Effect of Pilates Vs. Yoga on Balance, Cognition and Core Strength in Elderly

Changes in Skeletal Muscle

Reduction in performance of skeletal muscle is the significant factor of responsible factor of physical inability and progressive age. The reduced level of work done by skeletal muscle is in the form of sarcopenia [3]. Regulating factors of elderly skeletal muscle performance are nervous, muscular and skeletal systems [4]. Grossly, physiological and/ or anatomical degeneration will lead to decrease performance of skeletal muscle which are carried over by the way of living, biological and psychological elements [5].

Nervous system along with skeletal system controls more than 500 skeletal muscles [6]. The smallest functional unit of skeletal muscle fibre which goes under constant pumping which leads to movement of body like fast and powerful or small and time motions. Loss of sarcomere, difference in muscle fibre type and muscle atrophy, decreased level of activation of junction of nerve and muscle could affect the kinematics of muscle like velocity, force, strength of movement that ultimately leads to functional disability and hospitalization. Importance of maintaining muscle health throughout life truly depends on the metabolic functions and role of myokines [7].

Neuralogical Control of Muscles and Motion

Nervous system controls the largest movement and forces of human body skeletal muscle. The neural control of skeletal muscle goes as follows:

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Produces co – ordination, targeted movements [8].

Neurological Factors Responsible for Muscular Decline in Elderly

Motor neurons and muscle fibres are recruited more and more as the voluntary contraction force of muscle increases. Major factors of timing and strength of voluntary contractions comes from descending tract from motor cortex [9]. According to the previous studies, functionally healthy older adults usually will not lead difficulty in voluntary muscle activation and visa versa for the weaker older people [10, 11].

According to the prediction, amongst the total mass of people 22% are having old age than 60 years and 5 % will be counted of having old age till 2050 [12] in India due to improved quality of life and life expectancy the population ageing is showing an upward going and rising sharp graph [13]. As the age progresses, the population will have increased incidence of physical performance limitations. Those limitations leads to the risk of falls. So in today’s world prevention of limitations and treatment of physical performance improvement are very much important for public health benefits [4].

Ageing Muscle Morphology and Neurophysiological Manifestation

According to the figure showed below,

• Young adulthood shows the interconnected threads of

muscle which are part for varied motor units.

• Starting from adult life to elderly shows cycle of denervation – re innervation.
• Elderly is showing increased number of axonal ageing which eventually leads to grouped fibre atrophy [14].

Sensory and motor inputs contribute to declines in balance with age. Progressive decline in spinal motor neurons causes reduced in muscle fibre number and size i.e. sarcopenia, these results in reduced mechanical muscle performance, decreased muscle strength, power and force that eventually reduces functional capacity during everyday tasks due to the effects of ageing. Along with balance, strength, cerebellar integrity, Vestibulo – cochlear function, hearing and vision & proprioception all contributes for the falls in elderly [15].

Changes of ageing includes repeating cycles of denervation and re innervation which leads to grouping of fibre and extension of living MUs, neuronal loss, instable neuromuscular junction. Along with strength and power ageing also leads to impaired co – ordination that collectively cause falls and physical imperfection in performance [14].

All our systems, organs and tissues are all affected by the fundamental process of ageing. Total body decline is inevitable with ageing but it depends on person to person that at which rate and magnitude it makes changes in each system [16].

In older people, falls have become a major health issue. People aged 65and above are more prone for most frequent accidents which can lead to injury related hospitalisation. Disability, loss of independence and increased mortality are all associated with fall injuries [17]. A restricted activities related to daily life are the eventual results of falls in elderly are defined as a feeling of fear of fall. Fear of falling is multi factorial and multidimensional, which is widely accepted. Decreased functional capacity, impaired cognitive capacity and depression those all are responsible for feeling of fear of falling in both gender having old age [18].

Prevention of fall and assessment of balance training is helpful in counteracting the age related decline in function and aids in prolonging independence in elderly individuals [19]. Depending on the risk factors identifying and treating the reasons prevents the consequences of falls [20].

The complex interaction of neuromuscular, proprioceptive, vestibular and visual system is required for the ability to maintain balance in humans. And with ageing performance of many of these system declines gradually which results in impaired equilibrium and eventually progresses to risk of falling in elderly. Maintenance of balance and functional mobility in elderly is very important [20].

Many years ago an exercise was developed relayed on the eastern philosophical principle and motion technologies such as Yoga and western method of body conditioning such as P.H.ling’s medical gymnastics by JOSEPH PILATES (1880 – 1967). This method was developed for the core muscle which had more than 500 techniques of improving muscle flexibility and muscle strengthening exercise which is divided into two different categories: Mat pilates and pilates using Apparatus [21].

Pilates is kind of exercise that uses a combination of muscle that increases power, stretches muscle and also concentrate on breathing to develop strength of the trunk muscles and restore muscle balance for physical fitness. In Pilates one will have to activate several groups of muscles at the same time. This works on the co – activation and co - ordination of the muscles. Recent studies suggested that now a days Pilates exercise is used by many people of different age group, people having different body type and poeple having different level of physical ability because of flexibility of changes [22].

We can assume that Pilates is a different kind of physical movement that engages mind to focus on what the boding is doing. Which helps in increasing the cognitive functions? Researchers have found that when one has to think about how their body is moving, their brain cells grow at a faster rate and their nervous system creates better connections throughout the body.

Effect of Pilates on Cognitive Function:

• It helps in improving circulation and oxygenation in the brain
• Brain derived neutrophin supports neuronal survival in developing brain
• It provides mood enhancement
• Generates new neurons
• Increases neurotransmitters [23]

Yoga is considered as one of the complementary and alternative therapies which is more theorized as therapeutics than traditional exercise as it involves mind and body component. Yoga is active coordination of body and mind. Yoga focuses particularly on what is exactly happening in the body and how the body is actually being moved in the space which increases proprioception and consciousness. As yoga have gentle movements is can be addressed to prevent the risk of falls in persons having reduced balance, difficulty in mobility, decreased muscle strength and flexibility and it also focuses that how one can increase the awareness and proprioceptive function which can decrease the fear of fall and improve balance in elderly.

Exclusion Criteria

Any neurological disease and cardiovascular disease. Any psychiatric conditions, Malignancy, Medications known to effect muscle strength. Recent fractures. Any recent soft tissue injury.

Now they were divided into two groups, Pilates group and yoga group through sequential allocation. Participants were informed about the benefits and possible risk which mainly includes muscular soreness. Thus written consent was taken from all the subjects. Ethical approval was taken from institutional ethical; committee.

Baseline parameters for balance, cognition and core strength were assessed for all individuals by using berg balance scale, Montreal cognition scale and pressure biofeedback. Public garden at konkane chowk pimple saudagar area was use as a study setting where exercise was given to both the groups.

Participants of both the groups were called for exercise sessions for 4 weeks, 3 times a week for 45 min each session. Pilates and yoga both were practised using Mat. After completing the 4 week protocol the outcome measures were assessed again.

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Outcome Measures

Balance was measures using the berg balance scale. Cognition was measured using the Montreal cognition scale and the core strength was measured using the pressure biofeedback.

Statistical Analysis

The outcome measures were assessed and the values obtained were documented and tabulated for statistical analysis. Pre post assessment within group was done by paired t – test or wilcoxon test respective to the normality of the data. Pre post assessment between groups was done by using t – test or Man Whitney Rank sum test respective to the normality of data.

The outcome measure were assessed for both group A (Pilates) and group B (Yoga) all subjects were taken that is n = 11 each.

Data Analysis and Interpretation

Table 1 shows mean age of participants of both the groups. Graph 1b shows male and female ratio in Pilates and yoga groups. After applying t – test on mean age between groups (p = 0.801) were not found significant. Hence both the groups were comparable as the participants were of same age group.

Table 2 shows that there is marked increase in score of Montreal Cognition Assessment Scale in yoga group. While in Pilates group there is slight increase observed in Montreal Cognition Assessment Scale score.

Table 3 shows that there is marked increase in berg balance scale score in Pilates group while there is slight increase observed in yoga group in berg balance scale score.

Table 4 shows that there is marked improvement in both Pilates and yoga group in pressure biofeedback score.

Table 5 shows that in comparison between the groups for the Montreal Cognition Assessment Scale score there is marked increase in cognition score in yoga group. While in Pilates group there is slight increase observed in cognition.

Table 6 shows that in comparison between the groups for the berg balance scale score there is marked increase in balance score in Pilates group. While in yoga group slight increase was observed in cognition.

Table 7 shows that in comparison between the groups for the pressure biofeedback score there is marked improvement in the Pilates group. While in yoga group slight improvement was observed in core strength. Here the minus data indicates the improvement.