Prática de exercícios do método pilates em posição ortostática sobre o equilíbrio estático e dinâmico de idosas : um ensaio clínico controlado randomizado

Abstract

Importance: Aging is characterized by many changes at molecular, physiological, functional, motor, and psychological level, which may result in postural instability and reduction of muscle mass/strength. Such changes can reduce physical and functional capacity of the elderly, raising a greater risk in the occurrence of falls. The practice of physical exercise is widely used to improve physical/functional performance and reduce postural instabilities as well as the risk of falls. In this context, the Pilates method may be a good intervention to improve body balance, muscular strength and perception of quality of life in this population. Objective: To evaluate if the practice of exercises derived from the Pilates method with higher training volume in orthostatic position is able to improve the static and dynamic balance of elderly women who did not perform regular physical exercises previously.Design, Method and Participants: Randomized and controlled clinical trial, with blinded assessors and intention-to-treat data analyses. A total of 36 elderly women were invited to take part of the study and signed a Free and Informed Consent. Exercise protocols were administered over 12 weeks, biweekly, and each session lasted approximately 50 minutes. The subjects were assessed at pre- and post-intervention endpoints. Intervention: Subjects were randomized to participate in the experimental group (Pilates method with emphasis on orthostatic posture) or control group (Pilates method with lower training volume in orthostatic position), in a real-world protocol. Main Outcomes and Measurements: The main outcome was the dynamic body balance, assessed by the Timed Up and Go Test, BERG Balance Scale and Functional Reach Test. Results: Both groups did not differ at baseline, with exception for the number of medicines in use (p <0.01). For the inferential analysis, we used a conservative intention-to-treat approach including all the randomized subjects in the data analyses. The repeated-measures ANOVA, adjusted for the confounding variable "number of medicines in use", revealed no beneficial effects of Pilates exercises in both groups (p> 0.10). We also find both control and intervention groups attended only 70.33% and 72.20% of the scheduled sessions, respectively. It is noteworthy that only 16.6% of the elderly women performed all 24 proposed sessions and 22.22% completed less than 12 sessions. The non-retention rate of this study was 27.77%. Conclusion: Pilates method exercises did not provide benefits to the static and dynamic balance of the elderly woman in a real-world trial, which probably occurred due to the disruption of the principle of physical training continuity. The present results highlight the need of educating elderly users about the risk of non-benefit of the Pilates method in a real-world scenario, where absences and non-adhesion are a frequent problem.