Pilates: Get Facts on Exercises and Techniques

Author: Richard Weil, MEd, CDE
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

Pilates is a popular method of exercise in the United States, with more than 5
million individuals participating. What is Pilates, and should you be doing it?
I’ll answer those questions and more in this article.

What is the origin of Pilates?

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 the
purpose of 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.

QUESTION

Muscle weighs more than fat.
See Answer

What is Pilates?

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 on
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, and
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.

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Does Pilates work?

Pilates practitioners swear by the method, and in some circles, it almost
reaches cultlike status. It is true that there are 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, 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 web site. Stott Pilates
is an updated version of the original Pilates techniques that uses more modern
exercise principles. For instance, it states on the Stott web site 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 representative
of contemporary Pilates thinking, and so I think it is fair to confirm or
dispute the claims from that web site.

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 in order 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 that is there reduces 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, and 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, and so by association, it’s
reasonable to suggest that practicing Pilates could improve your daily
functioning. For instance, as the 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 has 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.
And 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 definitely 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, and 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
for 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. And 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 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, and 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, and so I suggest that you give it a try if
you are curious.

Will Pilates help with weight loss?

There are no studies to prove that Pilates contributes to weight loss. The
bottom line to 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). But 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 apparently healthy
adult participants with health-fitness benefits.”

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Can I do Pilates if I’m pregnant?

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 weight lifting 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.

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What credentials should I look for in an instructor?

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

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, and
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. Obviously, 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.

Where do I do Pilates?

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, and so if you feel you need extra
attention, you can ask for that. Individual fees range from $65 to $125 dollars
per hour depending upon the experience of the instructor and whether you do it
at the gym or at a private studio.

What is Pilates mat work?

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 to 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 exercise 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 abdominals)

feet

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 abdominals)

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)

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)

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 and 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 starting position, and then repeat on the other
side.

7. Repeat five to six times on each side.

The crisscross (works abdominals and legs)

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 sitting position.

Spine twist (works abs and back)

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 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 on 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!

Are there other types of Pilates?

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.

What should I wear to a Pilates class?

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.

Where can I find more information about Pilates?

http://www.pilatesmethodalliance.org/

The Pilates Body by Brooke Siler (Broadway Books 2000)

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

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