You have probably heard about the exercise method known as Pilates (Pi-LAH-teez). Nowadays it seems that Pilates is everywhere you look, and you may be wondering what all the hype is about. Is it a fad? A cult? Do you need to be able to touch the back of your head with your heels to be able to do it?

The answer to all these questions is no. Pilates is not a fad or a cult, and you do not need to be super-flexible, an athlete, or even a movie star to do it. Although Pilates has recently received the ringing endorsements of several celebrities, it is nothing new. Dancers have practiced it for more than 80 years. More recently, athletes have been using it to improve their strength and flexibility and prevent injuries. And more and more physical therapists are using it to help rehabilitate patients. In fact, there are many ways to modify Pilates so that it can be done by people who have various mobility restrictions, including people with arthritis.

What exactly is Pilates? Pilates is a nonimpact and nonaerobic form of strengthening and stretching exercise described by its creator as “the science and art of coordinated body-mind-spirit development through natural movements under strict control of the will.” Today you’re more likely to hear Pilates described as a strengthening of the “core” or “powerhouse” muscles (abdominals, back, and buttocks) through slow, mindful, and purposeful movements. You can do Pilates on a mat on the floor, up on a table, or on any of several specially designed apparatuses. To help you better understand this type of exercise and how it can benefit you, read the answers to the following common questions about Pilates.

Who came up with Pilates?

Pilates was developed by Joseph Pilates, who was born in Germany in 1880. As a child he was sickly, suffering from rheumatic fever, asthma, and rickets. Because he was so frail, he dedicated himself to building a strong body. He took up bodybuilding and became so physically fit that he was recruited to pose for anatomical charts. He was also a gymnast, a boxer, and a self-defense trainer. In 1912 he moved to England, and when World War I broke out in 1914, he was sent to an internment camp with other German citizens. In the camp he worked on his exercise routines and taught fitness exercises to other internees. As an orderly in a hospital at the end of the war, Pilates fashioned makeshift exercise devices that helped bedridden patients recover their strength faster. The routines and devices he developed during the war later became the basis for the Pilates Method. In 1926, he moved to New York and, along with his wife, opened a studio where many dancers rehabilitated and trained. Joseph Pilates himself trained daily and was physically fit until he died at the age of 87.

What makes Pilates unique?

The goal of Pilates is both a stronger and a more flexible body. Joseph Pilates had some training in yoga and was able to incorporate an emphasis on flexibility, deep breathing, and awareness of the body into his exercise method. Pilates is also unique in that every exercise strengthens muscles while elongating them. This approach differs from the common approach to strengthening, which builds muscle by loading the muscle as it shortens (as in weight training). In addition, the Pilates Method emphasizes quality over quantity. It energizes you without leaving you fatigued or with overworked and sore muscles.

Who can do Pilates?

Virtually anyone can use the Pilates Method. The young, the elderly, pre- and postnatal women, overweight people, and athletic people can all benefit from it. Furthermore, Pilates can be modified to help those with chronic pain, chronic conditions (including arthritis), low back pain, and even osteoporosis. It is an easily adaptable form of exercise, and there are many levels, from beginner to advanced. For people with arthritis in particular, Pilates can increase flexibility, strength, balance, and coordination without putting additional strain on the joints. Some people even find that Pilates reduces their arthritis pain. Remember, though, that Pilates is not aerobic; you will need to combine it with a type of aerobic exercise if your goal is to work your heart and lungs as well. And as with any exercise routine, you should always consult your doctor first.

Where can I take a Pilates class?

A good place to start is at a Pilates studio. You can find one in the phone book or online; there is usually at least one in every city. You should make sure that you work with a certified Pilates instructor who has a minimum of 100 hours of training. The instructor should also have experience teaching clients with arthritis or other mobility restrictions. I recommend that you have a few classes with the instructor by yourself or with a friend so the instructor can give you personal cues for your condition and body type. Then you can progress to a group class at the studio. Once you’ve got a good grounding in Pilates, you can try a Pilates DVD at home or join a class at your local gym that saves you money. But in general, small classes are better. A ratio of eight clients to one instructor allows the instructor to see you and give you verbal cues on how to correct your form. Large gym classes are not recommended if you are a beginner because you will need more cues than individuals usually get in such a class, to protect your body and perfect the exercises. (If and when you take a larger class, make sure you go up to the front so the instructor can watch you and help correct or cue you. This is not the time to be modest.)

Pilates classes at a studio are more expensive than your local gym’s aerobic classes because the training of the instructor is more specialized. But as the saying goes, “You get what you pay for.” If you start at the gym in a class of 20–30 people, you will not know whether you are doing the exercises correctly and may either hurt yourself or miss the whole point of the exercise, wasting your time and money. Most studios offer discounts if you sign up for more than one session at a time or if you go with a friend (semiprivate or duo classes). Prices will vary by area and also by type of exercise (the use of equipment might cost extra). The price might also be based on how experienced the instructor is.

What should I expect in a Pilates class?

If you are going to a Pilates studio, your instructor should first take your health history and assess your posture. This will help him or her decide on specific areas to work on for your posture and health. Be sure to let your instructor know of any limitations you have. For example, if your arthritis affects your knees, your instructor should know that so he or she can adapt the routine if necessary.

Your instructor will give you verbal and tactile cues as you perform the exercises. The workouts should be simple so you feel you are able to do them without becoming overly tired. Subsequent classes or sessions should progress in difficulty so you can build strength, fluidity of motion, and flexibility. Expect the process of learning the exercises to take more than one visit. You should not progress to more advanced exercises until you have demonstrated good form in the basic ones.

In addition, you should never hurt during a Pilates exercise or be sore afterward. You should feel tall and invigorated, not so exhausted that you slump down on the journey home.

What type of Pilates should I do?

There are a few different types of Pilates. Most common are Pilates on mats and Pilates done on equipment such as a “Reformer.” Mat Pilates is the most popular because it is economical and can be modified to suit many types of people. The exercises are done on the floor on a Pilates mat, which is much thicker than a yoga mat to protect your spine and joints. Mat Pilates may not be feasible for people who have trouble getting on and off the floor, but if you see a Pilates instructor one-on-one, he or she will be able to modify the exercises so that you are up on a table or sitting on a ball or chair. To get a taste of what’s involved in mat Pilates, you can try out these sample exercises.

The second most common type of Pilates is done on a Reformer. The Reformer is a flat cushioned table about two feet off the floor and about six feet long. It uses springs to assist or resist various exercise movements. The springs can be adjusted to resist movements (of the legs and arms) to build strength, but core muscles are challenged to stay elongated and in control of the motion. Resistance training helps fight osteoporosis, so the Reformer’s resistance feature means that Pilates on the Reformer can help people fight the effects of osteoporosis. (The same cannot be said of mat Pilates.) However, the equipment is large and not practical for many to fit into their homes, and it is also not safe for some people to use alone. On the other hand, the raised surface of the Reformer is easier for some people to get onto. Likewise, the fact that the springs can assist movements against gravity can make the Reformer an easier exercise choice for some people.

All Pilates studios have Reformers and teach both types of Pilates (and many more). The instructors are there to help you decide what will work best for you.

What are the principles of Pilates?

The foundation of the Pilates Method is proper breathing and proper placement of the pelvis, shoulder blades, ribcage, and head. Six basic principles help bring this about: concentration, control, centering, fluidity, precision, and breathing. Because each instructor brings his or her own experiences, there can be varied styles, but the basic principles should be the same.

Concentration. While practicing Pilates, you should always pay attention to your movements as you perform them, concentrating on how your body feels as it moves. For this reason, there is no distracting music or television during Pilates.

Control. All your movements should be completely controlled by your mind. You should avoid sloppy movements and should not rush through any movement simply to get through it. Slow, deliberate motions build awareness and strength.

Centering. Your abdominal, lower back, and buttock muscles are your powerhouse or core muscles. All the Pilates exercises initiate from these central muscles. Core strengthening has been shown to prevent back pain, improve posture, and prevent injuries.

Fluidity. In Pilates, grace of motion is emphasized over speed. Ultimately, each movement should feel as fluid as a long stride or a waltz. Since many Pilates exercises were designed to help rehabilitate injured dancers, you will find choreographed exercises that remind you of ballet.

Precision. You should concentrate on the right movement each time you exercise, or you will end up doing the exercise improperly and not getting the most out of it. Precision and control go together. Every exercise and movement has a purpose, and every instruction is vitally important to the success of the exercise. Being precise does not mean you must be perfect and as flexible as the instructor, but you need to try your best to be as precise as your body allows.

Breathing. Proper breathing will help you control your movements and keep you energized to complete the exercises. Muscles need oxygen to perform. However, we all tend to hold our breath through hard exercises or movements, which can fatigue the muscles and make them tense. The warm-up exercises in the Pilates Method help you remember proper breathing throughout the exercises. Each exercise is timed with your inhalation or exhalation so that you can maintain proper breathing throughout the exercise.

Carrie Cardinale is a physical therapist who has been treating individuals with arthritis since 1996. She has been using the Pilates Method since 2006.

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