Journal of Bodywork & Movement Therapies (2016) 20, 815e823

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RANDOMIZED CONTROLLED TRIAL

The effectiveness of Pilates on balance and

falls in community dwelling older adults
Sharon Josephs, PT, DPT, OCS a,*,
Mary Lee Pratt, PT, DPT, MAA, OCS a,b,
Emily Calk Meadows, DPT a,
Stephanie Thurmond, PT, DPT, ScD, CFMT, COMT a,
Amy Wagner, PT, DPT, GCS a

a
School of Physical Therapy, University of the Incarnate Word, USA
b
Pyramid Plaza Physical Therapy, USA

Received 31 October 2015; received in revised form 16 January 2016; accepted 23 January 2016

KEYWORDS Summary Purpose: The purpose of this study was to determine whether Pilates is more
Balance; effective than traditional strength and balance exercises for improving balance measures, bal-
Falls; ance confidence and reducing falls in community dwelling older adults with fall risk.
Pilates; Method: Thirty-one participants with fall risk were randomly assigned to the Pilates group (PG)
Physical therapy; or the traditional exercise group (TG). Both groups participated in 12 weeks of exercise, 2
Older adults; times/week for 1 h.
Balance confidence Results: There was significant improvement in the Fullerton Advanced Balance Scale for both
the PG (mean difference Z 6.31, p < .05) and the TG (mean difference Z 7.45, p Z .01). The
PG also showed significant improvement in the Activities-Specific Balance Confidence Scale
(mean difference Z 10.57, p Z .008).
Conclusion: Both Pilates and traditional balance programs are effective at improving balance
measures in community dwelling older adults with fall risk, with the Pilates group showing
improved balance confidence.
ª 2016 Elsevier Ltd. All rights reserved.

* Corresponding author. Pilates and Physical Therapy Center of San Antonio, 211 Post Oak Way, San Antonio, TX, 78230, USA. Tel.: þ1 210
410 0751.
E-mail addresses: sharonjosephsPT@gmail.com, josephs@uiwtx.edu (S. Josephs).

http://dx.doi.org/10.1016/j.jbmt.2016.02.003
1360-8592/ª 2016 Elsevier Ltd. All rights reserved.
816
Introduction
Falls are a common problem in older adults. There are
significant consequences from falling including injury,
decreased mobility and independence, increased health
care costs and psychological concerns from fear of falling
(Centers for Disease Control and Prevention, 2015a,b;
Kannus et al., 2005; Powell and Myers, 1995). The Centers
for Disease Control and Prevention (2015a,b) reported
that in 2013 in the United States, 2.5 million nonfatal fall
injuries in older adults were treated in the emergency
department and over 734,000 of those were hospitalized.
The direct medical costs of falls in older adults, adjusted
for inflation, were over $34 billion in the United
States (Centers for Disease Control and Prevention, 2015a).
Powell and Myers (1995) reported a study where 57% of
older adults living in the community reported fear of falling
and 30% reported avoidance of activities due to fear.
Avoidance of activities leads to further physical frailty and
loss of independence. As the population is aging, there is a
need to develop effective fall prevention programs
(Centers for Disease Control and Prevention, 2015a; Kannus
et al., 2005).
The 2012 Cochrane Review concluded that multiple
component group exercise significantly reduced rate of falls
(rate ratio 0.71, 95% CI, 0.63 to 0.82; 16 trials and 3622 par-
ticipants) and risk of falling (risk ratio 0.85% 95% CI 0.76 to
0.96; 22 trials, 5333 participants) in older adults living in the
community (Gillespie et al., 2012). A meta-analysis by
Sherrington et al. (2008) reported that the pooled estimate of
the effect of exercise was that it reduced the rate of falling by
17% (rate ratio 0.83, 95% CI 0.75e0.91, 44 trials, 9603 partic-
ipants). A meta-regression analysis showed that the greatest
relative effects were seen when the balance portion of the
program was challenging, the dose of exercise was greater
than 50 h for the entire program, equating to twice a week for
25 weeks, and the program did not include a walking compo-
nent. The inclusion of these relatively important components
improved the reduction in rate of falls to 42% (rate ratio 0.58,
95% CI 0.48e0.69). The optimal exercise prescription, how-
ever, has not yet been determined (Gillespie et al., 2012;
Sherrington et al., 2008; Arnold et al., 2008). Also, patients
need to continue exercise programs long term; otherwise the
benefits disappear (Wolf et al., 2001).
A problem discussed in the literature is the difficulty
recruiting and retaining older patients in a moderate in-
tensity exercise program (Means et al., 2005). Pilates is an
exercise method that is well suited for the older adult. The
equipment is adaptable and the intensity can be modified
to assist or resist depending on the level of the patient
(Anderson and Spector, 2000). The potential benefits of
Pilates include: improved posture, core and extremity
strength, flexibility, motor control, balance and body
awareness (Endelman, 2009).
Research using Pilates’ equipment to improve balance in
older adults, however, is still in its infancy stage, with only
4 studies reported and none specifically on patients with
fall risk (Kaesler et al., 2007; Siqueira Rodrigues et al.,
2010; Bird et al., 2012; Bird and Fell, 2014). Kaesler et al.
(2007) reported a study with a small sample size of 8 high
functioning subjects, aged 66e71 and no control group and
S. Josephs et al.
showed an improvement in the Timed Up and Go (TUG) and
balance sway measures following a Pilates-inspired exercise
program, 2 times per week for 8 weeks. Siqueira Rodrigues
et al. (2010) reported a randomized controlled trial of 52
women, aged 60e72, where the Pilates group (n Z 25)
showed improvement in the Tinetti test for balance and the
Latin America Development Group for Elderly score of
personal autonomy compared to a no treatment group of
age-matched controls (n Z 27). Their intervention was 2
times per week for 8 weeks. Bird et al. (2012) reported a
randomized crossover design trial of 32 subjects over the
age of 60. The Pilates exercises were performed for 5
weeks. They found an improvement in TUG, Four Square
Standing test and balance sway measures pre to post Pilates
for each group, but no difference between the groups. They
suggested that the lack of between group differences might
be due to the small sample size and/or the crossover
design. Bird and Fell (2014) then did a follow-up study 12
months after the initial intervention. Postural sway, dy-
namic balance and functional improvements seen after the
initial Pilates training were maintained 12 months later in
all participants, with increased benefits in participants that
continued Pilates exercise.
Balance confidence refers to a person’s perception of
their balance ability and is important to study as low bal-
ance confidence leads to avoidance of activities and phys-
ical frailty. Kendrick et al. (2014) in a Cochrane review of 24
studies and 1692 participants found a small to moderate
reduction in fear of falling following an exercise interven-
tion (standardized mean differences 0.37, 95% confidence
interval 0.18 to 0.56) without increasing the frequency of
falls. Six of the 24 studies used the Activities-Specific Bal-
ance Confidence Scale (ABC), a questionnaire that mea-
sures balance confidence.
There are many limitations in the current balance liter-
ature. Many traditional balance studies fail to describe their
exercise protocols in enough detail to allow them to be
reproduced (Arnold et al., 2008). Pilates studies have yet to
investigate the effectiveness of Pilates exercise using Pilates
equipment to reduce rates of falls, improve balance confi-
dence, study patients with documented fall risk or compare
Pilates to a traditional strength and balance program. The
literature indicates that this older population needs to
continue the program long term (Wolf et al., 2001). How-
ever, balance exercise programs provided by physical ther-
apists have difficulty meeting the current recommended
exercise dosage under the current funding model (Shubert,
2011). Group based therapy is billed at a fraction of the
rate of individual therapy, and Pilates is a form of exercise
that patients can continue following discharge.
The purpose of this study was to investigate the effec-
tiveness of Pilates group exercise versus traditional
strength and balance group exercise for improving balance,
reducing falls and improving balance confidence in com-
munity dwelling older adults with fall risk.
Methods and procedures
This study was a single blind randomized controlled trial.
The study was granted approval by the University of the
Incarnate Word Institutional Review Board.
Pilates effect on balance and falls in community dwelling older adults
Subjects and screening procedure
Thirty-nine subjects, 65 years of age and older living in the
community, were recruited through local physicians in the
area, seniors groups at churches and community centers,
word of mouth and notices posted in the local libraries.
Potential subjects signed an informed consent form and
underwent a screening evaluation by a blind student or
volunteer assessor. The assessors were trained in the
assessment procedure and the order of testing was stan-
dardized. The screening included a demographic question-
naire, fall history and medical history form, blood pressure
(BP) and heart rate (HR), Timed up and Go (TUG), Fullerton
Advanced Balance Scale (FAB) and Activities-Specific Bal-
ance Confidence Scale (ABC). A fall was defined as an un-
expected event in which the participant came to rest on
the ground, floor or lower level (Lamb et al., 2005).
Inclusion criteria were: 65 years of age or older living in
the community; impaired balance as defined by at least one
of the following: a fall in the past year, TUG >13.5 s or FAB
25; and ability to follow instructions as assessed by the
ability to complete the questionnaires without assistance.
Subjects were not screened for ability, such as use of an
assistive device for walking, but only that they met the
inclusion criteria of history of fall or meeting the cutoff for
balance compromise with the TUG or FAB. Exclusion criteria
included: participation in a Pilates program within the last
year; significant health problem that would keep the sub-
ject from participating; vestibular conditions and progres-
sive neurological conditions. Subjects were excluded if they
were not community dwelling, e.g. if they lived in an
institution such as an assisted living facility.
Outcome measures
The TUG is a widely used test of balance and has been
found to be reliable and valid and normative values have
been reported for community dwelling older adults (Steffen
et al., 2002; Lin et al., 2004). A TUG >13.5 s is associated
with fall risk (Shumway-Cook et al., 2000). The TUG is
considered to be appropriate for older people who are
frailer or who use walking aids (Lin et al., 2004). The test
was performed by measuring the time it took the subject to
stand up from an armchair, walk a distance of 3 m at their
usual pace with their usual assistive device, turn, walk back
to the chair and sit down (Podsiadlo and Richardson, 1991).
The FAB is a newer test and a more comprehensive
assessment of the multiple dimensions of balance as iden-
tified in the systems theory of postural control (Rose et al.,
2006; Sibley et al., 2015). The Berg balance scale is a more
widely used balance test, but it has been criticized for its
ceiling effect in community dwelling older adults
(Pardasaney et al., 2012). The FAB includes more difficult
static and dynamic balance tasks to make it less prone to
ceiling effects and more sensitive to evaluate the effec-
tiveness of an intervention conducted in a higher func-
tioning group of patients (Rose et al., 2006). It has been
shown to be reliable and valid, but normative values have
not been reported (Rose et al., 2006). A score of less than
or equal to 25 has been associated with fall risk (Hernandez
and Rose, 2008). The FAB was performed as per the
817
documented instructions (Rose, 2008), with one exception.
In the reactive postural control test where the assessor
removes their hand support from the patient to test their
postural reaction, the documented test does not inform the
patient that the assessor will be removing their hand. We
chose to inform our patients that we would be removing our
hand, but not when in order to maintain the patients’ trust
and for patient safety.
The patient also completed the ABC, a 16-item ques-
tionnaire that is a psychological measure of balance confi-
dence in performing specific activities (Powell and Myers,
1995). Each item is scored from 0% (no confidence) to
100% (full confidence in the ability to perform the activity
without losing balance). The ABC has been shown to be
reliable and valid (Powell and Myers, 1995). Scores on the
ABC showed an association with tandem stance time
(Cyarto et al., 2008), one-leg stance time (Cyarto et al.,
2008), TUG (Cyarto et al., 2008; Hatch et al., 2003) and
Berg Balance Scale (Hatch et al., 2003).
Procedures
Patients that met the inclusion and exclusion criteria were
randomly assigned to either the Pilates exercise group or
the traditional exercise group using a randomization table.
Groups were separated based on the participant group
allocation. Both groups exercised 60 min, 2 times per week
for 12 weeks. Participants that missed a session due to
illness or scheduling conflict made up the missed session,
such that each subject completed 24 sessions of exercise.
The groups were a maximum of 4 participants. The exercise
classes were taught by 1 of 2 physical therapists, both
Board Certified Clinical Specialists in Orthopaedics and
comprehensively certified Pilates instructors. The therapist
supervising a group continued with that group for the entire
12 weeks as much as possible, with the other physical
therapist substituting on occasion. Both therapists taught
both Pilates’ groups and traditional groups over the course
of the study. Additional student volunteers assisted with
spotting for safety purposes.
The Pilates group performed exercises as per Appendix 1.
The Pilates program utilized the Reformer, Cadillac and Chair
apparatus. Exercises were individually made more chal-
lenging by altering spring tension, reducing base of support,
adding complexity to the exercise and altering surface sta-
bility. Each exercise was performed for 10 repetitions. The
traditional group performed exercises as per Appendix 2.
Elastic resistance bands, ankle weights, foam balance pads,
boxes of varying heights and half foam rollers were props that
were used with the traditional group. Repetitions of the
resistance exercises were progressed individually. When the
patient could perform 20 repetitions, the resistance was
increased: elastic resistance bands were progressed to the
next color; ankle weights were progressed by 0.5 pounds; box
heights were progressed by 2 inches. All exercises for both
groups were performed in a challenging but pain-free way.
Modifications were made to exercises in consideration of a
patient with spine or peripheral joint pain by reducing the
range of motion performed during an exercise, reducing the
resistance or changing position. Occasionally, an exercise
was discontinued if a pain-free modification could not be
818
Figure 1 Summary of participants.
found. All patients were asked to work at level 12e14 on the
Borg Perceived Exertion Scale, which rates exertion subjec-
tively from 6 to 20 (Borg, 1970). It has been shown to be a valid
measure of exertion (Day et al., 2004; Eston and Evans, 2009).
On non-program days and daily following discharge
from the program, patients were asked to perform home
exercises. The same 15e20 min home exercise program
was given to both groups in order to minimize confound-
ing effects of the home exercise program. The home
lower extremity strength exercises were drawn from both
Pilates mat exercises and traditional physical therapy
exercises. The home program also included standing bal-
ance exercises. See Appendix 3. Patients were given a
home exercise handout and a monthly calendar to record
their home exercise participation. This was done in
anticipation of the patients performing their home exer-
cises on non-program days, and continuing for 8 weeks
following discharge from the program; their exercise dose
would then exceed the recommended 50 h. The calendar
was also used to record falls during the 1-year follow-up
after discharge.
The follow-up assessment occurred following comple-
tion of the 12 weeks of exercise. BP, HR, the TUG, FAB and
ABC were re-tested by an assessor who was blinded to
group assignment, using the standardized testing
procedure.
Following completion of the program, the patients were
telephoned once per month to obtain information on any
falls that occurred during the previous month. The patients
S. Josephs et al.
were also asked about their current participation in all
types of exercise (home program and other exercise such as
walking and group fitness classes). This data is currently
being collected and will be reported in a follow-up study.
Data analysis
All data was analyzed at the 0.05 alpha level using Microsoft
Excel and SPSS version 19 software. The pre-test to post-
test within group, between group, and interactions data
were analyzed with paired t-test, independent t-test and
2  2 factorial ANOVA respectively.
Results
Thirty-one patients met the inclusion criteria and 8 sub-
jects were excluded due to lack of fall risk as defined
above. Seven patients dropped out of the study and the
remaining 24 patients completed all 24 sessions of exercise
and the follow-up evaluation. See Fig. 1.
Of the 24 participants, 18 were female and 6 were male.
The age range was 65e85, with an average of 75.6 in the
Pilates group and 74.5 in the traditional group. Ten out of
13 patients in the Pilates group and 8 out of 11 in the
traditional group had fallen in the past year. Three patients
in each group met the inclusion criteria only because of the
fall they had in the past year, while not meeting the fall risk
criteria on the TUG and FAB. All subjects were similar at
Pilates effect on balance and falls in community dwelling older adults 819

baseline for age (p Z .693), sex for males and females Discussion
(p Z .094), education (p Z .812), number of falls
(p Z .703) and co-morbidities (p Z .274). However, there Both the Pilates and the traditional group improved in their
were differences in number of males (38.46% of PG, 9.1% of FAB scores, with neither group showing significant
TG) and amount of activity (77% physically active in PG, 45% improvement over the other. The traditional balance ex-
physically active in TG) between groups at baseline. Table 1 ercise literature indicates that effective fall prevention
presents the demographic data. In the traditional group, exercise programs include multiple components and chal-
there was a significant difference (mean difference Z 7.45, lenging balance exercises, so both of the exercise programs
p Z .01) between the pre-test and post-test scores of the in this study were designed to include core and lower ex-
FAB. In the Pilates group there was a significant difference tremity strength, flexibility and challenging balance exer-
in the pre-test and post-test scores of the FAB (mean cises. Both exercise groups were taught with an emphasis
difference Z 6.31, p < .05) and the ABC (mean on whole body alignment and core stabilization, similar to
difference Z 10.57, p Z .008) respectively. Table 2 pre- Pilates’ principles of exercise. Therefore, it is not surprising
sents the outcome data. There were no significant between that the study found no between group differences.
group differences on any of the selected tests. A 2  2 The Pilates group showed improvement in balance con-
factorial ANOVA showed no interaction between groups for fidence, as measured by the ABC, while the traditional
pre and post intervention scores, and type of intervention. group did not. This is an interesting finding considering that
Follow-up data on number of falls is still being collected for the balance measure, FAB, improved in both groups, with
future analysis. neither group showing significantly more improvement than
the other. One possible explanation for this is that the
patients in the Pilates group had to learn new skills on
Table 1 Demographic characteristics of participants at foreign equipment, and the learning of this novel skill lead
baseline for both groups. to improved balance confidence.
Means et al. (2005) discussed the problem of attrition in
Pilates Traditional
balance studies. Their study reported a 17% attrition rate
group group
during the intervention and discussed the difficulty in
Mean  SD age, years (range) 75.6  6.2 74.5  6.9 recruiting and retaining older patients in a moderate in-
(66e85) (65e83) tensity exercise program. This study had a 19% attrition
Number of males 5 1 rate in the Pilates group: 2 patients dropped out prior to
Number of females 8 10 starting any exercise and 1 dropped out due to a family
Mean height, inches (range) 65.2 63.8 (58e70) crisis. There was a 27% attrition rate in the traditional
(58e72) group: 2 of the patients dropped out following 2 weeks or
Mean weight, pounds (range) 158 169 (101e235) less of exercise, 1 dropped out as he did not feel he was
(107e230) improving and 1 dropped out due to a knee injury that
Education (# of patients) happened while on vacation. Studies have shown that the
Less than high school 1 0 benefits of exercise quickly diminish once the program is
High school graduate 0 2 completed (Wolf et al., 2001). Therefore, there is a need to
Some college/technical 4 3 develop programs that the patients can continue long-term
school as a wellness program. Long-term commitment to exercise
College graduate 3 2 also means that patients need to enjoy the program. It is
Graduate school 5 4 the experience of the investigators that Pilates is an exer-
Living situation (# of patients) cise method that older adults enjoy and may offer an option
Alone 6 5 for patients to participate in a program that can be initi-
With spouse 7 5 ated as a physical therapy intervention and continued long
With other 0 1 term as a wellness program.
Employment Shubert (2011) discussed the difficulty of providing the
# of participants working 4 2 recommended 50-h dose of strength and balance exercises in
Retired 9 9 physical therapy due to the current funding models. Group
Walks with an assistive device based exercise is more cost-effective than one-on-one
Yes 4 2 therapy as it is billed at a fraction of the rate. However,
No 9 9 group exercise presented a problem as challenging balance
Exercise regularly exercises also meant that there was a risk of falling during the
Yes 10 5 exercise. Additional student volunteer spotters were used to
No 3 6 ensure the safety of the patients. Group based programs are
Mean  SD number of falls 1.5  1.3 1.8  2.2 also social and this motivating factor may improve adherence
(range) (0e4) (0e7) compared to home programs (Phillips et al., 2004).
# that fell in the past year 10 8 The addition of home exercises has also been suggested
Mean  SD # of comorbidities 2.7  1.5 3.8  3.0 as a method to try to reach the recommended dose (Martin
(range) (0e5) (1e10) et al., 2013) and home exercises were included for both
Mean  SD # of medications 5.8 (0e13) 3.8 (1e9) groups on non-program days as well as following discharge
(range) from the program.
820 S. Josephs et al.

Table 2 Outcome variables at baseline and post intervention for both groups.
Test Pilates group Pilates group Mean p- Traditional Traditional Mean p-
pre-test post-test difference value pre-test group post-test difference value
average  SD average  SD average  SD average  SD
TUG (seconds) 14.38  6.54 13.07  4.59 1.31 NS 13.16  6.39 11.26  2.89 1.9 NS
FAB (0e40 points) 18.54  10.08 24.85  12.54 6.31 <.05 19.82  8.86 27.27  6.41 7.45 .01
ABC (0e100 points) 63.08  24.08 73.65  22.47 10.57 .008 70.18  16.02 74.91  18.87 4.73 NS
Abbreviations: TUG, Timed up and Go test; FAB, Fullerton Advanced Balance Scale; ABC, Activities-Specific Balance Confidence Scale;
SD, Standard deviation; NS, not significant.

Many previous studies failed to describe their exercise by requiring fewer hours of intervention to improve balance
program in enough detail to allow it to be reproduced in older adults (Bird et al., 2012).
(Arnold et al., 2008). This creates problems for clinicians
trying to compare programs and for clinicians attempting to Future research
incorporate evidence-based practice. The programs in this
study are described in detail, although repetitions, resis- Future research ideas include having 3 groups, Pilates,
tance and balance challenge were individually determined traditional and a control group and following the results
depending on the patient’s level such that the patient longer term. The initial Pilates research in healthy older
would work at a moderate intensity. adults indicates that balance can be improved in less than
the 50 h of recommended exercise dosage. This study in-
Study limitations dicates that balance and balance confidence can be
improved in less than 50 h in patients with fall risk. A future
The exclusion criteria were limited to make the study research study should investigate this further in adults with
generalizable. However, this did end up including some fall risk. The effectiveness of these programs to reduce
subjects with limited ability to improve due to their comor- rates of falls will be reported at a later date.
bidities: one patient had a quadriceps rupture with a failed
repair and one had weakness from post-polio syndrome, both
Conclusions
unrelated to the study. There were also 6 patients that
qualified for the study only because of a fall in the past year.
The results of this study suggest that both a short-term
Their TUG scores were initially low and their FAB scores were
Pilates program and a traditional exercise program with
initially high, with potentially limited ability to improve.
A limitation of the study is the small sample size, components of strength, flexibility and balance exercises,
supplemented with home exercises, can improve balance in
potentially under powering the study and the lack of a third
patients with fall risk. The Pilates program improved bal-
control group that received no intervention. Another limi-
tation was that, although the subjects were followed by ance confidence compared to the traditional program.
phone calls for 1 year, the patients were not re-tested at 1-
year follow up. Despite randomization of subjects to Conflicts of interest
groups, two variables showed differences at baseline that
may have affected the results. Although not statistically The authors have no conflicts of interest.
significant (p Z .094), there were more males in the PG
(n Z 5) than the TG (n Z 1). There were also more regular
exercisers (p Z .113) in the PG (n Z 10) than the TG Funding sources
(n Z 5). Repeating the study with a larger sample size
might minimize this effect. None.
The FAB was chosen because it is a higher level balance test
and not subject to the ceiling effect that the TUG and BERG Acknowledgments
are criticized for. However, it is a newer test, and there is less
research available on it compared to the other tests used.
Thank you to the students and volunteers that performed
A final limitation is cost effectiveness of Pilates-based
assessments and assisted with spotting during class. Thank
vs. traditional rehabilitation. Although Pilates equipment is
you to the Physical Therapy Department at University of the
potentially costlier at the outset compared to free weights
Incarnate Word for their encouragement and support.
and bands, the improvement in the ABC scale could
potentially justify the cost of Pilates apparatus. The ABC
scale is proven to be a valid predictor of balance impair- Appendix 1
ment and falls in older adults (Powell & Myers, 1995; Lajoie
and Gallagher, 2004). In addition, the initial Pilates Pilates Group 60 min;
research literature indicated benefit in less than 50 h of Beginner exercises are written in regular font; Pro-
total exercise dose, thus improving the cost effectiveness gressions are written in italics.
Pilates effect on balance and falls in community dwelling older adults 821

Reformer: Assisted squat standing

Curl up
Footwork double leg and single leg (3 springs) (Fig. 2) Upper extremity shoulder pull down, retraction, push up in
Bridge (generally 3 springs, progress to lighter/less standing using roll down bar; and punch using handles; vary
springs) base of support to narrow, tandem, add stepping to punch
Bridge with press away
Feet in straps (2 springs)
Scooter (2 springs)
Scooter without arms (1 spring)
Seated leg press (1e2 springs)

Figure 4 Side lying feet in straps on the Pilates Cadillac.

Appendix 2

Figure 2 Footwork on the Pilates reformer. Traditional Group 60 min

Chair: Beginner exercises are written in regular font; pro-
gressions are written in italics.
Standing leg press forward and lateral (reduce arm Supine:
support; add standing on unstable surface) (Fig. 3)
Supine hip extension Ball squeeze adduction with bridge
Prone scapular series Resistance band abduction with bridge
Single leg bridge with increasing hold times
Straight leg raise (progress weights)
Short arc quads (progress weights)

Side lying:

Clam (external rotation)

Clam with band at knees
Clam with band, propped on elbows
Side lying abduction with weights (progress weights)
Side lying adduction with weights (progress weights)
(Fig. 5)

Figure 3 Standing leg press forward on the Pilates Chair.

Cadillac:

Feet in straps supine, single leg; progress to double leg;

progress to side lying (Fig. 4)
Breathing; progress to single leg Figure 5 Side lying hip adduction with ankle weights.
822 S. Josephs et al.

Standing:

Wall slides (progress depth)

Step up laterally (reduce hand support, increase height
of step)
Step up forward (reduce hand support, increase height
of step)
Forward reach and side reach (increase excursion)
Leg kicks front, side and back with resistance band
(reduce hand support) (Fig. 6)
Sit to stand
Standing with increasingly narrow base of support: feet
together
Tandem stand, single leg stand (Fig. 7)
Obstacle course with steps, foam pads and reaching

Stretches

Hip flexor
Piriformis
Gluteal
Hamstring
Gastrocnemius

Figure 7 One leg standing balance exercise.

Appendix 3

Home exercises
Beginner exercises are written in regular font; Pro-
gressions are written in italics

Ball squeeze adduction with bridge

Resistance band abduction with bridge
Single leg bridge
Clam (external rotation), adding band at knees when
able, propping on elbow (Fig. 8)
Wall slides
Standing narrow base of support, progressing to tandem
and single leg when able

Figure 6 Standing leg kicks, hip flexion using resistance

band. Figure 8 Side lying clam exercise using resistance band.
Pilates effect on balance and falls in community dwelling older adults 823

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