A Comparison Of The Effects Of Yoga And Pilates For Pain Physical Function And Quality Of Life In Adults Over 50 Years

Denham-Jones, Laura

Abstract

This research compares the effects of yoga and Pilates for adults over 50 years,
focusing on the outcomes of pain, physical function, and quality of life, exploring these
activities in the relation to contraindications, physical activity guidelines, and participant
history and experience in order to inform best practices in intervention design and delivery.
A narrative review was conducted to establish an understanding of the older
population and the importance of their physical and psychosocial health, as well as to define
mat-based yoga and Pilates as movement practices, and to locate their role in public health
policy. Due to increases in life expectancy and rises in the age of pension eligibility, the
United Kingdom’s population aged between 50 and state pension age is growing. Older
people are more prone to musculoskeletal conditions, but pain and inactivity can be offset
by appropriate physical exercise, which is important for individual well-being and keeping
people in work. Yoga is recommended for strength in U.K. government physical activity
guidelines and both yoga and Pilates are recommended for back pain by the National Health
Service. Yoga and Pilates are the top group exercise choices in the United Kingdom and
particularly popular among women, who are more prone to experience chronic
musculoskeletal conditions. The two practices are customarily classified together and
denoted as “mind-body” classes in exercise venues, yet there is a paucity of research
comparing the two. The present research defines and differentiates yoga and Pilates in a
contemporary context, establishing best practices for adults over 50 years, including but not
limited to those with chronic musculoskeletal conditions, and comparing their respective
benefits using a mixed-methods approach.
Two systematic reviews by the researcher found that both yoga and Pilates are safe,
adaptable interventions for chronic musculoskeletal conditions in a >70% female sample
with a mean age over 50. Yoga was effective for osteoarthritis and neck pain, improving
physical function for osteoarthritis and sarcopenia. Pilates was effective for back, neck,
osteoarthritis, and osteoporosis pain. Back pain and osteoporosis patients showed
statistically significant functional and quality of life effects. The Pilates studies captured
benefits over a broader range of outcomes including physical function and quality of life
than did yoga, without specific modifications, and neither was found superior to other
exercise comparators. This finding suggested that preferences are not always linked to
orthopaedic health outcomes and informed the use of a mixed-methods approach for a
better understanding of what participants experience, and what is important to them, when
exercising.
A survey of yoga and Pilates participation in adults over 50 years (N=35) was then
conducted, exploring exercise habits, motivators, barriers, and perceived benefits as
experienced in real-world settings, where participants attend based on preference rather
than assignment, and interventions are not necessarily customised for this age group as they
are when in a trial setting. Participants of both tended to be long-term practitioners,
indicating the appeal and sustainability of these practices in later life. However, the survey
revealed that while yoga was a more popular and widely available choice than Pilates, it was
less suitable for those with existing injuries, and had a higher rate of injury in participation.
Back, knee, and shoulder were identified as the most prevalent injury sites. This finding
further suggested that motivations to practice physical yoga may be rooted in non-physical
outcomes such as mental well-being, and this supported the implementation of qualitative
methods to understand this phenomenon.
The systematic reviews and survey data were then used to design a separate yoga
and Pilates intervention for delivery to adults over 50 years in a comparative trial. The
effective studies located in the systematic reviews, as well as existing literature on yoga
injury, were used to inform exercise choice and progression, intervention frequency and
duration, and outcome measures. The qualitative survey data coupled with existing yoga
participation literature and studies of the use of Pilates in physiotherapy informed the
approach to teaching, which emphasised a positive participant experience thought to
support adherence and outcomes. The interventions were tested in an eight-week
comparative feasibility trial (N=24) measuring back, knee, and shoulder pain on a Numerical
Rating Scale (NRS), and physical function and quality of life on the SF-36. Thematic analysis
of a post-trial survey was used to add depth to the finding, and in-depth interviews were
used to assess the role of personal history and preference in participant experience.
Results show that Pilates significantly reduced back pain (P=0.024, effect size 0.65),
and there were non-statistically significant reductions to pain overall. The research supports
the recommendation of Pilates for back pain in general and the use of the trial’s novel
intervention specifically, a positive finding for the population of interest, as back pain is a
leading cause of early retirement. The thematic analysis of the post-trial survey and the
interviews identified themes of stress-reduction and self-confidence for yoga and Pilates
participants respectively, with the interviews revealing strong personal preferences. This
finding highlighted the relevance of qualitative research in assessing subjective interventions
and suggested that a high importance should be placed on personal histories and
preferences in exercise choice and referral. Pilates and yoga were both found to be suitable
movement practices for older adults, with a recommended emphasis on personalisation and
accessibility, awareness of contraindications, and evidence-based modifications for existing
musculoskeletal conditions. Yoga education for physiotherapists and a systematic approach
for both yoga and Pilates are recommended where the goal is specific physical or functional
outcomes and the safe fulfilment of exercise guidelines.
The research fills a gap in existing knowledge by comparing yoga and Pilates, an
under-explored area of study at the time of writing, using populations with chronic
conditions as well as healthy older adults, to reflect real-world group exercise settings. The
creation of a survey suitable for further testing and the creation and testing of original
evidence-based course protocols provide new insight into the views, motivators, and
barriers amongst over-50s regarding yoga or Pilates, with contextualisation and discussion of
contraindications. The mixed-methods approach, underpinned by a rationale rooted in a
constructivist and interpretivist position, provides a philosophical reasoning and critique on
study design for analysis of subjective interventions

• Thesis Type: Thesis
• Online Publication Date: Mar 27, 2025
• Deposit Date: Jan 22, 2025
• Publicly Available Date: Apr 28, 2025
• Keywords: Physical Activity; Ageing; Yoga; Pilates
• Award Date: Mar 27, 2025