Abstract
This study aimed to systematically review the available evidence on the effects of Pilates training programs on blood pressure in hypertensive patients. Randomized clinical trials and comparative studies were searched in four electronic databases until September 2023 (updated December 2023). The methodological quality of included studies was assessed using the Physiotherapy Evidence Database and Methodological Index for Non-Randomized Studies scales. A total of 4 randomized clinical trials and 7 comparative studies were included, showing a low (n = 1), hight (n = 6), and good (n = 4) methodological quality. Data synthesis indicated that participants who performed Pilates program obtained significantly reduces on systolic blood pressure and diastolic blood pressure, of −4.76 mmHg (95% CI: −6.55 to −2.97, p < 0.001) and −3.43 mmHg (95% CI: −4.37 to −2.49, p < 0.001), respectively, in comparison with those included in the comparison groups. When the analysis was performed by comparing hypertensive, and normotensive patients, the results remained non-significant for blood pressure (systolic blood pressure: 0.96 mmHg (95% CI: −2.85 to 4.77, P = 0.49); diastolic blood pressure: 1.18 mmHg (95% CI: −1.23 to 3.58, P = 0.34); mean blood pressure: 1.73 mmHg (95% CI: −1.96 to 5.42, P = 0.36). Evidence suggests Pilates is safe for hypertensive patients and can be part of their rehabilitation, but it may not necessarily offer superior results or improve exercise adherence compared to other modalities.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 digital issues and online access to articles
$119.00 per year
only $9.92 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
Data availability
The data associated with this review is available upon request.
References
Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16:223–37. https://doi.org/10.1038/s41581-019-0244-2.
Ruivo JA, Alcântara P. Hypertension and exercise. Rev Port Cardiol. 2012;31:151–8. https://doi.org/10.1016/j.repce.2011.09.006.
World Health Organization. Global Brief on Hypertension: Silent Killer, Global Public Health Crisis: World Health Day 2013. Geneva, Switzerland: World Health Organization; 2013. https://doi.org/10.5005/ijopmr-24-1-2.
Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387:957–67. https://doi.org/10.1016/S0140-6736(15)01225-8.
Pan J, Wu L, Wang H, Lei T, Hu B, Xue X, et al. Determinants of hypertension treatment adherence among a Chinese population using the therapeutic adherence scale for hypertensive patients. Medicine (Baltimore). 2019;98:1–7. https://doi.org/10.1097/MD.0000000000016116.
Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2018;71:e127–248. https://doi.org/10.1016/j.jacc.2017.11.006.
Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2:1–9. https://doi.org/10.1161/JAHA.112.004473.
Pescatello LS, Buchner DM, Jakicic JM, Powell KE, Kraus WE, Bloodgood B, et al. Physical activity to prevent and treat hypertension: a systematic review. Med Sci Sports Exerc. 2019;51:1314–23. https://doi.org/10.1249/MSS.0000000000001943.
Dimeo F, Pagonas N, Seibert F, Arndt R, Zidek W, Westhoff TH. Aerobic exercise reduces blood pressure in resistant hypertension. Hypertension. 2012;60:653–8. https://doi.org/10.1161/HYPERTENSIONAHA.112.197780.
Cao L, Li X, Yan P, Wang X, Li M, Li R, et al. The effectiveness of aerobic exercise for hypertensive population: a systematic review and meta-analysis. J Clin Hypertens. 2019;21:868–76. https://doi.org/10.1111/jch.13583.
Esmailiyan M, Amerizadeh A, Vahdat S, Ghodsi M, Doewes RI, Sundram Y. Effect of different types of aerobic exercise on individuals with and without hypertension: an updated systematic review. Curr Probl Cardiol. 2023;48:101034 https://doi.org/10.1016/j.cpcardiol.2021.101034.
Edwards JJ, Deenmamode AHP, Griffiths M, Arnold O, Cooper NJ, Wiles JD, et al. Exercise training and resting blood pressure: a large - scale pairwise and network meta - analysis of randomised controlled trials. Br J Sport Med. 2023;0:1–11. https://doi.org/10.1136/bjsports-2022-106503.
Lopes S, Félix G, Mesquita-Bastos J, Figueiredo D, Oliveira J, Ribeiro F. Determinants of exercise adherence and maintenance among patients with hypertension: a narrative review. Rev Cardiovasc Med. 2021;22:1271–8. https://doi.org/10.31083/j.rcm2204134.
de Souza MV, Vieira CB. Who are the people looking for the Pilates method? J Bodyw Mov Ther. 2006;10:328–34. https://doi.org/10.1016/j.jbmt.2005.10.005.
da Silva A, Mannrich G. Pilates on rehabilitation: a systematic review. Fisioter Em Mov. 2009;22:449–55.
Bullo V, Bergamin M, Gobbo S, Sieverdes JC, Zaccaria M, Neunhaeuserer D, et al. The effects of Pilates exercise training on physical fitness and wellbeing in the elderly: a systematic review for future exercise prescription. Prev Med. 2015;75:1–11. https://doi.org/10.1016/j.ypmed.2015.03.002.
da Costa LPP, dos Santos G, Haas P, Claudino R, Gonzáles AI. Hemodynamic responses of the Pilates method in hypertensens: a systematic review. Rev Bras Ciência e Mov. 2019;27:219–27. https://doi.org/10.31501/rbcm.v27i4.10626.
Gonzáles A, Nery T, Fragnani S, Pereira F, Lemos R, Bezerra P, et al. Pilates exercise for hypertensive patients: a review of the literature. Altern Ther Health Med. 2016;22:38–43.
Ali ZO, Esfarjani F, Bambaeichi E, Marandi M. The effects of pilates exercise on blood pressure and selective physical fitness components in sedentary overweight females. Br J Sports Med. 2010;44. https://doi.org/10.1136/bjsm.2010.078725.92.
Andrade IYTPde, Melo KCB, Andrade KTPde, Almeida LG, Moreira SR. Pilates training reduces blood pressure in older women with type 2 diabetes: a randomized controlled trial. J Bodyw Mov Ther. 2022;30:168–75. https://doi.org/10.1016/j.jbmt.2022.02.022.
Batista JP, Tavares JB, Gonçalves LF, de Souza TCF, Mariano IM, Amaral AL, et al. Mat pilates training reduces blood pressure in both well-controlled hypertensive and normotensive postmenopausal women: a controlled clinical trial study. Clin Exp Hypertens. 2022;44:548–56. https://doi.org/10.1080/10641963.2022.2079670.
Santos JMD, Sousa Filho LF, Carvalho VO, Wichi RB, Oliveira ED. Hemodynamic and creatine kinase changes after a 12-week equipment-based Pilates training program in hypertensive women. J Bodyw Mov Ther. 2020;24:496–502. https://doi.org/10.1016/j.jbmt.2020.06.020.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372. https://doi.org/10.1136/bmj.n71.
Silverman SR, Schertz LA, Yuen HK, Lowman JD, Bickel CS. Systematic review of the methodological quality and outcome measures utilized in exercise interventions for adults with spinal cord injury. Spinal Cord. 2012;50:718–27. https://doi.org/10.1038/sc.2012.78.
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (Minors): development and validation of a new instrument. ANZ J Surg. 2003;73:712–6. https://doi.org/10.1046/j.1445-2197.2003.02748.x.
Almeida IDS, Andrade LS, Sousa AMM, Junior GC, Catai AM, Mota YL, et al. Is the Combination of Aerobic Exercise with Mat Pilates Better than Mat Pilates Training Alone on Autonomic Modulation Related to Functional Outcomes in Hypertensive Women? Secondary Analysis of a Randomized Controlled Trial. Int J Environ Res Public Health. 2022;19:1–17. https://doi.org/10.3390/ijerph191710577.
da Silva Almeida I, de Souza Andrade L, de Sousa AMM, Junior GC, Turri-Silva N, Cunha Nascimento DD, et al. The effect of mat pilates training combined with aerobic exercise versus mat pilates training alone on blood pressure in women with hypertension: a randomized controlled trial. Phys Ther Rehabil J. 2022;102:1–11. https://doi.org/10.1093/ptj/pzab258.
Gonçalves LF, Batista JP, Tavares JB, De Souza TCF, Mariano IM, Amaral AL, et al. Mat pilates training and blood pressure reactivity responses to psychological stress: comparison between normotensive and hypertensive postmenopausal women. Blood Press Monit. 2022;27:297–304. https://doi.org/10.1097/MBP.0000000000000601.
Tolves T, Pippi CM, Moreira MB, Righi GdeA, Righi NC, Signori LU, et al. Pilates vs aerobic training effects in hypertensives: randomized trial. Rev Bras Med Do Esporte. 2022;30:1–6. https://doi.org/10.1590/1517-8692202430012021_0327i.
Wong A, Figueroa A, Fischer SM, Bagheri R, Park SY. The effects of mat pilates training on vascular function and body fatness in obese young women with elevated blood pressure. Am J Hypertens. 2020;33:563–9. https://doi.org/10.1093/ajh/hpaa026.
Araujo RMA, Santos RM, Júnior JCT, Junior MGN, Queiroz JCC, Araujo SS, et al. Pilates reduces blood pressure of hypertensive women. Motricidade. 2019;15:171–8.
Barghout HF, Abdel Hady AA, Shaheen AA, El Nahas NG. Effect of pilates exercises on cortisol hormone and blood pressure among hypertensive women. Int J Thin Film Sci Technol. 2023;12:89–96. https://doi.org/10.18576/ijtfst/120202.
Martins-Meneses DT, Antunes HKM, De Oliveira NRC, Medeiros A. Mat Pilates training reduced clinical and ambulatory blood pressure in hypertensive women using antihypertensive medications. Int J Cardiol. 2015;179:262–8. https://doi.org/10.1016/j.ijcard.2014.11.064.
de Brito DLS, Araújo DS, Barreto MVC, Freitas VH, de, Aniceto RR, Castro MR. de. Efeito do treinamento com o Método Pilates sobre a pressão arterial de mulheres idosas hipertensas e normotensas. Rev Bras Educ Fís Esporte. 2023;37:1–7. https://doi.org/10.11606/issn.1981-4690.2023e37190825.
Carlson DJ, Dieberg G, Hess NC, Millar PJ, Smart NA. Isometric exercise training for blood pressure management: A systematic review and meta-analysis. Mayo Clin Proc. 2014;89:327–34. https://doi.org/10.1016/j.mayocp.2013.10.030.
Pagonas N, Vlatsas S, Bauer F, Seibert FS, Zidek W, Babel N, et al. Aerobic versus isometric handgrip exercise in hypertension: A randomized controlled trial. J Hypertens. 2017;35:2199–206. https://doi.org/10.1097/HJH.0000000000001445
Coelho-Júnior HJ, Asano RY, Gonçalvez IdeO, Brietzke C, Pires FO, Aguiar SdaS, et al. Multicomponent exercise decreases blood pressure, heart rate and double product in normotensive and hypertensive older patients with high blood pressure. Arch Cardiol Mex. 2018;88:413–22. https://doi.org/10.1016/j.acmx.2018.01.001.
de Souza-Cavina AP, Junior EP, Machado AF, Biral TM, Lemos LK, et al. Effects of the Mat Pilates method on body composition: systematic review with meta-analysis. J Phys Act Heal. 2020;17:673–81. https://doi.org/10.1123/jpah.2019-0171.
Nascimento LS, Santos AC, Lucena JMS, Silva LGO, Almeida AEM, Brasileiro-Santos MS. Acute and chronic effects of aerobic exercise on blood pressure in resistant hypertension: study protocol for a randomized controlled trial. Trials. 2017;18:1–8. https://doi.org/10.1186/s13063-017-1985-5.
Santos LP, Moraes RS, Vieira PJC, Ash GI, Waclawovsky G, Pescatello LS, et al. Effects of aerobic exercise intensity on ambulatory blood pressure and vascular responses in resistant hypertension: a crossover trial. J Hypertens. 2016;34:1317–24. https://doi.org/10.1097/HJH.0000000000000961.
Wallace JP. Exercise in hypertension: a clinical review. Sport Med. 2003;33:585–98. https://doi.org/10.2165/00007256-200333080-00004.
de Souza-Andrade L, da Silva Almeida I, Mochizuki L, Sousa CV, Falk Neto JH, Kennedy MD, et al. What is the exercise intensity of Pilates? An analysis of the energy expenditure, blood lactate, and intensity of apparatus and mat pilates sessions. J Bodyw Mov Ther. 2021;26:36–42. https://doi.org/10.1016/j.jbmt.2020.12.007.
Alpsoy Ş. Exercise and hypertension. Adv Exp Med Biol. 2020;1228:153–67. https://doi.org/10.1007/978-981-15-1792-1_10.
Baffour-Awuah B, Pearson MJ, Dieberg G, Smart NA. Isometric resistance training to manage hypertension: systematic review and meta-analysis. Curr Hypertens Rep. 2023;25:35–49. https://doi.org/10.1007/s11906-023-01232-w.
Hansford HJ, Parmenter BJ, McLeod KA, Wewege MA, Smart NA, Schutte AE, et al. The effectiveness and safety of isometric resistance training for adults with high blood pressure: a systematic review and meta-analysis. Hypertens Res. 2021;44:1373–84. https://doi.org/10.1038/s41440-021-00720-3.
Palatini P. Exercise haemodynamics in the normotensive and the hypertensive subject. Clin Sci. 1994;87:275–87. https://doi.org/10.1042/cs0870275.
Li Y, Hanssen H, Cordes M, Rossmeissl A, Endes S, Schmidt-Trucksäss A. Aerobic, resistance and combined exercise training on arterial stiffness in normotensive and hypertensive adults: a review. Eur J Sport Sci. 2015;15:443–57. https://doi.org/10.1080/17461391.2014.955129.
Cardoso CG, Gomides RS, Queiroz ACC, Pinto LG, Lobo FdaS, Tinucci T, et al. Acute and chronic effects of aerobic and resistance exercise on ambulatory blood pressure. Clinics. 2010;65:317–25. https://doi.org/10.1590/s1807-59322010000300013.
Author information
Authors and Affiliations
Contributions
Conceptualization: D.G.D., S.V.M., and C.A.P.; methodology: S.V.M., J.D.G., C.A.P., and D.G.D.; software: D.G.D. and J.D.G; validation: C.A.P., D.G.D., and J.D.G.; formal analysis: S.V.M., D.G.D., and C.A.P.; resources: D.G.D. and C.A.P.; data curation: J.D.G. and C.A.P.; writing original draft preparation: D.G.D.; writing review and editing: S.V.M. and C.A.P.; visualization: J.D.G.; supervision: C.A.P. and D.G.D.; project administration: D.G.D., S.V.M., and C.A.P. All authors have read and agreed to the published version of the manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
González-Devesa, D., Varela, S., Diz-Gómez, J.C. et al. The efficacy of Pilates method in patients with hypertension: systematic review and meta-analysis. J Hum Hypertens 38, 200–211 (2024). https://doi.org/10.1038/s41371-024-00899-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41371-024-00899-1