Improve balance by focusing on concentration, coordination and rhythmic breathing while strengthening the core and lower limbs in standing positions.
If you want to add a valuable benefit for your middle- to older-aged clients, emphasize Pilates elements that enhance balance. Approximately 30% of people over age 65 who live at home fall each year, according to the Centers for Disease Control and Prevention (CDC 2013), and death rates from falls are increasing (CDC 2013). As many as 30% of those who fracture a hip from falling die within the first year (Gillespie et al. 2012). If you program balance training for fall prevention into your Pilates sessions, you may very well contribute to saving a life. It’s never too early to begin.
“Research shows that women as early as their mid-40s show reductions in balance [Choy, Brower & Nitz 2003], indicating benefits for balance-training exercise,” says Marie-Louise Bird, PT, PhD, lecturer in the School of Health Sciences at the University of Tasmania, in Launceston, Australia, and a mentor for Polestar® Pilates in Australia.
Balance tends to deteriorate with aging from loss of vision, hearing and proprioception; reduced strength, endurance and coordination; and medication side effects. Experts agree that regular exercise can significantly improve balance, but no consensus exists regarding what type of activity is best (Howe et al. 2011). As of 2011, the American Geriatrics Society’s clinical guidelines for fall prevention recommend balance, strength and gait training (see the sidebar). Since Pilates is a mind-body activity, researchers are interested in examining its effectiveness in bringing about better functional balance, especially as it pertains to improvements in proprioception and muscle endurance.
Like the best of any Pilates programming, balance training requires individualization, progression, and attention to safety. Clients have a range of abilities, with low to high levels of functioning. Therefore, safety is paramount, since people—especially those with poor balance—may hurt themselves if they fall during training. “A real challenge for instructors who are retraining or promoting balance control is to provide and encourage a challenge for clients in a safe environment,” says Bird. Experts recommend sticking to programming principles.
Research and Practical Application
Research supporting Pilates practice for fall prevention is growing. Bird, whose specialty is fall prevention exercise, conducted a study at the University of Tasmania that included 30 older adults with a median age of 69 years. Investigators found that a 5-week program of Pilates exercises resulted in improved dynamic balance, posture and strength that was maintained 1 year later, even for subjects who did not continue practicing after the end of the 5-week program.
Bird recommends that balance programs for fall risk reduction concentrate on lower-limb strength as well as balance, and that they include standing exercises with minimal hand support.
Best-practice recommendations for exercises to retrain balance include
- moving the body over the base of support and
- increasing challenge by narrowing the base of support or
- increasing challenge by using difficult and varied surfaces (Sherrington et al. 2011).
Pilates principles that are beneficial for balance training include concentration, coordination, breathing and alignment. Bird thinks concentration is important because exercises that improve body awareness are key to changing movement control. “We see changes in body organization and the way people move,” says Bird, noting that it’s difficult to quantify body awareness changes. “For the older adults I work with, the changes this makes to their function is powerful to see.”
In another Pilates balance-training study conducted at C.U. Shah Physiotherapy College in Surendranagar, India, researchers suggested that benefits from Pilates may stem from following pattern and protocol. “The exercises include maintaining a stable posture while concentrating on the rhythm of respiration . . . with increased awareness of kinesthesia, proprioception and movement coordination.”
That study included 51 ambulatory elderly individuals who lived in eldercare facilities. Subjects were divided into three groups: Pilates, conventional balance training and a control group. Investigators found that subjects who participated in a 6-week program of 45-minute Pilates classes three times a week significantly improved functional balance and quality of life (Surbala et al. 2014). Conventional balance training also produced significant improvements in both measures, but scores were higher among the Pilates participants.
If you have access to Pilates equipment, Bird recommends a circuit-style class with a mat warm-up, followed by standing exercises using the reformer, wunda or stability chair and trapeze table or, if a table is unavailable, resistance bands with an adjustable wall frame. She suggests the following exercises: scooter and standing side series on the reformer; any standing exercise on the chair (as long as the client doesn’t rely on the handles); and standing exercises using the trapeze table or adjustable wall frame.
Other exercises selected by researchers studying balance and Pilates include those that use the mat and stability ball. The C.U. Shah Physiotherapy College program included the following:
- hundred with head down
- shoulder bridge (without ball, then progressed to adding ball)
- single-leg circles
- alternate toe-tap
- leg-pull front
- spine twist (in kneeling position)
- ball leg-lift (sitting on ball)
- standing side splits (using ball)
- ball wall-squat
- tandem walking
“These exercises [above] in lying position are suitable for warm-up,” says Bird, but she adds that in order to “really improve balance,” exercises must be performed while standing.
Whether you create specific Pilates programming for those at risk of falling or you incorporate balance practice elements for your healthy clients, your clients will benefit. The role of trunk stability is a growing area of research interest in fall prevention. Future studies are likely to look at how to apply Pilates to enhance core stabilization as it relates to improving gait and functional balance. Interestingly, some of the founding Pilates principles seem to be critical to producing not only these physical benefits but also corresponding improvements in life quality. A significant aspect of preventing falls is reducing clients’ fear and increasing confidence in their ability to enjoy daily living. What a powerful gift to share with others!