Introduction and hypothesis
The objective was to describe the intra-abdominal pressures (IAP) generated during Pilates Mat and Reformer activities, and determine whether these activities generate IAP above a sit-to-stand threshold.
Twenty healthy women with no symptomatic vaginal bulge, median age 43 (range 22–59 years), completed Pilates Mat and Reformer exercise routines each consisting of 11 exercises. IAP was collected by an intra-vaginal pressure transducer, transmitted wirelessly to a base station, and analyzed for maximal and area under the curve (AUC) IAP.
There were no statistically significant differences in the mean maximal IAP between sit-to-stand and any of the Mat or Reformer exercises in the study population. Six to twenty-five percent of participants exceeded their individual mean maximal IAP sit-to-stand thresholds for 10 of the 22 exercises. When measuring AUC from 0 cm H2O, half the exercises exceeded the mean AUC of sit-to-stand, but only Pilates Reformer and Mat roll-ups exceeded the mean AUC of sit-to-stand when calculated from a threshold of 40 cm H2O (consistent with, for example, walking).
Our results support recommending this series of introductory Pilates exercises, including five Mat exercises and six Reformer exercises to women desiring a low IAP exercise routine. More research is needed to determine the long-term effects of Pilates exercise on post-surgical exercise rehabilitation and pelvic floor health.
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Nygaard I, Barber MD, Burgio KL et al (2008) Prevalence of symptomatic pelvic floor disorders in US women. J Am Med Assoc 300:1311–1316
Boyles S (2003) Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol 188:108–115. doi:10.1067/mob.2003.101
Boyles SH, Weber AM, Meyn L (2003) Procedures for urinary incontinence in the United States, 1979–1997. Am J Obstet Gynecol 189:70–75. doi:10.1067/mob.2003.376
Olsen AL, Smith VJ, Bergstrom JU et al (1997) Incidence and clinical characteristics of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506
Weir LF, Nygaard IE, Wilken J et al (2006) Postoperative activity restrictions: any evidence? Obstet Gynecol 107:305
Guttormson R, Tschirhart J, Boysen D, Martinson K (2008) Are postoperative activity restrictions evidence-based? Am J Surg 195:401–404
FitzGerald MP, Shisler S, Shott S, Brubaker L (2001) Physical limitations after gynecologic surgery. Female Pelvic Med Reconstr Surg 7:136–139
Ottesen M, Møller C, Kehlet H, Ottesen B (2008) Substantial variability in postoperative treatment, and convalescence recommendations following vaginal repair. Acta Obstet Gynecol Scand 80:1062–1068
Coleman TJ, Thomsen JC, Maass SD et al (2012) Development of a wireless intra-vaginal transducer for monitoring intra-abdominal pressure in women. Biomed Microdevices 4:347–355
Hsu Y, Coleman TJ, Hitchcock RW et al (2012) Clinical evaluation of a wireless intra-vaginal pressure transducer. Int Urogynecol J 23:1741–1747
Pilates Method Alliance (2014) Available at: http://www.pilatesmethodalliance.org. Accessed 9 October 2014
Latey P (2001) The Pilates method: history and philosophy. J Bodyw Mov Ther 5:275–282
Levine B, Kaplanek B, Jaffe WL (2009) Pilates training for use in rehabilitation after total hip and knee arthroplasty: a preliminary report. Clin Orthop Relat Res 467:1468–1475. doi:10.1007/s11999-009-0779-9
Cozen DM (2000) Use of Pilates in foot and ankle rehabilitation. Sports Med Arthrosc Review 8:395–403
Bryan M, Hawson S (2003) The benefits of Pilates exercise in orthopaedic rehabilitation. Tech Orthop 18:126–129
Johnson EG, Larsen A, Ozawa H et al (2007) The effects of Pilates-based exercise on dynamic balance in healthy adults. J Bodyw Mov Ther 11:238–242
Kloubec JA (2010) Pilates for improvement of muscle endurance, flexibility, balance, and posture. J Strength Cond Res 24:661–667
Culligan PJ, Scherer J, Dyer K et al (2010) A randomized clinical trial comparing pelvic floor muscle training to a Pilates exercise program for improving pelvic muscle strength. Int Urogynecol J 21:401–408
Pate RR, Pratt M, Blair SN et al (1995) Physical activity and public health. J Am Med Assoc 273:402–407
Shaw JM, Hamad NM, Coleman TJ et al (2014) Intra-abdominal pressures during activity in women using an intra-vaginal pressure transducer. J Sports Sci 32:1176–1185
Thomas S, Reading J, Shephard RJ (1992) Revision of the physical activity readiness questionnaire (PAR-Q). Can J Sport Sci 17:338–345
Isacowitz R (2006) Pilates: your complete guide to mat work and apparatus exercises. Human Kinetics, Champaign, IL
Hamad N, Shaw J, Nygaard I et al (2013) More complicated than it looks: the vagaries of calculating intra-abdominal pressure. J Strength Cond Res 27:3204–3215
Coleman TJ, Hamad NM, Shaw JM et al (2014) The effects of walking speeds and carrying techniques on intra-abdominal pressure in women. Int Urogynecol J. doi:10.1007/s00192-014-2593-5
Lilliefors HW (1967) On the Kolmogorov-Smirnov test for normality with mean and variance unknown. J Am Stat Assoc 62:399–402
Bø K, Bratland-Sanda S, Sundgot-Borgen J (2011) Urinary incontinence among group fitness instructors including yoga and Pilates teachers. Neurourol Urodyn 30:370–373
Addington WR, Stephens RE, Phelipa MM et al (2008) Intra-abdominal pressures during voluntary and reflex cough. Cough 4:2. doi:10.1186/1745-9974-4-2
Pruessner JC, Kirschbaum C, Meinlschmid G, Hellhammer DH (2003) Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology 28:916–931. doi:10.1016/S0306-4530(02)00108-7
Hagins M, Pietrek M, Sheikhzadeh A et al (2004) The effects of breath control on intra-abdominal pressure during lifting tasks. Spine 29:464
Dolan LM, Dixon WE, Brown K et al (2005) Randomized comparison of vaginal and rectal measurement of intra-abdominal pressure during subtracted dual-channel cystometry. Urology 65:1059–1063
Rosenbluth EM, Johnson PJ, Hitchcock RW, Nygaard IE (2010) Development and testing of a vaginal pressure sensor to measure intra-abdominal pressure in women. Neurourol Urodyn 29:532–535. doi:10.1002/nau.20794
Lewis Wall L, Hewitt JK, Helms MJ (1995) Are vaginal and rectal pressures equivalent approximations of one another for the purpose of performing subtracted cystometry? Obstet Gynecol 85:488–493
Junginger B, Baessler K, Sapsford R et al (2003) Interaction between bladder neck elevation, intra-abdominal pressure and activity of the pelvic floor and abdominal muscles during abdominal and pelvic floor manoeuvres. Int Urogynecol J 21:69–77
Ottesen M, Sorensen M, Kehlet H, Ottesen B (2003) Short convalescence after vaginal prolapse surgery. Acta Obstet Gynecol Scand 82:359–366
We would like to thank Pinnacle Performance for their use of the facility and equipment. We would also like to thank Sarah Holdsworth and Shauna North for their assistance in conducting the exercise protocol and Johanna de Gennaro for her help building the sensors that were used in this study.
The project described was supported by grant number R01HD061787-01 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Its content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflicts of interest
Tanner J. Coleman: project development, exercise protocol development, data collection, data analysis, data interpretation, manuscript writing; Ingrid E. Nygaard: project development, data interpretation, manuscript writing/editing; Dannielle N. Holder: project development, exercise protocol development, data collection, manuscript editing; Marlene J. Egger: data analysis, manuscript editing; Robert Hitchcock: project development, manuscript editing.
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Coleman, T.J., Nygaard, I.E., Holder, D.N. et al. Intra-abdominal pressure during Pilates: unlikely to cause pelvic floor harm. Int Urogynecol J 26, 1123–1130 (2015). https://doi.org/10.1007/s00192-015-2638-4
- Activity restrictions
- Intra-abdominal pressure
- Pelvic floor disorder
- Post-surgical exercise