Effectiveness of the Pilates method versus aerobic exercises in the treatment of older adults with chronic low back pain: a randomized controlled trial protocol

Background Chronic low back pain is potentially disabling for older adults, and exercise is considered the best treatment. The Pilates method and aerobic exercises have been proven to be effective in pain and function improvement in patients with low back pain, but evidence in the treatment of older adults with low back pain is scarce. Therefore, the objective of this study is to investigate the effectiveness of the Pilates method compared to aerobic exercises in the treatment of older adults with chronic nonspecific low back pain. Methods This is a randomized controlled trial with blinded assessor, to be held in a physical therapy clinic in Sao Paulo, Brazil. Seventy four patients aged 65 to 85 years with chronic nonspecific pain will be randomized into Pilates Group (n = 37) with exercises based on the Pilates method and Aerobic Group (n = 37) with treadmill aerobic exercise. The primary outcomes will be pain intensity and general disability, assessed eight weeks after randomization. The secondary outcomes will be: pain intensity and general disability, assessed six months after randomization; and global perceived improvement, specific disability, dynamic balance, muscle strength (gluteus maximus, gluteus medius, and lateral hip rotators), and pressure pain threshold, assessed eight weeks and six months after randomization. Therapists and patients will not be blinded. Discussion This study has the potential to reduce pain and, consequently, improve balance and function of older adults with chronic low back pain with both therapies. However, Pilates may be more effective because the exercises are more targeted to the trunk stabilization muscles. The results of this study may provide valuable information on the effects of Pilates and aerobic exercise in older adults with chronic low back pain and contribute to a better selection of the treatment program according to the patient preference. Trial registration ClinicalTrials.gov NCT02729779, April 6, 2016. Electronic supplementary material The online version of this article (10.1186/s12891-019-2642-9) contains supplementary material, which is available to authorized users.


Stretches Front Variant (standing with the ball)
Objective: mobilize the spine and stretch the muscles of the posterior chain.
Hamstring Stretch Variant (sitting on the floor with one leg extended and the other one flexed) Objective: mobilize the spine and stretch the muscles of the posterior chain.
Spine Stretch (sitting on the floor with both legs extended) Objective: mobilize the spine and stretch the muscles of the posterior chain.

Swan Front
Objective: mobilize spine, stretching the muscles of the anterior chain, and strengthen pectoralis major, triceps brachii and anterior deltoid muscles.
Swan (taking off the arms) Objective: mobilize the spine, control the scapular elevation movement and strengthen posterior chain muscles.
Swan (taking off arms and legs alternate) Objective: mobilize the spine, control the scapular elevation movement and strengthen posterior chain muscles.
Tower (in "V" position with the elastic forward and upward) Objective: stretch the posterior chain muscles and strengthen the abdominis, quadriceps femoris and iliopsoas muscles.
Long Spine (in "V" position with the elastic forward and downwards) Objective: stretch the posterior chain muscles and strengthen the abdominis, quadriceps femoris and iliopsoas muscles.

Jackknife
Objective: mobilize the spine and strengthen the abdominis, quadriceps femoris and iliopsoas muscles.
Mermaid (both hands on the ball) Objective: stretch lateral chain muscles and control scapular elevation movement.
Mermaid (one hand on the ball) Objective: stretch lateral chain muscles and control scapular elevation movement.

Side Arm Sit Variant
Objective: stretch lateral chain muscles and control scapular elevation movement.

Lower Limbs Exercises Basic
Intermediate Advanced Tower (with the elastic on one leg) Objective: stretch the posterior chain muscles and strengthen the quadriceps femoris and gluteus maximus muscles.
Tower (with the elastic on both legs) Objective: stretch the posterior chain muscles and strengthen the quadriceps femoris and gluteus maximus muscles.
Tower (with the elastic on one leg) Objective: stretch the posterior chain muscles and strengthen the quadriceps femoris, hamstrings and gluteus maximus muscles. Footwork (taking the foot support) Objective: stretch the gluteus maximus and piriformis muscles and strengthen the quadriceps femoris muscle.
One Leg Up and Down (with the ball) Objective: stretch the gluteus maximus and piriformis muscles and strengthen abdominis, iliopsoas and quadriceps femoris muscles.
Footwork Double Legato (four supports with heavy elastic band) Objective: strengthen the quadriceps femoris, triceps surae, iliopsoas and sartorius muscles.

Side Kicks Up and Down
Objective: strengthen the gluteus medius and tensor fascia lata muscles.
Side Kicks Up and Down (mild weight) Objective: strengthen the gluteus medius and tensor fascia lata muscles.
Side Kicks Up and Down (heavy weight) Objective: strengthen the gluteus medius and tensor fascia lata muscles. Side Kicks Inner-Thigh Lifts Objective: strengthen the gluteus maximus, hamstrings, adductor magno, adductor longus, pectineus and gracillis muscles.

One Leg Up-Down (mild weight)
Objective: strengthen the iliopsoas, rectus femoris and rectus abdominis muscles.

One Leg Up-Down (heavy weight)
Objective: strengthen the iliopsoas, rectus femoris and rectus abdominis muscles.

Fire Hydrant
Objective: strengthen the quadriceps femoris and gluteus muscles.

Fire Hydrant (mild elastic)
Objective: strengthen the quadriceps femoris and gluteus muscles.

Fire Hydrant (heavy elastic)
Objective: strengthen the quadriceps femoris and gluteus muscles.
Squatting with the ball on the wall Objective: strengthen the quadriceps femoris and gluteus muscles.
One-legged squat with ball on wall Objective: strengthen the quadriceps femoris and gluteus muscles.

Air squat
Objective: strengthen the quadriceps femoris and gluteus muscles.

Leg Series Diagonal
Objective: strengthen the gluteus medius and minimum, tensor fascia lata and sartorius muscles.

Leg Series Diagonal with circle
Objective: strengthen the gluteus medius and minimum, tensor fascia lata and sartorius muscles.

Leg Series Diagonal with the ball
Objective: strengthen the gluteus medius and minimum, tensor fascia lata and sartorius muscles. Horse Objective: strengthen the abductor muscles of the hip.

Horse (mild elastic)
Objective: strengthen the abductor muscles of the hip.

Horse (heavy elastic)
Objective: strengthen the abductor muscles of the hip.

Upper Limbs Exercises Basic
Intermediate Advanced Arms Biceps (with the elastic) Objective: strengthen the biceps brachii, brachialis and rectus abdominis muscles.

Arms Biceps (flexed legs with the elastic)
Objective: strengthen the biceps brachii, brachialis and rectus abdominis muscles.
Arms Biceps (standing with the elastic) Objective: strengthen the biceps brachii, brachialis and rectus abdominis muscles.

Arms Pull Up and Down
Objective: strengthen deltoid and trapezius muscles.

Arms Pull Up and Down Variant (mild elastic)
Objective: strengthen the deltoid, latissimus dorsi, teres major, pectoralis major and coracobrachialis muscles.

Arms Pull Up and Down Variant (flexed knees and mild elastic)
Objective: strengthen the abdominis, deltoid, latissimus dorsi, teres major, pectoralis major and coracobrachialis muscles.

Arms Pull Up and Down Variant (flexed knees and heavy elastic)
Objective: strengthen the abdominis, deltoid, latissimus dorsi, teres major, pectoralis major and coracobrachialis muscles.
Arm Triceps (mild elastic without feet support) Objective: strengthen the triceps brachii and abdominis muscles.
Arm Triceps (heavy elastic without feet support) Objective: strengthen the triceps brachii and abdominis muscles.

Abdominal Exercises Basic
Intermediate Advanced Teaser Objective: stretch the adductor magnus, adductor longus, adductor minimum, pectineus and gracillis muscles and strengthen the rectus abdominis and external oblique muscles.
The Hundred Variant (with feet on the air) Objective: work coordination, stretch adductor, pectineus and gracillis muscles and strengthen the rectus abdominis, external oblique, latissimus dorsi and teres major muscles.
Exercise On the Ball Objective: work coordination, stretch adductor, pectineus and gracillis muscles and strengthen the rectus abdominis, external oblique, latissimus dorsi and teres major muscles. The Hundred (pumping arms and stretching legs) Objective: work coordination and strengthen the rectus abdominis and external oblique muscles.
The Hundred (raising the ball) Objective: work coordination and strengthen the rectus abdominis and external oblique muscles.
The Hundred Variant (side) Objective: work coordination and strengthen the rectus abdominis and external oblique muscles.
Bridge with knees and feet supported Objective: strengthen the abdominis rectus, internal oblique, external oblique, iliopsoas, pectoral and triceps brachii muscles.

Bridge with knees supported
Objective: strengthen the abdominis rectus, internal oblique, external oblique, iliopsoas, pectoral and triceps brachii muscles.