Clinical Pilates Can Improve Cognitive Function, Quality of Life in People with MS
Symptoms of MS can include fatigue, weakness, impaired posture, and difficulties with movement and cognition. Symptomatic treatment of MS often combines medication, rehabilitation, exercise, nutrition, or mind-body techniques and complementary medicine.
Exercise is a frequently used treatment that has demonstrated significant improvements in muscle strength, exercise tolerance, and mobility in studies of people with MS. But the majority of these studies have focused on strengthening and aerobic exercises, not on exercises that improve core stability. Yoga and clinical Pilates are two mind-body techniques that do focus on core stability.
What is clinical Pilates?
Clinical Pilates is an effective form of exercise that focuses on strengthening the core postural muscles that provide stability to the spine and body. A stable core is important for maintaining functional independence in people with MS, and clinical Pilates focuses extensively on improving trunk stability.
Strong trunk muscles assist with activities and movements such as rotation, sitting up from a supine position, and standing up from a seated position. Studies involving healthy persons reveal that clinical Pilates is effective in improving flexibility, dynamic balance, and muscular endurance. However, it has not been extensively studied in people with MS.
How does clinical Pilates differ from regular Pilates?
Regular Pilates is conducted by a Pilates instructor, while clinical Pilates is prescribed and supervised by a specially trained physiotherapist or exercise physiologist. This expert has a deeper understanding of movement patterns, body functions, injury prevention, and healing. The specialist is able to assess each patient and determine what exercises would be most effective for the individual.
How does clinical Pilates benefit MS?
In a recent eight-week study, researchers investigated the rate of benefit of clinical Pilates in terms of cognition, disability, balance, coordination, mobility, physical performance, fatigue, depression, and quality of life in 20 people with MS.
Participants were randomly assigned to two groups: the clinical Pilates group (n=11) and the control group (n=9) engaged in a traditional exercise program. Pilates exercises were started with closed-chain exercises (where the hand or foot is always in contact with something) and advanced to open-chain exercises with increasing difficulty.
In comparing the before- and after-effects of Pilates and traditional exercises, researchers found statistically significant differences in the clinical Pilates group in terms of balance, physical performance, fatigue, and cognitive function. However, the control group also showed statistically significant differences in physical performance, and hand dexterity before and after the intervention.
In additional to physical performance tests to evaluate major muscle groups and the ability to perform ADLs, researchers employed the Trunk Impairment Scale (TIS), a tool used primarily in stroke patients but also in those with MS. However, no meaningful changes were seen in TIS evaluations in the patients who participated in this study. That may be due to the short length of the study and small number of participants. Authors suggest that future studies should include more cases and have longer training periods to detect more meaningful changes.
Improvements in cognition and quality of life**"¨**
In comparing the benefits between the two forms of exercise, researchers found statistically significant differences in cognitive function and quality of life in favor of the clinical Pilates group. Cognitive impairment affects up to 70 percent of people living with MS and with prevalence of 40-65 percent at any given time. Cognitive impairment can lead to reduced quality of life and interfere with employment and enjoyment of social activities. Treatment of cognitive issues can include disease-modifying therapy, treatment of MS symptoms, and cognitive rehabilitation.
While prior studies have investigated the effects of clinical Pilates training on balance, mobility, and muscle strength in MS patients, this is the first study to demonstrate positive changes in cognitive performance in MS patients following an eight-week trial of clinical Pilates. Pilates may prove to be a form of exercise which is not only good for the body but for the mind as well for people living with MS.
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Küçük F, Kara B, Poyraz EÇ, Idiman E. Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial. J Phys Ther Sci. 2016 Mar;28(3):761-8. doi: 10.1589/jpts.28.761. Epub 2016 Mar 31.