Pilates: What’s the point?

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Joseph Pilates was self-taught in his field; he was a bodybuilding, boxing, yogi, gymnastic martial artist! Whilst training the Metropolitan Police Service at the outbreak of the First World War he was interned on the Isle of Wight where he became a therapist type for his fellow prisoners. Using bedsprings rigged up around their rooms, he created the early version of the Cadillac and Reformers of today, strengthening the sick and injured with his resistance equipment.

Joseph Pilates’s work has been passed down in an almost folklore fashion: upheld and preserved by very few. Individualized instruction can be costly and time-consuming but, when provided by an instructor with proper training, safe and beneficial.

His method, which he called Contrology, was a philosophy surrounding the ideas that activating brain cells, stimulating the mind, would positively affect the body; this idea confounded in recent scientific evidence which suggests that exercise does indeed improve cognitive functions

In recent years the word ‘core’ has become synonymous with tight tummies, wash-board abs, rehabilitating back problems and muscular pain, post-natal miracles and included in staple gym vocabulary and if you’re good link firmly with Pilates instruction, but:

What is the core? Why is it important? And how does this make Pilates so special?

Pilates for Lower Back Pain?

Whilst Kibler, Press and Sciascia (2006) suggested that there is no universally accepted definition of ‘core’, research advocates the importance of transversus abdominus (TrA) and multifidi in lower back pain strengthening and rehabilitation programmes; with one of the strongest advocates for Pilates within the literature being the systematic review of 14 random-controlled trials (RCT) by Wells, Marshall, Hill and Bialocerkowski (2014) which concluded that Pilates exercise offers improvements in function and pain greater than other popular protocols, also concluding that Pilates programmes offers equivalent relief as massage in the short term.

Patti et al. (2015) also conducted a systematic review where the conclusions met the above; that there is a wealth of studies demonstrating a significance of Pilates exercise programmes over others in the treatment of chronic lower back pain. However, as above they surmised a need for further research for confirmation of long term effects. The eligibility of the above was not as inclusive with its criteria in terms of reliability of resource as the Wells et al. (2015) review as studies other than RCT’s were included; also they excluded non-English language papers. Like the strong reliability Wells et al. (2015) study, an earlier review by Miyamoto, Costa and Cabral’s (2013) with matched stronger inclusion criteria also found Pilates to be better than minimal intervention, as well as being not significantly better than the other short term pain reduction.

Pilates for Lower Back Pain – Fitworxs says YES PLEASE!

Pilates for Other Rehab?

Levine, Kaplaneck and Jaffe (2009) suggested that patient led Pilates programmes can be utilised without complication, to shorten recovery and improve the postoperative period on their small cohort; with further study needed to confirm its longer term effectiveness and overall safety. The exercises used within the protocols were adjacent to readily used rehabilitative and traditional class based classes, such as with the Australian Physiotherapy and Pilates Institute (APPI), although there was selection bias for the motivated participants in their results, also no control group; however the aim of their study was not to compare Pilates to another traditional plan, but to evaluate its efficacy as a viable option as a post-operative therapy.

Pilates for Other Rehab – Fitworxs says YES WE THINK SO!!

Pilates for Strength and Conditioning (S&C): For Sports Performance?

Well motor learning (or motor re-learning if you are within the injury realms) or movement pattern learning is all about breaking that complex movement into smaller manageable sub-units which can be built, trained and optimised to bring back together for the big picture. This notion is true for S&C programmes as well as injury programmes.

Dynamic correspondence is a concept which is looked at throughout programme planning to ensure that any exercise added to an S&C programme has a connection to a skill that is needed for the sport or event. For example Olympic lifting movements can be linked to explosive leg power increase, which is needed for effective jumping within a lot of team sports.

Pilates’ contrology was defined with developing the body uniformly and correcting postural misalignments. His total core strength + total arm strength = total leg strength (TCS + TAS + TLS) concept; where movement in one area needs to be controlled in the others, is a focal point with skills training: total control to enable optimal sport specific skill.

An effective S&C coach will be able to biomechanically assess a movement with the view to identify weaker muscles to facilitate the stronger ones during that given movement pattern. With that identification of the weaker muscles, motor (re)learning needs to ensue – in comes Pilates!

Pilates training providers, specifically higher level entry programmes for instructors such the APPI (where instructors have an allied health professional degree before learning) have the ability to use information from assessment or referral from S&C coaches and create a Pilates programme to focus on the issue; to strengthen the weakness, to create an unconscious strength, to optimise strength training, with rehabilitation needs, or not.

Pilates for S&C – Fitworxs says YES INDEED!!

Pilates for Getting Fit?

A RCT of 30 girls (16 = Pilates: 14 = control) participated in group classes for a 4-week period. The girls within the Pilates group showed a BMI reduction of 3.1 percentile comparative to the control group with 0.8 percentile; the Pilates group also showed higher enjoyment results. Although it didn’t ascertain whether there were aerobic demands, the results could be useful in increasing activity and potentially decreasing risk of obesity (Jago, Jonker, Missaghian, & Baranowski, 2006)

Although these are positive results for the use of Pilates to reduce BMI in adolescents the

population who are likely to want to actively utilise Pilates for BMI reduction is adults. Rogers and Gibson (2009) carried out an eight week trial on adults to ascertain whether traditional Pilates training can affect adults compared to a control. The Pilates group showed a 2.1% body fat reduction compared to control with a reduction of waist, arm and chest circumference (2.7, 1.7 and 0.5cm respectively); data supporting previous anecdotal claims by Olson and Smith (2005).

Positive evidence for the use of Pilate for body composition changes; similar results to Vaquero-Cristobal et al. (2015) and Cakmakçi’s (2011) studies where the participants showed a significant decrease in a full kinanthropometry profile of skinfolds, waist/hip ratio and fat mass data after a 16 week Pilates programme (after four weeks of no activity), as well as reducing BMI, weight, waist/hip ratio and fat mass percentages after an 8 weeks Pilates programme (carried out on obese women), respectively.

The downside of looking in to Pilates and body composition (BC) is the methodological flaws and lack of high quality empirical data to analyse: Aladro-Gonzalvo, Machao-Diaz, Moncada-Jimenez, Hernandez-Elizondo and Araya-Vargas (2012) attempted to carry out a systematic review on research analysing Pilates and BC, but of the seven studies they identified the poor reliability and validity of the quantitative data did not allow a clear analysis for a strong conclusion in summary of the positive effects of Pilates to BC.

Pilates for Getting Fit – Fitworxs says YES in certain circumstances.

Pilates for Yummy Mummy’s?

Pilates and Pregnancy have been linked for numerous benefits in literature, the media and many Starbucks coffee mornings.

For Mummy Sleepiness?

Ashrafinia, Mirmohammadali and Amelvalizadeh (2015) found a significant decrease of maternal fatigue after an 8 week Pilates programme. Their postpartum fatigue decrease quantified as decreased physical fatigue and mental fatigue and increased motivation and activity level; it could also be surmised that each positively affected participant could have a higher ability for proactivity for weight loss/body re-shaping as well!

For Mummy Pelvic Floor?

Pelvic floor muscle (PFM) activity is a big part of any new mums process back to feeling herself again, and Pilates again has been promoted in a big way to nearing that goal!

From literature we can be confident that PFM training (PFMT) during pregnancy can strengthen the PFM (de Oliveira, Lopes, Longo e Pereria, & Zugaib, 2007) which in turn has been shown, with strong evidence, to reduce stress incontinence, pain and sexual disturbances, as well as reducing risk of severe pelvic organ prolapse (Bø, 2006): evidence backed up by a 2012 Cochrane Review by Boyle, Hay-Smith, Cody and Mørkved (2012).

The link between PFMT and Pilates is more anecdotal with only one study specifically including Pilates and PFMT in their experimental variables. Culligan et al, (2010) carried our an RCT comparing the two for improvement of PFM strength, with conclusions brought forward that both experimental groups increased their PFM muscle strength from baseline, however with no difference between groups. This is great news for the theory behind PFMT training, as well as Pilates, being a positive exercise regime to take on surrounding pregnancy, although these ladies tested had ‘little to no dysfunction’ so more testing is needed for ladies who do present with incontinence symptoms.

Although there is strong evidence for Pilates for yummy mummy pelvic floors, there is still a long way to go to gain direct evidence for such an exercise regime for definite benefits for all mummies (Bø & Herbert, 2013).

Pilates for Yummy Mummies – Fitworxs says MOST LIKELY YES – more confirmation needed for

100% YES!!

So ‘core’ and Pilates have been found to have some serious positive effects for us!

Yes, there is a serious need for further and more reliable research into comparable treatments, alongside a control within research to firmly give us the evidence to say Pilates is the future but for now:

Pilates. Is there a point?

Fitworxs says YES!!

References:

Aladro-Gonzalvo, A. R., Machado-Dıaz, M., Moncada-Jimenez, J.,  Hernandez-Elizondo, J. & Araya-Vargas, G. (2012). The effect of Pilates exercises on body composition: A systematic review. Journal of Bodywork and Movement Therapies, 16, pp. 109-114.

Ashrafinia, F., Mirmohammadali, M., Rajabi, H., Kazemnejad, A., Haghighi, K. S., & Amelvalizadeh, M. (2015). Effect of Pilates exercises on postpartum maternal fatigue. Singapore Medical Journal, 56(3), 169–173.

Bø, K. (2006). Can pelvic floor muscle training prevent and treat pelvic organ prolapse? Acta Obstetrica et Gynecologica Scandinavica, 85(3), pp. 263-8.

Bø, K. & Herbert, R. D. (2013). There is not yet strong evidence that exercise regimes other than pelvic floor muscle training can reduce stress urinary incontinence in women: a systematic review. Journal of Physiotherapy, 59(3), pp. 159-168.

Boyle, R., Hay-Smith, E. J., Cody, J. D. & Mørkved, S. (2012). Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Systematic Review, 17(10), pp.71-74.

Cakmakçi, O. (2011). The effect of 8 week pilates exercise on body composition in obese women. Collegium Antropologicum, 35(4), pp. 1045-50.

Culligan, P. J., Scherer, J., Dyer, K., Priestley, J. L., Guingon-White, G., Delvecchio, D. & Vangeli, M. (2010). A randomised clinical trial comparing pelvic floor muscle training to a Pilates exercise program for improving pelvic muscle strength. International Urogynecology Journal, 21(4), pp. 401-8.

de Oliveira, C., Lopes, M. A., Longo e Pereira, C. & Zugaib, M. (2007). Effects of pelvic floor muscle training during pregnancy. Clinics (Sao Paulo), 62(4), pp. 439-46.

Jago, R., Jonker, M. L., Missaghian, M. & Baranowski, T. (2006). Effect of 4 weeks of Pilates on the body composition of young girls. Preventative Medicine Journal, 42, pp. 177-180.

Kibler, W. B., Press, J. & Sciascia, A. (2006). The role of core stability in athletic function. Sports Medicine, 36, pp. 189-198.

Levine, B., Kaplanek, B. & Jaffe, W. (2009). Pilates Training for Use in Rehabilitation after Total Hip and Knee Arthroplasty A Preliminary Report. Clinical Orthopaedics and Related Research, 467, pp. 1468–1475.

Miyamoto, G. C., Costa, L. O. P. & Cabral, C. M. N. (2013). Efficacy of the Pilates method for pain and disability in patients with chronic nonspecific low back pain: a systematic review with meta-analysis. Brazilian Journal of Physical Therapy, 17(6), pp. 517-532.

Olson, M. & Smith, C. (2005). Pilates Exercise: Lessons From the Lab. IDEA Fitness Journal, 2(10), pp. 1.

Patti, A.,  Bianco, A., Paoli, A., Messina, G., Montalto, M. A., Bellafiore, M., Battaglia, G., Iovane, A, & Palma, A. (2015). Effects of Pilates Exercise Programs in People With Chronic Low Back Pain A Systematic Review. Medicine, 94(4), pp. 1-9.

Rogers, K. & Gibson, A. L. (2009). Eight-Week Traditional Mat Pilates Training-Program Effects on Adult Fitness Characteristics. Research Quarterly for Exercise and Sport, 80(3), pp. 569-574.

Vaquero-Cristóbal, R., Alacid, F., Esparza-Ros, F., López-Plaza, D., Muyor, J. M. & López-Miñarro, P. A. (2015). The effects of a reformer Pilates program on body composition and morphological characteristics in active women after a detraining period. Women Health, 19, pp. 1-23.

Wells C., Kolt, G. S., Marshall, P., Hill, B. & Bialocerkowski, A. (2014). The Effectiveness of Pilates Exercise in People with Chronic Low Back Pain: A Systematic Review. PLoS ONE 9(7): pp. 402.

Written by Kristina

I own 2 FITWORXS clinics (est'd '06), am Head Sports Rehabilitator down at Grasshoppers RFC, am a Pilates Instructor who now also teaches for the Physiotherapy and Pilates Institute (APPI), Netball Lover & Happy Woman! "Forever Pushing for a Fitworxs Future!"

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