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Adıyaman Üniversitesi Sağlık Bilimleri Dergisi, 2021;7(2):129-135
doi:10.30569.adiyamansaglik.934499
Bu eser, Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı ile lisanslanmıştır.
Telif Hakkı © 2021 Adıyaman Üniversitesi Rektörlüğü
Research Article/Özgün Araştırma
The effect of pilates on body awareness, activity level, aerobic capacity and
balance in healthy young adults
Pilatesin sağlıklı genç yetişkin bireylerde vücut farkındalığı, aktivite düzeyi,
aerobik kapasite ve denge üzerine etkisi
Emrah ZİREK1, Yıldız ANALAY AKBABA2, Gecem İrem EMİR3, Ayça
ASLANTÜRK4, Merve KOYUNCU5
1Bingol University, Faculty of Health Sciences, 12000, Bingöl-Turkey
2Istanbul University-Cerrahpasa, Faculty of Health Sciences, 34147, İstanbul-Turkey
3Istanbul University Institute of Health Sciences, 34126, İstanbul-Turkey
4Istanbul University Cerrahpasa, Institute of Graduate Studies, 34320, İstanbul-Turkey
5Florence Nightingale Hospital, 34381, İstanbul-Turkey
Atıf gösterme/Cite this article as: Zirek E, Analay Akbaba Y, Emir G.İ, Aslantürk A, Koyuncu M. The effect of
pilates on body awareness, activity level, aerobic capacity and balance in healthy young adults. ADYÜ Sağlık Bilimleri
Derg. 2021;7(2):129-135. doi:10.30569.adiyamansaglik.934499
Abstract
Aim: In this study, it was aimed to investigate the
effects of Reformer Pilates on body awareness, activity
level, aerobic capacity and balance in young adults.
Materials and Methods: Participants were consisted
of Reformer Pilates (individuals who received a
program of muscle strengthening and flexibility
exercises; n=82) and sedentary groups (n=87). Body
Awareness Questionnaire (BAQ), International
Physical Activity Questionnaire Short Form (IPAQ-
SF), YMCA 3-Minute Step Test, Single-Limb Stance
Test (SLST), and Functional Reach Test (FRT) were
used in the evaluations of the participants.
Results: A statistically significant difference was
found in favor of the Reformer Pilates group in the
scores of BAQ, IPAQ-SF mild level activity, YMCA
3-Minute Steps Test, SLST with eyes closed, and
lateral FRT scores (p<0.05). In the sedentary group,
heart rate change after the YMCA 3 min Step Test was
statistically significantly higher (p=0.001).
Conclusion: Body awareness, aerobic performance,
and balance scores were found to be better in
individuals who practiced Reformer Pilates than in
sedentary individuals.
Keywords: Reformer Pilates, Functionality, Balance,
Body Awareness, Exercise.
Öz
Amaç: Bu çalışmada, genç erişkin bireylerde Reformer
Pilatesin vücut farkındalığı, aktivite düzeyi, aerobik
kapasite ve denge üzerine etkilerinin incelenmesi
amaçlanmıştır.
Gereç ve Yöntem: Katılımcılar Reformer Pilates (kas
güçlendirme ve fleksibilite egzersizi programı alan
bireyler; n=82) ve sedanter (n=87) gruplarından
oluşmaktaydı. Katılımcıların değerlendirmesinde
Vücut Farkındalığı Anketi (VFA), Uluslararası Fiziksel
Aktivite Anketi Kısa Form (UFAA-KF), YMCA 3-
Dakika Basamak Testi Tek Ayak Üzerinde Durma
Testi (TAÜDT) ve Fonksiyonel Uzanma Testi (FUT)
kullanıldı.
Bulgular: VFA, UFAA-KF hafif düzey aktivite,
YMCA 3-Dakika Basamak Testi, gözler kapalı
TAÜDT ve yana FUT skorlarında Reformer Pilates
grubu lehine istatistiksel olarak anlamlı farklılık
bulundu (p<0,05). Sedanter grupta YMCA 3 dakikalık
Adım Testi sonrası kalp hızı değişimi istatistiksel
olarak anlamlı derecede yüksekti (p=0,001).
Sonuç: Reformer Pilatesi uygulayan bireylerin vücut
farkındalığı, aerobik performans ve denge skorlarının
sedanter bireylere göre daha iyi olduğu bulunmuştur.
Anahtar Kelimeler: Reformer Pilates; Fonksiyonellik;
Denge; Vücut Farkındalığı; Egzersiz.
Yazışma Adresi/Address for Correspondence: Yıldız ANALAY AKBABA, Istanbul University-Cerrahpasa, Faculty of Health
Sciences, 34147, İstanbul-Turkey, E-mail: yildizanalay@iuc.edu.tr
Geliş Tarihi/Received:07.05.2021 Kabul Tarihi/Accepted:23.06.2021 Yayım Tarihi/Published online:30.08.2021
Bu makale araştırma ve yayın etiğine uygun hazırlanmıştır.
intihal incelemesinden geçirilmiştir.
The effect of pilates exercise on different health components. Zirek E, Analay Akbaba Y, Emir Gİ, Aslantürk A, Koyuncu M.
130
Introduction
The World Health Organization (WHO)
recommends physical activities of different
severity specific to individuals of different
age groups.1 There is evidence that regular
physical activity reduces the risk of various
chronic diseases such as heart attack, stroke,
diabetes, and cancer and positively affects
overall health by improving mental health and
quality of life.1,2 Pilates is one of the popular
and widespread physical activities throughout
the world that can be recommended.3 This
exercise form has different classifications,
such as classical, modern and clinical
(modified) Pilates. It can be applied on a Mat
or with the help of a tool (Reformer). Pilates
is a physical method and a holistic approach
that provides mental focus and reduces stress
and anxiety.4
The number of studies on Pilates is
increasing and diverse day by day. Pilates
aims to develop body awareness through
movements that are controlled, concentrated
and accurately initiated, and complemented
by appropriate efforts.5 It is reported that
Pilates positively affects the aerobic
parameters of individuals with both healthy
and limited aerobic capacity.6 In addition to
the effects on muscle strength and endurance,
it is reported that Pilates improves balance by
providing different proprioceptive inputs.
Pilates may also improve balance scores
regardless of the physical activity history of
individuals.7-10
In the literature, Pilates-related studies
generally include individuals with chronic
diseases, geriatric and obese individuals who
are at risk of falling, and only the effect of
Pilates on certain parameters has been
investigated.11-15 Although it has been
reported that Reformer Pilates increase body
awareness, static and dynamic balance,
general body flexibility, muscle strength, joint
range of motion, and posture, studies
evaluating different parameters together are
insufficient.7,16,17 The number of studies
evaluating the effectiveness of Pilates on
multi-faceted health components in groups
including young and healthy subjects is
limited.18 Therefore, in our study, we aimed
to investigate the effects of Reformer Pilates
on body awareness, activity level, aerobic
capacity, and balance in young adult healthy
individuals.
Materials and Methods
The type of the study
Our study was designed as a descriptive
observational study.
The population and the sample of the study
In our study, G*Power Analysis Program
was used to determine the sample size.
According to the results obtained from the
study conducted by Tolnai et al., the effect
size was determined as 0.129. With 95%
power (Type-1 error=0.05), the number of
participants was calculated as 124 participants
(62 participants for each group).14
This study was a single-center, controlled
study. Between 10.07.2020 and 10.01.2021,
90 individuals who perform Reformer Pilates
regularly for at least 2 months and 98
individuals without any regular exercise or
sports history in a similar age group were
evaluated in terms of eligibility. Of these
individuals, thirteen refused to participate in
the study (Reformer Pilates group: n= 5;
Sedentary Group: n=8). In addition, 6
individuals did not meet the inclusion criteria
(3 Active athletes in Reformer Pilates Group;
3 with Chronic disease in sedentary Group)
After the eligibility assessment, a total of 169
participants were included in the study (82
participants who performed Reformer Pilates
regularly and 87 sedentary participants). The
exercises were performed by a certified
physiotherapist.
The inclusion criteria of the study were: to
be between the ages of 18-30, to have the
cognitive ability to understand and interpret
the questions in the questionnaires, to perform
only the Reformer type of Reformer Pilates
for at least 2 months for the Reformer Pilates
group and not to perform any regular exercise
in the last 2 months for the sedentary group.
Participants who had chronic, neurological,
orthopedic, systemic, and/or pulmonary
disease and individuals who had any other
exercise/sport except Reformer Pilates (for
the Reformer Pilates group) were excluded
from the study.
Zirek E, Analay Akbaba Y, Emir Gİ, Aslantürk A, Koyuncu M. ADYÜ Sağlık Bilimleri Derg. 2021;7(2):129-135.
131
Written and oral information was given to
all participants and written informed consent
was obtained from all subjects.
Exercise Protocol
Reformer pilates group consisted of the
individuals who received a standard program
that included muscle strengthening and
flexibility exercises for at least 2 months, 3
days a week.
The exercises consisted of a program that
included muscle strengthening and flexibility
exercises. The Reformer Pilates focused on
spinal stabilization, muscular strength,
flexibility, balance, proprioception, and body
awareness. The exercises were performed in
different positions such as lying down, sitting
and standing. Each Reformer Pilates session
lasted approximately 60 minutes. The subjects
performed warm-up exercises on the mat for
10 minutes, Reformer exercises for 40
minutes, and cooling exercises on the mat for
10 minutes. The intensity of the exercises was
increased by changing the resistance of the
springs and adding different positions. The
number of repetitions of exercises was
increased according to individual progress.
The Reformer Pilates program was standard
and all sessions were performed by the same
physiotherapist.
Data collection tools
The demographic and clinical
characteristics of the participants were
evaluated by using the “Participant Report
Form”. In this form, demographic information
such as body mass index (BMI), marital
status, the habit of smoking, chronic disease,
and regular sports history were examined.
The body awareness of the participants
was evaluated by using the Body Awareness
Questionnaire (BAQ) and level of physical
activity with the International Physical
Activity Questionnaire-Short Form (IPAQ-
SF). For the functional assessments, Young
Men's Christian Association 3 Minute Step
Test was used for the assessment of aerobic
capacity, the Single-Limb Stance Test (SLST)
for static balance, and the Functional Reach
Test for the dynamic assessment of the
participants.
The body awareness questionnaire (BAQ)
is a questionnaire aimed at determining the
level of sensitivity of individuals to body
composition. The questionnaire consists of 18
items, and each item is rated between 1 and 7
by the participants (1=not true at all,
7=completely true). The total score is a
maximum of 126 and a high score taken from
the scale indicates that the individual's body
awareness level is high.8,19
The International Physical Activity
Questionnaire-Short Form (IPAQ-SF) is a
questionnaire that consists of 7 questions and
4 categories. The questionnaire categories the
activities as mild, moderate, and vigorous -
intensity. For each category, duration
(minutes), frequency (days), and metabolic
equivalent (MET) values are multiplied
together to obtain a total score. In the
calculation of IPAQ-SF data, activity levels
are used as 3.3 MET for walking, 4.0 MET
for moderate to vigorous activity, and 8.0
MET for vigorous activity.9
The Young men's Christian Association
(YMCA) 3 minute step test is a useful and
easily administered assessment for measuring
aerobic capacity. A 30.50 cm (12 in) step,
stopwatch, and metronome (96 beats/min)
were used for this test. Each participant was
asked to step up and down (Up-Up-Down-
Down) with each beat of the metronome for 3
minutes. At the end of the test, the participant
immediately sat down, and the heart rate 5
seconds after sitting was measured for 1
minute.10
The Single-Limb Stance Test (SLST) was
used to evaluate the static balance of the
participants. Participants were asked to stand
on one leg for 60 seconds with their arms
crossed over their chests and the time they
could stay in this position was recorded with a
stopwatch. The test was applied 3 times for
both the right and left legs, with the eyes open
and closed. The test was terminated and the
average time obtained was recorded when the
participant lost his/her balance or touched
their foot on the ground/the ankle of their
stance limb.20
Functional Reach Test (FRT); the test was
performed to evaluate the dynamic balance of
The effect of pilates exercise on different health components. Zirek E, Analay Akbaba Y, Emir Gİ, Aslantürk A, Koyuncu M.
132
the participants in two directions: forward and
lateral. The participants were asked to stand
while their dominant sidearm closed but
without touching the wall. The shoulder was
in 90⁰ flexion, the elbow was in extension,
while the dorsal hand was facing the wall.
The tip of the 3rd finger was marked on the
wall, the participant asked to lie as far as
he/she could without lifting his/her heels.
The new location of the 3.th finger was
marked, the difference between the start and
endpoint was measured and scored.21
Data analysis
The statistical analysis of the study was
made by using the SPSS version 21.0 (SPSS
inc. Chicago, IL, USA) package program. In
the data set, variables were defined as percent
(%), mean and standard deviation (SD). The
Shapiro Wilk test was used to examine the
distribution of the data. The Chi-Square test
was used to compare the categorical variables.
Independent Sample t-Test was used to
evaluate independent data found by the
Normal distribution. Values below 0.05 were
considered statistically significant.
Results
A total of 169 participants were included in
the study, including 82 subjects who regularly
performed Reformer Pilates and 87 sedentary
individuals. All of the participants were
female. The mean age of the participants was
26.93±4.52 years in the Reformer Pilates
group and 24.67±4.70 years in the sedentary
group. BMI was 21.93±3.08 kg/m2 in the
individuals in the sedentary group and
22.34±3.44 kg/m2 in the Reformer Pilates
group.
In the comparison of the demographic
characteristics of the groups, there was no
statistically significant difference in terms of
age, BMI, marital status, and presence of
chronic disease (p>0.05). Smoking and
exercising habits were more in the Reformer
Pilates group (respectively: p=0.008;
p=0.038). The weekly exercise frequency of
the subjects in the Reformer Pilates group was
found to be 3.09± 0.83 days (Table 1).
Table 1. Comparison of the demographic and clinical characteristics of the groups.
Variables
Reformer Pilates
(n=82)
Sedentary (n=87)
p
Age (Mean ±SD) (year)
26.9±4.52
24.7±4.7
0.479*
BMI (Mean ±SD) (kg/m2
22.34±3.44
21.93±3.08
0.414*
Reformer Pilates Frequency (day/week)
(Mean ±SD)
3.09±0.83
-
Reformer Pilates Session Duration (Mean± SD)
50.95±1.16
-
Marital Status: n (%)
Married
30 (36.6)
25 (28.7)
0.549**
Single
51 (62.2)
61 (70.1)
Divorced
1 (1.2)
1 (1.1)
Smoking: n (%)
Yes
23 (28.0)
13 (14.9)
0.038**
No
59 (72.0)
74 (85.1)
Chronic Disease: n (%)
Yes
23 (28.0)
19 (21.8)
0.351**
No
59 (72.0)
68 (78.2)
Sports History: n (%)
Yes
41 (50)
26 (29.9)
0.008**
No
41 (50)
61 (70.1)
SD: Standard Deviation. BMI: Body Mass Index
* Independent Sample t-Test.
**: Chi-Square test.
p<0.05 significant.
The comparison of the body awareness
level, physical activity level, and aerobic
performance of the groups is shown in Table
2. A statistically significant difference was
found in the BAQ and IPAQ-SF mild level
activity scores in the Reformer Pilates group
(respectively: p<0.00; p=0.022). The
difference in the IPAQ-SF moderate and
vigorous levels and the IPAQ-SF total score
was not statistically significant (p>0.05). In
the sedentary group, heart rate change after
the YMCA 3 min Step Test was statistically
significantly higher (p=0.001).
Zirek E, Analay Akbaba Y, Emir Gİ, Aslantürk A, Koyuncu M. ADYÜ Sağlık Bilimleri Derg. 2021;7(2):129-135.
133
Table 2. Comparison of body awareness level, activity level and aerobic performance of groups.
Reformer Pilates (n=82)
(Mean± SD)
Sedentary (n=87)
(Mean± SD)
p*
BAQ
104.45±16.63
88.74±16.47
<0.001
IPAQ-SF Total
1916.12±1827.70
1815.03±1293.87
0.677
IPAQ-SF Mild
1347.72±1541.01
896.23±945.61
0.022
IPAQ-SF Moderate
405.61±506.65
361.71±657.87
0.627
IPAQ-SF Vigorous
353.29±173.25
333.10±130.28
0.395
HR after the YMCA 3MST
108.95±14.63
123.77±21.43
0.001
SD: Standard Deviation, BAQ: Body Awareness Questionnaire IPAQ-SF: International Physical Activity Questionnaire Short Form, YMCA 3MST:
Young Men’s Christian Association 3 Minute Step Test; HR: Heart Rate.
* Independent Sample t-Test.
p<0.05 significant.
The comparisons of the static and dynamic
balance scores of the groups are given in
Table 3. There was a statistically significant
difference in the eyes' closed SLST scores for
both limbs in the Reformer Pilates group
(p<0.001; p<0.001). The lateral FRT score
was significantly higher in the Reformer
Pilates group (p=0.003).
Table 3. Comparison of static and dynamic balance scores of groups.
Reformer Pilates (n
= 82)
(Mean ± SD)
Sedentary (n = 87)
(Mean ± SD)
p*
SLST; Eyes Open (sec)
Right
58.02±8.27
57.33±7.05
0.559
Left
57.30±10.09
56.75±8.07
0.695
SLST; Eyes Closed Balance (sec)
Right
38.93±21.52
26.67±18.29
<0.001
Left
37.63±21.97
23.84±18.49
<0.001
Functional Reach Test (cm)
Forward
36.92±7.09
34.88±6.93
0.61
Lateral
27.14±5.08
24.83±4.96
0.003
SD: Standard Deviation. SLST: Single-Limb Stance Test, sec: second, cm: centimeter.
* Independent Sample t-Test.
p<0.05 significant.
Discussion
This study investigated the effect of
Reformer Pilates on body awareness, physical
activity level, aerobic capacity, and balance in
young adults. According to the results, body
awareness, balance, and aerobic capacity were
found better in individuals who regularly
exercise Reformer Pilates compared to
sedentary individuals.
Adams M et al. aimed to investigate the
experiences of their students in a semester-
long Pilates mat class and the results showed
that Pilates increased postural awareness in
78% of the students and also supported both
mental and physical well-being.22 In a similar
study made by Atılgan et al., university
students that applied Pilates during a semester
showed improvement in body awareness and
flexibility scores.23 Although there was also a
control group in our study; similar to these
results, we found that individuals who
performed regular Reformer Pilates had better
body awareness scores.
Johnson E.G. et al. applied a 10-session
Pilates-based exercise program to healthy
individuals and a significant improvement
was found in dynamic balance.17 Erden A. et
al. reported that an 8-week Pilates program
had significant effects on the improvement of
dynamic and static balance in healthy adults.8
In a study made by Kloubec et al., 12 weeks
of Pilates were performed on young adults,
and the results showed significant
improvement in posture and balance.7 One of
the aims of our study was to evaluate the
effect of regular Pilates practice on balance
parameters. In our study, similar to the
literature, balance results were found
significantly better in individuals who have
regular exercise habits for 3 days a week for
at least two months.
Fernández et al. In a meta-analysis
conducted in 2019, it was stated that Pilates
increased aerobic performance regardless of
health status.6 Diamantoulla et al. compared
two different types of Pilates applications
(aquatic and ground), and similar
improvements were found in both groups in
terms of aerobic capacity, strength,
endurance, and balance, while the percentage
The effect of pilates exercise on different health components. Zirek E, Analay Akbaba Y, Emir Gİ, Aslantürk A, Koyuncu M.
134
of fat loss and the development of flexibility
was higher in the ground group. Rayes et al.
investigated the effects of Pilates on aerobic
capacity and reported a significant
improvement in aerobic capacity parameters
after an 8-week Pilates program in individuals
without regular exercise habits.12 In our study
where we also investigated the effect of
Pilates application on aerobic performance.
The results of our study were consistent with
the literature. Although the number of
smokers was higher in the Reformer Pilates
group, it was found that aerobic performance
and balance scores were better than sedentary
individuals.
In a systematic review made by Hornsby et
al in 2020, it was reported that Pilates
improve flexibility, strength, and postural
control in children and young adults while
minimizing muscle energy expenditure and
improving the level of physical activity.24
García-Soidán et al. stated that a 12-week
Pilates application is a method that increases
physical activity and is easy to access and
apply.25 In our study, we also investigated the
effect of Pilates on physical activity level.
The results showed that only mild-level
activity was higher in the Pilates group
compared to the sedentary group, while the
medium, vigorous, and general activity levels
were at a similar level in both groups. These
results showed that individuals who perform
Reformer Pilates can have higher levels of
body awareness, aerobic capacity, and
balance than sedentary individuals, even if the
activity intensity is similar.
A key strength of the present study is that
it represents a comprehensive examination of
the effect of Reformer Pilates on multiple
health-related components such as body
awareness, physical activity level, aerobic
capacity, and balance in healthy young adults.
Another strength of this study is the presence
of a control group. The limitation of our study
is the absence of long-term follow-up. Future
studies are recommended to include long-term
follow-up and compare different Reformer
Pilates applications with larger sample sizes.
Conclusion
Reformer Pilates is an effective method to
improve body awareness, aerobic capacity,
and balance. Especially when compared with
sedentary individuals, it has been found that
Reformer Pilates has a significant positive
effect. We think that recommending Reformer
Pilates as a component of preventive
rehabilitation will be beneficial in terms of
public health.
Ethics Committee Approval
The ethical approval of the study was
obtained from Istanbul University-
Cerrahpaşa, Faculty of Medicine, Non-
Invasive Clinical Research Ethics Committee
dated 17.07.2020 with decision number
60350273-605.99-91919. Our research was
conducted under the principles of the
Declaration of Helsinki.
Informed Consent
Informed consent was obtained from all
subjects. In addition, necessary approvals
were obtained from the centers where the data
was collected.
Authors’ Contributions
Study Concept / Design: Y.A.A., I.E, A.A.,
M.K.; Data collecting: I.E, A.A., M.K.; Data
analysis and interpretation: E.Z, Y.A.A.;
Literature Review: E.Z., Y.A.A., I.E, A.A.,
M.K; Writers: E.Z., Y.A.A., I.E, A.A., M.K.
The final version of this article was read and
approved by all authors.
Acknowledgments
We would like to thank our colleagues who
supported the data collection in the study and
the participants who voluntarily provided data
for the scientific study.
Conflict of Interest
The authors declare that there is no conflict
of interest
Financial Disclosure
There is no person/organization that
financially supports this study.
Statements
Some of the article data was presented as a
verbal presentation at the "International
Zirek E, Analay Akbaba Y, Emir Gİ, Aslantürk A, Koyuncu M. ADYÜ Sağlık Bilimleri Derg. 2021;7(2):129-135.
135
Congress of Medicine and Health Sciences"
congress made between April 26-28, 2021.
Peer-review
Externally peer-reviewed.
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