Effects of Clinical Pilates Exercises on Symptoms, Posture, Balance and Quality of Life in GERD

The Effect of Clinical Pilates Exercises on Symptoms, Posture, Balance and Quality of Life in Individuals With Gastroesophageal Reflux Disease

This randomized, single-blind, parallel-group clinical trial investigates whether a six-week supervised clinical Pilates exercise program improves reflux symptom severity, postural alignment, dynamic balance, sleep quality, depressive symptoms, anthropometric measures, and overall health-related quality of life in adults with gastroesophageal reflux disease (GERD). Participants attended 18 face-to-face sessions over 6 weeks (3 times/week) under physiotherapist supervision. Outcomes included reflux symptom scores (GERD-Q, FSSG), health-related quality of life (SF-36), sleep quality (Pittsburgh Sleep Quality Index), depression (Beck Depression Inventory), postural alignment (PostureScreen Mobile), dynamic balance (Y-Balance Test), and anthropometric circumferences (chest, sub-sternal, waist).

Study Overview

• Status: Completed
• Conditions: Gastro Esophageal Reflux; Pilates Exercise
• Intervention / Treatment: Other: Usual Daily Activity (No Exercise Intervention); Behavioral: Supervised Clinical Pilates Exercise Training

Detailed Description

Design: randomized controlled, single-blind, parallel-group trial conducted at Istinye University Physiotherapy and Rehabilitation Application and Research Center (FIZYOTEM). Eligible adults (18-65 years) with a clinically confirmed diagnosis of gastroesophageal reflux disease and self-reported GERD symptoms for at least three months, who were physiologically able to participate in low-to-moderate intensity exercise, were enrolled. Allocation followed a computer-generated random sequence with concealed assignment to: (1) Clinical Pilates Group (PG): a progressive, posture-focused clinical Pilates program performed exclusively in the standing position to minimize intra-abdominal pressure, with no anterior trunk flexion or direct abdominal compression; (2) Control Group (CG): usual daily activity with no exercise intervention. The Pilates group completed 18 supervised face-to-face sessions across 6 weeks (3 sessions/week). Each session included a ~10-minute warm-up (Cleopatra, upper-extremity PNF patterns, Toy Soldier, Corkscrew, Chest Stretch), a main phase (Tic-Toc Arm Float, Bow & Arrow, Spine Twist, Footwork, Knee Lift & Aeroplane, Plié - Second to First - Moving Balance, Balance, Balance Plié with Arms), and a 5-10-minute cool-down/stretching phase. Progression across the 6 weeks was achieved by increasing repetitions (5 → 10) and active duration (5 s → 10 s → 15 s) while maintaining one set per exercise and a 30-second rest interval. To minimize gastric distension, sessions were scheduled at least 2 hours after a main meal or at least 30 minutes before eating. Assessments were performed pre- and post-intervention in fixed order with rest intervals. Reflux symptom severity was quantified using the Gastroesophageal Reflux Disease Questionnaire (GERD-Q) and the Frequency Scale for the Symptoms of GERD (FSSG). Health-related quality of life was assessed with the Short Form-36 (SF-36); sleep quality with the Pittsburgh Sleep Quality Index (PSQI); depressive symptoms with the Beck Depression Inventory (BDI). Postural alignment was analyzed using the PostureScreen Mobile application (anterior, posterior, right and left lateral views; sagittal and frontal translations and angulations). Dynamic balance was measured with the Y-Balance Test (anterior, posteromedial, posterolateral reach, bilateral). Anthropometric circumferences (chest, sub-sternal, waist) were measured with a standard tape. Statistical plan: distribution evaluated with the Shapiro-Wilk test; within-group changes assessed using paired-samples t-test or Wilcoxon signed-rank test as appropriate; between-group comparisons using independent-samples t-test or Mann-Whitney U test; categorical variables with chi-square test. Analyses were performed in IBM SPSS Statistics v25.0 with a two-tailed alpha of 0.05. Sample size was estimated a priori (G*Power 3.1) for a moderate effect (d=0.6), α=0.05, power=0.80, yielding 19 participants per group; post-hoc power for the primary outcome (GERD-Q) reached 0.96 (d=1.37). No external funding; no conflicts declared.

• Study Type: Interventional
• Enrollment (Actual): 33
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye)
    • Istinye University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age 18-65 years.
• Clinically confirmed diagnosis of gastroesophageal reflux disease (GERD).
• Self-reported GERD symptoms (heartburn, acid regurgitation, etc.) for at least 3 months prior to enrollment.
• Physiologically able to participate in low-to-moderate intensity exercise.
• Provision of written informed consent.
• Cognitive and psychosocial capacity to comply with the program.

Exclusion Criteria:

• History of upper gastrointestinal surgery (especially fundoplication).
• Achalasia or severe esophageal motility disorder.
• Endoscopic evidence of advanced esophagitis, Barrett's esophagus, or esophageal stricture (complicated GERD).
• Active peptic ulcer disease or inflammatory bowel disease.
• Uncontrolled hypertension, coronary artery disease, or severe pulmonary disease.
• Severe musculoskeletal disorders (advanced scoliosis/kyphosis, acute disc herniation, severe osteoarthritis) or vestibular balance disorders.
• Pregnancy or suspected pregnancy.

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
Active Comparator: No Intervention: Control Group (CG); Participants continued their routine daily activities without any structured exercise intervention for the 6-week study period. Outcome measurements were performed at baseline and at week 6 using identical procedures and instruments as the Pilates group.	Other: Usual Daily Activity (No Exercise Intervention); No supervised exercise; participants were instructed to maintain their usual physical activity pattern and lifestyle for 6 weeks. They received the same baseline and week-6 assessments as the experimental group.
Experimental: Experimental: Clinical Pilates Group (PG); Posture-focused clinical Pilates exercise program tailored for individuals with GERD. All exercises were performed in the standing position, avoiding anterior trunk flexion and direct abdominal compression to minimize intra-abdominal pressure. Sessions were held 3 times/week for 6 weeks (18 supervised face-to-face sessions). Each session contained a ~10-minute warm-up, a main phase of standing posture/balance Pilates exercises, and a 5-10-minute cool-down/stretching phase.	Other: Usual Daily Activity (No Exercise Intervention); No supervised exercise; participants were instructed to maintain their usual physical activity pattern and lifestyle for 6 weeks. They received the same baseline and week-6 assessments as the experimental group.; Behavioral: Supervised Clinical Pilates Exercise Training; 18 face-to-face sessions over 6 weeks (3×/week); physiotherapist-led, posture-focused program performed exclusively in the standing position. Warm-up/cool-down: Cleopatra, upper-extremity PNF patterns, Toy Soldier, Corkscrew, Chest Stretch (10 reps each). Main phase: Tic-Toc Arm Float, Bow & Arrow, Spine Twist, Footwork, Knee Lift & Aeroplane, Plié - Second to First - Moving Balance, Balance, Balance Plié with Arms. Progression by repetitions (5 → 10) and active duration (5 s → 10 s → 15 s); one set per exercise; 30-second rest between sets. Sessions were timed at least 2 hours after meals or at least 30 minutes before eating to limit gastric distension.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Gastroesophageal Reflux Disease Questionnaire (GERD-Q) total score	Six-item self-report instrument measuring frequency of typical reflux symptoms over the past week; total score range 0-18, with higher scores indicating greater symptom burden and a cut-off of ≥8 suggesting high probability of GERD. Safety Issue: No.	Baseline to Week 6

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency Scale for the Symptoms of GERD (FSSG) total score	Twelve-item self-report scale assessing the frequency of acid-reflux and dyspeptic symptoms; total score range 0-48, with higher scores indicating more frequent symptoms (≥8 considered positive for GERD). Safety Issue: No.	Baseline to Week 6
Short Form-36 Health Survey (SF-36) total score	36-item generic health-related quality-of-life questionnaire covering eight domains (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, mental health); each domain and the total score scaled 0-100, higher scores reflecting better health-related quality of life. Safety Issue: No.	Baseline to Week 6
Pittsburgh Sleep Quality Index (PSQI) global score	19-item self-report instrument generating a global score from seven components (subjective sleep quality, latency, duration, efficiency, disturbances, medication use, daytime dysfunction); global score 0-21, with higher scores indicating poorer sleep quality (≥5 indicates poor sleep). Safety Issue: No.	Baseline to Week 6
Beck Depression Inventory (BDI) total score	21-item self-report inventory assessing severity of depressive symptoms over the past week; total score 0-63, with higher scores indicating greater depressive symptom severity. Safety Issue: No.	Baseline to Week 6
Postural Alignment Parameters (PostureScreen Mobile)	Photographic postural assessment performed in anterior, posterior, right and left lateral standing views using the PostureScreen Mobile application. Outcomes include sagittal anterior translations and posterior translations of head, shoulder, thorax, pelvis, and segmental spinal translations (T1-T4, T4-T8, T8-T12, T12-L3, L3-SIPS); frontal lateral translations of head, shoulder, pelvis, and knee. Values reported in cm and degrees; values closer to zero indicate better postural alignment. Safety Issue: No.	Baseline to Week 6
Y-Balance Test reach distances	Dynamic balance assessment in which participants reach as far as possible in three directions (anterior, posteromedial, posterolateral) on each lower limb while maintaining single-leg stance. Maximum reach distance is recorded in centimeters bilaterally; greater reach distances reflect better dynamic balance and lower-limb neuromuscular control. Safety Issue: No.	Baseline to Week 6
Anthropometric circumference measurements	Tape-measure assessment of chest circumference, sub-sternal (sub-xiphoid) circumference, and waist circumference, recorded in centimeters using standardized landmarks at end-tidal expiration. Safety Issue: No.	Baseline to Week 6

Collaborators and Investigators

• Sponsor: Istinye University

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2025
• Primary Completion (Actual): June 15, 2025
• Study Completion (Actual): June 25, 2025

Study Registration Dates

• First Submitted: May 1, 2026
• First Submitted That Met QC Criteria: May 1, 2026
• First Posted (Actual): May 7, 2026

Study Record Updates

• Last Update Posted (Actual): May 7, 2026
• Last Update Submitted That Met QC Criteria: May 1, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: posture; physiotherapy and rehabilitation; pilates; Gastro Esophageal Reflux
• Additional Relevant MeSH Terms: Digestive System Diseases; Gastrointestinal Diseases; Esophageal Diseases; Esophageal Motility Disorders; Deglutition Disorders; Gastroesophageal Reflux
• Other Study ID Numbers: GERD-P 25-29

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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