Efficacy of Pilates in Functional Body Composition: A Systematic Review
, Gonçalo Dias 1,2,3,4, Rodrigo Mendes 2,5, Rui Sousa Mendes 2,3,4, Fernando Martins 2,3,5, Ricardo Gomes 2,3,4, José Gama 4, Maria António Castro 6,7 and Vasco Vaz 1,4
Round 1
Reviewer 1 Report
The subject matter is very appropriate, since the practice of Pilates by sedentary adults who are starting to practice physical activity is very common and it is very important to analyse the reasons for the practice of this type of activity.
INTRODUCTION
The introduction is very correct and appropriate. It perfectly justifies the reason for carrying out this research, supported by high quality current references.
MATERIALS AND METHODS
It expresses in a very clear and concise way the methodology used for this work, being very adequate and objective.
RESULTS
They highlight recent articles, from the last few years, based on the best existing databases. They clearly explain the most important aspects of each of them.
DISCUSSION AND CONCLUSIONS
A good comparison of the results obtained in the different studies is made and very good and appropriate conclusions are drawn.
Author Response
Reviewer 1
The subject matter is very appropriate, since the practice of Pilates by sedentary adults who are starting to practice physical activity is very common and it is very important to analyse the reasons for the practice of this type of activity.
INTRODUCTION
The introduction is very correct and appropriate. It perfectly justifies the reason for carrying out this research, supported by high quality current references.
MATERIALS AND METHODS
It expresses in a very clear and concise way the methodology used for this work, being very adequate and objective.
RESULTS
They highlight recent articles, from the last few years, based on the best existing databases. They clearly explain the most important aspects of each of them.
DISCUSSION AND CONCLUSIONS
A good comparison of the results obtained in the different studies is made and very good and appropriate conclusions are drawn.
R: Thank you very much for your consideration. We greatly appreciate the comments about the paper, which were relevant and enriching.
Mário Pereira and Colleagues
Author Response File: 
Author Response.pdf
Reviewer 2 Report
applsci-1813669
Thank you for giving me the opportunity to review this interesting manuscript entitled “Efficacy of Pilates in Functional Body Composition », which reviewed the last five years results of studies concerning the influence of pilates method on the functional body composition.
The topic is relevant, and the study can contribute to the extant literature providing new theoretical insights and will interest people in the discipline.
I would like to make some suggestions that should be considered by the authors in order, in my opinion, to improve the quality of the manuscript.
Major
The introduction is too short. More relevant references are needed:
Cavina, A., Pizzo Junior, E., Machado, A. F., Biral, T. M., Lemos, L. K., Rodrigues, C., Pastre, C. M., & Vanderlei, F. M. (2020). Effects of the Mat Pilates Method on Body Composition: Systematic Review With Meta-Analysis. Journal of physical activity & health, 17(6), 673–681. https://doi.org/10.1123/jpah.2019-0171
Fernández-Rodríguez, R., Álvarez-Bueno, C., Ferri-Morales, A., Torres-Costoso, A. I., Cavero-Redondo, I., & Martínez-Vizcaíno, V. (2019). Pilates Method Improves Cardiorespiratory Fitness: A Systematic Review and Meta-Analysis. Journal of clinical medicine, 8(11), 1761. https://doi.org/10.3390/jcm8111761
Fleming, K. M., & Herring, M. P. (2018). The effects of pilates on mental health outcomes: A meta-analysis of controlled trials. Complementary therapies in medicine, 37, 80–95. https://doi.org/10.1016/j.ctim.2018.02.003
Patti, A., Zangla, D., Sahin, F. N., Cataldi, S., Lavanco, G., Palma, A., & Fischietti, F. (2021). Physical exercise and prevention of falls. Effects of a Pilates training method compared with a general physical activity program: A randomized controlled trial. Medicine, 100(13), e25289. https://doi.org/10.1097/MD.0000000000025289
Vancini, R. L., Rayes, A., Lira, C., Sarro, K. J., & Andrade, M. S. (2017). Pilates and aerobic training improve levels of depression, anxiety and quality of life in overweight and obese individuals. Arquivos de neuro-psiquiatria, 75(12), 850–857. https://doi.org/10.1590/0004-282X20170149
I would strongly advise the authors of this paper to rewrite their introduction to produce a more contextualised introduction toward a clear purpose. Indeed, the authors must justify what differentiates this review from other previous reviews (e.g., Cavina et al?n 2019; Casonato et al., 2021; Vancini et al., 2017…)
The fact that the covering period was limited to 5 five years is a limitation of this study. This point must be justified in the introduction (and not only methods) and evoked as a limitation because it can explain why only a trend was obtained concerning the results.
The fact that relevant databases (e.g., Pub med and Google Scholar) were not included is another important limitation.
Quality ratings must be included.
The results provide a descriptive summary of the research, rather than advancing knowledge or offering insights in the effect of pilates method on the functional body composition.
The authors could consider another way of analysing the findings of the studies, such as a meta-analysis (see Fernández-Rodríguez et al., 2019). Another way of analysing the results might allow novel findings to emerge. However, it will need a significant revision and the authors will benefit from reading some of literature on how to conduct a systematic review such as Booth et al. (2016), Gough et al. (2016), and Tod (2019).
References
Booth, A., Sutton, A., & Papaioannou, D. (2016). Systematic approaches to a successful literature review. Sage.
D. Gough, S. Oliver, & J. Thomas (Eds.), An introduction to systematic reviews (pp. 43-70). Sage.
Tod, D. (2019). Conducting systematic reviews in sport, exercise, and physical activity. Palgrave Macmillan.
A limitation part is needed at the end of the “Discussion”.
Minor
The Acronym BW must be defined in the introduction, (even if it was defined in the abstract). (page 2)
More precision is needed in the first paragraph page 2(e.g., obesity, overweight).
The Acronym FBC must be defined in the introduction, (even if it was defined in the abstract). (page 2)
Transitions are needed between the different parts of the introduction.
The Acronym BC must be defined in the introduction, (even if it was defined in the abstract). (page 2)
The authors must justify the choice of using a very short covering period.
The aim and objectives must be clearly evoked at the end of the introduction.
Materials and Methods:
Why did the authors do not included Pub med and Google Scholar databases?
The justification concerning the use of a small time lapse (i.e., “between 1st of January of 2017 until 31st of December of 2021” “ This period was chosen due to the increase of studies about Pilates in the last 10 years [10] and the need to update and systematize the studies carried out in the last five years” is not enough to justify the study. Similar previous work (review) used larger samples.
Figure 1: please check for the typo.
Eligibility criteria and exclusion should be added in the figure for better clarity.
While no meta-analysis has been conducted, the authors could strengthen the review by making clear how they considered the quality ratings in their analyses/ review.
A result part with description/comparison and percentage is needed.
The authors could also consider another way of analysing the findings of the studies, such as a meta-analysis.
Discussion
“Obesity” must be defined earlier in the manuscript (introduction part).
The discussion is confused and some times not easy to follow. More transition is needed between the paragraphs. The discussion should not be a series of paragraphs but should follow a common thread. It could possibly include sub-parts with titles.
All the acronyms must be defined for better clarity and comprehension.
Table 7 is very interesting but it must be included in a “Results” part and not in “Discussion”.
References: The references must follow the guideline.
Author Response
Reviewer 2
Thank you for giving me the opportunity to review this interesting manuscript entitled “Efficacy of Pilates in Functional Body Composition”, which reviewed the last five years results of studies concerning the influence of Pilates method on the functional body composition.
The topic is relevant, and the study can contribute to the extant literature providing new theoretical insights and will interest people in the discipline.
I would like to make some suggestions that should be considered by the authors in order, in my opinion, to improve the quality of the manuscript.
Major
The introduction is too short. More relevant references are needed:
Cavina, A., Pizzo Junior, E., Machado, A. F., Biral, T. M., Lemos, L. K., Rodrigues, C., Pastre, C. M., & Vanderlei, F. M. (2020). Effects of the Mat Pilates Method on Body Composition: Systematic Review With Meta-Analysis. Journal of physical activity & health, 17(6), 673–681. https://doi.org/10.1123/jpah.2019-0171
Included: please, see line 86 and 240
Fernández-Rodríguez, R., Álvarez-Bueno, C., Ferri-Morales, A., Torres-Costoso, A. I., Cavero-Redondo, I., & Martínez-Vizcaíno, V. (2019). Pilates Method Improves Cardiorespiratory Fitness: A Systematic Review and Meta-Analysis. Journal of clinical medicine, 8(11), 1761. https://doi.org/10.3390/jcm8111761
Included: please, see line 83
Fleming, K. M., & Herring, M. P. (2018). The effects of pilates on mental health outcomes: A meta-analysis of controlled trials. Complementary therapies in medicine, 37, 80–95. https://doi.org/10.1016/j.ctim.2018.02.003
Included: please, see line 407
Patti, A., Zangla, D., Sahin, F. N., Cataldi, S., Lavanco, G., Palma, A., & Fischietti, F. (2021). Physical exercise and prevention of falls. Effects of a Pilates training method compared with a general physical activity program: A randomized controlled trial. Medicine, 100(13), e25289. https://doi.org/10.1097/MD.0000000000025289
Included: please, see line 81
Vancini, R. L., Rayes, A., Lira, C., Sarro, K. J., & Andrade, M. S. (2017). Pilates and aerobic training improve levels of depression, anxiety and quality of life in overweight and obese individuals. Arquivos de neuro-psiquiatria, 75(12), 850–857. https://doi.org/10.1590/0004-282X20170149
Included: please, see line 394
I would strongly advise the authors of this paper to rewrite their introduction to produce a more contextualised introduction toward a clear purpose. Indeed, the authors must justify what differentiates this review from other previous reviews (e.g., Cavina et al., 2019; Casonato et al., 2021; Vancini et al., 2017…)
R: Thank you very much for your suggestions. We added the highlighted text in lines 49; line 57 and lines 85-93. In addition, we emphasize that the studies proposed by the reviewer, which we are very grateful for, are now included and are also added in the references.
The fact that the covering period was limited to 5 five years is a limitation of this study. This point must be justified in the introduction (and not only methods) and evoked as a limitation because it can explain why only a trend was obtained concerning the results.
R: Thank you very much for your suggestions. Assuming the broader, but relatively innovative, concept of the FBC, we find the justification for an update of previously carried out revisions. Thus, we added the highlighted text (Please, see line 85).
The fact that relevant databases (e.g., PubMed and Google Scholar) were not included is another important limitation.
R: Thank you very much for your suggestion. We added this limitation (Please, see line 380). We emphasize that we carried out a search at EBSCO Discery Services and also included in this systematic review the Web of Science Core Collection search, which includes the MEDLINE database, which, in addition to expanding the spectrum of research, is on a large scale, coinciding with the PUBMED database.
Quality ratings must be included.
R: Thank you very much for your suggestion. We chose not to carry out the quality assessments, knowing the low/medium average of the quality of the Pilates studies presented in other systematic reviews and meta-analyses on this or others Pilates issues (c.f. Cavina et al., 2020 and Ganesan et al., 2020). In addition, the low number of studies in each parameter of the FBC did not allow for more powerful statistical procedures, taking, in our opinion, priority in the use of this tool for the analysis of eligible studies.
References: Kavitha Ganesan, Kumaresan A., Prathap Suganthirababu. Effects of Pilates exercise on balance in stroke: A systematic review. Biomedicine [Internet]. 2020Nov.11 [cited 2022Jul.21];40(1):20-4. Available from: https://biomedicineonline.org/index.php/home/article/view/93
The results provide a descriptive summary of the research, rather than advancing knowledge or offering insights in the effect of Pilates method on the functional body composition.
R: Thank you very much for your suggestions. The reviewer is indeed right and his proposal deserves to be further investigated in future research. It should be noted that this systematic review includes the main outputs, in a summarized way, of the studies that were analyzed. In fact, it is necessary, in laboratory research work and in real teaching-learning situations, to deepen these knowledge and insights to better understand the effect of the Pilates method on the functional body composition. In this way, we improved the results text at the end of each table (Please, see line 153: “We stand out the efficiency of Pilates practice in terms of related FBC matters and the relative short period of 4 weeks to feel these effects.”).
The authors could consider another way of analysing the findings of the studies, such as a meta-analysis (see Fernández-Rodríguez et al., 2019). Another way of analysing the results might allow novel findings to emerge. However, it will need a significant revision and the authors will benefit from reading some of literature on how to conduct a systematic review such as Booth et al. (2016), Gough et al. (2016), and Tod (2019).
References
Booth, A., Sutton, A., & Papaioannou, D. (2016). Systematic approaches to a successful literature review. Sage.
D. Gough, S. Oliver, & J. Thomas (Eds.), An introduction to systematic reviews (pp. 43-70). Sage.
Tod, D. (2019). Conducting systematic reviews in sport, exercise, and physical activity. Palgrave Macmillan.
R: Thank you very much for your suggestion. We take the option to present the Table 7 (Please see line 210), according to Boon, H.M.; Thomson, H. (2018): Effect direction in synthesis without meta-analysis: application of Cochrane Handbook of Systematic Reviews of Interventions 2018 guidance, to avoid limitation of meta-analysis with a small number of studies (Please, see line 213).
A limitation part is needed at the end of the “Discussion”.
R: Thank you very much for your suggestion. We included limitations also at the end of discussion (Please, see line 383).
Minor
The Acronym BW must be defined in the introduction (even if it was defined in the abstract) - (page 2).
R: Thank you very much for your suggestion. We checked all the acronyms.
More precision is needed in the first paragraph page 2 (e.g., obesity, overweight).
R: Thank you very much for your suggestion. We added a more accurate definition related with BMI values (please, see line 49).
The Acronym FBC must be defined in the introduction (even if it was defined in the abstract) - (page 2).
R: Thank you very much for your suggestion. We checked all the acronyms.
Transitions are needed between the different parts of the introduction.
R: Thank you very much for your suggestion. We added linking words as suggested. Please, see lines 59 and 77.
The Acronym BC must be defined in the introduction (even if it was defined in the abstract) - (page 2).
R: Thank you very much for your suggestion. We checked all the acronyms.
The authors must justify the choice of using a very short covering period.
R: Thank you very much for your suggestion. We add this text (Please, see line 89): “This time window, although configured as a limitation of the study, is justified by the recent introduction of the broad concept of FBC and by the increase of studies in this broader perspective, thus being able to bring an update of previous reviews and contribute to a better understanding of the effectiveness of the Pilates Method (mat, small equipment, apparatus, etc.) in its practitioners (Cavina et al, 2020 and Pereira et al., 2022).
References: Pereira MJ, Mendes R, Mendes RS, Martins F, Gomes R, Gama J, Dias G, Castro MA. Benefits of Pilates in the Elderly Population: A Systematic Review and Meta-Analysis. Eur J Investig Health Psychol Educ. 2022 Feb 22;12(3):236-268. doi: 10.3390/ejihpe12030018. PMID: 35323204; PMCID: PMC8947639.
The aim and objectives must be clearly evoked at the end of the introduction.
R: Thank you very much for your suggestion. (Please, see line 83: “Thus, in view of the above, this systematic review of studies aimed to collect and systematize the results of studies published in the last 5 years.”).
Materials and Methods:
Why did the authors do not included Pub med and Google Scholar databases?
R: Thank you very much for your pertinent question. The authors considered that, in addition to the Web of Science Core Collection and Scopus databases, the inclusion of the EBSCO Discovery Service assigns a wide range of journals and databases, conferring scientific relevance to the research without compromising the objective of the review.
The justification concerning the use of a small time lapse (i.e., “between 1st of January of 2017 until 31st of December of 2021”. “This period was chosen due to the increase of studies about Pilates in the last 10 years [10] and the need to update and systematize the studies carried out in the last five years” is not enough to justify the study. Similar previous work (review) used larger samples.
R: Thank you very much for your suggestion. We included this text in line 85: “This time window, although configured as a limitation of the study, is justified by the recent introduction of the broad concept of FBC and by the increase of studies in this broader perspective, thus being able to bring an update of previous reviews and contribute to a better understanding of the effectiveness of the Pilates Method (mat, small equipment, apparatus, etc.) in its practitioners (Cavina et al, 2020 and Pereira et al., 2022).
Figure 1: please check for the typo.
R: Thank you very much for your suggestion. We improve the quality of output (Please, see line 113).
Eligibility criteria and exclusion should be added in the figure for better clarity.
R: Thank you very much for your suggestion. Eligibility and exclusion criteria are included in the text (Please, see line 126). This option is based on the assumption of the FLOWCHART PRISMA filling criteria.
While no meta-analysis has been conducted, the authors could strengthen the review by making clear how they considered the quality ratings in their analyses/ review.
R: Thank you very much for your suggestion. As the authors selected a descriptive and comprehensive review to show trends, quality ratings were not developed. Something that can be investigated in future systematic reviews, which can increase knowledge and the body of studies on the subject under analysis.
A result part with description/comparison and percentage is needed.
R: Thank you very much for your suggestion. We add this proposal to the discussion (Please, see text highlighted: lines 262, 268, 275, 286, 293, 306, 326, 335, 341, 349, 361, 372 and 381). This description and comparison requested by the reviewer, although pertinent, comes up against the clear difficulty in obtaining studies with comparable results in terms of outputs that provide robust and reliable percentages, as shown by the state of the art.
The authors could also consider another way of analysing the findings of the studies, such as a meta-analysis.
R: Thank you very much for your suggestion. In place of a Meta-analysis, we show the option to Table 7, according to Boon, H.M.; Thomson, H. (2018): Effect direction in synthesis without meta-analysis: application of Cochrane Handbook of Systematic Reviews of Interventions 2018 guidance. This lacks the consistency and reliability of a meta-analysis, but we believe it to be the best analysis for the selected data.
Discussion
“Obesity” must be defined earlier in the manuscript (introduction part).
R: Thank you very much for your suggestion. We added a definition of the concept (Please, see line 49).
The discussion is confused and sometimes not easy to follow. More transition is needed between the paragraphs. The discussion should not be a series of paragraphs but should follow a common thread. It could possibly include sub-parts with titles.
R: Thank you very much for your suggestion. We rewrite parts of Discussion (Please, see text highlighted: lines 262, 268, 275, 286, 293, 306, 326, 335, 341, 349, 361, 372 and 381).
All the acronyms must be defined for better clarity and comprehension.
R: Thank you very much for your suggestion. All the acronyms were checked and are presented with full-text on first presentation (please, see lines 44, 52, 58 for example).
Table 7 is very interesting but it must be included in a “Results” part and not in “Discussion”.
R: Thank you very much for your suggestion. We change the location of table 7 (Please, see line 210).
References: The references must follow the guideline.
R: Thank you very much for your suggestion. We checked and updated the references.
Mário Pereira and colleagues
Reviewer 3 Report
Dear Authors,
Thank you for your manuscript. The idea is interesting however, before being considered for publication, some improvements are required.
Please add to the manuscript title information that it is the systematic review.
The Introduction section is very scarce and incomplete. It lacks a more detailed description of the components of functional body composition and their associations with pilates exercise. Also, nothing is said about existing evidence on the topic, and it remains unclear why this study is so important.
Next, in the Results section, there are six tables with the same titles. Then, why they are not presented as one? Or probably the authors had an idea to classify the studies based on some criteria, which should be reflected in the tables' titles. The comments in the results section are also very scarce, and results remain undescribed and unexplained. Also, the meaning of the symbols in Table 7 is confusing and unclear. The title says that there are some directions presented, while the legend says only about the sample sizes. Also, in Table 7 caption, there are abbreviations not being explained in the footnotes (BFP, HC, BMD, etc.).
Next, I can not judge the adequacy of the Discussion and Conclusions because the Results are not described.
Finally, the Authors use multiple abbreviations. Some of them are explained when used first, but some are not. Please revise all the abbreviations. Also, I suggest providing them on a separate list at the end of the paper.
Author Response
Reviewer 3
Thank you for your manuscript.
The idea is interesting however, before being considered for publication, some improvements are required.
Please add to the manuscript title information that it is the systematic review.
R: Thank you for your suggestion. We added the word “systematic” (Please, see line 1).
The Introduction section is very scarce and incomplete. It lacks a more detailed description of the components of functional body composition and their associations with pilates exercise. Also, nothing is said about existing evidence on the topic, and it remains unclear why this study is so important.
R: Thank you for your suggestion. (Please, see lines 59-64: “Thus, such concept should focus on nutritional status, including dietary pattern or hydration level, metabolic analysis, such as aerobic thresholds or caloric consumption, and the practitioner's health context, especially in unrelated diseases. In this way, we will be able to achieve the full benefits of physical activity that, combined with nutrition, may influence weight loss and control, but more importantly, the prevention and control of obesity-related diseases [4].”
And also, please, see lines 77-83, “Subsequently, from an interventionist point of view, Pilates can be one of the ways to achieve this purpose. This method can be characterized as a non-repetitive and strenuous form of exercise, adapted to the needs of each person, with benefits at various levels [6, 7], such as improvement in flexibility, strength, coordination, blood circulation, physical fitness and postural alignment [8, 9]. Due to its characteristics and also the trends presented by recent studies, Pilates appears to be a viable alternative for the control of blood pressure, among other pathologies [10, 11], seen as important to fight obesity and related diseases [12].”
Yet, please, see lines 85-93: “Thus, the current state of the art was mainly focused on a partial view of both the concept of Body Composition (BC) and Pilates itself [13]. In view of the above, this systematic review of studies aimed to collect and systematize the results of studies published in the last 5 years relating interventions in all Pilates Method forms with FBC.”
Next, in the Results section, there are six tables with the same titles. Then, why they are not presented as one?
R: Thank you for your suggestion. The reason is to get a better reading and understanding results. We added top bar with categories in each page to easy reading.
Or probably the authors had an idea to classify the studies based on some criteria, which should be reflected in the tables' titles. The comments in the results section are also very scarce, and results remain undescribed and unexplained.
R: Thank you for your suggestion. The authors intended to keep the data protected by making exact reference to the data presented in the abstract of the respective article.
Also, the meaning of the symbols in Table 7 is confusing and unclear. The title says that there are some directions presented, while the legend says only about the sample sizes. Also, in Table 7 caption, there are abbreviations not being explained in the footnotes (BFP, HC, BMD, etc.).
R: Thank you very much for your suggestion. New text was added. (Please, see lines 211-231)
Next, I can not judge the adequacy of the Discussion and Conclusions because the Results are not described.
Finally, the Authors use multiple abbreviations. Some of them are explained when used first, but some are not. Please revise all the abbreviations. Also, I suggest providing them on a separate list at the end of the paper.
R: Thank you very much for your suggestion. All the acronyms were checked and are presented with full-text on first presentation (please, see lines 44, 52, 58 for example).
Mário Pereira and Colleagues
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
I would like to thank the authors for all the changes made that improved the quality of the manuscript.
Author Response
The authors are grateful for the relevance and quality of the suggestions/proposals provided and that contributed to the improvement of the article. Thank you very much.Reviewer 3 Report
Dear Authors,
Thank you for the improved version of your manuscript. A good job was done. I have only one minor comment regarding your manuscript title (not the type of your study, which I believe is set as standard and will not be allowed to change). I suggest adding "systematic review" to the manuscript title: Efficacy of Pilates in Functional Body Composition: Systematic Review.
Author Response
The authors are grateful for the pertinent suggestion to improve the title. We add and thank you once again for the relevance and quality of the suggestions/proposals provided and that contributed to the improvement of the article.
Thank you very much.
