According to the findings of this study, the amount of ANA did not show a significant difference in all groups. These results were in lined with study performed by Azamian et al. [26] in a study on the effects of aerobic exercise for 8 weeks of stationary cycling on some inflammatory indicators in patients with rheumatoid arthritis. In this study, no difference was observed between case and control groups and Pilates exercises with celery seed consumption had no effect on ANA level.
There was a significant difference in flexibility levels (upper body and lower body) in middle-aged women with rheumatoid arthritis in the pre-test stage before the start of the training program and after the post-test program. This indicates those eight weeks of Pilates training with celery seed supplementation both led to a significant change in the two experimental groups. Thus, the measurements before and after the research were different.
These results indicate a stronger effect of Pilates exercises on increasing flexibility compared to the supplement and control groups; According to previous findings, the effects of combined exercise intervention in reducing pain and inflammation due to the presence of flavonoids in celery seeds and its effect on the nervous system reduces pain and inflammation [27].
Salehzadeh et al. [28] conducted a study on the effect of Pilates exercises on fatigue and motor disability and muscle flexibility in patients with multiple sclerosis in Tabriz and reported that 8 weeks of Pilates exercises in the exercise group reduced fatigue, motor disability and increased flexibility occurs in patients. Skendiz et al. [21] conducted a study aimed at the effect of Pilates training on strength, endurance, low flexibility in sedentary adult women. The results showed that Pilates exercises had a positive effect on abdominal muscle strength, abdominal muscle endurance and posterior flexibility. In line with the results of the present study, a study conducted by Aires et al. [29] on 60 female volunteers showed that Pilates could improve flexibility; The present results also showed that Pilates exercises were more effective in the exercise group compared to other groups and also, Kloubec [30]. The effect of Pilates exercise on hamstring flexibility in 50 men and women for 12 weeks, each week. 2 sessions and 1hour session were performed that in this study, hamstring flexibility was significantly increased which was consistent with the present study.
Regarding the effect of eight Pilates exercises with celery seed supplementation on muscle strength in middle-aged women with rheumatoid arthritis, it should be said that; There was a significant difference between the pre-test stage before the start of the training program and the post-test in muscle strength levels (arms and lower body) in middle-aged women with rheumatoid arthritis in the exercise and training groups with celery seed supplementation. This shows that eight weeks of Pilates training and celery seed supplementation both led to a significant change in the two experimental groups and the measurements before and after the study were different. Findings in muscle strength (arms and lower body) indicate a significant difference in post-test between exercise and training groups with celery seed supplementation. This suggests that eight weeks of Pilates exercises combined with celery seed supplementation may lead to changes in muscle wasting.
Because people with rheumatoid arthritis often have, weaknesses, strength development involves the coordinated functioning of several processes. In fact, the ability to produce maximum force is attributed to both the nervous system and the muscular system. Adjustments created as a result of exercise lead to an increase in maximal strength, including neural adaptations such as increased motor unit calling, the use of motor units in agreeable muscles, stimulation of motor units with greater frequency, spontaneous inhibition, increased neuromuscular skills and coordination. In performing movements and muscle adaptations such as increasing the cross-sectional area of the muscle and changing the muscle structure and metabolic adaptation [18].
According to the length of the present study, it seems that people who did the exercises in recalling and using the deep abdominal muscles and stability of the pelvic and paw muscles compared to people who did not do the exercises, had healed better. This coordination is probably due to neuromuscular adaptations. The findings of the present study on the effect of Pilates exercise on lower body muscle strength were consistent with the report of Ariera et al. [31](2017) who showed that the Pilates exercise group performed better than the control group in the post-test. Kamali and Norouzi 2016 [32] in a study that examined 8 weeks of Pilates training, observed an improvement in quadriceps and hamstring muscle strength scores in the experimental group. Also, the present study on the effect of Pilates training on upper body strength is in line with the findings of Bullo et al. [20] who reported that Pilates training is effective in increasing upper body strength. The results of Omidali et al. [25] by examining the effect of Pilates exercises on some physiological factors and physical fitness reported that training for 8 weeks, 3 sessions per week and 1 hour per session can improve hand strength; However, in this study, exercises for 8 weeks and 3 sessions and duration started from 20 minutes and ended at 55 minutes. Khalili et al. [33] study examined the effect of 8 weeks of Pilates exercises on pain and quality of life in men with rheumatoid arthritis. They also concluded that Pilates exercises increase the quality of life of these patients by increasing strength [33].
Studies have shown that age-related changes in skeletal muscle include muscle mass and strength 91% reduction in strength occurs through a reduction in the number and size of muscle fibers. Maximum muscle strength for men and women is generally between the ages of 20 and 30, when muscle is at its peak. Then there is a dramatic decrease in most muscle groups. Resistance exercise is an effective and healthy way to increase strength and muscle mass. These studies have examined the effect of Pilates exercises on muscle strength in different ways at different times. The present study aims to prevent the weakening of muscles and cartilage of secondary diseases due to inactivity that occurs in these patients with an exercise program. Decreased muscle strength in patients with rheumatoid arthritis is one of the main disorders that limit their daily activities, can worsen joint pain. Numerous studies have shown a decrease in isometric, isotonic and isokinetic force and muscle function in patients with rheumatoid arthritis. Their findings showed that Pilates exercises significantly improved muscle strength in the exercise group, which increased muscle strength could reduce the risk of falls and other injuries in these patients [29].
In general, the results of the present study show that 8 weeks of Pilates exercises with celery seed supplementation increase flexibility, muscle strength and reduce pain in patients with rheumatoid arthritis; This increase in flexibility, increase in muscle strength and decrease in pain was observed in the combined exercise groups and the exercise group with placebo more than the supplement and control groups increase muscle strength, flexibility and pain relief. These findings also indicate that regular physical activity and supplementation with celery seeds improve most of the important factors in patients with rheumatoid arthritis, which can be summarized as follows; Doing Pilates exercises and using celery seeds reduces pain in patients with rheumatoid arthritis, and better performance due to less pain can increase the motivation for these patients to participate in physical activity.
Also, according to the results of this study, the effect of celery seed supplement along with exercise can be considered more appropriate. Therefore, women with rheumatoid arthritis are advised to be sedentary and lack regular exercise, which is undoubtedly one of the most important causes of chronic diseases, increased secondary diseases and decreased muscle mass and a serious health risk. And Pilates largely avoids high impact, high power output, and heavy muscular and skeletal loading. And in general, the results of this research showed that a period of exercise can be effective in improving balance. Using these exercises by providing conditions to challenge the balance system can be an effective way to improve the subsequent balance and prevent falls among people with rheumatoid arthritis. According to the research findings, Pilates exercises can be used as a training method with a lasting effect to improve balance and reduce the risk of falls in patients with rheumatoid arthritis, which leads to increased muscle strength, flexibility and movement control. According to the research findings, Pilates exercises can be suggested as a safe and tolerable exercise method to improve balance and functional variables in middle-aged women without a history of regular exercise.
It is also recommended to use Pilates exercises with celery seed supplement to improve balance and restore mobility in patients with rheumatoid arthritis. In this regard, encouraging participation in physical activities can be useful in promoting community health and management of diseases associated with sedentary lifestyle; also, due to the lack of level change (ANA) in this study, the duration of the training program can be extended to get better results.