Effects of Reformer Pilates and Vestibular Exercise Programs on Balance and Gait in Children With Visual Impairment

Effects of Different Exercise Programs on Balance Performance and Gait Biomechanics in Children With Visual Impairment

This study looks at whether Reformer Pilates can help children and adolescents with visual impairment improve their balance, walking patterns, and muscle strength.

Participants are between 10 and 17 years old. They are randomly placed into one of two groups: an exercise group or a control group.

Those in the exercise group take part in 12 supervised Reformer Pilates sessions over 6 weeks, meeting twice a week. Those in the control group keep up with their usual daily activities and do not join the exercise program during this time.

Before and after the 6-week period, researchers measure each participant's balance, walking patterns, and muscle strength. They then compare how much each group changed.

Study Overview

• Status: Active, not recruiting
• Conditions: Visual Impairments
• Intervention / Treatment: Behavioral: Equipment-Based Pilates Exercise (Reformer); Behavioral: Vestibular Exercise Program

• Study Type: Interventional
• Enrollment (Actual): 75
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Istanbul
    • Istanbul, Istanbul, Turkey (Türkiye)
      • Türkan Sabancı Görme Engelliler Okulu

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Children and adolescents aged 10 to 17 years
• Diagnosis of visual impairment, classified as degree 2 to 5
• informed consent provided by a parent or legal guardian

Exclusion Criteria:

• Presence of an orthopedic disorder affecting balance, gait, or participation in the exercise program
• Presence of a neurological disorder affecting balance, gait, or participation in the exercise program
• Use of medications known to affect balance or gait

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

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Pilates (Equipment-Based Pilates(Reformer)) Group; Participants in this arm received a supervised Reformer Pilates exercise program twice weekly for 6 weeks, for a total of 12 sessions	Behavioral: Equipment-Based Pilates Exercise (Reformer); Participants in this arm attended a supervised Reformer Pilates program, held twice a week for six weeks (12 sessions in total). Sessions were structured around the Reformer apparatus and followed a progressive format, with exercise difficulty gradually increasing as participants advanced through the program.
Experimental: Vestibular Exercise Group; Participants in this group receive a supervised vestibular balance exercise program for 6 weeks, consisting of 12 sessions (two sessions per week).	Behavioral: Vestibular Exercise Program; Participants in this arm attended a supervised vestibular balance exercise program, held twice a week for six weeks (12 sessions in total). Exercises were performed under varying sensory conditions and progressed in difficulty as participants advanced through the program.
No Intervention: Control Group; Participants in this arm continued their usual daily activities and did not receive either of the study exercise programs during the study period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Static Balance Performance: Center of Pressure Sway Area	Center of Pressure Sway Area: Static balance performance is assessed using the TekScan pressure platform. Center of pressure (COP) sway area is measured during standardized quiet standing and expressed in square centimeters (cm²) and Higher values indicate greater postural sway.	Baseline and post-intervention at Week 6
Static Balance Performance: Center of Pressure Path Length	Center of pressure path length is measured using the TekScan pressure platform during quiet standing, representing the total displacement distance of the center of pressure, expressed in centimeters (cm).	Baseline and post-intervention at Week 6
Static Balance Performance: Antero-posterior Center of Pressure Excursion	Anteroposterior center of pressure excursion is measured using the TekScan pressure platform during quiet standing, representing postural sway in the forward-backward direction, expressed in centimeters (cm).	Baseline and post-intervention at Week 6
Static Balance Performance: Mediolateral Center of Pressure Excursion	Medio-lateral center of pressure excursion is measured using the TekScan pressure platform during quiet standing, representing postural sway in the side-to-side direction, expressed in centimeters (cm).	Baseline and post-intervention at Week 6
Gait - Spatiotemporal:Walking Speed	Walking speed is assessed using the iSen Inertial Motion Capture System by STT Systems (iSEN IMUs )during the walking test and it is expressed in meters per second (m/s).	Baseline and post-intervention at Week 6
Gait - Spatiotemporal: Gait Cadence	Gait cadence is assessed using the iSen IMUs and it represents the average number of steps taken per minute during walking.	Baseline and post-intervention at Week 6
Gait - Spatiotemporal: Step Length and Stride Length During Gait	Step length and stride length are assessed using the iSEN IMU system during walking, expressed in meters (m). Step length represents the average distance between consecutive foot contacts of opposite feet and stride length represents the average distance between successive contacts of the same foot.	Baseline and post-intervention at Week 6
Pelvic Symmetry	Pelvic symmetry during gait is assessed using the iSEN IMUs and it is expressed as a percentage (%).	Baseline and post-intervention at Week 6
Gait: Stance and Swing Phase Duration	During Gait Stance and swing phase durations are assessed bilaterally using the iSEN IMUs. Stance phase represents the portion of the gait cycle during which the foot is in contact with the ground, and swing phase represents the portion during which the foot is not in contact with the ground. Values are recorded separately for the right and left limbs, expressed in seconds and as a percentage of the gait cycle.	Baseline and post-intervention at Week 6
Gait: Double Support Duration During Gait	Double support duration is assessed bilaterally using iSEN IMUs and represents the portion of the gait cycle during which both feet are concurrently in contact with the ground. Values are recorded separately for the right and left limbs, expressed as a percentage of the gait cycle.	Baseline and post-intervention at Week 6
Gait Kinematics: Hip Flexion-Extension Angle During Gait	Hip flexion and extension angles during the gait cycle are assessed bilaterally using the iSEN IMUs and expressed in degrees (º). Maximum hip flexion angle and minimum hip extension angle are recorded separately for the right and left limbs.	Baseline and post-intervention at Week 6
Gait Kinematics: Hip Flexion-Extension Range of Motion During Gait	Hip flexion-extension range of motion during the gait cycle is assessed bilaterally using the iSEN IMUs and expressed in degrees (º),it is recorded separately for the right and left limbs.	Baseline and post-intervention at Week 6
Gait Kinematics: Knee Flexion-Extension Angle During Gait	Knee flexion and extension angles during the gait cycle are assessed bilaterally using the iSEN IMUs and expressed in degrees (º). Maximum knee flexion angle and minimum knee extension angle are recorded separately for the right and left limbs.	Baseline and post-intervention at Week 6
Gait Kinematics: Knee Flexion-Extension Range of Motion During Gait	Knee flexion-extension range of motion during the gait cycle is assessed bilaterally using the iSEN IMUs and expressed in degrees (º), recorded separately for the right and left limbs.	Baseline and post-intervention at Week 6
Gait Kinematics: Ankle Dorsiflexion-Plantarflexion Angle During Gait	Ankle dorsiflexion and plantarflexion angles during the gait cycle are assessed bilaterally using the iSEN IMUs and expressed in degrees (º). Maximum dorsiflexion angle and minimum plantarflexion angle are recorded separately for the right and left limbs.	Baseline and post-intervention at Week 6
Gait Kinematics: Ankle Dorsiflexion-Plantarflexion Range of Motion During Gait	Ankle dorsiflexion-plantarflexion range of motion during the gait cycle is assessed bilaterally using the iSEN IMUs system and expressed in degrees (º), it is recorded separately for the right and left limbs.	Baseline and post-intervention at Week 6
Gait Kinematics: Pelvic Tilt Angle During Gait	Maximum posterior and anterior pelvic tilt angles during the gait cycle are assessed using the iSEN IMUs inertial measurement unit system and expressed in degrees (º), recorded separately as posterior tilt and anterior tilt values.	Baseline and post-intervention at Week 6
Gait Kinematics: Pelvic Tilt Range of Motion	Pelvic tilt range of motion during the gait cycle is assessed using the iSEN IMUs , representing the combined anterior (posterior tilt) and interior (anterior tilt) excursion, expressed in degrees (º).	Baseline and post-intervention at Week 6

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Muscle Strength: Isometric Knee Extensor Muscle Strength	Knee Extension Isometric Strength Assessment: Participants will sit with knees at ~90° flexion, feet unsupported, distal posterior thigh positioned ~10 cm from the chair's front edge, arms on the armrests with hands gripping the handles, and thighs/pelvis stabilized with a strap. A dynamometer will be fixed to an apparatus mounted behind the chair using a rigid, non-stretch strap positioned ~2 cm proximal to the lateral malleolus and secured across the anterior tibial surface; participants will perform knee extension, applying maximal isometric force against the dynamometer through the strap. Three 5-second maximal contractions will be performed, with 1-minute rest between trials and verbal encouragement to ensure maximal effort; peak force will be recorded for each trial.	Baseline and post-intervention at Week 6
Muscle Strength: Isometric Knee Flexor Muscle Strength	Knee Flexion Isometric Strength Assessment: Participants will sit with feet unsupported, arms on the armrests with hands gripping the handles, and popliteal fossa positioned ~10 cm anterior to the chair's front edge, with thighs/pelvis stabilized using a strap. A dynamometer will be fixed to an apparatus mounted in front of the chair using a rigid, non-stretch strap positioned ~2 cm proximal to the lateral malleolus and secured across the posterior tibial surface; participants will flex the knee to 90° and apply maximal isometric force against the dynamometer through the strap. Three 5-second maximal contractions will be performed, with 1-minute rest between trials and verbal encouragement to ensure maximal effort; peak force will be recorded for each trial.	Baseline and post-intervention at Week 6
Trunk Muscle Endurance: Trunk Flexor Endurance	Trunk flexor endurance is assessed using a 1-minute curl-up test. Participants perform repeated curl-ups from a supine position with knees flexed at 90°, sliding their hands forward toward the knees and returning to the starting position with proper form. The number of correctly completed repetitions within 1 minute is recorded.	Baseline and post-intervention at Week 6
Trunk Extensor Endurance	Description: Trunk extensor endurance is assessed using a modified Sørensen test performed on a Roman chair, with the pelvis and lower extremities secured. Participants cross their arms over the chest and maintain the trunk horizontally aligned with the lower extremities, knees extended, for as long as possible. The test is terminated when the participant can no longer sustain the position, and the duration is recorded in seconds.	Baseline and post-intervention at Week 6

Collaborators and Investigators

• Sponsor: Marmara University
• Investigators: Principal Investigator: Selda Uzun, PhD, Marmara University

Study record dates

Study Major Dates

• Study Start (Actual): February 14, 2025
• Primary Completion (Estimated): November 30, 2026
• Study Completion (Estimated): December 25, 2026

Study Registration Dates

• First Submitted: August 24, 2026
• First Submitted That Met QC Criteria: August 24, 2026
• First Posted (Actual): August 27, 2026

Study Record Updates

• Last Update Posted (Actual): September 2, 2026
• Last Update Submitted That Met QC Criteria: August 31, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: Adolescents; Children; Muscle Strength; Balance Performance; Vestibular Exercise; Gait Biomechanics; Pilates (Equipment-Based Pilates)
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Eye Diseases; Sensation Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Vision Disorders
• Other Study ID Numbers: MARMARA-VI-RP-2026-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be made available to other researchers. Because the study population consists of children, data sharing is restricted in line with the permission obtained from the Provincial Directorate of National Education. Study results will only be presented in aggregate form, without any information that could identify individual participants.

Drug and device information, study documents

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