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Journal of Bodywork and Movement Therapies (2007) 11, 318326

Journal of Bodywork and Movement Therapies

www.intl.elsevierhealth.com/journals/jbmt

EXERCISE PHYSIOLOGY

Effects of Pilates exercise on trunk strength, endurance and exibility in sedentary adult females
Betul Sekendiza,, Ozkan Altuna, Feza Korkusuza,b, Sabire Aknb
a

Physical Education and Sports Department, Middle East Technical University (METU), Turkey Health Centre, METU, Turkey

Received 31 August 2006; received in revised form 28 November 2006; accepted 1 December 2006

KEYWORDS
Pilates mat exercises; Isokinetic muscle strength; Trunk strength; Flexibility; Endurance; Females; Sedentary

Summary The objective of this study was to examine the effects of Pilates exercise on abdominal and lower back strength, abdominal muscular endurance and posterior trunk exibility of sedentary adult females. The body fat and body mass index (BMI) pre- and post-data were also assessed as secondary outcomes. To assess abdominal and lower back strength, posterior trunk exion and extension data were obtained concentrically on a Biodex isokinetic dynamometer at speeds of 601 and 1201 s1. Abdominal muscular endurance was assessed using the crunch test and posterior trunk exibility was measured using the sit and reach test. Results of multivariate analysis revealed a signicant difference (po.05) between pre- and post-measures of 601 s1 exion/extension and 1201 s1 exion, and abdominal muscular endurance and posterior trunk exibility of the exercise group. It can be concluded that there was a positive effect of Modern Pilates mat exercises on abdominal and lower back muscular strength, abdominal muscular endurance and posterior trunk exibility in sedentary adult females regardless of the fact that the body weight and fat percentages did not differ signicantly. & 2007 Elsevier Ltd. All rights reserved.

Introduction
Joseph Pilates had developed a unique system of hooking springs and straps in hospital beds to
Corresponding author. Orta Dogu Teknik Universitesi, Beden Egitimi ve Spor Bolumu, Inonu Bul. PK: 06531, Ankara, Turkiye. Tel.: +90 532 547 12 56. E-mail address: betulsekendiz@hotmail.com (B. Sekendiz).

help disabled and immobilized patients regain strength and movement in order to counteract the deleterious effects of deconditioning after World War I, which was later going to be called Pilates (Friedman et al., 1980; Latey, 2001; Wilson, 2002). With his development of the universal reformer (Latey, 2001) the importance of training the core abdominal and lower back muscles to stabilize the torso and allow the whole body to

1360-8592/$ - see front matter & 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.jbmt.2006.12.002

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Effects of Pilates exercise in sedentary adult females move freely was recognized. This method inspired other exercises to reach the desired level of muscular strength and exibility on simple equipments such as mats (Latey, 2001, 2002; Runion, 2002). Within the last two decades Pilates exercises have infused new insights into the tness industry and lower back rehabilitation methods. Current Pilates exercise styles can be divided into (a) the repertory approach, and (b) the modern approach (Latey, 2001). The repertory approach being the traditional method, uses set exercise sequences and set numbers of repetitions with little amount of modication for an individuals different types of problems. However, in the modern approach, the initial emphasis is on understanding the body and improving awareness by tailoring the exercises to clients particular needs, weaknesses and strengths. In this respect, Modern Pilates mat exercise trainees should think of their bodies as single integrated units, with the goal of establishing a stable central core around which all movements take place (Argo, 1999). Through this approach the quality but not the quantity of the movement is imposed (Friedman et al., 1980). In this respect, Modern Pilates mat exercises resembles the theory of weight training to gain optimum strength and endurance (Ives and Sosnoff, 2000). Despite the increased popularity of Pilates mat exercises within the last two decades, little research has been conducted on the method and its benets in a sedentary population. Pilates mat exercises have been reported to be effective for improving static or postural balance among a group of dancers (Fitt et al., 1993). In recent studies (Geweniger, 2002; Handa et al., 2000; Springen, 2003), it was presented that Pilates mat exercises, utilized as a therapy technique for the rehabilitation of severe low back pain, can be benecial and effective with improved results documented in patients. However, further research is necessary to ascertain the methods potential to improve the outcome of Modern Pilates mat exercises in a sedentary population. The purpose of this 5-week prospective longitudinal study was to investigate the effects of Modern Pilates mat exercises on abdominal and lower back muscular strength, abdominal muscular endurance and posterior trunk exibility in sedentary adult females. The body fat and body mass index (BMI) were also assessed as secondary outcomes. 319 Dependent variables included: (a) BMI, (b) body fat, (c) abdominal and lower back muscular strength, (d) abdominal muscular endurance, and (e) posterior trunk exibility.

Subjects
Randomly selected 45 sedentary academicians in a university volunteered to participate in this study, who had not been attending regular exercise sessions, more than 45 min a day, three times a week for more than a year. Each woman completed a demographic and health history questionnaire. Eighty percent of the participants reported that they experienced low back pain from time to time. Informed consent forms regarding information on the study and possible side effects, such as muscle soreness in the abdominals and back muscles due to fatigue, were signed by the participants prior to the study. Subjects were randomly assigned to the Pilates and control groups. Four participants of the exercise group and three of the control group dropped out of the study. The reasons for the dropouts were reported to be either illness or personal decision. Therefore, the nal results reproduced data of 21 women (mean age: 3076.6 range 2647) of the exercise and 17 women (mean age: 3078.6 range 2647) of the control groups.

Pilates exercise
Exercises were implemented three times a week for ve consecutive weeks. This resulted in a total of 15 sessions completed, which is the recommended necessary number of exercise sessions to measure the expected outcomes of Modern Pilates mat exercises (Stott, 2006). A physical education and sports instructor who had 2 years of experience and certication in Modern Pilates mat exercises initiated the exercises. Participants followed a standardized exercise protocol for beginners that lasted for 60 min day1 (Friedman et al., 1980) (Appendix A). Some of the exercises in the protocol are shown in Figs. 1(a)(c), 2(a), (b), 3(a), (b), and 4(a), (b).

Instrumentation and procedures

Instruments for testing all variables were calibrated and used by the same researcher in order to control possible inter-tester variation. Both the exercise and the control groups were given pre- and post-tests on all variables measured. Prior to the testing, a standardized 5 min warm-up including brisk walking and upper-lower body stretching exercises were completed.

Subjects and method

Independent variables were groups (Pilates and control) and time (before and after exercise).

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320 B. Sekendiz et al.

Figure 2 (a) The shoulder bridge (starting position) and (b) the shoulder bridge.

Figure 1 (a) The hundred (modied, starting position), (b) and (c) the hundred (modied)arms are parallel to the oor, hovering 2 inches above it and are pulsed up and down for ve inhalations and ve exhalations. Pulses are repeated 10 times to equal 100.

Abdominal and lower back muscular strength

Abdominal and lower back muscular strength was assessed concentrically on a Biodex System II

Isokinetic Dynamometer (Biodex Inc., Shirley, NY, USA) at speeds of 601 and 1201 s1. These speeds met the velocity of the range of motion of the Modern Pilates mat exercises (Handa et al., 2000; Roetert et al., 1996). Participants were positioned in the dynamometer seated with their back and neck supported with the adjustable pads for safety. The thighs, pelvis and chest were constrained by seatbelts to prevent sagittal pelvic rotation and facilitate isolation of the trunk for exion/extension testing only. The ankles were placed on an adjustable feet pad in neutral position. Participants were instructed to keep their heads and arms in a xed position throughout the test. Before measurements, each subject was asked to perform a warm-up test of ve repetitions. The actual test of 10 repetitions at the two angular velocities was then carried out after a 10 s rest period. Peak torque/body weight ratios were statistically analyzed as the measure of muscle strength (Jackson and Pollock, 1985).

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Effects of Pilates exercise in sedentary adult females 321

Figure 3 (a) The saw (starting position), (b) the saw.

Figure 4 (a) Swimming (starting position) and (b) swimming.

Abdominal muscular endurance

Abdominal muscular endurance was assessed as the maximum curl-ups performed without rest in 1 min (Ransdell et al., 2002). Abdominal curl-ups were performed in the supine position with the knees exed at 451 with legs slightly apart and feet on the ground. The arms were extended along the sides of the body with hands in prone position and ngers outstretched. Participants were instructed to curl-up to lift the shoulder blades off the mat and slide their ngers from one end of a 12 cm ruler. After each curl-up, the subject was instructed to return to the starting position.

opposite edge. To measure exibility, the participant was instructed to push the yardstick placed at the edge of the box while holding the legs straight and the hands parallel to the oor as far as she could. According to the YMCA standards (Golding et al., 1989), the participant had to hold this reach long enough for the distance to be recorded. The farthest test score of three trials was recorded.

Body fat
Body fat was measured from skin-fold thicknesses using a Lange skin-fold caliper (16). Skin-fold thicknesses were measured at the triceps, suprailiac and thigh regions. Body fat percentage was calculated using the Jackson and Pollock equation (Golding et al., 1989).

Posterior trunk exibility

Posterior trunk exibility was measured by the sit and reach test (Clark et al., 1989). The participants warmed-up for 5 min and then sat on the oor with their heels touching the side of a box. Their nger tips were on the 0 cm edge of the box that was vertically marked in centimeters towards the

Body mass index

BMI was calculated as weight (in kg) divided by height (in m) squared (Sardinha and Teixeira, 2000). The participants were weighed using a pre-calibrated

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322 digital scale to the nearest .1 kg. Height was measured by a stadiometer to the nearest .1 cm. B. Sekendiz et al. or not there is a signicant difference between groups. Independent sample t-test results revealed that there was no signicant difference between control and Pilates groups with respect to BMI (t .914, p .367), abdominal 601 s1 (t 1.600, p .118), abdominal 1201 s1 (t .501, p .619), back strength 601 s1 (t .804, p .427), and back strength 1201 s1(t 1.072, p .291), body fat (t 1.250, p .220), abdominal endurance (t 1.704, p .101), and trunk exibility (t 1.219, p .231). It can be said that all baseline values of groups in the present study did not differ from each other.

Statistical analysis
Statistical Package for Social Sciences (SPSS) version 9.0 (SPSS, Inc., Chicago, IL) was used for the analysis of the data. A 2 (group) 2 (time) analysis of variance was conducted to evaluate the effect of exercise on abdominal and back strength, muscular endurance, trunk exibility, body fat percentage and BMI. In addition to these analyses, one-way analysis of covariance was conducted to identify any effect of body fat on BMI scores.

Abdominal and lower back strength

Results
Each pre-measure of groups was analyzed by independent sample t-test to delineate whether The result of the analysis on trunk exion indicated that the Pilates group produced signicantly higher peak torque/body weight values than the control

Table 1 Changes in abdominal and back strength, muscular endurance, trunk exibility, body mass index and body fat percentage. Variable Exercise group (N 21) (Mean7SD) Control group (N 17) (Mean7SD) F p

Abs and back strength 601 Flexion Pre Post 601 Extension Pre post 1201 Flexion Pre post 1201 Extension Pre Post Muscular endurance Curl-ups Pre Post Trunk exibility Sit and reach test Pre Post Body mass index Pre Post % Body fat Pre Post

133.0755.8 168.8757.4 95.28729.4 142.1762.6 75.3740.4 115.4753.1 78.9727.1 147.7745.8

102.3770.4 95.4761.4 84.9741.2 82.0735.0 83.3743.1 74.9734.0 146.47277.3 76.1734.3

8.564

.006

13.682

.001

10.372

.003

3.184

.083

14.079.8 29.279.8

21.9716.9 22.6715.8

37.369

.000

23.977.5 31.376.8 22.072.5 22.072.7 29.074.0 29.475.1

20.778.3 21.879.4 22.872.6 22.972.7 31.076.0 31.176.1

66.703

.000

2.145

.152

.173

.680

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Effects of Pilates exercise in sedentary adult females group in the post-test at both 601, and 1201 s1 (Table 1). Peak torque values relative to total body weight were used to compare subjects of different body size. Results of the repeated MANOVA test revealed a signicant interaction effect for group and measurements at 601 s1 exion (GreenhouseGeisser F 8.564, po.05), 601 s1 extension (Greenhouse-Geisser F 13.682, po.05), and 1201 s1 exion (Greenhouse-Geisser F 10.372, po.05). There was a signicant difference between pre-and post-measures of strength at 601 s1 exion/extension and 1201 s1 exion in the exercise group (Fig. 5(a) and (b)). Pilates exercise 323 group showed more improvement regarding Abdominal and Back Strength results than did the control group.

Abdominal muscular endurance

Results of repeated MANOVA revealed a signicant interaction effect for group and measurements (Greenhouse-Geisser F 37.3, po.05) indicating that there was a signicant difference between pre- and post-measurements of endurance only for the exercise group (Table 1) (Fig. 6). Pilates exercise group showed more improvement

30.0 25.0 20.0 15.0 10.0 5.0 0 N=

p = 0.006

Flexion 60-Pre

Flexion 120-Post

Extension 60-Pre

Extension 120-Post

30.0
p = 0.001

25.0 20.0 15.0 10.0 5.0 0 N=

16

GROUP

16 Control
Flexion 120-Pre

20 20 Exercise
Flexion 120-Post

16

GROUP 30.0 25.0

16 Control
Extension 120-Pre

20 20 Exercise
Extension 120-Post

30.0 25.0
p = 0.003

20.0 15.0 10.0 5.0 0

20.0 15.0 10.0 5.0 0 N=

p = 0.083

N=

16

GROUP

16 Control

20 20 Exercise
1

16

16 Control

20 20 Exercise

GROUP

Figure 5 (a) Abdominal and back strength at 601 s exion and extension.

exion and extension, (b) abdominal and back strength at 1201 s1

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324
ENDURANCE-Pre ENDURANCE-Post FLEXIBILITY- Pre

B. Sekendiz et al.
FLEXIBILITY- Post

50 p = 0.000 40

50

p = 0.000

40

30

30

20

20

10

10

0 N=

17

GROUP

17 Control

21 21 Exercise

0 N=

17

GROUP

17 Control

21 21 Exercise

Figure 6 Muscular endurance difference between exercise and control group.

Figure 7 Difference in trunk exibility between exercise and control group.

regarding abdominal endurance than did the control group.

Table 2 Characteristics of the exercise and control groups. Variable Exercise group (N 21) (Mean7SD) 30.276.6 164.875.7 61.977.1 22.072.5 Control group (N 17) (Mean7SD) 30.878.6 161.075.8 57.278.14 22.872.6

Posterior trunk exibility

Results of multivariate test revealed a signicant interaction effect for group and measurements (Greenhouse-Geisser F 66.7, po.001). There was a signicant difference between the pre- and postmeasures of exibility only for the exercise group (Table 1) (Fig. 7). Pilates exercise group showed more improvement regarding posterior trunk exibility than did the control group.
Age Height (m) Weight (kg) BMI (kg/m2)

BMI and body fat

BMI measures and the body fat ratios of the exercise and control groups were not statistically different. In addition to covariance effect, correlations of preand post-measures were calculated. The result of this analysis showed that there was a signicant covariance effect of both pre-body fat measures on pre-BMI measures (F 43.918, po.001, Z2 .33) and post-body fat measures on post-BMI measures (F 16.718, po.001, Z2 .32). See Table 2.

Discussion
With regard to the results of this study, Modern Pilates mat exercises were found to be an efcient

training method with signicant changes in abdominal and lower back strength, posterior trunk exibility and abdominal muscular endurance in sedentary adult females. Difference in the means of the pre- and post-tests of abdominal and lower back strength of the exercise group proved to be higher compared to the control group. There was a signicant difference between pre- and post-measurements of abdominal and lower back strength at 601 s1 exion/extension and 1201 s1 exion in the Pilates group. These ndings were in line with the literature (Fitt et al., 1993) conrming that Modern Pilates mat exercises increase muscular strength of the trunk. Abdominal muscular endurance and posterior trunk exibility of the Pilates group were signicantly higher in the follow-up tests than that of the control group, which supported previous ndings in the relevant literature (Fitt et al., 1993).

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Effects of Pilates exercise in sedentary adult females Despite the fact that the results of Modern Pilates mat exercises were generally positive, some limitations to the study are also worth mentioning. The nding that there was relatively greater improvement in the abdominal muscular strength compared to lower back muscles in the exercise group was probably due to the exercise protocol that was used in the study. Put another way, the reason for the insignicant results with the isokinetic test may be due to the early fatigue in the lower back muscles. In a future study in order to maintain similar results in the lower back and abdominal strength, the number of exercises that would emphasize lower back muscles could be increased in the exercise protocol. As mentioned earlier in the paper, the body fat and BMI pre- and post-data were also assessed as secondary outcomes of this study, however no signicant changes were noted. One of the leading reasons for this outcome may be due to the fact that the Modern Pilates mat exercises were practiced by the subjects for a period of 5 weeks that can be considered to be a short interval to effect the body fat and BMI measures. Another reason might be the fact that there was not any restriction in the diets of the participants. As Mayo et al. (2003) suggests work involving larger weight losses are entirely diet based. From this standpoint, in a future longitudinal study of at least 8 weeks, a diet associated with Pilates mat exercise regimen could be applied to sedentary adult females to monitor changes in body fat and BMI in addition to the hypothesized variables in this study. In a future study it would also be interesting to investigate if the applied Modern Pilates mat exercises affect psychological variables of participants. In conclusion, this study showed that Modern Pilates mat exercises contributed to increased quality of life in sedentary adult females through improvements in abdominal and lower back strength, posterior trunk exibility and abdominal muscular endurance. 7. Arm circles 8. Scapula elevation Exercises 1. Ab prep 2. Breast stroke 3. Spine stretch 4. The hundred 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. Half roll back The roll up Leg circles Spine twist Rolling like ball Single leg stretch Double leg stretch Criss cross Scissors Shoulder bridge Roll over preparation Hell squeeze prone Single leg kick Breast stroke Spine stretch The saw Neck pull preparation Obliques roll back Side kick series Spine stretch forward Swimming 5 5 1 10 see Figs. 1(a)(c) 8 8 8 8 8 8 8 8 8 8 see Figs. 2(a) and (b) 8 8 8 8 1 8 see Figs. 3(a) and (b) 8 8 8 5 8 see Figs. 4(a) and (b) 5 5 325

26. Leg pull front 27. Leg pull back

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Appendix A. Exercise protocol

Exercise Warm-up 1. Breathing 2. Imprint and release 3. Spinal rotation 4. Cat stretch 5. Hip rolls 6. Scapula isolation Repetitions

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