Aquatic vs Mat Pilates for Thoracic Kyphosis in Older Women (AMPKOW)

The Effect of Therapeutic Aquatic Exercise on the Improvement of Respiratory and Functional Capacity in Older Adults With Kyphosis

This study is a comparative interventional trial designed to evaluate the effects of Aquatic Pilates versus Mat Pilates on respiratory function, functional capacity, quality of life, and thoracic kyphosis in older women. Thoracic kyphosis is a common postural deviation in older adults that may negatively affect respiratory mechanics, physical performance, and quality of life.

Participants were allocated into four groups and assessed at three time points: baseline (pre-intervention), after 6 weeks of intervention, and immediately following the completion of a 12-week exercise program. Outcome measures included anthropometric characteristics (height, body weight, and body mass index), degree of thoracic kyphosis, respiratory function assessed via spirometric testing, functional capacity evaluated using standardized physical performance tests, and quality of life.

The intervention programs consisted of structured Aquatic Pilates and Mat Pilates protocols designed to improve postural alignment, respiratory efficiency, functional ability, and overall quality of life. The objective of the study is to compare the effectiveness of Aquatic Pilates versus Mat Pilates on respiratory, functional, and quality-of-life outcomes in older women with thoracic kyphosis.

Study Overview

• Status: Completed
• Conditions: Thoracic Kyphosis
• Intervention / Treatment: Behavioral: Aquatic Pilates; Behavioral: Mat Pilates

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Greece
  • Evrytania
    • Karpenisi, Evrytania, Greece, 36100
      • Municipal Indoor Swimming Pool of Karpenisi

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Female participants
• Αge 55-65 years
• Clinical diagnosis of thoracic kyphosis
• Thoracic kyphosis angle between 26° and 46°
• Ability to participate in exercise program
• Ability to provide written informed consent

Exclusion Criteria:

• Rheumatoid arthritis
• Chronic obstructive pulmonary disease (COPD)
• Cardiovascular disease
• History of spinal surgery
• History of lower limb surgery
• Recent fractures within the past 6 months
• Severe hyperkyphosis (>46°)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Aquatic Pilates Group; Participants completed a structured Aquatic Pilates exercise program over 12 weeks, consisting of 24 sessions performed twice weekly, with each session lasting 45 minutes. Exercise intensity was maintained at a light-to-moderate level according to established guidelines (ACSM Guidelines for Exercise Testing and Prescription, 2018). The program focused on core stabilization, postural alignment, spinal control, and coordinated breathing patterns. Exercises were performed in a water environment, utilizing buoyancy and hydrostatic resistance.	Behavioral: Aquatic Pilates; A structured 12-week Aquatic Pilates exercise program consisting of 24 sessions performed twice weekly. The intervention involved controlled exercise in a water environment utilizing buoyancy and hydrostatic resistance.; Other Names: Water-based Pilates
Experimental: Mat Pilates Group; Participants completed a structured Mat Pilates exercise program over 12 weeks, consisting of 24 sessions performed twice weekly, with each session lasting 45 minutes. Exercise intensity was maintained at a light-to-moderate level according to established guidelines (ACSM Guidelines for Exercise Testing and Prescription, 2018). The program focused on core stabilization, postural alignment, spinal control, and coordinated breathing patterns. Exercises were performed on land using a mat-based Pilates protocol.	Behavioral: Mat Pilates; A structured 12-week Mat Pilates exercise program consisting of 24 sessions performed twice weekly. The intervention was conducted on land using a mat-based Pilates protocol focusing on controlled movement and postural control.; Other Names: Land-based Pilates
No Intervention: Kyphosis Control Group; Participants with thoracic kyphosis did not receive any structured exercise intervention and were instructed to maintain their usual daily activities throughout the 12-week study period. They were assessed at the same time points as the intervention groups.
No Intervention: Healthy Control Group; Healthy older adults without thoracic kyphosis did not participate in any structured exercise program and maintained their usual daily activities during the study period. They were included as a reference comparison group and assessed at identical time points as the other groups.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Vital Capacity (VC)	Vital Capacity (VC) measured by spirometry using the SPIROANALYZER ST-95 spirometer. VC is reported in liters (L). Higher values indicate better pulmonary function.	Baseline, 6 weeks, and 12 weeks
Forced Vital Capacity (FVC)	Forced Vital Capacity (FVC) measured by spirometry using the SPIROANALYZER ST-95 spirometer. FVC is reported in liters (L). Higher values indicate better pulmonary function.	Baseline, 6 weeks, and 12 weeks
Thoracic Kyphosis Angle	Thoracic kyphosis angle measured using a kyphometer between T2 and T12 vertebrae. Results are reported in degrees (°). Lower values indicate reduced thoracic kyphosis.	Baseline, 6 weeks, and 12 weeks
Timed Up and Go Test (TUG)	Time required to stand up from a chair, walk 3 meters, return, and sit down. Measured in seconds. Lower scores indicate better mobility and functional performance.	Baseline, 6 weeks, and 12 weeks
4-Meter Gait Speed Test	Gait speed calculated over a 4-meter walking distance and reported in meters per second (m/s). Higher scores indicate better walking performance.	Baseline, 6 weeks, and 12 weeks
6-Minute Walk Test (6MWT)	Total distance walked during the 6-minute walk test. Reported in meters (m). Higher scores indicate better aerobic capacity and endurance.	Baseline, 6 weeks, and 12 weeks
Modified Physical Performance Test (mPPT) Score	Functional performance assessed using the Modified Physical Performance Test (mPPT). Higher scores indicate better functional capacity and physical performance.	Baseline, 6 weeks, and 12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Short Form-36 Health Survey (SF-36) Score	Health-related quality of life assessed using the 36-Item Short Form Health Survey (SF-36). Scores range from 0 to 100, with higher scores indicating better health-related quality of life.	Baseline, 6 weeks, and 12 weeks
PROMIS Global Health Scale v1.2	Health-related quality of life assessed using the PROMIS Global Health Scale v1.2. Results are reported as T-scores with a population mean of 50 and standard deviation of 10. Higher scores indicate better perceived health status.	Baseline, 6 weeks, and 12 weeks
Physical Activity Scale for the Elderly (PASE) Score	Physical activity assessed using the Physical Activity Scale for the Elderly (PASE). Total scores typically range from 0 to over 400, with higher scores indicating greater levels of physical activity.	Baseline, 6 weeks, and 12 weeks
Body weight	Body weight measured in kilograms (kg) using a calibrated scale	Baseline, 6 weeks, and 12 weeks
Ηeight	Height measured using a standard wall-mounted height measuring device	Baseline, 6 weeks, and 12 weeks
Βody Μass Ιndex (BMI)	Calculated as weight (kg) divided by height squared (m²) (kg/m²)	Baseline, 6 weeks, and 12 weeks

Collaborators and Investigators

• Sponsor: University of Athens
• Investigators: Study Director: HELEN SOULTANAKI, Dr, National and Kapodistrian University of Athens, School of Physical Education and Sport Science

Study record dates

Study Major Dates

• Study Start (Actual): January 2, 2025
• Primary Completion (Actual): March 27, 2025
• Study Completion (Actual): March 27, 2025

Study Registration Dates

• First Submitted: June 13, 2026
• First Submitted That Met QC Criteria: June 23, 2026
• First Posted (Actual): June 29, 2026

Study Record Updates

• Last Update Posted (Actual): June 29, 2026
• Last Update Submitted That Met QC Criteria: June 23, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: AQUA-PILATES-KYPHOSIS-2025-01

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