Pilates Training in the Elderly

Abstract

Aging brings along a series of musculoskeletal problems due to physiological changes. Many elderly people experience functional loss due to musculoskeletal problems. The demand for complementary, clinically effective, safe, patient-acceptable and, cost-effective therapeutic methods to reduce or partially prevent these losses is increasing day by day. Pilates is an exercise method that has beneficial effects on some health factors that are lost with aging. It is stated that it can strengthen the body against the difficulties it may encounter by strengthening the core stabilizing muscles around the pelvis and spine and improving the breathing pattern. It has been reported that Pilates has positive effects on posture, balance and fall risk, flexibility, strength, body composition and functional autonomy indicators for the advanced age group. In this review, the evidence of these most frequently studied effects of Pilates training in the elderly group is summarized in the light of the current literature.

Full text

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Pilates Training in the Elderly
Emir İbrahim Işık1, Selda Başar2
1 Abdi Sutcu Vocational School of Health Services, Cukurova University, Adana, Turkey
2 Faculty of Health Sciences, Gazi University, Ankara, Turkey
ORCID; 0000-0002-8219-6013, 0000-0002-1433-4349
Abstract: Aging brings along a series of musculoskeletal problems due to physiological changes. Many elderly
people experience functional loss due to musculoskeletal problems. The demand for complementary, clinically
effective, safe, patient-acceptable and, cost-effective therapeutic methods to reduce or partially prevent these losses
is increasing day by day. Pilates is an exercise method that has beneficial effects on some health factors that are lost
with aging. It is stated that it can strengthen the body against the difficulties it may encounter by strengthening the
core stabilizing muscles around the pelvis and spine and improving the breathing pattern. It has been reported that
Pilates has positive effects on posture, balance and fall risk, flexibility, strength, body composition and functional
autonomy indicators for the advanced age group. In this review, the evidence of these most frequently studied
effects of Pilates training in the elderly group is summarized in the light of the current literature.
Received :29.03.2021
Received in revised form :21.06.2021
Accepted :15.07.2021
Available online :15.09.2021
Keywords:
Pilates
Elderly
Older adults
Rehabilitation
Physical therapy
INTRODUCTION
Pilates has become one of today's fashion words thanks to the influence of media and social media.
Hundreds of new exercise videos added to the internet every day, including elite athletes and famous
people, have made pilates even more popular1. Pilates is not an exercise approach that includes
pre-determined standard positions and movements, on the contrary, it is a physical and spiritual
training method that anyone can do and increases physical strength, flexibility and
balance-coordination, reduces stress and anxiety, improves well-being and mental focus2. The basis of
the method is a body and mind centering technique based on providing and maintaining lumbopelvic
stability3.
Pilates, which was put into rehabilitation by medical units dealing with dance, has been the
preferred exercise method of the dance world for a long time4. It is not uncommon for healthcare
clinics today to have Pilates equipment5. Pilates training is used as part of rehabilitation programs for
orthopedic injuries, patients with neurological disorders, postpartum, chronic pain, arthritis, and many
other movement dysfunctions It is also preferred in special groups such as children and the elderly, as
well as in adults, for the protection and improvement of general health6, 7. The purpose of this review is
to explain the historical context of Pilates training and present the results of Pilates programs
implemented in the elderly population.
History of Pilates Training
Joseph Hubertus Pilates, the founder of the Pilates concept, was born in 1880 in Düsseldorf,
Germany. His childhood passed with diseases such as asthma and rickets. He trained in gymnastics,
boxing, yoga and karate to improve his health. He was a circus performer and self-defense arts
instructor when he was young. Combining Eastern and Western philosophies, he began to develop his
own exercise system called Contrology. His method soon gained popularity in Germany. He
immigrated to the United States in 1926 and quickly became popular while continuing his studies4.
Joseph Pilates died in 1967 at the age of 87. Since his death, his work has been continued by many
students7, 8. The principles outlined by Joseph Pilates in his book Return to Life through Contrology are
still valid today, and there are two more principles in the modified forms of Pilates training. These
eight principles adopted today are concentration, control, centering, fluency, precision, breathing,
relaxation and stamina7.
Principles of Pilates Training
Concentration: Pilates training r equires a mental focus on the target area of one' s own body.
Concentration draws attention to the working body segment, potentially improving neuromuscular
functioning and ultimately improving the quality of movement9.
Corresponding Author:
Emir İbrahim Işık
E-mail; eisik@cu.edu.tr
http://dx.doi.org/10.29228/jamp.50599
Int J Acad Med Pharm,
2021; 3 (3); 277-280
REVIEW
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278
Control: Pilates training aims at contracting the right muscle at
the right moment so that proper movement can occur. Every stage
from the beginning to the end of the movement continues and ends
under control. Controlled movement also reduces the risk of injury10.
Centering: Ther e are many muscles in the abdomen, lumbar
region and hip complex, which is accepted as the center of our body
and called the core region. Muscles such as the multifidus, quadratus
lumborum, iliopsoas, transversus abdominus, and diaphragm in this
region are mainly involved in the protection of the lumbar region. A
strong and active core is an indication of a strong center. With
centering, movements of the head, shoulders, thorax, pelvis and
extremities are organized around a central base9, 10.
Fluency: I n Pilates tr aining, the flow of movements is continued
with a body-mind interaction. Movements and transitions must occur
in a slow and fluid harmony to achieve the effects of training better.
Breathing and concentration are also included in this adaptation
process11.
Precision: Pilates training is concerned with quality, not qua n-
tity. Performing the movements correctly instead of repeating a certain
number of times increases the quality of the movement. The activation
and contraction of the targeted muscles at the targeted moment depend
on this. In cases where this principle is not sufficient, training moves
away from the integrity within itself2.
Breathing: I t is important to breathe properly during exercise.
Respiration is thought to be a catalyst for core stability8. Compared to
other exercise methods, diaphragmatic breathing is used less in Pilates
training. The reason for this is the view that increased intra-abdominal
pressure during diaphragmatic breathing reduces the activation of the
transversus abdominis muscle9.
Integrated Isolation: In order to learn the correct posture and
maximize the benefit to be gained from movements, daily activities
should be continued within the framework of centering and other
principles8.
Stamina-Routine: Pilates training provides muscular endurance
in the core and other small stabilizing muscles. Muscle endurance is
more important in spine training than pure muscle strength because the
deep stabilizers of the spine are constantly working2. At the same
time, it facilitates the formation of continuous functioning muscle
memory, which has become routine9, 10.
Use of Pilates Training in Rehabilitation
Pilates training is used more and more frequently by clinicians and
is preferred as one of the therapeutic exercise interventions. This is
due to the presence of more than 500 types of devices and exercises
that can be used in training to aid or resist movement12. In addition,
the short movement patterns required for various activities allow
clinicians to further evaluate patients for movement deficiencies4. It
has been used in orthopedic rehabilitation, neurological rehabilitation,
obstetric-gynecological rehabilitation, pediatric rehabilitation and
geriatric rehabilitation6, 7, 13-17.
Pilates Training for the Elderly
With aging, there is a decrease in the level of physical activity18.
In addition to the decrease in the activity level, it is known that the
elderly have inability to continue the exercise program when they are
included in an exercise program planned for them19. Factors affecting
older people's exercise participation patterns include concerns about
fitness for physical exercise in old age, the belief that exercise can be
harmful or at least not beneficial in preventing disease, and a
perceived lack of physical ability20, 21.
Modified forms of Pilates training are used for the elderly22.
Modifications such as reducing the number of repetitions in
movements, extending the progression time of training, reduced
position change and selection of suitable devices for the movement are
also preferred22, 23. The device to be used and the exercise intensity are
adjusted to assist or resist movement, depending on the physical level
of the individual24.
In the literature, it has been reported that the Pilates method has
positive effects on posture, balance and fall risk, flexibility, strength,
body composition and functional autonomy indicators for the elderly
population13, 25, 26. In addition to all these, it has been shown to
improve the general health of the elderly27. In line with these
indicators, a brief description of the health benefits of Pilates training
in the elderly is presented below:
Posture: Aging ca uses some postur al changes in the human
body. Old age causes postural changes such as head displacement28,
decrease in lumbar lordosis29, tendency to flexion in the whole body
and thoracic kyphosis30. Posture training and corrective exercises
are generally recommended in cases of deviation from the perception
of correct posture29, 31. Pilates training is an exercise program that can
serve this purpose. It is stated that it improves posture by increasing
body awareness7, 11. Some exercises used in Pilates training improve
trunk muscle stability to achieve and maintain an erect position32. It
also includes exercises aimed at strengthening weak and elongated
muscles and stretching strong and shortened muscles. In this way, it
contributes to the prevention of postural disorders caused by
adaptation33.
Muscle Strength: A decrease in muscle strength is observed with
neuromuscular losses that occur in the later stages of the aging
process34. In addition, the decrease in balance and the increase in the
risk of falling also restricts the movement and increases the speed of
the loss in muscle mass19. It is known that Pilates training provides a
good trunk stabilization by strengthening the core muscles and the
muscles around the spine in the elderly6, 11. It is said to improve
synchronization between respiratory muscles and trunk stabilizers by
increasing muscle control35. Although it focuses on the core muscles,
it was determined that the strength of the exercises with the
participation of the lower and upper extremities was adjusted and the
strength of the extremity muscles increased at the end of the Pilates
training thanks to the exercises performed with the loads created by
the body weight25, 36, 37.
Flexibility: With aging, joint range of motion decreases. The
elderly who are inflexible have increased muscle tone and a lower
flexural tolerance compared to the elderly who have normal
flexibility34. Because even simple tasks such as bathing require a lot of
range of motion, flexibility is associated with independence and
quality of life, especially for the elderly38. Pilates training is known to
improve flexibility. Training includes dynamic type stretching rather
than static stretching. It is thought that improvements in flexibility
after Pilates training may be a result of the gentle and regular
stretching movements that the exercises included39, 40. Regular
stretches can also contribute to flexibility by creating new contraction
units or sarcomeres on muscle fibers41. There are also studies
suggesting that improvements in flexibility may be related to a
reduction in body fat. This view is supported by the fact that the
reductions in range of motion are mainly due to the inhibition of
inter-segment movements caused by excess fat42.

279
Balance and Risk of Falling: E lderly falls ar e the main source
of disability, death, and healthcare benefits19. Thirty percent of falls
have been reported to cause serious injuries, reduce independence and
increase the risk of premature death43. Loss of balance is an important
modifiable risk factor for falls. For this reason, exercises aiming to
improve balance emerge as an important component of fall prevention
programs both in clinical practice and research literature30. Pilates
training consists of exercises that use resources such as gravity and the
resistance of the springs on the devices used to help maintain the
smooth movement44. It aims to prevent automatic movements
responsible for unwanted muscle activities that can cause injury45. It
has been determined that the effects such as strengthening the core
muscles, motor learning and the development of proprioceptive sense,
as well as the movements aimed directly at balance within the Pilates
training in the elderly, increase balance and reduce falls33, 36. In
addition, it has been argued that the postural improvement, muscle
strength and flexibility gained by training have a positive effect on
balance6. The aim of Pilates training is to fuse the mind and body. In
this way, the body uses the mechanical advantage at the highest level
to achieve optimum balance, strength and health46. From a clinical
point of view, Pilates consists of synergistic movement patterns that
include isometric, eccentric and concentric muscle contractions. These
movement patterns can easily be transformed into functional activities.
The lumbo-pelvic stability gained by Pilates training during functional
activities contributes to the prevention of falls by supporting
movement sensitivity, segmental mobility, coordination and balance
of the spine26, 47.
Body Composition: It is known that changing body composition
has an effect on the age-related decline in physical functions.
Understanding that body composition is particularly associated with
chronic disease morbidity and mortality risk has increased the
importance of studies on measurement and evaluation and regulation
of body composition48. Although there are many exercise methods to
regulate body composition in the elderly, Pilates training is one of the
exercises used for this purpose34.
Pilates training provides a gradual increase in exercise intensity
through exercise variety and difficulty when practiced both on the mat
without equipment and with equipment. Although this increase
provides significant benefits to the physical condition and trainable
physical abilities of the elderly individual, it improves muscle strength
and can affect the results of body composition23, 49. Although Pilates
training was not originally designed to achieve weight control, it is
seen as an alternative strategy that can be used in weight loss and body
composition regulation, especially in the elderly who do not like
traditional physical exercise models5, 11. It is stated that this training
can be preferred in the elderly who cannot do other aerobic exercises
that are more effective in reducing body weight13, 34.
Functional Autonomy: Functional autonomy depends on
variables such as strength, flexibility, coordination, balance,
interpretation of sensory stimuli, and cognitive capacity. Some or all
of these variables may be lost during the aging process38. Preserving
or improving autonomy requires work involving these variables. It is
known that physical activity can improve strength, endurance,
flexibility, balance, and motor skills18, 41. It is argued that Pilates
training also improves the abilities developed by physical activity in
the elderly in a similar way and enables the development of motor
control by increasing body-mind awareness10, 24, 31, 50. With the
development of functional autonomy, improvement in self-care skills
and a reduction in injury risk are achieved50.
Conclusion
As a result, Pilates training is a "multi-model" exercise approach
that includes the basic components of modern exercise training such as
balance, strength, and flexibility. Based on the available literature, it
can be concluded that Pilates training can be considered an effective
method for physical functions involving these components in the
elderly. At the same time, care should be taken to avoid unwanted
effects while performing Pilates training practices. For this, more
research is needed for specific protocol recommendations of Pilates
training interventions targeting the elderly. Individual benefits and
potential risks for the elderly should be discussed and the form of
Pilates training should be decided and applied carefully.
Authors’ note
This review is based on the general information section of the
doctoral thesis entitled “Comparison of the Effects of Clinical Pilates
and Aerobic Exercise Training on Physical Performance, Mood State
and Social Status in the Elderly with Mild Cognitive Impairment.”.
None of the authors has conflict of interest.
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