Background and Purpose
Anxiety disorders are among the most common mental health conditions, presenting significant challenges in both psychological and physical domains throughout a person’s life. They are known to impair cognitive functions such as inhibition, planning, and problem solving, which are crucial for effective daily functioning and information processing. Among the promising interventions for anxiety, Pilates has garnered increasing attention in recent years. Pilates exercises are believed to promote neurogenesis and enhance cognitive functioning by increasing levels of neurotrophins, which support neuronal growth and plasticity.
Despite Pilates’ rising popularity and preliminary evidence suggesting benefits for anxiety and cognitive function across diverse populations, there remains a paucity of studies specifically examining its effects on women diagnosed with anxiety disorders. The present study aims to fill this gap by investigating how an eight-week course of moderate to high intensity Pilates training influences cognitive performance and anxiety symptoms in women affected by anxiety disorders.
 
Methods
The study employed a semi-experimental, applied design. The statistical sample comprised 30 women aged 25 to 40 years residing in Babol city. Participants were randomly assigned to experimental and control groups through voluntary sampling, based on pre-established inclusion criteria.
Instruments

The Beck Anxiety Inventory (BAI), containing 21 items scored from 0 to 63, was used to assess anxiety levels. Its internal consistency reliability (Cronbach’s alpha) has been reported as 0.92.
The Tower of London Test (TOL), a computerized assessment consisting of 12 problem-solving tasks with a maximum score of 36, evaluates planning and problem-solving abilities. Its validity has been documented at 0.79.
The Go-No-Go Test (computerized) assesses behavioral inhibition by requiring participants to respond to certain stimuli (“go”) and inhibit responses to others (“no-go”). Its reliability stands at 0.87.

Intervention:
The experimental group participated in Pilates sessions for 8 weeks, 3 times per week, each lasting 60 minutes at moderate to intense exercise intensities. Intensity was regulated by calculating participants’ heart rate reserve (HRR) using the Karvonen formula and maintaining exercise intensity between 55 and 70% of HRR.
Procedure:
At baseline, participants completed the BAI, the TOL test, and the Go-No-Go test to establish anxiety and cognitive function parameters. The experimental group then engaged in Pilates training as detailed above, while controls maintained their usual activities without added exercise. After completing the intervention, posttest assessments identical to the baseline tests were conducted.
Statistical Analysis
Data were analyzed using SPSS version 26. Descriptive statistics summarized participant characteristics and baseline values. Multivariate analysis of covariance (MANCOVA) was applied to assess the effect of Pilates on anxiety and cognitive functions, controlling for potential confounders. Additionally, one-way ANOVA tested differences on specific cognitive components. Statistical significance was determined at the alpha level of 0.05.
 
Results
The results of Table 1 in the analysis of covariance show that Pilates exercises had a significant effect on the anxiety of women with anxiety disorders (p=0.00). The effect size obtained shows that 63% of the changes in anxiety reduction were due to Pilates exercises.
 
Table1- The results of covariance analysis of the effect of Pilates on anxiety





Observed power


Effect size


significance


 
F


Mean square


df


Sum of squares


Statistics




1.000


0.63


0.000


43.58


356.40


1


356. 40


Group





 
Table 2 shows that, according to the significance level obtained in the Tower of London test, Pilates exercises had a significant effect on planning and problem solving ((F^4,18) =3.38, p=0.031). The effect size shows that 0.42 of the changes made in the experimental group are related to the application of the independent variable. Another result of this study on the Go-No-Go test showed that cognitive inhibition did not change significantly under the influence of Pilates exercises ((F^4,20) =2.65, p=0.063).
 
Table 2- The results of multivariate covariance analysis of the effect of Pilates on the Tower of London and Go-No Go tests





Test


Statistics


Value


F


significance


Effect size


Observed power




Tower of London


Wilkes Lambda


0.57


3.37


0.031


0.429


0.736




Go-No-Go


Wilkes Lambda


0.65


2.65


0.06


0.34


0.63





 
The results of the between-group effects of the components of the Tower of London test using one-way analysis of variance show that the exercises performed in this study had the greatest effect on the components of delay time (p=0.002), total time (p=0.006), total score (p=0.032), respectively, and the test time (p=0.052) and number of errors (p=0.067) did not show a significant effect despite the improvement of these components. Also, the study of the between-group effects of the components of the Go-No-Go test showed that only the inhibition component had significant changes (p=0.013) and the presentation error (p=0.118) and omission error (p=0.089) components did not show a significant change despite the improvement in the post-test results.
 
Conclusion
The findings affirm that an eight-week Pilates training program substantially reduces anxiety and enhances cognitive functions related to planning and problem solving among women diagnosed with anxiety disorders. The key mechanism underlying these effects likely involves the intrinsic coordination of breathing and movement characteristic of Pilates. This integration activates the parasympathetic nervous system while reducing sympathetic nervous overactivity, facilitating relaxation and stress reduction.
Anxious individuals have a propensity to be distracted by irrelevant stimuli, with anxiety disproportionately impairing inhibitory control compared to other cognitive domains via diminished attentional mechanisms. This may explain why cognitive inhibitory improvements were less pronounced; longer or more intensive training might be necessary to produce significant gains in this area.
Pilates training positively influences executive functions by decreasing anxiety and increasing attentional capacity. For instance, enhanced performance on the Tower of London test may be attributed to anxiety reduction, allowing participants to allocate cognitive resources more efficiently, resulting in better accuracy and reduced mental effort.
The absence of a statistically significant impact of Pilates on inhibition in this sample aligns with attention control theory, which postulates that interference control improvements lag behind other cognitive domains following anxiety interventions.
 
Article Message
This study suggests Pilates can be a valuable non-pharmacological intervention to improve both mental health and cognitive functioning in women with anxiety disorders. Its benefits include anxiety reduction, enhanced planning and problem-solving abilities, and improved behavioral inhibition. These outcomes position Pilates as an effective holistic approach integrating mind-body health.
 
Ethical Considerations
Participation was voluntary, with written informed consent obtained from all participants. The study received ethical approval under code IR.UMZ.REC.1403.057 from the Ethics Committee of University of Mazandaran.
Authors’ Contributions

First author: Concept development, data collection, and literature review
Second author: Topic selection, data analysis, article writing, and project management
Third author: Topic selection, manuscript revision, and project management
Fourth author: Clinical diagnosis of anxiety in participants, manuscript editing and revision

Conflict of Interest
The authors declare no conflicts of interest related to this research.
 
Acknowledgments
The authors extend their sincere gratitude to all participants for their cooperation and commitment throughout this study.