PILATES SENIORS. for. Patricia Johnson May 17, 2008 Ventura, CA

Transcription

1 PILATES for SENIORS Patricia Johnson May 17, 2008 Ventura, CA

2 Contents Contents 2 Abstract 3 Biological and Physiological Aspects of Aging 4 Contributions of Pilates to Health and Well-being 6 Special Considerations When Teaching Pilates to Seniors 8 Case Study 9 Bibliography 12 2

3 Pilates for Seniors Abstract Controlology was the term Joseph Pilates used to describe his body of work. One of the tenets of Pilates is control. We all like to control our environment and our bodies. There is one thing, however, that no person can control: time. Time passes, and we age. As we age, our bodies naturally go through many physiological changes. Pilates can help to mitigate or delay many of these changes by increasing our strength, flexibility, mobility and balance. As an instructor of Pilates, however, we need to be aware of the common limitations encountered with seniors so as best to help them maintain their health and not cause injuries. This paper will describe the benefits of Pilates for seniors as well as the precautions and considerations that should be observed when working with this segment of our population. 3

4 Biological and Physiological Aspects of Aging As we age, our bodies go through numerous physical changes. Many of these changes are naturally occurring, but some are a result of environmental factors. Every individual will age differently depending on heredity, lifestyles, and history of injuries. Although we do not all age the same physically, for the purposes of this paper, any reference to Seniors will mean someone age 65 or older. Some of the most obvious physiological changes are in our structures, or our musculoskeletal system. Muscles tend to shorten, and a general reduction in the total mass of muscles is common. Along with this loss of mass is a gradual decline of muscle strength. As a side note, it appears that fast twitch fibers atrophy more quickly with aging than slow twitch fibers. Loss of calcium in our bones has a major impact on our skeletal system often leading to osteopenia or osteoporosis. One in every 2 women and 1 in every 4 men aged 50 or older will suffer an osteoporosis-related hip, spine or wrist fracture during their lives. Osteoporosis and its precursor osteopenia, are characterized by severe thinning of bone and an increased vulnerability to fracture. In our spine, these bone fractures tend to occur most frequently in the anterior thoracic vertebrae. Our spine is subjected not only to the force of gravity compressing it, but our lifestyles of hunching forward on computers, driving, and other daily activities that require rounding our back and collapsing our chest. Over the course of a normal lifetime, the spine degenerates and becomes shorter. When the back becomes rounded, it compresses the chest, which causes 4

5 shallow breathing. This, in turn, can lead to cardiovascular and other health problems. Poor posture also interferes with digestion and elimination. Joint cartilage breaks down, causing stiffness, pain and reduced mobility. Old injuries or just constant repetitive motions can lead to osteoarthritis, a condition characterized by inflamed and painful joints. An aging nervous system can contribute to a slower reaction time. Also, the vestibular nerve within the ear may be impaired leading to a decline in balance. Another fairly common nervous system disorder is Parkinson s disease, having a dramatic effect on the musculature including tremors, stiffness and a tendency to stoop and shuffle. The respiratory system can become weakened and less efficient thereby inhibiting proper breathing patterns. When observing the feet of many seniors, one will notice toes jammed together and deformed. Other foot ailments can include weak and fallen arches, claw toes and bunions. Healthy feet are crucial to an active and independent lifestyle, yet four out of five adults experience foot pain most of these people are over 50. Surveys indicate that many people think foot pain is normal. Poor foot structure can alter our body mechanics and lead to problems all the way up the legs and the trunk. Other common disorders in seniors include hypertension, heart disease, memory loss, diabetes and incontinence. Seniors are often taking prescribed medications that can alter their physiology 5

6 as well. In addition to the physical aspects of aging, many people experience psychological changes and may develop feelings of isolation and even depression. Contributions of Pilates to Health and Well-being We know that proper exercise and nutrition are fundamental to a healthy body. This is true for people of any age. Exercise can help, strengthen bone and muscle mass. Stretching in addition to strengthening, is pertinent to keeping flexibility in bones, joints and muscles. Pilates is a perfect choice for addressing these activities. Joseph Pilates himself was still performing and perfecting his methodology well into his 80s. Maintaining the health and integrity of the spine is a central theme of Pilates. The exercises focus on lengthening the muscles which helps facilitate decompression of the vertebrae. The strengthened muscles help keep the spine erect, thereby improving posture and the related problems mentioned above. Instability and decline in balance lead to many seniors falling and often breaking bones. A strong core is key to maintaining a stable spine and body. A tenet of Pilates is balance and these exercises focus on building stability in the core as well as the legs, thereby decreasing the likelihood of falling. Studies have shown the importance of weight-bearing exercise that loads and strengthens our bone tissue, so the bones are less likely to break if a fall does occur. 6

7 Physical activity, including Pilates, can halve the risk of developing heart disease or suffering stroke. Combined with proper nutrition and caloric intake, exercise can help prevent diabetes and obesity. It gets blood circulating throughout the entire body and improves breathing. Over 40 million Americans struggle with osteoarthritis. It is a major contributor to seniors decline in functionality. Immobility leads to deterioration of the joints. Using a gentle approach to Pilates with a focus on enhancing a full range of motion in the joints can mitigate the onset or effects of osteoarthritis. The foot work done in Pilates is ideal for maintaining foot health. It stimulates circulation and agility in the muscles, tendons and ligaments in the foot, ankles and legs. Pilates helps individuals feel better about themselves and stimulates positive feelings, thereby reducing depression. Even brief periods of mild exercise can result in immediate improvements in memory for older adults. It also fosters clearer thinking and faster reaction time by helping to speed transmission of nerve messages. Because of the mind-body approach of Pilates, physical benefits of the exercise also bring about better concentration and calmness in the mental realm. All of the above are essential to maintaining healthy bodies, but the true essence of health for most seniors is just being able to perform daily activities safely and easily. Being able to get dressed, stand up from a chair, or reach for something in a cupboard are often major undertakings for older adults. The strength and flexibility and balance achieved in Pilates is often necessary just to facilitate independent functionality for these individuals. 7

8 Special Considerations When Teaching Pilates to Seniors In general, a few concepts will apply when teaching the older client. Speak clearly and slowly so they can hear and process the information. Take care not to treat them as if they are children, but be clear and succinct with cueing. A gentle approach is also recommended and a thorough warm up is mandatory. Joints and muscles need to be prepared for the work. Gentle stretching throughout the session will be very beneficial. Many Pilates instructors love the challenge of the work and want to push clients to advanced levels to keep it interesting. Although we want to keep the sessions interesting for our senior clients, we should note that repetition and familiarity are approaches that most seniors prefer. Because of the slower reaction time for older students, performing simple, repetitive exercises is preferable to complex ones with multiple steps involved. Modifications and assists that apply to the general public will also apply to seniors, such as a ball under the head for support, or a towel under the hips for tight hamstrings. The most significant precaution for teaching Pilates to seniors pertains to those with osteopenia or osteoporosis. Clients with osteoporosis or osteopenia can use mat exercises to strengthen the muscles around the spine, with some adjustments. Because of the pressure on the vulnerable anterior thoracic vertebrae when performing forward flexion of the spine, it is best to avoid exercises such as hundred, roll up, or seal. Rotation and side-bending can also compromise these 8

9 vertebrae. A session that is focused on spine extension is optimal for keeping strength without compromising the bone. To strengthen the spine flexors, we can perform exercises such as Hundred with the head down, leg circles and single/double leg stretches with the head down. Also, we can start the client in a slightly hyper-extended position and have them use their flexors to come to neutral. Clients with arthritis can benefit from the joint mobility of Pilates. Instructors should take care that the facility is warm and the client is warmed up thoroughly so that there is no strain on the joints. Again, very gentle movement is most effective in these situations. If the joint is acutely inflamed, it would be best to avoid using that area of the body. Case Study My hypothetical case study is a 70 year-old woman. She is basically in good health, but is about 20 pounds overweight. She has not been real active physically in the past several years and would like to get herself in better shape. She has no significant health issues currently, but wants to work on preventing osteoporosis. I would start my client on the Cadillac because we can do both mat and Cadillac exercises here without having to get up and down on the floor. We could do her warm ups and most of her block system here. It is fairly easy to get on and off the machine, and the exercises tend to allow for more work on flexibility. All her springs would be very light on all the equipment until she got stronger. I would also do her lateral flexion/rotation and her back extension work on the ladder barrel at the beginning. 9

10 A sample session would be to do an initial Roll Down, then warm her up on the Cadillac with a basic fundamental mat warm up: Pelvic Curl, Supine Spine Twist, and Leg Changes. Since we want to be very thorough in the warm-up, I would include a couple of other exercises such as the Roll-up with the RUB, Chest Lift or Leg Circles. I may have her do some upper body stretches on a foam roller as part of the warm up. This could all be done on the Cadillac. We would then go into her foot work. The Reformer is the ideal place to learn foot work, but may be challenging for her to get on. The Cadillac also has its limitations for those who are not very flexible. So, I would probably start her out on the Wunda Chair for a few sessions and then see if I could aid her getting onto and off of the Reformer. For the abdominal block I would start with the Roll-up with the RUB, if we had not done that in her warm up. I would also have her do some mat exercises, such as the Hundreds Prep, while lying on the Cadillac. After the first 5-10 sessions I may add a Roll-up Top Loaded or Mini Rollup or Mini Roll-Ups Oblique. I would focus on no more than two abdominal exercises. Next would be the Basic Leg Springs Series for hip work. We would not do any spinal articulation in the first 5-10 sessions. After that I may add the Spine Stretch while sitting on the Cadillac still. Eventually I would try to work in more Cadillac work, such as a Tower Prep, but her flexibility and strength would need to be much improved. For her stretches, we would start with the Pole to open up her upper body. I would eventually want to take her to the Ladder Barrel, but would focus on that at the end of the session when doing lateral flexion. 10

11 Arm work could be done using a Magic Circle at first, perhaps sitting on a stability ball. When she was ready to increase her strength, we could move to the Ped-o-pul or the Cadillac (using the Ped-o-pul series instead of the Arms Standing Series). After she is used to these, and in an effort to help increase her balance, I may have her do these while sitting on a stability ball as well. For Leg Work, and again to help with her balance, the Standing Leg Press on the Wunda Chair is ideal with a very light setting. She may need a pole to help with her balance at first and maybe even have to do the move without the Wunda Chair until she could handle the weight resistance. Another option would be Side Lying Gluteal Series back on the Cadillac. For Lateral Flexion/Rotation and Back Extension, we could do Side Lifts and Back Extension while on the Cadillac. When she was ready we could end at the Ladder Barrel with Side Over Prep and Basic Back Extension. To wrap up the session, I would have her do Shoulder Stretches and, when she was able, Gluteal Stretches on the Ladder Barrel. If she needed any additional stretching I would let her do it here. Because of timing constraints, I would have to pick and choose from the above options depending on her abilities that day and the flow of each session. The order of the session may have to change to consolidate use of each piece of equipment, and I would want to get her on to the Reformer as a Cadillac alternative when she was able. The first sessions would be very basic to get her accustomed to the equipment and her own body and start to enhance her range of motion and flexibility. After that we could focus more on balance and strengthening moves. 11

12 Bibliography Pilates for Life by Jeannie Kim, Pilates Style Magazine, Sept/Oct 2005 Senior Fitness, home study guide, Aerobics and Fitness Association of America, The Pilates Method of Body Conditioning, Sean P. Gallagher & Romana Kryzanowska, BainBridge Books, 1958 Exercise: A Guide from the National Institute on Aging, U.S. Department of Health and Human Services, June 2001 The New Yoga for People Over 50, Suza Francina, Health Communications, Inc., 1997 Modifying Pilates for Clients with Osteoporosis, Sherri Betz, IDEA Fitness Journal, April