Home-based Pilates for symptoms of anxiety, depression and fatigue among persons with multiple sclerosis: An 8-week randomized controlled trial.

BACKGROUND: Symptoms of anxiety, depression and fatigue are common comorbidities among persons with multiple sclerosis (PwMS). A previous pilot study supported Pilates as a feasible exercise modality that may improve these outcomes among PwMS. OBJECTIVE: To quantify the effects of 8 weeks of home-based Pilates on symptoms of anxiety, depression and fatigue among PwMS. METHODS: A total of 80 PwMS (69 female) were randomized to twice-weekly home-based Pilates guided by a DVD) or wait-list control. Validated questionnaires assessed anxiety, depressive and fatigue symptoms at baseline, weeks 2, 4, 6 and 8. Using intention to treat, repeated measures analysis of covariance (RM-ANCOVA) adjusted for baseline physical activity examined between-group differences across time. Hedges' d quantified the magnitude of differences in outcome change. Sensitivity analyses examined female-only samples. RESULTS: Group × time interactions were statistically significant for all outcomes (all p ⩽ 0.005). Pilates significantly reduced (all p ⩽ 0.03) depressive symptoms (Quick Inventory of Depressive Symptomatology, d = 0.70; Hospital Anxiety and Depression Scale-Depression, d = 0.74), anxiety (State-Trait Anxiety Inventory, d = 0.30; Hospital Anxiety and Depression Scale-Anxiety, d = 0.49), cognitive (d = 0.44), physical (d = 0.78), psychosocial (d = 0.56) and total fatigue (d = 0.76). Female-only results were materially the same. CONCLUSION: Home-based Pilates significantly improved anxiety, depressive and fatigue symptoms among PwMS with minimal-to-mild mobility disability, including moderate-to-large, clinically meaningful improvements in depressive and fatigue symptoms.Trial Registration: ClinicalTrials.gov (NCT04120207).

Participant experiences of eight weeks of supervised or home-based Pilates among people with multiple sclerosis: a qualitative analysis.

PURPOSE: An exploratory qualitative study investigating participants' experiences of a feasibility study of supervised and home-based Pilates. METHODS: All 10 females who participated in an eight-week supervised (n = 4) or home-based Pilates (n = 6) program were invited and agreed to be interviewed. Data were collected via semi-structured interviews and researcher observations of participant experiences. Data were analysed using codebook thematic analysis framework. RESULTS: Two domain summaries emerged: (1) the suitability of home-based Pilates in particular for this population. Participants indicated that supervised and home-based Pilates was a safe, intensity-appropriate, and implementable exercise method to improve mental health outcomes among persons with multiple sclerosis (PwMS), and (2) the benefits experienced by PwMS while participating in Pilates. Home-based Pilates reduced both exercise participation and accessibility barriers commonly experienced by PwMS. Furthermore, PwMS reported improvements in mental health outcomes following Pilates, in both exercise environments. CONCLUSIONS: PwMS reported experiencing improved mood following regular Pilates training and indicated that home-based in particular reduced barriers regularly experienced by this population. Results support Pilates as a feasible exercise modality providing potential mood improvements among PwMS. Future appropriately powered home-based randomised controlled trials to further explore the effects of Pilates training on mental health among PwMS with minimal-to-mild mobility disability are warranted.Implications for RehabilitationParticipants in this study described the mental health benefits experienced from engaging in Pilates, a non-traditional exercise modality.Home-based Pilates overcame participatory and accessibility barriers to exercise among people with multiple sclerosis (MS).Participants valued that Pilates was low intensity and did not exacerbate fatigue.Home-based Pilates is a feasible exercise method for people with MS with minimal-to-mild mobility disability.

Acute effects of Pilates on mood states among young adult males.

BACKGROUND: Evidence supports positive effects of acute exercise on mood states. Non-traditional exercise modalities, including Pilates, remain understudied, particularly among males. This study examined mood state responses to a single Pilates bout among young adult males, and explored if responses differed according to analogue Generalized Anxiety Disorder (AGAD) or depression status, or physical activity level. METHODS: Eighty-seven young adult males completed 30-min of mat-based Pilates. Outcomes included state anxiety, worry, feelings of tension, depressed mood, anger, energy and fatigue, and total mood disturbance (TMD). Paired samples t-tests compared pre- and post-session means within the group; magnitude of change was quantified with standardized mean differences. Two condition X two time repeated measures ANOVA examined outcome differences according to AGAD and depression status, and physical activity level. RESULTS: Acute Pilates significantly reduced state anxiety, feelings of fatigue, and TMD, and significantly increased feelings of energy (allp ≤ 0.007). Small-to-moderate effect sizes were found for state anxiety, feelings of energy and fatigue, and TMD (all d = 0.22-0.51). Pilates resulted in significant improvements in state anxiety, feelings of fatigue and energy, and TMD among participants with AGAD (n = 28) (all d = 0.10-0.32, p < 0.007) and depressed (n=41) participants (all d = 0.01-0.19, p < 0.008). CONCLUSIONS: Notwithstanding potential limitations, including the absence of a control group and a lack of follow-up beyond immediate effects, this is the first report to support potential positive mood state responses to an acute bout of Pilates among young adult males. Findings varied based on analogue GAD and depression statuses, and physical activity level.

The effects of pilates on mental health outcomes: A meta-analysis of controlled trials.

OBJECTIVE: This meta-analysis estimated the population effect size for Pilates effects on mental health outcomes. DATA SOURCES: Articles published prior to August 2017 were located with searches of Pubmed, Medline, Cinahl, SportDiscus, Science Direct, PsychINFO, Web of Science, and Cochrane Controlled Trial Register using combinations of: Pilates, Pilates method, mental health, anxiety, and depression. STUDY SELECTION: Eight English-language publications that included allocation to a Pilates intervention or non-active control and a measure of anxiety and/or depressive symptoms at baseline and after the Pilates intervention were selected. DATA EXTRACTION: Participant and intervention characteristics, anxiety and depressive symptoms and other mental health outcomes, including feelings of energy and fatigue and quality of life, were extracted. Hedges' d effect sizes were computed, study quality was assessed, and random effects models estimated sampling error and population variance. DATA SYNTHESIS: Pilates resulted in significant, large, heterogeneous reductions in depressive (Δ = 1.27, 95%CI: 0.44, 2.09; z = 3.02, p ≤ 0.003; N = 6, n = 261) and anxiety symptoms (Δ = 1.29, 95%CI: 0.24, 2.33; z = 2.40, p ≤ 0.02; N = 5, n = 231) and feelings of fatigue (Δ = 0.93, 95%CI: 0.21, 1.66; z = 2.52, p ≤ 0.012; N = 3, n = 161), and increases in feelings of energy (Δ = 1.49, 95%CI: 0.67, 2.30; z = 3.57, p < 0.001; N = 2, n = 116). CONCLUSIONS: Though this review included a small number of controlled trials with small sample sizes and non-active control conditions of variable quality, the available evidence reviewed here supports that Pilates improves mental health outcomes. Rigorously designed randomized controlled trials, including those that compare Pilates to other empirically-supported therapies, are needed to better understand Pilates' clinical effectiveness and plausible mechanisms of effects.

Moderators of Exercise Effects on Depressive Symptoms in Multiple Sclerosis: A Meta-regression.

CONTEXT: This study examined the extent to which patient and trial characteristics moderate the effects of exercise on depressive symptoms among people with multiple sclerosis. EVIDENCE ACQUISITION: Twenty-four effects were derived from 14 articles published before August 2016 located using Google Scholar, MEDLINE, PsycINFO, PubMed, and Web of Science. Trials involved 624 people with multiple sclerosis and included both randomization to exercise training or a non-exercise control condition and measurement of depressive symptoms at baseline and at mid- and/or post-intervention. Hedges' d effect sizes were computed, study quality was assessed, and random effects models were used for all analyses. Meta-regression quantified the extent to which patient and trial characteristics moderated the estimated population effect. Analyses were completed in September 2016 and updated in February 2017. EVIDENCE SYNTHESIS: Exercise training significantly reduced depressive symptoms by a heterogeneous mean effect Δ of 0.55 (95% CI=0.31, 0.78, p<0.001). Significant improvement in fatigue moderated the overall effect (ß=0.37, p≤0.03). Significantly larger antidepressant effects resulted from trials in which exercise significantly improved fatigue (Δ=1.04, 95% CI=0.53, 1.55, k=8) compared with no significant improvement in fatigue (Δ=0.41, 95% CI=0.21, 0.60, k=14, z=2.91, p≤0.004). CONCLUSIONS: Exercise significantly improves depressive symptoms among people with multiple sclerosis. Exercise-induced improvements in fatigue significantly moderated exercise effects on depressive symptoms. Future trials may benefit from focusing on using exercise to concurrently improve depressive symptoms and fatigue as a symptom cluster.