Pilates vs Alternative Exercise on Cognition and Respiratory Function in Patients with Multiple Sclerosis: A Systematic Review and Meta-Analysis

Abstract

Background People with Multiple Sclerosis (PwMS) report a variety of cognitive and motor dysfunctions that may improve with exercise. Pilates exercises have improved physical function and quality of life in many populations, including PwMS. Pilates' mind-body training principles and breathing techniques may also improve cognition and respiratory function, but evidence is lacking. Purpose Examine evidence of the effects of Pilates compared to alternative exercise on cognition and respiratory function in PwMS. Methods Two reviewers independently searched PubMed, CINAHL, and SportDiscus through January 2023 for intervention studies comparing the effects of Pilates and alternative exercise for PwMS. Studies were included if participants were adults, had Expanded Disability Status Scale score of ≤6, and cognition or respiratory function were assessed. Means and SDs for both outcomes were extracted. Effect sizes (ES) and 95% confidence intervals (CI) were calculated within and between groups. ES were combined across studies using random effects models when the Q heterogeneity statistic was significant and fixed effect models otherwise. Results Four studies of low to moderate quality met inclusion criteria. Cognition was assessed through the Paced Auditory Serial Addition Test, or Brief International Cognitive Assessment of MS. Respiratory function was assessed through Maximal Inspiratory Pressure and Maximal Expiratory Pressure. Meta-analyses revealed Pilates had a statistically significant effect within-groups on cognition [ES = 0.63 (0.22 – 1.04)] and respiratory function [ES = 0.53 (0.03 – 1.03)], and between-groups [ES = 0.68 (0.34 – 1.02)] on cognition. Data were insufficient to analyze respiratory function between groups. Discussion Pilates moderately improves cognition and respiratory function from pre- to post-intervention and is superior to alternative interventions in improving cognition. Limitations of this study included small sample size and overlapping research groups potentially affecting generalizability and potential for bias. Further research is needed to support Pilates as an effective tool to manage multiple impairments in PwMS. People with Multiple Sclerosis (PwMS) report a variety of cognitive and motor dysfunctions that may improve with exercise. Pilates exercises have improved physical function and quality of life in many populations, including PwMS. Pilates' mind-body training principles and breathing techniques may also improve cognition and respiratory function, but evidence is lacking. Examine evidence of the effects of Pilates compared to alternative exercise on cognition and respiratory function in PwMS. Two reviewers independently searched PubMed, CINAHL, and SportDiscus through January 2023 for intervention studies comparing the effects of Pilates and alternative exercise for PwMS. Studies were included if participants were adults, had Expanded Disability Status Scale score of ≤6, and cognition or respiratory function were assessed. Means and SDs for both outcomes were extracted. Effect sizes (ES) and 95% confidence intervals (CI) were calculated within and between groups. ES were combined across studies using random effects models when the Q heterogeneity statistic was significant and fixed effect models otherwise. Four studies of low to moderate quality met inclusion criteria. Cognition was assessed through the Paced Auditory Serial Addition Test, or Brief International Cognitive Assessment of MS. Respiratory function was assessed through Maximal Inspiratory Pressure and Maximal Expiratory Pressure. Meta-analyses revealed Pilates had a statistically significant effect within-groups on cognition [ES = 0.63 (0.22 – 1.04)] and respiratory function [ES = 0.53 (0.03 – 1.03)], and between-groups [ES = 0.68 (0.34 – 1.02)] on cognition. Data were insufficient to analyze respiratory function between groups. Pilates moderately improves cognition and respiratory function from pre- to post-intervention and is superior to alternative interventions in improving cognition. Limitations of this study included small sample size and overlapping research groups potentially affecting generalizability and potential for bias. Further research is needed to support Pilates as an effective tool to manage multiple impairments in PwMS.