Effect of Pilates Exercises on Symptoms of Irritable Bowel Syndrome in Women: A Randomized Controlled Trial

Authors

  • Doaa Mohammed Mahmoud Allam Department of Physical Therapy for Internal Medicine, Faculty of Physical Therapy, Kafr El-Sheikh University, Kafr el-Sheikh - Egypt https://orcid.org/0009-0008-0510-4657
  • Heba Ali Abd Elghaffar Department of Physical Therapy for Cardiovascular and Respiratory Disorders, Faculty of Physical Therapy, Cairo University, Giza - Egypt
  • Amira Mostafa Elshamy Department of Medical Biochemistry, Faculty of Medicine, Tanta University, Tanta - Egypt
  • Mohammed Abdelmotaal Safa Department of Internal Medicine, Faculty of Medicine, Tanta University, Tanta - Egypt
  • Ahmad Mahdi Ahmad Department of Physical Therapy for Cardiovascular and Respiratory Disorders, Faculty of Physical Therapy, Cairo University, Giza - Egypt https://orcid.org/0000-0002-3148-885X

DOI:

https://doi.org/10.33393/aop.2024.3228

Keywords:

Anxiety/depression, Fatigue, Irritable bowel syndrome, Pilates exercises, Women

Abstract

Objective: Treatment of irritable bowel syndrome (IBS) is challenging, calling for therapeutic strategies other than pharmacological
treatment. This study aimed to investigate the effects of Pilates exercises on IBS symptoms and severity, frequency of complete spontaneous bowel movements, fatigue, anxiety, depression, and body weight in women with IBS.
Methods: Sixty women aged 20–45 with IBS were randomized into two groups: a study group (n = 30) receiving an 8-week Pilates program (2 sessions/week) plus dietary advice and a control group (n = 30) receiving dietary advice only. Inclusion criteria included moderate-to-severe IBS diagnosed via Rome IV criteria. The outcome measures were the IBS severity scoring system (IBS-SSS), the frequency of complete spontaneous bowel movements, the modified fatigue impact scale (MFIS), hospital anxiety and depression (HADS) scale, and body weight (BW).
Results: The study group showed more significant improvements than the control group in total IBS-SSS score (Cohen d = 0.73, p <0.001), frequency of complete spontaneous bowel movements (Cohen d = 0.50, p <0.001), total MFIS score (Cohen d = 0.74, p < 0.001), anxiety (Cohen d = 0.56, p < 0.001), and depression (Cohen d= 0.64, p <0.001). The study group also showed a significant reduction in body weight compared to baseline (p < 0.05). The control group showed significant improvements in all outcomes, except body weight, compared to baseline (p < 0.05).
Conclusion: Adding Pilates to dietary advice significantly enhances IBS outcomes, bowel movement frequency, fatigue, anxiety, and depression compared to dietary advice alone. However, dietary advice alone also yielded notable benefits.

Downloads

Download data is not yet available.

References

  1. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome Foundation Global Study. Gastroenterology. 2021;160(1):99-114.e3. https://doi.org/10.1053/j.gastro.2020.04.014 PMID:32294476 DOI: https://doi.org/10.1053/j.gastro.2020.04.014
  2. Kim YS, Kim N. Sex-gender differences in irritable bowel syndrome. J Neurogastroenterol Motil. 2018;24(4):544-558. https://doi.org/10.5056/jnm18082 PMID:30347934 DOI: https://doi.org/10.5056/jnm18082
  3. Galica AN, Galica R, Dumitrascu DL. Epidemiology of irritable bowel syndrome in Albania. J Gastrointestin Liver Dis. 2021;30(3):334-338. https://doi.org/10.15403/jgld-3828 PMID:34551031 DOI: https://doi.org/10.15403/jgld-3828
  4. Mearin F, Lacy BE, Chang L, et al. Bowel disorders. Gastroenterology. 2016;150(6):1393-1407. https://doi.org/10.1053/j.gastro.2016.02.031 PMID:27144627 DOI: https://doi.org/10.1053/j.gastro.2016.02.031
  5. Frändemark Å, Jakobsson Ung E, Törnblom H, et al. Fatigue: a distressing symptom for patients with irritable bowel syndrome. Neurogastroenterol Motil. 2017;29(1):e12898. https://doi.org/10.1111/nmo.12898 PMID:27401139 DOI: https://doi.org/10.1111/nmo.12898
  6. Tang HY, Jiang AJ, Wang XY, et al. Uncovering the pathophysiology of irritable bowel syndrome by exploring the gut-brain axis: a narrative review. Ann Transl Med. 2021;9(14):1187. https://doi.org/10.21037/atm-21-2779 PMID:34430628 DOI: https://doi.org/10.21037/atm-21-2779
  7. Mayer EA, Ryu HJ, Bhatt RR. The neurobiology of irritable bowel syndrome. Mol Psychiatry. 2023;28(4):1451-1465. https://doi.org/10.1038/s41380-023-01972-w PMID:36732586 DOI: https://doi.org/10.1038/s41380-023-01972-w
  8. Ford AC, Lacy BE, Talley NJ. Irritable bowel syndrome. N Engl J Med. 2017;376(26):2566-2578. https://doi.org/10.1056/NEJMra1607547 PMID:28657875 DOI: https://doi.org/10.1056/NEJMra1607547
  9. Ford AC, Sperber AD, Corsetti M, et al. Irritable bowel syndrome. Lancet. 2020;396(10263):1675-1688. https://doi.org/10.1016/S0140-6736(20)31548-8 PMID:33049223 DOI: https://doi.org/10.1016/S0140-6736(20)31548-8
  10. D'Silva A, MacQueen G, Nasser Y, et al. Yoga as a therapy for irritable bowel syndrome. Dig Dis Sci. 2020;65(9):2503-2514. https://doi.org/10.1007/s10620-019-05989-6 PMID:31832970 DOI: https://doi.org/10.1007/s10620-019-05989-6
  11. Portincasa P, Bonfrate L, de Bari O, et al. Irritable bowel syndrome and diet. Gastroenterol Rep (Oxf). 2017;5(1):11-19. https://doi.org/10.1093/gastro/gow047 PMID:28110300 DOI: https://doi.org/10.1093/gastro/gow047
  12. Fleming KM, Coote SB, Herring MP. Home-based Pilates for symptoms of anxiety, depression and fatigue among persons with multiple sclerosis: an 8-week randomized controlled trial. Mult Scler. 2021;27(14):2267-2279. https://doi.org/10.1177/13524585211009216 PMID:33870785 DOI: https://doi.org/10.1177/13524585211009216
  13. Yoo KT. Effects of mat Pilates on the autonomic nervous system in the elderly women. J Korean Soc Phys Med. 2022;17(4):27-35. https://doi.org/10.13066/kspm.2022.17.4.27 DOI: https://doi.org/10.13066/kspm.2022.17.4.27
  14. Aibar-Almazán A, Hita-Contreras F, Cruz-Díaz D, et al. Effects of Pilates training on sleep quality, anxiety, depression and fatigue in post-menopausal women: a randomized controlled trial. Maturitas. 2019;124:62-67. https://doi.org/10.1016/j.maturitas.2019.03.019 PMID:31097181 DOI: https://doi.org/10.1016/j.maturitas.2019.03.019
  15. Ju M, Zhang Z, Tao X, et al. The impact of Pilates exercise for depression symptoms in female patients: a systematic review and meta-analysis. Medicine (United States). 2023;102(41): E35419. DOI: 10.1097/MD.0000000000035419 DOI: https://doi.org/10.1097/MD.0000000000035419
  16. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. J Pharmacol Pharmacother. 2010;1(2):100-107. https://doi.org/10.4103/0976-500X.72352 PMID:21350618 DOI: https://doi.org/10.4103/0976-500X.72352
  17. Hadjivasilis A, Tsioutis C, Michalinos A, et al. New insights into irritable bowel syndrome: from pathophysiology to treatment. Ann Gastroenterol. 2019;32(6):554-564. https://doi.org/10.20524/aog.2019.0428 PMID:31700231 DOI: https://doi.org/10.20524/aog.2019.0428
  18. Pickett-Blakely O. Obesity and irritable bowel syndrome: a comprehensive review. Gastroenterol Hepatol (N Y). 2014;10(7):411-416. PMID:25904828
  19. Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Gastroenterology. 2016;150(6):1262-1279. https://doi.org/10.1053/j.gastro.2016.02.032 DOI: https://doi.org/10.1053/j.gastro.2016.02.032
  20. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920-924. https://doi.org/10.3109/00365529709011203 PMID:9299672 DOI: https://doi.org/10.3109/00365529709011203
  21. Francis CY, Morris J, Whorwell PJ. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther. 1997;11(2):395-402. https://doi.org/10.1046/j.1365-2036.1997.142318000.x PMID:9146781 DOI: https://doi.org/10.1046/j.1365-2036.1997.142318000.x
  22. Nuttall FQ. Body mass index: obesity, BMI, and health: a critical review. Nutr Today. 2015;50(3):117-128. https://doi.org/10.1097/NT.0000000000000092 PMID:27340299 DOI: https://doi.org/10.1097/NT.0000000000000092
  23. Spiegel B, Bolus R, Harris LA, et al. Measuring irritable bowel syndrome patient-reported outcomes with an abdominal pain numeric rating scale. Aliment Pharmacol Ther. 2009;30(11-12):1159-1170. https://doi.org/10.1111/j.1365-2036.2009.04144.x PMID:19751360 DOI: https://doi.org/10.1111/j.1365-2036.2009.04144.x
  24. Cao H, Wang Y, Su J, Zhao H, Han M, Liu JP. Acupuncture for chronic constipation. Cochrane Database Syst Rev. 2023;2023(4):CD004117. https://pmc.ncbi.nlm.nih.gov/articles/PMC10115435/ DOI: https://doi.org/10.1002/14651858.CD004117.pub4
  25. Ai YK, Liu ZS, Liu BY, et al. Minimal clinically important difference of the frequency of bowel movement for patients with chronic severe functional constipation treated with acupuncture. Zhongguo Zhenjiu. 2022;42(11):1247-1250. Chinese. https://pubmed.ncbi.nlm.nih.gov/36397222/
  26. Fatigue guidelines development panel of the Multiple Sclerosis Council for clinical practice guidelines. Fatigue and multiple sclerosis. Evidence-based management strategies for fatigue in multiple sclerosis. Paralyzed Veterans of America; 1998. https://pva.org/wp-content/uploads/2021/09/fatigue1b772.pdf
  27. Khalil H, Al-Shorman A, Alghwiri AA, et al. Cross cultural adaptation and psychometric evaluation of an Arabic version of the modified fatigue impact scale in people with multiple sclerosis. Mult Scler Relat Disord. 2020;39:101878. https://doi.org/10.1016/j.msard.2019.101878 PMID:31841967 DOI: https://doi.org/10.1016/j.msard.2019.101878
  28. Terkawi AS, Tsang S, AlKahtani GJ, et al. Development and validation of Arabic version of the Hospital Anxiety and Depression Scale. Saudi J Anaesth. 2017;11(5)(suppl 1):S11-S18. https://doi.org/10.4103/sja.SJA_43_17 PMID:28616000 DOI: https://doi.org/10.4103/sja.SJA_43_17
  29. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983Jun;67(6):361-70. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x PMID:6880820 DOI: https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
  30. Grönkvist R, Vixner L, Äng B, et al. Measurement error, minimal detectable change, and minimal clinically important difference of the Short Form-36 Health Survey, Hospital Anxiety and Depression Scale, and Pain Numeric Rating Scale in patients with chronic pain. J Pain. 2024;25(9):104559. https://doi.org/10.1016/j.jpain.2024.104559 PMID:38734041 DOI: https://doi.org/10.1016/j.jpain.2024.104559
  31. Hoffmann TC, Glasziou PP, Boutron I, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348(mar07 3):g1687. https://doi.org/10.1136/bmj.g1687 PMID:24609605 DOI: https://doi.org/10.1136/bmj.g1687
  32. Jayasinghe M, Karunanayake V, Mohtashim A, et al. The role of diet in the management of irritable bowel syndrome: a comprehensive review. Cureus. 2024;16(2):e54244. https://doi.org/10.7759/cureus.54244 PMID:38496157 DOI: https://doi.org/10.7759/cureus.54244
  33. National Institute for Health and Clinical Excellence (NICE). Irritable bowel syndrome in adults. Diagnosis and management of irritable bowel syndrome in primary care. Clinical Guideline 61 Update 2017. Online https://www.nice.org.uk/guidance/cg61https://www.ncbi.nlm.nih.gov/books/NBK553734/ (Accessed July 2024)
  34. McKenzie YA, Bowyer RK, Leach H, et al. IBS Dietetic Guideline Review Group on behalf of Gastroenterology Specialist Group of the British Dietetic Association. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet. 2016;29(5):549-575. https://doi.org/10.1111/jhn.12385 PMID:27272325 DOI: https://doi.org/10.1111/jhn.12385
  35. Vasant DH, Paine PA, Black CJ, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut. 2021;70(7):1214-1240. https://doi.org/10.1136/gutjnl-2021-324598 PMID:33903147 DOI: https://doi.org/10.1136/gutjnl-2021-324598
  36. Silva HJA, Lins CAA, Nobre TTX, et al. Mat Pilates and aquatic aerobic exercises for women with fibromyalgia: a protocol for a randomized controlled blind study. BMJ Open. 2019;9(2):e022306. https://doi.org/10.1136/bmjopen-2018-022306 PMID:30782866 DOI: https://doi.org/10.1136/bmjopen-2018-022306
  37. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Routledge; 1988. https://doi.org/10.4324/9780203771587 DOI: https://doi.org/10.4324/9780203771587
  38. Fani M, Mostamand J, Fani M, et al. The effect of aerobic exercises among women with mild and moderate irritable bowel syndrome: a pilot study. J Bodyw Mov Ther. 2019;23(1):161-165. https://doi.org/10.1016/j.jbmt.2018.02.003 PMID:30691746 DOI: https://doi.org/10.1016/j.jbmt.2018.02.003
  39. Daley A, Grimmett C, Roberts L, et al. The effects of exercise upon symptoms and quality of life in patients diagnosed with irritable bowel syndrome: a randomized controlled trial. J Sci Med Sport. 2010;12(2):E49. https://doi.org/10.1016/j.jsams.2009.10.103 DOI: https://doi.org/10.1016/j.jsams.2009.10.103
  40. Gao R, Tao Y, Zhou C, et al. Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials. Scand J Gastroenterol. 2019;54(2):169-177. https://doi.org/10.1080/00365521.2019.1568544 PMID:30843436 DOI: https://doi.org/10.1080/00365521.2019.1568544
  41. Liu J, Lv C, Wang W, et al. Slow, deep breathing intervention improved symptoms and altered rectal sensitivity in patients with constipation-predominant irritable bowel syndrome. Front Neurosci. 2022;16:1034547. https://doi.org/10.3389/fnins.2022.1034547 PMID:36408402 DOI: https://doi.org/10.3389/fnins.2022.1034547
  42. Alawami AS, Abdulla FA. Psychometric properties of an Arabic translation of the modified fatigue impact scale in patients with multiple sclerosis. Disabil Rehabil. 2021;43(22):3251-3259. https://doi.org/10.1080/09638288.2020.1731853 PMID:32109166 DOI: https://doi.org/10.1080/09638288.2020.1731853
  43. Miri H, Mehrabian H, Peyvandi MG, et al. Effect of pilates training on balance, muscular endurance, fatigue, and quality of life among women with multiple sclerosis. Health, Sport. Rehabilitation (Stuttg). 2023;9(4):73-84. https://hsr-journal.com/index.php/journal/article/view/247 DOI: https://doi.org/10.58962/HSR.2023.9.4.73-84
  44. Etemadifar M. Impact of clinical mat Pilates on body composition and functional indices in female patients with multiple sclerosis. View project. Crescent J Med Biol Sci. 2018;5(4):297-305. https://www.cjmb.org/text.php?id=206
  45. Amzajerdi A, Keshavarz M, Ezati M, et al. The effect of Pilates exercises on sleep quality and fatigue among female students dormitory residents. BMC Sports Sci Med Rehabil. 2023;15(1):67. https://doi.org/10.1186/s13102-023-00675-7 PMID:37101195 DOI: https://doi.org/10.1186/s13102-023-00675-7
  46. Akbaş E, Ünver B. A six-week pilates exercise protocol for improving physical and mental health-related parameters. Malaysian J Movement. Healthc Exec. 2018;7(2):65-79. DOI: https://doi.org/10.4103/2600-9404.323073
  47. Mohamed DMA, Hussien AMN, Kamel HEDH, et al. Effect of Pilates exercises on fatigue in post-menopausal women. Bull Fac Phys Ther. 2023;28(1):4-9. https://doi.org/10.1186/s43161-023-00140-z DOI: https://doi.org/10.1186/s43161-023-00140-z
  48. Eyigor S, Karapolat H, Yesil H, et al. Effects of pilates exercises on functional capacity, flexibility, fatigue, depression and quality of life in female breast cancer patients: a randomized controlled study. Eur J Phys Rehabil Med. 2010;46(4):481-487. PMID:21224783
  49. Barakou I, Sakalidis KE, Abonie US, et al. Effectiveness of physical activity interventions on reducing perceived fatigue among adults with chronic conditions: a systematic review and meta-analysis of randomized controlled trials. Sci Rep. 2023;13(1):14582. https://doi.org/10.1038/s41598-023-41075-8 PMID:37666869 DOI: https://doi.org/10.1038/s41598-023-41075-8
  50. Johannesson E, Simrén M, Strid H, et al. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol. 2011;106(5):915-922. https://doi.org/10.1038/ajg.2010.480 PMID:21206488 DOI: https://doi.org/10.1038/ajg.2010.480
  51. Alizadeh R, Zolfaghari Z, Nosratzehi S, et al. Effect of Pilates on anxiety, depression, and anthropometric indices of women with type 2 diabetes. Medical-Surgical Nursing Journal. 2023;12(2):e143695. https://doi.org/10.5812/msnj-143695 DOI: https://doi.org/10.5812/msnj-143695
  52. Park HY, Jung K, Jung WS, et al. Effects of online Pilates and face-to-face Pilates intervention on body composition, muscle mechanical properties, cardiometabolic parameters, mental health, and physical fitness in middle-aged women with obesity. Healthcare (Basel). 2023;11(20):2768. https://doi.org/10.3390/healthcare11202768 PMID:37893842 DOI: https://doi.org/10.3390/healthcare11202768
  53. Farzaneh A, Koushkie Jahromi M, Salesi M, Rostami R. The ameliorating impact of pilates training on anxiety and body mass index in menopausal symptoms. Womens Health Bull. 2020;7(4):46-53. https://womenshealthbulletin.sums.ac.ir/article_47061.html
  54. Komatsu M, Avila MA, Colombo MM, et al. Pilates training improves pain and quality of life of women with fibromyalgia syndrome. Rev Dor. 2016;17(4):274-278. https://doi.org/10.5935/1806-0013.20160088 DOI: https://doi.org/10.5935/1806-0013.20160088
  55. Song BH, Kim J. Effects of Pilates on pain, physical function, sleep quality, and psychological factors in young women with dysmenorrhea: a preliminary randomized controlled study. Healthcare (Basel). 2023;11(14):2076. https://doi.org/10.3390/healthcare11142076 PMID:37510517 DOI: https://doi.org/10.3390/healthcare11142076
  56. Najafi P, Hadizadeh M, Cheong JPG, et al. Effects of Tele-Pilates and Tele-Yoga on biochemicals, physical, and psychological parameters of females with multiple sclerosis. J Clin Med. 2023;12(4):1585. https://doi.org/10.3390/jcm12041585 PMID:36836119 DOI: https://doi.org/10.3390/jcm12041585
  57. Robayo A. Hypotalamus-Pituitary-Adrenal (HPA) Axes and Their Relationship with Stress, Mood, Personality, and Neurocognitive Functioning. In: Lopez-Soto T, Garcia-Lopez A, Salguero-Lamillar FJ, eds. The Theory of Mind Under Scrutiny: Psychopathology, Neuroscience, Philosophy of Mind and Artificial Intelligence. Springer Nature Switzerland; 2024:341-365. DOI: https://doi.org/10.1007/978-3-031-46742-4_11
  58. Ribeiro G, Ferri A, Clarke G, et al. Diet and the microbiota - gut - brain-axis: a primer for clinical nutrition. Curr Opin Clin Nutr Metab Care. 2022;25(6):443-450. https://doi.org/10.1097/MCO.0000000000000874 PMID:36102353 DOI: https://doi.org/10.1097/MCO.0000000000000874
  59. Hushmandi K, Jamali J, Saghari S, et al. The effect of eight weeks of pilates exercises on anthropometric indices and subjective well-being in obese middle-aged women. Open Public Health J. 2023;16(1):1-8. https://doi.org/10.2174/18749445-v16-e230810-2023-40 DOI: https://doi.org/10.2174/18749445-v16-e230810-2023-40
  60. Wang Y, Chen Z, Wu Z, et al. Pilates for overweight or obesity: a meta-analysis. Front Physiol. 2021;12:643455. https://doi.org/10.3389/fphys.2021.643455 PMID:33776797 DOI: https://doi.org/10.3389/fphys.2021.643455
  61. Cavina APS, Pizzo Junior E, Machado AF, et al. Effects of the mat Pilates method on body composition: systematic review with meta-analysis. J Phys Act Health. 2020;17(6):673-681. https://doi.org/10.1123/jpah.2019-0171 PMID:32396869 DOI: https://doi.org/10.1123/jpah.2019-0171
  62. Williamson DA, Bray GA, Ryan DH. Is 5% weight loss a satisfactory criterion to define clinically significant weight loss? Obesity (Silver Spring). 2015;23(12):2319-2320. https://doi.org/10.1002/oby.21358 PMID:26523739 DOI: https://doi.org/10.1002/oby.21358
  63. Magkos F, Fraterrigo G, Yoshino J, et al. Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Cell Metab. 2016 Apr 12;23(4):591-601. doi: 10.1016/j.cmet.2016.02.005 PMID: 26916363. DOI: https://doi.org/10.1016/j.cmet.2016.02.005
  64. Xu M, Liu D, Tan Y, et al. A Mendelian randomization study on the effects of plasma lipids on irritable bowel syndrome and functional dyspepsia. Sci Rep. 2024;14(1):78. https://doi.org/10.1038/s41598-023-50459-9 PMID:38167458 DOI: https://doi.org/10.1038/s41598-023-50459-9