|Year : 2021 | Volume
| Issue : 2 | Page : 121-126
Comparison of Pilates and dance aerobics on peak expiratory flow rate, body composition, and core strength in overweight and Grade 1 obese individuals – A randomized control trial
Gaurang Baxi, Ravina Randive, Divya Gohil, Soumik Basu, Tushar Palekar
Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
|Date of Submission||05-Jun-2020|
|Date of Decision||31-Aug-2020|
|Date of Acceptance||10-Oct-2020|
|Date of Web Publication||08-Jan-2022|
Dr. Ravina Randive
Dr. D. Y. Patil College of Physiotherapy, Sant Tukaram Nagar, Pimpri, Pune - 411 018, Maharashtra
Source of Support: None, Conflict of Interest: None
BACKGROUND: Overweight and obesity are a rapidly growing threat to health in most countries. It is an epidemic that increases the risk of diabetes, hypertension, heart disease, cancer and hence threatens to inundate health-care resources. Different form of exercises including Pilates and aerobics help improve the side effects of obesity. This study was conducted to compare the effects of Pilates and aerobics on peak expiratory flow rate (PEFR), body composition and core strength in overweight and Grade 1 obese individuals.
MATERIALS AND METHODOLOGY: Thirty-three overweight and obese individuals aged 20–30 years were divided into two groups - Pilates group (n = 17) and Aerobics group (n = 16). Pilates included warm up, mat exercises, and cool down. Aerobics included warm up followed by choreographed dance, strength training, high intensity, and relaxation. PEFR by peak flow meter, body composition by body composition analyzer and core strength by pressure biofeedback were assessed, before and after the intervention. Fifty minute session were conducted thrice a week, for 4 weeks.
RESULTS: Data were analyzed in the Winpepi and Primer software. Participants in both the groups showed significant improvement at the end of the study. However, the differences in between the group were not statistically significant.
CONCLUSION: Pilates and aerobics are equally effective in improving the PEFR, body composition and core strength in overweight and Grade 1 obese individuals.
Keywords: Aerobics, body composition, core strength, obesity, peak expiratory flow rate, Pilates
|How to cite this article:|
Baxi G, Randive R, Gohil D, Basu S, Palekar T. Comparison of Pilates and dance aerobics on peak expiratory flow rate, body composition, and core strength in overweight and Grade 1 obese individuals – A randomized control trial. BLDE Univ J Health Sci 2021;6:121-6
|How to cite this URL:|
Baxi G, Randive R, Gohil D, Basu S, Palekar T. Comparison of Pilates and dance aerobics on peak expiratory flow rate, body composition, and core strength in overweight and Grade 1 obese individuals – A randomized control trial. BLDE Univ J Health Sci [serial online] 2021 [cited 2022 Nov 30];6:121-6. Available from: https://www.bldeujournalhs.in/text.asp?2021/6/2/121/335326
Obesity is an epidemic disease that increases the risk of diabetes, hypertension, heart disease, cancer and hence threatens to inundate health-care resources. A balanced equation of energy intake and energy expenditure is required to maintain a normal body mass index (BMI) and prevent overweight and obesity. When this balance is disturbed, there is excess accumulation of fat leading to increase in overweight and obesity. Since obesity is related to many life-threatening comorbidities such as coronary heart disease, stroke, certain types of cancer, dyslipidemia and many others, WHO convened a consultation on obesity to analyze the epidemiological information, etiological factors, and consequences related to the same. The consultation classified the people into overweight and obese on the basis of their BMI, and concluded that a logical system is now available and should be taken up internationally. They also concluded that the causes of obesity are sedentary lifestyle, high fat energy dense diets, both due to changes happening in the society and behavioral patterns of community due to urbanization and industrialization and adaption of more western culture and disappearance of traditional lifestyles.
Obesity also has many adverse effects on the respiratory system. Respiratory muscle insufficiency causes a decrease in functional reserve capacity, expiratory reserve volume which leads to an increase in the demand for ventilation and breathing work load in obese individuals. This often causes ventilation-perfusion mismatch and alveolar hypoventilation. This leads to increased morbidity and mortality.
Peak expiratory flow rate (PEFR) is the maximum exhalation maintained by a subject for minimum 10 ms, which is expressed in the liters per minute. It is a tubular device used to assess that how quickly a person can exhale. It is commonly used in asthmatic patients to monitor the progress of disease. The peak flow readings are often classified into three zones of measurement according to the American Lung Association.
Pilates and Miller introduced the concept of Pilates in the 1920s. Pilates is a form of exercise which involves total body conditioning which focuses on flexibility and strength. The purpose is to develop mind and body uniformity, provide balance, flexibility, and strength. The principal aim of the exercise is to create core strength which will be the powerhouse for the rest of the body. Pelvic floor muscles act as a dynamic platform at the base of the pelvis, functioning as support mechanism. Pelvic floor muscle activity is a “lift and squeeze” movement - an action to stop the midstream flow while voiding urine. Joseph Pilates came up with two contractions call the “Knot” and “Scoop.” The knot involves pressing the neck back with downward bend of the neck. Scoop involves contraction and tightening of the abdominal muscles, in such a way that the muscle gets pulled in toward the spine and in a superior direction. Strengthening of the core requires to perform the scoop. Pilates focuses on improving the core strength, which is the powerhouse of the rest of the body. Pilates exercises helps to strengthen the core muscles, helping to correct muscle imbalances.
The “Core” has been described as a box divided into front wall, back wall, roof, and bottom. Abdominals make up the front wall, back wall by paraspinal and gluteal muscles, roof by the diaphragm muscles and pelvic floor and hip girdle forms the bottom. The entire box includes 29 muscles. Local muscles further divide into primary and secondary stabilizers. With the contraction of primary muscle stabilizers, there is no movement in spine. These muscles include multifidi and transverse abdominis.,,
Body composition analyzer is a common equipment used for assessing body composition. The analyzer passes a small electrical current into the body and measures the resistance to the current. The various components of body composition are water, protein, muscle, fat, bone, percentage body fat (PBF), BMI, waist–hip ratio (WHR), visceral fat index (VFI), and score of body composition.
Dr. Cooper and Kenneth coined the term Aerobics in the late 1960s. It is a form of exercise which involves different types of dance moves. Aerobics involves rapid stepping patterns involving the upper limb, lower limb, and truncal movements performed to music with cues provided by an instructor. Aerobics not only has effects on structural components but also has beneficial effects on mental health. It helps reduce physical stress. Dance aerobics is a good workout to boost up the immune system as well. And as it is the form which requires music the exercise does not get monotonous.,,
Obesity not only influences upper airway reflexes but also has an impact on lung mechanics. Literature also suggests that obesity may influence the central control of breathing. Respiratory muscle insufficiency causes a decrease in functional reserve capacity, expiratory reserve volume which leads to an increase in the demand for ventilation and breathing work load in obese individuals. This often causes ventilation-perfusion mismatch and alveolar hypoventilation. Obesity hypoventilation disorder also known as Pickwickian Syndrome, and it causes obstructive apnea. This was first studied in severely obese patients. In this, there is difficulty in breathing while asleep, and disturbed sleep. Rise dramatically with increasing obesity and in such cases, obesity has been a crucial modifiable risk factor. Symptoms like dyspnea are seen in individuals, who are overweight and obese, the origin of which can be cardiac, respiratory, or combination of the two. Mortality and morbidity is often the end of the pulmonary disorders. Hence, it is important to assess the PEFR values in them and also the effect of exercises on PEFR.
| Materials and Methodology|| |
Ethical clearance was obtained from the institutional ethics committee where the project was conducted. A total number of 62 participants were screened. Out of these 40 met the inclusion criteria and were enrolled into two groups by lottery method. Informed written consent was obtained from all participants.
- Overweight and obese individuals (BMI between 25–30) willing to participate
- Age group 20–30.
- Individuals with any known musculoskeletal, cardiopulmonary, or neurological impairment
- Individuals with Grade 2, 3 obesity.
Participants were included irrespective of their exercise habits, as the study focused on comparing the effects preintervention and postintervention.
Subjects were explained about the procedure and the outcome measures of the study. Depending on the lottery method, subjects were either a part of the Pilates group (PG) or Aerobics group (AG). There were 20 participants enrolled in each group. On the 1st day, demographic data height, weight, BMI, PEFR value, body composition, and core strength were taken. Same parameters were also assessed on the last day of the session, i.e., after 4 weeks on the 12th session. Body composition analysis was done using a body composition analyzer. The various components of body composition are water, protein, muscle, fat, bone, PBF, BMI, WHR, VFI, and score of body composition. For transverses abdominis strength assessment, the individual had to lie down in prone position and the pressure biofeedback was kept in between the anterior superior iliac spines. The cuff was inflated up to 80 mm Hg and the individual was asked to contract the muscle that is to pull the navel in and toward the spine and the pressure change on the dial was recorded.
PG: Before starting the exercises, individuals were taught how to recruit the core muscles by performing the scoop and knot technique, and scoop-pulling the navel toward the spine. All the exercises had to be started by performing a scoop and knot. All exercises were performed for 10 repetitions [Figure 1].
- Roll back – To sit upright with spine in neutral and lengthen through the spine. Hip and knee flexed, to place the hands over and below the knees forming a curve of the spine. To inhale while rolling back and to use the abdominals while coming back in the starting position
- Roll up – To lie in supine with one knee flexed and other extended. While coming into the sitting position with arms extended toward the knee, flex the extended knee and straighten the flexed knee
- The Hundred – Hip and knee in 90–90 position. Head lift, chin tuck, and press hands down ten times
- Single leg stretch – Head lift, one hip-knee flexed. To hold the ankle from outside and alternately flex and extend both legs
- One leg circle-Lying supine. Extend one knee and make a complete circle
- Criss-cross-Hip-knee in 90–90. Hands clasped behind the head. While extending the knee bring head up to the opposite side alternately
- Leg pull prone – To lie prone with the head in line with spine. Bend the arms and keep them close to the body. Lift the abdominals off the floor and hold it for a minute. Then to align the elbows directly over the shoulders. To hold this for a minute. Lift up on toes, straightening the legs. Lift one leg in the air shift weight anteriorly. Hold this position for a minute.
Cool down–Bhujangasana–lie in prone and be on extended hands. To lie on the back with hip knee flexed and inhale through nose and exhale through mouth.
AG: Aerobic session of 50 min on alternate days for 4 weeks. A total of 12 sessions were included. The session was as follows:
- Warm up: A warm up of 10 min which included - heel digs, toe touch, step touch, side step, v-box
- Choreography session: Jazz stretch, v box, lunges, polka, jazz walk. This session was for 15 min
- Strength training session: toes standing, squats, abdominal curls, planks. Each exercise 10 repetitions. This session for 15 min
- High intensity session: half star, half diamond, knee lift single double, kosack. (10 min
- Cool down: Jacobson's relaxation for 5 min.
For both groups of participants, participants were asked to exercise at a comfortable intensity of 4–6 on the Borg scale. Self-monitoring of the intensity was done by the participants. They were asked to slow down if they felt the severity of exercises was too much.
The same investigator took the pre and post assessments of all individuals, to avoid any kind of inter rater bias.
| Results|| |
Statistical analysis was started by comparing the pre-readings in both groups. Normality was checked in Winpepi (version 11.46). The t-test was applied for normally distributed data (transverse abdominis strength) and Mann–Whitney U test was applied for data which was not normally distributed (body composition, PEFR). Statistical analysis was done in Primer version 7.0.
[Table 1] shows analysis of various components of body composition. Except for muscle content, there was a significant difference within both groups pre and post intervention. However, there was no significant difference between both groups.
|Table 1: Pre- and post-intervention values of various parameters of body composition|
Click here to view
[Table 2] shows analysis of PEFR. There was a significant difference within both groups pre and post intervention. However, there was no significant difference between both groups.
|Table 2: Pre- and post-readings of peak expiratory flow rate in both groups|
Click here to view
[Table 3] shows analysis of transverses abdominis strength. There was a significant difference within both groups pre and post intervention. However, there was no significant difference between both groups.
|Table 3: Pre- and post-readings of transverses abdominis strength in both groups|
Click here to view
| Discussion|| |
This study was conducted to compare the effect between Pilates and aerobics on PEFR, body composition, and core strength in overweight and Grade 1 obese individual.
The results of this study suggest that the water content, muscle, and score of body composition increased post 4 weeks of intervention. Fat, BMI, VFI, and WHR decreased at the end of the study. As all exercises were performed on alternate days for 4 weeks, it resulted in an increased level of physical activity in the obese and overweight individuals which must have led to an improvement in the body composition.
Peak expiratory flow rate
The values within the group shows significant increase in the PEFR values after 4 weeks of Pilates and aerobics. No significance difference was seen in between both the groups. Obesity affects upper airway reflexes, mechanics of lung, and the central control of breathing. Respiratory muscle insufficiency causes a decrease in functional reserve capacity, expiratory reserve volume which leads to an increase in the demand for ventilation and breathing work load in obese individuals. This often causes ventilation-perfusion mismatch and alveolar hypoventilation which lowers the PEFR in obese individuals. A few studies have concluded that abdominal muscle exercises performed for 4 weeks increase the PEFR. A recent article studied the result of acute exercise on pulmonary function test of 1st year medical students. The study concluded that the measurement of PEFR after exercise was significantly higher than before exercise. Other studies also found similar results in their study., Airway dimensions, alveolar elastic recoil, and respiratory muscle effort are factors which affect PEFR. Respiratory muscle efficiency improves by increasing strength and function, which happen as a result of exercise training. Maximal inflation and deflation of the lungs occurs with improved strength of the respiratory muscles. This is an important physiological trigger for the release of surfactant and prostaglandin-(PG) E2 into the alveolar spaces, thus improving lung compliance and reducing bronchial smooth muscle tone, respectively. Increased PEFR level post exercise can be thus attributed to these factors.
There was a significant improvement seen within both groups. However, the differences between both groups were not significant. The “scoop” performed during Pilates focuses on in-drawing of the abdominal muscles and contraction of the pelvic floor muscles. As the scoop was performed with every exercise and the contraction had to be maintained throughout the exercise, this may be the reason for increased strength post 4 weeks of exercise. A study reported that when subjects performed an abdominal hollowing exercise inducing contraction of the local deep muscles, the transverses abdominis was contracted, while rectus abdominis, obliquus internus abdominis, obliquus externus abdominis, which are the global muscles contracted less. They concluded that the characteristics and thickness of transverse abdominis muscle increased after the exercises. Another study also concluded that both the aerobic and Pilates were effective in improving the core strength and also in trunk extensor muscle endurance.
The current study also shows an improvement in the PEFR, body composition and core strength in both the groups, post intervention. As the protocols of each group were of the same duration; strength training and endurance training were also a part of both protocols this maybe the reason of no significant difference seen in between groups.
| Conclusion|| |
This study concludes that both Pilates and aerobics were equally effective in improving the PEFR, body composition and core strength in overweight and Grade 1 obese individuals.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]