Comparison of Neuromuscular Integrative Activity and Pilates on Sedentary Females
Condition: Womens's Health; Healthy; Sedentary Behavior
Study type: Interventional

Summary: 
      The aim of this study was to compare the effects of Neuromuscular Integrative Action (NIA)
      and Pilates exercises on physical fitness and psychological effects in sedentary women. 20-45
      years old 43 sedentary females were randomly divided into Pilates and NIA groups. The
      6-Minute Walking Test (6MWT), the Sit and Reach Test, and the Static Plunk Test durations
      were used for the physical fitness level assessment at baseline and at the end of trainings.
      In addition, the Rosenberg Self-Esteem Scale, the Beck Anxiety Inventory, and the SF-36 were
      used to evaluate the psycho-somatic symptoms and health-related quality of life of the
      participants. Both groups received 60-min exercise sessions 2 days a week for 8 weeks.
    

Detailed description: 
      Participant Healthy female volunteers between the ages of 20 and 45 who performed desk jobs 8
      hours a day and with a sedentary lifestyle were included in this study. This is a parallel
      group randomized comparative study aimed to compare the effects of NIA and Pilates on
      physical fitness and psychological status. This study was conducted at …………. University
      School of Physical Therapy and Rehabilitation in 2017. Participants were excluded if
      participants had a risk of pregnancy, using pacemakers or metal implants in participiants'
      body, had an active athlete history, had any health problems preventing them performing
      exercises. Written informed consent was obtained from all participants, and participants
      signed the form approved by the ………………….. University Clinical Research Ethics Committee
      (020/55134) prior to participation in the study.

      Randomization of the volunteers were screened for eligibility and signed an informed consent
      form. Then, participants were randomized to Pilates and NIA groups using the sealed envelope
      method. An identification number (i.e., 1-54) was allocated to each volunteer. Each number
      was written on a separate piece of folded white paper and placed into an opaque envelope. The
      randomization process was performed by picking a random number from the sealed envelope to
      allocate each volunteer to either the intervention or control group.

      Outcomes Measures This is a prospective, single-blinded, randomized-comparative study, and it
      involved twice time at pre and post 8-week exercise program. Assessments were performed at
      the baseline and after eight weeks of intervention. The dependent variables were flexibility,
      cardiovascular endurance, Abdominal Strength-Endurance, Balance Assessment, self-esteem,
      anxiety, and quality of life. BMI was measured with a Tanita BC 418 (Tanita Corp., Tokyo,
      Japan), which is a segmental professional body analysis monitor measuring the impedance
      generated during the passage of an electric current of 50 kHz, 0.8 mA through tissues.

      Psychological Status Rosenberg Self-Esteem Scale The Rosenberg Self-Esteem Scale was
      developed by Morris Rosenberg and the validity and reliability studies of the Turkish version
      of the scale were performed by Çuhadaroğlu. The Rosenberg self-esteem scale is a 10-item
      scale that assesses global self-worth by measuring both positive and negative feelings about
      the self. Each item has a 4- point Likert scale ranging from strongly agree to strongly
      disagree. Higher scores indicate higher self-esteem. The scale was used for self-esteem
      measurement.

      Quality of Life Assessment Short Form Health Survey is a questionnaire assessing the quality
      of life of the subjects. Short Form Health Survey examines eight different parameters,
      namely, Functional Capacity, Physical Aspects, Bodily Pain, General Health, Vitality, Social
      Aspect, Emotional Aspect, and Mental Health domains. A higher score indicates a better
      quality of life.

      Beck Anxiety Inventory The Beck Anxiety Inventory is a 21-item self-report questionnaire for
      assessing the severity of anxiety. The Beck Anxiety Inventory assesses the grade of anxiety
      using 21 questions. A higher score indicates more severe anxiety and depression.

      Fatigue A Visual Analogue Scale was applied to assess the severity of perceived fatigue. The
      Visual Analogue Scale is a 10-cm scale that evaluates the severity of fatigue in the previous
      week.

      Physical Fitness Assessment Flexibility Assessment The Sit and Reach Test was used to
      evaluate the flexibility of the participants. The participants were placed in a long sitting
      position with straight legs. Participants were asked to lean forward four times and reach
      forward on the board. At the end of the fourth reach, the distance obtained after
      participants waited for two seconds was recorded in centimeters (cm).

      Cardiovascular Endurance Assessment The cardiorespiratory endurance of the participants was
      evaluated with the 6 Minute Walk Test. The test was conducted by measuring the distance the
      participants could walk in a 20-meter corridor with a fast and firm walk. At the beginning of
      the test, the heart rate and blood pressure of the participants were measured with a pulse
      meter heart rate monitor. Before the test, the fatigue levels of the participants were
      assessed by taking the perceived difficulty levels according to the Borg Rating of Perceived
      Exertion. After the test, evaluations were repeated.

      Abdominal Strength-Endurance Assessment Muscle strength and endurance of the abdominal
      muscles were evaluated by sit-up tests. The participants were placed on participants' back,
      hips and knees in flexion, with the plantar side of the foot on the bed. The arms were
      positioned according to the strength of the rectus abdominus muscle and participants were
      asked to perform trunk flexion for 60 seconds consecutively. The number of trunk flexions
      completed was recorded. Static abdominal strength and trunk stabilization were evaluated
      using a static plank test. Individuals assumed a position with the elbows on the ground with
      the fingertips touching the ground and the hip raised from the ground, and the knee, hip, and
      trunk were in a parallel line, the maximum time participants could keep this position was
      recorded. During the test, the participant was asked not to disturb the horizontal position
      of the trunk.

      Balance Assessment The balance of the participants was evaluated with the Functional Reach
      Test. The test measures dynamic balance and core stabilization. The participants were asked
      to stretch participants' hands forward while standing and reach from that distance without
      stepping forward and without support. The distance participants reached was recorded in cm.
      Interventions The NIA and Pilates programs were implemented by one of the researchers (AU)
      with trainings and qualifications in both approaches. The trainings were carried out for 60
      minutes, 2 days a week, for 8 weeks. Each session was performed by a Pilates instructor with
      a 10-year of Pilates training experience. NIA sessions were also performed by the same
      instructor (AA), and she had a 1-year NIA training experience. The participants were asked
      not to participate in any other physical activity program during the study. Prior to training
      sessions, a familiarization period of practice was conducted to introduce the participants
      with the methods and techniques.

      Pilates Mat Exercise Protocol The Pilates Mat exercise group followed an eight-week exercise
      program. The exercise protocol of this study was designed by the researchers. According to
      previous reports, 6 to 8 weeks of Pilates training has positive effects on physical and
      psychological health. As the program advanced, 20-cm diameter mini soft balls, Pilates rings,
      65 cmdiameter soft gymnastic balls, and rubber bands were used in this order as materials in
      Pilates exercises. After an initial warm-up exercises at a slow pace for 10 minutes, Pilates
      exercises with and without equipment were performed for 40 minutes. The exercises ended with
      a 10-minute recovery and stretching exercises for relaxation of all muscle groups
      Neuromuscular Integrative Action Protocol NIA includes nine basic movement forms, 13
      principles, and 52 basic moves. The nine movement forms were derived from martial arts, dance
      arts, and the healing arts of the Alexander Technique, Feldenkrais Method, and Yoga. The 13
      principles specify areas related to fitness, personal growth, and lifestyle. Centered on the
      joy of movement, participants focus on, for example, being sensitive to personal rhythms,
      making the correct movement choices, and experiencing positive changes in daily life. The
      moves of NIA are used to engage all body areas, improve fitness, and facilitate self-healing.
      Instrumental music, which plays throughout each 60-min session, is an integrative part of
      NIA, and the melody and beat of the music used are directly associated with the movements.
      For instance, the feet and the legs follow a pattern that maps directly on to the drum beat
      of a particular song, while the arms and the upper body express the melody of the rest of the
      instruments, such as the guitar, violin, or the singer's voice. Visual imagination is
      stimulated in NIA as the movements pertaining to the choreography relate a particular image
      or symbol.
    

Intervention name(s): Pilates; Neuromuscular Integrative Action
Intervention type(s): Other; Other
Intervention description(s): Pilates has been performed to all participants two times a week in order to compare the effects of NIA; NIA was the experimental group of this study.
Other intervention name(s): NIA Dance
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The volunteers were screened for eligibility and signed an informed consent form. Then, they were randomized to Pilates and NIA groups using the sealed envelope method. An identification number (i.e., 1-54) was allocated to each volunteer. Each number was written on a separate piece of folded white paper and placed into an opaque envelope. The randomization process was performed by picking a random number from the sealed envelope to allocate each volunteer to either the intervention or control group.
Masking: Single (Investigator)
Primary purpose: Prevention
Keywords: Physical Fitness,; Quality of Life; Exercise Therapy; Female