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Neuropilates, that is, the practice of pilates in a patient with a neurological condition, may benefit post stroke patients through improving their strength, postural control, alignment and stability, with previous studies showing significant improvements in balance and gait parameters post pilates interventions. This case study aimed to investigate the feasibility and outcomes of an online, remotely supervised one to one pilates class, once a week for 6 weeks with a post stroke patient. Outcomes measured included gait and balance through the “Timed Up and Go (TUG)” test, the “Five Times Sit to Stand (5TSTS)” test, the “Activities specific Balance Confidence (ABC) scale” and the “Tinetti” balance and gait assessment. Quality of life was also measured by the “Stroke Specific Quality of Life (SSQOL)” Scale and muscle tone was measured through use of the “Modified Ashworth Scale (MAS)”. Feasibility was assessed qualitatively based on information gathered from the client satisfaction questionnaire and the patient’s tolerance of the programme. Results demonstrated that the patient enjoyed and tolerated the programme well with modifications and that he would prefer online exercise training over face to face in the future. The patient improved his TUG score and his SSQOL score beyond the minimal detectable change. Smaller improvements were also seen in the 5TSTS test, the ABC scale and the Tinetti assessment. Mixed results were seen for muscle tone. Typical neuropilates exercise sets for post stroke patients in standing and seated positions are given as well as advice and protocols for ensuring high levels of safety with online exercising.

In a systematic review in 2011 of 16 randomised controlled trials including 727 participants overall, investigating the effects of pilates exercise in healthy individuals, strong evidence was found for improving flexibility and dynamic balance, while moderate evidence was found for improving muscular endurance [6]. It is worth noting, however, that control groups were inactive in 11 of these 16 randomised controlled trials and so placebo and hawthorne effects may have been relevant in the findings. The authors found contradictory results for strength, with pilates exercises improving hip, lower back and abdominal strength in 3 of the studies when compared with no exercise, but with no additional abdominal strength benefits found in one study when compared with a postural education group [7]. Differences in strength measurement, duration of intervention and level of supervision and instruction may account for these contradictory results between studies. In healthy children, a systematic review has shown that pilates appears to improve flexibility, strength and postural control [8] and in elderly populations, pilates has also been shown to have benefits with one systematic review of 10 studies demonstrating improvements in muscle strength, walking, activities of daily living, quality of life and dynamic balance [9]. Clinical pilatesIn clinical populations, the effects of pilates on low back pain has been examined in detail. A cochrane review of 10 trials, including 510 participants, showed low to moderate quality evidence that pilates reduces pain and disability in participants with non-specific low back pain when compared to minimal intervention. The authors, however, could not provide any