Impact of 6 Weeks Pilates Training on Menopause Specific Symptoms and Quality of Life in Menopausal Women: A Case Report

Introduction: The concept of menopause is a complete cessation of ovarian function. Most common symptom of menopause include muscle and joint ache, poor memory, lower back pain and trouble sleeping. The vasomotor and emotional domains reported less often compared with the physical and psychological domains. Such adverse changes in physical and mental health may have a negative impact on Quality of Life (QOL). Pilates is a mind body exercise focusing on muscle strength, core stability, endurance, muscle control, posture, and respiration which seems to improve both the physical and psychological components in women during menopause. The given study helps to provide the effect of 6 weeks Pilates training protocol on menopausal women’s presenting complaints as well as on her QOL. Complaints and clinical finding: Patient’s main concern were low back ache without any cause night sweats, fatigue, disturbed sleep wake cycle which lead to difficulties in performing activities of daily living which hampered the QOL of the patient. Physical findings revealed decrement in lower back and lower limb muscle strength along with some tightness. Scales helped to reveal that patient is having fatigue and tiredness and mat-exercise treatment protocol were formed. Therapeutic Intervention: 6 weeks Pilates training. Case Report Bais et al.; JPRI, 33(37B): 83-89, 2021; Article no.JPRI.71114 84 Conclusion: As there are minimal to no evidence present in reference to this study, it helps us to provide new and proper treatment protocol and it is helpful to know the effect of the same. It showed significant improvement in the muscular strength as well as reduction in stress level and helped in enhancing the QOL of the patient.


INTRODUCTION
The concept of menopause is a complete cessation of ovarian function [1]. The symptoms peal between 45-55 years and decrease in severity after 55 years [2]. Most common symptoms of menopause include muscle and joint pain, slow feeling, poor memory, lower back pain and trouble sleeping. The vasomotor and emotional domains reported less often compared with the physical and psychological domains [2]. Such adverse changes in physical and mental health may have a negative impact on Quality of Life (QOL) as women undergo transition from menopause [3].
Pilates is a mind body exercise focusing on strength, core stability, endurance, motor control, posture, and respiration [4]. Exercises may be mat based or require the use of specialized equipment and the concepts of Pilates include centering, focus, balance, precision flow and respiration [5]. Pilates seems to improve both the physical and psychological components in women during menopause [6].
As there are little to no evidence related to the effect of Pilates training on Menopausal women with respect to the related symptoms as well as the Quality of Life. This helps us to provide new and proper treatment protocol and it is helpful to know the effect of the same.

CASE PRESENTATION
A 48-year-old woman, visited to the clinic with the complaints of low back ache since 1 year which was insidious in onset and not of progressive nature. It was acute in onset and is of dull-aching type. Pain is of moderate intensity which aggravates on heavy exertional work and relieves on rest and medications. Pain was not associated with any radiation, tingling and numbness and patient marked 4 on NPRS scale. Along with these, patient also presented complaints of insomnia which was basically due to menopausal symptoms including hot flashes and night sweats. She presented disturbances in her sleep wake cycle which was that she may lie in bed for hours before she falls asleep, and other nights she does not felt difficulty in falling asleep. She started waking up between 2 to 4 hours after falling asleep due to extreme night sweats and hot flashes. She also started feeling tired after doing her normal household work which she used to perform efficiently without any tiredness. Due to all the presented complaints, she started having difficulties in performing the activities of daily living. There was no relevant past history or family history and patient did not have any musculoskeletal, cardiovascular and neurological diseases.
Past medical history revealed that patient was suffering from diabetes from past 3 years. There was no relevant past surgical history and family history.

THERAPEUTIC INTERVENTION
Patient underwent supervised Pilates training program of 6 weeks in order to prevent further risks and complications as well as to maintain and to increase muscle strength, enhance activities of daily living and to improve Quality of life of patient.
Exercises commands were given- Patient performed leg stretches (single and double), leg circles (single and double), pelvic curls and back extension exercises. All are performed for 10 repetitions each and 5 seconds hold and 3 sets of each exercise. As patient was getting tired easily, 10 second rest has been given between each exercise and 30 seconds rest after whole set. Fig. (a). Spine stretch forward Fig. (b). Criss- Cross   Fig. (c). Pelvic Lift Fig. (d). Hundred WEEK 3-WEEK 6: Along with the general stretches and the given exercises, additional exercises that are Spine stretch forward, curl up and criss-cross were added into the program.
The new exercises has been performed by patients with the same dosages.
Collectively, 30-40 minutes specific treatment protocol has been given including 5 minutes of warming up and 5 minutes of cooling down. Intensity was gradually increased week wise, Rate of Perceived Exertion scale has been used to maintain as well as increase the program intensity. Initially, it ranges between 9-11 and gradually progressed to 11-13 and it has been done for 3 days a week.

DISCUSSION
Strength, in this case was that the patient was able to perform all the exercises from the intervention in the correct manner and proper time.
The limitations of this case were that the patient used to get tired easily due to fatigue. In order to cope up with this, the patient performs proper breathing pattern long with the intervention technique.
Low back pain (LBP) is most common disorders of the musculoskeletal system [7]. It is one of the major symptom of menopause is lower back pain. Due to adverse changes in physical and mental health, it hampered the Quality of life of menopausal women.
So, 6 weeks of proper Pilates intervention were programmed [5]. Exercises were leg stretches (single and double), leg circles (single and double), pelvic curls and back extension exercises, spine stretch forward, curl up and criss-cross which mainly focuses on improving lumbar strength. As physiotherapy intervention includes Range of motion exercises (ROM), strengthening exercise, functional mobility exercises, trunk control exercises, weight bearing exercises for achieving several functional outcomes [8], all these got covered in Pilates training intervention. Studies showed that Pilates major exercises helps in improving low back pain, posture, balance and Quality Of Life of Older elderly female [9,10].
Along with the lower back pain issue, the patient also showed the symptoms of fatigue and disturbed night sleep. There has been significant improvement in sleep quality as well as reduction in fatigue by Pilates Exercise Program [11]. Studies on different aspects of perimenopausal problems were reported [12][13][14]. Warjukar et. al. reported about lipid profile, estradiol for evaluation of cardiovascular risk in pre-and post-menopausal women [15]. Aglawe et. al. reported about core therapy, supportive therapy, and alternative therapy in correlation to plethora of menopausal problems [16]. Pohane et. al. conducted a comparative study of menopausal age and symptoms with respect to prakriti in rural and urban regions [17][18][19][20]. Few more related were reviewed [21][22][23][24][25][26].

CONCLUSION
This case reports provide patient with a comprehensive treatment plan which showed significant improvement in the muscular strength as well as reduction in fatigue level and helped in enhancing the Quality of Life of the patient.

CONSENT AND ETHICAL APPROVAL
As per international standard or university standard guideline patients consent and ethical approval has been collected and preserved by the authors.