The effects of pilates on symptoms of anxiety, depression, and fatigue among people with multiple sclerosis

This programme of research investigated the effects of Pilates on symptoms of anxiety, depression, and fatigue among persons with Multiple Sclerosis (PwMS). Evidence supports mental health benefits of traditional exercise modes among otherwise healthy adults, chronically ill patients and adults with anxiety and depressive disorders. However, a paucity of evidence exists on the benefits of non-traditional modes, including Pilates. 

Thus, a meta-analysis was conducted to estimate the overall population effect of Pilates on mental health outcomes, among healthy and chronically ill populations. Random-effects meta-analysis of the available empirical evidence from controlled trials showed significantly reduced anxiety symptoms (Δ=1.29; 95%CI: 0.24-2.33; p≤0.02), depressive symptoms ∆=1.27; 95%CI: 0.44-2.09; p≤0.003), and feelings of fatigue (∆=0.93; 95%CI: 0.21-1.66, p≤0.012), however, no trial involved PwMS.

To address this research gap, an eight-week randomized controlled pilot trial examined the feasibility of Pilates to improve symptoms of anxiety, depression, and fatigue among PwMS, and underpin prospective research and development of a larger randomized controlled trial (RCT). Results revealed full compliance, no attrition or reported adverse events, hence establishing feasibility and proof-of-concept of home-based Pilates to improve mental health outcomes among women with MS with minimal-to-mild mobility disability.

Qualitative analysis of participant experiences of the feasibility study supported Pilates, particularly home-based, as a safe, intensity-appropriate, and implementable exercise method that improved perceived and measured mental health outcomes among PwMS. This critically informed protocol design, and implementation of an adequately powered RCT of home-based Pilates on symptoms of anxiety, depression, and fatigue among PwMS.

In the RCT intention-to-treat and completer analyses showed significant (all p⩽0.03), moderate-to-large improvements in symptoms of anxiety (State-Trait Anxiety Inventory, d=0.30; Hospital Anxiety and Depression Scale-Anxiety, d=0.49), depression (Quick Inventory of Depressive Symptomatology, d=0.70; Hospital Anxiety and Depression Scale-Depression, d=0.74), and fatigue (cognitive (d=0.44), physical (d=0.78), psychosocial (d=0.56) and total fatigue (d=0.76), including clinically meaningful improvements in depression and fatigue. These novel findings provide an original and significant contribution to knowledge, supporting home-based Pilates as an alternative low-impact exercise modality to improve mental health among PwMS.