Pilates for Increasing Function and Decreasing Fall Risk in the Elderly
Sam’s world view
Each month we hear from Sam Wood - she summarises the most recent articles published in the Pilates industry.
Over the last few decades, life expectancy has gradually increased, and as a result the world population is aging. Falls are the leading cause of injury-related mortality and morbidity in the elderly (Stenhagen et al. 2013). Many studies have shown that muscle strength affects balance, and many other studies have identified core fitness as a good fall prevention strategy. Some of the research already reviewed in this book has established that Pilates increases core strength (Herrington and Davies 2005, Kloubec 2010, Emery et al. 2010). Thus, recently there have been many studies conducted which hypothesize that Pilates can help decrease fall risk, and thus increase independence and quality of life in older adults.
Over the next few months, we will be sharing, reviewing, and summarising some of my favourite research studies on this important topic.
Pilates Reformer classes for decreasing fall risk in the elderly population
A group of physical therapists from Cal State Northridge University investigated whether or not participating in Pilates Reformer group exercise classes could affect fall risk, balance and postural control, gait velocity, functional mobility, balance confidence, and lower extremity active range of motion in subjects over 65 years old. In this study, 55 subjects (38 females, 17 males) with an average age of 77.6 who had a history of recent falls or were deemed a fall risk, were randomly assigned to either a Pilates group or a control group. The Pilates group did a 45-minute group Reformer class once per week for 10 weeks. Each subject performed 10 specific Pilates exercises: Pilates Footwork (in six stance positions), Pelvic Lift, Hundreds Prep Arm Circles (Drawing Down, Circles Flexion), Hundreds, Long Box Pulling Straps, Long Box Seated Arms: (Chest Expansion Seated, Biceps Curls, Serving Bread), Scooter, Reverse Scooter, Eve's Lunge, repeat Pilates Footwork. The control group was instructed to continue their usual activities, and not to start a new exercise program or perform Pilates exercises.
Before beginning the Pilates program, all subjects underwent various balance tests (Sensory Organization Test on the NeuroCom® system, Timed Up-and-Go (TUG), Activities-specific Balance Confidence (ABC) scale, Adaptation Test (ADT), Berg Balance Scale, and 10 Meter Walk Test) as well as range of motion tests (straight leg raise, hip extension, and ankle dorsiflexion). These measures were repeated at the post-test session within one week following the 10-week Pilates training period, and subjects were asked to recall the number, nature, and frequency of any falls since beginning the study.
After 10 weeks of Reformer classes, the Pilates group showed significant improvement in hip and ankle AROM, whereas the control group did not. This is an important finding, because activities of daily living such as getting up from a chair, going up and down stairs, and normal gait, require a minimum of 10 degrees of ankle dorsiflexion ROM (Root et al. 1977). Pilates Reformer training also had a positive effect on improving static and dynamic balance, functional mobility, and gait speed as measured by the balance and functional tests listed above. These results indicate a decrease in fall risk, as well as faster speeds of walking, turning, and transferring from a chair. All of these results are clinically important for older adults. Walking speed is said to decrease up to 16% per decade starting at age 60 (Abellan van Kan et. al 2009), and it has been shown to predict a person’s functional status (Beijersbergen et al. 2023).
To summarise, after 10 weeks of participating in a group Reformer class once per week, the Pilates group in this study demonstrated: reduced fall risk, increased range of motion, faster gait speed, and improvements in static and dynamic balance, functional mobility, and balance self-efficacy. All of these are meaningful improvements in functionality for the elderly population. The control group did not improve in any of these measures.
It is interesting to note that although a few of the exercises chosen for the study moderately challenged balance (for example standing on one leg for Scooter and holding on to suspended straps on a moving carriage for the Arm Circles and Pulling Straps), none of the exercises involved standing on a moving carriage. Perhaps the results would have been even more impressive had exercises that work specifically on balance in upright postures been included in the program. Such exercises would be expected to lead to greater improvements in balance and proprioception, but there is increased risk as these exercises would require more one-on-one supervision to ensure safety.
Samantha Wood MPT, MBA, NPCT, RYT, is a licensed physical therapist, a National Pilates Certified Teacher (NPCT), a Yoga Alliance–certified teacher, and an associate faculty member for BASI Pilates. She created and teaches three advanced education courses for BASI Pilates: Pilates for Injuries & Pathologies- Parts 1 and 2 (for Pilates teachers) and Pilates: Integration into Therapeutic Practice (for rehab professionals). Pilates for Injuries & Pathologies Part 2: Chronic Pain Syndromes and Neurological Conditions is a brand new course that will debut in 2025 in Tokyo and London.
References
Roller M., A. Kachingwe, J. Beling, D. Ickes, A. Cabot, G. Shrier. 2018. “Pilates Reformer exercises for fall risk reduction in older adults: A randomized controlled trial.” Journal of Bodywork & Movement Therapies 22: 993-998.