People with MS frequently experience disabling balance and mobility impairments. One component of balance is postural stability of the trunk. This is now commonly termed "core stability" . People with MS have been found to have reduced trunk stability during arm movements in sitting compared to healthy subjects, implying reduced core stability .
Pilates based core stability training is a precise, controlled form of exercise using the stabilising muscles of the body . Despite a lack of scientific evidence to support the effectiveness of core stability training in people with MS, it is increasingly being advocated as a treatment strategy. As a consequence core stability training is often integrated into rehabilitation programmes, both on an individual and group basis. Furthermore Pilates based exercise classes are popular with people with MS who pay to participate in these within community leisure settings.
In response to this, the Therapists in Multiple Sclerosis (TiMS) Research Group based in the United Kingdom (UK) , undertook a small scale multi-centre series of eight replicated single case studies (ABA design), across five geographically dispersed centres, to explore the effect of Pilates based core stability training on balance, mobility, and balance confidence in ambulant individuals with MS . Visual analysis (trend, level and slope between baseline and intervention phases), together with the 2 standard deviation band statistical analyses showed improvement in at least 6 of the 9 measures for the majority of individuals. Group analyses (repeated measures within-subjects analysis of variance) demonstrated significant improvement between baseline and intervention phases for the 10 metre Timed Walk (p = 0.019), MSWS-12 Scale (p = 0.041), Forward (p = 0.015) and Lateral Functional Reach (p = 0.012). These results provided preliminary scientific evidence to support the use of this intervention in ambulant individuals with MS.
The next stage is to build upon this existing evidence base by improving the methodological limitations of this pilot study. We intend to do this by undertaking an adequately powered multi-centred blinded randomised controlled study, with the primary aim of investigating the effectiveness of a 12 week face to face Pilates based individualised core stability training programme. Methodologically sound trials of this nature are essential to move our knowledge forwards in this area.
The design and implementation of an individualised core stability training regimen is believed to require specific skills; both on behalf of the physiotherapist and the patient. Therapists require post graduate training in this skill; and patients need to learn to voluntarily activate muscles (the core stabilisers) that are usually only recruited on an automatic basis . An important secondary aim, therefore, is to investigate whether any difference in outcome exists between a Pilates based core stability training approach, and provision of a standardised lower limb exercise programme. Finally, one of the recognised aims of Pilates based-core stability training is to selectively target the deep abdominal muscles in order to optimise the stabilising effect . A further secondary aim therefore is to use ultrasound imaging to determine if changes in resting thickness and activation levels of these deep muscles occur following exercise intervention.