Results
Six of the 309 identified study reports met the criteria for inclusion in the review. Five of these were RCTs and one was a controlled clinical trial. Overall, a high risk of bias was identified across most of the included studies. Common problems included lack of blinding of participants, assessors and therapists; lack of reporting of allocation concealment; no reporting of intention-to-treat analysis; and no inclusion of a placebo group delivery intervention for control group participants.
A significant pooled effect of pilates on balance (SMD=0.84; 95% CI 0.44 to 1.23) was observed but significant heterogeneity was detected (I2=61%). Consistent effects were seen across dynamic (SMD=0.62; 95% CI 0.15 to 1.08), static (SMD=1.21; 95% CI 0.66 to 1.77) and combined static and dynamic (SMD=1.25; 95% CI 0.66 to 1.85) balance outcomes (test for subgroup differences, p=0.15).
Only one study (n=60) reported data on falls. The results revealed a significant reduction in the number of falls in the pilates intervention participants (preintervention, 1.87; postintervention, 0.37) compared with the control group participants (preintervention, 1.63; postintervention, 1.30) during the 12-week follow-up period (SMD=2.03; 95% CI −2.66 to −1.40).
Programme duration ranged from 5 to 24 weeks and all studies provided exercise sessions of ≥2 hours per week. Only one study provided >50 hours of exercise during the study period. Three studies provided enough data to enable assessment of compliance with best practice recommendations of exercises providing a moderate or high challenge to balance. Among these studies, 2–36% of exercises were assessed as providing a moderate or high challenge to balance.
Considerations/limitations
The results of this meta-analysis reveal that pilates can be considered as an effective form of exercise to improve balance in older adults. However, the findings should be interpreted with caution due to the high heterogeneity (I2=61%) associated with balance outcomes, the high risk of bias in the included studies and the small sample sizes in all included studies (30–60 participants). Further well-designed RCTs that address these flaws are needed to progress the quality of work in this field.
Clinical implications
This meta-analysis suggests that pilates may be effective for improving balance among older adults. However, given the limitations found in this review, further high-quality studies are required to provide robust evidence regarding the effect of pilates on balance and falls among the older population.
Footnotes
Competing interests None declared.