Geriatric patients can benefit from individualized Pilates exercises.

The benefits of Pilates for the geriatric population are numerous. Pilates is an effective way to combat decreasing muscle mass, deconditioning joints, slowing motor reactions, and decreasing self-esteem. All this is done with very low impact, preventing possible further damage to an aging body.

Pilates equipment can easily be adapted for special populations and special needs. Pilates work done supine on a Studio Reformer unit is a closed-chain activity, in which the shoulders are fixed on shoulder pads and the feet are fixed on a foot bar. Plies, which are similar to squats, and legwork done supine, provide increased joint proprioception and allow corrective postural set engagement without the deep, compressive problems and jarring associated with stance exercises. The unit’s spring-resistance system can be manipulated to provide either assistive or resistive action. Even clients with end-stage knee and hip arthroses who are awaiting joint-replacement surgery can often experience nonsymptomatic Pilates training on a standard Reformer unit. In this way, they can still keep their muscles functioning preoperatively, can return home confidently, and can better withstand the rigors of acute postoperative care. I drill my clients with preoperative and postoperative information so that they will have a better chance for a positive outcome.

Equipment overview

The Trapeze Table, or Cadillac, is an excellent piece of equipment for newly postoperative clients—even those who have undergone joint-replacement surgery. One patient, who turned 50 this year, underwent two hip-replacement surgeries within 6 months last year. We were able to train him to be able to climb 19 stairs on postoperative day 4. The Trapeze Table proved indispensable for supine upper-extremity resistance work and for slowly bringing his legs up to postoperative speed. One of the great benefits of Pilates equipment is that you can often dissociate the involved area while still engaging the noninvolved peripheral biomechanical systems. By increasing lymphatic and arterial circulations, the problems that arise with immobilization can be diminished or avoided.

The Studio Reformer is also an invaluable piece of equipment for the osteoporotic group. While there is no specific adaptive equipment to enable clients with osteoporosis to exercise supine, those clients with a nonprominent kyphosis will benefit from the closed-chain torso strengthening that legwork done supine offers. It is also not difficult to make creative adaptations with pillows, hand towels, and pieces of foam for those clients who need a bit of positioning assistance. These clients should not engage in deep-trunk-flexion exercises, which are Pilates hallmarks, due to the risk of compression fractures. Although supine work can strengthen posture, extension work is best for these clients. All clients with osteoporosis, especially those with profound kyphoses, can benefit from the modified plank (like a push-up position) exercises.

My clinic has a Studio Reformer, which is lower to the ground than a Clinical Reformer. The lower Studio Reformer is a useful aid in balance training for higher-functioning geriatric clients who are able to use the standing platform on top of the Reformer. And, for clients in general, getting on and off the unit is much easier, especially when trying to learn to logroll on and off.

The Studio Reformer is also helpful when I must give moderate, and sometimes maximum, assistance to a beginning client or a client with impaired function. For instance, one exercise is a bilateral lower-extremity circumduction (oppositional leg circles) with the feet suspended by ropes in foot loops. Another one of my clients, now age 76, had a stroke 12 years ago. She started working on the equipment with me, along with an aide, about 10 years ago. I stand inside the Reformer and guide the client’s legs to assist the hemiparetic right side. I was extremely gratified when I accompanied her to have her hip x-rayed. Her physician was amazed by not only her strong abdominals, but also her mobility proficiency for someone of her age and condition.

Although many clients usually come to me with specific injuries and moved on after being treated, others have become long-term clients—some for more than 10 years. With ongoing appointments, I can help keep them on track and identify any faulty patterns, structure changes, or chronic health developments over time.

Special considerations

What else is necessary for success in working with the geriatric population? Although special equipment outside of the usual Pilates environment is not necessary, the clinician needs to be fully aware of his/her own biomechanics to avoid injury. Some clinics try to cut costs by purchasing only one piece of equipment, such as the Reformer–Trapeze Table combination. Working with clients who need extra balance-spotting and transfer assistance is difficult enough without the stress on the clinicians. Also, if Pilates trainers instead of physical therapists are used at a physical therapy facility, the trainers need to know more about the risks involved with each client’s diagnosis. For instance, clients with fibromyalgia or Sjogren’s syndrome, which cause them to have low endurance, need interval pacing. Diabetics need extra caution with surface-compression areas. The trainers should also know the contraindications that could limit Pilates training on a particular day. For instance, if a client complains of unusual shortness of breath or chest pains, the trainer should be advised to consult with the physical therapist for consultation. Some definite contraindications are recent falls with a potential head injury, recent radiation/chemotherapy, chest pains at rest, and open wounds. Even clients who have blood-sugar-regulation or thyroid-imbalance problems may not be able to tolerate moderate amounts of spring resistance on certain days.

Other limitations in using the equipment that the trainer should watch for and ask about are the client’s dizziness when the Reformer unit is in motion, loss of balance, and limited ability to process commands due to vision and hearing loss. In addition, communicating with a geriatric client takes generational finesse. There’s a fine line between asking how the client would like to be formally addressed and not talking down to a very accomplished person.

How easy is implementing Pilates at your clinic? Very. First, become familiar with Pilates through programs that specifically train health professionals, or any of the other Pilates Method Alliance-sanctioned certification programs. Use the same standards in hiring Pilates-certified training staff. Then, buy good solid equipment. For instance, I chose maple wood for its heaviness.

The older I get, the younger 70 seems to me—and to a lot of my clients—thanks to Pilates. Pilates has been an indispensable modality in both my practice and teaching for most of my career. Many of my clients are self-referred and consider their regular Pilates training with me to be an invaluable investment in the quality of their lives as they age.

Quite a few clients seek me out because they have been active all their lives and have had some injury, and are now trying to determine if it is appropriate to return to their old activity. For instance, Fran, age 65, is a former dancer, and she has been an avid fencer for the past 10 years. She slipped out of a lunge and landed full weight in the splits. Needless to say, she suffered an intense hamstring contusion, where she registered only 2+/5 of hamstring strength 1 month after her injury. With gentle progression and guidance, we enabled Fran not only to walk but also to return to her fencing passion.

Pilates can offer a true gateway of assistance to the geriatric group, helping them to rehabilitate and work up to a conditioning level for their favorite activity.

Suzanne Martin, MA, PT, DPT, is in private practice in Alameda, Calif. She can be reached through www.totalbodydevelopment.com.