Pilates and improvement of balance and posture in older adults: A meta-analysis with focus on potential moderators

Abstract

• Pilates training improves balance in older adults, but changes seem to be more consistent in dynamic than static balance. • Favorable adaptations in posture are less convincing due to the limited quantity of trials producing significant effect sizes. • Study quality moderated the effects on dynamic balance, with greater effect sizes reported by poorer quality trials. • Greater training volumes (duration x number of sessions) produced higher effect sizes for changes in dynamic balance and posture. The moderators of Pilates training on balance and posture in older individuals are unclear. We investigated through meta-analysis the effectiveness of Pilates to improve the balance and posture of older individuals and examine potential moderators of those effects. Electronic databases were searched by multiple reviewers until September 30th, 2021 to locate articles published in English, Spanish or Portuguese. Qualifying trials included adults aged ≥60 y and measured static/dynamic balance or posture pre-post intervention. Data on study design, sample characteristics, and features of Pilates interventions were tested as moderators of balance and posture outcomes. Twenty-seven trials included 1,017 individuals (69.2±4.7 y). Overall, sessions of 58.2±8.6 min were performed 2.1±0.5 d/wk for 12.3±9.7 wk. Information on loads was often imprecise. The effect sizes (ES) in controlled vs. uncontrolled trials were: static balance ( k =13, ES 0.270, 95% confidence interval [CI] 0.182-0.358 vs. k =4, ES 0.284, CI 0.155-0.413); dynamic balance ( k =14, ES 0.714, CI 0.428-1.000 vs. k =4, ES 0.648, CI (-0.008-1.303); posture ( k =2; ES 0.311, CI -0.106-0.729 vs. k =5, ES 0.349, CI 0.240-0.458). Trials with lower methodological quality as reflected by the median of TESTEX inventory produced greater ES for dynamic balance (ES 0.928 vs. 0.523; p<0.05). Greater training volumes (duration x number of sessions) increased ES of dynamic balance (ES 0.743 vs. 0.715) and posture (ES 0.422 vs. 0.176), the opposite occurring for static balance (ES 0.237 vs. 0.405) (p<0.05). Pilates seems to improve static and dynamic balance in older adults, while data on posture are less convincing. Poor study quality may overestimate the effects on dynamic balance. Greater training volumes appear to favor improvements in dynamic balance and posture.