Pilates effect on balance and falls risk in older adults: a meta analysis

<p><strong>Background:</strong> Balance impairment is a key modifiable risk factor for falls. Therefore, balance exercises form a key component of falls prevention programs. This review aimed to investigate the effect of Pilates on balance and fall risk in older adults and whether programs tested in prior trials met best-practice recommendations for falls prevention exercises.</p> <p><strong>Methods:</strong> MEDLINE, SPORTDiscus, CINAHL, PubMed, The Physiotherapy Evidence Database and The Cochrane Library were searched from earliest record to February 2014 for randomized and controlled clinical trials evaluating the effect of Pilates on balance and fall outcomes in older adults (~60 years). The Physiotherapy Evidence Database (PEDro) scale was applied to assess the methodological quality of selected studies.</p> <p><strong>Results:</strong> The electronic search identified 304 potential trials. Of these, 6 met the inclusion criteria and were included in this review. Four studies were identified as low quality (PEDro score < 6). The meta-analysis indicated a large significant effect on balance (SMD 0.88, 95% Cl 0.46 to 1.29). One study included falls outcomes and reported a significant reduction in the number of falls for Pilates participants (F = 8.87, p < 0.05). Three trials provided sufficient detail on exercises to enable assessment of best-practice recommendation compliance. Of these trials, 2%, 20% and 46% of exercises provided a moderate to high challenge to balance. All trials provided ~2 hours of exercise per week and only one provided > 50 hours of exercise during the trial period.</p> <p><strong>Conclusion:</strong> Pilates appears to have a beneficial effect on balance in older adults, however there is limited data on the impact on fall risk. Effects may have been over-estimated due to a lack of high-quality trials. Best-practice recommendations were rarely applied in prior trials. Pilates programs in clinical practice and research should apply best-practice recommendations for falls prevention exercise.</p>