User:PhysiologyStudent-T

 This page is a university assignment that intends to critique the article: Pilates and aerobic training improve levels of depression, anxiety and quality of life in overweight and obese individuals 

What is the background to this research?[edit | edit source][edit | edit source]
This article looks into the association between exercise and improvements in quality of life and mental health. This article has been written as obesity has been linked to increase risk of morbidities that are associated with either a decreased life span or quality of life. Obesity has been linked to the development of phycological distress in young adults and has been known to carry over into adulthood and can influence poor physical activity and eating behaviours. These reduced PA and healthy eating behaviours can also be indicators of the onset or contribution to depression. Heightened anxiety levels have also linked to inflammatory responses in obese individuals which consequently increases the risk of insulin resistance which is associated with diabetes.

There are few studies that have been able to conclusively show the benefits or cause and effect relationship of Pilates regarding physical health improvements in a overweight or obese population due to the lack of randomized controlled trials. This article attempts to fill the gaps in knowledge by providing verification of the effects that Pilates has on the over-all physical and mental (anxiety, depression, quality of life) health of overweight/obese individuals.

Providing conclusive results of a cause and effect relationship, will provide health professionals with valuable knowledge on the applications Pilates can have in regards to training and exercise programming for an overweight/obese individual or population that can then be utilised to gain positive health outcomes. Discovering this is of importance as the low impact nature of Pilates may be very attractive for an overweight/obese individual thus influencing higher rates of participation as a result, therefore leading to reduced anxiety and depression levels and increasing overall quality of life for the individual/community.

Where is the research from?[edit | edit source][edit | edit source]
This research is from São Paulo, Brazil and has been funded by FAPESP who are a public foundation who have a mission to support research projects and research institutions in all felids of knowledge. Besides funding research, the FAPSEP organisation has also been known to support large research programs in Biodiversity, Bioenergy, Global Climate Change and E-Science. The application of the research in overweight/obese population is a necessary piece of information to share as it can be related to the overweight/obese population of other countries and nationalities and can teach health professionals about the conclusive benefits of Pilates, and can appropriately use it to create effective exercise programs. The Authors of this article collectively have specialisations and a range of masters/doctorates in the fields of Exercise physiology, Sports Medicine, Biomechanics, and Rheumatology. Vancini is known for working in the following specialties: Physical exercise and health, physical exercise and quality of life and exercise physiology applied to the clinic. Barbosa de Lira, has expertise in exercise testing, Exercise physiology, exercise science and sport biomechanics and is currently working on a project regarding the effects of various calisthenics methods on state anxiety as a randomised trail. Jacon Sarro has strong backgrounds in physiotherapy and biomechanics and has vast experience in biomechanics as it applies to human motion analysis in sport and rehabilitation. The collective knowledge of the 5 authors provides confidence that the article could display reputable results.

Due to the nature of funding and operation from FAPSEP, there is no perceived conflict of interest or bias viewed or declared in the article regarding this research.

What kind of research was this?[edit | edit source][edit | edit source]
The study that has been conducted is a Randomised Control Trial. A randomised control trial is characterised by the random allocation of participants to intervention groups under controlled conditions. Randomised control trials are proving to become a cost effective method of gaining high quality evidence of whether there is a relationship between an intervention and an outcome. This kind of research is also able to hold them selves within other research methods (eg, meta-analysis or systemic reviews) to help provide strong bases of evidence for such studies. When comparing these results to other papers, it can be seen that the level of evidence is in line with other studies. Articles written by Schuch et al and Su Yeon Roh, support the basis of exercise (particularly Pilates) being an effective means of reducing and/or mitigating depression and its symptoms. Other literature has also shown the positive effects of exercise on overall quality of life and has also shown the benefits of increased PA and its effective reduction in overall weight in individuals who have undergone a Pilates exercise program. Rayes et al has shown that a Pilates exercise intervention has resulted in participants gaining improvements in oxygen uptake, lean mass and reductions in overall fat mass showing that Pilates is an effective alternative training method for individuals or groups who are overweight or obese.

What did the research involve?[edit | edit source][edit | edit source]
All participants (n = 72) were initially assessed to determine whether they met the inclusion criteria (BMI ≥25, at least 6 months of no PA, and no history of disease except obesity) and were then allocated into a control group (n = 20), Walking group (n = 21), and a Pilates group (n = 22). The participants were provided with 8 weeks of treatment 3 days per week on non-consecutive days lasting 1 hour per session. The study was organized into 3 phases, the pre-intervention, treatment period and post intervention. In the 3 days pre and post treatment intervention (control/walking/Pilates) all participants were evaluated on their anthropometry and Cardiopulmonary exercise test (CPET). In the 2 days pre and post treatment intervention, participants were also evaluated on their quality of life, anxiety and depression using the SF-36 questionnaire, IDATE and Beck Depression Inventory.
 * Provide a lay summary of what the participants did in the study?

The approach of conducting a randomised control trial has been able to allow the article to provide us with robust research and results that show a cause and effect relation ship between the intervention groups and the desired outcomes of the trial. As a result of a randomised control trial being one of the most rigorous study methods of ascertaining the effectiveness of an intervention, it can be viewed as one of the best approaches to take when assessing interventions.

Limitations of this randomised control trial is the subjectivity of the questionnaires that were used to assess quality of life, anxiety and depression and anxiety, leading to a potential loss in accuracy due to any under/over reporting of results by the participants. The mean participant age for the Pilates group was quite high compared to both the walking and control groups. Base values for participants were high at the beginning of the intervention leading to a small amount of significant differences at small time points.

What were the basic results?[edit | edit source][edit | edit source]
It was found that both walking and Pilates had positive effects on the quality of life, depression and anxiety domains that were being assessed. When comparing the walking and Pilates group results to that of the control group, it can be seen that the vitality domain showed 25.8% lower scores in the walking group than the control group. The Pilates group improved their own scores by 28% through out their intervention (47.4 ± 22.7 before vs 65.9 ± 18.7 after), the social functioning of both the waking group and the Pilates group increased by 20.3% and 29.2% respectively. The Pilates group showed a strong increase in the quality of life domains with score increases of 40.8% (46 ± 40 vs 77.8 ± 15.3), Mental health scores were shown to increase on both the waking (21.8%) and Pilates group (19%) compared to the control group. Depression had a significant decline in both the walking and Pilates group by 35.2% and 27.5% respectively. Anxiety was also shown to have diminished levels of 15.1% (walking group) and 14.1% (Pilates group) following the training interventions.

The results have shown that there are positive implications of PA regarding its effects on quality of life, anxiety and depression in overweight/obese individuals. This is important as an increase in the quality of life experienced by an individual or group that is associated with PA can be an effective motivator for the continued or even increases in future PA levels. Understanding these findings is important as exercise and health specialists can understand the implications and application of adding Pilates into a individualised or community based exercise program, as the low-impact method of resistance that is applied through Pilates reduces any perceived barrier to exercise that may be attributed to any weight bearing or locomotion difficulties caused by obesity.

What conclusions can we take from this research?[edit | edit source][edit | edit source]
The conclusions that can be viewed in this particular article, is that both walking and Pilates have positive associations with improvements in both mental and physical health domains as well as having positive impacts on quality of life scores. Both the walking and Pilates groups were viewed to have lower results (low depression and anxiety) in all assessed criteria post intervention compared to the control group, showing that either walking, Pilates or a mixture of both are viable options of exercise prescription for an overweight/obese individual or population. Given that the results of this article align with other research, and that the method of research used has been shown to be a strong indicator of the effectiveness of desired interventions, it is fair to state that this article and its findings are strong and conclusive in regards to what it is trying to achieve. However, the effects of Pilates are somewhat over stated as the article aims to assess the effects of both walking and Pilates, however the implications and mechanisms of Pilates are far more dominant than that of walking in this article. Further research is warranted regarding Pilates and its relations to positive health outcomes, as the research is limited in this respect, hence why there may have been such a large emphasis on its results during this randomised controlled trial.

Practical advice[edit | edit source][edit | edit source]
Pilates is an effective exercise option to utilise in regards to seeking improvements in either psychological domains or physical domains as the research indicates it has positive correlations with positive changes in both the reduction of adverse mental health symptoms and therefore improved quality of life, but it also is an effective tool when utilised for the purposes of weight reduction and lean mass accumulation. Seeking the advise of a health professional or a Pilates instructor to conduct or implement a Pilates program is recommended, as exercising in a controlled environment can ensure that appropriate progression/regression models are used in regards to exercise intensity.

Providing accessible exercise that is low-impact and puts less strain on the joints can be a motivator in Pilates participation and the promotion of mental health and reduction in fat mass can be intrinsic motivators for the participant once the exercise regime has been conducted. It would be wise to implement Pilates in a clinical or group exercise setting as it will offer the additions of core stability, flexibility, posture and breathing along with the already mentioned benefits of this study.

Further information/resources[edit | edit source][edit | edit source]
Listed are the links to articles, companies and organisations who use Pilates as a form or PA when working with overweight/obese individuals that may provide further insight as further readings.

https://www.hfe.co.uk/blog/adapting-pilates-for-obesity/

https://theteaser.peakpilates.com/pilates-for-the-overweight/

https://healthfitness.clubconnect.com/fitness-library/pilates-for-the-overweight-client

References[edit | edit source][edit | edit source]
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