J. Biomedical Science and Engineering, 2013, 6, 1171-1177 JBiSE
http://dx.doi.org/10.4236/jbise.2013.612146 Published Online December 2013 (http://www.scirp.org/journal/jbise/)
Conventional kinesiotherapy or Pilates mat exercises,
what is more efficient for abdominal weakness?
A feasibility study
Renan Lima Monteiro1, Laio Braga de Oliveira2, Luiz Armando Vidal Ramos1*,
Mauricio Oliveira Magalhães1, Marília Maniglia de Resende2, Bianca Callegari3
1Department of Physical, Speech and Occupational Therapy, School of Medicine of University of Sao Paulo, Sao Paulo, Brazil
2Educational Association of Amazonia—SEAMA, Amapá, Brazil
3Department of Physical Therapy and Occupational Therapy, Institute of Health Sciences, University Federal of Pará, Belém, Brazil
Received 29 October 2013; revised 28 November 2013; accepted 9 December 2013
Copyright © 2013 Renan Lima Monteiro et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
In accordance of the Creative Commons Attribution License all Copyrights © 2013 are reserved for SCIRP and the owner of the
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ABSTRACT
The aim of this feasibility study was to contrast rectus
abdominis (RA) muscle strength and electrical activ-
ity after two abdominal training protocols, conven-
tional kinesiotherapy (CK) and Pilates mat exercises
(PME). 13 participants were randomized to one of
two groups: CK and PME, and were trained accord-
ingly. The upper rectus abdominis (URA) and lower
rectus abdominis (LRA) were independently exam-
ined and inter and intra group comparisons were
done. Findings demonstrate a significant increase in
RA strength after both protocols, relative to baseline.
Significantly increased electrical activation was seen
in the URA after CK. Training with PME, although
as efficient as CK in strength improvement, produced
decreased activation level of muscles. CK training
induced an opposite result. The differences after
training suggest that CK and PME training pro-
grammers may strength RA, but the neuromuscular
activation strategies for that are not the same. PME
can be incorporated into protocols to improve ab-
dominals strength, and trunk stabilization.
Keywords: Rectus Abdominis; Pilates Mat Exercise;
Surface Electromyography
1. INTRODUCTION
Pilates mat exercise (PME) has become a fast-growing
popular trend in rehabilitation and conditioning programs.
It aims to improve flexibility, increase global muscular
strength and endurance, by emphasizing spinal and pel-
vic alignment, proper breathing, and the development of
a strong core or center (tones abdominals while strength-
ening the back). PME is considered to improve coordina-
tion and balance and is claimed to increase activation of
abdominal muscles during athletics or daily living activi-
ties [1-3]. Joseph Pilates (1880-1967) developed this
method seeking to match scientific principles of physical
training with oriental philosophies and movement tech-
niques [4,5].
The rectus abdominis muscle (RA) is a superficial and
important postural muscle, which also stabilizes pelvic
movements, assists in breathing and supports mainte-
nance of proper intra-abdominal pressure. When ab-
dominal strength is not adequate to counter the pull of
the antagonist Erector Spine under load, these low back
muscles are put at a mechanical disadvantage further
placing additional stresses on lower back [6,7].
Conventional kinesiotherapy (CK) is often used for
strengthening the RA, since this seems to be associated
with decreased risk of lumbar spine lesions, or with im-
proved rehabilitation after these lesions [8-11].
Both CK and PME focus on several deep and superfi-
cial muscles, including the RA. A better comprehension
of how the different types of exercises recruit the RA is a
necessary step for the development of specific abdominal
routines that better attend customized needs of patients
or trainees [2,11-13]. Several studies investigated the
effectiveness of CK in activating the RA for strength,
pain relief, and rehabilitation after specific lesions [6-8,
10,14]. Few studies focused, however, on the effective-
*Corresponding author.

R. L. Monteiro et al. / J. Biomedical Science and Engineering 6 (2013) 1171-1177 1172
ness of PME in improving abdominis muscular activity.
Preview findings suggested low back pain, muscular
strength and dynamic balance improved following Pi-
lates, but rectus abdominis muscle activity was never
measured, especially with sEMG [1-4,15-19]. Critchley
et al. proposed, in 2011, the first prospective study into
the effects of PME on abdominal muscles. Using ultra-
sound to measure Transverses abdominal (TrA) and
Oblique internal abdominal thickness, they found that
PME training appears to increase TrA activity during the
exercises but not during functional postures. There was
no mention, however, about the muscles’ electrical activ-
ity patterns [20].
The aim of this feasibility study was to compare the
effects of PME and a conventional strength training pro-
gram of CK on the RA electrical activity and force. Sci-
entific evidence to support the differences between these
methods is yet missing. The secondary objective of this
study was to contrast muscular activity in the upper
(URA) and lower portions (LRA) of the RA after each
intervention.
2. METHODS
2.1. Experimental Approach to the Problem
This study attempted to identify differences in force de-
velopment and also in muscle recruitment patterns
among two abdominal exercise methods. The Pilates me-
thod has been gaining recognition recently as a novel
choice for strength and/or endurance of abdominal and
lumbar muscles [2,3]. Few studies have investigated the
electromyographic activity and strength during PME, and
none of them had this follow-up investigation [18,21].
CK, however, includes several modes of exercises to
improve strength an has been well investigated [9,10,22,
23]. By comparing both methods in a longitudinal study,
differences in the electrical activation associated to the
force generated may be identified. The results of this
study are relevant to head coaches, strength coaches,
coaches, athletic trainers and physical therapists in the
fact that they may use different kinds of exercises con-
cerning their aims. See Figure 1.
2.2. Participants
This feasibility study included participants were ran-
domized to one of two groups: conventional kinesio-
therapy (CK) and Pilates mat exercises (PME). Abdomi-
nal hypotonic was estimated using the Canadian Stan-
dardized Test of Fitness [24]. Participants were asked to
conduct a series of abdominal flexions and were included
if incapable of doing at least 24 repetitions in one minute.
This study was conducted in the Clinical Assessment
Laboratory of “Faculdade Seama”, and participants agreed
to participate by signing informed consent. The study
Baseline Assessement
(13)
Randomization (13)
PME group
(7)
CK group
(6)
Figure 1. Study design flow chart.
was conducted in accordance to the Health National
Council guidelines (Resolution 196/96).
2.3. Procedures
Firstly, all basic anthropometric measurements were col-
lected and the subjects were familiarizes with the tasks
and methods. The same investigator performed all pro-
cedures and tasks with each subject to ensure uniformity.
All exercises were explained and demonstrated by an
instructor trained in Pilates method by Metacorupus Stu-
dio Pilates®.
Maximal isometric voluntary contraction (MIVC) was
used to measure the RA force and URA and LRA elec-
trical activity at baseline. The test was performed 3 times
and the average of electrical activity and force parame-
ters was used for further comparisons.
MIVC was conducted with participants in dorsal decu-
bitus, with hip and knees straight and strapped with a belt.
The measurement position was resisted curl-up with
maximal isometric resistance applied to the shoulders
[25]. Arms were crossed over the chest. RA maximal
force contraction was measured during the test by digital
dynamometer (Berman load cells, Primax Inc. São
Paulo-SP) with maximal capacity of 200 Kgf, attached
bellow the bed. Surface electromyography (sEMG) was
used to measure muscle activity.
2.4. sEMG Measurements
An 8-resolution channel data acquisition system (model
EMG820C, Emgsystem Inc; São José dos Campos, Bra-
zil), consisting of a signal conditioner with a band-pass
filter of 20 - 450 Hz, and amplifier gain of 2000, was
used to obtain the biological signals. All data were proc-
essed for analysis by specific software (Labview Emg-
system, Inc). sEMG activity was captured by differential
surface electrode (SDS500), and performed by an A/D
board with 14-bit resolution input range, sampling fre-
quency of 2000 Hz, common rejection module greater
than 100 dB, signal noise less than 0.3 μV RMS and im-
pedance of 109 Ω.
The electrodes (20 mm diameter and centre-to-centre

R. L. Monteiro et al. / J. Biomedical Science and Engineering 6 (2013) 1171-1177 1173
distance 20 mm) were placed bilaterally in the ventral
portion of the upper and lower parts muscle, and verti-
calized according to the guidance of the Surface EMG
for the Non-invasive Assessment of Muscles. The skin
was shaved, sanded, and swabbed with alcohol-soaked
cotton before electrode placement to minimize skin re-
sistance. The reference electrode was applied to the lat-
eral malleolus of the dominant leg [26].
All data processing was performed and analyzed using
MATLAB routines (Matlab10; The Mathworks Inc.,
Natick, MA). The EMG signal was processed to the root
mean square (RMS) using a moving window of 50 mil-
liseconds. For each portion, URA and LRA, the mean
RMS value across all MVIC trials represented the maxi-
mal activity (RMSMVIC). RMSMVIC values were normal-
ized by maximum peak (RMSMVICPEAK) obtained during
contraction of each portion of muscle using de following
equation [27]:
 

MVIC MVICPEAK
Activation level%RMSRMS100
The EMG data were collected bilaterally from the
URA and LRA. The mean of the two values was ob-
tained and used for comparison between PME and CK.
After the baseline assessments, women were random-
ized to one of the two groups. A total of 15 sessions
(three times per week for 5 weeks) were conducted. Pa-
tients were then reassessed following the same protocol
and measurements were contrasted against baseline and
between groups.
2.5. Pilates Mat Exercises and Conventional
Kinesiotherapy
Following randomization, participants received informa-
tion about their exercise programs and were encouraged
to progress the exercises for 5 weeks, without absences.
Volunteers who missed any of the sessions, for any rea-
son, were excluded from the final sample.
PME consisted of conducting three exercises (The
Hundred, One Leg Stretch, and One Leg Circle) under
individual supervision of the therapist. Progressions were
permitted whereby load could be increased changing
limb movements or position.
The Hundred focuses on strengthening the RA and the
external oblique muscles. Patients were positioned in
dorsal decubitus, in crook lying, arms by side. They were
asked to draw-in abdominal muscles, raising heads and
shoulders from the mat. The arms should be raised and
pulsed up and down while breathing. Volunteers could
progress to lifting legs to 90˚, but keeping the lower back
on the mat and the abdominals flat. Three series of 30
repetitions were conducted.
One Leg Stretch aimed to strength the RA, external
oblique and rectus femoris muscle. Participants started in
crook lying and arms by side. They were asked to draw-
in abdominal muscles, lifting straighten alternate legs to
full knee extension. Volunteers could progress to starting
with both legs in 90˚. Three series of 30 repetitions were
conducted.
On leg circle aims to strength the RA, external oblique,
rectus femoris, iliopsoas, sartorius, tensor fasciae latae,
pectineus, anterior fibers of the gluteus medius, and glu-
teus minimus. Volunteers started in the same position
from One Leg Stretch, but now they should describe 5
small circles with raised leg. Volunteers could progress
to starting with both legs in 90˚, and circle only one leg.
Three series of 10 repetitions were conducted.
CK consisted of three abdominal exercises (flexion,
modified flexion, and abdominal paddling exercises).
Abdominal flexion aimed to strength the RA and flexors
of the hip. Volunteers were positioned in dorsal decubi-
tus with knees in flexion and hands on the back of the
head. Abdominal flexion was conducted in order to bring
the chest to the vertical position. Three series of 10 repe-
titions were conducted.
Modified abdominal flexion also aimed to strength the
RA and flexors of the hip. Different than in traditional
abdominal flexion, hands were over the chest, and eleva-
tion of the chest was up to 30˚. Three series of 10 repeti-
tions were conducted.
Abdominal paddling exercises focused on strengthen-
ing the RA. Arms were extended above the head and legs
were in extension. Simultaneous flexion of the trunk and
legs were conducted, and arms were extended until being
parallel to the ground. Three series of 10 repetitions were
conducted.
2.6. Statistical Analyses
Sample size was estimated using SigmaStat 3.5. Consid-
ering the mean and standard initial RMS founded and
assuming a confidence interval of 95% and power of
80%, required sample was determined as being 12. The
Shapiro-Wilk test was used to assess data distribution
(normality test). The t Student test compared groups.
Significance was determined at the 0.05 level.
3. RESULTS
This feasibility study included 13 participants where 7
participants in the Pilates mat exercises (PME) group and
6 in the conventional kinesiotherapy (CK) group. Table
1 displays the demographic data. Groups were similar
regarding age, body mass index, body fat and baseline
characteristics.
Figure 2 displays the pre-and post intervention data in
those in the PME group. Although there was a decreas-
ing tendency, activation level was not significantly dif-
ferent for the URA (p = 0.428) and LRA (p = 0.109).
Strength of the RA increased significantly with training

R. L. Monteiro et al. / J. Biomedical Science and Engineering 6 (2013) 1171-1177 1174
Table 1. Characteristics of the population.
Variables PME (n = 7) CK (n = 6) p
Age (years) 27.0 ± 4.4 25.0 ± 3.1 0.45
BMI (Kg/m2) 21.6 ± 1.6 21.7 ± 1.9 0.68
Abdominal flexions 18.0 ± 4.8 16.6 ± 5.3 0.80
% Body fat 28.2 ± 0.9 27.6 ± 3.3 0.65
p-value for t test; Mean and standard deviation: age, BMI = body mass
index, abdominal flexions and % body fat.
73.4 73.8
9.9
58.3
69.1
24
URAActivationlevel(%) LRAActivationlevel(%) Force(N)
PilatesMatExercisesGroup
Initial Final
*
Figure 2. Pilates mat exercise group—activation level (%) and
force (N) RA values (URA and LRA, significant differences
marked p < 0.05).
(p = 0.004).
Figure 3 displays similar data in those receiving CK.
Results were significant for URA (p = 0.042) but not for
LRA (p = 0.373). RA strength improved significantly
with training (p = 0.001).
Contrasts between groups are displayed in Figure 4.
No significant differences were seen for activation level
of the LRA (p = 0.431). URA, in the PME group, had
significant decreased activation level compared to those
in CK group, who had increased activation (p = 0.014).
Strength improved in both groups after intervention and
differences were not significant between groups (p =
0.885).
4. DISCUSSION
The aim of this feasibility study was to contrast rectus
abdominis (RA) muscle strength and electrical activity
after two abdominal training protocols, conventional
kinesiotherapy (CK) and Pilates mat exercises (PME).
The results demonstrated that both interventions were
capable of strengthen the RA, and there were no signifi-
cant difference in the amount of strength improved using
PME or CK programmers. The characteristics of the
electrical activity from the different portions of RA,
however, suggested that there are distinct patterns of
muscle recruitment for the production of this force. The
differences after 5 weeks also suggests that distinct train-
ing programmers may strength RA, but the neuromuscu-
39
60.2
8.1
81
60.3
24
URAActivationlevel(%) LRAActivationlevel(%) Force(N)
ConventionalKinesiotherapyGroup
Initial Final
*
*
Figure 3. Conventional kinesiotherapy group—activation level
(%) and force (N) RA values (URA and LRA, significant dif-
ferences marked p < 0.05).
Figure 4. Pilates mat exercise and conventional kinesiotherapy
groups comparison—final-initial activation level (%) and final-
initial force (N) RA values (MIVC URA and MIVC LRA, sig-
nificant differences marked p < 0.05).
lar activation strategies for that are not the same. Train-
ing with PME, although as efficient as CK in strength
improvement, produced decreased activation level of
muscles after 5 weeks. CK training, on the other hand,
induced an opposite result.
Since one of our goals was to contrast RA electrical
activity post-interventions, relative to baseline, results
suggest that only URA had significant improvement after
CK, while LRA portion showed a non-significant trend.
Abdominal muscular activation following CK is well
demonstrated [8-10,14,23,25,28,29]. Findings suggest
that superior chains of the RA are activated during ab-
dominal flexion, demonstrating that this muscle is re-
quested during exercise [28,30]. Axler and McGill [8]
also found a differential pattern of activation for the su-
perior and inferior parts of the RA during different types
of abdominal exercises, and high levels of activity under
specific exercise conditions (trunk curl), suggesting the
benefit of these exercises relative to sit-up exercise types.
Other studies, on the other hand, failed to demonstrate
the difference [31].
The differential response of the URA and LRA to CK

R. L. Monteiro et al. / J. Biomedical Science and Engineering 6 (2013) 1171-1177 1175
may be explained by the fact that CK was conducted
under higher speed than PME, which emphasizes paced
and synchronic rhythms [5,32]. Accordingly, CK proba-
bly recruited a higher number of motor units during ex-
ercises, relative to PME [22]. These results are in agree-
ment with others [23], which suggested that pace of ex-
ercising and numbers of motor units are directly corre-
lated. Comfort et al. [33] also suggest that maximal
speed of RA contraction is associated with increased
electrical activity, relative to slow contraction paradigms.
Evidence also suggests the influence of force and speed
in the EMG signal during dynamic exercises [34]. Ac-
cordingly, CK probably activated a higher number of
fibers during training, reflecting in increased activation
during MIVC.
Bloomer and Goldfarb [35] suggest that eccentric
muscular action is associated to micro lesions. PME aims
to strength agonists and antagonists trough eccentric
muscular action [2,16,18]. It may be that those in the
PME group were more likely to have these lesions and
the electrical activity captured the regenerative response.
Differently, those in the CK group had increased strength
and this is supported by the fact that the superior portion
of the RA is intensively activated by exercises of the
trunk-curl type [10]. It has also been suggested that in
order to increase strength, increased electrical activity
and increased frequency of neuronal activation are si-
multaneously required [13]. Pandofe et al. [36] found the
relationship between RA strength and RA electrical ac-
tivities by demonstrating that women with level 5 of
strength had EMG activity that was above normal.
Therefore our findings are in alignment with the litera-
ture.
Most studies on abdominal exercises are focused on
biomechanics and movements [22,23,28,33], and few
focused on the effectiveness of specific training proto-
cols, making it difficult to put our findings in context.
Those in the PME group had significant increase in their
strength, and this has been demonstrated by others [3,10,
20,37], in support to our findings. It is difficult to explain
however, the de-linkage between strength and electrical
activity decreased evidenced by our data. Few studies
had focused in electrical activity of muscles with PME,
and those who did, are cross-sectional studies that com-
pared pattern of muscle recruitment during some trials of
specific exercises [21,27,38,39]. This is the first longitu-
dinal study evaluating activation level of RA in PME
training. It may be that PME used other muscles in order
to promote trunk flexion, including the internal and ex-
ternal oblique’s, paravertebral chains, gluteus and quad-
riceps [16,40]. Altogether, they may have been synergis-
tic to the movement and reduced overload on RA. In this
regard we suggest that both CK and PME increase RA
strength, albeit trough divergent principles.
5. PRACTICAL APPLICATIONS
The mat exercises require minimal equipment and can be
accomplished in non-gym or clinical settings. Many Pi-
lates exercises are similar to those employed in motor
control and spinal stabilization training programmers.
These findings suggest PME can be incorporated into
protocols to improve abdominals strength force, and
trunk stabilization. However the differences between the
activation pattern recruitment should be further deep
investigated.
6. CONCLUSION
CK and PME increased RA muscular strength. The infe-
rior part of RA activation decreased following supervi-
sion PME, compared to the group following CK, where
activation increased.
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