Investigation of the Effects of Pilates Training in Pregnant Women
Condition: Healthy Lifestyle; Health Behavior
Study type: Interventional

Summary: 
      Pregnancy is a physiological stress state that affects all body systems and requires
      physical, mental, and social harmony in the woman.

      The pregnancy process continues with visible changes in the female body and psychological
      changes and fluctuations. The mental and physical adaptation of the mother to the changes
      that occur during pregnancy can be increased by interventions that can be done in this
      process. Exercises are at the top of these interventions.

      Exercise has been shown to affect the fetus, mother, and pregnancy positively. In the guide
      published by the American Obstetricians and Gynecologists Committee in 2015, It was stated
      that pregnant women should exercise at least half an hour of moderate-intensity on most days
      of the week. They also recommended exercises such as Pilates, yoga, and swimming as safe
      activities for pregnant women.

      Pilates exercises are ideal for preparing the pregnant woman's body until birth, and after
      birth plays a vital role in the recovery of the mother's body. Above all, it makes women feel
      more comfortable in this temporary body and makes them more active. When the literature is
      examined, it is seen that studies which include the effects of Pilates during pregnancy are
      still insufficient All of these studies examining the effects of Pilates education on
      pregnant women show us that Pilates education can positively contribute to pregnant women.
      However, in all studies, it is stated that the effects of Pilates on different dimensions of
      pregnancy should be examined, and additional studies with high evidence value are needed.

      Based on this, to ensure that pregnant women have a healthier and more comfortable pregnancy
      period, a randomized controlled blind study was planned to investigate the effects of Pilates
      training on core stability, balance, mood, and quality of life in pregnant women.
    

Detailed description: 
      Pilates exercises are ideal for preparing the pregnant woman's body until birth and after the
      delivery and play a vital role in the recovery of the mother's body. Above all, it makes
      women feel more comfortable in this temporary body and causes them to be more active. When
      the literature is examined, it is seen that studies which include the effects of Pilates
      during pregnancy are still insufficient. All of these studies examining the impact of Pilates
      education on pregnant women show us that Pilates education can positively contribute to
      pregnant women. However, in all studies, it is stated that the effects of Pilates on
      different dimensions of pregnancy should be examined, and additional studies with high
      evidence value are needed.

      Based on this, to ensure that pregnant women have a healthier and more comfortable pregnancy
      period, a randomized controlled blind study was planned to investigate the effects of Pilates
      training on core stability, balance, mood, and quality of life in pregnant women.

      Fifty-eight pregnant women, who completed the first trimester of pregnancy, have been
      included in the study. Inclusion and exclusion criteria were established according to the
      guidelines of the American Obstetricians and Gynecologists Committee. The Local Ethics
      Committee approved the study and written informed consent was obtained from all patients to
      participate.

      - Procedures The subjects were separated into two groups, Pilates and the control group, in a
      randomized manner. The Pilates method was given by a physiotherapist with an Australian
      Pilates and Physiotherapy Institute certificate and was experienced in pregnancy and Pilates.
      The control group was followed through the home program. The blind physiotherapist did the
      evaluations before and after the treatment.

      Pilates groups were taken into about one hour of training two days a week. Pregnancy training
      exercises recommended by the Australian Pilates and Physiotherapy Institute were used in
      training. Throughout the Pilates training, the physiotherapist controlled the movements, and
      the necessary corrections were made through tactile and verbal warnings and imagery. The
      subjects in the control group were asked to follow a home program that consisted of
      relaxation and respiration exercises for eight weeks, two times per week.

      Core stability, balance, mood, and quality of life were evaluated before and after the study.

      In our study, it was thought that the application of all core stability tests in pregnant
      women may not be appropriate for the safety of pregnant women and that pregnancy is a factor
      affecting the reliability of the test. Therefore, the Sahrmann core stability test and core
      endurance tests evaluated core stability. Among the core endurance tests, trunk flexion test,
      right-left side bridge test, and prone bridge test were used.

      Sharman Core Stability Test: Consists of 5 levels. Level 1 was applied to pregnant women. The
      pregnant woman was laid on her back and knees flexed for the test. The biofeedback device
      (Stabilizer™, Chattanooga Group Inc., Chattanooga, TN) was placed in the lumbar region. Then
      the pressure biofeedback was inflated to 40 mmHg. In this position, the abdominal draw-in
      maneuver was taught, which provides remote activation of M. transversus abdominis. The
      pregnant were asked to flex their legs one by one and then both. The pressure change in the
      device during the test was recorded.

      Core endurance measurements were recorded with a clock as seconds. The tests ended when the
      subjects broke the test positions.

      Side bridge test: The subjects were asked to lay on their left or right sides and to extend
      their legs entirely. Then the subjects were asked to create a straight line with their body
      by lifting their hip from the floor.

      Trunk flexion test: This was initiated when the subjects sat up with their back resting
      against a wedge angled 55◦ from the floor.

      Prone bridge test: In this test, the subjects put their elbows on the ground as the starting
      position and open their feet about the width of their hips while keeping their body straight
      as they are required not to arch or bow.

      Balance was evaluated using the Biodex-BioSway™ (Biodex Medical Systems, Shirley, NY, USA)
      Portable Balance System, an objective measurement method. This device assesses balance with
      three different tests. In our study, a postural stability test was used. This test evaluates
      the individual's ability to hold the center of gravity on the support surface during
      standing. In our study, total stability index scores of the right, left, and double legs were
      used for statistical analysis.

      Three different questionnaires evaluated the moods of the pregnant. Edinburgh Postnatal
      Depression Scale (EPDS): In 2009, it was stated that EPDS was a reliable tool for assessing
      depressive symptoms during pregnancy. The scale is a self-report scale consisting of 10
      items.

      The Wijma Delivery Expectancy/Experience Scale- A version (W-DEQ A) was developed to measure
      the fear of birth. The 33-item scale is a six-point Likert-type scale.

      State-Trait Anxiety Scale (STAI Form 1-2): The Likert-type scale measures state and trait
      anxiety levels separately with 20 questions.

      Quality of life was evaluated with Short Form-36. The scale consists of 36 items and provides
      the measurement of 8 dimensions. The fourth and fifth questions of the scale are considered
      with yes/no, and the other questions are reviewed with a Likert-type rating.

      Statistical Analysis SPSS 21.0 (SPSS Inc., Chicago, IL, USA) for Windows software program was
      used in all statistical analyses. In the data evaluation, mean, standard deviation, median,
      interquartile range, and minimum and maximum values were used for numerical measurements
      among descriptive statistics. Whether measurements display normal distribution was tested
      with the Shapiro-Wilk test. The Mann-Whitney u test and Independent Samples T-test were
      performed in the two-group comparisons. A p<0.05 was accepted as statistical significance.
    

Intervention name(s): pilates group
Intervention type(s): Other
Intervention description(s): Pilates, which lasts for eight weeks, three days a week for 1 hour, will be carried out by Australian Pilates and Physiotherapy Institute certified and experienced Ph.D. Physiotherapist Halil Ibrahim Bulguroglu. Microsoft Teams program will be used to implement the online practice method. The individuals in both pilates exercise groups will be divided into six small groups of 3 or 4 people to make the exercises more effective. In this study, the program will be 15 minutes of warm-up, 30 minutes of pilates, and 15 minutes of cool-down and stretching exercises. The exercises will be performed in ten repetitions. The same exercises will be applied in online pilates and face-to-face pilates training.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Using a computer program, the investigators randomly placed individuals who completed the initial assessment into the pilates group (PG) or control group (CG).
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Pilates exercises; Pregnant; Mood; Core