Randomized crossover clinical trialPilates exercises improve low back pain and quality of life in patients with HTLV-1 virus: A randomized crossover clinical trial
Introduction
Human T-lymphotropic virus type 1 (HTLV-1) was the first human retrovirus identified (Poisez et al. 1980). HTLV-1 exists worldwide, with about 20 million people infected. This virus is endemic in certain areas of the world such as Africa, Japan, Malaysia, the Caribbean islands, Central America, and Latin America (Mueller et al., 1996). In Brazil, the city of Salvador has the highest prevalence of cases in the country (Dourado et al., 2003). About 5% of infected individuals develop severe pathologies (Manns et al., 1999). Among the clinical alteration commonly observed, HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP), which is associated with HTLV-1 infection, interferes most with HTLV patients' quality of life, due to its neurological effects (Ribas and Melo, 2002).
HAM/TSP mainly affects females between the ages of 35 and 49 and progresses slowly, causing reductions in muscle strength, changes in the urinary system (retention or urinary incontinence), intestinal constipation, decreased libido and erectile dysfunction in males (Proietti et al., 2005). Ten years after the onset of HAM/TSP about 30% of patients develop paraplegia (Franzoi and Araújo, 2007). Individuals with HAM/TSP have biomechanical, functional and sensory abnormalities, characterized by decreased muscle strength of the pelvic girdle and lower limbs, gait disturbances, spasticity, muscle shortening and/or joint hypomobility, predisposing these individuals to postural abnormalities and generalized pain, which can affect their quality of life (Macêdo et al., 2002).
Low back pain is the most common type of pain in patients infected by the HTLV-1 (Netto and Brites, 2011), and may be related to muscle dysfunction, which is even more pronounced in the presence of spasticity (Gessain et al., 1985). Low back pain in these patients is generally treated with analgesics, but their prolonged use, due to the chronic nature of the pain, causes serious side effects. This has led to the search for alternative therapies that target the causes of the pain.
The Pilates method can improve physiological and psychological functions, as well as teach functional posture and appropriate motor patterns, and may be useful for these patients (Goldby et al., 2006; La Touche et al., 2008). This method of exercise is based on attention to the details of movement, and patterning of significant muscle groups, especially the core (powerhouse) muscles (Muscolino and Cipriani, 2004). Dysfunction of these muscles has been associated with LBP (Hodges and Richardson, 1996). Previous studies addressing the functional recovery of patients with other diseases that exhibit similar symptoms to those of HTLV-1 point to the benefits of specific therapeutic exercise programs (La Touche et al., 2008), suggesting that a program based on the Pilates method could be useful for patients with HTLV-1 associated back pain (Posadzki et al., 2011). Therefore, the aim of this study was to assess the possible/potential therapeutic effect of the Pilates method on chronic low back pain in patients infected by the HTLV-1 and its impact on patients' quality of life.
Section snippets
Methods
A randomized crossover clinical trial was developed, involving patients infected by the HTLV-1 from the Integrative and Multidisciplinary Center for HTLV (CHTLV) of the Bahian School of Medicine and Public Health in Salvador, Bahia, Brazil. The following individuals were included in the study: 1) Individuals infected by the HTLV-1, who had reported low back pain for at least six months (felt everyday or almost everyday); 2) Age 18 or older and younger than 65; 3) Able to understand the exam
Results
Twenty-eight patients diagnosed with HAM/TSP were evaluated for eligibility. Of these, six were excluded, five because they had sporadic pain and one because contact was lost. The final sample of 22 patients was made up of 16 women and six men, with a mean age of 48.73 ± 10.07 years, with a mean body mass index of 25.18 ± 4.07. During the study five patients dropped out, but the analyses included the 22 patients in the intent to treat model (Fig. 1). At baseline, the randomization technique was
Discussion
Our results demonstrated that a Pilates exercise program had a positive impact on pain intensity and quality of life in patients with HTLV-1 associated low back pain. Improvement was seen in pain intensity as evaluated by the patients, as well as almost all the studied quality of life domains: physical functioning, physical role functioning, bodily pain, vitality, general health perceptions, social role functioning and mental health. However, no impact was found on emotional role functioning.
References (31)
- et al.
Effect of pilates training on people with fibromyalgia syndrome: a pilot study
Archives of Physical Medicine and Rehabilitation
(2009) - et al.
The effects of a Pilates training program on arm-trunk posture and movement
Clinical Biomechanics (Bristol, Avon)
(2010) - et al.
Antibodies to human T-lymphotropic vírus type-I in patients with tropical spastic paraparesis
Lancet
(1985) - et al.
Motor control problems in patients with spinal pain: a new direction for therapeutic exercise
Journal of Manipulative Physiological Therapeutics
(2000) - et al.
Treating non-specific chronic low back pain through the Pilates method
Journal of Bodywork and Movement Therapy
(2008) - et al.
Maximizing the benefits of Pilates-inspired exercise for learning functional motor skills
Journal of Bodywork and Movement Therapies
(2000) - et al.
Human T-lymphotropic virus type I infection
Lancet
(1999) - et al.
Pilates and the powerhouse
Journal of Bodywork and Movement Therapies
(2004) - et al.
Pilates for low back pain: a systematic review
Complementary Therapy in Clinical Practice
(2011) - et al.
Multiple sclerosis and postural control: the role of spasticity
Archives of Physical Medicine and Rehabilitation
(2010)
Isokinetic measurement of trunk muscle strength in women with chronic low-back pain
American Journal of Physical Medicine and Rehabilitation
Validation of the Brazilian version of the generic six-dimensional short form quality of life questionnaire (SF-6D Brazil)
Ciência e Saúde Coletiva
Musculoskeletal fitness and health-related quality of life characteristics among sedentary office workers affected by sub-acute, non-specific low back pain: a cross-sectional study
Physiotherapy
HTLV-1 in the general population of Salvador Brazil: a city with African ethnic and sociodemographic characteristics
Journal of Acquired and Immune Deficiency Syndromes
Effects of Pilates exercises on functional capacity, flexibility, fatigue, depression and quality of life in female breast cancer patients: a randomized controlled study
European Journal of Physical and Rehabilitation Medicine
Cited by (29)
Pilates exercise improves the clinical and immunological profiles of patients with human T-cell lymphotropic virus 1 associated myelopathy: A pilot study
2020, Journal of Bodywork and Movement TherapiesCitation Excerpt :The principles of Pilates are based on the breath awareness movement, motor control, concentration, harmonic motion or fluidity of movement, center of force and precision (Sacco et al., 2005; Ferreira et al., 2007; Netto et al., 2008; Mattos, 2011). Borges et al. observed that Pilates exercises alleviate lower back pain and quality of life of patients with HAM/TSP (Borges et al., 2014). In addition to these benefits, Pilates also improves the balance, mobility and muscle strength of wheelchair patients with multiple sclerosis (Van Der Linden et al., 2014; Guclu-Gunduz et al., 2014).
Effects of a Pilates protocol in individuals with non-specific low back pain compared with healthy individuals: Clinical and electromyographic analysis
2020, Clinical BiomechanicsCitation Excerpt :Thus, like a clockwork gear, the stabilizing muscles of the lumbar spine must “work” together rather than individually to maintain core stability (Mcneill, 2010). Pilates exercises have proven to be useful in low back pain patients to improve pain, function and aspects related to quality of life (Borges et al., 2013; Natour et al., 2015). However, no study has been found in the literature evaluating whether the effects of the method on individuals with low back pain, verified by EMG, as well as whether these effects are similar to those found in people with non-specific low back pain and in healthy people.
Pilates exercises and quality of life of patients with chronic kidney disease
2019, Complementary Therapies in Clinical PracticeCitation Excerpt :Similar results were reported in patients with chronic unspecific lower back pain [57] and cancer [54]. Borges et al. [58] indicated that after pilates exercises, QOL dimensions, except for physical functioning, had significant improvements in patients with lower back pain. Angin et al. [59] showed that physical functioning and general health dimensions along with the total QOL of patients with multiple sclerosis significantly improved with the exercises.
Pilates workouts can reduce pain in pregnant women
2018, Complementary Therapies in Clinical PracticeFactors associated with pain in individuals infected by human T-cell lymphotropic virus type 1 (HTLV-1)
2017, Brazilian Journal of Infectious DiseasesCitation Excerpt :As cross-sectional studies do not establish causal relationship, it is difficult to establish whether this association is due to the demand for treatment of pain or physiotherapy itself causes more pain in patients. The few clinical trials that tested the efficacy of physiotherapy in patients with HTLV-1 showed that therapeutic exercise can be useful in reducing pain intensity, and improving quality of life.41,42 For this reason, our hypothesis is that the strength of association found in this study is related to worse pain conditions.
Pain prevalence, characteristics and associated factors in human T-cell lymphotropic virus type 1 infected patients: a systematic review of the literature
2016, Brazilian Journal of Infectious DiseasesCitation Excerpt :However, two other trials, one using Zidovudine plus Lamivudine in a six-month treatment regimen in 16 subjects,24 and the other using Prednisolone, Pegylated Interferon and Sodium Valproate in 13 participants for 25 weeks25 did not find significant differences between drugs and placebo regarding improvement of pain. Pilates exercises and physical therapy (with proprioceptive neuromuscular facilitation) had clinical relevance in the control of the lower back pain in HTLV-1 infected patients and HAM/TSP patients.26,27 This suggests that pain in these patients may have, in part, a mechanical origin, which needs to be properly investigated.
- 1
These authors contributed equally for this study.