Publications

Background: Evidence supporting the effectiveness of non-pharmacological exercise interventions to mitigate the side effects of aromatase inhibitor (AI) therapy among breast cancer (BC) patients remains limited. Given that AI-related adverse effects are associated with reduced quality of life, there is a clear need to address these symptoms. Thus, this study investigated the effects of the Pilates Method (PM) intervention on thoracic spine extensor myofascial stiffness (M-FS), pain sensation, and quality of life (QoL).

Methods: A randomized, two-arm, parallel-group supportive care trial with blinded outcome assessment compared an exercise intervention group (experimental group; EG) and a usual-care group (U-CG) pre- and post-intervention (per-protocol analysis). Eligible BC patients receiving AI therapy were randomized to either group. The EG completed a 12-week Pilates mat intervention (two supervised group sessions per week, 60 min each). Primary outcomes included measurement M-FS of thoracic spine extensor muscles (MyotonPRO®) at Th3, Th7, and Th12 spine levels, alongside assessments of pain sensation (The Brief Pain Inventory), and QoL (EORTC QLQ-C30, EORTC QLQ-BR23). Between-group and within-group differences were analyzed using a two-way repeated-measures ANOVA, followed by Bonferroni post hoc tests.

Results: 42 BC women were randomized to the EG (n = 28) and the U-CG (n = 14); 22 and 14 participants, respectively, were included in the final analysis. Significant time × group interaction effects for M-FS were observed at the Th3 (F = 17.04, ηp2 = 0.33, p < 0.001), Th7 (F = 20.13, ηp2 = 0.37, p < 0.001), whereas the interaction at Th12 was not statistically significant (F = 1.15, ηp2 = 0.03, p > 0.01). Significant time × group interaction effects with large effect sizes were found for pain severity, physical interference, and affective interference (all p < 0.001), whereas pain indicators increased in the U-CG. QoL improved in the EG, reflected by higher global health status (GHS) (F = 18.69, ηp2 = 0.36, p < 0.001), with significant improvements in systemic therapy side effects, arm symptoms (both p < 0.001). Clinically meaningful changes were observed in GHS and BC-specific symptom scales in the EG. No serious adverse events were observed.

Conclusion: A supervised PM-based intervention may improve selected treatment-related musculoskeletal outcomes in BC women receiving AI. The observed reductions in thoracic extensor M-FS (Th3, Th7), accompanied by enhancements in quality of life, substantiate the potential clinical significance of Pilates-based physiotherapy as an adjunctive rehabilitation approach within this population. Given its observed analgesic effects, the PM may represent a complementary supportive strategy alongside guideline-recommended aerobic and resistance training interventions in oncology rehabilitation.

Keywords: aromatase inhibitor-associated musculoskeletal symptoms, myofascial mechanical properties, exercise oncology

In conclusion, the findings of this study suggest that a supervised Pilates Method-based intervention may be associated with improvements in selected treatment-related musculoskeletal outcomes in women with breast cancer receiving aromatase inhibitor therapy. The observed reductions in thoracic extensor myofascial stiffness and pain, together with improvements in quality of life, support the potential clinical relevance of Pilates-based physiotherapy as a supportive rehabilitation strategy in this population. Although no circulating biomarkers related to treatment toxicity or skeletal muscle function were assessed, these findings may indirectly suggest that Pilates Method-based intervention—potentially acting as a form of fascia-oriented exercise—may help prevent deterioration in physical function in women with BC. This may be particularly relevant in this population, where high levels of kinesiophobia and fear of physical activity frequently limit participation in exercise.