Natural Therapies Review – Review Results and Summary
The release on Friday 4 April of the Natural Therapies Review Report and Professor Michael Kidd’s recommendation (as Chair of the Review) to have Pilates re-included for health fund rebates is a significant milestone. (If the recommendation had been to continue with the exclusion for Pilates, we would have had an exceedingly hard time in being able to do anything about this.) Again, enormous thanks to Dr Penny Latey for her incredible contribution to this outcome.
Given this hurdle has now been cleared, the government needs to remove the limitations imposed by Circular 69/18 and the health funds need to decide to include benefits for Pilates for their members. We will be in touch with members to advise how they can help in this process.
The below is a summary of the main takeaways from the reports and announcement.
Re-inclusion for health fund rebates
Pilates along with the following natural therapies: Alexander Technique, naturopathy, shiatsu, tai chi, western herbal medicine and yoga, have been recommended for re-inclusion as eligible for private health insurance benefits by Professor Michael Kidd. (Professor Kidd was the chair for the review and will be taking on the role of Chief Medical Officer in June this year.)
He did not recommend re-including as eligible for private health insurance benefits the following: aromatherapy, Bowen therapy, Buteyko, Feldenkrais, homeopathy, iridology, kinesiology, reflexology and Rolfing.
What is Pilates?
In the report, this is the Pilates description:
The Pilates system of body conditioning is founded on stabilising the core musculature (including the abdominal, gluteal and paraspinal muscles), while performing a controlled range of motions. Exercises are performed according to six key principles: centring (tightening and strengthening the body’s core ‘trunk’ muscles); concentration (with sensory awareness); control (ensuring postural integrity and functional alignment); precision (the accurate application of the exercise technique); flow (ensuring a smooth transition between movements and exercises); and focused coordinated breathing.
Contemporary Pilates involves a range of more than 500 exercises, which may be performed on a mat using auxiliary apparatus or specially designed equipment. Pilates professional teaching skills are specific to the method and include the use of cueing by demonstration or verbal direction for correct anatomical function, as well as using imagery, metaphor and non-invasive hands-on assistance for the correct performance of each exercise to facilitate improved motor control.
Pilates classes in the reviewed studies typically lasted 45 to 60 minutes, with sessions occurring one to five times per week for 4 to 26 weeks.
Pilates and Low Back Pain
The review identified a significant number of studies focusing on low back pain. The evidence regarding Pilates for low back pain suggests that:
- There is low certainty evidence that Pilates results in a large reduction in pain.
- There is moderate certainty evidence that Pilates probably results in a moderate reduction in disability.
- There is moderate certainty evidence that Pilates has little to no effect on functional capacity for people with low back pain.
Overall, while the evidence suggests benefits for pain and disability in people with low back pain, the certainty varies, and it appears Pilates may not significantly improve functional capacity in this population. The findings for pain and disability are consistent with a previous Cochrane review, but this review, including more recent studies, provides moderate certainty for disability.
Pilates for Other Health Conditions
- Moderate certainty:
- Pilates is effective in improving incontinence-related quality of life in men (after radical prostatectomy) (from two studies, 126 participants),
- Low Certainty:
- Pilates may improve activities of daily living in women with type 2 diabetes (one small study).
- Pilates may improve mental wellbeing in people with multiple sclerosis (one small study) and anxiety in people at risk of mental health conditions (one study).
- Pilates may improve global assessment, pain, and quality of life in people with HTLV-1 associated myelopathy (small number of trials).
- Pilates may improve balance in people with Parkinson’s disease (evidence limited to a small number of small trials).
- Pilates may improve pain and disability in people with chronic neck pain (evidence limited to a small number of small trials).
- Very Low Certainty:
- Pilates may have potential benefits for global assessment, pain, quality of life, and spinal mobility in spondyloarthropathies (limited evidence from one small trial).
- Pilates may have potential benefits for non-narcotic analgesic use in low back pain (one small trial).
- Pilates may have potential benefits for static balance in osteoporosis (limited evidence from a small number of small trials).
- Pilates may have potential benefits for general health perception in those at risk of age-related mental decline (one small study). The evidence for pain in chronic neck pain is also very uncertain.
- Unknown Effect:
- The effect of Pilates is unknown for women undergoing breast cancer treatment, people with hypertensive heart disease, people with chronic widespread pain, or people with shoulder pain due to a lack of studies with critical or important outcomes.
It’s important to note that for many of these conditions, the conclusions are based on a small number of studies with limited participants, and the certainty of the evidence is generally low. More research is needed to confirm these potential benefits. The review itself acknowledges limitations due to the prioritisation of conditions, the exclusion of non-English language studies, and the lack of long-term data.
Recommendations
This paragraph is of particular importance in the letter from Professor Michael Kidd:
“Given the nature of the therapies, it is difficult to achieve high certainty in the evidence due to study design limitations, such as the difficulties in using double blinding or sham/placebo in most of the therapies. I have therefore recommended re-inclusion where there is moderate certainty evidence of their clinical effectiveness for at least one health outcome in one health condition against the best available comparator where the majority of the evidence favours effectiveness. This excludes very low certainty evidence, where the reviewers’ confidence was so limited that interpretation was not provided. This is consistent with the retention of eligibility for massage following a finding in the 2015 review of moderate evidence for its short-term effectiveness for two health conditions.”
Qualifications of Pilates Instructors in Research
In the studies included in this review, the treatment provider was often not specified. However, when the qualifications were reported, the interventions tended to be delivered by experienced Pilates instructors or physical therapists trained in the Pilates method. This highlights the importance of proper training and experience in delivering Pilates interventions, especially within a therapeutic context. There is no evidence that gym Pilates provides any of the benefits attributed in the review.
Why is the evidence not stronger?
There may be some disappointment in the fact that the evidence was not stronger. We understand anecdotally that Pilates does amazing things. The difficulty is having this translated into actual research. There are many reasons for this, including small and short trials.
It is important to note that the research only provides evidence that has moderate to low certainty. It does not mean that Pilates is ineffective for a myriad of different health conditions.
Source Documents
If you wish to read the original documents, they can be found here:
The reports include a substantial amount of technical detail, like forest plots and risk of bias summaries. If there is interest in learning more about these, please let us know.
Robyn Rix, PAA President
April 6, 2025
Comments are closed.