My PhD journey .. the end is finally in sight … – Karl Fleming.

Greetings again out there in Blog land, I am back to update you on my PhD thesis-by-publication journey, which hopefully shall conclude following my VIVA in mid-October.

My programme of research investigated the effects of Pilates, a mind/body exercise, on symptoms of anxiety, depression, and fatigue among persons with Multiple Sclerosis (PwMS). MS is a chronic disease of the central nervous system characterised by inflammatory demyelination and axonal reduction.  Despite growing evidence supporting the benefits of exercise, PwMS are less active than healthy individuals. A variety of treatment strategies are required because physical, emotional, and cognitive symptoms and severity vary between PwMS.  Symptoms of anxiety, depression, and fatigue are prevalent among PwMS, and traditional exercise modes improve these symptoms among PwMS. However, the effects of non-traditional exercise modes, like Pilates, are understudied.

A meta-analysis was conducted to estimate the overall population effect of Pilates, on mental health outcomes, among healthy and chronically ill populations. Random-effects meta-analysis of the available empirical evidence from controlled trials showed significantly reduced anxiety symptoms, depressive symptoms, and feelings of fatigue, however, no trial involved PwMS. This is the first review to support mental health benefits of Pilates and was published by Complementary Therapies in Medicine.  

To address this research gap, an eight-week randomized controlled pilot trial examined the feasibility of Pilates to improve symptoms of anxiety, depression, and fatigue among PwMS, and underpin prospective research and development of a larger RCT. Results revealed full compliance, no attrition or reported adverse events, hence establishing feasibility and proof-of-concept of home-based Pilates to improve mental health outcomes among women with MS with minimal-to-mild mobility disability. This trial was published in Psychology of Sport and Exercise.

Qualitative analysis of participant experiences of the feasibility study supported Pilates, particularly home-based, as a safe, intensity-appropriate, and implementable exercise method that improved perceived and measured mental health outcomes among PwMS. This study, published in Disability and Rehabilitation, critically informed the published protocol design (Mental Health and Physical Activity), and implementation of an adequately powered RCT of home-based Pilates on symptoms of anxiety, depression, and fatigue among PwMS.

Eight weeks of twice-weekly home-based Pilates resulted in significantly improved anxiety, depressive, and fatigue symptoms, among PwMS with minimal-to-mild mobility disability, including moderate-to-large clinically meaningful improvements in depressive and fatigue symptoms. The powered RCT, now published as the primary evidence in the exercise-mental health among PwMS research area within the high-impact and high-quality Multiple Sclerosis Journal, importantly was underpinned by cumulative and appropriately-evolving meta-analytic, feasibility, and qualitative evidence produced and gleaned throughout this published programme of research.

Future trials should replicate and expand these findings among larger samples of both males and females, pre-screened for the presence of specific symptoms, within the MS community, including those with different disease severity, and augment other empirically supported treatments, including CBT and pharmacotherapy, for symptoms of anxiety, depression, and fatigue.

Karl Fleming is a Postgraduate Researcher in the Department of Physical Education and Sport Sciences. University of Limerick.  His research topic concerns an analysis on the effects of Pilates on symptoms of anxiety, depression, and fatigue among people with Multiple Sclerosis.

Contact:  Email: ORCID

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