Effects of Pilates exercises on cardiorespiratory fitness: A systematic review and meta-analysis

Cardiorespiratory fitness (CRF) is recognized as an important marker of functional capacity and cardiovascular health, reflecting an individual's bodily function and overall health [1]. In order to develop this component of physical fitness, for healthy individuals, rhythmic and aerobic exercises are recommended (eg, walking, running, dancing, and cycling), performed ≥ 3–5 days a week, lasting between 20 and 60 min, and maintaining an intensity between 30% and 89% of reserve heart rate or reserve oxygen consumption, depending on the individual's fitness level [2]. However, more recent evidence has shown that resistance exercises (eg, weight training, elastic bands, springs), typically aimed at improving muscular fitness (strength, power, and muscular endurance), have the capacity to develop CRF [3,4]. Although there are aspects that supposedly potentiate CRF gain through resistance training, such as multi-joint exercises [3] and greater training volume [4], meta-analysis studies have shown that, in general, resistance training improves CRF in both young adults [5] and in older adults [6].

Although increases in CRF are not generally associated with resistance training, performing these exercises, especially at high intensities, seems to promote physiological adaptations similar to those observed in conventional aerobic training, such as an increase in mitochondrial enzymes, mitochondrial proliferation, conversion of type IIx muscle fibers into type IIa, and vascular remodeling. These adaptations provided by resistance training may not be enough to improve the CRF of people with a high level of training, such as athletes, however, they can benefit people targeting different aspects related to health [7].

A specific form of resistance training that needs to be further explored regarding its possible effects on CRF is Pilates exercise. The technique is becoming increasingly popular around the world. In the USA, for example, between 2011 and 2021, nearly 10 million practitioners were registered per year [8]. In Brazil, after Yoga, Gymnastics, and Stretching, Pilates is the sixth most practiced physical activity, ranking second when only people aged ≥60 years are considered [9]. The exercises can be performed using only a gym mat (mat Pilates) or with equipment specifically designed for the technique (Pilates on equipment). Initially, the technique was named Contrology, by its creator Joseph Hubertus Pilates, who defined it as the balance/coordination between body and mind in the execution of exercises, focusing on posture and breathing [10]. Pilates is therefore recognized as a “mind-body” exercise, involving the following basic principles for its performance: concentration, breathing, control, fluidity, precision, and centering [11]. In this sense, in general, the focus is on the quality of the movement, without the characteristics of a strenuous physical exercise modality. This is evident in the total energy expenditure during a Pilates session, which is relatively low, ranging from 64 to 213 kcal, depending on the protocol used [[12], [13], [14]].

Despite this, two systematic review studies and meta-analyses [15,16] observed that Pilates exercises are effective in improving CRF. However, one of the reviews [15] considered only mat Pilates exercises and the older adult population, with the meta-analysis involving only three studies, and thus restricting the discussion of the findings. The other review [16] included nine studies in the meta-analysis, but presented limitations that may have overestimated the effects of Pilates on CRF, since it considered: a) case series studies and non-randomized clinical trials; b) participants with comorbidities (heart failure, chronic stroke, and obesity) analyzed together with healthy participants; c) a clinical trial that combined Pilates with aerobic training, compared to a control group that maintained the usual routine.

In this sense, the current study seeks to remedy these limitations by performing a systematic search in the literature for randomized clinical trials (RCTs), with the objective of verifying the effects of Pilates exercises on CRF in healthy adults, considering the age group (young adults and older adults), form of Pilates application (mat or equipment), and exercise dose administered.

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