An Online Pilates Program for People with Hypermobility: A Pragmatic Clinical Trial Looking at Function, Interoception, Kinesiophobia, and Physical Activity Levels

Purpose: This study evaluated whether an independent, online modified Pilates program alters function, interoception (internal body awareness), activity levels, and kinesiophobia (fear of movement) in people with symptomatic joint hypermobility. Patients and Methods: This pragmatic clinical trial included and exercise group that did 8 weeks of modified Pilates and an 8-week waitlist control group. People with symptomatic hypermobility were asked to do an independent, online Pilates program designed specifically for people with hypermobility; each module was about 25 minutes, and participants were asked to do at least 3 days/week. Outcome measures included the Bristol Impact of Hypermobility (BIoH), International Physical Activity Questionnaire (IPAQ), Revised Body Awareness Questionnaire (BARQ), and Tampa Scale of Kinesiophobia (TSK). Clinical Trial # NCT07118865. Results: A total of 420 participants completed questionnaires at 8 weeks: 200 completed 8 weeks of Pilates and 220 were on a waitlist. The Pilates group demonstrated statistically significant improvements in BIoH, BARQ, and TSK immediately after the intervention (p< 0.001 for each) and compared to the control group (p< 0.001 for each). Improvements in the Pilates group remained statistically significant at 6 months. IPAQ did not change for any group. Conclusion: This online Pilates program for people with symptomatic hypermobility improved BIoH, BARQ, and TSK, though changes were modest. The exercises did not improve IPAQ. Online exercise may provide a cost-effective way to encourage life-long activity in people with hypermobility. Limitations include the inability to monitor performance of the Pilates, high drop-out rates, and the inability to control for changes in other treatments patients may have received.