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Pilates COREterly

Fall 2012

Teaching & Learning

The Importance of Industry Research

Sherri R. Betz, PT, GCS, CEEAA, PMA®-CPT
Chair, PMA Research Committee
Vice-President, Polestar Pilates Education

Why is research important to the Pilates industry and why is this initiative rising now?

Since Pilates is no longer the novel approach to exercise and has become more mainstream, the industry needs to differentiate itself from other fitness methods in order to remain a viable and credible exercise approach. Pilates has reached its peak in popularity and has begun to decline in the fitness industry. Studio owners can no longer just open their doors and expect a flood of clients to walk in the door. We have to work hard at marketing and educating the public to understand that Pilates is not a passé fad. Research is a way to create this credible public perception.

However, in order to be a credible choice in the evidence-based medical rehabilitation community, the Pilates community needs to invest in research. Pilates should not depend on anecdotal evidence to support its claims. Pilates needs to be compared against other forms of exercise in randomized clinical trials with large numbers of subjects in order to be taken seriously by evidence-based medical practitioners. Many practitioners make claims as to what Pilates can do for certain conditions, but how do they know that it is the Pilates method that is actually making that difference? The difference in the client’s outcome could be that the instructor’s expertise and intention changed the client’s perception of himself or herself or that ANY exercise that a client began after being sedentary improved their strength, flexibility, posture, balance or decreased their pain. If we don't compare Pilates side by side with other forms of exercise, controlling for as many variables as possible, we will never know if it is really Pilates that made the difference.

Have we even defined what Pilates is for our industry and in medical literature?

In her 5 year doctoral research, Polestar Pilates educator, Lise Stolze, MPT, CSCS, PMA®-CPT, had difficulty establishing a definition of Pilates for the medical literature while working with the Journal of Orthopedic & Sports Physical Therapy editors. There really has never been a clear definition of Pilates established in current published research. Dr. Stolze polled many practitioners and consulted the PMA Board members to help define Pilates. She used the word Pilates-based to define the method in her study. Dr. Stolze, et al. has published one of the highest levels of research on Pilates in her May 2012 paper, “Derivation of a Preliminary Clinical Prediction Rule for Identifying a Subgroup of Patients With Low Back Pain Likely to Benefit From Pilates-Based Exercise.” She worked with renowned researcher, Dr. John Childs, who has been instrumental in establishing Clinical Prediction Rules for many pathologies treated in the field of physical therapy practice. The objective of the study was to derive a preliminary clinical prediction rule for identifying a subgroup of patients with low back pain (LBP) likely to benefit from Pilates-based exercise.

What kind of research are we talking about? Are the research initiatives for each of the main Pilates markets (rehab, studios, commercial fitness)?

Research can be conducted case-by-case, in small groups or in large groups. Brent Anderson, PhD, PT, OCS, PMA®-CPT’s doctoral research involved comparing small groups of subjects (n=10) each receiving different treatment approaches with low back pain. One group did Pilates Reformer group classes (active approach) and the other received massage therapy (passive approach).

Examples of RCT comparison research:

Anderson BA. Randomized clinical trial comparing active vs. passive approaches to the treatment of recurrent and chronic low back pain [thesis]. Miami, FL: University of Miami; 2005.

Cairns MC, Foster NE, Wright C. Randomized controlled trial of specific spinal stabilization exercises and conventional physiotherapy for recurrent low back pain. Spine (Phila Pa 1976). 2006;31:E670-681.

Koumantakis GA, Watson PJ, Oldham JA. Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain. Phys Ther. 2005;85:209-225.

(continued above)

What can studio owners and Pilates instructors do to move this initiative along?

One of the best things that Pilates instructors and Pilates studio owners can do is to join the Pilates Method Alliance. Through this non-profit organization, developed to support the Pilates professional, funds can be raised to support research and to actually give grants to researchers who are interested in conducting Pilates-based research. Funding research also gives credibility to our profession. The more members we have, the more pools of resources will be available to fund research and programs of interest to Pilates professionals. No one can do research alone, we need to do this together!

Many Pilates teachers believe that one must be a medical professional to conduct research. The truth is that anyone can conduct research. In order to publish research in a peer-reviewed journal, one must obtain an IRB (Institutional Review Board) approval to be sure that the research is conducted humanely. An IRB is also known as an independent ethics committee or ethical review board, is a committee that has been formally designated to approve, monitor, and review biomedical and behavioral research involving humans. They often conduct some form of risk-benefit analysis in an attempt to determine whether or not research should be done.

Research Design: Levels of Evidence

There are several research designs in a hierarchy that provide stronger level of evidence than others based on their characteristics.

  • Systematic Review: A summary of the medical literature that uses explicit methods to perform a comprehensive literature search and critical appraisal of individual studies, and that uses appropriate statistical techniques to combine these valid studies.
  • Meta-analysis is a particular type of systematic review that attempts to combine and summarize quantitative data from multiple studies using sophisticated statistical methodology.
  • Randomized Controlled Trial is an experimental, prospective study in which “participants are randomly allocated into an experimental group or a control group and followed over time for the variables/outcomes of interest.”
  • Cohort study is an observational, prospective or retrospective study. A cohort study “involves identification of two groups (cohorts) of patients, one that received the exposure of interest, and one that did not, and following these cohorts forward for the outcome of interest.”
  • Case-control study is an observational, retrospective study which “involves identifying patients who have the outcome of interest (cases) and control patients without the same outcome, and looking back to see if they had the exposure of interest.”
  • Case Series is a descriptive report “on a series of patients with an outcome of interest. No control group is involved.”
  • Editorials and Expert Opinion: The clinical experience, expertise, and judgment of a respected healthcare professional do play important roles in evidence-based practice. Sometimes there will not be methodologically sound research to answer your clinical question, and expert opinion will be important in your decision-making process. Keep in mind that both expert opinion and scientific research should be evaluated for selective use of evidence and other biases.

There are several ways to begin simple research:

  1. Ask a question.
  2. Gather current data on your question.
  3. Questionnaires: A simple questionnaire can be administered to each and every new client Administer the same questionnaire again periodically to see if the response to the questions changes over time after receiving Pilates lessons.
  4. Case Reports: Documenting exercises in lessons, pain-levels, and functional improvements can be assembled into a case report. This type of research does not have a comparison or a control group.

As the chair of the PMA Research Committee, I have coached a few Pilates teachers through the process of putting together a case report that they will be presenting at the PMA Conference Research Forum.

Are there any research resources for professionals to look at?

  1. University Databases
  2. Pubmed
  3. PedRo (Australian Database)
  4. Published Texts

We really need to get busy as professionals to validate our beloved Pilates industry so that the medical community and the public at large will begin to take the industry more seriously. My goal as chair of the PMA Research Committee is to change the public perception that Pilates is just an “ab workout!”

NOTE: If you are interested in presenting research you can contact Sherri at the address below.

Sherri R. Betz, PT, GCS, CEEAA, PMA®-CPT
Chair, PMA Research Committee
Vice-President, Polestar Pilates Education