Effects of Clinical Pilates Exercises on Symptoms, Posture, Balance and Quality of Life in GERD

The Effect of Clinical Pilates Exercises on Symptoms, Posture, Balance and Quality of Life in Individuals With Gastroesophageal Reflux Disease

This randomized, single-blind, parallel-group clinical trial investigates whether a six-week supervised clinical Pilates exercise program improves reflux symptom severity, postural alignment, dynamic balance, sleep quality, depressive symptoms, anthropometric measures, and overall health-related quality of life in adults with gastroesophageal reflux disease (GERD). Participants attended 18 face-to-face sessions over 6 weeks (3 times/week) under physiotherapist supervision. Outcomes included reflux symptom scores (GERD-Q, FSSG), health-related quality of life (SF-36), sleep quality (Pittsburgh Sleep Quality Index), depression (Beck Depression Inventory), postural alignment (PostureScreen Mobile), dynamic balance (Y-Balance Test), and anthropometric circumferences (chest, sub-sternal, waist).

Design: randomized controlled, single-blind, parallel-group trial conducted at Istinye University Physiotherapy and Rehabilitation Application and Research Center (FIZYOTEM). Eligible adults (18-65 years) with a clinically confirmed diagnosis of gastroesophageal reflux disease and self-reported GERD symptoms for at least three months, who were physiologically able to participate in low-to-moderate intensity exercise, were enrolled. Allocation followed a computer-generated random sequence with concealed assignment to: (1) Clinical Pilates Group (PG): a progressive, posture-focused clinical Pilates program performed exclusively in the standing position to minimize intra-abdominal pressure, with no anterior trunk flexion or direct abdominal compression; (2) Control Group (CG): usual daily activity with no exercise intervention. The Pilates group completed 18 supervised face-to-face sessions across 6 weeks (3 sessions/week). Each session included a ~10-minute warm-up (Cleopatra, upper-extremity PNF patterns, Toy Soldier, Corkscrew, Chest Stretch), a main phase (Tic-Toc Arm Float, Bow & Arrow, Spine Twist, Footwork, Knee Lift & Aeroplane, Plié - Second to First - Moving Balance, Balance, Balance Plié with Arms), and a 5-10-minute cool-down/stretching phase. Progression across the 6 weeks was achieved by increasing repetitions (5 → 10) and active duration (5 s → 10 s → 15 s) while maintaining one set per exercise and a 30-second rest interval. To minimize gastric distension, sessions were scheduled at least 2 hours after a main meal or at least 30 minutes before eating. Assessments were performed pre- and post-intervention in fixed order with rest intervals. Reflux symptom severity was quantified using the Gastroesophageal Reflux Disease Questionnaire (GERD-Q) and the Frequency Scale for the Symptoms of GERD (FSSG). Health-related quality of life was assessed with the Short Form-36 (SF-36); sleep quality with the Pittsburgh Sleep Quality Index (PSQI); depressive symptoms with the Beck Depression Inventory (BDI). Postural alignment was analyzed using the PostureScreen Mobile application (anterior, posterior, right and left lateral views; sagittal and frontal translations and angulations). Dynamic balance was measured with the Y-Balance Test (anterior, posteromedial, posterolateral reach, bilateral). Anthropometric circumferences (chest, sub-sternal, waist) were measured with a standard tape. Statistical plan: distribution evaluated with the Shapiro-Wilk test; within-group changes assessed using paired-samples t-test or Wilcoxon signed-rank test as appropriate; between-group comparisons using independent-samples t-test or Mann-Whitney U test; categorical variables with chi-square test. Analyses were performed in IBM SPSS Statistics v25.0 with a two-tailed alpha of 0.05. Sample size was estimated a priori (G*Power 3.1) for a moderate effect (d=0.6), α=0.05, power=0.80, yielding 19 participants per group; post-hoc power for the primary outcome (GERD-Q) reached 0.96 (d=1.37). No external funding; no conflicts declared.

Inclusion Criteria:

• Age 18-65 years.
• Clinically confirmed diagnosis of gastroesophageal reflux disease (GERD).
• Self-reported GERD symptoms (heartburn, acid regurgitation, etc.) for at least 3 months prior to enrollment.
• Physiologically able to participate in low-to-moderate intensity exercise.
• Provision of written informed consent.
• Cognitive and psychosocial capacity to comply with the program.

Exclusion Criteria:

• History of upper gastrointestinal surgery (especially fundoplication).
• Achalasia or severe esophageal motility disorder.
• Endoscopic evidence of advanced esophagitis, Barrett's esophagus, or esophageal stricture (complicated GERD).
• Active peptic ulcer disease or inflammatory bowel disease.
• Uncontrolled hypertension, coronary artery disease, or severe pulmonary disease.
• Severe musculoskeletal disorders (advanced scoliosis/kyphosis, acute disc herniation, severe osteoarthritis) or vestibular balance disorders.
• Pregnancy or suspected pregnancy.