Effect of Different Volumes of Training of Pilates Exercises on Elderly
Condition: Aging; Exercise Movement Techniques
Study type: Interventional

Summary: 
      It will be an experimental study conducted with elderly of both sexes, these will be divided
      randomly into three groups and the intervention will happen twice a week, for 60 minutes, for
      12 weeks. The aim of the study is to compare the effect of different volumes of Pilates
      exercise training on muscle strength, postural balance, flexibility, functional autonomy,
      depressive symptoms and lung function in the elderly community. The investigators believe
      that Pilates exercises will have beneficial effects for the elderly, but the hypothesis is
      that the group that performs a greater volume of Pilates exercise training will have a
      greater improvement in the investigated outcomes than the group with the lowest volume.
    

Detailed description: 
      Aging is an involuntary and progressive process that leads to biological, structural and
      functional changes such as loss of mass and muscle strength. The aging process leads to
      changes in the visual, vestibular, sensory and motor systems, causing slow reaction time,
      compromising the postural balance. Flexibility and mobility also tend to decrease with aging
      favoring the onset of lesions and loss of functional autonomy. The regular practice of
      physical exercise helps to prevent these changes related to aging. Among the various
      possibilities of physical exercise, the Pilates method has been well-suited for the elderly,
      since it incorporates the training components recommended by the American College of Sports
      Medicine (ACSM), is the strength, balance, and flexibility. However, researchers have
      questioned the lack of scientific evidence that confirms all the benefits of the method,
      especially in the elderly. The findings described in the literature are still controversial.
      A systematic review of six randomized controlled trials (RCTs) has shown limited evidence in
      improving strength, flexibility, and balance in both sexes.

      Physical decline negatively affects the personal autonomy and quality of life of the elderly
      and Pilates seems to have positive effects on these aspects. Rodrigues et al. (2010) observed
      a significant evolution in the functional performance of healthy elderly women in rising from
      the seated position (11.8%) and lying position (26%) and a significant improvement in quality
      of life (p = 0.04) after intervention with Pilates exercises . As for depressive symptoms,
      Mokhtari et al. (2013) identified a significant reduction (p <0.007) in this symptomatology
      after Pilates practice. However, both studies reached only two points on the PEDro Scale.
      Recent investigations found a significant increase in maximal inspiratory pressure (MIP) of
      19.5%, maximal expiratory pressure (MEP) of 8.7% and Abdominal Transversal thickness of 42.3%
      after the program. However, the study presented some limitations, such as the absence of a
      control group and the inability of the blindness of the evaluators.

      It is also important to highlight the lack of reports on how the programs are carried out and
      when there is a description there is a heterogeneity in the prescription of the exercises. In
      the two reviews cited above, only two of the included studies presented the prescribed
      volume: ten replicates and three series of ten repetitions. Some studies have also described
      the volume: two sets of ten repetitions, two to four sets of 15 to 20 seconds of contraction
      for isometric exercises and 15 to 20 repetitions for dynamic exercises. A single series of 10
      replicates with a 30-second interval between the series. It is known that the literature
      suggests for the muscular strength gain in the elderly a training volume of two to three sets
      per exercise, seven to ten repetitions per set and a moderate to high intensity and as noted
      most Pilates exercise programs have not followed these recommendations. The aim of the study
      is to compare the effect of different volumes of Pilates exercise training on muscle
      strength, postural balance, flexibility, functional autonomy, depressive symptoms and lung
      function in the elderly community.

      The elderly will be invited through advertisements in social networks, local media, and
      posters distributed in the centers for the coexistence of the elderly, health centers and
      churches. Initially, each individual who agrees to participate in the study will sign the
      Free and Informed Consent Form. Next, the investigators will collect the data referring to
      the variables: cognitive aptitude, sociodemographic, clinical characterization, and
      anthropometric measurements. All participants will be evaluated for muscle strength, balance,
      flexibility, functional autonomy, depression and lung function before and after the
      intervention, including those who do not complete 80% of their presence during the
      intervention period. For the self-report questionnaires an evaluator will be trained and for
      the performance questionnaires/tests two evaluators will be trained and they will be blind to
      the intervention.

      The risks of participating in the research are: the participants feel embarrassed in some
      interview questions, present some imbalance and risk of falls, muscle aches and increased
      blood pressure (BP) and heart rate (HR). However, to minimize them, the participant may
      refuse to answer any of the questions and interrupt the interview, as each position of the
      balance tests the interviewer will first demonstrate the task, then support the participants
      and only withdraw support after the consent of the participant, always standing next to it.
      The stretching will be performed in case of muscle discomfort and the monitoring of
      cardiorespiratory variables will be done.

      How much of the benefits will participants be contributing to a greater knowledge about the
      effects of Pilates exercises in the elderly, the results obtained with the research will
      favor the formulation of adequate exercise programs and an improvement of care for the
      elderly, improving the quality of care, in the prevention of functional problems and falls.
      In addition, participants will have a thorough assessment of their overall health,
      well-being, and physical and functional aspects and may improve the deficiencies presented by
      performing Pilates exercises. Pilates will promote improved strength, muscular flexibility
      and well-being and provide socialization.
    

Intervention name(s): Pilates Method Exercises
Intervention type(s): Other
Intervention description(s): Pilates Method exercises performed on the apparatus, on the ground and with accessories. They will always be performed by a physiotherapist with teaching certification in the Pilates methodology and will be supervised by two properly trained physiotherapy trainees. Participants will start the exercise program in small groups of up to 8 people, twice a week for 60 minutes, for 12 weeks, totaling 24 sessions. The first day of intervention for both groups will be devoted to explaining the six principles described by Joseph Pilates: centralization, concentration, control, precision, fluidity and breathing, and some fundamentals such as the neutral position of the spine. And in all sessions, these principles will be remembered by the physiotherapist.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Subjects will be randomized into three groups, two intervention groups and one group will be the control. The randomization process will be done by a person who does not participate in the survey, at random.org, and concealment of the allocation will occur using opaque and sealed envelopes.
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Exercise Movement Techniques; Elderly; Muscular Strength; Postural Balance; Flexibility; Pilates