Effectiveness of physical activity counseling and PILATES exercises in women with prediabetes and type 2 diabetes: a randomized controlled trial

BACKGROUND: Physical activity (PA) has a protective effect on impaired glucose and pilates effectively supports patients with high plasma glucose levels. OBJECTIVE: This study aimed to evaluate the effects of ACSM (American College of Sports Medicine) person‐centered PA counseling using the 5A model (Assess, Advise, Agree, Assist, And Arrange), combined with Pilates exercises, on metabolic control variables in patients with prediabetes (PD) and type 2 diabetes (T2D). METHODS: Ninety women with T2D and PD were randomly assigned to three groups: Group 1 (Pilates + PA counseling), Group 2 (PA counseling), and Group 3 (standard treatment). Both intervention groups also received standard treatment. Primary outcomes were metabolic measures (blood glucose and lipid parameters). Secondary outcomes included body composition (body fat %, visceral fat, muscle mass) and physical performance (functional capacity, PA level, balance). Measurements were taken at baseline and after 12 weeks. RESULTS: No significant between‐group differences were found in metabolic or body composition outcomes. However, Group 1 showed higher PA levels (p = .002, η2 = 0.13) and step counts (p = .003, η2 = 0.12) compared with the control group. Both intervention groups improved functional capacity (p = .001, η2 = 0.15) and balance (p < .001, η2 = 0.26). In T2D participants, functional capacity improved in Group 1 and 2 (both p < .001, η2 = 0.25). In PD participants, steps counts increased in Group 1 (p = .003, η2 = 0.24) compared with Group 3, while PA levels and balance scores (p < .001, both, η2 = 0.31, η2 = 0.43, respectively) improved in Groups 1 and 2. The remaining parameters showed no differences (p > .05). CONCLUSION: Physical activity counseling using the 5A model plus Pilates exercises may improve functional capacity, PA level, number of steps, and balance. In Type 2 diabetes, PA counseling alone may prevent declines in functional capacity. In PD, PA counseling improves PA levels and balance, and adding Pilates may further boost daily steps.