as the booklet study group only reported using analgesics. This inconsistency within the groups could cause a bias between the groups. Another limitation within the experiment is the lack of a definition to define what an improvement is within the experiment.
$^{References}$
* 1 2 3 4 Baptista, A., Cazotti, L., Jones, A., Natour, J., & Ribeiro, L. (2015). Pilates Improves Pain, Function and Quality of Life in Patients with Chronic Low Back Pain: A Randomised Controlled Trial. Clinical Rehabilitation , 59-68.
* 1 2 Bialocerkowski, A., Kolt, G., & Wells, C. (2014). Indications, Benefits, and Risks of Pilates Exercise for People with Chronic Low Back Pain: A Delphi Survey of Pilates-Trained Physical Therapists. Physical Therapy: Journal of the American Physical Therapy Association , 806-817
* 1 2 Cardoso, J., Dias, J., Guariglia, D., Menacho, M., Obara, K., Pereira, H., et al. (2011). Comparing the Pilates Method With No Exercise or Lumbar Stabilisation For Pain and Functionality in Patients with Chronic Low Back Pain: Systematic Review and Meta-analysis. Clinical Rehabilitation , 10-20.
* ↑ Cabral, C., Franco, Y., Liebano, R., Miyamoto, G., Moura, K., Oliveira, N., et al. (2014). Efficacy of the Addition of Interferential Current to Pilates Method in Patients with Low Back Pain: A Protocol of a Randomised Controlled Trial. BMC Musculoskeletal Disorders , 237-245.
* ↑ Warner Shaie, K. (1983). Longitudinal Studies of Adult Psychological Development. What Can We Learn From the Longitudinal Study of Adult Development? , 1-17.
* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Cabral, C. M., Costa, L. O., Thalissa, G., & Miyamoto, C. G. (2013). Efficacy of the Addition of Modified Pilates Exercises to a Minimal Intervention in Patients with Chronic Low Back Pain: A Randomised Controlled Trial. In R. L. Craik, & e. al., Physical Therapy: Journal of the American Physical Therapy Association Vol. 93, Issue 3 (pp. 310-320). São Paulo: Elsevier Science Publishers.
* ↑ Boutron, I., Brorson, S., Emanuelsson, F., Hilden, J., Hróbjartsson, A., Ravaud, P., et al. (2013). Observer Bias in Randomized Clinical Trials with Measurement Scale Outcomes: A Systematic Review of Trials With Both Blinded and Non blinded Assessors. US National Library of Medicine , 201-211.