The effectiveness of pilates in preventing falls in healthy older adults
Donatoni da Silva, Larissa
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Falls are a major cause of morbidity and mortality in older adults and evidence suggests that fall rates are rapidly increasing likely due to an aging population, which is placing a significant financial burden on health care systems across the world. Falls present one of the highest risks for the older population and many factors contribute to the increased risk of falls and fear of falling in older adults, such as reduced physical activity and mobility, decreased muscle mass and balance and lack of walking. Rehabilitation and falls prevention exercises are required to help older adults improve their mobility and independence. Therefore, this research aimed to investigate the effectiveness of a Pilates intervention, that included a supplementary home-based exercise programme, to decrease the risk of falls in healthy older adults in Ireland. A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was carried out. A PICOS approach was adopted to set the inclusion and exclusion criteria and evaluate the outcome measures: mobility, functional mobility, fear of falling, gait, postural balance and the number of falls during the Pilates intervention programme. Twelve randomised controlled trials (RCTs) of Pilates interventions, including comparisons with control groups and other forms of exercise were included. Overall, there were 702 participants, with 308 allocated to Pilates groups, 316 to control groups and 78 to a three-arm exercise group. Pilates showed an effect in postural stability in the mediolateral sway comparison to control groups (MD = -1.77, 95% CI, -2.84 to -0.70, p = 0.001, heterogeneity: I² = 3%), mobility (MD = 9.23, 95% CI, 5.74 to 12.73, p < 0.00001, 15 heterogeneity: I² = 75%) and fear of falling (MD = -8.61, 95% CI, -10.16 to -7.07, p < 0.00001, heterogeneity: I² = 88%). In relation to other exercises group, Pilates showed positive effects in functional mobility (MD= -1.21, 95% CI, -2.30 to -0.11, p = 0.03, heterogeneity: I² = 80%), mobility (MD = 3.25, 95% CI, 1.46 to 5.04, p < 0.0004, heterogeneity: I² = 0%). The first and the second studies that are included in this thesis describe the mat Pilates intervention, including the supplementary 6-week home-based exercise programme, with the pre- and post-intervention testing. The first study examined the feasibility of a Pilates intervention for healthy older adults using the following outcomes: functional mobility, mobility, fear of falling, physical activity, postural balance and the spatiotemporal parameters of gait for six participants. Exploratory results were reported of the 6-week intervention. The second study, a cohort study, used snowballing to recruit participants. With 32 eligible participants included in the study. The results participants with previous experienced of Pilates suggests that functional mobility (p < 0.001), mobility (p < 0.001), gait velocity (p = 0.022), swing time (p = 0.049), stance time (p = 0.013) and double support time (p = 0.040). Postural stability in the mediolateral (p = 0.025) and anteroposterior sway (p = 0.037), and Physical activity (p = 0.017) were positively affected after the 6-week mat Pilates intervention. The third study of this thesis reports on the prospective, open-label randomised crossover study. This third study was carried out over a 7-month period, with a one-month washout period. Volunteer participants (n = 61) were randomly assigned to Group 1 (Control-Pilates) or Group 2 (Pilates-Control) for twelve weeks. The Pilates intervention included accessories and supplementary home-based exercises. The primary outcome measures were gait velocity, the postural stability parameter of mediolateral sway and fear of falling. The secondary outcome measures included cadence, stride length, step length, stance time, swing time, step time, double support time of gait, the postural stability parameter of anteroposterior sway, functional mobility, mobility and physical activity. The results of this twelve-week Pilates intervention indicated that Pilates had an effects in functional mobility (p = 0.002), mobility (p = 0.001), postural stability in the mediolateral sway (p = 0.040) and the spatiotemporal parameters of gait: cadence (p = 0.019), step time (p = 0.028), stance time (p = 0.012), and double support time (p = 0.031). In conclusion, the Pilates interventions were found to improve functional mobility, mobility, gait, fear of falling and postural stability for the meta-analysis. The results of six- and 12-week Pilates intervention indicated that Pilates may reduce the risk of falls and suggests that Pilates interventions for healthy older people may change their functional mobility, mobility, postural stability and spatiotemporal parameters of gait. However, high-quality RCTs that include the number of falls during the intervention program and participants with and a without history of falls still needed. Further, Pilates intervention programmes with longer follow-up periods are required.