Effect of aerobic and Pilates exercise on balance, gait, functional capacity, lower extremity strength, fear of falling, sleep quality, and quality of life in older adults

The primary objective was to compare the effects of aerobic and Pilates exercise programs on balance, gait performance, functional capacity, lower extremity strength, fear of falling, sleep quality, and quality of life in older adults. A secondary objective was to determine which exercise modality yields greater improvements in these outcomes, thereby providing evidence to guide the selection of effective exercise interventions for promoting health and well-being among the older adults. Forty-four older adults, aged 60–69 years, were randomly assigned into either the aerobic (n = 22) or Pilates exercise group (n = 22). The aerobic group trained three sessions per week (30 min of active exercise per session; 90 min/week), while the Pilates group (PG) trained two sessions per week (45 min of active exercise per session comprising mat, standing, and TheraBand components; 90 min/week), each for eight weeks, yielding equivalent total active exercise volumes (720 min per group). The outcomes of Mini-Balance Evaluation System Test (MBEST), Timed Up and Go test (TUGT), 2-Minute Walk Test (2MWT), 10-Meter Walk Test (10MWT), Five-Time Sit-to-Stand test (5xSTST) and self-reported questionnaires of the Fall Efficacy Scale International (FES-I), Pittsburgh Sleep Quality Index (PSQI), and WHOQOL-Brief were collected at baseline and post-treatment. Groups were equivalent at baseline across all measures. Significant Group × Time interaction effects were observed for gait velocity (10MWT) and dynamic balance (MBEST), with the aerobic group demonstrating significantly greater improvements in both (10MWT: p = 0.016; MBEST: p < 0.001). ANCOVA adjusting for baseline score, age, and BMI confirmed these between-group differences (10MWT: p = 0.012; MBEST: p < 0.001). Significant time main effects (p < 0.05) were observed for all remaining outcome measures (TUGT, 5×STST, 2MWT, FES-I, PSQI, all WHOQOL-Brief domains), indicating meaningful within-group improvements shared across both interventions. Both aerobic and Pilates exercise programs produced clinically meaningful improvements in gait velocity, functional capacity, and balance in older adults, with the aerobic group demonstrating significantly greater improvements in dynamic balance. Both interventions additionally reduced fall-risk classifications based on clinical threshold analyses. The findings of this study suggest that aerobic exercise may be the preferred modality for optimizing functional mobility and balance in community-dwelling older adults, though both modalities offer valuable and clinically meaningful health benefits. Future trials equalizing both volume and frequency are warranted to confirm modality-specific effects with full design equivalence. This Clinical Trial is registered with Thai Clinical Trials Registry (TCTR) approved by WHO. Registration number TCTR20240403002. Date of registration 13 March 2024. URL https//www.thaiclinicaltrials.org/#.