Development of the Simplified Pilates Exercise Programme for Prevention of Falls in Older Adults: A Pilot Randomized Controlled Trial

Grant Data
Project Title
Development of the Simplified Pilates Exercise Programme for Prevention of Falls in Older Adults: A Pilot Randomized Controlled Trial
Principal Investigator
Dr Wong, Wai Lung Thomson   (Principal investigator)
Ms Tsui Wing Sze   (Co-Investigator)
Mr Liang Kenneth Tat Keung   (Co-Investigator)
Dr Macfarlane Duncan James   (Co-Investigator)
Dr Tse Choi Yeung Andy   (Co-Investigator)
Start Date
Completion Date
Conference Title
Presentation Title
Older Adults, Pilates, Elderly falls, Fall prevention, Balance training, Psychological benefits
Rehabilitative and Physical Medicine,Psychology
Block Grant Earmarked for Research (104)
HKU Project Code
Grant Type
Seed Fund for Basic Research
Funding Year
In recent decades, due to the socio-economic developments and better medical technologies, proportion of older adults has increased dramatically (Lord, Clark, & Webster, 1991). Indeed, aging population is commonly witnessed in many parts of the world (Anderson & Hussey, 2000; Badley & Wang, 1998; Meng & D'Arcy, 2013; Muniz-Terrera, van den Hout, Piccinin, Matthews, & Hofer, 2013; Sheets & Gallagher, 2013; Stewart, MacIntyre, Capewell, & McMurray, 2003; Wang, Colditz, & Kuntz, 2007). Hong Kong is not an exception. The government in Hong Kong has forecasted that the number of older adults aged 65 or above in Hong Kong will increase from 1.6 million in 2012 to 3.6 million by 2041 (Census and Statistics Department, 2012). With the drastic increase in older population, numbers of health issues among older adults are aroused. For example, older adults are more prone to many health-related problems such as declining muscular and cardiovascular endurance and strength (Buchner & Wagner, 1992; Jette, Branch, & Berlin, 1990), increasing rate of morbidity and mortality (Khaw, 1999; Rubenstein, 2006) and declining mental functioning (Chiu, Lam, Chi, Leung, Li, Law et al., 1998; Chu, 2012). In addition to these problems, major concern is the increase of fall incidents (Lrez, Ali Ozdemir, Evin, Irez & Korkusuz 2011). In Hong Kong, about one in five community-dwelling older adults fall each year and 75% of those fall incidents would result in an injury include head trauma and hip fractures (Department of Health, 2013). These injuries are considered prominent factors that noticeably reduce independency of life, quality of life and consequently increase the risk of early death (Stevens, Ballesteros, Mack, Rudd, DeCaro, & Adler, 2012). In this regard, researchers are keen to look for preventive strategies. One of the most effective fall preventive strategies should be physical exercise. A considerable amount of research has been performed to investigate the role of physical exercise in the context of fall prevention. Systematic reviews of more than 50 randomized controlled Trials (RCTs) have confirmed that physical exercise is an effective strategy to prevent falls for both health and clinical population (Gillespie, Robertson, Gillespie, Lam, Gates, Cumming et al., 2009; Lord, Sherrington, Menz, & Close, 2007; Sherrington, Whitney, Lord, Herbert, Cumming, & Close, 2008; Topp, Mikesky, Dayhoff, & Holt, 1996). This is partly due to the fact that physical exercise may have delayed age-related physical functioning deterioration such as lower limb muscle weakness and balance deficiencies (Lord et al., 2007; Lord & Sturnieks, 2005; Sherrington et al, 2008; Tromp, Smit, Deeg, Bouter, & Lips, 1998). For example, exercise involving balance training could lower the fall risk by 17% in contrast to muscle strength training (Sherrington et al., 2008). In particular, number of previous studies suggested that progressive resistance exercise, functional movement and postural exercise can strengthen the trunk muscles and reduce older adult's fall risks (Smith & Smith, 2005; Skelton & McLaughlin, 1996; Seguin & Nelson, 2003). Among these, Pilates (pul-a-tee) exercise receives an increasing attention (Bernardo, 2007; Latey, 2001; DiLorenzo, 2011; Segal, Hein, & Basfrod, 2004; Smith & Smith, 2005). Originally developed by Joseph Pilates after World War I, Pilates exercise combines of muscle strengthening, stretching and breathing to develop trunk muscles and restore muscle balance (Bernardo, 2007; Cozen, 2000; Critchley, Pierson, & Battersby, 2011; Latey, 2011). Contrary to the traditional resistance exercise which focus on an isolated muscle group, Pilates exercise requires activation and coordination of several muscle groups at a time (Irez et al., 2011; Pilates, 2001). These muscles activation and coordination are essential for maintaining balance, which requires well-coordinated voluntary movements and reflexive muscular response (Fransson, Johnsson, & Hafstorm, 2000; Hyun, Hwangbo, & Lee, 2014). Indeed, recent research has suggested that Pilates exercise may reduce fall risks and improved postural stability in older adults (Hyun et al., 2014; Irez er al., 2011; Mokhtari, Nexakatalhossaini, & Esfarjani, 2012; Pata, Lord, & Lamb, 2013; Smith & Smith, 2005). From the psychological perspective, Pilates exercise is regarded as a mind-body exercise which combined the mental focus of and specific breathing of yoga with the physicality of gymnastics and other sports (Ungaro, 2002) for a complete coordination of body, mind and spirit (Gallagher & Kryzanowska, 2000). With this mind-body concept, Pilates exercise is evidenced with psychological benefits such as improving self-efficacy, sleep quality and mood (Caldwell, Harrison, Adams, & Triplett, 2009). Nevertheless, psychological risk factors of fall such as attention control, anxiety and fear of falling (Brown, Polych, & Doan, 2006; Maki, Holliday, & Topper, 1991; Tinetti, Speechley, & Ginter, 1988; Murphy, Williams, & Gill, 2002; Woollacott & Shumway-Cook, 2002) are not examined in any of the Pilates exercise studies. Over the past few decades, Pilates exercise has been diversified with modification to suit different individual needs and abilities (Well, Kolt, & Bialocerkowski, 2012). However, traditional Pilates exercise programme (Pilates, 2001) may be too demanding for most of the older adults which may affect their exercise compliance. Objectives: There is no published research that has investigated how expert-design simplified Pilates exercise can be incorporated in older adult fall prevention exercise programme. Therefore, the primary objective of the present proposed study is to investigate the effectiveness of an expert-design simplified Pilates exercise programme, which minimizes the complexity of the traditional Pilates programme, in the context of reduction of fall risk factors and fall prevention in older adults. The secondary objective is to investigate the effect of an expert-design simplified Pilates exercise programme on psychological fall risk factors in older adults.