Pilates mat.jpg

Pilates is a system of exercises using special apparatus, designed to improve physical strength, flexibility, and  posture and enhance mental awareness[1]. The method was designed by Joseph Hubertus Pilates from Germany whose father was a Greek ancestry Gymnast and mother was a Neuropath. In his childhood Pilates was weak and sickly (suffered from asthma, rickets and rheumatic fever). He strongly needed to take care of his physical health and that is why he become very interested in practicing body building, gymnastic, yoga and ‘kung fu’. As a 14 years old he had perfectly developed his musculature and was asked to pose for pictures of anatomical charts.

Before he turned 30 he moved to England where he worked as a boxer, circus performer and self defence trainer. When Word War I began he was interned to an internment camp where he has been teaching and improving his system of mat exercises he called himself ‘Contrology’. [2] [3] [4] After the war Pilates returned to Germany where he collaborated with Rudolf Laban and other important experts of dance and physical exercise. At the age of 42 he moved to United States where (with his wife Clara) opened his first Studio. Soon his method become popular between well known dancers who wanted to become more aware of usage of mind to control muscles and who needed help with proper training, recovery and rehabilitation.[3]

In his life he published 2 books related to his method:
• Your health (1934)
• Return to life (1945) [2]

"I must be right. Never an aspirin. Never injured a day in my life. The whole country, the whole world, should be doing my exercises. They'd be happier." - Joseph Hubertus Pilates, in 1965. He died in United States in 1967.[3]

Pilates Method   

Pilates as a method and an exercise movement yields numerous benefits.[4] Its systematic practice leads to increased lung capacity and circulation. It also improves joint health and bone density. When exercising Pilates it is important to remember that every movement should be done slowly and include each of the 6 basic principles. 

  1. Concentration - Pay attention to starting position, slow and smooth movements as well as each part of the body. Stay focused and do not let yourself distracted.
  2. Breathing - Oxygen inhalation refreshes brain and body. Deep breaths clear the lungs, relaxes and gives a better focus. Coordinate breathing with movement to understand body work.
  3. Control - Exercises needs to be done with a full control of muscle work.
  4. Centering - All movements starts from centering – engaging core muscles (deep muscles such as diaphragm, lumbar multifidus,transversus abdominis, pelvic floor muscles and their assistants: erector spinae, latissimus dorsi, gluteus maximus, oblique abdominis, rectus abdominis).Centering helps to improve balance and posture in-other words it is called powerhouse of the body. One of the primary goals of Pilates is to strength powerhouse or core-stabilisation[5].
  5. Precision - Keep attention to each exercise. They need to be done properly to benefit from them.
  6. Flow of movement - Every movement should start from a strong centre and flow gently and slowly. [6][7]

Pilates Classic Exercises 

In 'Return to life' book Pilates described his original 34 matwork exercises. For the first time book was published in 1945.[9]


Today there are plenty of different schools teaching and training modern Pilates. Method is used and can be found in fitness and physiotherapy industries. Exercises have been changed and some new equipment has been added. [2]

Pilates in Physical Therapy

  • The interest and popularity of Pilates is increasing worldwide. In addition to being used in fitness programs, it is being used in some rehabilitation programs.[11] There are plenty of scientific researches add clinical evidences confirming benefits of Pilates exercise.
  • People with Multiple Sclerosis (MS) frequently experience balance and mobility impairments, including reduced trunk stability. Pilates-based core stability training, which is aimed at improving control of the body's stabilising muscles, is popular as a form of exercise with people with MS and therapists.[12]
  • Studies have shown the effectiveness of a few weekly Pilates sessions as helping to reduce lower back pain. There has been found an important improvement of pain, disability and physical and psychological perception of health in individuals who did the daily sessions of Pilates. [13]
  • There was a positive effect of Modern Pilates mat and ball exercises of reducing obesity, body composition parameters and flexibility at sedentary obese women. [14]

Pilates and Low Back Pain

Pilates as a rehabilitation programme is used in treatment of chronic low back pain (CLBP) and its results could be compared to exercise programs results [15] . A Cochrane Rewiew shows that there is a low to moderate quality evidence that support effectiveness of Pilates programme on pain and disability in cases of low back pain (LBP) [16]. Most of Pilates programmes for LBP depend on improving or activation to power house[17].Mainly it consist of isometric contraction of abdominal muscles,pelvic floor muscles, gluteus maximus and multifidus.[16] Exercises consisted of 5 min of warm-up (breathing and mobility exercises), 50 min of Pilates exercises (stretching and strengthening exercises for muscles of the trunk and lower and upper limbs) and 5 min of cool down (relaxation exercises and massage with ball). Exercises were performed with concentric and eccentric contraction of trunk, spine, upper and lower limb muscles in all planes of movement. Each exercise was done with a single series, with a 2 min interval between exercises, and the number of repetitions varied from 8 to 12, corresponding to approximately 60% to 70% of one maximum repetition as assessed with the Borg scale.The exercises were performed at three levels of difficulty: basic, intermediate and advanced. The basic exercises were adapted to the conditions of each patient by reducing or increasing resistance (e.g, the roll-up exercise using the tower bar on the Cadillac can be performed with the spring in the high position to make the movement easier or in the low position to make the movement more difficult)[16][18] [19].

Pilates in Women's Health

Pregnancy is a specific stage in women’s life, a time when they face physiological and biomechanical changes that, without proper monitoring, lead to the emergence of musculoskeletal discomforts. Most of these issues are associated with postural changes, balance, ligament laxity, body weight increase and cardiorespiratory disorders. The Pilates method provides several benefits such as increased respiratory capacity, improved muscle strength and the strengthening of torso-stabilizing muscles, flexibility, spine mobility, postural alignment, coordination, proprioception, balance and motor control. Given the specific condition of pregnant women and the variations derived from such condition, Pilates may positively contribute to these women's health within their physical and psychological limitations. Pregnant women are known for the several physiological changes they go through; thus, Pilates can make important contributions to their health, such as the promotion of quality of life and well-being to improve their adaptation to each gestational week[20]. A study conducted to address the importance of Pilates, clinical guidelines and physical activities practiced in the main pregnancy periods (trimesters) through a bibliographical analysis concluded that the knowledge about the physiological and psychological changes affecting pregnant women, in association with the training in Pilate’s techniques, may promote and contribute to a gestational period with no complications and to reduce the risk of low-back pain and osteoarticular discomforts. Stabilization, strengthening and stretching exercises should be performed, but the gestational week and the patient's physical and emotional limitations must be respected. It is possible seeing that the physical activity is beneficial to pregnant women. Thus, such practice should be encouraged by health professionals.[20]


Pilates for Pelvic Health

Pilates exercise programs have been assessed for its potential to have a positive effect on pelvic health in women. Modified pilates for urinary incontinence has been assessed by Lausen et al. (2018). This study aimed to assess the effectiveness of a 6-week course of MP classes as an adjunct to standard physiotherapy care for urinary incontinence through a randomized control trial. Women who attended the modified pilates classes and who had lower symptom severity at baseline: improved self-esteem, decreased social embarrassment and lower impact on normal daily activities. Alternatively, women with higher symptom severity showed improvement in their personal relationships.[22] Additionally, pilates has also been found to beneficial in males post-prostatectomy dealing with urinary incontinence, and the results showed that ten sessions of pilates can increase muscle strength, accelerate the return to continence, and improve quality of life.[23] Another study examined the effect of a pilates exercise program and a pelvic floor muscle-training (PFMT) program on improvements in pelvic muscle strength in women, and the authors found improvements in both groups, with no significant difference between.[24] These findings are not consistent and require further research, as some studies have found no difference between groups completing pilates training and remaining sedentary.[25] It has been shown that it may be necessary to incorporate exercises into the pilates program to evoke voluntary pelvic floor muscle contractions in order to see a positive impact on the strength of the pelvic floor muscles.[26]


  1. Oxford Dictionaries, Definition of Pilates in English. Available from: http://oxforddictionaries.com/definition/english/Pilates (accessed 20 Oct 2013).
  2. 2.0 2.1 2.2 Wikipedia, Pilates. Available from: http://en.wikipedia.org/wiki/Pilates (accessed 20 Oct 2013).
  3. 3.0 3.1 3.2 Wikipedia, Joseph Pilates. Available from: http://en.wikipedia.org/wiki/Joseph_Pilates (accessed 20 Oct 2013).
  4. 4.0 4.1 Pilates Method Alliance, An Exercise in Balance: The Pilates Phenomenon. Available from: http://www.pilatesmethodalliance.org/i4a/pages/index.cfm?pageid=3277 (accessed 20 Oct 2013).
  5. Muscolino, J.E. and Cipriani, S., 2004. Pilates and the “powerhouse”—I. Journal of bodywork and movement therapies8(1), pp.15-24.
  6. Powers S. Stefanie Powers, Guide to Longevity and Well - being through Pilates. London: Gaia Books Ltd. 2005.
  7. Ackland L. Body Power, a unique system of exercise developed from work of Joseph H Pilates. London: Thorsons, 2001.
  8. Brad Leeon. 6 Basic Principles. Available from: http://www.youtube.com/watch?v=mO0mKsDmP8M (accessed 20 Oct 2013).
  9. Joseph Pilates Original 34 poses from Return to Life. Available from: http://www.easyvigour.net.nz/pilates/h_pilates_classic.htm (accessed 4 Sept 2013).
  10. Charles Kenner. Joseph Pilates Classical Mat Exercises. Available from:http://www.youtube.com/watch?v=5ShtfZp3Mwg (accessed 20 Oct 2013).
  11. Di Lorenzo CE. Pilates: what is it? Should it be used in rehabilitation? Sports Health 2011;3(4):352-61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23016028 (accessed 20 Oct 2013).
  12. Freeman J, Fox E, Gear M, Hough A.Pilates based core stability training in ambulant individuals with multiple sclerosis: protocol for a multi-centre randomised controlled trial. BMC Neurol 2012;12:19. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22480437 (accessed 20 Oct 2013).
  13. Notarnicola A, Fischetti F, Maccagnano G, Comes R, Tafuri S, Moretti B. Daily pilates exercise or inactivity for patients with low back pain: a clinical prospective observational study. Eur J Phys Rehabil Med 2013. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24104699 (accessed 20 Oct 2013).
  14. Cakmakçi O.The effect of 8 week pilates exercise on body composition in obese women.Coll Antropol 2011;35(4):1045-50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22397236 (accessed 20 Oct 2013).
  15. Wajswelner, H., Metcalf, B. and Bennell, K., 2012. Clinical Pilates versus general exercise for chronic low back pain: randomized trial. Medicine & Science in Sports & Exercise44(7), pp.1197-1205.
  16. 16.0 16.1 16.2 Yamato, T.P., Maher, C.G., Saragiotto, B.T., Hancock, M.J., Ostelo, R.W., Cabral, C., Costa, L.C.M. and Costa, L.O., 2016. Pilates for low back pain. Sao Paulo Medical Journal134(4), pp.366-367.
  17. Miyamoto GC, Franco KFM, van Dongen JM, et al Different doses of Pilates-based exercise therapy for chronic low back pain: a randomised controlled trial with economic evaluation Br J Sports Med Published Online First: 10 March 2018. doi:10.1136/bjsports-2017-098825
  18. Muscolino, J.E. and Cipriani, S., 2004. Pilates and the “powerhouse”—II. Journal of bodywork and movement therapies8(2), pp.122-130.
  19. Balady, G.J., Berra, K.A., Golding, L.A., Gordon, N.F., Mahler, D.A., Myers, J.N. and Sheldahl, L.M., 2003. Diretrizes do ACSM para os testes de esforço e sua prescrição. Rio de Janeiro: Guanabara239.
  20. 20.0 20.1 Martin AC, Alvares RF, Nascimento TR, Paranaiba SSW, Da Silva-Morais TK, Santos C.D. Pilates for Pregnant Women: A Healthy Alternative. Journal Women's Health Care. 2017 April 6:366.
  21. Women's health. 8 Pilates Abs Exercises from Women's Health. Available from: https://www.youtube.com/watch?v=42r0A-WUiNY [last accessed 2/2/2019]
  22. Lausen A, Marsland L, Head S, Jackson J, Lausen B. Modified Pilates as an adjunct to standard physiotherapy care for urinary incontinence: a mixed methods pilot for a randomised controlled trial. BMC women's health. 2018 Dec;18(1):16.
  23. Gomes CS, Pedriali FR, Urbano MR, Moreira EH, Averbeck MA, Almeida SH. The effects of Pilates method on pelvic floor muscle strength in patients with post‐prostatectomy urinary incontinence: A randomized clinical trial. Neurourology and urodynamics. 2018 Jan;37(1):346-53.
  24. Culligan PJ, Scherer J, Dyer K, Priestley JL, Guingon-White G, Delvecchio D, Vangeli M. A randomized clinical trial comparing pelvic floor muscle training to a Pilates exercise program for improving pelvic muscle strength. International urogynecology journal. 2010 Apr 1;21(4):401-8.
  25. Ferla L, Paiva LL, Darki C, Vieira A. Comparison of the functionality of pelvic floor muscles in women who practice the Pilates method and sedentary women: a pilot study. International urogynecology journal. 2016 Jan 1;27(1):123-8.
  26. Torelli L, de Jarmy Di ZI, Rodrigues CA, Stüpp L, Girão MJ, Sartori MG. Effectiveness of adding voluntary pelvic floor muscle contraction to a Pilates exercise program: an assessor-masked randomized controlled trial. International urogynecology journal. 2016 Nov 1;27(11):1743-52.