November 2017 Issue

Focus on Fitness: Pilates — Health Benefits for Both Young and Old
By Jennifer Van Pelt, MA
Today's Dietitian
Vol. 19, No. 11, P. 58

Pilates (pronounced pi-LAH-teez) is named after its creator, Joseph Pilates, who originally called it "contrology" when he introduced this exercise method in the 1920s in New York City. A full-body workout that focuses primarily on the larger core muscles (abdominals, back, hips, thighs), Pilates can be performed either as floor exercises on a mat or on specially designed equipment. Pilates exercises are done in a specific sequence, designed as a system to provide full-body benefits, including increased strength and flexibility and improved posture and balance. Because Pilates is performed using certain breath patterns, such as deep diaphragmatic and lateral breathing, it's considered a mind-body exercise modality.

Since I last wrote about Pilates in 2012, its popularity and press coverage has fluctuated and often has been overshadowed by news about other fitness activities (eg, yoga and trendy new workouts such as Pound). Pilates generally is considered a niche workout for dancers and athletes and isn't as commonly offered in gyms, mainly because it requires specialized training to instruct both mat and equipment-based Pilates (eg, Pilates Reformer equipment). Pilates instructors most often teach in dedicated Pilates studios, private boutique fitness studios, and yoga studios. Mat Pilates generally is taught in a class format, while equipment-based Pilates is taught one on one or in a small group. Pilates can, therefore, be more expensive than other fitness activities, and expense may limit regular participation.

In 2016, the Pilates Method Alliance, a professional association for Pilates instructors and Pilates Anytime, an online Pilates studio offering subscription-based video classes, conducted a survey of the Pilates industry in the United States. The survey showed that 50% of respondents cited cost as the primary reason for no longer practicing Pilates. The survey also revealed that the majority of Pilates practitioners are women aged 35 and older. More than 40% of those surveyed were aged 55 and older, indicating that Pilates is particularly appealing to the baby boomer generation. When asked why they practiced Pilates, 80% of respondents replied that it "is for people my age."1

Older surveyed Pilates practitioners recognize the benefits of Pilates for aging adults—benefits that are supported by recently published research studies. An August 2017 systematic review and meta-analysis of 15 randomized controlled trials that studied Pilates in those older than age 60 found significant improvements in dynamic, static, and overall balance compared with other balance and fall prevention training approaches.2 Two smaller randomized trials also found significant improvements in lower-body strength, aerobic conditioning, overall balance, and confidence in balance when older adults practiced Pilates compared with other balance exercises.3,4

The Pilates survey revealed that only 10% of those surveyed were aged 18 to 34, possibly indicating that the Pilates industry isn't effectively marketing to younger exercisers. Or perhaps Pilates and its benefits aren't as apparent to younger exercisers. YouTube celebrity Cassey Ho is successfully marketing her POP Pilates (www.poppilateslife.com) program, a choreographed mat Pilates workout, in online and gym class formats taught by licensed instructors. With faster movements set to upbeat current pop music, POP Pilates is intended specifically to attract younger exercisers and those bored with traditionally sequenced Pilates classes.

Cost also may be a deterrent for younger exercisers as well as those looking for inexpensive ways and places to work out. Less expensive online classes, such as POP Pilates, may increase Pilates participation. 

Overall interest in Pilates is expected to grow over the next few years due to the following, which also may increase accessibility and affordability:

• Barre workouts—currently a popular trend—incorporate Pilates exercises, increasing interest in Pilates for sculpting and strengthening. Frequently offered in yoga studios, barre workouts have introduced yoga practitioners to Pilates as complementary to yoga.

• Affordable home Pilates equipment, such as the AeroPilates brand, is being marketed online and by home shopping TV networks. Equipment-based Pilates workouts usually are more expensive and less accessible, since they require one-on-one work with a certified Pilates instructor using dedicated Pilates equipment not typically available in most gyms. Home Pilates equipment has expanded the market and exposure for equipment-based Pilates workouts to all exercisers—not just dancers and athletes.

• Online fitness video streaming services are offering more affordable alternatives to in-person Pilates classes. For example, Pilates Anytime offers thousands of Pilates classes for all fitness levels for a monthly subscription fee that's a fraction of the cost of a gym membership or in-person Pilates studio classes (www.pilatesanytime.com). Amazon.com also offers Pilates videos with its Prime Video service.

• Research into the clinical applications of Pilates is vigorous, and Pilates is being used for medical rehabilitation applications. Positive results have generated interest from the clinical community in using Pilates exercises in conjunction with physical therapy and therapeutic rehabilitation for various medical conditions.

In the 2016 Pilates survey, 95% of respondents indicated they practiced Pilates regularly because it "is good for you," and cited benefits of improved muscle tone and flexibility, enhanced performance, and stress relief.1 Recently published evidence suggests that Pilates also can benefit individuals with certain medical conditions. For those familiar with the founder of Pilates, the potential clinical benefits of his exercise method shouldn't be surprising—he developed Pilates after experiencing the benefits of exercise as a sickly adolescent and after rigging hospital beds to act as exercise equipment for bedridden patients. Thus, Pilates has therapeutic origins that now seem to be attracting the interest of the medical community.

The following clinical studies have found that Pilates has particular benefits for women after breast cancer treatment, those who've had a stroke, and individuals with juvenile idiopathic arthritis (JIA):

• A January 2017 randomized study found that Pilates significantly reduced the severity of lymphedema compared with standard lymphedema exercises in women being treated for lymphedema following breast cancer treatment. Patients who practiced Pilates for eight weeks also showed significant improvements in overall quality of life, upper extremity functional scores, and social appearance anxiety.5

• Eight weeks of modified mat-based Pilates exercises also significantly improved gait in poststroke patients, including stride length, walking speed, balance, and knee and hip range of motion.6,7

• The Ottawa Panel, a Canadian medical organization that develops evidence-based clinical guidelines, added Pilates to its recommendations for the management of JIA. Their review of evidence found that Pilates improves quality of life, function, pain, and range of motion in children with JIA. Pilates received the strongest level of recommendation and resulted in improvement in more outcomes than other evaluated exercises (eg, aquatic exercise, home exercise, and cardio-karate).8

Pilates is worth recommending to clients due to its wide range of health benefits. (For information on Pilates for low back pain, see my April 2012 Focus on Fitness column.) New online video streaming options and DVDs are ideal for clients who don't want to or can't spend money on studio classes. For those with movement limitations or beginning exercisers, Pilates can be modified to meet the needs of anybody. Pilates can even be done seated in a chair. As Joseph Pilates said, "Change happens through movement, and movement heals."

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

References
1. Pilates Method Alliance, Pilates Anytime. The 2016 Pilates in America Study. https://www.pilatesmethodalliance.org/files/documentlibrary/Pilates%20in%20America%
20Study%20-%20Final%2005-08-17.pdf
. Published May 8, 2017.

2. Moreno-Segura N, Celedonia IC, Ballester-Gil Y, María Clara BI, Blasco JM. The effects of the Pilates training method on balance and falls of older adults: a systematic review and meta-analysis of randomized controlled trials. J Aging Phys Act. 2017;3:1-21.

3. Josephs S, Pratt ML, Calk Meadows E, Thurmond S, Wagner A. The effectiveness of Pilates on balance and falls in community dwelling older adults. J Bodyw Mov Ther. 2016;20(4):815-823.

4. Vieira ND, Testa D, Ruas PC, Salvini TF, Catai AM, Melo RC. The effects of 12 weeks Pilates-inspired exercise training on functional performance in older women: a randomized clinical trial. J Bodyw Mov Ther. 2017;21(2):251-258.

5. Şener HÖ, Malkoç M, Ergin G, Karadibak D, Yavuzşen T. Effects of clinical Pilates exercises on patients developing lymphedema after breast cancer treatment: a randomized clinical trial. J Breast Health. 2017;13(1):16-22.

6. Roh S, Gil HJ, Yoon S. Effects of 8 weeks of mat-based Pilates exercise on gait in chronic stroke patients. J Phys Ther Sci. 2016;28(9):2615-2619.

7. Lim HS, Kim YL, Lee SM. The effects of Pilates exercise training on static and dynamic balance in chronic stroke patients: a randomized controlled trial. J Phys Ther Sci. 2016;28(6):1819-1824.

8. Cavallo S, Brosseau L, Toupin-April K, et al. Ottawa Panel evidence-based clinical practice guidelines for structured physical activity in the management of juvenile idiopathic arthritis. Arch Phys Med Rehabil. 2017;98(5):1018-1041.

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