Effects of Mat and Reformer Pilates in Multiple Sclerosis

March 25, 2026 updated by: Cagla Ozkul, Gazi University

Effects of Mat and Reformer Pilates Training on Postural Adjustments, Balance, and Walking in Patients With Multiple Sclerosis

Our study aims to investigate the effects of core stability-based Mat Pilates and Equipment-Based Pilates training on anticipatory postural adjustments (APA), balance, and gait in individuals with Multiple Sclerosis (MS). Participants diagnosed with MS will be randomly assigned to Mat Pilates, Equipment-Based Pilates, or a control group. Both Pilates programs will be conducted twice a week for eight weeks.

Assessments will be conducted before and after the training period. Anticipatory postural adjustments (APA) will be evaluated using electromyography (EMG) electrodes placed on the Erector Spinae and Tibialis Anterior muscles while participants take a step. Biomechanical responses related to APAs, specifically center of pressure displacement, will be measured using a force platform (Biodex® BioSway).

Core endurance will be assessed using the lateral bridge test, Modified Biering-Sorensen test, trunk flexion test, and prone bridge test, while core strength will be evaluated through sit-ups and push-ups. Balance will be measured using posturography. The Activities-Specific Balance Confidence (ABC) Scale will assess confidence in performing daily activities requiring balance. Functional mobility will be evaluated using the Timed Up and Go (TUG) test. Spatiotemporal gait parameters and variability will be analyzed with the BTS® G-WALK system. The Multiple Sclerosis Quality of Life Questionnaire (MSQOL-54) will assess quality of life.

This study is unique in that, unlike previous Pilates studies, it will be the first to examine the effects of different Pilates methods on APAs, which are crucial for both locomotor activities and postural stability in individuals with MS. Additionally, it will be the first study to evaluate two commonly used Pilates techniques in terms of their impact on balance and gait.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

30

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Diagnosis of Multiple Sclerosis by a specialist physician
  • Having a disability level between 0-4.5 according to the Expanded Disability Status Scale (EDSS)
  • Being between the ages of 18-65
  • Not having had an attack in the last 3 months
  • Mini-Mental Test score > 25

Exclusion Criteria:

  • Having another neurological disorder
  • Having orthopedic, cardiovascular, and pulmonary problems that may affect the research results
  • Having vision, hearing, and perception problems
  • Having a disease that may affect the immune system, such as infection, cancer

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Mat Pilates
In Mat Pilates training, exercise balls and elastic bands will be used. The exercises will be done with 10 repetitions for the first 4 weeks, and with 20 repetitions for the last 4 weeks. The difficulty level of the exercises will be increased in the following weeks according to the patient's condition.
Other: Mat Pilates
In Mat Pilates training, exercise balls and elastic bands will be used. The exercises will be done with 10 repetitions for the first 4 weeks, and with 20 repetitions for the last 4 weeks. The difficulty level of the exercises will be increased in the following weeks according to the patient's condition.
Experimental: Reformer Pilates
In the Reformer Pilates group, the difficulty level of the exercises will be provided by different positions, and the springs' resistance will be increased.
Other: Reformer Pilates
In the Reformer Pilates group, the difficulty level of the exercises will be provided by different positions, and the springs' resistance will be increased.
No Intervention: Control group
The control group will perform the relaxing exercise at home.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Anticipatory postural adjustments (APA)
Time Frame: 8 weeks

Data will be collected using an EMG-IMU system (Trigno Avanti, Delsys), with an accelerometer detecting perturbation onset and EMG recording tibialis anterior activity (1000 Hz, 16-bit; SENIAM placement).

Participants will stand barefoot on a force platform (feet shoulder-width apart) while perturbations are applied via a 4-kg pendulum. They will receive impacts with both hands at shoulder level and maintain balance. Three trials will be performed.

EMG signals will be rectified, low-pass filtered (100 Hz), and analyzed from -600 to +500 ms around perturbation onset (T0). APAs (-100 to +50 ms) will be baseline-corrected and normalized, with mean values used for analysis.

CoP data will be recorded during 30-s trials with perturbation at 15 s. CoP ellipse area will be calculated, and the mean of three trials will be analyzed.
8 weeks
Postural stability
Time Frame: 8 weeks

Postural stability will be assessed using a force plate (K-Force, K-Invent), a validated and reliable tool for CoP analysis. Measurements will be taken under eyes-open and eyes-closed conditions, each lasting 30 seconds and repeated three times, with 10-second rests between trials and a 1-minute break between conditions.

The primary outcome will be CoP ellipse area (mm²), representing postural sway. Mean values from the three trials for each condition will be used for analysis.
8 weeks
Gait Parameters
Time Frame: 8 weeks

Spatiotemporal gait parameters will be assessed using a wearable inertial sensor system (G-Walk, BTS Bioengineering, Italy). Participants will walk a 10-m distance at a self-selected comfortable speed in three trials. Acceleration data will be sampled at 100 Hz and transmitted via Bluetooth to G-Studio software for analysis.

Measured parameters will include gait velocity, cadence, stride length, gait cycle duration, and double support time (% of gait cycle). The mean of the three trials will be used for statistical analysis.
8 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Mobility
Time Frame: 8 weeks
Functional mobility will be assessed using the Timed Up and Go (TUG) test, a reliable and valid clinical measure. Participants will stand up from a chair, walk 3 m, turn, return, and sit down. After one familiarization trial, three trials will be recorded, and the mean value will be used for analysis.
8 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Gazi University

Investigators

  • Principal Investigator: Cagla Ozkul, PhD, Gazi University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 10, 2025

Primary Completion (Actual)

January 23, 2026

Study Completion (Actual)

February 10, 2026

Study Registration Dates

First Submitted

March 21, 2025

First Submitted That Met QC Criteria

April 15, 2025

First Posted (Actual)

April 17, 2025

Study Record Updates

Last Update Posted (Actual)

March 30, 2026

Last Update Submitted That Met QC Criteria

March 25, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2023 - 960

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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