Pilates (cont.)

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.

Medically Reviewed by a Doctor on 1/17/2014