Effects of Hatha Yoga and Reformer Pilates on Hyperkyphosis

Condition(s) studied

Investigational drug(s) / intervention(s)

Home-based Exercise: The subjects in this group will be given the exercises included in the Physical Activity guideline of the Ministry of Health as a home programme.

Hatha Yoga Group: The sessions will begin with the classic sun salutation series (Suryanamaskar) consisting of 12 basic poses of yoga. The sun salutation series will be used as a warm-up for 10 minutes. After warming up, postures aimed at stretching the front group muscles of the body and strengthening the back group muscles will be preferred. In the cooling phase, the session will be ended by relaxing with Savasana pose for 10 minutes.

Reformer Pilates Group: Exercise sessions will start with the foot series and the starting position on the back will be preferred. This series, which is progressed by maintaining the body composition, is considered as a warm-up exercise of the body. Then, the body is continued with exercise series targeting the thoracic region and core region.

Study summary

The vertebral column is an S-shaped structure that carries the body weight and transmits it to the feet. Kyphosis, a natural curvature of the spine, can increase with poor posture and muscle weakness, leading to postural kyphosis. This condition results in forward head positioning, rounded shoulders, and scapular winging, causing back pain, poor posture, balance issues, and respiratory difficulties. With technological advances, poor posture habits have become more common, especially in adolescents. Kyphosis can also affect balance, walking speed, and increase the risk of falls in older adults. Exercises like Hatha yoga and reformer Pilates are effective methods for improving posture, muscle strength, and quality of life. The aim of this study is to compare the effects of Hatha yoga and reformer Pilates exercises on posture, pain, balance, quality of life, body image, and respiratory function in individuals with hyperkyphosis.

Eligibility

Primary outcome measure(s)

• New York Posture Evaluation Scale — At baseline and after 8 weeks
  The New York Posture Evaluation Scale was first published in 1958. It evaluates the body in 13 different parts in terms of posture changes that may occur. If the posture is correct, 5 points are given, 3 points if it is moderately impaired, and 1 point if it is severely impaired. The total score obtained as a result of the test varies between 13-65 points. A high score means that the posture is good.
• Measurement of the degree of kyphosis with Flexicurve — At baseline and after 8 weeks
  Flexicurve will be used to determine the degree of hyperkyphosis. Flexicurve, a noninvasive method, is recommended as a practical and affordable tool for monitoring age-related spinal degenerative processes and curvature changes. One end of the Flexicurve is placed on the bony prominence of the cervical seventh (C7) vertebra and caudally along the spine to the thoracic twelfth vertebra. The mould is then removed from the spine and the shape transferred to paper. Showing the relationship between the length and width of the thorax; Values are obtained according to the formula (width / length) x 100
• Determination of the distance between the occiput and the wall — At baseline and after 8 weeks
  It is a practical method widely used for screening and monitoring hyperkyphosis. The individual's back and heels should be as close to the wall as possible and the head should remain in a natural position. Hyperkyphosis is considered to be present if the occiput does not touch the wall when the back and heels are against the wall and the head is facing forwards. The degree of hyperkyphosis is assessed by measuring the distance between the occiput and the wall. The severity of hyperkyphosis is classified as mild (≤5 cm), moderate (5.1-8 cm) and severe (\>8 cm).
• Determination of the distance between wall C7 — At baseline and after 8 weeks
  There are also studies suggesting that it would be more appropriate to use C7 in the measurement because it is closer and adjacent to the thoracic vertebrae than the occiput. Due to the close location of C7 to the thoracic vertebrae, errors that may be encountered when the participant moves his/her head will be prevented. The measurement is performed with the back, heels and sacrum against the wall, in as upright a posture as possible and looking forwards. The distance of the spinous process of C7 perpendicular to the wall is measured using two rulers. According to the test results, the severity of hyperkyphosis is expressed in three different levels: mild (≤ 5 cm), moderate (5.1- 8 cm) and severe (\> 8 cm).
• Visual Analogue Scale — At baseline and after 8 weeks
  Perceived pain ranges from no pain to extreme pain. For pain intensity according to the VAS, 'no pain' is graded as 0 points and 'worst possible pain' is graded as 10 points.
• Timed balance test — At baseline and after 8 weeks
  In this test, the duration of standing on one and two legs with eyes open and closed is analysed. It is a static balance test
• Flamingo balance test — At baseline and after 8 weeks
  It is a test that measures the duration of static balance in seconds within a one-minute evaluation process. The tool used as an auxiliary material is fixed on the floor. The person conducting the research sits facing the person with the stopwatch. The second observer stands next to the person to help ensure the balance of the person and to see the number of errors in the instrument. One foot of the person stays in the air during this test and when this foot touches the ground or when the person drops this foot completely, the error is recorded and the stopwatch is stopped. After the balance is restored, the stopwatch is restarted and the best score is taken and recorded as the test score. If the person makes fifteen or more errors within 30 seconds after the balance is restored, the test score is reflected as 0.
• Timed up and go test — At baseline and after 8 weeks
  This test requires a chair, a stopwatch and a three-metre walking space. The test starts with sitting on a chair, the individual gets up with a warning, walks 3 metres, returns and sits down. It is a test used in dynamic balance assessment.
• Functional reach test — At baseline and after 8 weeks
  With the help of a tape measure mounted on the wall, the ability of the subjects to reach without losing their balance is evaluated. It is a test used in dynamic balance assessment.
• Nottingham Health Profile (NHP) — At baseline and after 8 weeks
  It is used to assess quality of life. The questionnaire consists of 38 items. It evaluates six dimensions of quality of life including energy; 3 items, pain; 8 items, emotional reactions; 9 items, sleep; 5 items, social isolation; 5 items, physical activity; 8 items. Each section is scored between 0-100, '0' indicates the best health status, while 100 points indicates the worst health status.
• Body Image Assessment — At baseline and after 8 weeks
  It will be evaluated with the Multidimensional Body-Image Self-Relationship Scale (MBSRI). This scale is a scale that evaluates the body image of the individual in terms of self-attitudinal aspects. The scale also includes sub-headings that include evaluations of the individual's satisfaction with body image, physical capacity and health status. The scale consists of seven subheadings and 57 items in total. The subheadings generally provide psychological and physical evaluations. In the scale, emotional-cognitive-behavioural evaluations are made on the psychological side and physical appearance-physical competence and biological integrity evaluations are made on the physical side. A maximum score of 285 and a minimum score of 57 can be obtained from the scale.
• Pulmonary Function Test (SFT) — At baseline and after 8 weeks
  In our study, SFT measurements will be performed with COSMED Pony FX device (Italy, 2011). Within the scope of the measurement rules, it will be ensured that the subjects have not eaten for at least 2 hours, have not drunk alcohol for at least 4 hours and have not smoked for at least 24 hours. In the test performed in the sitting position, the subjects will be asked to breathe normally for 4 or 5 times, then to make a deep inspiration, followed by a forced, rapid and deep expiration to release all the air. At least three repeated measurements will be performed and the measurement with the highest value in the sum of FEV1 and FVC recommended by ATS will be recorded.
• Chest circumference measurement — At baseline and after 8 weeks
  It is performed to evaluate thoracic expansion, chest wall mobility and respiratory type. A bendable, non-elastic tape measure not wider than 7 mm is preferred and measurements are made with feet shoulder-width apart and body weight equally distributed on both feet. In addition, the arms should be slightly abducted for comfortable measurement. In our study, measurements will be performed from three different regions: axillary (4th costal level), epigastric (xiphoid process level) and subcostal (9th costal level) during maximal inspiration, maximal expiration and normal respiratory phase using a tape measure in standing position. The measurements will be repeated three times and the highest value will be recorded. Then, the difference between maximal inspiration and expiration will be found and recorded separately for each region.
• Total body weight measurement — At baseline and after 8 weeks
  Total body weight measurement will be performed with a Tanita BC-700 (Tanita-Japan) body analyzer as weight in kilograms.
• Height measurement — At baseline and after 8 weeks
  Height in meters will be measured with a height measuring tape.
• Body mass index calculation — At baseline and after 8 weeks
  Weight and height will be combined to report BMI in kg/m\^2).
• Lower extremity fat percentage measurement — At baseline and after 8 weeks
  Lower extremity fat percentage will be measured using a Tanita BC-700 (Tanita-Japan) body analyzer.
• Total body fat percentage measurement — At baseline and after 8 weeks
  Total body fat percentage measurement will be measured using a Tanita BC-700 (Tanita-Japan) body analyzer.
• Lower extremity muscle percentage measurement — At baseline and after 8 weeks
  Lower extremity muscle percentage measurement will be measured using a Tanita BC-700 (Tanita-Japan) body analyzer.
• Total body muscle percentage measurement — At baseline and after 8 weeks
  Total body muscle percentage measurement will be measured using a Tanita BC-700 (Tanita-Japan) body analyzer.

Trial sites (1)

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