The main treatment for breast cancer is the total or partial mastectomy that can be or not followed by chemotherapy. Although the rate of survivals has been increased in the last five years, these treatment procedures can cause negative consequences as negative symptoms of self-esteem, poor quality of life (QoL) and losses in sexuality. Pilates exercises has been investigated in the treatment of the homolateral arm of the surgery showing encouraging results, but considering that Pilates technique enhances the strength of the hole body, including improvement of pelvic floor muscles (PFM) as shown by previous studies, the aim of this study is to investigate the impact of these exercises technique on sexuality, self-esteem and QoL in survival women of breast cancer.

This randomized clinical trial consisted of 16 mastectomized women that were divided into two groups: experimental (G1) and control (G2). It were included sedentary women, over 18 years old, with at least 1 year after partial or total mastectomy of malignant neoplasm, sexually active (considered at least 1 intercourse in the last 4 weeks), no PFM dysfunctions, no urinary infection and no neurologic diseases. After signing the consent form, their PFM function was assessed according the PERFECT scheme, the maximum voluntary contraction (MVC) of PFM was measured    where by a perineometer, the sexual function assessed by the Female Sexual Function Index (FSFI) and the self-esteem and quality of life by the EORTC questionnaires EORTC QLQ-BR23 and EORTC QLQ-C30, respectively. Both groups were re-assessed at the end of the 7 weeks. The experimental group, G1, underwent 15 sessions of Pilates exercises, twice a week during 7 weeks, supervised by a physiotherapist. The exercise protocol was composed by eleven Pilates postures: Bent Knee fall out, Pelvic clock, Aductor squeeze, Abductor squeeze, Shoulder bridge, Dead bugs & femur arcs, Roll up, Frog, Side kick, Cat, Legwork standing. The control group, G2, performed the same exercise protocol, but at home and without the supervision of any professional. The data were described in mean and standard deviation, analysis of variance by ANOVA, and post-test of BONFERRONI, considering a level of significance of 5%.

Groups were homogeneous at baseline. At the end of the treatment the PFM MVC of the G1 increased from 17.0 ± 13.3 to 25.8 ± 16.5 cmH2O (p = 0.044) but there was no difference between groups (p= 0,196). In the PERFECT scheme, G1 improved in all domains (P – p=0.029; E – p< 0,01; R - p< 0,01; F - p< 0,01) and this was significant between groups (P – p= 0,032; E – p< 0,01; R – p=0,05; F – p=0,05). In the FSFI questionnaire, G1 increased from 19.9 ± 9.9 to 23.5 ± 10.7 (p = 0.012), but there was no difference between groups. In EORTC QLQ-C30 the G1 showed improvements in the following domains: physical functional scale (p = 0.008) and emotional scale (p = 0.002) and in this domain the result was significant between groups (p=0,013). For EORTC QLQ-BR23, G1 showed improvement in the domains: sexual function (p = 0.001), future perspectives (p = 0.001) and side effects (p = 0.001), no difference was found between groups in this scale. The G2 showed improvement in the EORTC QLQ-C30 questionnaire were presented improvement in the fatigue domain (p=0.005), nausea (p=0.032) and pain (0.021), and in the EORTC QLQ-BR23 G2 showed improvement in the breast symptoms domain (p=0.004).

In this study, Pilates training promoted benefits on sexual function and PFM function of survival women of breast cancer within 7 seven weeks of treatment. In a previous study involving 60 women after mastectomy, the Pilates method improved functional capacity, fatigue, depression and QoL. The improvement of the physical and emotional aspects found probably happened because Pilates is a method of physical conditioning that involves the connection of body and mind leading to a better neuromotor performance, developing a better muscular resistance, proprioception and strength, through the principles of fluidity, precision and motion control. The improvement of sexual function probably happened because of the improvement of PFM function as a previous study demonstrated a positive correlation between the female sexual function index assessed by the FSFI and the pelvic floor muscle contractility, and according this previous study the greater the strength of the MAP the better the sexual function. Similar encouraging results were also found in other population such as improvement of QoL of pregnant women and decrease in urinary incontinence in men.

The results indicate that Pilates exercises increased the contractility and pressure of the pelvic floor muscles, improved the sexual function, self-esteem and quality of life of women who survived breast cancer.

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