Effects of clinical Pilates exercises on glycemic control, blood lipids, and physical fitness parameters in women with prediabetes: a randomized controlled trial

Abstract

Introduction: Prediabetes is a high-risk state for type 2 diabetes. Early lifestyle interventions, especially exercise, are crucial for prevention. Objective: To examine the effects of a 16-week clinical Pilates program on glycemic control, lipid profile, and physical fitness in prediabetic women. Methods: In this randomized trial, 49 women were assigned to a Clinical Pilates group (n = 25) or control group (n = 24). After dropouts, 42 participants (Pilates: n = 21, Control: n = 21) completed the study. The intervention group received supervised Pilates sessions (3x/week) plus diabetes education for 16 weeks; the control group received education only. Primary outcome was glycated hemoglobin (HbA1c); secondary outcomes included glucose, insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), lipid profile, handgrip strength (HGS), core strength/endurance, balance, and exercise beliefs. Results: Compared with controls, the Pilates group showed significant reductions in HbA1c (p < .001, eta(2) = 0.900), fasting glucose (p < .001, eta(2) = 0.731), insulin (p < .001, eta(2) = 0.939), and HOMA-IR (p < .001, eta(2) = 0.915). Lipid profile improved, with reductions in Low-density lipoprotein (LDL) (p = .010, eta(2) = 0.850), triglycerides (p = .005, eta(2) = 0.699), very low-density lipoprotein (VLDL) (p = .005, eta(2) = 0.699), total cholesterol (p = .023, eta(2) = 0.623), and increased high-density lipoprotein (HDL) (p = .003, eta(2) = 0.479). HGS (p < .001, eta(2) = 0.962), sit-ups (p < .001, eta(2) = 0.914), and push-ups (p < .001, eta(2) = 0.913) improved in Pilates participants. Core endurance increased across all tests (p < .001, eta(2) = 0.865-1.000), and balance improved (p = .043, eta(2) = 0.955). Perceived exercise benefits increased (p < .001, eta(2) = 0.588), and barriers decreased (p < .001, eta(2) = 0.823). Conclusion: Clinical Pilates appears to be an effective, scalable strategy for improving metabolic and physical outcomes in prediabetic women. This study provides preliminary evidence for its potential integration into community-based programs to reduce diabetes incidence, ease healthcare burden, and promote long-term health.