The effects of clinical pilates on physical fitness parameters, symptom severity and kinesiophobia in women with premenstrual syndrome

PMS, which occurs before menstruation, is a psychoneuroendocrine syndrome of unknown etiology (Takeda, 2023). PMS symptoms start in the last 7-10 days of the cycle and end in 2-4 days after the onset of menstruation. This menstrual cycle continues repeatedly. It occurs with physical symptoms such as breast bloating and tenderness, fatigue, headache and weight gain, and psychological mood symptoms such as depressed mood, irritability, and stress, and symptoms usually disappear with the onset of menstruation (Dilbaz & Aksan, 2021). PMS may lead to various biological and psychological changes in the body, negatively affecting body composition, general physical endurance, flexibility, endurance (Abedy et al., 2014) Studies have shown that regular exercise reduces the severity of PMS symptoms (Bağlan Yentür et al., 2024; ElDeeb et al., 2020; Jadhakhan et al., 2023; Oksuz & Unal, 2017; Yesildere Saglam & Orsal, 2020). There are a limited number of studies in the literature examining the effect of PMS on physical fitness parameters and kinesiophobia with clinical pilates-based exercise training. Due to the limited number of studies in the literature on individuals with PMS, it was aimed to investigate the effect of a clinical pilates-based exercise programme on functional fitness parameters, symptom severity, and kinesiophobia. Our study included 40 participants who applied to obstetrics and gynaecology outpatient clinic, were referred from Atlas University Hospital to us with a diagnosis of PMS, voluntarily accepted to participate in the study and met the inclusion criteria. Participants were randomised into two groups, clinical pilates and control. The study was conducted at Fizyotherapy Vadistanbul Clinic Pilates Wellness Center. Body composition of all participants was measured by 'waist circumference, hip circumference and waist/hip ratio measurement'; physical fitness parameters were measured by '6-minute walk test (6MWT)'; flexibility parameter was measured by 'Sit and Reach Test'; endurance parameter was assessed by 'Trunk Flexion, Lateral Bridge, Modified Biering-Sorensen, Prone Bridge' tests; PMS symptom severity was assessed by 'Premenstrual Syndrome Scale' (PMSS); kinesiophobia was assessed by 'Tampa Kinesiophobia Scale (TKS)'. In this 8-week study, clinical pilates and control groups were given recommendations to increase general well-being. In addition to these recommendations, participants in the clinical pilates group were given supervised clinical pilates-based exercise training for a total of 16 sessions, twice a week for 8 weeks, each session lasting 50 minutes, starting at the end of the menstrual cycle. All evaluations were repeated at the end of 8 weeks. SPSS v.26 program was used for data analysis. Shapiro-Wilk test was used to analyze whether the data showed normal distribution. The analysis of qualitative variables was interpreted with χ2-test. In intragroup comparisons in numerical data showing normal distribution: Paired Sample T-test and Independent Samples T-test was used for intergroup comparisons. For non-normally distributed or ordinal data, Wilcoxon test was used for intra-group comparisons and Mann Whitney U test for inter-group comparisons. Statistical significance level was accepted as p<0.05 for all analyzes. After 8 weeks of training, improvements in body composition, functional capacity, endurance, all sub-parameters and total score of PMSÖ and TQS were statistically significant only in the clinical pilates group compared to the control group (p<0.05). In both groups, statistically significant improvements were found only in the flexibility value (p<0.05). A statistically significant difference was found in the post-treatment flexibility difference value in the clinical pilates group compared to the control group (p<0.05). In conclusion; Pilates-based exercise training, which is suitable for individuals of all ages, offers a variety of exercises and increases the participation rate by increasing motivation, can be recommended as an approach that has the potential to manage physical and psychological symptoms, especially in the management of conditions such as PMS. We think that clinical pilates, which is a low-medium intensity and safe type of exercise shown in our study to have positive effects on both physical and mental health, will raise awareness about the possibility of choosing clinical pilates as an alternative exercise modality when creating individual rehabilitation programs. Keywords: Endurance, flexibility, physical fitness, functional capacity, kinesiophobia, clinical pilates, premenstrual syndrome, premenstrual symptom, body composition