An evidence-based report on the effectiveness of Pilates training for healthy adults.
Pilates continues to grow in popularity, and its practice is now familiar to people around the world, with studios throughout North America, South America, Europe, Asia and the Middle East. Enthusiastic marketers may claim that Pilates can solve everything from weight issues to problems in the bedroom, but we serve our clients well when we educate them about benefits of Pilates training that are validated by scientific consensus. While Carl Sagan accurately said, “The absence of evidence is not evidence of absence,” this article focuses on what we can confidently claim, based on a growing body of research.
Interest in researching the Pilates method is stimulated by its increasing popularity among the general public and by its use in rehabilitation (Cruz-Ferreira et al. 2011). When Joseph Pilates opened his New York City studio in the 1920s, his method was embraced by prominent dance-community members, such as George Balanchine, and evolved into an integral part of dance training. Early research, therefore, focused on the benefits of Pilates for healthy adults and for dancers. More recent studies have examined its effectiveness in helping people with a variety of pain-related issues, with particular attention paid to chronic low-back pain (Wells, Kolt & Bialocerkowski 2012). Appraisals of existing research have noted, however, that many available studies lack rigorous scientific standards. The good news is that this situation is improving.
Benefits Supported by Research
Strong evidence exists that consistent Pilates practice can improve flexibility and dynamic balance, and there is moderate evidence that training can increase muscle endurance in healthy individuals (Cruz-Ferreira et al. 2011b).
Backed By Strong Evidence
To researchers, “strong evidence” means findings from multiple well-designed studies that include randomized, controlled trials. The following studies support the claims that Pilates can improve flexibility, dynamic balance and muscle endurance:
Improved flexibility. Adult women who practiced Pilates mat work experienced improvements in posterior trunk flexibility (Sekendiz et al. 2007) and hamstring flexibility (Kloubec 2010) compared with control-group members who made no lifestyle changes. Among healthy young adults, mat Pilates participants improved low-back, hamstring and upper-body flexibility compared with active control subjects (Rogers & Gibson 2009). In a study of women over 60, Pilates practitioners gained flexibility in the hamstrings and low back, while those who remained inactive did not (Irez et al. 2011).
Better dynamic balance. With 5 weeks of Pilates equipment training, dynamic standing balance improved in healthy adults (average age, 27) compared with control subjects (Johnson et al. 2007). Women over 60 who took Pilates mat lessons for 12 weeks made gains in dynamic balance and reaction time and had fewer falls (Irez et al. 2011).
More muscle endurance. Female subjects who practiced Pilates mat work three times per week for 5 weeks improved abdominal muscle endurance compared with inactive controls (Sekendiz et al. 2007). Young healthy adults showed improvements in both abdominal and low-back muscle endurance after 8 weeks of classes, three times a week; the control group consisted of unsupervised active young adults (Rogers & Gibson 2009). In a study with both younger and older adults, aged 25–65, abdominal and upper-body muscle endurance increased in those who took 12 weeks of Pilates classes, two times per week (Kloubec 2010).
Backed By Moderate Evidence
Scientists have identified these additional effects from Pilates training, but more research is needed to confirm the findings:
Improved muscle activation. Studies conducted by Michele Olson, PhD, FACSM, professor of exercise science at Auburn University in Montgomery, Alabama, showed that particular Pilates moves involving less flexion recruited the deep abdominal muscles more efficiently than standard crunches. Exercises with the least flexion—the hundred and the double-leg stretch—resulted in the highest recruitment of the internal obliques and the transversus abdominis (Archer 2008).
Another study showed that centering—or activating the abdominal muscles, lumbar multifidus and pelvic-floor muscles—while dynamically contracting the biceps brachii under load, led to more recruitment of upper-arm muscles than doing the same movement without a conscious core contraction (Barbosa et al. 2013).
More life satisfaction. Women who participated in twice-weekly, 1-hour Pilates mat classes for 6 months enjoyed greater life satisfaction (Cruz-Ferreira et al. 2011a).
Improved psychological well-being. In addition to being more satisfied with their lives, these women improved their physical self-concept and health perception, contributing to an improvement in overall psychological well-being (Cruz- Ferreira et al. 2011a). Self-efficacy, mood and sleep quality improved in college students who practiced Pilates for one 15-week semester (Caldwell et al. 2009).
Enhanced brain function. An analysis of five case studies showed that the brain’s neural networking activity increased over 10 weeks of intensive Pilates mat training (90 minutes per class, four times per week) (Bian et al. 2013).
Additional studies featuring larger sample sizes, a randomized, controlled study design and more follow-up are required to support these preliminary findings.
While Pilates enthusiasts and instructors may experience many more gains from consistent practice, the benefits identified above are those that science has validated so far. Much more research is required. Areas of interest include exploring the impact of Pilates practice on motor learning, body composition and muscular strength, and understanding which moves are best suited to which people. For example, certain exercises may pose risks for people with spinal issues, whereas other moves may be more appropriate for sport-specific applications.
With Equipment or With a Mat?
Studies have not definitively answered the question regarding the relative benefits of Pilates mat exercises versus training that uses various equipment pieces. More research has assessed the value of mat routines. Cruz-Ferreira and associates have noted, “This is not surprising because mat exercises are not as demanding in terms of supervision, are more affordable and readily available and can be taught in larger groups” (Cruz-Ferreira et al. 2011b). Cherie Wells, lecturer in physiotherapy and clinical education coordinator at the University of Western Sydney in Penrith, Australia, who has conducted multiple review studies of the Pilates method, said, “Specialized equipment such as the reformer or the trapeze table provide variable spring resistance that can tailor exercises according to an individual’s ability and are proposed to provide greater proprioceptive feedback, which may assist people in the correct performance of exercises.”
“The mat is the primary Pilates tool,” said Olson. “You can learn all of the breathing and muscle engagement techniques on the mat. A level of mat mastery is actually quite important before moving on the equipment. On the mat, you don’t have the advantage of the help of the equipment.” Experts agree that further research is required to compare the effects of Pilates exercise with or without the use of specialized equipment for healthy adults.
How Much Practice Is Required?
To get the most benefit from a Pilates routine, research evidence supports the conclusion that healthy individuals should train two to three times a week for at least an hour per session. Most Pilates study designs have required subjects to do the exercises for at least 50 minutes, two to three times a week, over 5–15 weeks (Cruz-Ferreira et al. 2011b). When it comes to an exercise prescription to ensure particular results, investigators look for a “dose-response” relationship. In scientific terms, this means a change in effect on a subject, caused by differing levels of exposure (or dose) to a stressor (in this case, the exercise program) over a certain period of time.
Olson, who has conducted six Pilates studies, said, “Done 2 or more days a week, [Pilates can yield] many benefits in 6–8 weeks.” Wells agrees with this observation, but notes that studies with healthy individuals include a wide variety of exercise parameters, in contrast to research for people with chronic low- back pain (CLBP).
“In relation to people with CLBP, some colleagues and I have recently conducted a Delphi survey of Australian physiotherapists where there was consensus that people with CLBP should undertake supervised 50- to 60-minute supervised sessions, two to three times per week, for 3–6 months, for maximal benefits,” said Wells.
Conclusion: Stick With the Facts
Modern Pilates continues to evolve through the refinements of generations of teachers and the addition of scientific insight. Olson wisely urges instructors to “stick with the facts.” “We know Pilates helps to strengthen the trunk and create body awareness. It is mindful. . . . This makes us aware of how our body, muscles and skeleton work cooperatively to perform proper and purposeful movement—whether it be during exercise or during daily life activities.”
These attributes can help people of all ages and ability levels improve daily living and sports performance. The value of Pilates continues to lie within its essential elements—concentration, control, centering, precision, breathing and flow. Stay tuned for more research.