The aim of this study is to investigate, during a Classical Pilates programme with participants suffering from high blood pressure, whether supportive communication from the instructor to the participant has any effect on the impact of the practice on physiological (blood pressure) and psychological (retention, motivation, quality of life and life satisfaction) variables, compared with neutral and routine communication.
adults (≥18 years) with stage 1 or 2 hypertension (SBP 140-179 mmHg and/or DBP 90-119 mmHg) with confirmed diagnosis;
stable medication regimen for ≥4 weeks;
no regular Pilates practice in the last 6 months;
capacity to provide informed consent.
individuals with uncontrolled hypertension (SBP ≥180 or DBP ≥120 mmHg);
unstable cardiovascular disease;
significant uncompensated musculoskeletal pathology;
absolute contraindication to exercise;
Parallel
Self-Determination Theory Based Supportive Communication
BehavioralThe intervention will last 24 weeks, and both groups (intervention and control) will follow a classical Pilates matwork programme, twice a week in 50-minute sessions. Lessons for the control and experimental groups will be conducted separately. The programme will consist of 50-minute sessions of classical Pilates matwork sequence, based on the original exercises by Joseph Pilates. In this experimental group, in addition to exercise, supportive communication (autonomy, competence and relatedness) will be introduced.
Control
Other interventionThe control group will undergo the same 24-week intervention as the experimental group, with two 50-minute sessions per week, following the same classical Pilates matwork protocol described above. There is no supportive communication in this variant, instead, communication is neutral, as usual in any class. Neutral communication refers to natural communication that includes tips, technical adjustments, answers to queries and safety advice, but without any specific concerns regarding autonomy, competence or relatedness.
Blood Pressure
Resting SBP and diastolic blood pressure (DBP) measured with a validated automatic sphygmomanometer following 2024 ESC guidelines (three measurements, 1-2 min interval; the mean of the last two readings will be used for analysis). Ambulatory blood pressure monitoring will not be included due to logistical and financial constraints in a small-scale study. Furthermore, as this method is uncomfortable, it may itself constitute a barrier to the study, given that three measurements must be taken within a short period of time (3 months). However, automated office blood pressure measurement, taken at rest, when carried out rigorously and in accordance with the guidelines, may offer a level of accuracy similar to that of ambulatory monitoring.
Adherence/Retention
Attendance records (percent of sessions attended) and study completion rate.
Motivational Regulation: Behavioural Regulation in Exercise Questionnaire-3 (BREQ-3)
The Portuguese version of the BREQ-3 assesses the regulation of motivation in exercise through 18 items, which are subdivided into six dimensions (amotivation, external regulation, introjected regulation, identified regulation, integrated regulation and intrinsic motivation), with responses given on a 5-point Likert scale, ranging from 0 ("I strongly disagree") to 4 ("I strongly agree").
Short Form Health Survey-12v2 (SF-12v2)
The SF12v2 is a shortened version of the SF-36 (Short-Form Health Survey-36), which measures physical and mental health in relation to quality of life on a 12-item scale covering eight dimensions (physical functioning, physical role limitations, bodily pain, general health perceptions, energy/vitality, social functioning, emotional role limitations and mental health), which are summarised into two domains: the physical component summary and the mental component summary. Items are scored on a scale of 0 to 100 ("worst health state" to "best health state").
Satisfaction With Life Scale (SWLS)
The SWLS is a subjective, self-reported well-being scale that assesses overall life satisfaction, including five short items rated on a 7-point Likert scale ranging from 1 ("strongly disagree") to 7 ("strongly agree").
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