IS PILATES EXERCISE EFFECTIVE FOR LOW-BACK PAIN? A REVIEW OF REVIEWS : ACSM's Health & Fitness Journal

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IS PILATES EXERCISE EFFECTIVE FOR LOW-BACK PAIN? A REVIEW OF REVIEWS

Yoke, Mary M.A., M.M.

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ACSM's Health & Fitness Journal 20(1):p 29-31, January/February 2016. | DOI: 10.1249/FIT.0000000000000169
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As the Pilates method has grown in popularity, there has been a lot of buzz about its beneficial effects on low-back pain. Many studies during the past 15 years have tried to document and quantify the value (or lack of value) of Pilates exercises on low-back health.

For those not familiar with the Pilates method, here’s a very brief history: Joseph Pilates developed a system of physical training during the mid-20th century that initially was adopted primarily by dancers but became increasingly part of fitness programming at many facilities in the 1990s and continues to this day. Originally called Contrology, Pilates’ system involves a large number of exercises designed to promote concentration, control, centering, fluidity, precision, and proper breathing. Mat Pilates classes are common in most fitness facilities; core stability, balance, muscle endurance, posture, and flexibility are emphasized. Pilates studios and some fitness entities offer Pilates exercises on special apparatus, including the Reformer, Cadillac, Barrel, and Chair. Because of the focus on the core, many assume that Pilates exercises will reduce low-back pain.

In a systematic review of systematic reviews, Wells et al. (4) found inconclusive results regarding the effect of the Pilates method on low-back pain. It should be noted that a systematic review is considered to be the most valid form of research because studies chosen for inclusion in a review must meet stringent criteria for validity, reliability, and the use of appropriate methodology and analysis. After finding 44 systematic reviews on Pilates and low-back pain, Wells et al. (4) selected five that met their highest standard of criteria.

Unfortunately, the results of this comprehensive analysis were inconclusive, meaning that some of the reviewed studies showed that Pilates exercises were beneficial for low-back pain sufferers, and others showed that Pilates exercises made no difference in the subject’s back pain or, in some cases, actually made the pain worse. These contradictory findings may be due to several causes. For example, several different exercise protocols were used across the studies included in the systematic reviews. In other words, different instructors selected different Pilates exercises and programmed them in different orders in their classes. It is possible that instructors in some of the studies taught using principles of progression (e.g., easy and safe Pilates exercise variations for those with back pain) and some did not. Instructors in some of the studies may have given hard and potentially risky Pilates exercises to the entire class without showing modifications and thus increased the chance that participants with low-back pain would show no improvement or even exacerbate their condition. Some studies had participants perform Pilates exercises for 15 minutes, whereas other studies involved 60-minute sessions. The frequency of sessions throughout the week also varied.

Other factors that added to the inconsistent findings among the reviews included different outcome measurement tools (e.g., levels of participants’ back pain were measured using differing scales and indexes), measurement that occurred at varying points in time (e.g., some studies measured pain levels after 6 weeks and some after 12 months), and the fact that participants in the studies had different forms of low-back pain.

In summary, the Pilates method holds the potential to help those with low-back pain, but evidence-based studies about its effectiveness show varying results. It is this author’s opinion that the primary factor in whether or not Pilates exercises are helpful for back pain is the ability of the instructor to provide safe and appropriate exercise variations and modifications.

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BENEFITS OF VARIOUS CIRCUIT TRAINING PROTOCOLS

In a study by Skidmore et al. (2), three different circuit weight training protocols were evaluated, specifically with regard to effects on the cardiovascular system. The protocols were as follows: 1) traditional circuit weight training, which involved 30 seconds of weightlifting followed by 30 seconds of rest in a 1:1 ratio; 2) aerobic circuit weight training, which consisted of 30 seconds of weightlifting followed by 15 seconds of rest, with four 2.5-minute bouts of submaximal cycling interspersed throughout the workout; and 3) combined circuit weight interval training, which used the same exercises as in the second protocol (described above), except that the four cycling sequences involved three 30-second maximal sprint intervals (high-intensity training). All experimental trials were preceded by a warm-up and followed by a cool-down period on the cycle ergometer; each session was 40 minutes in total duration. Weightlifting exercises used three sets, and all exercises were performed to a specific metronome beat to standardize the lifting tempo and the total number of reps completed. Heart rates, rate of perceived exertion, and blood lactates were obtained at specified intervals for the 11 female participants (mean age, 34 years), all of whom were regular exercisers.

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What were the results? As you might imagine, the combined circuit weight interval training protocol produced significantly higher heart rates, rates of perceived exertion, and blood lactate levels than the other two protocols. Although caloric expenditure was not measured directly, the authors speculate that more calories were burned in the combined circuit weight interval training protocol because of the higher intensity, greater amount of total work performed, and the evidence of anaerobic energy production. The authors also note that merging circuit weight training with interval training may be an optimal solution for those with limited time and particularly for those individuals who are moderately or highly trained.

DRUMMING FOR WELLNESS?

It may be time to consider a new group exercise modality: drumming. Although the trendy new version of group fitness drumming, Pound, also known as Poundfit, has not yet been studied, researchers Mungas and Silverman (1) examined mood states of 17 university students after a 45-minute group drumming session based on the HealthRHYTHMS® model.

The 12-item Quick Mood Scale was given before and after the drumming session and was used to assess students’ levels of drowsiness, anxiety, depression, confusion, and aggression, among other constructs. Compared with the control group (which consisted of students playing beginner classical guitar music), the drummers were significantly more wide awake, relaxed, cheerful, friendly, and clear headed after the 45-minute session of rhythmic drumming.

Although caution is advised in generalizing these psychological findings to the fitness setting and to more diverse groups, the positive results are promising. Group drumming is social and fun and involves a strong mind/body component. Studies are needed to quantify additional health and wellness benefits, as well as energy expenditures — especially when drumming is combined with traditional fitness moves such as squats, lunges, low rows, and supine abdominal curl-ups, as in the Pound technique. Stay tuned!

THE BENEFITS OF PERSONAL FITNESS TRAINING

Surprisingly, very few studies have evaluated whether or not hiring a personal trainer actually produces results. Is it worth the time and money to find and use the services of a qualified personal trainer? Researchers Storer et al. (3) asked exactly that in a recent quantitative study comparing exercise with a personal trainer versus training alone. Thirty-four men (aged 30 to 44 years) were randomized into two groups in a health club setting: 17 men worked with a personal trainer in a nonlinear periodized program, and 17 men exercised alone. All men were experienced exercisers. Both groups trained for a total of 12 weeks, 3 times per week. Lean body mass, 1RM (chest press and leg press muscle strength), vertical jump (leg power), and V˙O2max (aerobic capacity) were evaluated in both pretest and posttest. As you might expect, the men who received personal training all had significantly greater improvements in all fitness parameters than the men who directed their own training. For example, the personal training group averaged an increase of 1.3 kg of muscle mass during the 12 weeks, whereas the men without trainers had an average increase of 0 kg of lean body mass, a significant difference. The V˙O2max was increased by 7% in the personal training group but only by 0.8% in the non-personal training group. The men with personal trainers also exercised longer and more frequently (with an average of an additional 1.8 days per week of training) than the self-directed men, even though the self-directed group also increased their training frequency by an average of an additional 1.3 days. In short, it seems that the time spent with a knowledgeable and effective trainer was much more productive than the time spent exercising alone.

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Although these findings are good news for most of us in the health/fitness industry, we must realize that the traditional model of personal training is still only for a select few — those with the time, money, and wherewithal to hire a qualified professional. The majority of Americans unfortunately are unable to take advantage of such an elite service, no matter how effective it may be. Health/fitness professionals need to brainstorm and devise additional ways to motivate and help the greater public achieve healthy results and increased well-being.

1. Mungas R, Silverman MJ. Immediate effects of group-based wellness drumming on affective states in university students. Arts Psychother. 2014; 41: 287–92.
2. Skidmore BL, Jones MT, Blegen M, Matthews TD. Acute effects of three different circuit weight training protocols on blood lactate, heart rate, and rating of perceived exertion in recreationally active women. J Sports Sci Med. 2012; 11 (4): 660–8.
3. Storer TW, Dolezal BA, Berenc MN, Timmins JE, Cooper CB. Effect of supervised, periodized exercise training versus self-directed training on lean body mass and other fitness variables in health club members. J Strength Cond Res. 2014; 28 (7): 1995–2006.
4. Wells C, Kolt GS, Marshall P, Hill B, Bialocerkowski A. Effectiveness of Pilates exercise in treating people with chronic low back pain: A systematic review of systematic reviews. BMC Med Res Methodol. 2013; 13: 7.
© 2016 American College of Sports Medicine.