By Stacy Baca, OTR/L

Pilates is a gentle, yet powerful way to get in touch with your body, release your spirit, and calm your mind. It can help you conquer fatigue, limited movement, and decreased strength. It can prevent you from developing complications such as pain, stiffness, and lymphedema. So, what exactly is Pilates and where can I get some?

Most of us are at least generally familiar with Pilates as a form of exercise. It’s on the roster at the local gym. Everyone talks about their “core” or lack thereof; and the thought of someone who practices Pilates conjures up images of a “six pack” around the middle, and not the kind of six pack that requires you to pull a metal tab.

So, though Pilates may be part of our common vernacular, it’s not widely understood in its entirety. Pilates methods give us a way to tackle the drooping effects of Father Time or reduce our belly-print on Mother Earth, but it goes far beyond cosmetic results. It is actually a multi-layered philosophy that involves mind-body connection, breathing technique, lightness of spirit, and ease of movement. Some say it has Yoga-esque qualities and the direct impact of a session can still be felt afterwards as you walk to your car or cruise the produce aisle. Some describe feeling lighter, some feel grounded, and others actually feel taller and more erect after just one experience.

Exercise with a rich history

Developed by Joseph Pilates, a former circus performer and boxer turned body builder, gymnast, wrestler, skier, and diver (!!!), in England during World War I, Pilates Method began as mat work exercises designed to rehabilitate detainees of the war. The equipment Pilates used to build strength and endurance were simple items available to him: bedsprings and keg rings. He incorporated ideas from Zen Buddhism, yoga, and Greek philosophy. After building his reputation as a physical trainer and healer in Europe, he and his wife, Clara, established a studio in New York in 1925. Here, Pilates took on many students and soon got noticed by the dance community, which fueled most of Pilates’ work. Yet, it was the 1980s before his principles took hold with everyday Americans.

Joseph Pilates’ personal and professional successes were rooted in his idea of overall health. He focused on what he considered the core of health -- the spine and the abdomen -- believing that strength and flexibility in these areas promoted the same in all other body parts originating from this, the body’s center. He later developed exercises focusing on the essential gliding of the scapular bones (your back’s “wing bones”) and the strength of the muscles surrounding the scapula.

Pilates exercises are performed primarily on a mat or other equipment such as a reformer, unique because gravity’s force can be reduced to create ease of movement or utilized to create gentle resistance. Most exercises are performed lying on your back, stomach, or your side, providing support and the opportunity to isolate specific muscles or focus on large muscle groups. Additionally, with each exercise flow, you are asked to focus on your breath, every inhalation and exhalation coordinated with exertion. This flow provides your body with oxygenating nourishment and creates a meditative attention to your physicality and emotional state.

Infusion into the medical community

With this sort of balanced scientific and spiritual approach, Pilates has gotten some attention in the medical community as a valid treatment for patients with varying diagnoses, including those recovering from breast cancer. Many physical therapists find the holistic qualities Pilates espouses to be an effective component of both clinic- and home-based exercise regimes. It simultaneously builds strength, flexibility, and confidence in the movements of the body. Occupational therapists recognize Pilates’ impact on the stabilizing core muscles as a foundation for increased function and greater independence in activities of living such as self-care (dressing, bathing, and hygiene), home care, community activities, and leisure endeavors.

One such occupational therapist is Naomi Aaronson, author of various articles on Pilates as a treatment for those recovering from breast cancer and founder of Recovercises (recovercisesforwellness.com). The program, based in the New York City area, educates and empowers cancer survivors to “live fully as they learn to live with cancer” through articles, courses, resources, and products. Naomi began her career as a recreation therapist and aerobics instructor before she graduated with a degree in occupational therapy in 1990. As an occupational therapist, she worked in a clinic, where she treated many breast cancer patients recovering from surgery and breast reconstruction.

First introduced to Pilates as a result of treatment she received after her own car accident, Naomi felt Pilates was an intuitive fit into her practice. “Pilates emphasizes proximal (trunk) stability, distal (arms, legs, head, neck) mobility, gentle progression, and one-on-one attention.”  Naomi’s patients experienced excellent progress. They learned focused concentration, breathing, and scapular stabilization resulting in controlled pain, swelling, and increased movement throughout their bodies. They were able to function better at home and in their communities. “The patients were feeling it (their body movements) and had to do fewer repetitions because they were focused on the quality of their movements, not the number of repetitions… they felt what worked and how it should or shouldn’t feel,” as Pilates exercise should never cause pain, a point Naomi stresses.

Though Naomi’s work originally centered on treating women recovering from surgery and breast reconstruction, she soon learned that Pilates had the potential to also help with many side effects of breast cancer treatment such as: pain, lymphedema, weight gain, and shoulder problems. It helped with fatigue, giving patients more strength and endurance, and most certainly impacted women’s psychosocial adjustment to breast cancer, giving them ways to impact their bodies and move with pain-free fluidity.

In Naomi’s fitcommerce.com article, “Pilates Helps Breast Cancer Survivors Recover,” she addresses specifically how Pilates can help women recovering from breast cancer. The following is adapted from that article.

• Pilates improves lymphatic drainage by its emphasis on deep breathing along with abdominal exercises which help pump excess lymphatic fluid back to the heart.
• Pilates strengthens the middle back musculature through exercise. This promotes better posture, often impaired after breast surgery.
• Pilates can be done in individual sessions if fatigue, anemia or infection risk is a factor. In addition, it can accommodate special needs and considerations as it can be performed in standing, sitting, lying on the back or belly, or side-lying positions.
• Pilates can improve rhythm and balance between back and shoulder muscles as women often restrict shoulder movement due to pain, fear, and decreased proprioception (awareness of where the body is in space).
• Pilates’ emphasis is minimal repetitions of an exercise done with correct form. This is perfect for someone at risk for lymphedema or who is fatigued.

Though qualitative improvements often speak for themselves, clinical research into the effects of Pilates on the recovery of individuals with breast cancer is still very thin. One recent though small study, conducted by K.S. Keays in 2007 and published in the journal, Physical Therapy, found that Pilates moderately improved shoulder abduction (movement of the arm away from the side of the body) and external shoulder rotation. Clearly, further research is needed to validate the wide scope of effectiveness Pilates treatment can bring. Yet individual experiences continue to be encouraging.

You may be thinking that Pilates could be worth a try. Can I just go to the gym and take a class? The answer lies with you and your doctor. The first step is to advocate for yourself. Understand that a key component to overcoming many side effects of treatment and preventing complications lies in taking care of yourself; this includes exercise both while you are undergoing chemotherapy and while you are recovering from various treatments. Discuss this desire with your doctor. Talk about the specifics of your experiences, your course of treatment, and determine together where Pilates may fit into your recovery.

The goal of any recovery is long-term health so, yes, at some point, attending a Pilates class may be an excellent way of maintaining your goal. But early in your recovery, an option that can lead to this point of maintenance is to attend a comprehensive rehabilitation program that incorporates Pilates into its physical and occupational therapy protocols. A certified and licensed physical or occupational therapist with experience treating patients recovering from breast cancer is educated in the process of the disease, as well as the physical and psychological implications of breast cancer. They understand symptoms of harmful complications and contraindications to avoid, including signs of pain. These skilled rehabilitation therapists are trained to adjust, grade, and individualize your treatment based on this knowledge. They operate under a prescription from your doctor and are professionally responsible, under their state licensure and professional ethics, to treat only within their scope of practice and capabilities.

During consultations with your doctor about the potential for physical and occupational therapy, be sure to discuss scenarios that suggest that Pilates and certain rehabilitation modalities could cause physical harm and therefore, should be avoided. These situations to avoid include, but are not limited to:

• Your bone density is compromised due to chemotherapy. Have your doctor conduct a DEXA scan (bone density test) to determine if your bones have been weakened.
• You have recently had a TRAM Flap reconstruction. Your abdomen needs time to heal before challenging its muscles.
• You experience intense pain, immediate or lasting, during treatment.
• You experience any abrupt changes in heart-rate, breathing, or blood pressure during treatment.

It is normal to have some hesitation about returning to an exercise routine after breast cancer treatment. You may feel you need to guard the side of your body that has been treated. You may feel self conscious about how you look or how you move. You may worry about harming or straining yourself. Still, rehabilitation and Pilates experts believe that it is more difficult to restore function in someone who has restricted their exercise and movement for a long period of time. They believe that early intervention and prevention is beneficial to many patients, especially when a Pilates regime is tailored to your specific needs and tolerances. Ask your doctor and therapists to guide you in making decisions that can help you reach your highest potential.

Once you become more physically stable and confident, therapists and doctors might also help point you in the direction of qualified Pilates instructors in the community. Naomi Aaronson recommends one-on-one instruction to start with, and an instructor that understands your condition. There is no central regulation authority for Pilates instructors, but by bringing an understanding of your individual needs, informed questions, and an internal sense of the type of instructor with whom you feel most comfortable, you will find yourself enjoying a healthy and productive experience. The decisions you make, after all, are truly about how you can best develop healthy habits, with the support of professionals and people you respect and trust, as part of that journey.

Many of us know that the key to maintaining any healthy habit is to enjoy the process. None of us wants to eat sawdust, so we chose healthy foods that are colorful, vary in texture, and taste delicious. Most of us cannot slip into a deep meditation on a busy rush-hour commute, so we find tiny rituals throughout our day that bring us peace like a cup of tea in the morning or a warm bath at night. The same ideas must be applied to our physical, spiritual, and emotional recovery from breast cancer. If Pilates is or has ever been a practice you thought you might enjoy, if it is something you have done regularly or not so regularly, if it is a challenge you think you can welcome, consider it. Enjoy it. And see where it will take you. Maybe it will become a fulfilling component to a full life of health and being well.

Stacy Baca, OTR/L is an occupational therapist with seventeen years of experience in neurological rehabilitation, physical rehabilitation, and rehab management. She has spent her career learning about alternative therapies to benefit her patients and her own personal well-being, including such methods as Pilates, yoga, and Feldenkrais. She works for a not-for-profit organization dedicated to providing education and assistance to individuals in need of assistive technology.