Pilates for Senior Citizens on ADVANCE for Physical Therapy ...

We know of Pilates as one of the most popular recent trends in health and fitness. We read about Hollywood stars claiming their svelte bodies are due to hours spent in Pilates sessions, and we hear that professional athletes use Pilates for core conditioning and cross training. We now are learning even more about Pilates for rehabilitation from injury or surgery.

If you seem surprised, however, to hear that your grandmother has been taking Pilates sessions, you shouldn't be. With the aging baby boomer population and an increased national focus on health and fitness, Pilates is becoming one of the most effective options for rehabilitation and post-rehabilitation fitness for people of all ages.

What We Know About Pilates

Pilates is an exercise system developed by the late Joseph Pilates in the early 20th century that balances the whole body with a focus on stretching, strengthening, spinal alignment and core stabilization. By using principles such as breathing, control and flow, Pilates exercises help improve posture and muscle control so that movements are more efficient.

Core muscles such as the transverse abdominus and multifidus are a main focus and special attention is paid to proper mechanics and precise movements. In addition, the mind-body connection is emphasized so that the work is focused on quality of movement rather than quantity.

Exercises can be done on a mat or on any number of medieval-looking equipment designed specifically for Pilates, such as the reformer, Cadillac and Chair.

The equipment uses pulleys and springs that provide resistance or assistance, depending on the exercise. By manipulating the equipment, an exercise can be made either easier or harder, or the muscle focus can be changed entirely, providing many options for both exercise progression and modification. It is this unique system of assisting and relieving forces that allows muscles to be trained without increased pressure on the joints. This makes equipment such as the reformer ideal for people of all ages, especially those with conditions such as arthritis and degenerative disc disease.

The effects of Pilates have not been extensively studied, but what we do know is that a Pilates exercise program can result in improved abdominal strength and endurance, improved trunk extensor strength, improved posture, increased flexibility and decreased pain and functional disability.^1-5 Additionally, Pilates-based programs have been found to lead to positive outcomes in patients with chronic low-back pain, fibromyalgia and breast cancer.^4,6-8?

The majority of studies document a method of Pilates mat exercises, but a few include exercises on the Pilates equipment as part of the regimen. In fact, one study found that an exercise program using the Pilates reformer in healthy adults resulted in increased dynamic standing balance as measured by the Functional Reach Test.⁹

Further, a Pilates-based program has even been proposed as an effective preoperative and postoperative regimen for patients undergoing total hip and knee arthroplasties.¹⁰

In the Clinic and Beyond

In the absence of substantial research on the effects of Pilates exercise, we must look to the clinic for practical application and results. More and more physical therapists are turning toward Pilates-based therapeutic exercise to treat their patient populations.

Since 2004, I have been using Pilates in addition to manual therapy, modalities and traditional physical therapy interventions to treat patients of all ages and diagnoses. What has traditionally been known as a form of exercise for active younger populations and dancers is now being used with older adults with tremendous results.

There are a few main reasons why Pilates is an excellent choice of exercise for the older adult population in the clinic and beyond. First, the principles and techniques used in Pilates are a natural fit for physical therapy, where many of these patients often begin their fitness journey. With an emphasis on core stabilization, neuromuscular re-education and postural correction, the very nature of Pilates exercise aligns with many of the techniques we as physical therapists use to treat these patients.

Whether a patient has lumbar spinal stenosis or degenerative disc disease, physical therapy will most likely focus on improving flexibility, posture and local core stabilizers. As therapists we will spend time educating the patient on recruiting the correct muscles and inhibiting the muscles that exacerbate the dysfunction.

So many long-standing orthopedic injuries we see in older adults stem from an imbalance of some kind, and Pilates exercises can correct these imbalances by emphasizing both strength and flexibility simultaneously.

Pilates is also ideal for older patients because the equipment used provides the clinician with even more opportunities for therapeutic intervention. Each apparatus can provide support or resistance-sometimes both-and can allow for more creativity and freedom in rehabilitation, which is sometimes necessary for our older patients.

For example, footwork exercises (such as a supine leg press) on the reformer provide the clinician with an opportunity to correct closed-chain dysfunction without the effects of gravity on the patient's joints. This is especially helpful for treating those with painful arthritic joints early on in rehabilitation when standing activities are not tolerated.

For an exercise like sidelying straight leg raise or leg circles, the use of springs on the Cadillac can provide both resistance and assistance through the motion, and can challenge the dynamic stability of the pelvis while the patient remains supported in a safe position.

What may seem like complicated pieces of equipment for athletes are actually very well-designed pieces of machinery that can help us achieve improved mobility and strength in our patients without the pull of gravity or harsh positions used in so many typical gym machines. It is our job to modify activities and exercises when they are unsafe or painful; the Pilates equipment allows us to do this easily.

Lastly, educating our older patients in Pilates principles and movements can lead to improved carryover after discharge. Pilates studios and classes are everywhere, and although it may not be appropriate for an elderly patient to go into any Pilates class, most Pilates studios offer private sessions with certified instructors which can serve as an excellent next step when insurance benefits end or when a patient wants more than just a home exercise program.

Reputable Pilates training programs include guidance on working with patients with injuries and limitations, and require many hours of practice and observation before completion.

Most respectable Pilates instructors are very open to collaborating on a client's care, and welcome the advice of physical therapists to help make their client's sessions more effective. Clinics offer private Pilates sessions with a physical therapist after discharge, which can serve as a useful transition for a patient before he or she enters a group class.

Keep an Open Mind

As physical therapists we have many tools available to us. I have found Pilates to be one of the best, and I am definitely not alone in this discovery. As this fitness trend continues to grow, try to keep an open mind and see it as an effective intervention for not only our younger athletic population, but for our grandmothers and grandfathers as well. ⁿ

References

1. Kloubec, J. (2010). Pilates for improvement of muscle endurance, flexibility, balance, and posture.?Journal of Strength Conditioning Research, 24(3), 661-667.

2. Sekendiz, B., Altun, O., et al. (2007). Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females. Journal of Bodywork Movement Therapy, 11(4), 318-326.

3. Kolyniak, I., Cavalcanti, S., & Aoki, M. (2004). Isokinetic evaluation of the musculature involved in trunk flexion and extension: Pilates method effect. Rev Bras Med Esporte, 10(6), 491-493.

4. Rydeard, R., Leger, A., & Smith, D. (2006). Pilates-based therapeutic exercise: Effect on subjects with nonspecific chronic low-back pain and functional disability: A randomized controlled trial. Journal of Orthopedic and Sports Physical Therapy, 36(7), 472-484.

5. Segal, N., Hein, J., & Basford, J. (2004). The effects of Pilates training on flexibility and body composition: An observational study. Archives of Physical Medicine and Rehabilitation, 85(12), 1977-1981.

6. Altan, L., Korkmaz, N., Bingol, U., & Gunay, B. (2009). Effect of Pilates training on people with fibromyalgia syndrome: A pilot study. Archives of Physical Medicine and Rehabilitation, 90(12), 1983-1988.

7. Keays, K., Harris, S., Lucyshyn, J., & MacIntyre, D. (2008). Effects of Pilates exercises on shoulder range of motion, pain, mood and upper-extremity function in women living with breast cancer: A pilot study. Physical Therapy, 88(4), 494-510.

8. Eyigor, S., Karapolat, H., et al. (2010). Effects of pilates exercises on functional capacity, flexibility, fatigue, depression and quality of life in female breast cancer patients: A randomized controlled study. European Journal of Physical Rehabilitation Medicine, 46.

9. Johnson, E., Larsen, A., et al. (2007). The effects of Pilates-based exercise on dynamic balance in healthy adults. Journal of Bodywork Movement Therapy, 11(3), 238-242.

10. Levine, B., Kaplanek, B., Scafura, D., & Jaffe, W. (2007). Rehabilitation after total hip and knee arthroplasty: A new regimen using Pilates training. Bull NYU Hosp Jt Dis, 65(2), 120-125.

Meghan B. Tierney is owner of One Physical Therapy and Wellness in Bryn Mawr, PA. She received her Comprehensive Pilates training through Body Arts and Science International in 2005.

Source: http://physical-therapy.advanceweb.com/Features/Articles/Pilates-for-Senior-Citizens.aspx

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