Comparison of two different Pilates exercise methods in women with dysmenorrhea: a randomized controlled trial

The objective of this study is to analyze and compare the effects of Mat Pilates and Reformer Pilates methods on pain intensity, menstrual pain and symptoms, depression, fatigue, and sleep quality in women with dysmenorrhea. This study included 45 women aged 18-50 years with dysmenorrhea, randomly assigned to three groups: control (n = 15), Reformer Pilates (n = 15), and Mat Pilates (n = 15). The 12-week intervention involved Pilates training twice weekly for the intervention groups. Participants reported pain and related symptoms on the first day of menstruation to standardize assessments. Outcomes included the visual analog scale (VAS) for pain, menstrual symptom scale (MSS), fatigue impact scale (FIS), beck depression inventory (BDI), and Pittsburgh sleep quality index (PSQI). The primary statistical analysis focused on whether the 12-week changes differed between the Mat Pilates and Reformer Pilates groups. Between-group differences were assessed using one-way ANOVA or Welch's test, with post hoc pairwise comparisons (Tukey HSD or Tamhane T2) as appropriate; paired t-tests evaluated within-group changes. The clinical trial registration number is NCT06774521. A substantial enhancement was noted in the BDI (p = 0.001), FIS Total (p = 0.002), and MSS Total (p = 0.025) scores in the Mat Pilates group following the intervention. No significant differences were identified in PSQI (p = 0.334) or VAS scores (p = 0.051). In the Reformer Pilates group, significant improvements were observed in BDI (p = 0.003), PSQI (p < 0.001), VAS (p < 0.001), FIS Total (p = 0.009), and MSS Total (p < 0.001) scores. A subsequent analysis of the differences among the three groups in terms of 12-week changes in VAS scores (p = 0.002), BDI (p = 0.012), PSQI (p < 0.001), FIS total score (p = 0.027), and MSS total score (p < 0.001) revealed statistically significant overall differences. Based on the 12-week changes (AI-BI), Reformer Pilates resulted in significantly greater improvements than Mat Pilates in VAS (p = 0.009), PSQI (p < 0.001), Negative Effects/Somatic Complaints (p = 0.030), and MSS Total (p = 0.019). However, no statistically significant differences were observed between Reformer Pilates and Mat Pilates in BDI, the FIS subscales (Physical, Cognitive, and Social), FIS-Total, or MSS-Coping Methods (p > 0.05). Both Mat Pilates and Reformer Pilates were effective in improving dysmenorrhea-related outcomes, including pain, menstrual symptoms, depression, and fatigue. However, Reformer Pilates demonstrated superior benefits compared with Mat Pilates in reducing pain intensity, improving sleep quality, decreasing negative effects/somatic complaints, and reducing overall menstrual symptom severity. Improvements in depression, fatigue, and coping methods were comparable between the two Pilates approaches. These findings suggest that Pilates exercises may serve as a potential therapeutic modality for the management of menstrual symptoms.Trial registration: The protocol is registered with http://clinicaltrials.gov/ (08/01/2025, Clinical Trial, NCT06774521).