The effect of Pilates classes on balance and well-being in people with multiple sclerosis: a pilot study
Lucia White Clinical Specialist Physiotherapist, Wiltshire PCT
and Dr Margaret Mayston, Senior Teaching Fellow, Faculty Lifesciences, University College London
Way Ahead 2008;12(3):5-7
Introduction
The National Service Framework (NSF) for Long-term Conditions recognises the importance of greater social participation and engagement in leisure activities amongst people with long term conditions such as MS[1]. The effects of different exercise modalities such as aerobic, muscle strengthening and improvement of flexibility in people with MS have also been the focus of some relatively recent research[2-5]. Indeed, a recent Cochrane Review suggested that there are benefits from carrying out exercise for people with MS[6]. However, while this research pointed to the benefits of different types of exercise for people with MS, there was no evidence to suggest that one form of exercise proved to be more effective than another. With this in mind, the present study set out to investigate the effect of Pilates classes on people with MS.
In spite of its popularity, relatively little research has looked into the potential benefit of Pilates exercise for people with MS. Pilates works on the principle of improving muscle strength around the trunk, and is hypothesised to improve balance and function in the rehabilitation of orthopaedic and neurologically impaired patients. However, there is little evidence to support this hypothesis and so the purpose of the present study was to establish whether Pilates classes for ambulatory people with MS would affect their balance, and whether participation in such activity posed any risks to people with MS[7-10].
Methodology
Subjects
All participants were from the Wessex MS Therapy Centre in Warminster. Each participant was invited to attend 12 one hour classes of Pilates over a six week period. To take part in the study, participants had to fulfil the following criteria:
- adults (18 or over) with a diagnosis of MS
- able to walk 20 metres with or without an aid
- able to stand independently for 2 minutes
- able to get on and off the floor with minimal assistance
The following exclusion criteria applied:
- attendance at a Pilates classes within the past three months
- currently experiencing a relapse
- pregnancy
- other unrelated medical problems
- currently involved in other research
Outcome measures
The primary outcome measure was the effect the classes had on balance as measured by the Berg Balance Scale (BBS), a standard measure of balance. The participants had to undergo 14 short functional tasks before and after the program and an increase of 6 points on the BBS would indicate a clinically significant difference[11-12].
The secondary outcome measure used was the Multiple Sclerosis Impact Scale MSIS-29 - a patient reported outcome measure. The MSIS-29 is a questionnaire that assesses the participants' perspective of their physical and psychological well-being[13]. An independent assessor collected the data over four points in time. The first two were collated before the intervention in order to establish a baseline for the participants. The third was conducted immediately after the six week intervention and the final follow-up assessment was carried out seven weeks after completion.
Statistical analysis
The tests applied were all non-parametric due to the ordinal nature of the data collected. The Friedman's and Wilson signed rank tests were used. Statistical significance was set at p<0.05.
Results
Twelve participants were recruited and ten completed - eight with secondary progressive MS and two with relapsing remitting MS. The mean age was 49 years (range 37-59). Eight participants completed the follow-up measurements.
Berg Balance Scale (BBS)
Figure 1 shows a graph of the data collected using the BBS. No significant difference was found over the whole study period in the data (Friedmans test p>0.05 (n=8)), indicating that the group's balance as a whole had not been changed by the exercise intervention.
Figure 1 clearly shows that there are fluctuations in the participants' balance throughout the study period. For example, the score of participant B increased by 7 points between the first two data collection times (baseline period), which indicated a clinically significant change[11]. However, this participant revealed that nervousness at the first data collection may have influenced the results that day. Participant A and G had relatively stable baselines indicating that their condition was not changing before the intervention, and they showed improvement by 6 and 8 points respectively after the intervention - indicating a clinically significant change. These two participants both had ataxic symptoms which might suggest that Pilates is beneficial for this type of clinical presentation. However, participant C had similar symptoms, but did not show any improvement after the classes.
Figure 1: A graph showing the data collected from the BBS over the full study period. An improvement in the participant is indicated by an increase in score. (pre-1 - data collection 2 weeks before the classes began; pre-2 - data collection just before the classes began; post - data collection just after the classes had finished; follow up - data collection seven weeks after the classes finished)
Figure 2: A graph showing the percentage mean for all three outcome measures. Improvement in the BBS is shown by an increase in score and a decrease in the MSIS-29. Error bars are +/- 1 standard deviation. (pre- 1 - data collection 2 weeks before the classes began; pre-2 - data collection just before the classes began; post - data collection just after the classes had finished; follow up - data collection seven weeks after the classes finished).
MSIS - 29 Physical
Statistical analysis of the data collected from the MSIS-29 Physical over the whole study period showed significant changes (Friedman test p=0.03 (n=8)), reflective of the participants' perception of changing physical state over the whole study period. However, no significant change was found as a result of the intervention period (Wilcoxon signed rank test p>0.05 (n=10)), signifying that the Pilates did not have an effect on individuals' perspective of their physical state. The results suggest that the participants gradually improved their MSIS-29 Physical score, but that this improvement cannot be directly linked to the Pilates classes.
MSIS - 29 Psychological
No significant changes were found (Friedmans test p>0.05 (n=8)) in the data, which suggested that the Pilates classes had no effect on the participants' psychological state.
Discussion
This study shows that people with MS are able to attend Pilates classes as an exercise group with no detrimental effects. There was a high level of adherence to the Pilates program and participation in such group activities encouraged greater social independence.
However, this study had a number of weaknesses including the small sample size and lack of a control group. It is also possible that balance was not the main function that Pilates exercises influenced in these participants, and functional improvement or muscle strength may have occurred without a change in balance. A measure of daily activity might therefore prove useful in future investigations into the effectiveness of this exercise modality for people with MS.
Conclusion
No statistically significant improvements were observed in the results obtained from this study. The two outcome measures, balance and perceived well-being, showed no significant improvement as a result of participation in Pilates classes. However, the lack of any detrimental effects and the high adherence rate to Pilates, suggests that it may be a very suitable form of exercise for people with MS. Further research is needed to clarify the effectiveness of this form of exercise in people with MS.
Acknowledgements
The study authors would like to thank: the MS Trust for funding the clinical time spent with the participants; the Wessex MS Therapy Centre for the use of their facilities; and Dr MJ Mayston for supervision and support throughout the project.
References
- The National Service Framework for Long-term Conditions.
London: Department of Health; 2005 - Freeman J, Allison R.
Group exercise classes in people with multiple sclerosis: a pilot study.
Physiother Res Int 2004; 9(2):104-7 - DeBolt L, McCubbin JA.
The effects of home-based resistance exercise on balance, power, and mobility in adults with Multiple Sclerosis.
Arch Phys Med Rehabil 2004; 85(2):290-7 - White LJ. Dressendorfer RH.
Exercise and Multiple Sclerosis.
Sports Med 2004; 34: 1077-100 - Kileff J. Ashburn A.
A pilot study of the effect of aerobic exercise on people with moderate disability multiple sclerosis.
Clin Rehabil 2005; 19(2):165-169 - Rietberg MB, Brooks D, Uitdehaag BMJ, et al.
Exercise therapy for multiple sclerosis.
Cochrane Database of Systematic Reviews 2005; 1: CD003980 - Barr KP, Griggs M, Cadby T.
Lumbar stabilization; core concepts and current literature, Part 1.
Am J Phys Med Rehabil 2005; 84:473-480 - Smith K, Smith E.
Integrating pilates-based core strengthening into older adult fitness programs: implications for practice.
Top Geriatr Rehabil 2005; 21(1): 57-67 - Bryan M, Hawson S.
The benefits of pilates exercises in orthopaedic rehabilitation.
Tech Ortho P 2003; 18(1):126-129 - Lange C, Unnithan V, Larkam E et al.
Maximizing the benefits of pilates-inspired exercise for learning functional motor skills.
J Bodywork Mov Ther 2000; 4(2):99-108 - Berg K, Wood-Dauphinee S, Williams JI et al.
Measuring balance in the elderly; preliminary development of an instrument.
Physiother Can 1989; 41:304-310 - Lord SE, Wade DT, Halligan PW.
A comparison of two physiotherapy treatment approaches to improve walking in multiple sclerosis; a pilot randomized controlled study.
Clin Rehabil 1998; 12(6):477-486 - Hobart J, Lamping D, Fitzpatrick R, et al.
The Multiple Sclerosis Impact Scale (MSIS-29) A new patient based outcome measure.
Brain 2001; 124 (5) 962-973
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