stroke refers to cerebrovascular bleeding and a neural disease caused by nontraumatic 
 reasons and is accompanied by brain damage or functional loss of lower body muscles on the 
 paretic side1 , 2 . despite the development of modern medicine , economic growth , and 
 widening interests in health , its occurrence is increasing quickly due to unbalanced 
 lifestyles , environmental pollution , and excess stress in fast - paced societies1 , 2 .
it 
 has been reported that loss of motor ability and balance due to stroke can limit some daily 
 living activities such as walking and may lead to secondary injury like falls . generally , 
 gait in stroke patients
is characterized by reduced gait parameters3,4,5 , and decreased gait function following stroke in particular is known 
 as the fundamental reason why patients fail to safely return to society6,7,8 .
yang et al.9 reported that because 
 hemiplegia patients with lesions support more than 60% of the load on the non - paretic limb 
 during standing , it could result in an asymmetric gait pattern
. they also reported that a 
 stroke patient group showed lower gait velocity , stride time , stride length , and cadence 
 compared with a group of healthy elderly .
grasies10 and vattanasilp et al.11 showed that patients with stroke tend to reduce the range of motion 
 ( rom ) of paretic lower limb joints during walking , while fonseca et al.12 reported that increased stiffness of the hip joint can 
 reduce energy efficiency , which results in limited walking and running movement . in 
 addition , turnbull et al.13 , who analyzed 
 the gait cycles of eight elderly hemiplegia patients for ten years , reported that the 
 patients showed increased double support time and decreased single support time during 
 walking , indicating that patients tended to walk as slowly and stably as possible to secure 
 stability .
as reported from previous studies , the predominant characteristic of hemiplegia patients 
 with stroke is the difficulty with walking due to weakened lower limb muscles and imbalance . 

therefore , many researchers have conducted studies focusing on the recovery of gait ability 
 as the ultimate purpose of rehabilitation of patients with stroke14,15,16 .
pilates exercise is also called contrology and it is based on the 
 idea of muscle control .
it focuses to make a neutral spine of body to prevent excess flexion 
 and extension of the spine when walking upright17 , 
 18 . since pilates exercise has been 
 shown to have positive effects on development of muscular strength and endurance and 
 improvement of flexibility , it has been used not only for exercise programs for healthy 
 adults but also for rehabilitation for the elderly19 , 
 21 . moreover , unlike other exercise 
 programs , pilates exercise can be performed with various tools to adjust the fitness level 
 for the elderly , who have weaker physical strength and it can be performed at home without 
 having to visit a rehabilitation center22 , 23 . as pilates is reported to develop the 
 deep core muscles , which helps to improve the stability of spine , reduce back pain , and 
 control the pelvis and hip joints24,25,26,27,28,29,30 , 
 it is thought to have a positive influence on gait ability , and many researchers have 
 actually reported the effectiveness of pilates exercise on gait ability for the elderly17 , 18 , 21 .
despite the various positive effects of pilates , however , it is still not widely applied to 
 stroke patients .
therefore , the purpose of this study was to investigate the effects of an 
 8-week program of pilates exercise on gait in chronic hemiplegia patients and to determine 
 whether or not it can be used for rehabilitation in poststroke patients .
twenty poststroke participants ( age , 66.1  4.4 yrs ; height , 162.3  8.3  cm ; weight , 67.4  
 12.3  kg ) were recruited for this study .
the exclusion criteria for the poststroke 
 participants included moderate / severe chronic white matter disease on mri or orthopedic and 
 other gait - influencing diseases such as arthrosis or history of lower - extremity joint 
 replacement .
participants who were involved in other studies or rehabilitation programs were 
 also excluded from this study . the objective and requirements of this study were explained 
 to all participants , and written informed consent was obtained from each participant prior 
 to participation .
the university s institutional review board approved the study 
 protocol . after completing participants selection ,
the participants were randomized into two matched 
 number groups : the pilates exercise group ( eg ) and control group ( cg ) . during the 
 intervention period ,
the eg performed pilates exercise , while the cg did not perform any 
 kind of exercises or receive any treatment . the pilates exercise program used in this study
was conducted by two certified pilates 
 instructors and one physical therapist three times a week , 60 minutes per session , for 8 
 weeks .
the exercise was composed of warm - up exercise , the main exercise , and cool - down 
 exercise . for improving core muscles stability ,
breathing exercises were conducted in a 
 sitting posture before and after the main exercise .
the details of the program are provided 
 in table 1table 1.pilates exercise programprogramwarm - up exercise1 . breathing : 8 sets10  min2 .
spine stretch side : 8 setsexercise2 . draw a sword : 8 sets40  min3 .
swan : 8 sets . in order to investigate the effects of the 8 weeks of pilates exercise ,
a 3-d motion 
 analysis with 8 infrared cameras ( oqus , qualisys , sweden ) was performed twice ( a week before 
 and after the pilates exercise period ) .
the subjects were required to wear black spandex 
 shorts , a dark t - shirt , and a pair of walking / running shoes during data collection .
to 
 identify lower limb movements , 12 reflective markers were attached to the lower body .
after 
 sufficient warm - up , each subject was asked to walk on a treadmill ( instrumented treadmill , 
 bertec , usa ) , and his / her walking trials were captured with sampling rate of 100  hz . the 
 cameras were positioned around the treadmill for sufficient tracking redundancy and were 
 calibrated using the nlt ( non - linear transformation ) method .
the treadmill speed was set at 
 each subjects preferred speed which was measured before the experiment .
each subject was 
 recorded while walking for 30 seconds , and five strides from the middle of the recording 
 were used for analysis . to evaluate the asymmetric pattern of gait parameters , the asymmetry index proposed by 
 robinson et al.31 was 
 used .
xparetic and xnon - paretic are the values of a gait parameters 
 recorded for the paretic and non - paretic limbs , respectively
. to verify the effect of the 8-week pilates exercise on the gait of poststroke patients , the 
 two - way anova with repeated measure was used , and statistical significance was set at 
 =0.05 .
the gait parameters and asymmetry indexes before and after the 8 weeks of exercise are 
 presented in tables 2 and 3table 2.kinematic gait parameters between exercise periodsvariablescontroltrainingpre - trainingpost - trainingstride length ( cm)33.25  12.9043.91  19.35stride time ( s)1.52  0.361.40  0.32stride velocity ( cm / s)21.54  3.4131.48  12.81step length ( cm)paretic17.22  4.2424.63  8.25non - paretic16.03  8.6919.28  11.28hip rom ( deg)paretic22.55  5.9122.77  6.84non - paretic26.01  10.4330.61  5.47*knee rom ( deg)paretic25.30  12.5520.38  3.08non - paretic48.39 
8.8952.03  8.72*ankle rom ( deg)paretic12.14  2.8311.67  6.76non - paretic14.69  2.3919.96  6.07values are group mean  standard deviation . * significant difference between pre- and 
 post- pilates training .
significant difference between groups 
 ( p<0.05)table 3.asymmetry indexes of kinematic gait parameters between training periods ( unit : 
 % ) variablescontroltrainingpre - trainingpost - trainingpre - trainingpost - trainingstep length28.2  25.733.1  35.039.3  29.237.2  33.5hip rom42.4 
37.944.8  34.735.5  24.331.9  20.0knee rom67.6  51.068.1  40.871.4  48.765.9  45.4ankle rom52.1  40.150.9  47.752.2  36.148.4  21.0values are group mean  standard deviation .. for the gait parameters , increased patterns were found for all variables and 
 statistical significances were found for stride length , gait velocity , knee rom , and hip rom 
 ( table 1 , p<0.05 ) .
for the asymmetry 
 indexes , insignificant improvements were found for all variables ( table 2 , p>0.05 ) .
significant difference between groups 
 ( p<0.05 ) values are group mean  standard deviation .
the main purpose of this study was to examine the effectiveness of an 8-week pilates 
 exercise on walking in poststroke patients and to provide guidance for physical therapy 
 whether or not the exercise can be used for rehabilitation in poststroke patients .
gait in 
 stroke patients is characterized by reduced temporospatial variables , reduced rom of lower 
 extremity joints , and asymmetry in the lower extremities3,4,5 . in this study
, it was proved that an 8-week pilates exercise 
 program effectively improved patients gait parameters . since gait speed is easy to measure and a reliable outcome of rehabilitation , it has been 
 widely used in studies on stroke patients3 , 30 .
gait speed is increased when stride 
 length is increased or stride time is decreased . in this study ,
the pilates exercise group 
 showed a statistically significantly improved gait speed , whereas the control group did not 
 ( table 1 , p<0.05 ) .
the subjects in the 
 pilates exercise group seem to have increased their gait speed by increasing their stride 
 length after the exercise period ( table 1 , 
 p<0.05 ) .
this is probably because the pilates exercise developed the deep muscles , such 
 as the transverse abdominis and internal oblique that take charge of the stability of the 
 body and this may have helped to improve the stability of spine and the muscular strength 
 and flexibility of the pelvis and hip joints24,25,26,27,28,29 .
unlike general pilates exercise , the 
 pilates exercise used in the present study included lower limb strengthening exercise .
this 
 exercise may strengthen the quadriceps , gluteus medius , adductor magnus , gastrocnemius , and 
 anterior tibialis , which can help to increase stride length .
the effect of strengthening the 
 deep muscles is also seen in the increased rom of the lower extremity joints in the pilates 
 exercise group after the exercise period ( table 
 1 , p<0.05 ) .
another gait characteristic of stroke patients is that over 60% of weight is loaded on the 
 lower limb on the non - paretic side during walking , so they show asymmetrical gait in 
 temporospatial parameters9 .
the present 
 study showed no statistical differences in the asymmetry indexes of variables in either 
 group . in the case of the exercise group , however ,
insignificantly improved symmetric 
 patterns were found ( from 5.3% to 10.1% ) after the exercise period ( step length , 5.3% ; hip 
 rom , 10.1% ; knee rom , 7.7% ; ankle rom , 7.3% ; p>0.05 , table 2 ) .
the lack of statistically significant improvements in asymmetry indexes 
 was probably the result of a limited number of subjects or a short exercise period . in this 
 study , we chose eight weeks as the exercise period because many previous intervention 
 studies for elderly have shown the effectiveness of 8-week interventions .
as pilates 
 exercise strengthens the deep muscles , however , it is thought to require a longer exercise 
 period compared with resistance training , cardiovascular exercises , or underwater exercises , 
 which strengthen the superficial muscles .
this issue should be examined in a follow - up 
 study . in conclusion , this study proved the effect of pilates exercise , which has not been used as 
 a means of intervention to rehabilitate motor functions of poststroke patients .
the 8-week 
 program of pilates exercise had a positive influence on improving the gait ability of 
 poststroke patients , and the intervention could be applied to poststroke patients with 
 various levels of physical disability by adjusting the intensity of exercise .
 [ purpose ] the purpose of this study was to investigate the effects of an 8-week program 
 of pilates exercise on gait in chronic hemiplegia patients and to determine whether or not 
 it can be used for rehabilitation in postsrtoke patients . [ subjects and methods ] twenty 
 individuals with unilateral chronic hemiparetic stroke ( age , 66.1  4.4 yrs ; height , 162.3 
  8.3  cm ; weight , 67.4  12.3  kg ) participated in this study and were randomly allocated 
 equally to either a pilates exercise group or a control group . to identify the effects of 
 pilates exercise , a 3-d motion analysis with 8 infrared cameras was performed . 
 [ results ] 
 for the gait parameters , improvements were found in the pilates exercise group for all 
 variables , and statistical significance was observed for stride length , gait velocity , 
 knee range of motion and hip range of motion . for the asymmetry indexes , 
 insignificant 
 improvements were found for all variables in the pilates exercise group . 
 [ conclusion ] in 
 conclusion , an 8-week program of pilates exercise had a positive influence on improving 
 the gait ability of poststroke patients , and the intervention could be applied to 
 poststroke patients with various levels of physical disability by adjusting the intensity 
 of training . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION