Pilates Training on Pulmonary and Endurance Function in Female Patients with Multiple Sclerosis

Multiple Sclerosis as a neurodegenerative disease by affecting motor neurons could cause decrease muscle strength, endurance, and physical performance. Respiratory muscle weakness could occur in the early phase of the disease, and its complications appear in the advanced phase—this phenomenon as an essential factor, which could influence Pulmonary Functional Capacity. Pilates exercise as a rehabilitation program by focusing on muscle control, strength, core stability, flexibility, posture, and breathing is recommended to multiple sclerosis patients. This research aimed to investigate the effect of Pilates training on Pulmonary Function and Endurance Function in female patients with Multiple Sclerosis.

This study employed two groups with pre–test and post–test as quasi–experimental research design. The subjects were the female multiple sclerosis patients who were registered in Gholdasht Multiple Sclerosis Center of Najafabad–Isfahan. The participants were 40 female multiple sclerosis patients (age= 33.08±8.88 yrs., BMI= 22.20±4.92 Kg/m–2) with Relapsing Remitting and Expanded Disability Status Score 2–6. They were selected by purposive sampling and randomly divided to equal Pilates and Control groups. During the study, five subjects (Pilates=2, Control=3) were excluded from the study. The Pilates group subjects participated in exercise training 3d/week for eight–week. Each session began with a seven–minute warm–up. The main exercise training continued for 30–40 minutes. The main exercises included Hundred, Roll–Up, Roll–Down, and Single Leg Circle movements, and ended with a seven–minute as the cool–down. The intensity of the protocol adjusted to increase. In the first month, one to two sets and in the second month, two to three sets of repetitions (which started with three to four repetitions and gradually increased to reach up to 10) of movements were done. Movements consisted of 10 seconds exercise, 10 seconds rest, 30 seconds rest between each movement, and 60 seconds rest between each set. The Control groups had their usual lifestyle. Respiratory volumes and Peak oxygen uptake were measured before and after the protocol by using MIR SPIROLAB III made by Italy and Six Minutes Walking Distance Test, respectively. Forced Vital Capacity, Forced Expiratory Volume in the first second, Forced Expiratory Flow rate 25–75%, Peak Expiratory Flow rate, Maximal Voluntary Ventilation were measured, and Peak oxygen uptake was predicted by using the equation “Peak oxygen uptake (ml/kg×min)=4.948+[0.023×mean Six Minutes Walking Distance (meter)]” before and after the protocol. Descriptive analysis was adopted for demographic and clinical characteristics and are reported as mean± standard deviation. Kolmogorov–Smirnov test was used for determination of normality of the distribution, and Levene᾿s test was used to show homogeneity of variance between two–groups before the start of the protocol. The differences among groups were assessed by using analysis of covariance (ANCOVA) test to compare post–tests by considering covariates pre–tests (p< 0.05).

Eight–week Pilates training showed significant increase in Forced Vital Capacity (F=8.44 , p=0.008) (4.19%), Forced Expiratory Volume in the first second (F=6.23, p=0.020) (13.48%), Forced Expiratory Flow rate 25–75% (F=7.82, p=0.011) (11.00%), Peak Expiratory Flow rate (F= 5.95, p= 0.023 ) (13.16%), Maximal Voluntary Ventilation (F=6.10, p=0.022) (18.56%), and Peak oxygen uptake (F=12.99, p=0.002) (5.20%) variables, while there was no significant change in Forced Expiratory Volume / Forced Vital Capacity.

Pilates exercise as a rehabilitation program for these patients can improve some of the parameters related to pulmonary volumes, pulmonary capacities, and Endurance Function. The Endurance Function decreases in multiple sclerosis ambulatory patients and could evaluate easily by using field tests such as Six Minutes Walking Distance Test. Endurance Function has a relationship with Pulmonary Function, so Pulmonary Function could be managed indirectly by improving physical fitness and Endurance Function following exercises such as Pilates.