Pilates training is associated with reduced ambulatory blood pressure and enhanced autonomic reflex responsiveness in women with hypertension

OBJECTIVE: To investigate the effects of a 13-week Pilates Method (PM) program, combining mat and apparatus-based exercises, on ambulatory blood pressure (BP), autonomic reflex regulation, and endothelial function in women with hypertension receiving pharmacological treatment. METHODS: Twenty-eight women with hypertension (39-59 years) were randomized to a control group (CG, n = 14) or a Pilates group (PG, n = 14). The PG completed supervised PM sessions twice weekly, while the CG maintained usual care. Outcomes included ambulatory BP monitoring (24-h, daytime, and nighttime), heart rate variability (HRV), autonomic reflex tests (Valsalva ratio, deep breathing, HR and BP response to standing, and isometric handgrip), flow-mediated dilation (FMD), and circulating nitric oxide (NO) and nitric oxide synthase (NOS). Analyses were adjusted for baseline body weight. RESULTS: Significant Group × Time interactions were observed for all ambulatory BP parameters (all P ≤ 0.022, η2p = 0.19-0.31), with greater reductions in PG (e.g., 24-h SBP -10.3 mmHg, P = 0.009). Among autonomic reflex tests, only the deep breathing test demonstrated a significant interaction (P < 0.001, η2p = 0.61), whereas HRV indices did not change. FMD showed no time or interaction effects. NO decreased in the CG (P = 0.002) but remained stable in the PG, while NOS decreased in the PG (P < 0.001). CONCLUSION: A 13-week PM program was associated with reductions in ambulatory BP and enhanced autonomic reflex responsiveness in women with hypertension. PM appears to be a feasible and safe low-to-moderate-intensity adjunct to pharmacological treatment, with favorable hemodynamic effects.