Effects of Proprioceptive Neuromuscular Facilitation-Based Reformer Pilates and Hatha Yoga on Functional Fitness, Balance, and Cognitive Performance in Older Women: A 16-Week Randomized Controlled Trial

Abstract Background Aging is associated with progressive declines in neuromuscular function, postural control, and cognitive performance, which may compromise functional independence. Mind–body exercise approaches such as Pilates and Yoga have been suggested as effective strategies to counteract these age-related changes; however, comparative evidence examining their multidimensional physiological effects remains limited. Purpose This randomized controlled trial aimed to compare the effects of PNF-supported Reformer Pilates and Hatha Yoga interventions on joint mobility, trunk stability, dynamic balance, spinal mobility, muscular endurance, hand grip strength, and working memory performance in older women. Methods Women aged 65–85 years were randomly assigned to a Pilates group, a Yoga group, or a control group. Participants in the exercise groups completed structured training programs twice weekly for 16 weeks. Functional performance was evaluated using the Beighton score, Trunk Stability Push-Up (TSPU), Y-Balance Test (upper and lower quarter), Step Down test, trunk flexor/extensor and side bridge endurance tests, Schober test, inclinometer measurements, hand grip strength, and the N-back working memory test. The primary outcomes of the study were trunk stability, dynamic balance, spinal mobility, and trunk muscular endurance, assessed using the TSPU, YBT-LQ, Schober/inclinometer measurements, and trunk endurance tests. Joint mobility, hand grip strength, and working memory performance were considered secondary outcomes. Data were analyzed using two-way repeated measures ANOVA (time × group). Results Significant time × group interactions were observed across the majority of outcomes, indicating differential adaptations between interventions. For the predefined primary outcomes — trunk stability (TSPU), dynamic balance (YBT-LQ), spinal mobility (Schober/inclinometer), and trunk muscular endurance — both exercise programs improved relative to the control group, with large time × group interaction effects (partial η² ≈ 0.56–0.87); these improvements tended to be more pronounced in the Pilates group. For the secondary outcomes joint mobility (Beighton), handgrip strength, and working memory (N-back) significant but comparatively smaller interaction effects were observed (partial η² ≈ 0.15–0.32) and should be interpreted more cautiously given their exploratory nature and the number of comparisons performed. As no direct physiological measures were obtained, any mechanistic interpretation remains tentative and derived from previous literature rather than directly assessed in the present study. Conclusion Both PNF-supported Reformer Pilates and Hatha Yoga appeared beneficial for improving functional and cognitive performance in older women. Pilates-based training showed greater improvements in several primary outcomes; however, these findings should be interpreted cautiously due to baseline differences, intervention characteristics, and multiple outcome analyses. Further confirmation is needed.