Pilates

Pilates is a form of resistance exercise.

The Pilates "method," as it is now known, is an exercise system focused on improving flexibility, strength, and body awareness, without necessarily building bulk. The method is a series of controlled movements performed on specially designed spring-resistant exercise apparatus (the Reformer, the Cadillac, the Spine Corrector, the Ladder Barrel, and the Wunda Chair) or the floor (mat work), and the sessions are supervised by specially trained instructors. Pilates is resistance exercise, not aerobic (cardio), although the heart rate will certainly rise for a deconditioned individual. However, it's closer to weight lifting than it is to jogging, biking, or other aerobic activities, so you should consider it resistance exercise.

Two of the key elements of Pilates are core muscle strength* and spinal alignment. The core musculature is loosely defined as the spine, abdomen, pelvis, hips, and the muscles that support these structures. Some of the main core muscles are the erector spinae (located in your back along your spine), the internal and external obliques (the sides of your abdomen), the transverse abdominis (located deep in your gut, this muscle pulls your belly button in toward your spine), the rectus abdominis (the "six-pack"), and hip flexors (in your pelvis and upper leg).

During a Pilates session, whether it's on the machines or the floor, your instructor will continuously prompt you to concentrate deeply on your core muscles, as well as on your breath, the contraction of your muscles, and the quality (not quantity) of your movements. These are also key elements of Pilates, and your instructor will emphasize them at every session. The objective is a coordination of mind, body, and spirit, something Joseph Pilates called "contrology." In his first book published in 1945, Pilates' Return to Life Through Contrology, the 34 original exercises that Pilates taught to his students are described along with the guiding principles of contrology.

Admittedly, the history of many ancient fitness activities is sometimes sketchy. Tai chi, swimming, yoga, and even running all started thousands of years ago, and although there is some documentation, the precise beginnings are unknown. Things are different with Pilates. The beginning is clear. It was created in the 1920s by the physical trainer Joseph Pilates (1880-1967) for rehabilitation. Some of the first people treated by Pilates were soldiers returning from war and dancers such as Martha Graham and George Balanchine (to strengthen their bodies and heal their aches and pains). Since the 1920s, the basic tenets that Joseph Pilates set down have been preserved, and to this day, even with some modifications, the Pilates remains true to its origins.

Pilates practitioners swear by the method, and in some circles, it almost reaches cult-like status. There are indeed many benefits to Pilates, but some of the benefits, even if they do occur, are unproven in research. What I've done here is present the claims made by Pilates proponents and then objectively present whether there is research to support the claims. Before I go further, I want to state that I believe that Pilates can be a great workout. It can help strengthen and tone muscles and improve flexibility, and the movements on the machines can be challenging and fun. It also has the potential to be an intense workout since the movements are slow, controlled, and deliberate. I refer individuals to Pilates who (1) are looking for an alternative or complement to weight lifting, (2) might need supervised resistance-exercise sessions, or (3) want a change of pace and would like to try something new.

The claims

The following claims are stated on the Stott Pilates website. Stott Pilates is an updated version of the original Pilates techniques that use more modern exercise principles. For instance, it states on the Stott website that there are more preparatory (warm-up) exercises than the original work by Joseph Pilates. Stott Pilates is widely taught throughout the U.S. and is representative of contemporary Pilates thinking, so I think it is fair to confirm or dispute the claims from that website.

Claim #1. Longer, leaner muscles (less bulk, more freedom of movement)
You can increase the flexibility of muscles and the physical sensation may even be that they feel longer, but for muscles to lengthen, the bones they attach to must lengthen as well, and no exercise lengthens bones. As for leaner muscles, muscle doesn't typically contain lots of fat, and there are no studies to demonstrate that the fat is reduced when you do Pilates. In fact, exercise might increase it. Research shows that intramuscular fat is elevated in athletes and that it is used immediately for fuel during exercise.

Claim #2. Improves postural problems
In one three-month study with 47 adults who practiced Pilates mat work one time per week for three months, the subjects reported that their posture felt improved at the end of the study (perhaps the result of pulling their shoulder blades together), but their height, which was used to assess postural improvement, did not change. In a more thorough postural assessment in a study of 24 females who did either traditional weight training or the Pilates Reformer machine for 12 weeks, results showed that both groups responded almost identically with moderate changes in posture. There is a very small sample of studies on posture and Pilates, so more research should be done before a general claim can be made that Pilates actually improves posture.

Claim #3. Increases core strength, stability, and peripheral mobility
To measure core strength properly, electromyography should be used. Electromyography (EMG) is a test that measures muscle activity and the nerves controlling the muscles. It is similar to an EKG machine that you might see on TV only it measures electrical activity in the muscles and not the heart. An EMG can detect how active a muscle is, and when a test is performed before and after a study, it can detect whether the treatment had any effect. I located one EMG study that measured the effect of Pilates on three superficial core muscles: the rectus abdominis (the six-pack), external obliques (sides of your abdomen), and the rectus femoris (muscle in your leg that is part of the quads and used during sit-ups). These muscles were tested during five Pilates abdominal exercises and were compared to a general crunch. The Pilates exercises produced EMG values that were comparable to and/or higher than the general crunch, leading the investigators to conclude that the Pilates mat exercises tested appeared to recruit the superficial abdominal muscles to a level that is sufficient for conditioning. This is good news since the crunch is one of the gold standards of abdominal exercises and other exercises are typically measured against it. Pilates has been shown to moderately improve flexibility, therefore, it can improve peripheral mobility (mobility of the limbs).

Claim #4. Helps prevent injury
There is no evidence that Pilates helps prevent injury. Pilates has been shown to moderately improve flexibility, but not even flexibility has been proven to prevent injury.

Claim #5. Enhances functional fitness, ease of movement
Functional fitness refers to how strength, power, endurance, and flexibility affect your function during activities of daily living (shopping, carrying packages, housework, etc.). I don't think anyone would dispute that getting stronger can help improve function, and Pilates certainly can improve strength, so by association, it's reasonable to suggest that practicing Pilates could improve your daily functioning. For instance, as a result of increased strength, you might carry packages and climb stairs with less effort. The only problem is that there is no research to support the claim that Pilates enhances functional fitness. Again, it doesn't mean that it doesn't have an effect, and I believe that it could, it's just that it hasn't been rigorously studied.

Claim #6. Balances strength and flexibility
I'm not exactly sure what it means to balance strength and flexibility, but there is evidence that practicing Pilates regularly can help improve both strength and flexibility independently. An important question is if Pilates increases strength or flexibility more than other types of exercise (for example, traditional resistance exercise). Only one study that I am aware of compared the two. In that study, the good news was that Pilates improved strength equally to traditional resistance exercise, and so what it means is that if you practice Pilates, you can be confident that your strength will improve (provided you're not already very strong from working out regularly with weights) and that it may improve as much as if you were lifting dumbbells.

Claim #7. Heightens body awareness
Body awareness and Pilates have never been studied. There are scales to measure body awareness, such as the Body Awareness Questionnaire, but there are no studies to my knowledge that have used it with Pilates. My guess is that it does increase body awareness because as people start moving more they certainly get more in touch with how their body feels. Pilates instructors are certainly well-trained to help prompt and cue you to focus on your muscles as you perform the exercises. If it does nothing else, it certainly teaches you to think about how your muscles are working while doing the exercises. An interesting question would be whether Pilates would have an additional body-awareness effect on already conditioned individuals with high body awareness, or would the effect, if there is one, be limited to sedentary couch potatoes.

Claim #8. No-impact, easy on the joints
Pilates is low-impact as far as the joints are concerned. There is no pounding like there is with some aerobic activities because many of the Pilates exercises are performed on your back or your belly. Nevertheless, keep in mind that your joints are still moving through their range of motion under tension, so it's not entirely free of risk. Individuals who have arthritis or other medical or orthopedic conditions that limit mobility (knee arthritis, fibromyalgia, etc.) should pay attention to any symptoms, and the instructor should be notified in advance of any problems. Speak with your doctor if you have any questions or concerns about the safety of Pilates for you.

Claim #9. Can be customized to suit everyone from rehab patients to elite athletes
There is some justification for the use of Pilates in rehabilitation. In one study of the effect of Pilates compared with traditional treatment on individuals who had low back pain, it was shown that there was a significant and similar reduction in pain intensity and disability in both groups. In another study of low back pain, where the effects of Pilates were compared to traditional care, Pilates was more effective in decreasing low back pain and disability. However, the number of studies is very small, and so it's difficult to say how effective Pilates is for rehabilitation. As for customizing Pilates to suit everyone, instructors are trained to modify the exercises to meet the needs of the client; the tension on the machines can be adjusted to meet the strength of the client; and Pilates mat work can be modified to the simplest of exercises. In the hands of the right instructor, there should be an opportunity for almost anyone to give Pilates a try.

Claim #10. Complements other methods of exercise
Pilates is a resistance exercise and could certainly be used as an alternative to, or a complement to, traditional weight lifting. I've known many individuals who do both Pilates and free weights. I don't believe there is one right answer, and so I encourage you to experiment and see what you think.

Claim #11. Improves performance in sports (golf, skiing, skating, etc.)
The only study I was able to locate that addresses sports performance and Pilates was a study on the effect of six weeks of Pilates mat training on tennis serve velocity, and the researchers concluded that there was no meaningful relationship. One could argue that Pilates could improve athletic performance by increasing strength, power, and flexibility, but there are some potential problems. When athletes train for sports, they need to train specifically for their sport (specificity of training). For instance, a lineman explosively stands up and blocks an opponent during a football game, so he needs to do explosive squats during his training. Most of the work with Pilates is non-weight-bearing and in a supine or prone position; this is nothing like what a lineman, or most other athletes for that matter, do for their sport. Therefore, it is my thought that free weights have the advantage because you can mimic athletic motions more specifically. For instance, you can have a golfer stand at the high pulley machine and go through the motion of the golf swing (even using a golf club handle) to train the muscles that are specifically working during the swing, whereas this would be more difficult on a Pilates machine. Pilates could certainly recruit golfing muscles, but you wouldn't be in a golfer's stance when you do it. But this is all speculation. Comparison studies between Pilates and free weights need to be done to determine if Pilates can improve sports performance.

Claim #12. Improves balance, coordination, and circulation
There is no real evidence that Pilates improves any of the above. I believe that balance would improve with the proper Pilates training, but I also believe that balance training can be done very effectively with an individual standing on the floor, and there are also devices like rocker boards that assist with balance training. As for circulation, it improves with aerobic and resistance exercise, and so it stands to reason that it would improve with Pilates since it too is a form of resistance exercise, but there are no studies to prove it.

It's important to note that although many of the Pilates claims are unsubstantiated, it doesn't mean that Pilates doesn't provide benefits. It's just that they haven't been confirmed with studies. When a claim is supported with research, it is called empirical evidence. When a claim is supported by what individuals have to say about it, it is called anecdotal evidence. There isn't a lot of empirical evidence for the benefits of Pilates, but it's fair to say that there is lots of anecdotal evidence, so I suggest that you give it a try if you are curious.

There are no studies to prove that Pilates contributes to weight loss. The bottom line of weight loss is that you must consume fewer calories than you burn no matter how much exercise you do. Even if you run a marathon every day you, will not lose weight if you consume more calories than you burn. Now, if you practice Pilates, or any other exercise for that matter, then you do burn calories, and that helps.

There is also the potential for a positive interaction between exercise and your calorie intake where you ask yourself, Why eat more if I'm doing all this exercise and I want to lose weight? You might lose weight if you start thinking like that. Interestingly, calorie expenditure during six different Pilates mat exercises has been carefully studied.

The researchers found that on average, a 165-pound person burned 480 calories per hour during an advanced Pilates workout (comparable to walking 4.5 miles per hour), 390 calories per hour during an intermediate workout (comparable to basic stepping), and 276 calories per hour during a basic workout (comparable to moderate stretching). However, the calories burned varied for each individual, leading the investigators to conclude that "Pilates mat workouts vary widely in energy cost depending on both the skill level/intensity of the workout and the particular exercise movement being performed. The advanced and intermediate workouts tested in this study appear to be of sufficient intensity to provide healthy adult participants with health-fitness benefits."

You should check with your doctor if you are pregnant and want to try Pilates. There are currently no studies to prove the safety or efficacy of Pilates during pregnancy. This is not to say that it is unsafe, but you should check with your doctor first. There is evidence that aerobic exercise during pregnancy at a level great enough to produce a training effect does not adversely affect birth weight or other maternal and infant outcomes and that it may be associated with fewer pregnancy-associated discomforts, but there is limited research on weightlifting and pregnancy.

The American College of Obstetricians and Gynecologists, in their position statement on pregnancy and exercise, recommend limiting repetitive isometric or heavy resistance weight lifting and any exercises that result in a large rise in blood pressure. Pilates can be both isometric and high intensity, and so the instructor should account for that if teaching you Pilates and you are pregnant. Again, check with your doctor if you are pregnant and want to try Pilates.

Currently, there is no single agency certifying Pilates instructors, so instructors can have a variety of experiences and training. According to the Pilates Method Alliance (an international nonprofit professional association for the Pilates method), instructors should be able to do the following:

• Accurately assess a client's posture and movement patterns
• Understand what the client is doing in a session
• Have the ability to build an appropriate, client-specific program
• Pace the workout for an effective movement experience

Ask a potential instructor how long their training was and how much practical experience they have if you're concerned about their credentials. A weekend retreat to learn mat Pilates is not the same as a comprehensive one-year program that includes anatomy and physiology and hundreds of hours of working on the machines and the mats.

Pilates is growing in popularity, and so most large fitness centers with an aerobics program offer Pilates mat classes. The larger centers might also have a dedicated Pilates room with machines, or at least some Pilates equipment on the main gym floor. If your local fitness center doesn't offer Pilates, check online for Pilates studios in your area.

Many studios and fitness centers offer group sessions at discount rates, so be sure to check for those. Individual sessions are also available for the mat or machines, so if you feel you need extra attention, you can ask for that. Individual fees range from $65 to $125 per hour depending upon the experience of the instructor and whether you do it at the gym or a private studio.

Pilates mat work is a series of exercises that are done on the floor without Pilates machines. The attention to the flow of movement and the core muscles is the same as when you do Pilates on the machines, and mat work is a challenging workout in its own right. There is a growing demand for Pilates, but because qualified Pilates instructors may be lacking in your area and the machines take up space and are expensive, Pilates on the mat may be your best bet. Below are some exercises that you can do at home. A yoga mat or any type of exercise mat will do. Spread out two or three heavy bath towels on the floor if you don't have a mat. Check with your doctor before doing any of these exercises if you have medical or orthopedic conditions that affect your movement. Stop doing any exercise that causes pain. I recommend a simple knee hug before and after these exercises to keep your lower back loose. To do a knee hug, lie on your back, allow your back and shoulders to sink into the floor, then hug one knee to your chest, then the other, then both. Repeat six to eight times or until your lower back feels looser.

Teaser (works the abdominals)

1. Lie on your back, with the soles of your feet flat on the floor, knees squeezing together, arms overhead stretching behind you.
2. Inhale and exhale and allow your spine to sink into the floor.
3. Bring your arms forward, and let your head and torso follow.
4. Roll up to a midway point between lying down and sitting up and hold that position (your abdominals should be working the entire time) for three seconds.
5. Let your arms go back, and then lower your torso and head to the floor.
6. Repeat six to eight times.

The hundred (works the abdominals)

1. Lie on your back, and pull your knees to your chest. Exhale as your chest and abdomen sink into the floor.
2. Straighten your arms along your sides, and lift your legs straight up to the ceiling.
3. Lift your head and shoulders so that you are looking toward your feet.
4. Squeeze your buttocks and inner thighs together so that you cannot see between your legs.
5. Start moving your arms up and down along your sides about 12 inches in a rapid motion. Breathe in and hold for five seconds, and then exhale for five seconds as you try to reach forward even more.
6. Lower your legs halfway down toward the floor (legs should be at a 45-degree angle from your hips).
7. Continue to move your arms up and down and hold for a count of 50 to 100.

Leg circles (works legs and hips)

1. Lie on your back with your arms at your side.
2. Inhale and exhale and allow your spine to sink into the floor.
3. Straighten your leg toward the ceiling and point your toe.
4. Keep your opposite leg straight (the one on the floor).
5. Move your leg across your body, draw a small circle with it, and bring it back to the starting position. Make sure to keep your hips flat on the floor.
6. Move your leg in the opposite direction (away from the center line of your body), draw a small circle with it, and then return to the starting position.
7. Repeat six to eight times on each side.

The corkscrew (works abs, back, and legs)

1. Lie on your back with your arms at your side.
2. Straighten your legs toward the ceiling, keeping your thighs and knees close together.
3. Inhale and exhale and allow your spine to sink into the floor.
4. Inhale, move both legs to one side, and draw a small circle with them while keeping them close together.
5. Make sure to keep your hips on the floor when you circle.
6. Return to the starting position, and then repeat on the other side.
7. Repeat five to six times on each side.

The crisscross (works the abdominals and legs)

1. Lie on your back with your hands behind your head.
2. Lift your head, and bring your knees toward your chest.
3. Straighten your right leg and then lift, and twist your torso until your right elbow touches your left knee.
4. Hold the position for one to two seconds.
5. Repeat with the other side.
6. Exhale fully as you hold each position.
7. Keep your shoulders as high off the floor as possible.
8. Repeat eight to 10 times on each side.
9. Finish by pulling both knees to your chest, and then roll up to a sitting position.

Spine twist (works the abs and back)

1. While on the floor, sit up very straight (try to make a 90-degree angle at your hips).
2. Straighten your legs out in front of you and squeeze them together.
3. Straighten your arms out to your sides at shoulder height and parallel with the floor.
4. Breathe in and try to pull your belly button toward your spine.
5. Exhale and rotate your torso toward one side while keeping your upright posture.
6. Keep your buttocks on the floor and look behind you.
7. Hold for one to two seconds and then inhale and return to the starting position.
8. Repeat on the other side.

If you're looking for a novel and challenging workout that will help strengthen, tighten, and loosen up your muscles, then Pilates might be just the thing. You can do it in classes or privately, on machines or the floor, or at home on your own following a DVD or video. Pilates may not be for everyone, but if you're adventurous and thinking about it, I encourage you to give it a try. Any activity that expands your fitness choices is worth the effort, and if you think you need variety to stay motivated, then go for it!

American ingenuity has worked its way into Pilates. There's Pilates on the ball, yoga Pilates, and even Pilates with exercise bands. These are not what Joseph Pilates had in mind, but I don't know of any downside, and if they provide you with variety and alternatives, you like them, and they get you to work out, then I recommend giving one of them a try or sticking with it if one is working for you.

Wear clothing that you can move comfortably in. Leotards, tights, sweatpants, shorts, tank tops, or any other clothing that stretches will work. Your instructor will need to see your body, so tighter-fitting clothing is better, plus loose or baggy clothing might not be your best choice because you will be put into positions on the machines that may reveal more of you than you are comfortable with. You will be barefoot or just in socks, so shoes are not an issue. Leave long necklaces or large bracelets at home as they will interfere with your workout.

http://www.pilatesmethodalliance.org/

The Pilates Body by Brooke Siler (Broadway Books 2000)

http://www.collagevideo.com Pilates videos and DVDs