Effects of Pilates exercises on pain, functional status and quality of life in women with postmenopausal osteoporosis

Summary

Objective

The present study aimed to evaluate the effects of Pilates exercise program on pain, functional status and quality of life in women with postmenopausal osteoporosis.

Design

The study was performed as a randomized, prospective, controlled and single-blind trial.

Participations

Seventy women (age range, 45–65 years) with the diagnosis of postmenopausal osteoporosis were included.

Methods and interventions

Patients were randomly allocated into two groups (home and Pilates exercise groups). Patients in the Pilates exercise group underwent a supervised Pilates exercise program twice a week for one year. Patients in the home exercise group were asked to perform a home exercise program consisting of thoracic extension exercises. Patients were evaluated at baseline and after one year of participation in the exercise programs.

Main outcome measurements

Visual Analog Scale for pain, six-minute walking and sit-to-stand tests for functional status, and the Qualeffo-41 Questionnaire and the Short Form-36 (SF-36) for quality of life. Patients were also asked to report the number of falls during the intervention.

Results

At the end of the study, the results of 60 patients were analyzed. A significant improvement was noted in all evaluation parameters at the end of the exercise program in the Pilates exercise group. Except for Qualeffo- Leisure Time Activities, SF-36 physical role limitation and emotional role limitation subscales, a significant improvement was noted in all other evaluation parameters at the end of the exercise program in the home exercise group. Improvement was significantly greater in the Pilates exercise group compared to the home exercise group in all parameters.

Conclusion

Pilates exercises may be a safe and an effective treatment alternative for the quality of life in patients with postmenopausal osteoporosis.

Introduction

Osteoporosis (OP) is the most common metabolic bone disease. It has become a major public health problem in many countries due to the increase in life expectancy (Kanis, 1991). Fractures occur in patients with OP after low-energy traumas, and particularly hip fractures may be a significant cause of mortality (Warriner et al., 2011) Pain, functional loss, social isolation, emotional disturbances may negatively affect patients' general well-being and quality of life (Lips and van Schoor, 2005).

The main goal of treatment in OP is to prevent fractures. Bone loss should be stopped or slowed down in order to achieve this goal, bone strength should be preserved, and factors contributing to fracture should be eliminated or reduced. Although several medical treatment alternatives have been recommended to prevent bone loss or increased bone formation, exercise has also been emphasized as a part of management in OP in various treatment guidelines (North American Menopause Society, 2010). Weight-bearing and strength-training exercises have been reported to have positive effects on bone loss. It has been suggested that high-intensity exercises may have greater beneficial effects on bone; however, it has also been reported that patients might benefit from even mild-intensity exercises. In addition to its positive effects on bone mass, it is well known that exercise also has beneficial effects on pain, function loss, balance and quality of life (Bergland et al., 2011). A significant number of osteoporotic fractures occur because of falls; thus, exercise programs improving muscle strength of the trunk and lower-extremities, as well as general strength and postural stability are required to prevent falls (Campbell et al., 1997).

Although exercise has been regarded as an integral part of OP management, a standard exercise program that has been conclusively proven to increase bone mineral density (BMD) and improve quality of life does not currently exist. A wide spectrum of exercises ranging from aerobic exercises (such as cycling and running) to programs such as Tai chi have been used in studies included in systematic reviews (Howe et al., 2011).

Pilates is a specific exercise program developed after the First World War by Joseph Pilates (1880–1967). Being initially adopted only by athletes and dancers, Pilates exercises have been used in general sports activities and rehabilitation programs in recent years. The aim of Pilates training is to improve general body flexibility and health by focusing on especially strengthening the muscles of the trunk, and coordination of posture and breathing (Latey, 2002).

Although Pilates exercises are considered as a part of sports activities to be performed by healthy individuals, it has also been recommended as a therapeutic approach in numerous musculoskeletal disorders. In two different studies conducted in our clinic, we have reported the beneficial effects of Pilates on pain and quality of life in patients with fibromyalgia and ankylosing spondylitis (Altan et al., 2009, 2011). In addition to these beneficial effects on musculoskeletal disorders, Pilates was also shown to have positive effects on personal autonomy, static balance and quality of life in a study involving an elderly population (Siqueira Rodrigues et al., 2010). These data suggest that Pilates may provide beneficial effects in patients with OP who are susceptible to falls that have been associated with significant mortality and morbidity.

The aim of the present study was to evaluate the effects of supervised Pilates exercises on pain and quality of life in patients with postmenopausal OP.