FE v19n5 artigo 8


Acute effects of Mat Pilates on ambulatory blood pressure variability in post menopause women

Efeito agudo do Mat Pilates sobre a variabilidade da pressão arterial ambulatorial em mulheres após a menopausa


Jaqueline Pontes Batista¹, Igor Moraes Mariano¹, Ana Luiza Amaral¹, Larissa Aparecida Santos Matias¹, Tállita Cristina Ferreira De Souza¹, Ana Paula Magalhães Resende¹, Guilherme Morais Puga¹


1Physical Education and Physical Therapy Department, Federal University of Uberlandia, Uberlândia/MG, Brazil


Received on: June 29; 2020; Accepted on: September 10, 2020.

Corresponding author: Prof. Guilherme Morais Puga, Faculdade de Educação Física e Fisioterapia, Universidade Federal de Uberlândia, Rua Benjamin Constant, 1286 Aparecida 38400-678 Uberlândia MG, Brazil


Jaqueline Pontes Batista: jaquebpontes@gmail.com

Igor Moraes Mariano: igormmariano@gmail.com

Ana Luiza Amaral: anaribeiro.am@gmail.com

Larissa Aparecida Santos Matias: larissa_matias02@hotmail.com

Tállita Cristina Ferreira de Souza: tallita_crystina@hotmail.com

Ana Paula Magalhães Resende: anapaulamrb@gmail.com

Guilherme Morais Puga: gmpuga@gmail.com



Background: After menopause, women increase the risk of developing cardiovascular disease. Physical exercise is one of the treatments for reducing the incidence of these diseases, and the Pilates method consists of a complete conditioning program. Aims: To verify the responses of Ambulatory Blood Pressure Monitoring (ABPM) and Blood Pressure Variability after a single session of Mat Pilates in non-obese post menopause women. Methods: This is a randomized crossover study with 15 normotensive postmenopausal women, who participated in a single Mat Pilates session and a control session. The Mat Pilates session lasted 50 minutes, with 5 minutes of warm-up. In each exercise, there was 1 set of 10 repetitions with 45 seconds of rest between sets. The control session should have the same duration, but the volunteers remained seated. ABPM was assessed for 24 hours after the intervention. Statistical analysis: Two-way ANOVA with Newman-Keuls post hoc was used to analyze ABPM variables and Student's t test for analysis of blood pressure variability. Results: There was no significant difference (p < 0.05) in systolic blood pressure nor diastolic blood pressure responses during 24h, awake and sleep phases and in its variability between Pilates and Control sessions. Conclusion: Acute Mat Pilates did not reduce ABPM or its variability in non-obese postmenopausal women.

Keywords: menopause, arterial pressure, exercise therapy.



Introdução: Após a menopausa mulheres tem maior risco de desenvolver doenças cardiovasculares. A prática de exercício físico é um dos tratamentos para e redução da incidência dessas doenças, e o método Pilates consiste em um programa completo de condicionamento físico. Objetivos: Verificar as respostas da Monitorização Ambulatorial da Pressão Arterial (MAPA) e da Variabilidade da Pressão Arterial após uma única sessão de Mat Pilates em mulheres após a menopausa não obesas. Métodos: Este é um estudo cruzado randomizado com 15 mulheres pós-menopáusicas normotensas, que participaram de uma única sessão de Mat Pilates e de uma sessão de controle. A sessão de Pilates durou 50 minutos, com 5 minutos de aquecimento. Em cada exercício, houve 1 série de 10 repetições com 45 segundos de descanso entre as séries. A sessão controle teve a mesma duração, mas as voluntárias permaneciam sentadas. A MAPA foi avaliada durante 24 horas após a intervenção. Estatística: Utilizou-se ANOVA de dois fatores com post hoc de Newman-Keuls para análise das variáveis da MAPA e teste t de Student para análise da variabilidade de pressão arterial. Resultados: Não houve diferença significativa (p <0,05) nas respostas da pressão arterial sistólica e diastólica durante 24h, vigília e sono ou em sua variabilidade entre as sessões de Pilates e Controle. Conclusão: O Mat Pilates não reduziu os valores pressóricos da MAPA ou sua variabilidade em mulheres após a menopausa não obesas.

Palavras-chave: menopausa, pressão arterial, terapia por exercício.




Aging is one of the risk factors for cardiovascular diseases development, especially hypertension (HT) [1]. When comparing HT prevalence between sexes, it is observed that men have greater presence of HT, but after menopause, this prevalence becomes higher in women [2]. The lack of estrogen production, changes in the lipid profile and social factors, which make women become more sedentary [3], generate physiological dysregulations after menopause and therefore may explain this inversion of prevalence.

Among the strategies for treatment and prevention of cardiovascular diseases, the practice of physical exercise is noteworthy. These are responsible for several hemodynamic responses, including reducing blood pressure (BP) after a single session of different exercises (i.e. post exercise hypotension; PEH), both in normotensive and hypertensive individuals [4]. Among the resistance exercises, the Pilates method stands out for the great adherence, especially of middle age women [5].

Pilates method is a complete conditioning program, which aims to work out strength, flexibility and balance [6]. Thus, this method has six essential principles: concentration, control, precision, movement fluidity, breathing control and use of the strength core [7]. Although Joseph Pilates (the creator of the method) and Miller affirm that this method is capable to improve the cardiovascular system [6], few are the studies that demonstrate this [8,9].

In this sense, one of the methods used to evaluate cardiovascular responses to exercise is ambulatory blood pressure monitoring (ABPM). Through this evaluation it is possible to check BP for 24 hours after a physical exercise session [10], making it possible to analyze how these values vary (i.e. blood pressure variability; BPV) [11]. Thus, we have as primary objective to test the hypothesis that a session of Mat Pilates can alter the pressure values of ABPM and secondary, to test the BPV in normotensive post menopause women.




Study design


This is a randomized cross-over study with normotensive postmenopausal women. As inclusion criteria, participants were required to be: in post menopause (amenorrhea for at least 12 months and [FSH] > 40 mUI/mL); aged between 50 and 70 years for being the age group in which menopause occurs, and able to perform exercises, since our study evaluates variables after a successful exercise protocol. The study did not include women under hormonal therapy, since the use of these drugs generates physiological variables that we will not analyze; that have history of stroke or acute myocardial infarction, or have diagnosis of diabetes mellitus, and smokers as a way of standardizing the sample. All participants went through a medical evaluation before the intervention, obtaining a certificate to attest individual suitability for exercise practice. Exclusion criteria was applied to volunteers who failed to perform the protocol test and volunteers in which the ABPM presented more than 25% of error. Table I presents the general characteristics of the sample.


Table I - General characteristics (n = 15).


SBP = Systolic blood pressure; DBP = Diastolic blood pressure; HR = Heart Rate.


Before the body composition measurement, all participants were instructed not to perform vigorous physical exercise 24h before the test and to avoid alcohol and caffeine consumption 72h before the test. Regarding the order of execution of the experiment, a simple randomization was performed using a program on the web (https://www.random.org/lists/). The volunteers were randomly selected to know the order of execution, being an acute Mat Pilates session and a control session. The evaluations were carried out in the morning, respecting less than 48 hours between them.

The study was conducted between January and June of 2016, at the Laboratory of Cardiorespiratory and Metabolic Physiology of the Federal University of Uberlândia, Uberlândia/MG, Brazil. It was approved by the local Ethics Committee (002095/2015) and all volunteers assign a consent term.

At the first visit, an anamnesis was performed followed by anthropometric assessments. On the second visit the familiarization with the method was carried out, followed by an explanatory lecture about the six principles of Pilates. On Pilates session, volunteers arrived at the site at 07:00 am and remained in seated position for 20 minutes to assess BP at rest. The exercise protocol was then performed for 50 minutes and soon after the ABPM device was placed on the volunteer's non-dominant arm, being withdrawn 24 hours later. On control session, the same process was performed, but without the exercise protocol, being that the volunteers performed the same exams, however, they sat at rest for 50 minutes, not performing any type of exercise. All participants were instructed to maintain their living habits, including feeding, and not to perform vigorous activities within 48 hours prior to the sessions.


Experimental sessions


The control session lasted 50 minutes. The volunteers were seated, being able to perform some quiet activity, such as conversations, reading books or magazines and even using their cell phones.

The Mat Pilates session lasted 50 minutes, with 5 minutes of warm-up. In each exercise there was 1 set of 10 repetitions with 45 seconds of rest between then. Was used only body weight and auxiliary materials, such as mats, swiss ball and flexible ring, in addition we use the rate of perceived exertion scale (RPE) for intensity control, the session was performed in RPE between 11-14, regarding moderate exercise intensity [12]. Twenty exercises were chosen from the classics, classified as such by the method creator [6], and are described in detail in the supplementary table. During the sessions, the volunteers were instructed not to perform the Valsalva maneuver.


Baseline characteristics


Baseline BP and heart rate (HR) were monitored through calibrated and validated automatic oscillometric monitors (Omron HEM-7113, Shimogyo-ku, Kyoto, Japan) in 3 non-consecutive days. At each time frame, 3 measurements of systolic BP (SBP), diastolic BP (DBP), mean BP (MBP) and HR were performed and considered the mean for analysis. The anthropometric evaluations were performed in an isolated environment during the morning. The following variables were evaluated: body mass, through an electronic scale (Filizola, São Paulo, SP, Brazil); height, measured with a fixed stadiometer (Sanny, São Bernardo do Campo, SP, Brazil) and waist and hip circumferences, through an inelastic tape 0.5 cm wide (Filizola, São Paulo, SP, Brazil).


Ambulatorial Blood Pressure Monitoring


To evaluated SBP, DBP and HR in 24-hour, wake and sleep phases, the Dyna-MAPA+ device (Cardios, São Paulo/SP, Brazil) was used. This device took measurements every 15 minutes from 07:00am to 11:00pm and every 30 minutes from 11:00pm to 07:00am. The device was placed shortly after the end of the experimental sessions. Through 24 hours recording, the mean BP values were calculated every two hours for point-to-point analysis. From the information reported in an events diary in which volunteers indicated the moment they slept and woke up during the use of the device, the values of the 24h, wake and sleep phases were performed. Through ABPM records, BPV was evaluated through the indices: SD24 (mean of 24-hour standard deviations), SDdn (mean values of diurnal and nocturnal standard deviations corrected for the number of hours included in each phase) and ARV (mean differences weighted by the time interval between consecutive readings).


Statistical analysis


The sample size (n = 15) was calculated using G*Power 3.1 (α = 0.05; power = 0.80; effect size = 0.7). This effect size was calculated from the average difference in systolic hypotension between the Pilates and control sessions, considered as 3.3±3.6 mmHg [13]. Since we did not find studies with Pilates and 24-hour measurements, the effect size found (ES = 0.91) was reduced to 0.7 to suit a more pessimistic situation with 24-hour measurements. The descriptive results are presented in mean ± standard deviation. The Shapiro-Wilk test was applied to verify data normality. The two-way ANOVA for repeated measurements was used to compare the sessions in 24-hour, sleep and wake phases, as well as every two hours in ABPM. The Newman-Keuls post hoc was applied when necessary. For BPV analysis, the Student t-test was applied. All analyzes were performed using the software Statistica 10.0 (TIBCO Software Inc., Palo Alto, CA, USA), adopting a level of significance of p < 0.05.




After we recruited twenty women that fit in the inclusion criteria, five volunteers did not agree to participate, and fifteen non-obese postmenopausal women finished all the sessions. Figure 1 shows the results of ABPM from all women. There were no differences in SBP, DBP and MBP responses during total 24 hours, awake and sleep phases between sessions. Figure 2 shows SBP, DBP and MBP responses over time (every 2 hours). Statistical analysis showed no significant difference between the Mat Pilates and control sessions. Additionally, table II shows BPV variables (SD24, SDdn and ARV) from SBP, DBP and MBP, and t student test did not show significant differences between sessions.



SBP = Systolic blood pressure; DBP = Diastolic blood pressure; MBP = Mean blood pressure. Statistical difference by two-way ANOVA.

Figure 1 - Systolic, diastolic and mean blood pressure during the 24 hours, sleep and wake phases.



SBP = Systolic blood pressure; DBP = Diastolic blood pressure; MBP = Mean blood pressure. Statistical difference by two-way ANOVA.

Figure 2 - Systolic, diastolic and mean blood pressure every two hours, for 24 hours.


Table II - Blood pressure variability.


SD = Standard deviation; CI = Confidence interval; SBP = Systolic blood pressure; DBP = Diastolic blood pressure; MBP = Mean blood pressure; SD24 = mean of 24 hours standard deviations; SDdn = mean of day and night standard deviation corrected for the number of hours included in each phase; ARV = mean differences weighted by the tine interval between consecutive readings. Statistical difference by Student t-test.




The current study indicated that a single session of Mat Pilates did not change ambulatory BP responses during 24 hours after its performance in non-obese postmenopausal women. Moreover, this exercise did not change BPV during this period in these population.

Blood pressure analyzes after physical exercise have been studied in the last decades, and BP reductions after a single exercise session were observed in both high cardiometabolic risk [14] and healthy populations [4,15]. When comparing BP responses between different types of exercise, aerobic exercise seems to be more effective in promoting BP reductions, either in 24-hour, awake or sleep phases [10], but that are still little explored after Pilates performance. Thus, to our knowledge, the present study was the first to investigate BP responses through ABPM in postmenopausal women after a Mat Pilates session. Therefore, despite having a relatively small sample size, but which is in accordance with the sample calculation and similar studies, it has clinical relevance, since this is a population predisposed to develop cardiovascular diseases [1], and who is also the one who most seeks the practice of the Pilates for treatment or prevention of various diseases [5].

In this sense, a review [16] about Pilates in hypertensive patients suggested that the benefits of this method are like traditional isometric exercises in BP reduction, since they are widely used in Pilates. They also suggest that this type of resistance training is more attractive to practitioners than usual weightlifting training, thus increasing adherence to physical exercise. This characteristic gains great importance in hypertensive patients due to the low adherence to the drug treatment [17], being that the use of non-pharmacological strategies as a form of antihypertensive treatment has become one of the main demands of patients, caregivers and health professionals [18].

However, when analyzing a single session of Pilates, hypotensive responses do not look promising in healthy populations. In studies similar to the present study, with normotensive women after menopause [19], young men [13] or women already trained in the modality, mostly normotensive [20], demonstrated that there was no hypotensive effect of a single Pilates session when comparing to the control in the first 60 minutes post exercise. This result is maintained even though it has increased the bioavailability of salivary nitrite (nitric oxide precursor, a potent vasodilator) [19]. On the other hand, a study with hypertensive patients [21] demonstrated SBP and MBP falls between 5 and 8 mmHg, 60 minutes after the Pilates session compared to the control. Is important to note that these studies, monitored the BP responses for a short period of time (around 60 minutes) and not during 24h as our study.

Although in normotensive patients Pilates does not appear to be effective in promoting BP responses acutely, studies with chronic interventions [8,9] have also been investigating this phenomenon and found promising cardiovascular outcomes, mainly fall in resting SBP [8]. However, clinical trials are still quite conflicting. For example, SBP falls were found after Mat Pilates training phase in young women [7] and in elderly women [8]. On the other hand, in another study [22], it was found that 20 sessions of Pilates are not able to decrease BP in sedentary young women.

Besides the direct benefits in BP, there is evidence that the practice of Pilates can bring benefits to body composition [23], lipids profile [24], fasting glucose [25], bioavailability of salivary nitrite [19] and symptoms of anxiety and depression [26]. These data may suggest indirect control of BP in long term, by reduction of associated factors.

In addition to BP values being important predictors of cardiovascular risk, the way these values fluctuate during the day (i.e. BPV) are also important to identify low risks of cardiovascular diseases [27]. Although the practice of regular exercise has an apparent correlation with lower values of BPV [28], in the present study we did not find differences in any BPV index after Mat Pilates performance. These results corroborate with several exercise studies with healthy men and women with same age [29-31]. However, it is worth mentioning that these studies analyzed chronic effects of exercise and most of them intervened with aerobic exercises [29-31], some with dynamic resistance [32] or isometric [33], but we do not know about these variables after Pilates training.

It is also worth mentioning that the characteristics of exercise can influence these responses. In the present study, the intensity of exercise was moderate (RPE between 11 and 14) and duration of 50 minutes, and no BP reduction after the exercise performance was evidenced. In this sense, although some studies show that exercise intensity does not influence the hypotensive response of exercise [34], others demonstrate that exercise intensity may influence the duration of such response [35,36], just as the magnitude may be dependent on the duration of the exercise [37]. In addition, this relationship with intensity and duration of training also seems to influence the responses of BPV [38]. It is important to note that it is not easy to control the exercise intensity during Mat Pilates performance due the characteristics of the mixed movements (aerobic, resistance and isometric) when compare with the performance of only aerobic (running, jogging or walking) or resistance exercise for example.

Another interesting point is that, in general, Pilates proves to be quite safe for practice, since it causes minor changes in HR, SBP and Double product during exercise [13,39]. In addition, the parasympathetic parameters of heart rate variability do not change after a Pilates session in a normotensive population [19]. These results may suggest a low degree of autonomic stress post Pilates session in this population, whereas traditional resistance exercise seems to generate the highest post-exercise autonomic stress [15,19]. However, in hypertensive patients these values were altered [21].

Finally, an important characteristic of this population that might have limited the occurrence of PEH is the resting BP value, since baseline BP was normal, which prevents a large magnitude of BP falls, but which may be different in hypertensive patients [40]. In this sense, in populations with cardiometabolic dysfunctions the results in BPV after exercise also seem to be promising [41], which may suggest a more interesting regulatory effect in this type of population, but which are still little studied after Pilates training. These differences may occur due to compensatory mechanisms, such as the baroreflex, which prevent large magnitude in hypotension in normotensive individuals [40]. It is worth mentioning that the present study did not evaluate those mechanisms associated with variations in BP or BPV, as it was not proposed for this analysis.

Considering the above mentioned, this study has clinical relevance since it provides an alternative to traditional exercises when trying to understand the responses in women's BP after menopause to the Pilates method. In addition, this study will be the basis for possible future studies with hypertensive women, since we verified the safety of the method session in the cardiovascular system in women without the disease. Thus, more studies are needed to investigate the physiological mechanisms using different devices of Pilates Methods. In addition, for the best application in clinical practice, it is necessary to conduct investigations on chronic responses to Pilates training and in hypertensive individuals.




Based on our results we conclude that a single session of Mat Pilates does not change post-exercise ambulatory blood pressure responses nor blood pressure variability during 24 hours in non-obese post-menopausal women.


Disclosure of potential conflicts of interest


All authors declare no conflicts of interest.




This study was funded by the Minas Gerais State Research Foundation (FAPEMIG) (APQ-00750-14) and the National Council for Scientific and Technological Development – CNPq (456443/2014-2) e CNPq (794078/2013).


Authors contribution


Conception and design of the research: JP Batista, LAS Matias, TCF de Souza, APM Resende and GM Puga; Obtaining data: JP Batista, IM Mariano, AL Amaral, LAS Matias, TCF de Souza, APM Resende and GM Puga; Analysis and interpretation of data: JP Batista, IM Mariano, AL Amaral, LAS Matias, TCF de Souza, APM Resende and GM Puga; Statistical analysis: JP Batista and IM Mariano; Obtaining financing: JP Batista, GM Puga; Writing of the manuscript: JP Batista, IM Mariano, AL Amaral, LAS Matias, TCF de Souza; Critical review of the manuscript for important intellectual content: APM Resende, GM Puga.


Academic linkage


This article represents part of the master's dissertation of Jaqueline Pontes Batista, supervised by Professor Guilherme Morais Puga at the Federal University of Uberlândia, Postgraduate Program in Health Sciences - FAMED-UFU, Uberlândia, MG.




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Supplementary table I - Pilates exercise program.




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