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Graeuling J.1, Maletzke S.1, Bungartz G.1, Bohlander A.2, Schulte-Frei B.1
1Fresenius University of Applied Sciences, Department of Health & Social, Cologne, Germany, 2Polestar GmbH, Cologne, Germany
Background: Chronic unspecific low back pain (LBP) is a substantial health problem affecting 67% - 84% of all adults in industrialized countries at some point in their lives. As the leading cause of activity limitation and work absence throughout much of the world, LBP accounts, in the US alone, for an estimated 149 million lost work days per year with a total estimated costs of US$ 100 to 200 billion. A recent review pointed out studies testing Pilates training to combat LBP, however, came to the conclusion that high quality evidence is lacking.
Purpose: This trial evaluated the effects of autonomous Pilates training on trunk muscle activity, well-being and chronic LBP intensity in affected patients.
Methods: Fifty-one participants were randomly allocated into an intervention- (n=27) and a control-group (n=24). The intervention group was instructed in a Pilates allegro reformer training and performed the exercises autonomously for eight weeks, 2x/week, 60 minutes/training. The control group received no treatment. Muscle activity was measured of M. obliquus int. (OI) and M. multifidus (MF) using surface electromyography (sEMG). The sEMG signals were calculated and displayed as a percentage of Maximum Voluntary Contraction (MVC). Pain intensity was assessed using the Oswestry disability index (OWD-I) and well-being by means of the WHO-5 Well-Being Index (WHO-5). All outcomes were measured in both study groups before the intervention and after the eight week period.
Results: Muscle activity of the OI muscle was increased significantly (p 0.05) after the Pilates intervention as compared to pre- exercise sEMG values (mean value differences). For MI muscle activity the majority of patients in the intervention group showed an improvement (76.9% vs. 50% in control group), however, mean value differences did not reach significance.
These improvements translated to a significant increase in well-being in the intervention group from 59.52% to 72.62% (mean score change of 13.08%; p 0.05). Pain intensity as assessed using the OWD-I decreased from 16.15% to 9,62% disability in the intervention group (mean score change of 6.53 %; p 0.05), with no changes in the control group, respectively. Cohen´s d values were calculated to measure the size of the clinical effect for each measure. Both indices revealed a large effect with d=0.83 for WHO Well-Being Index and d=0.76 for OWD-I.
Conclusion(s): This study demonstrates that an autonomous 8-week Pilates exercise program is well suited to relieve LBP and increase the overall well-being of people with LBP. Apart from these subjective outcome measures sEMG values substantiate that the improvements come with an increase in trunk muscle activity. Together these data provide novel evidence supporting the safety and efficacy of Pilates training to treat LBP.
Implications: Considering the prevalence of LBP and the accessibility and ease of use, Pilates exercise appears to be a valuable strategy for health care professionals to help patients suffering from LBP in a short term setting. Potential long term effects of this exercise regimen as well as benefits for LBP subgroups still have to be established.
Funding acknowledgements: Polestar GmbH supports during the training intervention.
Topic: Musculoskeletal: spine
Ethics approval: This study was approved by the ethics committee of Fresenius University of Applied Science, Idstein, Germany
All authors, affiliations and abstracts have been published as submitted.
