Someone somewhere once said, "Age is no excuse for weakness."
I believe that is true.
Many older adults have the perception that they cannot exercise for fear of injury, when just the opposite is true. A body will respond to proper training regardless of age. Unfortunately, many older adults fail to realize that someone who does not exercise is potentially more prone to injury and poor health.
What Happens as We Get Older?
Balance, agility, proprioception, and kinesthetic awareness all start to diminish as we age or become sedentary. We use vision, the vestibular system, and the complex of nerve endings in our muscles, joints, and tendons to keep ourselves upright. As we get older or become sedentary, these sensory systems operate less effectively.
Additionally, the muscular system starts to weaken from the core to the extremities as we get older. Our core (consisting of the abdominal wall, back, and pelvic musculature) becomes weak with progressive weakening of the hip and shoulder stabilizers. Loss of flexibility also impairs our ability to move properly and hold good postural alignment. As a result, many older adults experience orthopedic injuries such as hip and shoulder fractures from falls due to loss of balance, and to overuse-repetitive stress injuries.
Many therapists are turning to Pilates as a method of rehabilitation and training for older adults experiencing these aging-related challenges.
Why Pilates?
Pilates is effective because it is an extremely flexible rehabilitation system. Exercises can be modified based on each client's needs to best facilitate a positive movement experience. The exercises can be assistive in nature or, as a client gets stronger, be made more challenging through modifications. The training is low impact and weight bearing, and positional restrictions can be accommodated.
Pilates starts with nine principles of training that make it a perfect therapeutic remedy for this population:
- Breathing—the essential link between the mind and body, relaxes, improves focus.
- Concentration—paying attention to movement quality.
- Control—optimizing form and technique.
- Centering—moving from a stable, balanced, and flexible core.
- Precision—greater efficiency in movement patterns.
- Balanced Muscle Development—postural and muscular symmetry.
- Rhythm and Flow—smooth-flowing movement.
- Whole Body Movement—integrating movement through the mind, body, and spirit.
- Relaxation—using just the effort needed to accomplish a task, and releasing tension.
Through Pilates, an older adult can achieve a strong core, integrating stabilizing muscles and creating a strong, balanced foundation from which to move. Pilates enables them to better react to their environments.
The Right Equipment
Exercise balls and foam rollers can be incorporated into a modified, at-home Pilates regimen.
Pilates equipment includes: the Reformer, the Trapeze Table, a chair, barrels and small apparatus such as circles and the Pilates mini-balls.
For an older client population, the Trapeze Table and clinical Reformer are ideal due to the ease of getting on/off the equipment, and to the variety of exercises one can perform on each piece. This versatility is a key benefit; you can make more efficient use of your time instead of having to move older clients from one piece of equipment to another.
Mat Pilates is a great form of exercise for home programs. You can incorporate the principles of Pilates and modify the exercises using foam rollers and exercise balls for home programs.
Case Study: Treating Osteoporosis
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| What are certain cautions to be considered using Pilates with older adults? Find out online. www.PTProductsOnline.com. |
Client "A" is a 5-foot-7-inch, 120-pound, 67-year-old female. She was diagnosed with "established" osteoporosis 3 years ago with a T-score of -2.2 of the lumbar spine and -3.2 at the femoral neck. She initially had a single-leg standing balance of <2 seconds bilaterally and exhibited an unstable gait with an excessively wide base. Client "A" was an ideal candidate for the classic fall and hip fracture.
She started Pilates training three times per week and began using the medication recommended by her physician. After 1 year, her T-scores have changed to -1.3 at the lumbar spine and -2.4 at the femoral neck. In addition, her diagnosis has changed from osteoporosis to osteopenia. Her balance has improved to allow single-leg standing >90 seconds while doing standing Pilates exercises, including single-heel raises. The fracture risk for the client has gone from high to moderate, and her fall risk has gone from high to low.
Types of Pilates Equipment Found in Therapeutic Clinics
The Reformer
The Reformer is the most well-known piece of Pilates equipment, and it provides an effective, low-impact, resistance-based workout that is friendly to the joints. It consists of a gliding carriage inside a wooden or metal frame connected to a system of springs, pulleys, and ropes. Users sit, kneel, stand, or lie on the carriage, and push and pull the footbar and the ropes. Resistance is provided by the attached springs. Reformer exercises target every part of the body.
Trapeze Table (or the Cadillac)
The Cadillac is a raised horizontal tabletop surrounded by a four-poster frame, on which various bars, straps, springs, and levers are affixed. A tremendous variety of exercises can be performed on the Cadillac—from gentle spring-assisted sit-ups to advanced acrobatics while hanging from the upper bars. Resistance is provided behind, in front, and above at a variety of angles.
The Reformer/Trapeze Combo
This piece of equipment combines the Reformer and the Trapeze Table. The Reformer is hidden underneath two removable tabletop mats, and greatly increases the amount of exercises that can be done. Another variation—the Reformer/Trapeze combination—resembles a standard Reformer, with a half wall of Cadillac features on one end.
Fitness Chairs
Pilates fitness chairs activate the legs, buttocks, shoulder girdle, arms, and core, as well as heightens neuromuscular coordination. Pilates fitness chairs (or combo chairs) resemble a stool with single or split steps at the bottom. Handles, chair backs, rotational disks, and other accessories can be added for increased variety.
Although many exercises are performed sitting on the chair and pressing down on the steps or pedals, many more can be performed lying on the floor, standing up, or lunging forward.
Magic Circles
This is a circular ring made from sprung steel or flexible plastic, with contoured handles. Circles are available in a range of resistance tensions (from band level 2 to 4) and diameters (12 inches to 14 inches) to meet the needs of different body sizes and ability levels. They can be used standing, sitting, or lying down on your front, back, or side. Magic circles are a simple way to add resistance training to mat exercises.
The Ladder Barrel
This consists of ladder-like rungs and a rounded barrel-like surface on which a multitude of stretching, strengthening, and flexibility exercises can be performed. The barrel is separated from the ladder by a sliding base that can adjust to accommodate different torso sizes and leg lengths in a range of Pilates exercises.
Rob Kopitzke, PT, MPI, USACC, NMR, is the president of Body Concepts Inc, a Pilates-based physical therapy clinic in El Dorado Hills, Calif. Kopitzke has extensive training in biomechanics of the foot and lower extremities. Two long-term manual therapy courses on the spine and a variety of other orthopedic-sports medicine courses round out his physical therapy training.
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