Think Pilates is just another Hollywood fad like that sudden yoga/Buddhism trend (which is, like, soooo ’98)? Well, don’t take Julia’s word for it…how about the great dancer/choreographer George Balanchine? Both he and the late Martha Graham were early pioneers of the Pilates method. Dancers have known for years—more than seventy years—about the benefits of this method of body conditioning.

Mr. Pilates

Joseph Pilates was born in Germany in 1880, a frail child who grew to become obsessed with fitness. Devoted to the idea of transforming his health, Pilates became an accomplished gymnast, boxer and circus performer, as well as a student of yoga and karate. Students of the Pilates method claim that he incorporated elements from each of these fitness regimens, but it was while interned in a prison camp during World War I that he began to develop his method in earnest.

During his stay at the prison camp, Pilates used whatever props were available—his bunk, the bedsprings, a chair—along with the core of his work, which he referred to as “the mat work”. While other prisoners grew sick and weakened, Pilates thrived. After teaching his method to the other prisoners, the guards were so impressed that it became a mandatory exercise for the entire camp. This was during the worst pandemic influenza of the twentieth century and yet not a single prisoner died. Later, he was hired to train the most elite cadres of British troops.

Over the years, many athletes—including boxer Max Schmelling—included this method into their training, while choreographer George Balanchine was so enamored of the Pilates method that he incorporated its mat routine into the dance piece, “Seven Deadly Sins”. Dancers, always vulnerable to injury, discovered that using Pilates led to quicker recovery time and have consistently used this method from its inception to this day Alas, Pilates did not catch on with the general public. Earlier in the century, Pilates predicted it would be fifty years before the importance of his work was recognized. Apparently, he was right. It is probably to his credit that he lived to be a healthy 87.

So, What is Pilates?

Although Pilates is usually shown being performed on huge, complicated-looking machinery, Pilates first defined his series of 34 specific exercises to be performed individually, on a mat, without aid or assistance from any machinery or equipment. In the Introduction to his 1945 book of exercises, Return to Life Through Contrology (guess he decided to change the name!), Pilates says: “Contrology is complete coordination of body, mind, and spirit. Through Contrology you first purposefully acquire complete control of your own body and then through proper repetition of its exercises you gradually and progressively acquire that natural rhythm and coordination associated with all your subconscious activities.”

In other words, this isn’t the exercise to do while watching the soaps. This method requires full participation, as it focuses on the whole body. There is no flailing about; huffing and puffing is not necessary nor is it desired. Instead, the upper and lower muscle systems are coordinated within the body’s center, working very specific areas with careful, fluid movements. All movements are extremely slow and rhythmic, allowing weaker muscles to be located, which leads to better support for the joints.

“Girdle of Strength”

Joseph Pilates often referred to the “girdle of strength”—the area including the abdominal muscles, extending out to the buttocks and the latissimus dorsi (the muscles in the back that control shoulder and arm movements)—claiming that the strength needed for the exercises originates in the abdominal muscles. If these muscles are not in control, then other muscles such as those in the back, neck or shoulders can be damaged. It is by using the abdominals and learning correct breathing that leads to strength and improved posture.

Breathing

Open any book on Pilates (and there are dozens, at least) and proper breathing will be emphasized, over and over again. Each movement is tied to a specific manner of breathing and the way that you breathe is just as important as the movements themselves…especially since most of us breathe “wrong”, expanding only the top part of our lungs. Instead, you should breathe from the diaphragm so that your stomach rises and falls, rather than your chest. Practice this way of breathing for five minutes and you should actually feel yourself relaxing.

Concentration

Often, we become so distracted by our various responsibilities that we are complete unaware of our movements. In Pilates, the movements focus on a very specific area of the body; concentration is essential.

Control

One of the reasons that Pilates is an ideal ROM exercise for arthritis is that the movements are very controlled; chances for injury are minimal. In the beginning, these movements may feel clumsy, but once you have a grasp of the move, you will be able to execute the movements with grace and control.

Fluidity

Each exercise leads to the next, moving seamlessly from one to the other. Even though each movement has a beginning and ending, you blend the movements into each other, stretching and continuing, so that the end of one movement gracefully becomes the beginning of another.

Are Those Exercise Machines or Torture Chambers?
Many people shy away from Pilates because they’ve seen it performed on huge, complicated machinery. Repeat after me: you do not have to use the resistance machines. Joseph Pilates designed 500 different movements, but they all evolved from the 34 core movements, what he called “mat work”. So if money is a problem or you live in a small town where even the fitness instructors say, “Pi-who?”, rest assured, you can still benefit from Pilates.

However, if you live near a Pilates studio, using the resistance machines helps you become more aware of how the movement works each muscle, which can also help you improve your mat work. Also, it creates an intensity which is hard to achieve on your own. If at all possible, at least try to find a qualified “mat work” instructor who can guide you, adjust your posture, demonstrate breathing and correct movements and add new exercises as you become stronger. Even in little ol’ Radford, Virginia, pop. 15,000 (with students; more like 12,000 without), we have a certified Pilates “mat instructor”.

Pilates and Arthritis

So, is Pilates safe for arthritis? Sure. Not only has Pilates been used (in conjunction with medical treatment) to treat rheumatoid arthritis, it has also been used for back and neck pain, osteoarthritis, mastectomies, joint replacements, scoliosis, lupus, fibromyalgia, chronic fatigue syndrome, and joint and muscle injuries. In fact, many physical therapists, orthopedists, and chiropractors have integrated the Pilates method of body conditioning into their rehabilitative programs. The slow, controlled movements are ideal for protecting joints and improving alignment. Even so, consult your doctor and/or physical therapist before starting any exercise program, especially if you’ve been sedentary for an extended period of time.

If you are occasionally irritated by my aerobics teacher tone, here is my confession: I hate to work out. In fact, not only do I hate to work out, I will—at any given excuse—duck out of exercise the way a sinner skips Sunday school.

“I’m too busy,” is my excuse of choice and it’s true—this holiday season was more hectic than usual. At any rate, New Year’s Day came with all of its requisite guilt and I realized that I had not really exercised in nearly two months. Full of resolve, I pulled out one of my exercise tapes and some of my hand weights and set to work. Realizing that I was probably not up to my usual level, I did only half of the tape and used my lightest weights. True, I sort of glossed over the cool-down, but I got through the workout easily. In fact, I even felt a little cocky, knowing that I could have completed the entire workout, if I had wanted.

At 3 AM, I awoke in pain. At first, I thought that I had been slammed with a five-alarm flare—which was true—but it was more than that. It was my muscles. Gingerly, I made my way downstairs, taking a full minute and a half to reach the bottom. I increased the dreaded Prednisone, I iced, I heated, I rested…and still, I could barely even lift my arms, much less function like a human being.

The only thing that hurt more than my muscles (and, of course, my joints) was my pride. I couldn’t believe that such a baby workout could crip me out for three days. Then I remembered about muscle atrophy, another one of those fun components of rheumatoid arthritis. When you have RA, you must exercise, not only to keep your joints limber, keep your weight down, keep the circulation going, but also to keep your muscles from literally wasting away. True, by a certain age (which I passed, a while back) everyone has to exercise to avoid muscle atrophy. But when you have RA, the process is accelerated. It’s as if you have to exercise—not to get ahead, but just to keep up with your own body.

Realistically speaking, however, there will probably be periods of time in which you don’t or can’t exercise. If you’re getting over a flare, maybe you’re even a little gun-shy. So how do you get back into the exercise groove? Very carefully, of course…

Easing Back into Exercise
See your doctor.

Overkill? Maybe. But if it’s been awhile, it can’t hurt to get checked out by your rheumatologist. Not only can he/she check on your general well-being (blood pressure, heart, lungs, etc), he/she can best determined your level of severity and make appropriate suggestions for getting back into shape.

If you RA is extremely active, if you haven’t exercised in years or if your general health is poor, you may be referred to a physical therapist. Don’t be embarrassed! There is no shame in having a problem, only in doing nothing about it. A physical therapist is specially trained to work your weakest muscles and joints. It’s hard and even painful, but a good physical therapist can work wonders for even the wheelchair bound and can certainly help you develop a realistic exercise plan.

Underestimate your exercise level.

Let’s say that—miracles of miracles—you wake up feeling almost normal on a coincidentally gorgeous day. You blow the dust off of your walking shoes, step out into the sunshine and tell yourself, “I feel like I could walk a mile!”

Terrific! Walk half a mile.

Chances are that on a good day, you probably could walk that mile without any major problems. But your body still benefits from that half a mile and you can always build up to a mile or two or even 5. Building up, however, is the key. If you’re feeling truly impatient, look at it this way: how many miles are you going to be walking if you are knocked back with a flare? In this case, the tortoise truly does win the race.

Choose your exercise carefully.

Speaking of walking, I would like to take this opportunity to state that, contrary to what the “experts” claim, walking is not for everyone. Some of us have severe deformities in the metatarsals, which leaves very little cushioning…even with good shoes and orthotics. This is just one example of comparing your exercise needs with your arthritic limitations. For someone whose feet are severely afflicted, swimming or rollerblading would be a better option.

Another example might be someone whose neck is affected. While walking might not present a problem, many yoga poses would be out of the question and might even be dangerous. This is why it is important to discuss your exercise options with your doctor before starting. Not only can he/she offer suggestions he/she can also discuss which exercises should not be attempted.

Study beforehand

Again, this probably sounds like overkill, but if you’ve been out of the game for awhile, it can’t hurt to watch others before attempting a workout yourself, especially if you are planning on taking a class. While aerobics/aquatics/yoga/tai chi/pilates teachers may be very knowledgeable in their field, chances are that they don’t know squat about arthritis. Ask an instructor if you can watch an actual class before signing up. Watch carefully and take notes about possible problems. Afterwards, approach the instructor and ask if certain poses, steps, etc can be modified (and they almost always can); you may even decide that this particular class is not for you. Most instructors will be happy to work with you. If not, that is a red flag that you may not be dealing with a professional. Avoid any instructor who seems unsure of him/herself, is unable/unwilling to answer your questions or who seems threatened by the idea of adapting any part of the routine.

This is also an excellent way to “review” an exercise tape. Most exercise videos can be rented from the local video store; if not, the more reputable exercise programs offer a money-back guarantee. Either way, try to watch the tape more than once before attempting to follow the routine. The terrific thing about workout videos is that you can stop them. If there is a part you don’t understand or a move that you feel you should modify (and even Tae Bo can be modified!), stop the tape and write a note to yourself. Later, after you have warmed up, you might want to try out the adapted form before you start the actual workout.

Plan your exercise time and keep it sacred.

Morning stiffness makes exercise nearly impossible for some of us; evening fatigue for others. Pay attention to your body and decide when the best time is for you. If you are a procrastinator or if you really, really hate exercise, you might even consider “scheduling” exercise time on your calendar. Writing anything down as an appointment somehow makes it seem more important…

Exercise Time!
You must warm up before any type of exercise…

That includes yoga, tai chi, pilates, swimming or any other kind of “soft” exercise. Some of you are probably saying, “You mean, I gotta stretch before I stretch?”—which is a common misconception. Warming up is not stretching; it is the light exercise you do to warm you muscles before you even stretch. A few minutes on the treadmill (or around the block), marching in place, or easy dancing are all excellent ways to warm up. Five minutes is fine for non-arthies, but I feel that arthritic folk should probably aim for ten. Since our muscles are stiffer, they are more prone to injury.

Still not convinced? Okay, well here’s what the experts at AskMen.comhave to say:

“The theory behind warm-ups is that muscular contractions are dependant on temperature. Because increased muscle temperature improves work capacity and a warm-up increases muscle temperature, it is assumed that one is necessary.

“The amount of knee fluid also increases with a warm-up, oxygen intake improves, and the amount of oxygen needed for exercise is reduced. This is why performance improves after warming-up. Nerve messages also travel faster at high temperatures. Your reflexes will be faster and so will your muscular reactions, therefore you will reduce the potential risk of injuries.”

And, as an infamous lover of the hard way, let me share what happened to me—pre-arthritis—when I didn’t warm up properly. I was late for ballet class, and instead of warming up properly, I jumped in with the rest of the class who were in the middle of the barre (a series of advanced leg stretches performed on a chest-high bar). Since the teacher didn’t notice me sneak in, I thought I was pretty slick; in fact, I was winking at one of my classmates when something popped in my left hamstring, sending me and my smartass grin to the floor. That was 7 years ago, and I still have problems with that hamstring. Please…it’s only ten minutes. Take the time to warm up.

then stretch.

Even so, it’s not enough to just warm up your muscles. They must also be stretched to avoid injury. Any reputable class or video will have both a warm up and a stretch incorporated into their routine; if you are on your own, and are unsure about what to stretch and how, Carol Dickman offers 21 different stretches on her website Stretch.com.

Don’t go for the burn.

The “burn” is for Jane Fonda and millions of other non-arthies; we have built-in burns that don’t need to get worse. If you are following an instructor, stay well below his/her pace; there will be time enough to catch up as you build up your strength. In fact, for the first few times, stay well below the level that feels challenging. This may seem frustrating, but it will help you prevent flares and muscle blowouts, which will ultimately help you attain the level that is best for you.

Cooling down.

Okay…everybody makes mistakes. Perhaps kickboxing wasn’t such a great idea. If the exercise you chose truly hurts you, by all means, stop—gradually. During any aerobic activity, blood is sent to the extremities and, of course, the heart rate is increased. If you stop suddenly without cooling down, it puts extra stress on the heart, causes the blood to pool in your legs and can lead to muscle stiffness and tenderness…and who needs that?

Cooling down is much like warming up except that you are gradually slowing rather than quickening your pace. Walking in place or on the treadmill, taking a couple of slow laps in the pool, or even just lifting your knees to waist level until your heart rate normalizes are all ways of cooling down. By finishing up with a five-minute stretch, you further decrease your chances of next-day muscle aches.

Afterwards…
Hit the water.

Warm water seems to have restorative powers for arthritic folk. Five minutes in a Jacuzzi is heaven, but even a hot shower or bath is a nice way to finish up a workout and prevent stiffness. Make it a bubble bath and you’ve rewarded yourself for a job well done!

Schedule lightly.

The first few days of a new workout—or an increase in level—is not the time to finish all those chores that you’ve put off for a week. Keep the errands and housework to a minimum. Order out. Give your kids the car keys or teach them the fine art of walking. Until you know how your body is going to react, allow yourself time to recover.

Re-evaluate.

Remember: the next morning is Judgement Day.

Ease out of bed slowly and assess your level of stiffness and pain. Some increased stiffness and soreness should be expected, but if you are truly in pain then you need to re-assess your workout. Could you reduce the intensity or adapt some of the movements? Would it be possible to perform the same exercise at a slower pace or at half the duration? Chances are good that by adjusting the tempo or time, you will be able to continue your workout. If, however, you don’t feel that an adjustment is possible, then it’s time to look for a different way of exercising.

Fortunately or unfortunately, exercise is not an option for folks with RA. We must exercise regularly to protect our bodies from further degeneration. If care is taken, if we are ready and prepared to adapt, there are many types of exercise that are still open to us. And, whether or not you truly like exercise, when you work out, it feels as if you have broken a barrier…and isn’t feeling less limited, even by a small degree, worth all of the sweat and soreness?