Pilates and the Overweight or Obese Client
By Jeanan Yasiri Moe, M.Sc., Teacher in Training, Club Pilates (2019)
Depending on when and where you started engaging with Pilates exercise (PE) you may have an inaccurate expectation of who are the best clients for this increasingly popular form of exercise and movement.
I became engaged with PE 25 years ago at a relatively exclusive studio that catered to younger “ladies who lunch” and others that didn’t appear to have a need to return to the office, as I did. In fact, the studio held hours on weekdays only between 9:00 – 3:00 pm which made my desire to join their classes with any frequency difficult.
The instruction was pure and classic Pilates method, rigid in its approach and very exclusive to those who had body types that could sustain deep bends, far reaches, noticeably sunken abs and a perfect Teaser for a long while.
With my love for the exercise, I eventually decided to invest in my own classic reformer bed. While it commanded a substantial fee, I knew it could be a way to stay strong and toned over my life. However, when you work out by yourself for years you lose form and the exactness that a coach and colleagues can provide. I eventually hoped to find a class that fit in my busy work schedule again.
Nine months ago Club Pilates opened in my neighborhood. I was anxious to see whether my knowledge of PE had sustained and immediately joined.
A few things struck me in my first few classes. At 56 years of age, my balance was far more compromised than I expected. I could barely stand on top of the Bosu or the Wunda Chair. The demographic of the class had changed too. More people were my age and much older.
But what really struck me was the fact that so many clients were overweight. While this is the face of our nation and world today, I really couldn’t immediately reconcile that PE would be a form of exercise that would be helpful to these clients. I had always thought of it as movement promoting length, toning and leaner features. Extreme weight issues would seem to get in the way of that outcome.
Today, as a Pilates teacher in training, I am studying how this exercise can positively impact the client who is overweight or obese. I have learned it can most definitely improve movement, flexibility, stamina and form.
Understanding obesity
Unfortunately, it is not new news. Our world is facing an obesity epidemic that has increased rapidly over the last 20+ years. Health care professionals recognize it is at crisis proportions with more than 72 million people or one-third of the U.S. population of adults being obese with one billion people worldwide. The statistics for children are equally startling.
The Centers for Disease control say the epidemic impacts people across all groups of our society, irrespective of age, gender, race, ethnic, socioeconomic status, education level or geographic location.
In defining obesity, we consider what a person’s body mass index (BMI) is. The BMI is a measure based on your weight in relation to your height. The greater your BMI, the greater your risk of health problems from being overweight and possibly obese. A BMI of 22 is in the middle of the normal weight range and is associated with the best health outcomes. Someone with a BMI over 30 is considered obese. That translates to someone who is about 5’9” weighing more than 203 lbs. (Source www.verywellfit.com)
Obesity has major life impact on those who manage it. It has physical, psychological and social consequences concerning almost all aspects of daily living and movement. Obese individuals:
- Suffer more fatigue due to poor sleep patterns and are often less apt to engage in physical activity as a result.
- Are at risk for other health concerns including cardiac and stroke issues, Type 2 diabetes and leg, knee and joint issues due to the weight they carry.
Can Pilates exercise positively the obese client? What the research says:
Research does indicate that PE does have marked beneficial physiological effects on the overweight and/or obese client.
Work by Niehues, Gonzales, Lemos and Haas found that lung function and functional capacity in obese adults improved with use of PE (Niehues, 2015) (1) In their review of patients and literature, they initially observed that PE can be effective in improving chest capacity and expansion and lung volume. That is due to the fact that at its core PE works through the center of force, made up of the abdominal muscles and gluteus muscles lumbar, which are responsive for the stabilization of the body and associated with breath control. (In fact, we know that Joseph Pilates, the founder of the movement, suffered from asthma in his youth which led to his vision of creating an exercise form that would improve inhalation and lung function.) Because different Pilates exercises increase activation of the abdominal muscles, that facilitates action in the diaphragm. This study found that PE promotes strengthening of the abdominal muscles and that improved diaphragm function which led to positive respiratory function.
In another study on the effects of exercises combined with a low calorie diet, the authors found that the combination, of which included PE as one of the exercise options, had direct effects on the serum leptin concentration after follow up for 16 weeks beyond the effect expected. It is to say that the combination of a lower calorie diet and PE allowed overweight and obese people to realize longer term benefits of their exercise if maintained. (Ramezankhany, 2010) (2)
In a study that looked at young sedentary women impacted by weight issues over a 10-week longitudinal study, the researchers concluded that Pilates training occurring even just once a week over a relatively short 10-week period, results in significant improvements in skeletal muscle mass, flexibility, balance, core and abdominal muscle strength, body awareness and negative affect. The researchers went on to say the research clearly demonstrates the acute and chronic benefits of Pilates training on both physical and psychological measures in young, overweight women. (Tolnai, 2016) (3)
Another study looking at pain relief and flexibility in overweight Pilates clients found that there was pain-relief and functional improvement attributed to Pilates exercise in the short term. There was also improved flexibility and dynamic balance as well as enhanced muscular endurance in the short term. (Kamioka, 2016) (4)
Finally, a study reported in the Journal of Pediatrics in 2007 heralded a city park-based KidFIT program that integrated use of PE with overweight minority children ages 9 and 10. The six-week program showed beneficial improvements in body weight, body mass index, physical performance and nutrition knowledge that positively impacted children who were obese. The researchers concluded that Project KidFIT could be replicated in other communities to enhance both movement and nutrition training in vulnerable youth. (Bush, 2007) (5)
What reality dictates
Many people manage “body issues” and that fact is no different for the overweight or obese client. While adopting a new exercise modality can be a challenge for some, doing so as an individual that carries a lot of weight, uncomfortably and perhaps with some psychological strain, can be even more difficult.
That is why our overweight and obese clients do require a holistic approach to facilitating how they can integrate Pilates into their routine. Promoting to the client that Pilates exercise promotes strength, coordination, and can even promote weight loss, are all ways of helping ease the client into their first few classes. A study performed in 2005 did find that while Pilates burns just about 4-7 calories per minute, many obese people do lose weight when they routinely do the exercises. It may be due to heightened body awareness and a new ability to listen to their body, pay attention to nutrition and other movement. (Olson and Smith, 2005) (6)
Finally, Pilates exercise simply makes people feel better about themselves having integrated movement into their lives. It builds stability, strength, stamina and stretch, all of which are empowering to women and men regardless of their body mass index.
Points to consider when teaching the overweight client
In reviewing recommendations from a number of personal trainers from New York to the UK, I learned there are many methods to find success with clients impacted by weight. When organizing an exercise sequence consider:
- Touch may not be welcome by clients.
- Asking permission to touch to correct or help a client maneuver is always necessary but seriously important with this population as touch may be a very private matter and unwelcome.
- Many overweight clients are on medication to prevent cardiac and stroke issues that can cause dizziness.
- The weight distribution of the individual is important to note.
- If they are heavy in the chest, elevate the head and shoulders. If they are heavy in the legs, support the legs when they are lifted.
- Heavy clients may have tighter lateral hip rotators and hip flexors while also having weak abs, inner thighs and glutes
- Consider using a small prop to activate the inner thighs such as a circle or a ball.
- Getting down and up from the mat may be difficult or impossible. Using the Reformer bed or RTC/Cadillac is preferred to floor-based mat work for many overweight clients, especially early on.
- If a client can get to the mat and lie supine, their neck may overextend to allow their head to rest on the floor. Correct that with a block or two under their head.
- The same is true when lying prone, a block or two under their forehead can prevent uncomfortable neck flexion. When lying on your side, a block or two under the ear can prevent their head from hanging with the neck in lateral flexion.
- Obese female clients may find prone uncomfortable due to having a large bust.
- Locating pelvic bones, abs, etc. may be difficult for the client.
- We often ask people to locate their pelvis bones by placing their hands on the lower abs or locate the gap between the lower back and the mat. But, this may not work for some clients where there is no gap. Asking the client to visualize these features may be more helpful and empathetic.
- Balance can be impacted with people who are overweight.
- If you are asking someone to stand, ensure they have a good base of support.
- Feet may need to be shoulder width apart instead of hip width apart. A similarly widen stance if kneeling may be more comfortable.
- Having the client stand near a wall for additional support can be helpful.
- Limbs may be heavy.
- Ankles, knees and hips as well as the lower back can be impacted by weight.
- Doing squats may be hard, but seated knee extensions can serve as an alternative.
- Range of motion can be impacted.
- It may be necessary for some weight loss to occur before a broader range of motion is realized.
- Incontinence issues may exist due to pressure on the pelvic floor.
- Planks are not recommended. When the client is ready to try, provide the option of knees on the floor.
Conclusions
Pilates is an excellent option for the client who has interest in trying the exercise. It not only provides opportunities to begin moving but allows an increase in activity and success over time.
If the client is interested in weight loss, encouraging even a light cardio option, like walking, as an exercise to team with Pilates is a good idea. That in combination with a lower calorie diet will undoubtedly allow the client to realize quicker results, feel the increase in strength and stamina that they are seeking and feel successful.
While the classic Pilates exercise over decades past still has a home in many studios, the all-inclusive nature of Club Pilates encourages a diversity of bodies, experiences, ages and goals. I couldn’t be more delighted to be engaged again with Pilates exercise with a group, a coach and now with the privileged opportunity to help others realize the real benefits this movement can provide over a lifetime.
Citations:
- Pilates Method for Lung Function and Functional Capacity in Obese Adults. Janaina Rocha Niehues; Ana Ines Gonzales, M.Sc.: Robson Lemos, PhD; Patricia Haas, PhD; Alternative Therapies, Sep/Oct 2015, Vol 21, No.5)
- Comparing Effects of Aerobics, Pilates Exercises and Low Calorie Diet on Leptin Levels and Lipid Profiles in Sedentary Women. Azam Ramezankhany, Parvaneh Nazar Ali, Mahdi Hedayati. Iranian Journal of Basic Medical Sciences, Vol. 14, No. 3 May – June 2011, 256-263
- Physical and psychological benefits of one-a-week Pilates exercises in young sedentary women: A 10-week longitudinal study. Nora Tolnai, Zsofia Szabo, Ferenc Koteles, Attila Szabo. Physiology & Behavior, 163, 2016, 211-218
- Effectiveness of Pilates exercise: A quality evaluation and summary of systematic reviews based on randomized controlled trials. Hiroharu Kamioka, Kiichiro Tsutani, Yoichi Katsumata, Takahiro Yoshizaki, Hiroyasu Okuizumi, Shinpei Okada, Sang-Jun park, Jun Kitayuguch, Takafumi Abe, Yoshiteru Mutoh. Complementary Therapies in Medicine, 25 (2016) 1-19.
- Park-Based Obesity Intervention Program for Inner-City Minority Children. Cresendo L. Bush, Med, Shadston Pittman, Siripoom McKay, MD, Tina Ortiz, William W. Wong, PhD and William j. Kush, MD. The Journal of Pediatrics, November 2007, 513-517
- Pilates exercise: lessons from the lab: a new research study examines the effectiveness and safety of selected pilates mat exercises. Michele Olson and Carrie Myers Smith, IDEA Fitness Journal, Nov-Dec 2005, p. 38+
