Mat Pilates With Paced Breathing Versus Diaphragmatic Breathing in Stage II Hypertension

Effects of Paced Breathing Versus Diaphragmatic Breathing Combined With Mat Pilates on Cardiopulmonary Endurance, Dyspnea, Stress, Anxiety, and Quality of Life in Patients With Stage II Hypertension: A Randomized Controlled Trial

This randomized controlled trial aims to compare the effects of mat Pilates combined with paced breathing versus mat Pilates combined with diaphragmatic breathing on stress, anxiety, cardiopulmonary endurance, dyspnea, and quality of life in patients with Stage II hypertension. Participants will be recruited from the Physiotherapy Department of the University of Lahore Teaching Hospital. Outcome measures will include DASS-21, 6-Minute Walk Test (6MWT), Modified Borg Dyspnea Scale, and SF-12 Health Survey. The intervention will be conducted three times per week for six weeks.

Study Overview

• Status: Completed
• Conditions: Hypertension; Essential Hypertension; Stage II Hypertension
• Intervention / Treatment: Behavioral: Paced Breathing; Other: Mat Pilates

Detailed Description

This study is a randomized controlled trial conducted at the Physiotherapy Department of the University of Lahore Teaching Hospital, Lahore. A total of 63 hypertensive patients will be screened from the Outpatient Department (OPD) after clinical diagnosis by a qualified medical specialist.

Eligible participants who meet inclusion criteria and provide written informed consent will be enrolled using a non-probability purposive sampling technique. Participants will be randomly allocated into two parallel groups using a sealed envelope method to ensure allocation concealment.

Participants in:

Group A:

Will receive mat Pilates exercises combined with paced breathing training.

Group B:

Will receive mat Pilates exercises combined with diaphragmatic breathing training.

Both groups will undergo supervised intervention sessions three times per week on alternate days for a total duration of six weeks. Each session will last approximately 45-60 minutes.

Outcome measures will be assessed at baseline and at the end of the six-week intervention period.

• Study Type: Interventional
• Enrollment (Actual): 63
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan
      • University of Lahore Teaching Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adults aged 40 to 50 years
• Clinically diagnosed Stage II hypertension confirmed by a qualified healthcare provider
• On a stable antihypertensive medication regimen for at least 4 weeks
• Moderate dyspnea levels as measured by the Modified Borg Dyspnea Scale
• Not currently participating in any structured exercise or rehabilitation program
• Able to understand instructions and complete questionnaires
• Willing to provide written informed consent

Exclusion Criteria:

• Uncontrolled hypertension (e.g., blood pressure greater than 180/110 mmHg)
• History of recent cardiovascular events (e.g., myocardial infarction within the past 6 months)
• Severe neurological or musculoskeletal disorders limiting mobility
• Severe anxiety or stress requiring psychiatric intervention
• Severe cognitive impairment or communication barriers
• Currently enrolled in another clinical trial or structured wellness program
• Any medical contraindication to physical activity as advised by a physician

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Mat Pilates + Paced Breathing; Participants assigned to this arm will receive a supervised mat Pilates program combined with paced breathing exercises, performed three times per week on alternate days for six weeks. Each session will last approximately 45-60 minutes.	Behavioral: Paced Breathing; Participants will perform paced breathing exercises using a controlled respiratory rate guided by therapist instruction during sessions. Paced breathing will be integrated with mat Pilates sessions, three times per week for six weeks.
Experimental: Mat Pilates + Diaphragmatic Breathing; Participants assigned to this arm will receive a supervised mat Pilates program combined with diaphragmatic breathing exercises, performed three times per week on alternate days for six weeks. Each session will last approximately 45-60 minutes.	Other: Mat Pilates; Standardized mat-based Pilates exercises focusing on breathing control, core stability, postural alignment, flexibility, and strengthening. Sessions will be supervised and conducted three times per week on alternate days for six weeks, with each session lasting approximately 45-60 minutes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Stress and Anxiety Levels (DASS-21)	Stress and anxiety levels will be assessed using the Depression Anxiety Stress Scale - 21 items (DASS-21). Each subscale consists of 7 items scored on a 4-point Likert scale (0 = Did not apply to me at all to 3 = Applied to me very much or most of the time). Scores are multiplied by 2 to calculate final subscale scores. Higher scores indicate greater psychological distress.	Baseline and at 6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cardiopulmonary Endurance (6-Minute Walk Test)	Cardiopulmonary endurance will be measured using the 6-Minute Walk Test (6MWT). The total distance walked in meters over six minutes will be recorded. Higher distance indicates improved cardiopulmonary endurance.	Baseline and at 6 weeks
Dyspnea Severity (Modified Borg Dyspnea Scale)	Dyspnea will be assessed using the Modified Borg Dyspnea Scale, a numerical rating scale ranging from 0 (no breathlessness) to 10 (maximal breathlessness). Higher scores indicate more severe dyspnea.	Baseline and at 6 weeks
Health-Related Quality of Life (SF-12)	Quality of life will be assessed using the 12-Item Short Form Health Survey (SF-12), which evaluates physical and mental health domains. Higher scores indicate better perceived health status.	Baseline and at 6 weeks

Collaborators and Investigators

• Sponsor: University of Lahore

Publications and helpful links

General Publications

• Batista, J. P., Tavares, J. B., Goncalves, L. F., de Souza, T. C. F., Mariano, I. M., Amaral, A. L., Rodrigues, M. d. L., Matias, L. A. S., Magalhaes Resende, A. P., & Puga, G. M. (2022). Mat Pilates training reduces blood pressure in both well-controlled hypertensive and normotensive postmenopausal women: a controlled clinical trial study. Clinical and Experimental Hypertension, 44(6), 548-556.
• Bartolain, T. (2024). Short-Term Pilates Exercise Intervention and Its Impact on Functional Movement in Healthy Middle-Aged Adults.
• Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1).
• BAKIR, N., VURAL, P. I., & DEMİR, C. (2024). The Effects of Diaphragmatic Breathing Exercise on Hot Flashes in Menopausal Women during the COVID-19 Pandemic Period: A Randomized Controlled Trial. Gümüshane Üniversitesi Saglik Bilimleri Dergisi, 13(3).
• Amaral, A. L., Batista, J., Goncalves, L., Tavares, J., Souza, T. C., Mariano, I., Rodrigues, M., Junior, J. C., Araujo, K., & Ribeiro, P. (2021). EFFECTS OF MAT PILATES TRAINING ON BODY COMPOSITION AND CARDIOMETABOLIC MARKERS IN POSTMENOPAUSAL WOMEN WITH MULTIMORBIDITY. Journal of hypertension, 39, e416-e417.
• Almeida, I. d. S., Andrade, L. d. S., Sousa, A. M. M. d., Junior, G. C., Catai, A. M., Mota, Y. L., & Durigan, J. L. Q. (2022). 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. International Journal of Environmental Research and Public Health, 19(17), 10577.
• Akpama, T. G. (2024). Study on the influence of socioeconomic factors on hypertension prevalence.
• Adawiyah, R., & Sinaga, W. (2024). HUBUNGAN GENETIK DAN USIA DENGAN PENYAKIT HIPERTENSI DI PUSKESMAS PASAR MINGGU JAKARTA SELATAN. Mayapada Nursing Journal, 1(1), 15-20.

Study record dates

Study Major Dates

• Study Start (Actual): September 15, 2025
• Primary Completion (Actual): October 15, 2025
• Study Completion (Actual): November 18, 2025

Study Registration Dates

• First Submitted: February 19, 2026
• First Submitted That Met QC Criteria: February 19, 2026
• First Posted (Actual): February 25, 2026

Study Record Updates

• Last Update Posted (Actual): February 25, 2026
• Last Update Submitted That Met QC Criteria: February 19, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Diaphragmatic Breathing; Breathing Exercises; Mat Pilates; 6-Minute Walk Test; Paced Breathing; Cardiopulmonary Endurance
• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Essential Hypertension; Hypertension
• Other Study ID Numbers: UOL/IREB/25/12/0004

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared. This study is being conducted as an academic research project. The informed consent obtained from participants does not include provisions for public data sharing, and the dataset contains sensitive personal health information. Data will be stored securely and used only for academic and research purposes in accordance with institutional ethics approval.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No