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Journal of Bodywork and Movement Therapies (2007) 11, 238242

Journal of
Bodywork and
Movement Therapies
www.intl.elsevierhealth.com/journals/jbmt

EXERCISE PHYSIOLOGY

The effects of Pilates-based exercise on dynamic

balance in healthy adults
Eric G. Johnson, PT, DPTSc, Andrea Larsen, DPT, Hiromi Ozawa, DPT,
Christine A. Wilson, MPT, Karen L. Kennedy, MPT
Loma Linda University, Department of Physical Therapy, School of Allied Health Professions,
Nichol Hall Office #1900, Loma Linda, CA 92350, USA
Received 26 July 2006; received in revised form 8 August 2006; accepted 10 August 2006

KEYWORDS
Pilates;
Balance;
Functional reach
test;
Mobility

Summary Professionals in theater, athletics, and rehabilitation settings have

integrated Pilates-based exercise into their practice. The Pilates method of exercise
claims to have several benefits including improving posture and improving balance;
however, there are few studies to support these statements. We studied the effects
of Pilates-based exercise on dynamic balance in healthy adults. A certified Pilates
instructor conducted all exercise sessions. After completing 10 Pilates-based
exercise sessions a significant change (P :01) in dynamic balance was found in
the functional reach test (FRT) mean scores in the exercise group (n 17). The
control group (n 17) demonstrated no significant change (P :54). The results
suggest that Pilates-based exercise improved dynamic balance as measured by the
FRT in healthy adults.
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Introduction
Pilates is an exercise system developed over a
period of approximately 50 years, beginning in the
1920s by Joseph H. Pilates (Anderson and Spector,
2000). Pilates-based exercises can be performed on
the floor, termed mat work by the Pilates
community, or on a variety of machines, termed
apparatus work. Perhaps the most commonly
Corresponding author. Tel.: +1 909 558 4632x47471;

fax: +1 909 558 4291.

E-mail address: ejohnson@llu.edu (E.G. Johnson).

used apparatus is the Reformer. The Reformer is a

single bed frame that is equipped with a carriage
that slides back and forth using springs to regulate
tension and resistance. Cables, bars, straps, and
pulleys allow a variety of Pilates-based exercises to
be done from multiple positions (see Fig. 1).
Postural muscles, including the transverse abdominis and internal and external oblique muscles,
provide trunk stability, which is crucial to balance
(Mullhearn and George, 1999). Pilates-based exercise incorporates the principles of trunk stability,
which is also referred to as core stability or core
control (Akuthota and Nadler, 2004). According to

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doi:10.1016/j.jbmt.2006.08.008

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The effects of Pilates-based exercise on dynamic balance in healthy adults

239

postural set over a base of support and can be

reliably measured using the functional reach test
(FRT) (Duncan et al., 1990).
The FRT requires the subject to stand upright
with feet approximately shoulder width apart and
arms raised to 901 of shoulder flexion while making
a fist.
A baseline measurement of the third metacarpal
is taken using a wall-mounted yardstick and the
subject is asked to lean as far forward as possible
without changing their base of support.
A new measurement of third metacarpal position
is taken and the total amount of excursion is
recorded. The test is repeated a total of three
times and the average excursion, in centimeters, is
the FRT score (see Figs. 2A and B).
Hall et al. (1999) determined that Pilates-based
exercise improved static balance in an elderly
population. The effects of Pilates-based exercise
on dynamic balance in healthy adults have not
been previously investigated. The purpose of
this study was to determine if Pilates-based
exercise could improve dynamic balance in
healthy adults using the FRT as the outcome
variable.

Methods

Figure 1 Pilates-based exercises including (A) tall arm

series, (B) open leg rocker, and (C) leg press series.

Akuthota and Nadler, the core is described as a

box with the abdominals in the front, paraspinals
and gluteals in the back, the diaphragm as the roof,
and the pelvic floor and hip girdle musculature as
the bottom.
Professionals in rehabilitation settings, theater,
and athletics have integrated Pilates-based exercise into their practice. In addition to improving
core stability and flexibility, Pilates-based exercise
claims to improve balance, which may be helpful
for improving athletic performance (Anderson and
Spector, 2000; Hutchinson et al., 1998; Segal et al.,
2004) Balance is described as being either static or
dynamic. Dynamic balance requires moving a stable

Forty subjects were randomized into control

(N 20) and experimental (N 20) groups with
each group being pre-tested to obtain a baseline
FRT measurement. The experimental group completed ten Pilates sessions within a 5-week period.
Subjects were excluded if they had any medical
condition that would impair their balance, had any
heart-related conditions that would have prevented them from exercising, had previously
participated in a Pilates-based exercise program,
or subjects who had begun a new exercise program
within the previous 6 months. All subjects voluntarily signed an informed consent form approved by
the Loma Linda University Institutional Review
Board prior to participation in the study. All Pilates
exercise sessions were conducted by a certified
Pilates instructor at the Loma Linda University
Medical Center Outpatient Physical Therapy Department. No more than five subjects at a time
attended an exercise session to assure proper
supervision and correct performance of the exercises. All Pilates exercises were performed on a
Reformer and included a tall arm series, open leg
rocker, leg press series and tall kneel arm
series (See Figs. 1AC). The control group received
no Pilates training during the five-week period

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E.G. Johnson et al.

Results
A two-way repeated measures ANOVA was used to
compare the outcome variable for the factors group
(exercise vs. control) and time (pre vs. post). Based
on ANOVA results, an interaction occurred for FRT
and a paired t-test was used to investigate the
change in each group. An independent t-test was
used to compare the mean change in FRT scores
between the exercise and control group and to
determine the effect of the Pilates-based exercise
intervention. Data were analyzed on 34 subjects as
three subjects from the control group did not
return for their post-test measurements and three
subjects from the experimental group were excluded secondary to missing more than two Pilates
exercise sessions. The control group consisted of six
males and 11 females, with a mean age of 27.3
years (SD 4.0) and the exercise group consisted
of three males and 14 females, with a mean age of
27.5 years (SD 3.6). There was no significant
difference between groups for age (P :98) or
gender (P :44). Additionally, no significant difference was found between groups in mean scores for
the FRT (P :09) pre-tests. Verbal confirmation
was obtained from control subjects that they had
not begun any new exercise programs or changed
their current activity levels since the pre-test.
Post-test analysis revealed a significant change
(P :01) in the mean FRT scores in the Pilates
group after the ten Pilates exercise sessions. The
control group demonstrated no significant change
in mean FRT scores (P :54) (Table 1).

Discussion
Dynamic balance is a complex phenomenon, requiring integration of the sensory, musculoskeletal,
and nervous systems (Akuthota and Nadler, 2004;
Shumway-Cook and Woollacott, 2001). Pilatesbased exercise challenges these systems while
focusing on the principles of breathing, control,
Figure 2 Forward reach test.

and was instructed to refrain from beginning a

new exercise program or changing their current
activity levels during this time period. Both
groups received a post-test measurement of balance within 7 days of the end of a 5-week
period. All pre- and post-FRT measurements were
taken by an examiner who was blind to the two
groups.

Table 1 Comparison of dynamic balance measurements using functional reach test scores (in)
between control and exercise groups.
Pre-test

Post-test

Mean SD

Mean SD

P-value

Exercise (n 17) 13.61 2.53 14.84 2.43 .01

Control (n 17) 15.10 2.41 14.79 2.36 .54
 Paired t-test.

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The effects of Pilates-based exercise on dynamic balance in healthy adults
centering, precision, concentration, and flow
(Anderson and Spector, 2000). The results of our
study demonstrated that healthy subjects who
participated in Pilates-based exercise had significant improvement in dynamic balance as measured
by the FRT. Pilates instructors provide verbal and
tactile cueing during the exercise routine and
participants are given feedback to help them
correct faulty movement patterns while emphasizing core stability (Anderson and Spector, 2000). We
suspect that the subjects in our study who
participated in the 5-week Pilates-based exercise
session improved their core stability and became
more kinesthetically aware of how to reduce faulty
movement patterns, resulting in improved motor
control.
Subjects in our study received consistent feedback from a certified Pilates instructor during every
exercise session to minimize movement error and
facilitate improved control of movement. The FRT
measures dynamic balance from a functional upright standing posture and is determined by the
amount of tibial advancement over a stable base of
support. Changes in flexibility of the gastrocnemius-soleus muscle group could allow for greater
tibial advancement and contribute to an improved
FRT. However we do not believe that was the case
in this study.
Bandy et al. (1997) determined that a minimum
of a 30 s static hold at the terminal position of a
muscle is required in order to make a plastic change
in muscle length. Pilates-based exercise does not
typically include this type of sustained end-range
stretching, suggesting that the improvements in
dynamic balance in our exercise group were likely
due to an increase in core stability, or improved
motor control, rather than an increase in flexibility
of the gastrocnemius-soleus muscle group.
Zakas et al. (2005) have reported on the acute
effects of a variety of stretching protocols on ROM
in 20 sedentary subjects aging 6585 years old
(mean age 75.9). Their findings suggest that a
single 60 s static stretch produces the same effect
as two 30 s and four 15 s stretches. The difference,
as it relates to the present investigation, is that our
subjects were tested using the FRT within 72 h of
completing the Pilates program and not immediately afterward. Any acute effects of the Pilates
exercise program were negated and we ultimately
measured the lasting changes in dynamic balance.
Lack of adequate core control can result in spinal
instability causing a decrease in ability of the body
to maintain dynamic balance (Stokes et al., 2000).
Even though subjects in the exercise group were
within the normal range for dynamic balance prior
to beginning the Pilates-based exercise program,

241

small but statistically significant improvements

were made. While these small changes might not
affect basic activities of daily living in healthy
adults, they might improve athletic performance.
Hutchinson et al. (1998) reported that the combination of Pilates exercise and leap training improved the leaping ability in elite rhythmic
gymnasts by more than 16% after 1 month of
training. Further research is warranted to investigate the effects of Pilates-based exercises on
athletic performance.
Despite the fact that all subjects were asked to
perform their best on the FRT, during pre- and posttest measurements, the Hawthorne effect should
be considered when interpreting the results of the
present investigation.
Note. The so-called Hawthorne effect refers to
an initial improvement in a process, possibly
influenced by observation of that process (Jones,
1992).

Conclusion
Pilates-based exercise was shown to improve dynamic
standing balance in healthy adults. Our findings
suggest that Pilates-based exercise may be a useful
tool for clinicians and trainers to incorporate with
their patients and clients who are looking to improve
their dynamic balance. Pilates-based exercise may
benefit athletes who are seeking small gains to
improve performance through precise, controlled
movements. In conclusion, ten sessions of a Pilatesbased exercise improved dynamic balance as measured by the FRT in healthy adults.
Financial disclosure and conflict of interest. All
the authors confirm that there are no conflicts of
interest or financial benefits associated with the
writing and publication of this paper.

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