A six-week pilates exercise protocol for improving physical and mental health-related parameters

Abstract

Main Problem: Pilates, as a body-mind exercise method has an increasing popularity in recent years especially among young women. But there is not enough evidence whether this exercise method contributes to the physical or/and psychological condition of individuals. The aim of this study was to investigate the effectiveness of an original six-week Pilates Exercise Protocol on young females’ health-related parameters including anthropometric features, emotional state, fatigue, and quality of life. Methods: Fifty-one sedentary females aged between 18 and 25 were randomly assigned to Pilates Exercise Group (n=25), and Control Group (n=26). Pilates Exercise Group performed a six-week Pilates exercise protocol whereas Control Group did not participate any regular physical activity during six weeks. Anthropometric features, anxiety, depression, fatigue, and quality of life of the subjects were assessed at the baseline and after six weeks. Results: Weight (p=0.005), body mass index (p=0.005), waist (p<0.001), hip (p=0.002), and thigh circumferences (p<0.001), severity of anxiety (p=0.001), depression (p=0.001), and fatigue (p<0.001) significantly decreased in Pilates Exercise Group after six weeks besides vitality (p=0.005), and mental health (p=0.021) domains of quality of life increased. There were no significant differences in Control Group (p>0.005) after six weeks except of anxiety (p=0.010), and fatigue (p=0.032). Conclusions: The current Pilates exercise protocol contribute to the physical, and psycological well being of young females in terms of anthropometric features, emotional state, fatigue, and some domains of quality of life.

Full text

Malaysian Journal of Movement, Health & Exercise, 7(2), 65-79, 2018
65
A SIX-WEEK PILATES EXERCISE PROTOCOL FOR IMPROVING
PHYSICAL AND MENTAL HEALTH-RELATED PARAMETERS
Eda Akbaş* and Banu Ünver
Bülent Ecevit University, Faculty of Health Sciences, Department of Physiotherapy and
Rehabilitation 67600 Zonguldak/TURKEY
*Email: akbas.pt@gmail.com
(Received 1 April 2018; accepted 28 May 2018; published online 3 July 2018)
To cite this article: Akbaş, E. & Ünver, B. (2018). A six-week pilates exercise protocol for
improving physical and mental health-related parameters. Malaysian Journal of Movement,
Health & Exercise, 7(2), 65-79. https://doi.org/10.15282/mohe.v7i2.239
Link to this article: https://doi.org/10.15282/mohe.v7i2.239
Abstract
Main Problem: Pilates, a body-mind exercise method, has experienced
increasing popularity in recent years, especially among young women. But
there is not enough evidence whether this exercise method contributes to the
physical or/and psychological condition of individuals. The aim of this study
was to investigate the effectiveness of an original six-week Pilates mat
exercise protocol on young females’ health-related parameters including
anthropometric features, emotional state, fatigue, and quality of life.
Methods: Fifty-one sedentary females aged between 18 and 25 were
randomly assigned to Pilates Exercise Group (n=25), and Control Group
(n=26). Pilates Exercise Group performed a six-week Pilates mat exercise
protocol whereas Control Group did not participate in any regular physical
activity f[r six weeks. Anthropometric features, anxiety, depression, fatigue,
and quality of life of the subjects were assessed at the baseline and after six
weeks. Results: Weight (p=0.005), body mass index (p=0.005), waist
(p<0.001), hip (p=0.002), and thigh circumferences (p<0.001), severity of
anxiety (p=0.001), depression (p=0.001), and fatigue (p<0.001) significantly
decreased in the Pilates Exercise Group after six weeks and vitality
(p=0.005), and mental health (p=0.021) domains of quality of life increased.
There were no significant differences in Control Group (p>0.005) after six
weeks except anxiety (p=0.010), and fatigue (p=0.032). Conclusions: The
current Pilates mat exercise protocol contribute to the physical, and
psychological well-being of young females in terms of anthropometric
features, emotional state, fatigue, and some domains of quality of life.
Keywords: Depression, exercise, Pilates, quality of life

A sıx-week pılates exercıse protocol
66
Introduction
The World Health Organization defines health as “A state of complete, physical, mental,
and social well-being, not merely the absence of disease or infirmity” (Callahan, 1973).
The modern era and lifestyle, unfortunately, worsen well-being of the individuals and
cause inactive lifestyle contrary to human biomechanics. In today's society, especially
young population suffer from the consequences of inactivity (Furnham, Badmin, &
Sneade, 2002; Runfola et al., 2013). Worsening of body composition and fitness levels due
to an inactive lifestyle may impair the physical and psychological health of the young
population (von Sperling de Souza & Brum Vieira, 2006).
There is consensus in the literature that physical activity/exercise is a correct, and healthy
way to improve well-being (Kelley, Kelley, Hootman, & Jones, 2010; Sjøgaard et al.,
2016; Standage & Ryan, 2012; Vancampfort et al., 2011; Wang et al., 2010). Physical
activity regulates the energy balance of the body, providing weight control, and
determining body composition. Also, mood and anxiety can be altered depending on the
intensity and type of the physical activity.
Pilates supposed that the balance between body and mind is an important factor in
achieving health, and happiness. Pilates also holds that contrology stimulates the mind and
decreases mental strain (Pilates & Miller, 1945). Pilates training minimizes unnecessary
muscle recruitment by maintaining a neutral spine position and core stabilization. Pilates
exercises improve general body flexibility and health by improving strength, posture, and
the coordination of movements. The control of large group muscles with coordination, and
focusing on breathing may increase aerobic capacity (Caldwell, Harrison, Adams, &
Triplett, 2009), and further improve mental health (Kucuk & Livanelioglu, 2015).
Heretofore, some researchers have also reported that the holistic approach of Pilates based
training may offer physical and psychological improvements for human health (Akbas &
Erdem, 2016; Bernardo, 2007; Cruz-Ferreira et al., 2011; Karaman, Yuksel, Kinikli, &
Caglar, 2017; Kucuk & Livanelioglu, 2015), and various intensities benefit quality of life,
mental health, fatigue, physical fitness levels, and body types in diverse rates (Anderson
& Spector, 2000; Arslan, Çakmakçi, Taşkin, Çakmakçi, & Ismet, 2012; Ashrafinia et al.,
2015; Caldwell et al., 2009; Campos de Oliveira, Gonçalves de Oliveira, & Pires-Oliveira,
2015; Cruz-Ferreira et al., 2011; Frank, Edwards, & Larimore, 2017; Ginsberg et al., 2016;
Hassan & Amin, 2011; Kucuk & Livanelioglu, 2015; Leopoldino et al., 2013; McGrath,
O'Malley, & Hendrix, 2011; Memmedova, 2015; Miller & Mesa, 2013; Pourvaghar,
Bahram, Sharif, & Sayyah, 2014; Rogers & Gibson, 2009; Roh, 2016; Segal, Hein, &
Basford, 2004; Shanazari, Marandi, & Minasian, 2013; Soysal Tomruk, Uz, Kara, &
Idiman, 2016; Stan et al., 2012; Şavkın, 2014; Vieira, Faria, Wittmann, Teixeira, &
Nogueira, 2013). The method is recommended by health professionals, both as
rehabilitative for the people who have diseases, and preventive for undiagnosed or healthy
individuals (Herrera-Gutiérrez, Olmos-Soria, & Brocal-Pérez, 2015). However, only a few
clinical trials have investigated the effectiveness of Pilates training in healthy young
females (Bavli & Koybasi, 2016; Caldwell et al., 2009; Kucuk & Livanelioglu, 2015;
Parikh & Arora, 2016; Tolnai, Szabo, Koteles, & Szabo, 2016). Previous studies could not
demonstrate the influences of Pilates-based training on psychological variables (Cruz-

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67
Ferreira et al., 2011). Although there have been many studies describing the benefits of
Pilates-based training, these studies vary in terms of duration, intensity and/or the exercises
they contain and diverse periods, and intensities of Pilates training programs had different
effects on health-related parameters. Furthermore, since exercise protocols have not been
clearly reported in such studies, they cannot provide realistic proposals for clinics and
society in order to improve the individuals’ health.
The Pilates method has seen increasing popularity in last decades particularly among
young women in order to avoid the physical and psychological consequences of sedentary
lifestyle (Littleton & Ollendick, 2003), but evidence-based studies in this field remain
limited in the context of this population. Previous studies promised certain contributions
to improve health-related parameters but could not offer any clear exercise program for
individuals and their outcomes were contradictory. We aimed to create a standardized
protocol to improve the physical and mental health of young females with this study. The
question addressed was whether our original Pilates exercise protocol would contribute to
improving their anthropometric features, emotional state, fatigue, and quality of life. Our
hypothesis was that the current six-week program could provide physical and
psychological benefits to young females.
Materials and Methods
Participants
Subjects were recruited from female volunteers between the ages of 18, and 25. Written
informed consent was obtained from all participants, and they signed in the form approved
by Bulent Ecevit University Clinical Research Ethics Committee (2017-74-09/08) prior to
participation in the study.
Pregnancy, participation in regular physical training such as exercise classes or sport for
more than one hour at least once a week during the previous year, taking medications
affecting the emotional state, exercise contraindications due to cardiovascular or
neurological disorders, inability to cooperate for assessments and insufficient attendance
at least 80% of exercise sessions were exclusion criteria.
To estimate sample size, a preliminary power analysis was applied. Per a previous study
(Kucuk & Livanelioglu, 2015), we used 8.48 as the standard deviation values, and 8.19 as
the difference in mean of the BDI. Consequently, we needed 19 individuals in each group
to have 80% power with 5% type I error level. Anticipating 7 dropouts in each group, the
sample size was determined as 26 participants for each group. Eligible participants were
randomly assigned to Pilates Exercise Group (PEG) (n=26), and Control Group (CG)
(n=26). One participant of the PEG excluded from the study owing to insufficient
attendance. Thus, 25 subjects in the PEG and 26 in the CG completed the study (Figure I).
The control group was asked to maintain their normal sedentary activities including daily
living activities, and not to participate in regular physical activity during the study.
Endpoint assessments were conducted after verbal confirmation that participants had not
participated in regular physical activity within the past six weeks.

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Figure 1: Flow diagram
Assessments
This prospective, single-blind, randomized-controlled study involved pre and post-
measurement tests. Assessments were conducted at the baseline and after six week period.
The dependent variables including weight, waist, hip and thigh circumferences, the
severity of anxiety, depression and fatigue and quality of life were assessed in all subjects.
Weight was assessed while subjects were barefoot and wearing light clothes, and Body
Mass Index (BMI) was calculated as weight divided by height squared (kg/m2). Waist
circumference was measured at the mid-level between the lowest rib margin and the iliac
crest. Hip circumference was measured at the widest level on great trochanters. The thigh
circumference was measured 1 cm below the gluteal fold level perpendicular to the long
axis of the thigh (Norton K, 1996; Snijder et al., 2003).
Beck Anxiety Inventory (BAI) was used to evaluate the anxiety symptoms. BAI is a 21-
item self-report questionnaire for assessing the severity of anxiety (Ulusoy, 1998). For the
assessment of depression, the Beck Depression Inventory (BDI) was used. This index
evaluates the grade of depression using 21 questions similarly to BAI (Hisli, 1989). A
higher score indicates more severe anxiety and depression according to the scales.
The severity of fatigue was assessed with the Fatigue Severity Scale (FSS). FSS is a self-
report questionnaire investigating the severity of fatigue with 9 items. Grading of each
item ranges from 1 to 7. One indicates fully disagreement where 7 indicates full agreement.
The final score is calculated of the mean value of these items (Armutlu et al., 2007;
Michalos, 2014).

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69
Short Form Health Survey (SF-36) which is a multidimensional test was used to assess the
quality of life of the subjects. SF-36 is comprised of Functional Capacity, Physical
Aspects, Bodily Pain, General Health, Vitality, Social Aspect, Emotional Aspect, and
Mental Health domains. A higher score indicates a better quality of life (Kocyigit, 1999).
Pilates Mat Exercise Protocol
The Pilates exercise group followed an original six-week Pilates mat exercise protocol
created by the researchers of this study (Table I). According to previous reports, 6 to 8
weeks of Pilates training has positive effects on physical and psychological health (Bavli
& Koybasi, 2016; Pourvaghar, Bahram, Sharif, & Sayyah, 2014; Rogers & Gibson, 2009).
We preferred the 6-week protocol to demonstrate efficacy as soon as possible in this study.
Sessions were conducted twice a week and duration of each session was 40-50 minutes in
average including 5 minutes of warming up and 5 minutes of cooling down. Exercises
were performed as group training and supervised by a physical therapist, taking into
account the potential benefits of group interaction on motivation and coordination. The
protocol was predominantly composed of training for the abdomen, hip and lower limbs
in order to improve body image by the way of reducing body weight, waist, hip and thigh
circumferences. All exercises were performed focusing on the alignment, and awareness
of the core, and breathing correctly. Current protocol comprised of progressive three
phases. Phase-1 contained simple movements such as hundreds, crunches, rolling and
some simple training series for back and hip during the first two weeks. All Phase-1
exercises were part of the program of the following phases. At the beginning of the third
week, a few more complicated exercises were added to the program. Phase-3, which was
performed during last two weeks period of the protocol, was composed of the most
complicated and difficult exercises in addition to the previous ones. Figure II contains
detailed information about the current protocol. Individual limitations were respected
while training, and exercises were modified according to the subjects’ abilities. The trainer
demonstrated each activity using verbal and visual instructions to facilitate the correct
position and movement. All exercises were coordinated in the group. There was a 10
seconds rest interval between each exercise.

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Table 1: Pilates Mat Exercise Protocol
* min: minutes
Statistical Analysis
Data were analyzed using SPSS 15.0 for Windows. Level of 5% was used to determine
significant differences. Normality tests indicated that quantities data were not normally
distributed. Descriptive statistics were used for demographic data, while the Wilcoxon
signed-rank test was used for comparing intra-group, and the Mann-Whitney U test was
used for inter-group analysis.
Results
Demographic features and the baseline outcomes of the participants are shown in Table 2.
At baseline, no significant differences were found between the PEG, and CG in age (years),
height (cm), thigh circumference (cm), and the scores of BDI, BAI, FSS, and SF-36
(p>0.05). Weight (Kg), BMI (kg/m2) waist circumference (cm), and hip circumference
(cm) were significantly higher in the PEG at the baseline (p<0.05) (Table 2).
Phase 1
(1&2 Weeks)
Phase 2
(3&4 Weeks)
Phase 3
(5&6 Weeks)
Frequency
Warm up (5 min)
Warm up (5 min)
Warm up (5 min)
2
times/week
Hundreds
Hundreds
Hundreds
Crunches/extended legs
and arms
Crunches/extended
legs and arms
Crunches/extended legs
and arms
Bent knee crunch
Bent knee crunch
Bent knee crunch
Rolling like a ball
Rolling like a ball
Rolling like a ball
Bent knee raise in
crawling position
Bent knee raise in
crawling position
Bent knee raise in
crawling position
Fire hydrant
Bent knee cross in
crawling position
Bent knee cross in
crawling position
Hip isometrics
Fire hydrant
Fire hydrant
Bridging
Hip isometrics
Hip isometrics
Knee Swim
Bridging
Bridging
Side leg series
Knee Swim
Knee Swim
Cool down (5 min)
Hip abduction/in
bridging
Hip abduction/in
bridging
Cross bridging
Cross bridging
Cat and cow
Straight leg raise/in
bridging
Side leg series
Cat and cow
Cool down (5 min)
Straight leg raise/in
crawling
Leg raise with bent
knee/in crawling
Side leg series
Cool down (5 min)

Malaysian Journal of Movement, Health & Exercise, 7(2), 65-79, 2018
71
Table 2: Demographic Features and Initial Outcomes of the Participants
PEG (n=25)
CG (n=26)
p
Age (year)
21.44±1.35
21.26±1.51
0.549
Height (m)
1.61±0.51
1.63±0.49
0.163
Weight (kg)
57.00±4.78
54.65±6.41
0.025*
BMI (kg/m2)
21.88±1.68
20.44±2.05
0.001*
Waist Circumference (cm)
70.56±4.37
66.00±5.62
<0.001*
Hip Circumference (cm)
96.68±4.36
92.57±6.24
0.001*
Thigh Circumference (cm)
54.00±4.05
51.00±4.87
0.054
BAI
15.88±1.07
17.57±8.48
0.336
BDI
13.32±7.72
13.38±7.83
0.917
FSS
4.69±1.04
4.81±1.24
0.450
SF36-Functional Capacity
88.00±9.78
86.34±1.17
0.788
SF36-Physical Aspects
69.00±34.06
65.38±36.79
0.795
SF36-Bodily Pain
70.28±2.00
70.26±2.24
0.970
SF36-General Health
58.52±16.39
61.30±16.20
0.550
SF36-Vitality
55.80±14.69
48.46±21.94
0.198
SF36-Social Aspect
71.68±2.28
66.50±2.58
0.263
SF36-Emotional Aspect
54.52±35.75
55.30±37.57
0.954
SF36-Mental Health
60.00±1.36
54.92±2.10
0.460
Mann-Whitney U test * p<0.05
m: meter; kg: kilogram; cm: centimeter; BMI: Body Mass Index; BAI: Beck Anxiety Inventory;
BDI: Beck Depression Inventory; FSS: Fatigue Severity Scale; SF36: Short Form Health Survey
Intragroup analysis revealed a significant reduction in weight, BMI, waist circumference,
hip circumference, and thigh circumference (p<0.05) in the PEG while there was no
significant difference in CG after six weeks (p>0.05) (Table III).
Six weeks after the baseline, BAI scores significantly decreased in both groups (Table III)
nevertheless inter-groups analysis indicated that the reduction in the anxiety was
significantly in favor of PEG (p=0.017). There was also a significant reduction in BDI
score (p<0.05) in the PEG, while it did not change in CG after six weeks (p>0.05) (Table
III).
FSS scores significantly decreased in the both of the groups compared to baseline
outcomes (p<0.05) (Table III) moreover reduction in fatigue was significantly over in the
PEG (p=0.007).
Analysis revealed that vitality and mental health domains significantly increased after six
weeks in the PEG (p<0.05) while no significant differences were identified for the
functional capacity, physical aspects, bodily pain, general health, social aspect or
emotional aspect items (p>0.05) (Table III). Quality of life did not change in CG in terms
of emotional or physical components after six weeks (p>0.05) (Table III).

A sıx-week pılates exercıse protocol
72
Table 3: Intra-group Analysis of the Outcomes
Wilcoxon signed-rank test * p<0.05
m: meter; kg: kilogram; cm: centimeter; BMI: Body Mass Index; BAI: Beck Anxiety Inventory;
BDI: Beck Depression Inventory; FSS: Fatigue Severity Scale; SF36: Short Form Health Survey
Discussion
This study investigated the effectiveness of an original Pilates mat exercise protocol on
weight, BMI, anthropometric features, emotional state, fatigue, and quality of life among
young females. Our findings revealed that the six weeks Pilates mat Exercise Protocol
contribute to decrease weight, BMI, waist circumference, hip circumference, thigh
circumference, anxiety, depression, fatigue, and improve some domains of quality of life
of young females.
Physical exercise is one of the most common weight control and slimming methods
worldwide and is frequently preferred by females (von Sperling de Souza & Brum Vieira,
2006). Among exercise methods, Pilates-based training has seen increasing popularity in
recent years. However, results of the studies investigating the effect of Pilates on
anthropometric features and body mass are conflicting (Arslan, Çakmakçi, Taşkin,
Çakmakçi, & Ismet, 2012; Kucuk & Livanelioglu, 2015; Rogers & Gibson, 2009; Segal,
Hein, & Basford, 2004; Şavkın, 2014). Trials have shown that different periods and
intensities of Pilates training programs have different effects on these parameters. In the
current study, a six-week Pilates mat exercise protocol provided a reduction in weight,
BMI, waist, hip, and thigh circumferences compared to baseline outcomes of the
participants. This study confirms the findings of some previous ones, however, contradicts
to the report of Segal et al, who indicated 6 months of Pilates training did not change
weight, or other body composition parameters in adults (Segal et al., 2004). Segal et al.
explained this absence of changes in body composition with the low intensity of Pilates
exercise program (one hour per week). Although the intensity of the program conducted
in that study was lower than ours, the duration was higher. We think that the difference
between the outcomes of our study and previous one might be related to the differences in
content rather than the length of the training programs. Rogers and Gibson (2009) and
PEG (n=25)
CG (n=26)
Before
After
p
Before
After
p
Weight (kg)
57.00±4.78
56.28±4.80
0.005*
54.65±6.41
54.53±5.88
0.617
BMI (kg/m2)
21.88±1.68
21.61±1.69
0.005*
20.44±2.05
20.41±1.93
0.649
Waist Circumference (cm)
70.56±4.37
68.20±4.84
<0.001*
66.00±5.62
66.19±6.01
0.352
Hip Circumference (cm)
96.68±4.36
95.12±4.62
0.002*
92.57±6.24
92.76±6.20
0.375
Thigh Circumference (cm)
54.00±4.05
51.64±3.62
<0.001*
51.00±4.87
51.69±5.27
0.552
BAI
15.88±1.07
8.80±7.99
0.001*
17.57±8.48
13.07±8.79
0.010*
BDI
13.32±7.72
6.92±5.09
0.001*
13.38±7.83
9.88±9.48
0.067
FSS
4.69±1.04
3.30±1.03
<0.001*
4.81±1.24
4.29±1.39
0.032*
SF36-Functional Capacity
88.00±9.78
88.00±13.69
0.655
86.34±1.17
83.46±14.47
0.346
SF36-Physical Aspects
69.00±34.06
80.00±25.00
0.162
65.38±36.79
65.38±36.10
0.937
SF36-Bodily Pain
70.28±2.00
75.16±25.29
0.159
70.26±2.24
72.07±15.07
0.414
SF36-General Health
58.52±16.39
63.52±16.97
0.129
61.30±16.20
54.23±12.46
0.060
SF36-Vitality
55.80±14.69
66.68±15.72
0.005*
48.46±21.94
52.88±18.71
0.385
SF36-Social Aspect
71.68±2.28
76.20±19.31
0.233
66.50±2.58
63.38±20.15
0.936
SF36-Emotional Aspect
54.52±35.75
59.92±31.75
0.531
55.30±37.57
59.11±35.58
0.573
SF36-Mental Health
60.00±1.36
68.72±14.72
0.021*
54.92±2.10
58.92±16.95
0.389

Malaysian Journal of Movement, Health & Exercise, 7(2), 65-79, 2018
73
Şavkın (2014) both reported that 8 weeks Pilates training was sufficient in slimming the
participants in the waist and other regions of the body except thigh circumference. Unlike
these studies, a more intensive use of lower extremity exercises in our study might have
resulted in the reduction in thigh circumference. It is not possible to comment on this issue
since the authors did not provide detailed information about their exercise protocols.
In today's society, body image problems are unfortunately becoming widespread, and
unhealthy methods are taken depending on these perceptions especially of young girls.
Many studies have found high levels of subjective, and extreme body image dissatisfaction
about a person's physical appearance (Runfola et al., 2013). Weight control and slimness
may contribute women to improve their satisfaction with body image, and physical health.
According to our findings, the current Pilates mat exercise protocol promises to achieve
this in a correct and healthy way.
Present study also indicated that the severity of anxiety and depression of young females
who participated in Pilates training decreased compared to baseline. These findings are
inconsistent with previous reports in this subject (Cruz-Ferreira et al., 2011; Hassan &
Amin, 2011; Memmedova, 2015; Miller & Mesa, 2013; Roh, 2016). In a case report,
Miller and Mesa (2013) declared that “Pilates can help in the present moment releasing
anxiety, and stress but depending on the severity of anxiety it can add to the levels once
the client leaves, and goes back into the world.” This emphasizes the importance of
consistency for the effectiveness of the exercise. Simple, practical, feasible and
entertaining programs may help individuals to incorporate exercise into their lifestyle and
provide permanence of the positive effects. Heretofore, many opinions have been
developed about the effective mechanisms of Pilates exercises on the emotional health.
Memmedova (2015) summarized the mechanisms of Pilates on reducing anxiety through
the increase of body energy, sleep quality, attention, concentration, blood circulation, and
oxygen flow to the brain owing to blood circulation increment, relaxing of muscles, and
whole body, and breathing effect. The Pilates method has often been shown to be effective
in the increased release of serotonin from the brain. Increased levels of serotonin can be
helpful in the reduction of the symptoms associated with depressive symptoms and poor
or pessimistic attitudes (Ginsberg et al., 2016; Hassan & Amin, 2011). Further, breathing
as an integral aspect of Pilates has been found to have a positive effect on the vagus nerve,
which can influence emotional states such as anxiety and depression (Frank, Edwards, &
Larimore, 2017). Additionally, we think that group training might contribute to the
emotional state in terms of anxiety, and depression of the subjects through promoting
social interaction which helps the individuals to get rid of their daily stress.
There have been very few trials examining the effects of Pilates exercises on fatigue in the
literature (Ashrafinia et al., 2015; Shanazari, Marandi, & Minasian, 2013; Soysal Tomruk,
Uz, Kara, & Idiman, 2016; Stan et al., 2012). Our finding is consistent with the previous
researchers in terms of reduction in fatigue but none of them were conducted in healthy
populations. Our study is unique at this point. Authors reported that Pilates exercises might
reduce fatigue by the way of reducing redundant muscle activity and activate needful
muscles for functionality (Anderson & Spector, 2000). When people learn to contract their
muscles correctly in training sessions, they may use their muscles more effectively during
their daily activities. Further, the acceleration of physical activity might increase the

A sıx-week pılates exercıse protocol
74
fatigue threshold by improving endurance. Another possible mechanism might be the
deep, and relaxing respiration associated with the Pilates. Increasing airflow and lung
capacity might easier to perform any activity. In the current study, body mass reduction
might be another factor which helped fatigue reduction in the participants.
Our findings confirmed the past knowledge in terms of improving vitality, and mental
health domains of SF-36. The positive effects of Pilates training in quality of life in the
sedentary population were previously reported (Campos de Oliveira, Gonçalves de
Oliveira, & Pires-Oliveira, 2015; Leopoldino et al., 2013; McGrath, O'Malley, & Hendrix,
2011; Vieira, Faria, Wittmann, Teixeira, & Nogueira, 2013). However, frequency,
duration or intensity of training were all incomparable with our study. Pilates thought the
contrology stimulates the mind and decreases mental strain (Cruz-Ferreira et al., 2011;
Pilates & Miller, 1945). By allowing the brain to relax, it is possible for Pilates to increase
focus and concentration. Additionally, the control of muscles with coordination and
focusing on breathing might increase aerobic capacity, and further improve mental health
(Caldwell et al., 2009; Kucuk & Livanelioglu, 2015). We think that a longer and more
intensive program may be more effective to improve the quality of life of practitioners.
According to the present study, it is possible to report that the current Pilates mat exercise
protocol has positive effects on the health-related physical and psychological parameters
of young females. But as a limitation, it is not possible to reveal the mechanisms of effects
through this study. We could only guess, and comment on possible effect mechanisms.
The baseline outcomes of weight, BMI, waist and hip circumferences of PEG and CG were
significantly different despite randomization. We were unable to achieve homogeneity
between the two groups at the baseline. Relatively small sample size might be the possible
reason for this limitation. Besides, we did not perform normality test amongst the groups
prior to the intervention. More accurate results could be obtained from normally
distributed data obtained from a larger number of participants. Heretofore several studies
investigated the possible effects of Pilates exercises on undiseased or diseased populations,
but our study was different from previous ones in terms of offering an original six-week
Pilates exercise protocol which is effective at weight loss, slimming, emotional state,
fatigue and some domains of quality of life. This evidence-based study is significant in
terms of presenting a clear, reliable, basic, and effective protocol to the literature in order
to improve the physical, and psychological well-being of young females.
Conclusion
In conclusion, an original 6-week (twice a week for a total of 12 sessions) Pilates mat
exercise protocol contributes to the physical, and psychological well-being of young
females in terms of body mass, slimness, anxiety, depression, fatigue, and quality of life.
However, there is still need for long-term and larger sample sized future studies to clarify
the possible effect mechanisms of Pilates exercises and evidence based on this subject.

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75
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