Eyigor, S., Karapolat, H., Yesil, H., Uslu, R., & Durmaz, B. (2010). 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, 46, 481–487.

To investigate the impact of Pilates exercise on physical parameters, as well as on fatigue, depression and quality of life among women with breast cancer.

Patients selected for participation were randomly assigned to a home exercise program or to the hospital exercise program. Those in the hospital program performed Pilates exercise for one hour per day three times a week for eight weeks. All patients were given an instructional booklet showing pictures of the exercise program as well as information about lymphedema prevention and activities of daily living. All patients were instructed to perform these exercises once daily at home and to walking 20 to 30 minutes per day, three days a week. Assessments were performed prior to the intervention and eight weeks after the exercise program.

• The sample was comprised of 42 participants.
• Mean age was 49.13 years.
• All participants were female.
• Of the participants, 98% had a total mastectomy.
• There was an average of 38 months since diagnosis of breast cancer.
• All patients had completed treatment.
• Forty percent had adjuvant treatment.

• Single site
• Outpatient
• Turkey

The phase of care was late effects and survivorship.

This was a prospective, randomized two-group, pre-/post study.

• Six-minute walk test
• Modified sit-and-reach test (for flexibility)
• Brief Fatigue Inventory (BFI)
• Beck Depression Inventory (BDI)
• European Organization for Research and Treatment of Cancer QOL scale (EORTC) quality of life QOL scale
   

• Almost 50% of the initial sample assigned to home exercise failed to complete the study due to lack of interest, difficulty commuting to the hospital, or medical problems.
• The hospital exercise group showed significant improvement in the six-minute walk test (p = 0.00), depression scores (p = 0.01), and functional aspects on the QOL scale (p = 0.04).
• The only difference between groups was seen in the six-minute walk test, with hospital exercise patients showing improvement and others showing a decline.

Supervised Pilates exercise appears to have positive effects on depression and physical functioning. There was no effect seen on fatigue. A substantial number of those on a home exercise program failed to complete the study, and findings and comparisons are limited by the small sample size.

• The study had a small sample size, with less than 100 participants.
• Baseline sample/group differences were of import.
• The study had risks of bias due to no control group, no blinding, no appropriate attentional control condition, and the sample characteristics.
• The intervention was expensive, impractical, and required training.
• Only women with breast cancer were studied, so findings may not apply to other types of patients. The home exercise intervention was not well described, and apparently consisted of just the booklet and a recommendation to do exercises. The fact that so many patients in the home exercise did not complete the study raises the question of the practicality and ability to maintain patient interest in this approach. Patients in the hospital exercise group had higher baseline fatigue and depression scores and may have had greater opportunity for improvement. Patients in the hospital exercise group did this in a group setting; related social support may have influenced results.

This study provides some evidence that exercise can be of benefit to patients in managing depression. The study has multiple limitations.