April 2019 Issue

Focus on Fitness: Update on Pilates
By Jennifer Van Pelt, MA
Today’s Dietitian
Vol. 21, No. 4, P. 54

In 2018, Pilates (pronounced pi-LAH-teez) turned 100 years old. This exercise method was created by German self-defense and physical trainer Joseph Pilates during his internment in a British World War I camp for prisoners of war. Devising exercise equipment from bed springs, camp prisoners could perform resistance training to improve their health. Of historical note, none of the prisoners practicing the early version of the Pilates method died during the severe influenza epidemic of 1918, although others at the same camp did succumb to the illness. Pilates cited the good health of his trainees through the epidemic as proof of the effectiveness of his exercise regimen.

There’s no question that Pilates practiced on a mat or equipment (eg, Pilates Reformer, newer commercial Pilates equipment) is an effective workout for strengthening muscles and improving flexibility and balance. Just ask the thousands of dancers and athletes who use Pilates to improve performance and the more than 10 million exercise consumers who practice it regularly. However, more evidence is required before anyone can make scientific conclusions of its effectiveness for improving medical conditions. Based on the number of research studies published or in progress since November 2017 when Today’s Dietitian (TD) last covered Pilates, the evidence supporting its health benefits continues to grow—confirming the early conclusions of its creator. More than 100 studies on the biomechanics and/or clinical benefits of Pilates have been published since late 2017. This month, I’ll summarize results from several of these studies and provide some guidance to share with clients interested in adding Pilates to their weekly exercise regimen.

New evidence supports conclusions from earlier studies summarized in TD’s 2017 article that had found benefits of Pilates for women with breast cancer and older adults. Newly published studies also support the practice of Pilates for those with multiple sclerosis, chronic kidney disease, musculoskeletal pain, and Parkinson’s disease. The following list reviews recent study results:

• A small February 2019 study found that modified Pilates exercises performed three times per week for 12 weeks significantly improved quality of life for patients with chronic kidney disease.1

• A January 2019 systematic review and meta-analysis of 14 studies on Pilates for patients with multiple sclerosis found significant improvements in balance confidence and walking ability, which led to improved quality of life. The researchers noted that benefits related to functional mobility, cardiorespiratory fatigue, and fatigue were equivalent to other exercise methods.2

• A January 2019 systematic review of all published studies up to 2018 that evaluated Pilates for chronic nonspecific low back pain (CNLBP) concluded that Pilates can be used as a therapeutic exercise option for those with CNLBP, provided the movements selected are modified appropriately. Research suggests that sessions should be approximately 60 minutes long and performed two to three times weekly, and supervised by trained and qualified instructors. Published evidence is insufficient to determine whether one type of Pilates—mat vs equipment-based—is more superior, as studies didn’t compare the two methods.3

• A December 2018 systematic review and meta-analysis of seven randomized studies on Pilates for women with breast cancer found significant positive effects on functional status, mood, and fitness, similar to other exercise modalities. Pilates was slightly more beneficial for reducing pain and improving upper extremity functionality.4

• A small October 2018 randomized controlled study of mat Pilates with resistance bands found significant improvements in dynamic balance and leg strength for patients with Parkinson’s disease.5

• A small September 2018 randomized controlled trial comparing Pilates with pharmaceutical treatment for chronic neck pain found that Pilates effectively and significantly reduced pain and improved function. The group performing two Pilates sessions weekly for 12 weeks also significantly improved general health, vitality, and mental health, as well as reduced their use of pain medications.6

• A June 2018 meta-analysis of nine randomized controlled trials assessed the efficacy of mat Pilates on the physical functioning of older adults. The researchers found that Pilates significantly improved dynamic balance, leg strength, hip and low back flexibility, and cardiorespiratory fitness in older adults.7

Pilates research and ongoing interest from the rehabilitation community suggests that it will continue to evolve for a variety of therapeutic indications.8

Guidance for Clients
Clients interested in trying Pilates should consider the following:

• Pilates using dedicated equipment can be expensive per session. Mat Pilates classes are offered at many gyms and yoga or dance studios and already may be included for free if clients are facility members.

• After an investment in equipment-based Pilates classes and learning the exercises, clients interested in continuing to practice on equipment may want to consider a home Pilates system, such as the AeroPilates or similar equipment.

• Regular exercisers with no Pilates experience can try various classes (online or in person) in accordance with their fitness level. Movements may be challenging, but easily followed, so clients shouldn’t fear looking uncoordinated as they might in other classes, such as dance-based aerobics.

• Clients with medical conditions or movement limitations can practice modified Pilates, provided they have clearance from a physician. Some facilities offer modified Pilates performed seated in a chair, or standing with support of a chair. Facilities with pools also may offer aqua Pilates classes, which are ideal for those with arthritis or who may benefit from the support of water while exercising.

• Pilates instructors should be trained and certified in the Pilates style(s) they teach—mat and/or equipment-based Pilates. Clients should make sure they inform instructors about any medical issues they have that may require exercise modifications and shouldn’t be afraid to ask to observe a class first.

• As with any type of exercise, there’s a risk of injury. Clients shouldn’t hesitate to stop performing a movement or ask for modifications if they experience pain or excessive discomfort.

• Certain Pilates movements aren’t appropriate for those with low bone density or osteoporosis. A few Pilates exercises involve rolling back onto the spine; the pressure of body weight and the floor can fracture spinal vertebrae. These movements shouldn’t be performed if clients have these medical conditions.

Ideally, Pilates should be part of a well-rounded exercise regimen that also includes cardiovascular conditioning and other strengthening/stretching activities. Interestingly, some research studies found that Pilates improved cardiorespiratory fitness. Pilates may, therefore, be a good choice for those just starting to exercise or those who find other traditional aerobic activities difficult to perform. Once cardiovascular fitness improves, exercisers may be able to add other aerobic activities. To derive benefits, Pilates should be practiced at least twice weekly on a regular basis. As Joseph Pilates said, “In 10 sessions you’ll feel the difference, in 20 sessions you’ll see the difference, and in 30 sessions you’ll have a whole new body.”

— Jennifer Van Pelt, MA, is a certified group fitness instructor and health care researcher in the Lancaster, Pennsylvania, area.

1. Rahimimoghadam Z, Rahemi Z, Sadat Z, Mirbagher Ajorpaz N. Pilates exercises and quality of life of patients with chronic kidney disease. Complement Ther Clin Pract. 2019;34:35-40.

2. Sánchez-Lastra MA, Martínez-Aldao D, Molina AJ, Ayán C. Pilates for people with multiple sclerosis: a systematic review and meta-analysis. Mult Scler Relat Disord. 2019;28:199-212.

3. Eliks M, Zgorzalewicz-Stachowiak M, Zeńczak-Praga K. Application of Pilates-based exercises in the treatment of chronic non-specific low back pain: state of the art [published January 12, 2019]. Postgrad Med J. doi: 10.1136/postgradmedj-2018-135920.

4. Pinto-Carral A, Molina AJ, de Pedro Á, Ayán C. Pilates for women with breast cancer: a systematic review and meta-analysis. Complement Ther Med. 2018;41:130-140.

5. Mollinedo-Cardalda I, Cancela-Carral JM, Vila-Suárez MH. Effect of a mat Pilates program with TheraBand on dynamic balance in patients with Parkinson’s disease: feasibility study and randomized controlled trial. Rejuvenation Res. 2018;21(5):423-430.

6. de Araujo Cazotti L, Jones A, Roger-Silva D, Ribeiro LHC, Natour J. Effectiveness of the Pilates method in the treatment of chronic mechanical neck pain: a randomized controlled trial. Arch Phys Med Rehabil. 2018;99(9):1740-1746.

7. Bueno de Souza RO, Marcon LF, Arruda ASF, Pontes Junior FL, Melo RC. Effects of mat Pilates on physical functional performance of older adults: a meta-analysis of randomized controlled trials. Am J Phys Med Rehabil. 2018;97(6):414-425.

8. Byrnes K, Wu PJ, Whillier S. Is Pilates an effective rehabilitation tool? A systematic review. J Bodyw Mov Ther. 2018;22(1):192-202.