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Title: Establishing the scope of pilates through systematic evaluation: evidence and current practice
Author: Allen , Stephanie
ISNI:       0000 0004 5356 3851
Awarding Body: University of Ulster
Current Institution: Ulster University
Date of Award: 2014
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Pilates is an increasingly popular form of exercise that is widely used both within fitness and rehabilitation. There is also a growing evidence-base for Pilates however the authors of previously conducted studies acknowledge numerous limitations which affect the interpretation of the results. Hence the need for future well-designed randomised controlled trials (RCTs) with appropriate target populations, details of the intervention and use of standardised and valid outcome measures. The overall aim of this thesis was to investigate the scope of Pilates through systematic evaluation of current literature and current use of Pilates. This was achieved through exploring and establishing the types of clients attending Pilates classes, their rationale for attendance at classes and the facilitators and barriers to attending Pilates. In addition, clients' perceived effects of Pilates, the timeframe to achieve these effects and the ways in which exercises were planned and progressed in the class setting were also explored and established. This information was then related to the current literature-base to form a basis for recommendations to inform the design of high-quality RCTs. To achieve this, five novel studies were undertaken. The focus groups with Pilates instructors (n=27) and clients attending Pilates classes (n=25) highlighted that Pilates is a method of providing individually-modified and supervised exercises in a group setting for those self-managing long-term musculoskeletal conditions, particularly low back pain. The use of relaxation and education were also deemed to be additional facilitators to clients attending classes. A wide variety of effects were experienced by clients over the period of attendance at classes including reductions in pain, confidence to exercise and improvements in strength, flexibility, body awareness, posture, core stability and balance. However, numerous barriers were also expressed to practicing Pilates including cost, predominately female classes and lack of correction from the Pilates instructor when independently carrying out the exercises. The two large-scale questionnaire surveys of Pilates instructors (n=4201797, response rate 53%) and clients attending Pilates classes (n=762/971, response rate 78.5%) reinforced the findings of the previous focus group studies with Pilates used as an exercise approach for improving overall general health and well-being, in terms of health maintenance and in the rehabilitation of a wide variety of medical conditions, particularly musculoskeletal disorders. A wide variety of effects were again reported with the most prevalent including improvements to posture, core stability, body awareness and sense of well-being. Clients were long-term users of Pilates and the majority reported noticing the overall effect of Pilates from 3-6 months. Facilitators to this long-term attendance included personal adaptation of the exercises in a small group setting and collaborative goal-setting with barriers again including cost and lack of independent practice of Pilates. The final study, a systematic review of literature (n=38 randomised controlled trials) highlighted the potential for a number of positive effects of Pilates across a wide variety of populations particularly those with low back pain, the healthy population and a sedentary/obese population. These included reductions in pain and disability and improvements in strength, flexibility, balance, core stability, function, body composition parameters, general health, psychological effects and on hemodynamic and metabolic parameters. However, due to the numerous limitations in the studies in terms of heterogeneity of the Pilates interventions and lack of standardised outcome measures and control groups, caution must be taken when interpreting the results. In addition, many of the studies were at high risk of bias. Hence, it can be concluded that there is a need for further well-designed research trials to accurately determine the effectiveness of the Pilates method. The findings of the five studies have provided a basis for future recommendations in the design of a high quality RCT.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available