Caspian Journal of Neurological Sciences

http://cjns.gums.ac.ir

Pilates Exercise and Functional Balance in Parkinson's Disease

Bakhshayesh Babak (MD) 1 , Sayyar Shaghayegh (MSc Stu) 2* , Daneshmandi Hasan (PhD) 3

ARTICLE INFO ABSTRACT

Article type: Background: Parkinson's disease as a progressive disorder of the nervous

Original Article
system leads to the disability of postural control system.
Objectives: In the present study the effects of Pilates exercises on
functional balance in patients with Parkinson's was investigated.
Article history: Materials and Methods: This control trial included 30 patients with
Received: 9 July 2016 idiopathic Parkinson's disease who were selected as subjects randomly
Accepted: 15 November 2016 and assigned into either exercise groups or control group. Participants in
Available online: 18 February 2017 exercise and control groups attended an 8-week Pilates program or
CJNS 2017; 3 (8): 25-38
DOI: walking program respectively. Functional balance, core stability and
https://doi.org/10.18869/acadpub.cjns.3.8.25 lower limb strength were evaluated by Fullerton Balance Scale (FAB),
valid functional core stability and strength tests respectively, before and
after interventions. In order to analyze the data paired samples t-test and
independent samples t-test and SPSS version 22 were used.
Results: Attending an eight-week Pilates exercise was associated with a
1. Neurosciences Research Center, Neurology significant improvement in functional balance, core stability indicators
Department, Pouursina Hospital, School of
Medicine, Guilan University of Medical and lower limb strength (p=0.000), while the difference of the variables
Sciences, Rasht, Iran in control group was not significant. Also the difference between the
2. Department of Sport Sciences, University of results of functional balance, core stability and lower limb strength of
Guilan, Rasht, Iran two groups in post-test was significant (p=0.000).
3. Professor, Department of Sport Sciences,
Conclusion: Given that Pilates exercises involve both musculoskeletal
University of Guilan, Rasht, Iran system and nervous system, can be an effective intervention to improving
balance in patients with Parkinson's disease.

Keywords: Parkinson Disease; Exercise; Movement

Copyright © [2017] Caspian Journal of Neurological Sciences. All rights reserved.
*Corresponding author:
Department of Sport Sciences, University of  Please cite this paper as:
Guilan, Rasht, Iran Bakhshayesh B, Sayyar Sh, Daneshmandi H. Pilates Exercise and Functional Balance in
Email: Shaghayegh.sayyar@yahoo.com Parkinson's Disease. Caspian J Neurol Sci 2017; 3(8): 25-38.

Introduction
exercises including high expectations of the

R
esearch suggests that regular
exercises are more effective on outcome, the lack of time and fear of falls
improving motor function in patients should also be overcome. Given the decreased
with Parkinson’s disease (PD) compared to motor learning ability in this group of
conventional therapeutic methods [1,2]. The patients, the exercises should be designed
physical exercises prescribed for these based on amplifying the sensory inputs and
patients should be short-term, simple and doing basic functional trainings and also the
closely monitored and the barriers to familiarity and safety of the training

25
 Caspian J Neurol Sci 2017 February; 3(8): 25-38

atmosphere [3-5]. Research results suggest Pilates exercises are safer and simpler to
that aerobic exercises are significantly more improve balance skills, especially dynamic
effective than stretching and strengthening balance, in this group [13]. Considering the
exercises on improving parameters such as higher rate of imbalance and falls in old
walking, balance, motor function and muscle patients with PD rather than healthy ones, this
strength and reducing the risk of falls [3-9]. type of exercises can therefore play a key role
Studies also suggest that regular physical in improving motor functions and balance in
exercises have both long-term and short-term these patients [14]. Conradsson et al. (2015)
beneficial effects on patients with PD, and reported significantly higher effects on neural
that a combination of balance, flexibility and adaptations in patients with PD for advanced
resistance exercises, especially in groups, balance exercises compared to conventional
maximizes the improvement of motor therapeutic methods [15]. Canning et al.
function in the patients [10]. Moreover, from (2014) also reported the effectiveness of
the onset of the disease, patients with PD face balance and strength training programs on
problems such as the lack of balance, reducing the risk of falls in patients with PD
coordination and flexibility which cause [16]. Exercise programs may therefore
secondary disorders in these patients. So constitute effective strategies for delaying or
designing a unique and beneficial exercise reversing motor dysfunction in patients with
program in which a combination of muscle PD. Exercise can improve physical function,
strengthening, stretching and aerobic health-related quality of life, strength, balance
exercises is used to develop muscle function and walking speed in these patients and so
and restore balance seems crucial. Pilates is reduce their depression. Exercise can
one of these exercises that plays a key role in therefore decelerate the progression and
skill learning, motor unit recruitment, emergence of symptoms in the early stages of
increasing motor cortex plasticity, improving the disease [10,17]. The key question in the
the use of muscles and restoring balance by present study is whether physical exercises
creating proper physiological adaptations and controlled programs designed based on
[11]. Although some studies have been Pilates exercises and conventional therapeutic
conducted on the effectiveness of Pilates methods can reduce the range of the disease
exercises on imbalance, these studies are symptoms associated with balance indices in
mostly concentrated on elderly without patients with PD?
specific neurologic disorder. Newell et al.
(2012), who studied the effects of Pilates Materials and Methods
exercises on balance and walking in older
The present randomized controlled clinical
adults, concluded that short-term Pilates
trial used a pretest-posttest quasi-
exercises can significantly improve variables
experimental approach. The statistical
associated with walking and balance and
population comprised all patients with PD
therefore reduce the risk of falls in this group
presenting to neurologists of health centers in
[12]. Hyun et al. (2014) reported significant
Guilan University of Medical Sciences,
effects on balance by Pilates exercises and
Guilan province, Iran in 2016. Before
balance exercises on unstable surfaces in old
beginning the study, this clinical trial was
women. Estimates however showed that
approved by the Ethics Committee of Guilan

26
Pilates Exercises and Parkinson's Disease Bakhshayesh B. et al.

University of Medical Sciences disorders affecting the safety of the exercise

(IR.GUMS.REC.1394.460) and registered in program as well as unwillingness to
the Iranian Registry of Clinical Trials participate in the study.
(IRCT2016071228885N1). Based on similar The selected patients were briefed on the
studies conducted, sample size requirements study objectives and all the relevant issues
of experimental research and using the sample and introduced to the researcher. Purposive
size estimation formula (Formula 1: N=the convenience sampling was used to select 32
number of presenting patients, s=1.44, patients with idiopathic PD based on the
d=0.25, confidence interval=95% and inclusion and exclusion criteria and the
power=80%), the sample size was calculated subject’s consent. These patients were
as 15 for each group. randomly and sequentially assigned to the
experimental and control groups. It is worth
𝑁𝑡 2 𝑠 2
Formula 1: Sample size calculation 𝑛 = mentioning that one subject in each group
𝑁𝑑 2 +𝑡 2 𝑠 2
withdrew during the study and the number of
Furthermore, the number of subjects in subjects ultimately reduced to 30 (12 women
each group was considered 16 to prevent and 18 men, 11 with stage 2 of the disease
disruption of the study owing to the potential and 19 with stage 3).
dropout of the subjects for any reasons. Before beginning the study, all the subjects
After making the necessary arrangements, were familiarized with the study setting and
all these patients were investigated by method during a briefing session and all
neurologists in terms of the inclusion criteria questions and ambiguities were resolved.
so as to select eligible candidates. The Given the physical characteristics of the
inclusion criteria comprised developing patients with PD and also their age group, the
moderate idiopathic PD (stage 2 and 3 of the study setting was completely made safe and
Hoen & Yahr Scale [17] (i.e. the disease selected in the vicinity of a health center so as
affected one side or both sides of the body to provide the subjects with the fastest
and the patient suffered from imbalance while therapeutic measures in case of the emergence
they were still able to perform daily of potential problems. All the participants
activities), age over 50, the disease being then completed consent forms and
diagnosed at least three years before, lacking demographic questionnaires. After collecting
other neurological diseases or any chronic demographic information such as age, gender,
physical and psychological disorders, height and weight and familiarizing the
specialists confirming the lack of cognitive subjects with the experiment methods, the
disorders, the ability to independently stand study variables including balance and risk of
and walk, not using balance and walking aids, falls indices were measured. It is worth noting
having a history of balance and walking that all the study subjects were constantly
disorders owing to PD, the lack of monitored during the study by a neurologist
involvement in exercise programs or and consumed their medicines including
physiotherapy treatments and being able to dopaminergic drugs and/or dopamine
regularly participate in the training sessions. agonists. All the tests were administered at
The exclusion criteria comprised having pain, least two hours after using these medicines.
deformation of limbs and any type of

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 Caspian J Neurol Sci 2017 February; 3(8): 25-38

The experimental group characteristics Strengthening exercises, particularly those

Owing to the problems of patients with PD focusing on the muscles responsible for
such as impaired control of posture, gait and maintaining balance and the standing position
balance and inflexibility, which exist from the such as the plantarflexors, the knee flexor and
onset of the disease and cause secondary extensormuscles and the dorsal spinal
complications, developing exercise programs muscles, also seem crucial. A variety of
based on retraining the proper posture as well mobility exercises may also constitute a part
as increasing the range of movements and of exercise programs in order to enhance the
muscle strength and balance becomes functional capacity and improve gait pattern
increasingly important [18]. The posture of [19-21]. The Pilates instructor provided the
patients with PD mainly consists of forward training group with basic information about
drop of shoulders and neck and bending of the method and principles of Pilates exercises
hands and knees. The exercise sessions in the first session. The training program
should therefore begin with teaching how to comprised 24 one-hour sessions, three
maintain the proper direction of the posture in sessions a week (as a total of 8 weeks). Each
different conditions (standing, sitting, supine session began with 10-minute warm-up
and prone) as a habit by daily repeating these exercises, including stretching exercises and
exercises as often as possible. Balance mobility exercises for the upper and lower
exercises are a fundamental pillar for extremity and the trunk, continued for 45
rehabilitating patients with PD. Different minutes performing 10 selected Pilates
walking and standing exercises can improve exercises aimed at increasing the strength of
balance in these patients and help them core muscles, range of motion and strength of
perform daily routines. Stretching and lower limb and ended with 5 minutes of
flexibility exercises for joints and muscles are recovery exercises including stretching and
crucial for relieving the rigidity. relaxation exercises (Table 1).

Table 1. The selected Pilates training program

Weeks The first two weeks The second two The third two weeks The fourth two weeks
(without tools) weeks (ball) (TheraBand) (compound)
Exercise
Warm-up Stretching 10 minutes 10 minutes 10 minutes 10 minutes
One Leg Stretch 6 repetitions 8 repetitions 10 repetitions 12 repetitions
Oblique Curl Up 6 repetitions 8 repetitions 10 repetitions 12 repetitions
Knee Fold Scissors 6 repetitions 8 repetitions 10 repetitions 12 repetitions
Main Shoulder bridge 6 repetitions 8 repetitions 10 repetitions 12 repetitions
program Torpedo 6 repetitions 8 repetitions 10 repetitions 12 repetitions
Prone Leg Pull 6 repetitions 8 repetitions 10 repetitions 12 repetitions
Prone Trunk Extension 6 repetitions 8 repetitions 10 repetitions 12 repetitions
Trunk Rotation 6 repetitions 8 repetitions 10 repetitions 12 repetitions
Trunk Lateral bending 6 repetitions 8 repetitions 10 repetitions 12 repetitions
Semi-squat 6 repetitions 8 repetitions 10 repetitions 12 repetitions
Front/Side Splits
One Leg Stance
Cool-down Stretching 5 minutes 5 minutes 5 minutes 5 minutes
Break between the sets 30 seconds 30 seconds 15 seconds 15 seconds

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Pilates Exercises and Parkinson's Disease Bakhshayesh B. et al.

The principles of exercise, including the functioning older adult population. In fact,
procedure and how to maintain the optimal this multidimensional test was designed based
posture, contraction of truncal muscles and on identifying the multiple factors
proper breathing during the exercises, were contributing to balance and evaluates the
explained to the subjects before each exercise. sensory, musculoskeletal and neuromuscular
The patients were adequately supervised and systems that might cause balance disorders.
banned from continuing the exercises if they The advantages of this test include high-level
experienced any unpleasant and annoying balance evaluation and the ability of
feelings such as pain, vertigo, malase and predicting falls in higher-functioning older
palpitations. The exercises began with 6-8 adults. This test comprises 10 different
repetitions depending on the ability of the balance assignments to measure different
subjects and without any coercion. The dimensions of balance [22]. These
repetitions and duration of exercises gradually assignments include standing with feet
increased during eight weeks of the protocol together and eyes closed, extending hands
depending on the characteristics of each forwards with arms stretched to get an object
subject. The Thera-Band ®small ball was also (pencil) held at shoulder height, turning 360
used for applying resistance. degrees right and left, stepping on and
climbing down a 15-cm high stool, tandem
The characteristics of control group walk, standing on one leg, standing on foam
The control group subjects were selected with eyes closed, two-footed jump, walking
to optimally match with those in the while turning the head and showing the
experimental group. Along with daily control of postural reaction. This scale is
physical activities, the controls proceed to scored between 0 and 40 depending on the
progressive walking from 10 minutes in the subject’s performance. Each assignment’s
first week to 30 minutes at the end of the score is 0-4, with 0 indicating inability to
training period in a times pan similar to that fulfill the balance assignment and 4 showing
used in the experimental group. Balance and the subjects’ ability to accomplish the task
other relevant variables including core ideally and totally independently. The total
stability indices (trunk flexion, trunk score is calculated by summing up the scores
extension, lateral trunk flexion and the of the ten sections [22,23]. A test-retest
lumbopelvic complex performance) and the reliability coefficient of 0.96 and an inter-
functional lower extremity strength were rater reliability of 0.94-0.97 were also
ultimately evaluated in both groups at the end calculated for this tool [22-24].
of the 8th week of the training protocol.
Trunk flexion endurance test
The fullerton advanced balance (FAB) scale The patient sits, with thighs and knees bent
The clinical FAB scale used in the present by 90 degrees and hands crossed on the chest.
study to assess balance was developed by In order to create more stability, ankles are
Rose and Lucchese in 2006 to evaluate static fixed using a support band or a supportive
and dynamic balance under different sensory person’s hand. The patient is then asked to
conditions in community-dwelling higher- rise from the floor by 60 degrees (besides the
angle specified on the wall or using a 60-

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 Caspian J Neurol Sci 2017 February; 3(8): 25-38

degree board) and maintain the trunk flexion pelvis orientation is recorded in seconds. Ito
at this angle. The duration in which the et al. (1996) reported a reliability coefficient
person is able to maintain their position of 0.94 for this test in women and 0.97 in men
without losing the favorable posture is [27].
recorded in seconds. This test is performed to
evaluate the functional capacity of anterior The step-down test
core muscles. Okada et al. (2011) reported an This unilateral test was used in the present
internal reliability coefficient of 0.97 for this study to evaluate the performance of the
test [25]. lumbopelvic complex. The subjects will squat
on one leg on an 8-inch (20.32-cm) step and
Trunk lateral flexion endurance test the number of repetitions in 30 seconds is
In order to evaluate the strength of lateral recorded. Each repetition comprises a
core muscles, the person takes a lateral downward motion with the heel hitting the
recumbent position with the body along a floor and the thigh returning to the full
straight line and no flexion in hip and knee extension position. This test is also performed
joints. In order to enlarge the supporting on both legs and the total score obtained is
surface and create more stability, the upper calculated. Loudon et al. (2002) reported a
leg is placed beside and in front of the lower reliability coefficient of 0.94 for this test [28].
leg. The person is then asked to raise their
thighs and buttocks while using only the feet The 30-second chair stand test
and a forearm to support the body. The This is a proper tool for measuring the
opposite arm should also be placed on the functional lower extremity strength in older
chest. The duration in which the person is adults. In order to perform this test, a 17-inch
able to maintain their posture without (43-cm) chair is placed against the wall or
disrupting the body direction and lateral supported by another person to avoid the risk
flexion of the lumbar region is recorded in of slipping. The subject begins the test in a
seconds. This test is performed on both sides sitting position in the center of the chair
of the body. The internal reliability without relying on the seatback and with their
coefficient of this test was calculated as 0.99 hands crossed on the chest. On “Go”, the
by Okada et al. [25,26]. subject rises to a standing position and sits
down as quickly as possible while
Trunk extension endurance test maintaining the standard position. The
In this test, the person is asked to take a number of correct movements in 30 seconds
prone position and hold their chest above the is then recorded. Duncan et al. (2013) used
floor using a small pillow in the lower this test for functional evaluations of patients
abdomen to avoid excessive curvature in the with PD and reported a reliability coefficient
lumbar region. Efforts are made to maintain of 0.99 [29]. Rikli and Jones (2013) and
the maximum trunk extension as long as Telenius et al. (2015) also calculated a
possible by maintaining the lumbopelvic reliability coefficient of 1 in older adults
stability through gluteal muscles contraction. [30,31].
The duration in which the person can hold The Shapiro-Wilk test was finally used to
this position without disrupting the spine and test the normality of the data collected. The

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Pilates Exercises and Parkinson's Disease Bakhshayesh B. et al.

data associated with the subjects’ the Hoen & Yahr Scale) in the experimental
characteristics including age, height and and control groups in terms of functional
weight and also other descriptive and balance and the relevant factors including
inferential variables were analyzed in SPSS- core stability indices (trunk flexion, trunk
22. The paired-samples t-test was used to extension, lateral trunk flexion and the
compare the results obtained before and after lumbopelvic complex performance) and the
the intervention and the independent-samples functional lower extremity strength.
t-test to compare the results in the two groups. Table 2 presents general characteristics of
p≤0.001 was set for statistical significance. the subjects and the descriptive data of the
quantitative variables in the experimental and
Results control groups.

The present study investigated 30 patients

with moderate idiopathic PD (stage 2 and 3 of

Table 2. General characteristics of the subjects and descriptive information of quantitative

variables
Experimental Control group
Variable
Mean±SD Mean±SD
Age (yr) 57±6.24 58.31±7.37
Duration of PD (yr) 7.27±3.80 8.19±3.14
Height (cm) 164.67±8.49 164.94±8.83
Weight (kg) 71.78±5.78 73.40±8.50
Functional balance (pretest) 7±2.92 7.01±2.54
Functional balance (posttest) 32.67±5.16 7.27±2.84
Trunk flexion (pretest) (sec) 6.27±4.16 4.47±3.11
Trunk flexion (posttest) (sec) 64.93±18.18 6.07±3.41
Trunk extension (pretest) (sec) 1.53±1.88 1.47±1.06
Trunk extension (posttest) (sec) 31.33±7.21 0.93±0.79
Lateral trunk flexion (pretest) (sec) 2±1.46 2.01±1.27
Lateral trunk flexion (posttest) (sec) 49.40±8.34 1.87±1.30
Lumbopelvic function (pretest) (repetition) 11.67±3.57 11.33±4.45
Lumbopelvic function (posttest) (repetition) 49.73±9.76 11.67±4.70
Lower extremity strength (pretest) (repetition) 9.87±3.54 9.93±3.15
Lower extremity strength (posttest) (repetition) 24±2.67 11.53±3.60

Table 3 presents the difference between strength after participating in the selected
the two groups in terms of the mean Pilates exercise program (p<0.001). This test,
functional balance, the mean core stability however, showed no significant differences in
indices and the mean lower extremity strength terms of the scores of functional balance
in the pretest and posttest. The results of the (p=0.364), trunk flexion (p=0.268), trunk
paired t-test in the experimental group extension (p=0.135), lateral trunk flexion
showed significant improvement in the scores (p=0.796), the lumbopelvic complex
of functional balance, trunk flexion, trunk performance (p=0.465) and the lower
extension, lateral trunk flexion, lumbopelvic extremity strength (p=0.158) in the control
complex performance and the lower extremity group.

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 Caspian J Neurol Sci 2017 February; 3(8): 25-38

Table 3. The difference in the mean results of functional posttests and pretests in the experimental and
control group (the paired-samples t-test, p≤0.001)
Variable Group Difference in the mean T P df
(posttest-pretest)
Functional balance Experimental -25.66±3.67 -27.031 0.000* 14
Control -0.26±1.10 -0.939 0.364 14
Trunk flexion Experimental -58.67±19.47 -11.67 0.000* 14
Control -1.6±5.37 -1.15 0.268 14
Trunk extension Experimental -29.80±5.87 -19.66 0.000* 14
Control 0.53±1.3 1.57 0.135 14
Lateral trunk flexion Experimental -47.4±8.53 -21.51 0.000* 14
Control 0.13±1.96 0.264 0.796 14
Lumbopelvic function Experimental -38.07±10.55 -13.28 0.000* 14
Control -0.33±1.72 -7.51 0.465 14
Lower extremity strength Experimental -14.13±3.54 -15.45 0.001* 14
Control -1.6±4.15 -1.49 0.158 14
* The posttest and pretest values are significantly different (p<0.001)

Tables 4 and 5 respectively present the balance, trunk flexion, trunk extension, lateral
difference in the pretest and post-test mean trunk flexion, the lumbopelvic complex
values of functional balance, core stability performance and the lower extremity strength
indices and the lower extremity strength in the two groups (p<0.001), while the pretest
between the two groups. The independent t- figures showed no significant differences
test indicated significant differences between between the two groups.
the mean post-test values of functional

Table 4. The difference in the mean results of functionalpretest between the experimental and
control group (the independent-samples t-test, p≤0.001)
Variable Difference in the mean T P df
Functional balance 0±1.07 0 1 28
Trunk flexion 1.8±1.34 1.34 0.191 28
Trunk extension 0.07±0.56 0.12 0.906 28
Lateral trunk flexion 0±0.54 0 1 28
Lumbopelvic function 0.33±1.48 0.23 0.823 28
Lower extremity strength -0.07±1.22 -0.05 0.957 28

Table 5. The difference in the mean results of functionalposttest between the experimental and
control group (the independent-samples t-test, p≤0.001)
Variable Difference in the mean T P df
Functional balance 25.4±1.52 16.69 0.000* 28
Trunk flexion 58.87±4.78 12.32 0.000* 28
Trunk extension 30.40±1.87 16.24 0.000* 28
Lateral trunk flexion 47.54±2.18 21.79 0.000* 28
Lumbopelvic function 38.07±2.8 13.6 0.000* 28
Lower extremity strength 12.47±1.6 10.76 0.000* 28
* There are significant differences between the mean posttest values of the two groups

Discussion
The present study was conducted to strength in patients with PD. According to the
investigate the effects of a selected Pilates results obtained, eight weeks of Pilates
exercise program on functional balance and exercises significantly improved functional
the factors associated with balance such as balance in the experimental group.
core stability indices and the lower extremity Furthermore, significant differences were

32
Pilates Exercises and Parkinson's Disease Bakhshayesh B. et al.

observed in the core stability indices such as exercises can be investigated based on the
trunk flexion, trunk extension, lateral trunk systems theory. According to this theory the
flexion, the lumopelvic complex performance ability to control the body’s position resulted
and the lower extremity strength improved by from simultaneous and complex interaction
this exercise. Postural instability is one of the between the nervous system and the
most debilitating aspects of PD, which can musculoskeletal system (the postural control
increase falls and reduce mobility and system). A combination of sensory data (to
functional capacity in these patients. Patients detect the body position in space) and the
with PD suffer a smaller range of stability and musculoskeletal system ability is essential to
consequently higher postural fluctuations apply proper force for the postural and
compared to other peers. Postural control balance control and consequently movement
disorders are also significantly associated using the systems cited. In this model, the
with the risk of falls in these patients [32]. central nervous system uses the visual,
Many studies confirm the effectiveness of vestibular and proprioceptive data, including
regular exercises on improving motor and joint position sensation and peripheral
non-motor symptoms in patients with PD. sensation, to obtain data about the body’s
Postural control indices are significant and center of gravity concerning gravity and base
effective factors on maintaining independence of support and provide appropriate motor
and quality of life in these patients and responses as pre-programmed movement
significantly improve by training patterns. Based on the systems theory and
interventions [2,16,33]. Different training also the effect of physical activities on
interventions including aerobic exercises, improving these systems, Pilates exercises
hydrotherapy as well as balance and gait can be associated with balance improvement
training cause significant therapeutic benefits in patients with PD who experience balance
by enhancing the functional capacity in these disturbance caused by the central nervous
patients [34,35]. There are different theories system dysfunction [38,39]. In addition,
as to how exercise programs improve balance. Pilates exercises can improve balance through
Generally, physical activities improve balance improving psychological factors such as
through modifying the central and peripheral stress and anxietyin participants. Also it
balance systems in the body [5]. The results increases the muscle strength. Since reduction
of most researchers suggest that resistance in the lower extremity strength move the
training and balance exercises are more center of gravity to in front of the ankle,
effective on improving balance disorders, which in turn causes imbalance and falls, the
especially in patients with mild and moderate Pilates therefore seems to correct balance
levels of PD, compared to other exercise disorders by focusing on the functional
methods [10,36]. Based on physiological improvement of core muscles and axial
principles, skeletal muscles are heavily stability through creating neuromuscular
affected by Pilates exercises as a type of adaptations [18,37,40,41]. Kibar et al. (2015)
resistance training, in which the body weight found eight weeks of Pilates exercise to have
is applied as the resistance and the increasing beneficial effects on the static and dynamic
repetitions as the overload weight [37]. The balance and core muscle endurance in older
balance improvement caused by Pilates adults, while they found no significant

33
 Caspian J Neurol Sci 2017 February; 3(8): 25-38

relationship between core muscle endurance effective on balance functions than is light
and balance [42]. Kloubec et al. (2010) also walking. The studies conducted by Gopal
found these exercises to significantly improve Nambi et al. (2014) and Appell et al. (2012)
core muscle strength, while failing to indicate more significant effects of Pilates
significantly affect balance and posture in the exercises on balance than those of walking,
middle-aged [43]. Comparing the effects of which is consistent with the present study
Pilates and balance exercises designed on [48,49]. Some studies however indicate
unstable surfaces, Hyun reported that both of significantly positive effects of more
these methods significantly improve static complicated types of exercises such as
and dynamic balance in old women and walking on treadmill and in different
increase their balance abilities, and that directions, walking on unstable surfaces with
Pilates seems a safer method for improving open and closed eyes, walking in different
balance capacity in older adults if more safety directions as well as moving and walking in
measures are taken [13]. Given the significant water on balance indices. These exercises
differences observed in the functional balance mainly improve the musculoskeletal factors
of the study subjects participating in the contributing to mobility, neuromuscular
Pilates exercise program compared to that of coordination and the application of balance-
the controls, the selected Pilates training motor strategies, which are followed by
program used in the present study can have facilitating motor learning, while light
desirable effects on the improvement of walking does not cause such significant
balance in patients with PD, which is changes [15,50-54].
consistent with the studies conducted by Bird
et al. (2013), Newell et al., Oliviera et al. Conclusion
(2015), Mesquita et al. (2015) and Jonson et
al. (2013) [12,36,41,44,45]. Furthermore, Given that Pilates exercise affects both the
Pilates exercises seem to be associated with muscular and the nervous system, they can
the functional improvement in core stability well treat balance disorders emerging
muscles and also strength improvement and especially in patients with postural control
recruitment of trunk and lower extremity disorders. This type of training program can
muscles. This activation of core muscles in therefore be recommended as a modality of
mobility patterns of extremities improves treatments for these patients.
postural control and generates rotational
torque to move the limbs. These results are Study Limitations
consistent with the studies conducted by Owing to the limitations in selecting
Kibler et al. (2006) and Jankovic et al. (2007) subjects, the present study recruited male and
[46,47]. Pilates was designed based on the female patients with PD aged over 50.
principle of retraining postural control and Moreover, only patients with stage 2 and 3 of
motor learning and is therefore a proper PD could be included owing to the patients’
method for exercising mind-body awareness limited cooperation. It was also impossible to
and controlling postural movements, accurately control medication consumption
particularly to maintain balance in older during the study, therefore, a neurologist
adults. This is why these exercises are more

34
Pilates Exercises and Parkinson's Disease Bakhshayesh B. et al.

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doi:org/10.1155/2012/854328.
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Similar studies are recommended on larger 2009; Suppl 3:S53-8. doi: 10.1016/S1353-
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van de Warrenburg BP, Smulders K, Dontje
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