Your study found no significant difference between high- and low-intensity Pilates for chronic non-specific low back pain. What are the key takeaways for physiotherapists in terms of prescribing Pilates-based exercise for patients with low back pain?

We observed that physiotherapists don’t need to meticulously control the intensity of Pilates exercises.

Closely monitoring intensity is challenging when working with multiple patients simultaneously.

Our results show that regular practice, rather than intensity, is what matters.

This allows the clinician’s focus to stay on applying the six fundamental principles of the method.

Why do you think both high- and low-intensity Pilates were similarly effective in terms of pain relief and disability reduction? Does this challenge traditional assumptions about exercise intensity in physiotherapy?

The beneficial effects of Pilates stem from regular physical activity.

Physiologically and psychologically, the exercises performed in Pilates promote the release of endorphins and endogenous opioids, relieving pain.

Thus, the equivalence we saw across intensities does challenge the traditional idea that ‘more is better’.

The low-intensity group experienced fewer side effects than the high-intensity group. What are the practical implications of this finding for clinicians managing patients with low back pain?

Fewer side effects increase patient adherence to treatment, helping to break the cycle of pain and disability.

Understanding barriers to physical activity is vital for consistency and success in therapy.

How can physiotherapists balance intensity with patient preferences and goals when prescribing Pilates exercises? Should every patient receive tailored exercises with the intensity adjusted?

A careful assessment before starting Pilates is essential.

During the initial evaluation, the physiotherapist must understand the patient’s preferences, limitations and goals.

This allows for personalising the treatment plan, adjusting intensity and other parameters (ie, duration and movement type).

Flexibility in adjusting intensity over time is also crucial for patient progress.

Can you elaborate on how this study supports the integration of Pilates into broader physiotherapy practices for patients with chronic non-specific low back pain?

This study reinforces the idea that Pilates effectively reduces pain and disability and is adaptable to varied exercise intensities.

With a focus on movement control and strengthening, Pilates offers a personalised approach to each patient’s needs, making it safe and effective within a comprehensive therapy plan for long-term chronic low back pain.

What future research should researchers conduct to explore the effects of Pilates and other exercise modalities on chronic low back pain further?

Future research should investigate how different Pilates parameters (ie, duration, volume and movement type) can influence chronic low back pain treatment.

It’s also essential to focus on identifying which patient subgroups respond best to each approach, directly comparing different modalities, evaluating combined interventions (Pilates and manual therapy/education), analysing long-term effects and factors involved in maintaining the benefits, and conducting cost-effectiveness analyses.

>>Anita Coelho became a physiotherapist in 2016 and obtained a master’s degree from the Federal University of Ceará in 2023. Anita has extensive experience in musculoskeletal physiotherapy and is committed to continuously improving her knowledge to provide exceptional care to her patients.