Physiotherapy and Pilates to Improve Pulmonary Function

Original Editor - Eugenie Lamprecht Top Contributors - Kim Jackson

Introduction[edit | edit source]

The Pilates method is commonly used by physiotherapists for various reasons such us; injury recovery, fall prevention, muscle imbalances, posture correction, general strengthening, and much more. One benefit of Pilates that’s often overlooked is the improvement in pulmonary function[1].

While Pilates is predominantly used for strengthening and flexibility, studies have also indicated that Pilates improves respiratory endurance, lung volumes and, inspiratory and expiratory flow rates[1].

'Breath' is one of the foundation principles in the Pilates method and is known as the ‘engine’ behind Pilates. The positive effects of these controlled breathing techniques include;


Biomechanics of Breathing[edit | edit source]

It’s important to understand the normal biomechanics of breathing in order to truly understand the benefits of breathing sets in Pilates. Pulmonary ventilation consists of 2 phases[2];

  1. Inhalation Contraction of the diaphragm and intercostal muscles to increase the volume of the thoracic cavity. This increase in volume leads to the intrapulmonary pressure being lower than atmospheric pressure. Therefore, air flows into the lungs until the intrapulmonary pressure is higher than the atmospheric pressure
  2. Exhalation A passive recoil of the lung tissue and relaxation of respiratory muscles leads to a decrease in volume which causes air to flow out of the lungs due to an increase in intrapulmonary pressure following the decrease in volume. Exhalation is a passive phase of breathing predominantly, however, forced exhalation is possible by contraction of accessory muscles such as the abdominal muscles, which push the diaphragm upwards and reducing the volume.

During vigorous exercise, the demand for pulmonary ventilation increases, and accessory muscles are often recruited.


Breathing During Pilates[edit | edit source]

Pilates focusses on 3 key methods during exercise; lateral breathing, set breathing patterns, and active breathing[2].

  1. Lateral Breathing refers to the lateral expansion of the ribcage while maintaining abdominal contraction (a downward pull of the deep abdominal muscles) during breathing. This is different from diaphragmatic breathing and aims to maintain abdominal contraction in order to protect the spine during exercises/ movements.
  2. Set breathing patterns are coordinated with each exercise or movement. Inhalation occurs during one phase of a specific movement/ exercise, and exhalation during another phase of the movement.
  3. Active breathing or otherwise known as percussive breathing. Active breathing aims to consciously activate respiratory muscles to enable the lungs to expand and transport oxygen. This method of breathing assists contraction or activation of certain targeted muscles. Inhalation occurs through the nose and exhalation through the mouth with pursed lips. A great example of active breathing is the ‘hundreds’ exercise; performing 5 arm-pumps during exhalation and 5 arm-pumps during inhalation.

Who Can Benefit[edit | edit source]

  1. Obese individuals: Effectively improve respiratory function & functional capacity[4].
  2. Cystic Fibrosis: Improve respiratory muscle strength[5].
  3. Ankylosing Spondylitis (Axial Spondyloarthritis): A multimodal training combining Pilates, McKenzie and Heckscher exercises are proven to improve pulmonary functioning in these individuals[6].
  4. Chronic stroke: Effectively improve cardiopulmonary function[7].
  5. Following cardiac surgery: Significant improvement in vital capacity and ventilation in individuals following cardiac surgery[8].
  6. Following renal transplantation: Improves FEC1 and FVC in individuals following renal transplantation[1].
  7. The elderly: Improve pulmonary function and respiratory muscle strength among the elderly[9].
  8. Non-communicable diseases[10].

Physiotherapy Relevance[edit | edit source]

Pilates can improve pulmonary function in the following ways:[1]

  1. Strengthens respiratory muscles: Literature indicates that Pilates can significantly improve maximal inspiratory - and maximum expiratory pressures. By combining movements and postures with breathing at a low pace but increased depth, the respiratory muscles have to be contracted while other muscles of the body perform movements. This, in turn, leads to improved respiratory muscle strength.
  2. Improves pulmonary parameters: Studies found improved maximum voluntary ventilation (MVV), peak expiratory flow (PEF), and forced vital capacity (FVC) among individuals following Pilates training. Improved ventilation and perfusion are due to the respiratory rehabilitative method associated with pilates when coordinated breathing is utilized.
  3. Improves cardio-respiratory parameters: Enhanced peak VO2, VO2max, respiratory exchange ratio (RER), oxygen equivalent (EQO2), maxEQO2, and maximum ventilation were observed among individuals following Pilates training. The fact that Pilates improves VO2 max means that it leads to cardiovascular changes, enhanced circulation, and vascularity to the muscles.
  4. Improves Trunk stability & mobility: One of the fundamental principles in Pilates is the centre (the core/ trunk), and because all these segments are connected a stronger core/ trunk will lead to improved diaphragm function and respiratory efficiency.

As physiotherapists, we often manage patients with various respiratory conditions. Respiratory muscle training in combination with the Pilates method is found to be more effective in improving pulmonary function[11], so when prescribing certain Home-exercise programmes it is suggested to utilize these pilates principles, by coordinating certain breathing exercises with postures and movement.

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 Kaur H, Paul M. Pilates Training: for Improving Respiratory Function a Systematic Review. International Journal of Health Sciences and Research. 2019;9(1):280-6.
  2. 2.0 2.1 2.2 Isacowitz R, Clippinger KS. Pilates anatomy. Champaign, IL: Human Kinetics; 2019.
  3. Armando Hasudungan. Mechanism of Breathing. Available from: [last accessed 3/9/2020]
  4. Niehues JR, Gonzáles I, Lemos RR, Haas P. Pilates method for lung function and functional capacity in obese adults. Alternative therapies in health and medicine. 2015;21(5):73-80.
  5. Franco CB, Ribeiro AF, Morcillo AM, Zambon MP, Almeida MB, Rozov T. Effects of Pilates mat exercises on muscle strength and on pulmonary function in patients with cystic fibrosis. Jornal Brasileiro de Pneumologia. 2014 Oct;40(5):521-7.
  6. Roşu MO, Ţopa I, Chirieac R, Ancuta C. Effects of Pilates, McKenzie and Heckscher training on disease activity, spinal motility and pulmonary function in patients with ankylosing spondylitis: a randomized controlled trial. Rheumatology international. 2014 Mar 1;34(3):367-72.
  7. Lim HS, Yoon S. The effects of Pilates exercise on cardiopulmonary function in the chronic stroke patients: a randomized controlled trials. Journal of physical therapy science. 2017;29(5):959-63.
  8. Cordeiro AL, Barbosa AF, Leitão LP, Araújo PA, Carvalho S, Guimarães A. Pilates principles in lung function in patients in cardiac surgery postoperative. Braz J Surg Clin Res. 2015;11(2):16-9.
  9. Gildenhuys GM, Fourie M, Shaw I, Shaw BS, Toriola AL. A randomised controlled study investigating pulmonary function & respiratory muscle strength in older adults after training with Pilates. Afri J Phys Health Educ Rec Dance. 2013 Nov 1(Suppl 1):194-203.
  10. Miranda S, Marques A. Pilates in noncommunicable diseases: A systematic review of its effects. Complementary therapies in medicine. 2018 Aug 1;39:114-30.
  11. Alvarenga GM, Charkovski SA, Santos LK, Silva MA, Tomaz GO, Gamba HR. The influence of inspiratory muscle training combined with the Pilates method on lung function in elderly women: A randomized controlled trial. Clinics. 2018;73: e356.