High-intensity and low-intensity Pilates have similar effects on pain and disability in people with chronic non-specific low back pain: a randomised trial

Question: In people with chronic non-specific low back pain, what is the effect of high-intensity Pilates exercise compared with low-intensity Pilates exercise on pain, disability, patient-specific function, kinesiophobia and isometric hip strength? Design: Randomised trial with concealed allocation, blinded assessors and intention-to-treat analysis. Participants: One hundred and sixty-eight people with chronic non-specific low back pain and aged between 18 and 60 years. Interventions: Participants were allocated to undertake 1-hour sessions of clinical Pilates at either high-intensity or low-intensity, twice per week for 6 weeks. Outcome measures: The primary outcomes were the numerical pain scale and the Roland Morris Disability Questionnaire at the end of the 6-week intervention period. The secondary outcomes were the Patient-Specific Functional Scale, the Tampa Scale for Kinesiophobia and isometric hip strength at 6 weeks. Pain and disability were also re-measured 6 and 12 months after the intervention. Results: The two Pilates regimens had negligible differences in effects on all outcomes at the end of the intervention period. At 6 and 12 months, the between-group differences in pain intensity were still negligible but the confidence intervals around those estimates spanned from around no effect to a worthwhile benefit (> 1.4) from low-intensity Pilates compared with high-intensity Pilates: 6-month MD 0.6 (95% CI -0.2 to 1.4) and 12-month MD 0.8 (95% CI 0.0 to 1.6). The effect on disability remained negligible at 6 and 12 months. Adverse events were less common in the low-intensity group: absolute risk reduction 0.20 (95% CI 0.10 to 0.31). Conclusion: High-intensity and low-intensity Pilates had very similar effects on pain, disability and other outcomes in people with chronic non-specific low back pain. Physiotherapists should endorse low-intensity Pilates exercises for managing chronic non-specific low back pain because the effects on most outcomes are very similar to high-intensity Pilates exercise but there are fewer side effects. Registration: RBR-2d2vb9. [Coelho ACS, Dourado JF, Lima POP (2025) High-intensity and lowintensity Pilates have similar effects on pain and disability in people with chronic non-specific low back pain: a randomised trial. Journal of Physiotherapy 71:100-107] (c) 2025 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).